1. The client with acute renal failure has a serum potassium of 6.0 mEq/L.

The nurse would plan which of the following as a priority action? a) check the sodium level b) place the client on a cardiac monitor c) encourage increased vegetables in the diet d) allow an extra 500 ml of fluid intake to dilute the electrolyte concentration 2. The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication: a) during dialysis b) just before dialysis c) the day after dialysis d) on return form dialysis 3. The client with chronic renal failure has an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter dressing while bathing. The nurse should immediately: a) change the dressing b) reinforce the dressing c) flush the peritoneal dialysis catheter d) scrub the catheter with povidineiodine 4. The client hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale and anxious. The nurse suspects air embolism. The priority action for the nurse is to: a) discontinue dialysis and notify the physician

b) monitor vital signs every 15 minutes for the next hour c) continue dialysis at a slower rate after checking the lines for air d) bolus the client with 500 ml of normal saline to break up the air embolus 5. The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the best understands the information if the client states to record daily the: a) amount of activity b) pulse and respiratory rate c) intake and output and weight d) blood urea nitrogen and creatinine levels 6. A client who has a renal mass asks the nurse why an ultrasound has been scheduled, as opposed to other diagnostic tests that may be ordered. The nurse formulates a response based on the understanding that: a) all other tests are more invasive than an ultrasound b) all other tests require more elaborate postprocedure care c) an ultrasound can differentiate a solid mass from a fluid-filled cyst d) an ultrasound is much more cost effective than other diagnostic tests 7. A client has been admitted to the hospital with a diagnosis of acute glomerulonephritis. During history-

taking the nurse first asks the client about a recent history of: a) bleeding ulcer b) deep vein thrombosis c) myocardial infarction d) streptococcal infection 8. A nurse is assigned to care for a client with nephrotic syndrome. The nurse assesses which important parameter on a daily basis? a) weight b) albumin levels c) activity tolerance d) blood urea nitrogen (BUN) level 9. A client is being admitted to the hospital with a diagnosis of urolithiasis and ureteral colic. The nurse assesses the client for pain that is: a) dull and aching in the costovetebal area b) aching and camplike thoughout the abdomen c) sharp and radiating posteriorly to the spinal column d) excruciating, wavelike, and radiating toward the genitalia 10. A client with renal failure is receiving epoetin alfa (Epogen) to support erythropoiesis. The nurse questions the client about compliance with taking which of the following medications that supports red blood cell (RBC) production? a) iron supplement b) zinc supplement c) calcium supplement d) magnesium supplement

11. A client has an arteriovenous (AV) fistula in place in the right upper extremity for hemodialysis treatments. When planning care for this client, which of the following measures should the nurse implement to promote client safely? a) take blood pressures only on the right arm to ensure accuracy b) use the fistula for all venipunctures and intravenous infusions c) ensure that small clamps are attached to the AV fistula dressing d) assess the fistula for the presence of a bruit and thrill every 4 hours 12. A nurse is assessing a client who is diagnosed with cystitis. Which assessment finding is inconsistent with the typical clinical manifestations noted in this disorder? a) hematuria b) low back pain c) urinary retention d) burning on urination 13. A client with urolithiasis is scheduled for extracorporeal shock wave lithotripsy (ESWL). The nurse assesses to ensure that which of the following items are in place or maintained before sending the client for the procedure? a) IV line and a foley catheter b) NPO status and a foley catheter c) signed informed consent, NPO status, and an IV line d) signed informed consent and clear liquid restriction preprocedure 14. The home care nurse is making

follow-up visits to a client following renal transplant. The nurse assesses the client for which signs of acute graft rejection? a) hypotension, graft tenderness, and anemia b) hypertension, oliguria, thirst, and hypothermia c) fever, hypertension, graft tenderness, and malaise d) fever, vomiting, hypotension, and copious amounts of dilute urine 15. A client is scheduled for computed tomography (CT) of the kidneys to rule out renal disease. As an essential preprocedure component of the nursing assessment, the nurse plans to ask the client about a history of: a) familial renal disease b) frequent antibiotic use c) long-term diuretic therapy d) allergy to shellfish or iodine 16. The client is admitted to the emergency department following a motor vehicle accident. The client was wearing a lap seat belt when the accident occurred and now the client has hematuria and lower abdominal pain. To assess further whether the pain is caused by bladder trauma, the nurse asks the client if the pain is referred to which of the following area? a) hip b) shoulder c) umbilicus d) costovertebral angle 17. The female client is admitted to

the emergency department following a fall from a horse and the physicianorders insertion of a foley catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should: a) notify the physician b) use a smaller size of catheter c) administer pain medication before inserting the catheter d) use extra povidone-iodine solution in cleansing the meatus

18. A nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that he fistula is patent? a) palpation of a thrill over the fistula b) presence of a radial pulse in the left wrist c) absence of a bruit on auscultation of the fistula d) capillary refill less than 3 seconds in the nail beds of the fingers on the left hand 19. The male client has a tentative diagnosis of urethritis. The nurse assesses the client for which of the following manifestations of the disorder? a) hematuria and pyuria b) dysuria and proteinuria c) hematuria and urgency d) dysuria and penile discharge 20. The nurse is planning teaching for a female client diagnosed with urethritis caused by chlamydial

infection. The nurse would plan to include which of the following points in the teaching session? a) altering the perineal pH using a spermicide with a condom b) keeping follow-up appointments for repeat cultures in 4 to 7 days c) discontinuing antibiotics after 3 weeks of uninterrupted administration d) identifying sexual partners for the last 12 months so they can be treated 21. The client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. The priority nurse action would be to: a) check the shunt for the presence of bruit and thrill b) observe the site once as time permits during the shift c) check the results of the prothrombin time as they are determined d) ensure that small clamps are attached to the arteriovenous shunt dressin 22. The nurse develops a postprocedure plan of care for a client who had a renal biopsy. The nurse avoids documenting which intervention in the plan? a) administering analgesics as needed b) encouraging fluids to at least 3L in the first 24 hours c) testing serial urine samples with dipstick for occult blood d) ambulating the client in the room and hall for short distances

23. The client with urolithiasis has a history of chronic tract infections. The nurse plans teaching the client to avoid which of hte following? a) long-term use of antibiotics b) weaning synthetic underwear and pantyhose c) high-phosphate foods, such as dairy products d) foods that make the urine more acidic, such as cranberries 24. The client who has a history of gout also is diagnosed with urolithisis and the stones are determined to be of uric acid type. The nurse gives the client instructions in which foods to limit, including: a) milk b) liver c) apples d) carrots 25. The client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of: a) pyelonephritis b) glomerulonephritis c) trauma to the bladder or abdomen d) renal cancer in the client's family 26. Which of the following should be considered in the diet of the client with end-stage-renal-disease (ESRD)? a) limit fluid intake during anuric phase

b) limit phosphorus and vitamin D-rich food c) limit calcium-rich food d) limit carbohydrates 27. A client has been admitted to the hospital for urinary tract infection and dehydration. The nurse determines that the client has received adequate volume replacement if the blood urea nitrogen level drops to: a) 3 mg/dL b) 15 mg/dL c) 29 mg/dL d) 35 mg/dL 28. A adult client has had laboratory work done as part of a routine physical examination. The nurse interprets that the client may have a mild degree of renal insufficiency if which of the following serum creatinine levels is noted? a) 0.2 mg/dlL b) 0.5 mg/dL c) 1.9 mg/dL d) 3.5 mg/dL 29. The nurse instructs a client with renal failure who is receiving hemodialysis about dietary modifications. The nurse determines that the client understands these dietary modifications if the client selects which items from the dietary menu? a) cream of wheat, blueberries, coffee b) sausage and eggs, banana, orange juice

c) bacon, cantaloupe melon, tomato juice d) cured pork, strawberries, orange juice 30. A nurse is inserting an indwelling urinary catheter into the urethra of a male client. As the nurse inflates the balloon, the client complains of discomfort. The appropriate nursing action is to: a) aspirate the fluid, remove the catheter and insert a new catheter b) aspirate the fluid, advance the catheter farther, and reinflate the balloon c) remove the syringe from the balloon, discomfort is normal and temporary d) aspirate the fluid, withdraw the catheter slightly, and reinflate the balloon 31. The client with continuous ambulatory peritoneal dialysis (CAPD) has cloudy dialysate. Which of the following is the best initial nursing action? a) send fluid to the laboratory for culture b) administer antibiotic c) do nothing, this is expected d) stop drainage of fluid 32. Which of the following may be included in the diet of the client with chronic renal failure? a) orange slices b) watermelon slices c) cantaloupe slices d) apple slices

33. The client with chronic renal failure is on chronic hemodialysis. Which of the following indicate improvement of the client's condition due to hemodialysis? Select all that apply a) the client's BP is 130/90 b) the client's serum potassium is 4.8 mEq/L c) the client's hemoglobin level is 10 g/dL d) the client's serum calcium is 7.7 mg/dL f) the client's serum sodium is 140 mEg/L g) the client's serum magnesium is 4 mEq/L h) the client's weight has increased from 60 kg to 63 kg 34. The client is in end-stage renal failure (ESRD). Which of the following foods may be allowed for the client? a) banana b) apple c) carrot cake d) cantaloupe 35. The client has end-stage renal disease. He had undergone kidney transplant 5 days ago. Which of the following is the most important intervention for the client to prevent infection? a) observe sepsis b) increase fluid intake c) avoid clients with flu d) avoid crowded places 36. Which of the following should the nurse include in the nursing care plan of the client who is diagnosed to have

renal failure, whose BUN is 32 mg/dl, serum creatinine is 4 mg/dl, hematocrit is 38%. He is complaining of fatigue and edema. a) low protein diet and fluid restriction b) high protein diet and fluid restriction c) low protein diet and increase in fiber d) high protein diet and potassium restriction 37. The client in end-stage of renal failure had undergone kidney transplant. Which of the following assessment findings indicate kidney transplant rejection? a) increased urinary output, BUN = 15 mg/dL b) HCT = 50%, Hgb = 17 g/dl c) decreased urinary output, sudden weight gain d) decreased urinary output, sudden weight loss 38. Which of the following assessment findings indicates that pyridium is effective in a client with urinary tract infection? a) the client's urine culture yields negative result b) the client is able to void every 2 to 3 hours c) the client verbalizes that she is relieved from pain d) the client is able to void 30-60 ml/hour 39. Which of the following antihypertensive medications is contraindicated for clients with renal

insufficiency? a) beta-adrenergic blockers b) calcium-channel blockers c) direct-acting vasodilators d) angiotensin-converting enzyme inhibitors

primarily bicarbonate ions c) sodium ions in exchange for primarily potassium ions d) potassium ions in exchange for primarily sodium ions 43. Which of the following problems is expected in a client who is in endstage renal failure? a) anemia b) thalassemia c) renal calculi d) hypotension 44. Which of the following client responses shows a correct understanding of continuous ambulatory peritoneal dialysis (CAPD)? a) I am expected to perform the procedure at home b) the procedure lasts for one hour c) I have to sit and raise my legs during the procedure d) I have to go to the hospital for this procedure 45. The client with chronic renal failure is undergoing peritoneal dialysis. He asks why the nurse monitors his blood glucose levels. Which of the following will be the most appropriate response by the nurse? a) I have to check if you have diabetes mellitus b) the dialysate contains glucose c) the procedure may lower your blood glucose levels d) it is a routine procedure for every client who undergoes the treatment

40. The client has been diagnosed to have glomerulonephritis. What should the nurse observe in the urine? a) blood b) pus c) white blood cells d) glucose 41. The client for intermittent selfcatheterization is concerned with the cost of materials for the procedure. Which of the following is the most appropriate response by the nurse? a) I will refer you to social welfare department b) you should be more concerned with your health rather than the cost of materials c) the materials can be reused if properly cleaned and safely kept d) you better discuss your concern with your primary health care provider 42. A client has been diagnosed to have chronic renal failure. Sodium polysterene sulfonate (exchange resin kayexalate) is prescribed. The action of the medication is that it releases a) bicarbonate in exchange for primarily sodium ions b) sodium ions in exchange for

46. Which of the following is an expected finding in the client with chronic renal failure? a) anemia b) polyuria c) increased creatinine clearance d) increased serum calcium levels 47. In the oliguric phase of renal failure, what is the most appropriate nursing diagnosis? a) fluid volume deficit b) activity intolerance c) ineffective breathing pattern d) fluid volume excess 48. Which of the following complaints is common in a client with pyelonephritis? a) right upper quadrant pain b) left upper quadrant pain c) pain at the costovertebral region d) pain at the suprapubic region 49. The client had been diagnosed to have chronic renal failure. He had undergone hemodialysis for the first time. What signs and symptoms when experienced by the client suggest that he is experiencingdisequilibrium syndrome? a) restlessness, hypotension, headache b) nausea and vomiting, hypertension, dizziness c) lethargy, hypotension, dizziness d) thachycardia, hypotension, headache Situation: Three year old Carlo has

been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome. 50. The diagnosis of Idiopathic Nephrotic Syndrome has been confirmed. Which unexpected finding would the nurse report? a) proteinuria b) distended abdomen c) blood in the urine d) elevated serum lipid levels 51. Carlo's potential for impairment of skin integrity is related to: a) joint inflammation b) drug therapy c) edema d) generalized body rash 52. Prednisone is prescribed for Carlo. The nurse evaluate its effectiveness by a) checking his BP every 4 hours b) checking his urine for protein c) weighing him each morning before breakfast d) observing him for behavioral changes 53. At Carlo's last check-up when he was 2 1/2 years old, his BP was 95/60, PR was 110/min and weight was 15 kg. Which unexpected assessment today would the nurse report to help the diagnosis? a) BP: 95/60 b) weight: 20 kg c) PR: 110 d) temp: 37 C 54. Urinalysis was ordered for her, with instruction about the examination, when can you collect

urine specimen for culture? a) noon time if specimen is available b) evening before retiring c) anytime as soon as there is specimen d) A.M. only 55. Intravenous pyelography was ordered, your nursing preparation would include the following. Except: a) enema on the morning of the test b) check for history of allergies c) hydrating Mrs. Cruz orally four hours before the procedure d) NPO 8 hours before the test

elevated WBC count d) urinary frequency and casts in the urine 58. The physician orders a combination of Sulfamethoxazole and Phenazopyridine hydrochloride (Azogantrisol) for the patient. Which therapeutic effect should this combination drug have: a) plain relief and a decreased WBC count b) equal fluid intake and output c) polyuria with reddish stain d) increased complaints of bladder spasm after 20 minutes 59. Diagnosis of acute pyelonephritis has been established your nursing intervention includes the following except: a) provide health teaching and discharge planning b) administer antibiotic c) measure I and O d) provide adequate comfort and rest 60. The least that you would include in your health teaching is: a) low sodium diet compliance b) medication regimen c) follow-up culture d) signs and symptoms of recurrence and the need to report

56.By doing IVP, this would visualize her: 1) 2) 3) 4) 5) bladder ureter and bladder bladder and kidneys ureter and kidneys ovary

a) 1 and 5 b) 3 c) 1 and 4 d) 4 57. The physician suspects acute pyelonephritis based on the patient's physical examination. Which clinical manifestation should the nurse expect to assess? a) lower abdominal pain, dysuria and urinary frequency b) pyuria, hematuria and groin pain c) flank pain, urinary frequency and an

61. A client with nephrotic syndrome asks the nurse, "Why should I even bother trying to control my dietand the edema? It doesn't really matter what I do if I can never get rid of this kidney problem, anyway!" The nurse

selects which of the following as the most appropriate nursing diagnosis for this client? a) anxiety b) powerlessness c) ineffective coping d) disturbed body image 62. A client with acute renal failure is having trouble remembering information and instructions as a result of altered laboratory values. The nurse avoids doing which of the following when communicating with this client? a) giving simple, clear directions b) including the family in discussions related to care c) explaining treatments using understandable language d) giving thorough and complete explanations of treatment options 63. A client who has never been hospitalized before is having trouble initiating the stream of urine. Knowing that there is no pathological reason for this difficulty, the nurse avoids which of the following because it is the least helpful method of assisting the client? a) running tap water in the sink b) assisting the client to a commode behind a closed curtain c) instructing the client to pour warm water over the perineum d) closing the bathroom door and instructing the client to pull the call bell when done 64. The nurse provide homecare instructions to a client who has

been hospitalized for a transurethral resection of the prostate (TURP). Which statement by the client indicates the need for furtherinstructions? a) I need to include prune juice in my diet b) I need to avoid strenuous activity for 4 to 6 weeks c) I can lift and push objects up to 30 pounds in weight d) I need to maintain a daily intake of 6 to 8 glasses of water 65. The nurse has given instructions about site care to a hemodialysis client who had an implantation of arteriovenous (AV) fistula in the right arm. The nurse determines that the client needs furtherinstructions if the client states the need to: a) sleep on the right side b) avoid carrying heavy objects with the right arm c) perform range-ofmotion exercises routinely on the right arm d) report an increased temperature, redness, or drainage at the site

66. The nurse is caring for a client who has just returned to the nursing unit after an intravenous pyelogram (IVP). The nurse determines that which of the following is the priority for the postprocedure care of this client? a) maintaining the client on bedrest b) ambulating the client in the hallway c) encouraging the increased intake of

oral fluids d) encouraging the client to try to void frequently 67. The nurse is evaluating the effects of care for the client with nephrotic syndrome. The nurse determines that the client showed the least amount of improvement if which of the following informationwas obtained serially over 2 days of care? a) serum albumin 1.9g/dL, up to 2.0g/dL b) initial weight 208 pounds, down to 203 pounds c) blood pressure 160/90mm Hg, down to 130/78mm Hg d) daily intake and output of 2100 ml intake and 1900 ml output 2000 ml intake and 2900 ml output 68. A client is being discharged to home while recovering from acute renal failure (ARF). The client indicates an understanding of the therapeutic dietary regimen if the client states the need to eat foods that are lower in: a) fats b) vitamins c) potassium d) carbohydrates 69. The nurse is caring for a client who has returned from the postanesthesia care unit after prostatectomy. The client has a three-way Foley catheter with an infusion of continuous bladder irrigation (CBI). The nurse determines that the flow rate is adequate if the color of the urinary drainage is:

a) dark cherry b) clear as water c) pale yellow or slightly pink d) concentrated yellow with small clots 70. A client with chronic renal failure has a protein restriction in the diet. The nurse should include in a teaching plan to avoid which of the following sources of incomplete protein in the diet? a) nuts b) eggs c) milk d) fish 71. A client with acute renal failure has an elevated blood urea nitrogen (BUN). The client is experiencing difficulty remembering information due to uremia. The nurse avoids which of the following when communicating with this client? a) giving simple, clear directions b) including the family in discussions related to care c) giving thorough, lengthy explanations of procedures d) explaining treatments using understandable language 72. At the beginning of the work shift. the nurse is checking a client who has returned from the post-anesthesia care unit following transurethral resection of the prostate (TURP). The client has bladder irrigation running via a three-way Foley catheter. The nurse should notify the physician if which color if urine is noted in the urinary drainage bag?

a) pale pink b) dark pink c) bright red d) tea-colored 73. The nurse is assisting in participating in a prostate screening clinic for men. The nurse questions each client about which sign of prostatism? a) ability to stop voiding quickly b) absence of postvoid dribbling c) excessive force in urinary system d) hesitancy when initiating urinary stream

c) 0.5 to 1kg d) 1 to 1.5kg 76. The nurse is administering epoetin alfa (Epogen) to a client with chronic renal failure. The nurse monitors the client for which adverse effect of this therapy? a) anemia b) hypertension c) iron intoxication d) bleeding tendencies 77. The client scheduled for transurethral prostatectomy (TURP) has listened to the surgeon's explanation of the surgery. The client later asks the nurse to explain again how the prostate is going to be removed. The nurse tells the client that the prostate will be removed through: a) the urethra b) a lower abdominal incision c) an upper abdominal incision d) an incision made in the perineal area 78. The nurse is reviewing a urinalysis report for a client with acute renal failure and notes that the results are highly positive for proteinuria. The nurse interprets that this client has which type of renal failure? a) prerenal failure b) postrenal failure c) intrinsic renal failure d) atypical renal failure 79. The nurse caring for a client immediately following transurethral

74. An adult with renal insufficiency has been placed on a fluid restriction of 1200 mL per day. The nurse discusses the fluid restriction with the dietitian and then plans to allow the client to have how many milliliters of fluid from 7:00 AM to 3:00 PM? a) 400 b) 600 c) 800 d) 1000 75. A client with chronic renal failure has learned about managing diet and fluid restriction between dialysis treatments. The nurse determines that the client is compliant with the therapeutic regimen of the client gains no more than how much weight between hemodialysis treatments? a) 2 to 4kg b) 5 to 6kg

resection of the prostate (TURP) notices that the client has suddenly become confused and disoriented. The nurse determines that this may be a result of which potential complication of this surgical procedure? a) hyponatremia b) hypernatremia c) hyperchloremia d) hypochloremia 80. A client with chronic renal failure has received dietary counseling about potassium restriction in the diet. The nurse determines that the client has learned the information correctly if the client states to do which of the following for preparation of vegetables? a) eat only fresh vegetables b) boil them and discard the water c) use salt substitute on them liberally d) buy frozen vegetables whenever possible 81. A client with chronic renal failure has started receiving epoetin alfa (Epogen). The nurse reminds the client about the importance of taking which prescribed medication to enhance the effects of this therapy? a) ferrous gluconate b) aluminum carbonate c) aluminum hydroxide gel d) calcium carbonate (Tums) 82. The nurse is planning to do preoperative teaching with a client scheduled for a transurethral resection of the prostate (TURP). The nurse plans to include in the discussion that

the most frequent cause of postoperative pain will be: a) bladder spasms b) bleeding within the bladder c) the lower abdominal incision d) tension on the Foley catheter 83. A client is being discharged to home after undergoing a transurethral resection of the prostate (TURP). The nurse teaches the client to expect which variation in normal urine color for several days following the procedure? a) dark red b) pink-tinged c) clear yellow d) cloudy amber 84. A client with nephrotic syndrome states to the nurse: "Why should I even bother trying to control my diet and the edema? It doesn't really matter what I do, if I can never get rid of this kidney problem anyway!" Based on the client's statement, the nurse addresses which potential client problem? a) anxiety b) powerlessness c) ineffective coping d) disturbed body image 85. A client has just been diagnosed with acute renal failure. The laboratory calls the nurse to report a serum potassium level of 6.1 mEq/L on the client. The nurse takes which immediate action? a) calls the physician

b) checks the sodium level c) encourages an extra 500ml of fluid intake d) teaches the client about foods low in potassium 86. After the lungs, the kidneys work to maintain body pH. The best explanation of how the kidneys accomplish regulation of pH is that they a. Secrete hydrogen ions and sodium. b. Secrete ammonia. c. Exchange hydrogen and sodium in the kidney tubules. d. Decrease sodium ions, hold on to hydrogen ions, and then secrete sodium bicarbonate.

include which of the following instructions? a) Follow a high potassium diet b) Strictly follow the hemodialysis schedule c) There will be a few changes in your lifestyle. d) Use alcohol on the skin and clean it due to integumentary changes.

87. Dialysis allows for the exchange of particles across a semipermeable membrane by which of the following actions? a) Osmosis and diffusion b) Passage of fluid toward a solution with a lower solute concentration c) Allowing the passage of blood cells and protein molecules through it. d) Passage of solute particles toward a solution with a higher concentration. 88. A client is diagnosed with chronic renal failure and told she must start hemodialysis. Client teaching would

89. A client is undergoing peritoneal dialysis. The dialysate dwell time is completed, and the dwell clamp is opened to allow the dialysate to drain. The nurse notes that the drainage has stopped and only 500 ml has drained; the amount the dialysate instilled was 1,500 ml. Which of the following interventions would be done first? a) Change the clients position. b) Call the physician. c) Check the catheter for kinks or obstruction. d) Clamp the catheter and instill more dialysate at the next exchange time.

90. A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of 200/100, a heart rate of 110, and a respiratory rate of 36. Oxygen saturation on room air is 89%. He complains of shortness of breath, and +2 pedal edema is noted. His last hemodialysis treatment was

yesterday. Which of the following interventions should be done first? a) Administer oxygen b) Elevate the foot of the bed c) Restrict the clients fluids d) Prepare the client for hemodialysis. 91. A client has a history of chronic renal failure and received hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which of the following interventions is included in this clients plan of care? a) Keep the AV fistula site dry. b) Keep the AV fistula wrapped in gauze. c) Take the blood pressure in the left arm d) Assess the AV fistula for a bruit and thrill

93. Which of the following clients is at greatest risk for developing acute renal failure? a) A dialysis client who gets influenza b) A teenager who has an appendectomy c) A pregnant woman who has a fractured femur d) A client with diabetes who has a heart catherization

94. In a client in renal failure, which assessment finding may indicate hypocalcemia? a) Headache b) Serum calcium level of 5 mEq/L c) Increased blood coagulation d) Diarrhea

92. Which of the following factors causes the nausea associated with renal failure? a) Oliguria b) Gastric ulcers c) Electrolyte imbalances d) Accumulation of waste products

95. A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic renal failure. Which finding indicates that the fistula is patent? a) Absence of bruit on auscultation of the fistula. b) Palpation of a thrill over the fistula c) Presence of a radial pulse in the left wrist

d) Capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand.

evaluate the clients status after dialysis? a) Potassium level and weight b) BUN and creatinine levels

96. The client with chronic renal failure is at risk of developing dementia related to excessive absorption of aluminum. The nurse teaches that this is the reason that the client is being prescribed which of the following phosphate binding agents? a) Alu-cap (aluminum hydroxide) b) Tums (calcium carbonate) c) Amphojel (aluminum hydroxide) d) Basaljel (aluminum hydroxide)

c) VS and BUN d) VS and weight. 99. The hemodialysis client with a left arm fistula is at risk for steal syndrome. The nurse assesses this client for which of the following clinical manifestations? a) Warmth, redness, and pain in the left hand. b) Pallor, diminished pulse, and pain in the left hand. c) Edema and reddish discoloration of the left arm d) Aching pain, pallor, and edema in the left arm. 100. A client is admitted to the hospital and has a diagnosis of early stage chronic renal failure. Which of the following would the nurse expect to note on assessment of the client? a) Polyuria b) Polydipsia c) Oliguria d) Anuria 101. The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment the nurse notes that the clients temperature is 100.2. Which of the following is the most appropriate nursing action? a) Encourage fluids

97. The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for: a) Hypertension, tachycardia, and fever b) Hypotension, bradycardia, and hypothermia c) restlessness, irritability, and generalized weakness d) Headache, deteriorating level of consciousness, and twitching. 98. A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to

b) Notify the physician c) Monitor the site of the shunt for infection d) Continue to monitor vital signs 102. The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of a headache and nausea and is extremely restless. Which of the following is the most appropriate nursing action? a) Notify the physician b) Monitor the client c) Elevate the head of the bed d) Medicate the client for nausea 103. The nurse is assisting a client on a low-potassium diet to select food items from the menu. Which of the following food items, if selected by the client, would indicate an understanding of this dietary restriction? a) Cantaloupe b) Spinach c) Lima beans d) Strawberries 104. The nurse is reviewing a list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response knowing that the glucose:

a) Prevents excess glucose from being removed from the client. b) Decreases risk of peritonitis. c) Prevents disequilibrium syndrome d) Increases osmotic pressure to produce ultrafiltration. 105. The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? a) Monitor the clients level of consciousness b) Maintain strict aseptic technique c) Add heparin to the dialysate solution d) Change the catheter site dressing daily 106. A client newly diagnosed with renal failure is receiving peritoneal dialysis. During the infusion of the dialysate the client complains of abdominal pain. Which action by the nurse is most appropriate? a) Slow the infusion b) Decrease the amount to be infused c) Explain that the pain will subside after the first few exchanges d) Stop the dialysis

107. The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the dwell time for the dialysis at the prescribed time because of the risk of: a) Infection b) Hyperglycemia c) Fluid overload d) Disequilibrium syndrome 108. The client with acute renal failure has a serum potassium level of 5.8 mEq/L. The nurse would plan which of the following as a priority action? a) Allow an extra 500 ml of fluid intake to dilute the electrolyte concentration. b) Encourage increased vegetables in the diet c) Place the client on a cardiac monitor d) Check the sodium level 109. The client with chronic renal failure has an indwelling catheter for peritoneal dialysis in the abdomen. The client spills water on the catheter dressing while bathing. The nurse should immediately: a) Reinforce the dressing b) Change the dressing c) Flush the peritoneal dialysis catheter

d) Scrub the catheter with providone-iodine 110. The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air embolism. The nurse should: a) Continue the dialysis at a slower rate after checking the lines for air b) Discontinue dialysis and notify the physician c) Monitor vital signs every 15 minutes for the next hour d) Bolus the client with 500 ml of normal saline to break up the air embolism. 111. The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the client best understands the information given if the client states to record the daily a) Pulse and respiratory rate b) Intake, output, and weight c) BUN and creatinine levels d) Activity log 112. The nurse is monitoring a client receiving peritoneal dialysis and nurse notes that a clients outflow is less than the inflow. Select actions that the nurse should take. a) Place the client in good body alignment

b) Check the level of the drainage bag c) Contact the physician d) Check the peritoneal dialysis system for kinks e) Reposition the client to his or her side. 113. The nurse assesses the client who has chronic renal failure and notes the following: crackles in the lung bases, elevated blood pressure, and weight gain of 2 pounds in one day. Based on these data, which of the following nursing diagnoses is appropriate? a) Excess fluid volume related to the kidneys inability to maintain fluid balance. b) Increased cardiac output related to fluid overload. c) Ineffective tissue perfusion related to interrupted arterial blood flow. d) Ineffective therapeutic Regimen Management related to lack of knowledge about therapy. 114. The nurse is caring for a hospitalized client who has chronic renal failure. Which of the following nursing diagnoses are most appropriate for this client? Select all that apply. a) Excess Fluid Volume b) Imbalanced Nutrition; Less than Body Requirements c) Activity Intolerance

d) Impaired Gas Exchange e) Pain. 115. What is the primary disadvantage of using peritoneal dialysis for long term management of chronic renal failure? a) The danger of hemorrhage is high. b) It cannot correct severe imbalances. c) It is a time consuming method of treatment. d) The risk of contacting hepatitis is high. 116. The dialysis solution is warmed before use in peritoneal dialysis primarily to: a) Encourage the removal of serum urea. b) Force potassium back into the cells. c) Add extra warmth into the body. d) Promote abdominal muscle relaxation. 117. During the clients dialysis, the nurse observes that the solution draining from the abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. Which interpretation of this observation would be correct? a) Bleeding is expected with a permanent peritoneal catheter

b) Bleeding indicates abdominal blood vessel damage c) Bleeding can indicate kidney damage. d) Bleeding is caused by too-rapid infusion of the dialysate. 118. Which of the following nursing interventions should be included in the clients care plan during dialysis therapy? a) Limit the clients visitors b) Monitor the clients blood pressure c) Pad the side rails of the bed d) Keep the client NPO. 119. Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the purpose of giving this drug to a client with chronic renal failure? a) To relieve the pain of gastric hyperacidity b) To prevent Curlings stress ulcers c) To bind phosphorus in the intestine d) To reverse metabolic acidosis. 120. The nurse teaches the client with chronic renal failure when to take the aluminum hydroxide gel. Which of the following statements would indicate that the client understands the teaching?

a) Ill take it every 4 hours around the clock. b) Ill take it between meals and at bedtime. c) Ill take it when I have a sour stomach. d) Ill take it with meals and bedtime snacks. 121. The client with chronic renal failure tells the nurse he takes magnesium hydroxide (milk of magnesium) at home for constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because: a) MOM can cause magnesium toxicity b) MOM is too harsh on the bowel c) Metamucil is more palatable d) MOM is high in sodium 122. In planning teaching strategies for the client with chronic renal failure, the nurse must keep in mind the neurologic impact of uremia. Which teaching strategy would be most appropriate? a) Providing all needed teaching in one extended session. b) Validating frequently the clients understanding of the material. c) Conducting a one-on-one session with the client. d) Using videotapes to reinforce the material as needed.

123. The nurse helps the client with chronic renal failure develop a home diet plan with the goal of helping the client maintain adequate nutritional intake. Which of the following diets would be most appropriate for a client with chronic renal failure? a) High carbohydrate, high protein b) High calcium, high potassium, high protein c) Low protein, low sodium, low potassium d) Low protein, high potassium 124. A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it: a) Is relatively low in cost b) Allows the client to be more independent c) Is faster and more efficient than standard peritoneal dialysis d) Has fewer potential complications than standard peritoneal dialysis 125. The client asks whether her diet would change on CAPD. Which of the following would be the nurses best response? a) Diet restrictions are more rigid with CAPD because standard peritoneal dialysis is a more effective technique.

b) Diet restrictions are the same for both CAPD and standard peritoneal dialysis. c) Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant. d) Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because CAPD works more quickly. 126. Which of the following is the most significant sign of peritoneal infection? a) Cloudy dialysate fluid b) Swelling in the legs c) Poor drainage of the dialysate fluid d) Redness at the catheter insertion site