1) The cause of ___________ failure is impaired blood supply to the kidney

(Fluid Volume Deficit, hemorrhage, heart failure, shock)

A. prerenal
B. Intrarenal
C. Postrenal
D. perirenal
2) What electrolytes are in urine?

A. Na
B. K
C. Cl
D. HCO3-
E. All of the above
3) Which diagnostic test would be monitored to evaluate glomerulat filtration
rateand renal function?

A. Sreum creatinine and BUN

B. Urinalysis
C. Kidney biopsy
D. creatinine clearance
4) Marina with acute renal failure moves into the diuretic phase after one week
of therapy. During this phase the client must be assessed for signs of
developing:

A. Hypovolemia
B. renal failure
C. metabolic acidosis
D. hyperkalemia
5) true or false? Creatinine, phosphate, sulfates, and uric acid should not be
present in urine because they signify renal failure.

A. True
B. False
6) The nurse is reviewing laboratory results on a client with acute renal failure.
Which one of the following should be reported immediately?

A. Blood urea nitrogen 50 mg/dl

B. Hemoglobin of 10.3 mg/dl
C. Venous blood pH 7.30
D. Serum potassium 6 mEq/L
7)Nurse Liza is assigned to care for a client who has returned to the nursing
unit after left nephrectomy. Nurse Lizas highest priority would be

A. Hourly urine output

B. Temperature
C. Able to turn side to side
D. Able to sips clear liquidQ.
8) The charge nurse assigned in the care for a client with acute renal failure
and hypernatremia to you, a newly graduated RN. Which actions can you
delegate to the nursing assistant?
A. Provide oral care every 3-4 hours
B. Monitor for indications of dehydration
C. Administer 0.45% saline by IV line
D. Assess daily weights for trends
9) __________ in BUN/Creatinine ratio indicate fluid volume
excess,malnutrition and fluid volume excess or malnutrition ?

A. Increase
B. Decrease
10) The most serious electrolyte disorder associated with kidney disease is

A. hypermagnesemia
B. hyponatremia
C. hyperkalemia
D. metabolic acidosis
11) A client in acute renal failure is a candidate for continuous renal
placement therapy (CRRT). The most common indication for use of CRRT is

A. azotemia
B. pericarditis
C. hyperkalemia
D. fluid overload
12) A history of infection specifically caused by group A beta-hemolytic
streptococci is associated with which of the following disorders?

A. Acute glomerulonephritis
B. Acute renal failure
C. Chronic renal failure
D. Nephrotic syndrome
13) The leading cause of ESRD is the client with a history of
 A. hypotension
B. anemia
C. prostate cancer
D. diabetes Mellitus
14) The risk for __________________ is particularly high when ischemia and
exposure to a nephrotoxin occur at the same time.

A. acute tubular necrosis or tubular necrosis

B. acute glomerulonephritis
C. chronic renal failure
D. UTI
15) What controls the amount of water absorption?

A. antidiuretic hormone (Vasopressin)

B. melanin
C. thyroxine
D. prolactin
16) What does urine mostly consist of?

A. H2O (Water)
B. NaCl (Salt)
C. Urea
D. KCl
17) How much water do normal kidneys excrete each day?

A. 3-4 liters
B. 5-6 liters
C. 1-2 liters
D. 7-8 liters
18) Chronic kidney disease is defined by Kidney Disease Outcomes Quality
Initiative (K/DOQI) as evidence of structural or functional kidney abnormalities
(abnormal urinalysis, imaging studies, or histology) that persists for at least
______________ months, with or without a decreased GFR.

A. 1
B. 2
C. 3
D. 6
E. 12
19) What is the # 1 renal function test?
 A. Renal Clearance/Creatinine Clearance
B. Osmolarity
C. Serum Creatinine
D. BUN
20) For a male client in the oliguric phase of acute renal failure (ARF), which
nursing intervention is most important?

A. Encouraging coughing and deep breathing

B. Promoting carbohydrate intake
C. Limiting fluid intake
D. Providing pain-relief measures
21) How much salt do normal kidneys excrete each day?

A. 1-2 mg
B. 5 g
C. 3-4 g
D. 6-8 g
22) Which is a normal value of Blood Urea Nitrogen (BUN)?

A. 0.5-1.1 mg/dL
B. 5-20 mg/dL
C. 40-70 mg/dL
D. 250-500 mg/dL
23) When the kidneys cannot effectively regulate fluid and electrolyte balance
and eliminate metabolic waste products, intake of these substances must be
regulated. Fluid and Sodium intake are ________.

A. encouraged
B. limited
C. restricted
24) The nurse is caring for the client who has had a renal biopsy. Which of the
following interventions would the nurse avoid in the care of the client after this
procedure?

A. Encourage fluids to at least 3L in the first 24 hours

B. Administering narcotics as needed
C. Testing serial samples iwth dipsticks for occult blood
D. Ambulating the client in the room and hall for short distances
25) A female client is admitted with a diagnosis of acute renal failure. She is
awake, alert, oriented, and complaining of severe back pain, nausea and
vomiting and abdominal cramps. Her vital signs are blood pressure 100/70
mm Hg, pulse 110, respirations 30, and oral temperature 100.4F (38C). Her
electrolytes are sodium 120 mEq/L, potassium 5.2 mEq/L; her urinary output
for the first 8 hours is 50 ml. The client is displaying signs of which electrolyte
imbalance?

A. Hyponatremia
B. Hyperkalemia
C. Hyperphosphatemia
D. Hypercalcemia
26) how many ml/hr of urine output is the normal minimum?

A. 30
B. 35
C. 40
D. 45
27) Signs and symptoms of acute kidney rejection that the nurse should teach
the patient to observe for include

A. tachycardia and headache

B. fever and painful transplant site
C. severe hypotension and weight loss
D. recurrent urinary tract infections and oral yeast infections
28) ________ renal failure is a slow, insidious process of kidney destruction. It
may go unrecognized for years as nephrons are destroyed and renal mass is
reduced.

A. Chronic
B. Acute
29) The client with renal failure should be on which type of diet?

A. high protein, high carbohydrate, low calorie

B. adequate calorie intake, high carbohydrate, limited protein
C. Limited protein, low carbohydrate, adequate calorie intake
D. Low calorie, limited protein, low carbohydrate
30) A client suffering from acute renal failure has an unexpected increase in
urinary output to 150ml/hr. The nurse assesses that the client has entered the
second phase of acute renal failure. Nursing actions throughout this phase
include observation for signs and symptoms of

A. Hypervolemia, hypokalemia, and hypernatremia.

B. Hypervolemia, hyperkalemia, and hypernatremia.
 C. Hypovolemia, wide fluctuations in serum sodium and potassium levels.
D. Hypovolemia, no fluctuation in serum sodium and potassium levels.
31) _________ is the most frequent complication during hemodialysis.

A. hypertension
B. bleeding
C. Infection
D. Dialysis dementia
32) After 1 week a client with acute renal failure moves, into the diuretic
phase. During this phase the client must be carefully assessed for signs of:

A. Hypovolemia
B. Hyperkalemia
C. Metabolic acidosis
D. Chronic renal failure
33) What is the #1 cause of death when kidneys fail?

A. hyperkalemia
B. hypokalemia
C. hypernatremia
D. hyponatremia
34) The nurse is reviewing laboratory results on a client with acute renal
failure. Which one of the following should be reported IMMEDIATELY?

A. Blood urea nitrogen 50 mg/dl

B. Hemoglobin of 10.3 mg/dl
C. Venous blood pH 7.30
D. Serum potassium 6 mEq/L
35) When the kidneys have too few nephrons to excrete metabolic wastes and
regulate fluid and electrolyte balance adequately, the client is said to have
____________, the final stage of Chronic Renal Failure.

A. End-stage renal disease (ESRD)

B. renal insufficiency
C. acute tubular necrosis
D. dialysis
36) _________ renal Failure is a rapid decline in renal function with an abrupt
onset

A. acute
B. chronic
37) How do kidneys control Na+ levels and K+ levels?

A. The kidneys release renin, which controls angiotensin. The angiotensin

controls aldosterone. Aldosterone controls the levels of Na+ and K+
B. Kidneys release aldosterone which controls renin. Renin causes the release
of angiotensin. Angiotensin controls the levels of Na+ and K+
C. The kidneys release renin which controls K+. The kidneys release
angiotensin which causes Na+ realease.
38) Anti-hypertensive therapy in patients with chronic renal disease is for?

A. Renal protection
B. Cardiovascular protection
C. Both renal and cardiovascular protection
D. None of the above
39) ____________ is a treatment for renal failure in which blood id
continuously circulated (artery to vein or vein to vein) and filtered, allowing
excess water and solutes to empty into a collecting device. Fluid may be
replaced with a balanced electrolyte solution as needed during treatment.

A. Hemodialysis
B. Continuous ambulatory peritoneal dialysis
C. Continuous cyclic peritoneal dialysis
D. Continuous Renal Replacement Therapy
40) __________ failure is caused by obstruction of urine flow. (urethral
obstruction by enlarged prostate or tumor; ureteral or kidney pelvis obstruction
by calculi)

A. prerenal
B. intrarenal
C. postrenal
D. perirenal
41) Agents that damage the kidney tissue are called:

A. nephrons
B. nephrotoxins
C. antibodies
D. enterotoxins
42) Which phase of Acute Renal Failure results in FVE and edema due to salt
and water retention, hypertension, Azotemia, hyperkalemia, muscle
weakness, nausea, diarrhea, and high serum creatinine and BUN levels?
 A. initiation phase
B. maintenance phase
C. recovery phase
D. intrarenal phase
43) A patient rapidly progressing toward ESRD asks about the possibility of a
kidney transplant. In responding to the patient, the nurse knows that
contraindications to kidney transplantation include

A. hepatitis C infection
B. extensive vascular disease
C. coronary artery disease
D. refractory hypertension
44) Which of the following medications does not interfere with either creatinine
secretion or the assay used to measure the serum creatinine?

A. Ibuprofen
B. Cimetidine
C. Trimethoprim
D. Cefoxitin
E. Flucytosine
45) A female client with acute renal failure is undergoing dialysis for the first
time. The nurse in charge monitors the client closely for dialysis equilibrium
syndrome, a complication that is most common during the first few dialysis
sessions. Typically, dialysis equilibrium syndrome causes:

A. confusion, headache, and seizures.

B. acute bone pain and confusion.
C. weakness, tingling, and cardiac arrhythmias.
D. hypotension, tachycardia, and tachypnea.
46) Clients with chronic renal failure should notify the physician of any weight:

A. loss of 2 pounds over a 5 day period

B. gain of 2 pounds over a 2 day period
C. loss of 5 pounds over a 5 day period
D. gain of 5 pounds over a 2 day period
47) Nurse Tristan is caring for a male client in acute renal failure. The nurse
should expect hypertonic glucose, insulin infusions, and sodium bicarbonate
to be used to treat:

A. hypernatremia.
B. hypokalemia.
 C. hyperkalemia.
D. hypercalcemia.
48) The client with ESRD tells the nurse that she hates the thought of being
tied to the machine, but is also glad to start dialysis because she will be able
to eat and drink what she wants. Based on this information, the nuse identifies
the nursing diagnosis of

A. self-esteem disturbance related to dependence on dialysis

B. anxiety related to perceived threat to health status and role functioning
C. ineffective management of therapeutic regimen related to lack of knowledge
of treatment plan
D. risk for imbalanced nutrition: more than body requirements, related to
increased dietary intake
49) How acidic is urine compared to blood?

A. 100 times more acidic

B. 200 times less acidic
C. 1000 times more acidic
D. 2000 times more acidic
50) Impaired metabolic processes such as Hyperkalemia, Acidosis,
Hyperlipidemia, Hyperuricemia, and malnutrition are some effects of
___________.

A. hematuria
B. oliguria
C. uremia
D. nephrotoxins
51) ________ failure is caused by Acute damage to renal tissue and nephrons
or acute tubular necrosis: abrupt decline in tubular and glomerular function
due to either prolonged ischemia and/or exposure to nephrotoxins. (Acute
glomerulonephritis, malignant hypertension, ischemia; nephrotoxic drugs or
substances; red blood cell destruction; muscle tissue breakdown due to
trauma, heatstroke)

A. Prerenal
B. Intrarenal
C. Postrenal
D. Perirenal
52) Common early manifestation of kidney disease are loss of concentration
and dilute urine and loss of ability to concentrate and dilute urine .
 A. True
B. False
53) A client with acute renal failure is aware that the most serious
complication of this condition is:

A. Constipation
B. Anemia
C. Infection
D. Platelet dysfunction
54) 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
55) How much KCL do normal kidneys excrete each day?

A. 6-8 g
B. 1 g
C. 6-8 mg
D. 3 mg
56) Clients on continuous ambulatory peritoneal dialysis (CAPD) must empty
their peritoneal cavity and replace the dialysate every __________ hours.

A. 24
B. 6-8
C. 4-6
D. 48
57) Which of these drugs is nephrotoxic?

A. Diuretics
B. ACE inhibitors
C. NSAIDs
D. Sodium bicarbonate/ Potassium bicarbonate
58) 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. Polydypsia
C. Oliguria
D. Anuria
59) A client on peritoneal dialysis notices that the collecting bag of dialysate is
cloudy, what is this an indication of?

A. The client needs to change their dialysate

B. The patient needs a kidney transplant
C. Medication was added to the dialysate
D. The patient is infected and experiencing peritonitis
60) End-stage renal disease is defined as GFR less than ________________
ml/min per 1.73m2.

A. 45
B. 30
C. 15
D. 10
E. 5
61) During the _________ phase of Acute Renal Failure, Oliguria develops
and the kidneys cannot efficiently eliminate metabolic wastes, water,
electrolytes, and acids.

A. maintenance
B. initiation
C. recovery
62) What tests and results prove the presence of dilute urine?

A. Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l)

B. GFR (100 ml/min), and/or Specific Gravity (1.030)
C. Serum Creatinine (1.5 mg/dl)
63) Which of the following are abnormal to be found in the urine?

A. K
B. Amino acids
C. Glucose
D. all of the above
E. Amino acids and glucose
64) ESRD occurs when the GFR is less than ___ per minute.

A. 5 ml
 B. 10 ml
C. 15 ml
D. 25 ml
65) urine in the blood

A. uremia
B. uticaria
C. urethritis
D. urethrorrhea
Answers and Rationales
1. A. prerenal
2. E. All of the above
3. D. creatinine cleatance
4. A. Hypovolemia
5. B. False . Creatinine, phosphate, sulfates, and uric acid should be found in
urine.
6. D. Serum potassium 6 mEq/L . Although all of these findings are abnormal,
the elevated potassium is a life threatening finding and must be reported
immediately.
7. A. Hourly urine output . After nephrectomy, it is necessary to measure urine
output hourly. This is done to assess the effectiveness of the remaining
kidney also to detect renal failure early.
8. A. Provide oral care every 3-4 hours . Providing oral care is within the scope
of practice for the nursing assistant. Monitoring and assessing clients, as well
as administering IV fluids, require the additional education and skill of the
RN.
9. B. Decrease
10.C. hyperkalemia
11.D. fluid overload
12.A. Acute glomerulonephritis
Acute glomerulonephritis is also associated with varicella zoster virus,
hepatitis B, and Epstein-Barr virus.
Acute renal failure is associated with hypoperfusion to the kidney,
parenchymal damage to the glomeruli or tubules, and obstruction at a
point distal to the kidney.
Chronic renal failure may be caused by systemic disease, hereditary
lesions, medications, toxic agents, infections, and medications.
Nephrotic syndrome is caused by disorders such as chronic
glomerulonephritis, systemic lupus erythematosus, multiple myeloma,
and renal vein thrombosis.
13.D. diabetes Mellitus
14.A. acute tubular necrosis or tubular necrosis
15.A. antidiuretic hormone
16.A. H2O (Water)
17.C. 1-2 liters
18.C. 3
19.A. Renal Clearance/Creatinine Clearance
20.C. Limiting fluid intake . During the oliguric phase of ARF, urine output
decreases markedly, possibly leading to fluid overload. Limiting oral and I.V.
fluid intake can prevent fluid overload and its complications, such as heart
failure and pulmonary edema. Encouraging coughing and deep breathing is
important for clients with various respiratory disorders. Promoting
carbohydrate intake may be helpful in ARF but doesnt take precedence over
fluid limitation. Controlling pain isnt important because ARF rarely causes
pain.
21.D. 6-8 g
22.B. 5-20 mg/dL
23.B. limited
24.D. Ambulating the client in the room and hall for short distances
25.A. Hyponatremia . The normal serum sodium level is 135 145 mEq/L. The
clients serum sodium is below normal. Hyponatremia also manifests itself
with abdominal cramps and nausea and vomiting
26.A. 30
27.B. fever and painful transplant site
28.A. chronic
29.B. adequate calorie intake, high carbohydrate, limited protein
30.C. Hypovolemia, wide fluctuations in serum sodium and potassium
levels. The second phase of ARF is the diuretic phase or high output phase.
The diuresis can result in an output of up to 10L/day of dilute urine. Loss of
fluids and electrolytes occur.
31.A. hypertension
32.A. Hypovolemia
33.A. hyperkalemia
34.D. Serum potassium 6 mEq/L. Although all of these findings are abnormal,
the elevated potassium is a life threatening finding and must be reported
immediately.
35.A. End-stage renal disease (ESRD)
36.A. acute
37.A. The kidneys release renin, which controls angiotensin. The angiotensin
controls aldosterone. Aldosterone controls the levels of Na+ and K+
38.C. Both renal and cardiovascular protection
39.D. Continuous Renal Replacement Therapy
40.C. postrenal
41.B. nephrotoxins
42.B. maintenance phase
43.B. extensive vascular disease
44.A. Ibuprofen
45.A. confusion, headache, and seizures. Dialysis equilibrium syndrome causes
confusion, a decreasing level of consciousness, headache, and seizures. These
findings, which may last several days, probably result from a relative excess
of interstitial or intracellular solutes caused by rapid solute removal from the
blood. The resultant organ swelling interferes with normal physiologic
functions. To prevent this syndrome, many dialysis centers keep first-time
sessions short and use a reduced blood flow rate. Acute bone pain and
confusion are associated with aluminum intoxication, another potential
complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest
hyperkalemia, which is associated with renal failure. Hypotension,
tachycardia, and tachypnea signal hemorrhage, another dialysis
complication.
46.D. gain of 5 pounds over a 2 day period
47.C. hyperkalemia. Hyperkalemia is a common complication of acute renal
failure. Its life-threatening if immediate action isnt taken to reverse it. The
administration of glucose and regular insulin, with sodium bicarbonate if
necessary, can temporarily prevent cardiac arrest by moving potassium into
the cells and temporarily reducing serum potassium levels. Hypernatremia,
hypokalemia, and hypercalcemia dont usually occur with acute renal failure
and arent treated with glucose, insulin, or sodium bicarbonate.
48.C. ineffective management of therapeutic regimen related to lack of
knowledge of treatment plan
49.C. 1000 times more acidic
50.C. uremia
51.B. Intrarenal
52.A. True
53.C. Infection . Infection is responsible for one third of the traumatic or
surgically induced death of clients with renal failure as well as medical
induced acute renal failure (ARF)
54.A. Notify the physician
55.A. 6-8 g
56.C. 4-6
57.C. NSAIDs
58.A. Polyuria
59.D. The patient is infected and experiencing peritonitis
60.C. 15
61.A. maintenance
62.A. Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l)
63.E. Amino acids and glucose. Amino acids (proteins) found in the urine
indicate trauma to the glomeruli. Glucose found in the urine indicate BS
levels to be above the renal threshold.
64.C. 15 ml
65.A. uremia

1. 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.
2. A client is diagnosed with chronic renal failure and told she must start
hemodialysis. Client teaching would 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.
3. 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.
4. 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.
5. 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
6. 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
7. 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
8. 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
9. 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.
10. 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)
11. 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.
12. A client with chronic renal failure has completed a hemodialysis
treatment. The nurse would use which of the following standard indicators to
evaluate the clients status after dialysis?

A. Potassium level and weight

B. BUN and creatinine levels
 C. VS and BUN
D. VS and weight.
13. 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.
14. 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
15. 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
B. Notify the physician
C. Monitor the site of the shunt for infection
D. Continue to monitor vital signs
16. 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
17. 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
18. 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.
19. 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
20. 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
21. 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
22. 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
23. 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. Just before dialysis

B. During dialysis
C. On return from dialysis
D. The day after dialysis
24. 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
25. 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.
26. 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
27. The client with an arteriovenous shunt in place for hemodialysis is at risk
for bleeding. The nurse would do which of the following as a priority action to
prevent this complication from occurring?

A. Check the results of the PT time as they are ordered.

B. Observe the site once per shift
 C. Check the shunt for the presence of a bruit and thrill
D. Ensure that small clamps are attached to the AV shunt dressing.
28. 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.
29. 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.
30. 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.
31. 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.
32. 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.
33. 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.
34. 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.
35. 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.
36. 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.
37. 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
38. 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.
39. 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
40. 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
41. 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.
42. 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
43. The main indicator of the need for hemodialysis is:

A. Ascites
B. Acidosis
C. Hypertension
D. Hyperkalemia
44. To gain access to the vein and artery, an AV shunt was used for Mr.
Roberto. The most serious problem with regards to the AV shunt is:

A. Septicemia
B. Clot formation
C. Exsanguination
D. Vessel sclerosis
45. When caring for Mr. Robertos AV shunt on his right arm, you should:

A. Cover the entire cannula with an elastic bandage

B. Notify the physician if a bruit and thrill are present
C. User surgical aseptic technique when giving shunt care
D. Take the blood pressure on the right arm instead
Answers and Rationales
1. A. Osmosis allows for the removal of fluid from the blood by allowing it to
pass through the semipermeable membrane to an area of high concentrate
(dialysate), and diffusion allows for passage of particles (electrolytes, urea,
and creatinine) from an area of higher concentration to an area of lower
concentration. Fluid passes to an area with a higher solute concentration.
The pores of a semipermeable membrane are small, thus preventing the flow
of blood cells and protein molecules through it.
2. B. To prevent life-threatening complications, the client must follow the
dialysis schedule. Alcohol would further dry the clients skin more than it
already is. The client should follow a low-potassium diet because potassium
levels increase in chronic renal failure. The client should know hemodialysis
is time-consuming and will definitely cause a change in current lifestyle.
3. C. The first intervention should be to check for kinks and obstructions
because that could be preventing drainage. After checking for kinks, have the
client change position to promote drainage. Dont give the next scheduled
exchange until the dialysate is drained because abdominal distention will
occur, unless the output is within parameters set by the physician. If unable
 to get more output despite checking for kinks and changing the clients
position, the nurse should then call the physician to determine the proper
intervention.
4. A. Airway and oxygenation are always the first priority. Because the client is
complaining of shortness of breath and his oxygen saturation is only 89%,
the nurse needs to try to increase his levels by administering oxygen. The
client is in pulmonary edema from fluid overload and will need to be dialyzed
and have his fluids restricted, but the first interventions should be aimed at
the immediate treatment of hypoxia. The foot of the bed may be elevated to
reduce edema, but this isnt the priority.
5. D. Assessment of the AV fistula for bruit and thrill is important because, if not
present, it indicates a non-functioning fistula. No blood pressures or
venipunctures should be taken in the arm with the AV fistula. When not
being dialyzed, the AV fistula site may get wet. Immediately after a dialysis
treatment, the access site is covered with adhesive bandages.
6. D. Although clients with renal failure can develop stress ulcers, the nausea is
usually related to the poisons of metabolic wastes that accumulate when the
kidneys are unable to eliminate them. The client has electrolyte imbalances
and oliguria, but these dont directly cause nausea.
7. D. Clients with diabetes are prone to renal insufficiency and renal failure. The
contrast used for heart catherization must be eliminated by the kidneys,
which further stresses them and may produce acute renal failure. A teenager
who has an appendectomy and a pregnant woman with a fractured femur
isnt at increased risk for renal failure. A dialysis client already has end-stage
renal disease and wouldnt develop acute renal failure.
8. D. In renal failure, calcium absorption from the intestine declines, leading to
increased smooth muscle contractions, causing diarrhea. CNS changes in
renal failure rarely include headache. A serum calcium level of 5 mEq/L
indicates hypercalcemia. As renal failure progresses, bleeding tendencies
increase.
9. B. The nurse assesses the patency of the fistula by palpating for the presence
of a thrill or auscultating for a bruit. The presence of a thrill and bruit
indicate patency of the fistula. Although the presence of a radial pulse in the
left wrist and capillary refill time less than 3 seconds in the nail beds of the
fingers on the left hand are normal findings, they do not assess fistula
patency.
10.B. Phosphate binding agents that contain aluminum include Alu-caps,
Basaljel, and Amphojel. These products are made from aluminum hydroxide.
Tums are made from calcium carbonate and also bind phosphorus. Tums are
prescribed to avoid the occurrence of dementia related to high intake of
 aluminum. Phosphate binding agents are needed by the client in renal failure
because the kidneys cannot eliminate phosphorus.
11.D. Disequilibrium syndrome is characterized by headache, mental confusion,
decreasing level of consciousness, nausea, and vomiting, twitching, and
possible seizure activity. Disequilibrium syndrome is caused by rapid
removal of solutes from the body during hemodialysis. At the same time, the
blood-brain barrier interferes with the efficient removal of wastes from brain
tissue. As a result, water goes into cerebral cells because of the osmotic
gradient, causing brain swelling and onset of symptoms. The syndrome most
often occurs in clients who are new to dialysis and is prevented by dialyzing
for shorter times or at reduced blood flow rates.
12.D. Following dialysis, the clients vital signs are monitored to determine
whether the client is remaining hemodynamically stable. Weight is measured
and compared with the clients predialysis weight to determine effectiveness
of fluid extraction. Laboratory studies are done as per protocol but are not
necessarily done after the hemodialysis treatment has ended.
13.B. Steal syndrome results from vascular insufficiency after creation of a
fistula. The client exhibits pallor and a diminished pulse distal to the fistula.
The client also complains of pain distal to the fistula, which is due to tissue
ischemia. Warmth, redness, and pain more likely would characterize a
problem with infection.
14.A. Polyuria occurs early in chronic renal failure and if untreated can cause
severe dehydration. Polyuria progresses to anuria, and the client loses all
normal functions of the kidney. Oliguria and anuria are not early signs, and
polydipsia is unrelated to chronic renal failure.
15.D. The client may have an elevated temperature following dialysis because
the dialysis machine warms the blood slightly. If the temperature is elevated
excessively and remains elevated, sepsis would be suspected and a blood
sample would be obtained as prescribed for culture and sensitivity purposes.
16.A. Disequilibrium syndrome may be due to the rapid decrease in BUN levels
during dialysis. These changes can cause cerebral edema that leads to
increased intracranial pressure. The client is exhibiting early signs of
disequilibrium syndrome and appropriate treatments with anticonvulsant
medications and barbituates may be necessary to prevent a life-threatening
situation. The physician must be notified.
17.C. Cantaloupe (1/4 small), spinach (1/2 cooked) and strawberries (1 cups)
are high potassium foods and average 7 mEq per serving. Lima beans (1/3 c)
averages 3 mEq per serving.
18.D. Increasing the glucose concentration makes the solution increasingly more
hypertonic. The more hypertonic the solution, the greater the osmotic
 pressure for ultrafiltration and thus the greater amount of fluid removed
from the client during an exchange.
19.B. The major complication of peritoneal dialysis is peritonitis. Strict aseptic
technique is required in caring for the client receiving this treatment.
Although changing the catheter site dressing daily may assist in preventing
infection, this option relates to an external site.
20.C. Pain during the inflow of dialysate is common during the first few
exchanges because of peritoneal irritation; however, the pain usually
disappears after 1 to 2 weeks of treatment. The infusion amount should not
be decreased, and the infusion should not be slowed or stopped.
21.B. An extended dwell time increases the risk of hyperglycemia in the client
with diabetes mellitus as a result of absorption of glucose from the dialysate
and electrolyte changes. Diabetic clients may require extra insulin when
receiving peritoneal dialysis.
22.C. The client with hyperkalemia is at risk for developing cardiac
dysrhythmias and cardiac arrest. Because of this the client should be placed
on a cardiac monitor. Fluid intake is not increased because it contributes to
fluid overload and would not affect the serum potassium level significantly.
Vegetables are a natural source of potassium in the diet, and their use would
not be increased. The nurse may also assess the sodium level because sodium
is another electrolyte commonly measured with the potassium level.
However, this is not a priority action at this time.
23.C. Antihypertensive medications such as enalapril are given to the client
following hemodialysis. This prevents the client from becoming hypotensive
during dialysis and also from having the medication removed from the
bloodstream by dialysis. No rationale exists for waiting a full day to resume
the medication. This would lead to ineffective control of the blood pressure.
24.B. Clients with peritoneal dialysis catheters are at high risk for infection. A
dressing that is wet is a conduit for bacteria for bacteria to reach the catheter
insertion site. The nurse assures that the dressing is kept dry at all times.
Reinforcing the dressing is not a safe practice to prevent infection in this
circumstance. Flushing the catheter is not indicated. Scrubbing the catheter
with povidone-iodine is done at the time of connection or disconnecting of
peritoneal dialysis.
25.B. If the client experiences air embolus during hemodialysis, the nurse should
terminate dialysis immediately, notify the physician, and administer oxygen
as needed.
26.B. The client on hemodialysis should monitor fluid status between
hemodialysis treatments by recording intake and output and measuring
 weight daily. Ideally, the hemodialysis client should not gain more than 0.5
kg of weight per day.
27.D. An AV shunt is a less common form of access site but carries a risk for
bleeding when it is used because two ends of an external cannula are
tunneled subcutaneously into an artery and a vein, and the ends of the
cannula are joined. If accidental connection occurs, the client could lose
blood rapidly. For this reason, small clamps are attached to the dressing that
covers the insertion site to use if needed. The shunt site should be assessed
at least every four hours.
28.A, B, D, E. If outflow drainage is inadequate, the nurse attempts to stimulate
outflow by changing the clients position. Turning the client to the other side
or making sure that the client is in good body alignment may assist with
outflow drainage. The drainage bag needs to be lower than the clients
abdomen to enhance gravity drainage. The connecting tubing and the
peritoneal dialysis system is also checked for kinks or twisting and the
clamps on the system are checked to ensure that they are open. There is no
reason to contact the physician.
29.A. Crackles in the lungs, weight gain, and elevated blood pressure are
indicators of excess fluid volume, a common complication in chronic renal
failure. The clients fluid status should be monitored carefully for imbalances
on an ongoing basis.
30.A, B, C. Appropriate nursing diagnoses for clients with chronic renal failure
include excess fluid volume related to fluid and sodium retention;
imbalanced nutrition, less than body requirements related to anorexia,
nausea, and vomiting; and activity intolerance related to fatigue. The nursing
diagnoses of impaired gas exchange and pain are not commonly related to
chronic renal failure.
31.C. The disadvantages of peritoneal dialysis in long-term management of
chronic renal failure is that is requires large blocks of time. The risk of
hemorrhage or hepatitis is not high with PD. PD is effective in maintaining a
clients fluid and electrolyte balance.
32.A. The main reason for warming the peritoneal dialysis solution is that the
warm solution helps dilate peritoneal vessels, which increases urea
clearance. Warmed dialyzing solution also contributes to client comfort by
preventing chilly sensations, but this is a secondary reason for warming the
solution. The warmed solution does not force potassium into the cells or
promote abdominal muscle relaxation.
33.B. Because the client has a permanent catheter in place, blood tinged
drainage should not occur. Persistent blood tinged drainage could indicate
damage to the abdominal vessels, and the physician should be notified. The
 bleeding is originating in the peritoneal cavity, not the kidneys. Too rapid
infusion of the dialysate can cause pain.
34.B. Because hypotension is a complication of peritoneal dialysis, the nurse
records intake and output, monitors VS, and observes the clients behavior.
The nurse also encourages visiting and other diversional activities. A client
on PD does not need to be placed in bed with padded side rails or kept NPO.
35.C. A client in renal failure develops hyperphosphatemia that causes a
corresponding excretion of the bodys calcium stores, leading to renal
osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed
to bind phosphates in the intestine and facilitate their excretion. Gastric
hyperacidity is not necessarily a problem associated with chronic renal
failure. Antacids will not prevent Curlings stress ulcers and do not affect
metabolic acidosis.
36.D. Aluminum hydroxide gel is administered to bind the phosphates in
ingested foods and must be given with or immediately after meals and
snacks. There is no need for the client to take it on a 24-hour schedule. It is
not administered to treat hyperacidity in clients with CRF and therefore is
not prescribed between meals.
37.A. Magnesium is normally excreted by the kidneys. When the kidneys fail,
magnesium can accumulate and cause severe neurologic problems. MOM is
harsher than Metamucil, but magnesium toxicity is a more serious problem.
A client may find both MOM and Metamucil unpalatable. MOM is not high in
sodium.
38.B. Uremia can cause decreased alertness, so the nurse needs to validate the
clients comprehension frequently. Because the clients ability to concentrate
is limited, short lesions are most effective. If family members are present at
the sessions, they can reinforce the material. Written materials that the client
can review are superior to videotapes, because the clients may not be able to
maintain alertness during the viewing of the videotape.
39.C. Dietary management for clients with chronic renal failure is usually
designed to restrict protein, sodium, and potassium intake. Protein intake is
reduced because the kidney can no longer excrete the byproducts of protein
metabolism. The degree of dietary restriction depends on the degree of renal
impairment. The client should also receive a high carbohydrate diet along
with appropriate vitamin and mineral supplements. Calcium requirements
remain 1,000 to 2,000 mg/day.
40.B. The major benefit of CAPD is that it frees the client from daily dependence
on dialysis centers, home health care personnel, and machines for life-
sustaining treatment. The independence is a valuable outcome for some
 people. CAPD is costly and must be done daily. Side effects and complications
are similar to those of standard peritoneal dialysis.
41.C. Dietary restrictions with CAPD are fewer than those with standard
peritoneal dialysis because dialysis is constant, not intermittent. The
constant slow diffusion of CAPD helps prevent accumulation of toxins and
allows for a more liberal diet. CAPD does not work more quickly, but more
consistently. Both types of peritoneal dialysis are effective.
42.A. Cloudy drainage indicates bacterial activity in the peritoneum. Other signs
and symptoms of infection are fever, hyperactive bowel sounds, and
abdominal pain. Swollen legs may be indicative of congestive heart failure.
Poor drainage of dialysate fluid is probably the result of a kinked catheter.
Redness at the insertion site indicates local infection, not peritonitis.
However, a local infection that is left untreated can progress to the
peritoneum.
43.D.
44.C.
45.C.