47 ARF QUESTIONS WITH CORRECT ANSWERS 2024

47 ARF QUESTIONS WITH CORRECT ANSWERS 2024 1. A patient admitted with severe dehydration has a urine output of 380 ml over the next 24 hours and elevated blood urea nitrogen (BUN) and creatinine levels. A finding that the nurse would expect when reviewing the patient's urinalysis is a. proteinuria. b. bacteriuria. c. high specific gravity. d. tubular casts. Answer: C Rationale: The patient's renal failure has been caused by the prerenal problem of hypovolemia. Prerenal oliguria is characterized by the ability of the kidneys to concentrate urine, resulting in a high urine specific gravity. The urinalysis in intrarenal failure would show proteins and tubular casts. Bacteriuria would be typical of a urinary tract infection (UTI), not renal failure. Cognitive Level: Application Text Reference: pp. Nursing Process: Assessment NCLEX: Physiological Integrity 2. A patient with acute renal failure (ARF) has an arterial blood pH of 7.30. The nurse will assess the patient for a. tachycardia. b. rapid respirations. c. poor skin turgor. d. vasodilation. Answer: B Rationale: Patients with metabolic acidosis caused by ARF may have Kussmaul respirations as the lungs try to regulate carbon dioxide. Tachycardia and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in ARF. Cognitive Level: Application Text Reference: pp. Nursing Process: Assessment NCLEX: Physiological Integrity 3. A patient with severe heart failure develops elevated BUN and creatinine levels. The nurse plans care for the patient based on the knowledge that collaborative care of the patient will be directed toward the goal of a. preventing hypertension. b. replacing fluid volume. c. diluting nephrotoxic substances. d. maintaining cardiac output. Answer: D Rationale: The primary goal of treatment for ARF is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient's heart failure is causing ARF, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct. Cognitive Level: Application Text Reference: pp. Nursing Process: Planning NCLEX: Physiological Integrity 4. When reviewing the laboratory values for a patient admitted with a severe crushing injury after an industrial accident, the nurse will be most concerned about levels of a. creatinine. b. potassium. c. white blood cells (WBCs). d. BUN. Answer: B Rationale: The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately. The nurse will also review the other laboratory values, but abnormalities in these are not immediately life threatening. Cognitive Level: Application Text Reference: p. 1200 Nursing Process: Assessment NCLEX: Physiological Integrity 5. A patient admitted with sepsis has had several episodes of severe hypotension. Laboratory results indicate a BUN 50 mg/dl (10.7 mmol/L), serum creatinine 2.0 mg/dl (177 µmol/L), urine sodium 70 mEq/L (70 mmol/L), urine specific gravity 1.010, and cellular casts and debris in the urine. The nurse knows these findings are consistent with a. chronic renal insufficiency. b. prerenal failure. c. postrenal failure. d. acute tubular necrosis. Answer: D Rationale: The specific gravity and presence of casts and debris in the urinalysis suggest intrarenal failure and acute tubular necrosis. The sudden onset indicates that the renal failure is acute, not chronic. In prerenal failure, there would not be casts or debris in the urine. The patient does not have risk factors for postrenal failure. Cognitive Level: Application Text Reference: pp. Nursing Process: Assessment NCLEX: Physiological Integrity 6. A patient in the oliguric phase of acute renal failure has a 24-hour fluid output of 150 ml emesis and 250 ml urine. The nurse plans a fluid replacement for the following day of ___ ml. a. 400 b. 800 c. 1000 d. 1400 Answer: C Rationale: Usually fluid replacement should be based on the patient's measured output plus 600 ml/day for insensible losses. Cognitive Level: Application Text Reference: pp. Nursing Process: Implementation NCLEX: Physiological Integrity 7. The health care provider orders IV glucose and insulin to be given to a patient in ARF whose serum potassium level is 6.3 mEq/L. To best evaluate the effectiveness of the medications, the nurse will a. monitor the patient's electrocardiograph (ECG). b. check the blood glucose level. c. obtain serum potassium levels. d. assess BUN and creatinine levels. Answer: C Rationale: Changes in potassium will impact on the ECG and muscle strength, but the nurse should expect to recheck the serum potassium level during the infusion of glucose and insulin to determine the effectiveness of the therapy. The blood glucose level should be monitored during the infusion to assess for hypoglycemia or hyperglycemia. The BUN and creatinine levels will not change with administration of glucose and insulin. Cognitive Level: Application Text Reference: pp. Nursing Process: Evaluation NCLEX: Physiological Integrity 8. A patient in ARF has a gradual increase in urinary output to 3400 ml a day with a BUN of 92 mg/dl (33 mmol/L) and a serum creatinine of 4.2 mg (371 μmol/L). The nurse should plan to a. use a urine dipstick to monitor for proteinuria. b. auscultate the lungs to assess for pulmonary edema. c. take the blood pressure to check for hypotension. d. draw blood to monitor for hyperkalemia. Answer: C Rationale: During the diuretic phase of ARF, fluid and electrolyte losses may cause hypovolemia, hypotension, hyponatremia, and hypokalemia. Proteinuria, pulmonary edema, and hyperkalemia occur during the oliguric phase. Cognitive Level: Application Text Reference: p. 1201 Nursing Process: Planning NCLEX: Physiological Integrity 9. After noting increasing QRS intervals in a patient with ARF, which action should the nurse take first? a. Notify the patient's health care provider. b. Check the chart for the most recent blood potassium level. c. Look at the patient's current BUN and creatinine levels. d. Document the QRS interval. Answer: B Rationale: The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with ARF, but these would not directly affect the ECG. Documentation of the QRS interval is also appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening bradycardia. Cognitive Level: Application Text Reference: p. 1200 Nursing Process: Implementation NCLEX: Physiological Integrity 10. A patient with renal insufficiency is scheduled for an intravenous pyelogram (IVP). Which of the following orders for the patient will the nurse question? a. Ibuprofen (Advil) 400 mg PO PRN for pain b. Dulcolax suppository 4 hours before IVP procedure c. Normal saline 500 ml IV before procedure d. NPO for 6 hours before IVP procedure Answer: A Rationale: The contrast dye used in IVPs is nephrotoxic, and concurrent use of other nephrotoxic medications such as the NSAIDs should be avoided. The suppository and NPO status are necessary to ensure that adequate visualization during the IVP. IV fluids are used to ensure adequate hydration, which helps reduce the risk for contrast-induced renal failure. Cognitive Level: Application Text Reference: p. 1203 Nursing Process: Implementation NCLEX: Physiological Integrity 15. The RN observes an LPN/LVN carrying out all these actions while caring for a patient with renal insufficiency. Which action requires the RN to intervene? a. The LPN/LVN carries a tray containing low-protein foods into the patient's room. b. The LPN/LVN assists the patient to ambulate in the hallway. c. The LPN/LVN administers erythropoietin subcutaneously. d. The LPN/LVN gives the iron supplement and phosphate binder with lunch. Answer: D Rationale: Oral phosphate binders should not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder should be given with a meal and the iron given at a different time. The other actions by the LPN/LVN are appropriate for a patient with renal insufficiency. Cognitive Level: Application Text Reference: p. 1211 Nursing Process: Implementation NCLEX: Psychosocial Integrity 16. Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess a. the BUN and creatinine. b. the blood glucose level. c. the patient's bowel sounds. d. the level of consciousness (LOC). Answer: C Rationale: Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not impact on the nurse's decision to give the medication. Cognitive Level: Application Text Reference: pp. 1202, 1210 Nursing Process: Assessment NCLEX: Physiological Integrity 17. The nurse has instructed a patient who is receiving hemodialysis about dietary management. Which diet choices by the patient indicate that the teaching has been successful? a. Scrambled eggs, English muffin, and apple juice b. Cheese sandwich, tomato soup, and cranberry juice c. Split-pea soup, whole-wheat toast, and nonfat milk d. Oatmeal with cream, half a banana, and herbal tea Answer: A Rationale: Scrambled eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate. Cognitive Level: Application Text Reference: pp. Nursing Process: Evaluation NCLEX: Physiological Integrity 20. A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it a. can accommodate larger needles. b. increases patient mobility. c. is much less likely to clot. d. can be used sooner after surgery. Answer: C Rationale: AV fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not impact on needle size or patient mobility. Cognitive Level: Application Text Reference: p. 1221 Nursing Process: Implementation NCLEX: Physiological Integrity 21. In preparation for hemodialysis, a patient has an AV native fistula created in the left forearm. When caring for the fistula postoperatively, the nurse should a. check the fistula site for a bruit and thrill. b. assess the rate and quality of the left radial pulse. c. compare blood pressures in the left and right arms. d. irrigate the fistula site daily with low-dose heparin. Answer: A Rationale: The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula. Cognitive Level: Comprehension Text Reference: p. 1221 Nursing Process: Implementation NCLEX: Physiological Integrity 22. A patient begins hemodialysis after having had conservative management of chronic kidney disease. The nurse explains that one dietary regulation that will be changed when hemodialysis is started is that a. unlimited fluids are allowed since retained fluid is removed during dialysis. b. increased calories are needed because glucose is lost during hemodialysis. c. more protein will be allowed because of the removal of urea and creatinine by dialysis. d. dietary sodium and potassium are unrestricted because these levels are normalized by dialysis. Answer: C Rationale: Once the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is allowed. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes. Cognitive Level: Application Text Reference: p. 1211 Nursing Process: Implementation NCLEX: Physiological Integrity 23. A patient with chronic kidney disease (CKD) is started on hemodialysis, and after the first treatment, the patient complains of nausea and a headache. The nurse notes mild jerking and twitching of the patient's extremities. The nurse will anticipate the need to a. increase the time for the next dialysis to remove wastes more completely. b. switch to continuous renal replacement therapy (CRRT) to improve dialysis efficiency. c. administer medications to control these symptoms before the next dialysis. d. slow the rate for the next dialysis to decrease the speed of solute removal. Answer: D Rationale: The patient has symptoms of disequilibrium syndrome, which can be prevented by slowing the rate of dialysis so that fewer solutes are removed during the dialysis. Increasing the time of the dialysis to remove wastes more completely will increase the risk for disequilibrium syndrome. CRRT is a less efficient means of removing wastes and, because it is continuous, would not be used for a patient with CKD. Administration of medications to control the symptoms is not an appropriate action; rather, the disequilibrium syndrome should be avoided. Cognitive Level: Application Text Reference: p. 1224 Nursing Process: Planning NCLEX: Physiological Integrity 24. A patient with diabetes who has chronic kidney disease (CKD) is considering using continuous ambulatory peritoneal dialysis (CAPD). In discussing this treatment option with the patient, the nurse informs the patient that a. patients with diabetes who use CAPD have fewer dialysis-related complications than those on hemodialysis. b. home CAPD requires more extensive equipment than does home hemodialysis. c. CAPD is contraindicated for patients who might eventually want a kidney transplant. d. dietary restrictions are stricter for patients using CAPD than for those having hemodialysis. Answer: A Rationale: Patients with diabetes have better control of blood pressure, less hemodynamic instability, and fewer problems with retinal hemorrhages when using peritoneal dialysis than when using hemodialysis. CAPD is less expensive and has fewer dietary restrictions than hemodialysis. CAPD is not a contraindication for a kidney transplant. Cognitive Level: Application Text Reference: p. 1220 Nursing Process: Implementation NCLEX: Physiological Integrity 25. A patient who has been on continuous ambulatory peritoneal dialysis (CAPD) is hospitalized and is receiving CAPD with four exchanges a day. During the dialysate inflow, the patient complains of having abdominal pain and pain in the right shoulder. The nurse should a. massage the patient's abdomen and back. b. decrease the rate of dialysate infusion. c. stop the infusion and notify the health care provider. d. administer the PRN acetaminophen (Tylenol). Answer: B Rationale: Abdominal pain and referred shoulder pain can be caused by a rapid infusion of dialysate; the nurse should slow the rate of the infusion. Massage and administration of acetaminophen (Tylenol) would not address the reason for the pain. There is no need to notify the health care provider. Cognitive Level: Application Text Reference: p. 1219 Nursing Process: Implementation NCLEX: Physiological Integrity 26. The nurse is assessing a patient who is receiving peritoneal dialysis with 2-L inflows. Which information should be reported immediately to the health care provider? a. The patient complains of feeling bloated after the inflow. b. The patient's peritoneal effluent appears cloudy. c. The patient has abdominal pain during the inflow phase. d. The patient has an outflow volume of 1600 ml. Answer: B Rationale: Cloudy-appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient. Cognitive Level: Application Text Reference: p. 1219 Nursing Process: Assessment NCLEX: Physiological Integrity