N321: Exam 2 - NCLEX-Style Questions RenalGU

N321: Exam 2 - NCLEX-Style Questions (Renal/GU)

Leave the first rating Students also studied Terms in this set (38) Science MedicineNursing Save Renal NCLEX Questions 30 terms lilnurseangelPreview Renal Disorders/Dialysis & Peritone...132 terms rnin2018Preview NCLEX questions-Laboratory Values...14 terms Bs2williamsPreview Fluid an 33 terms Ale A diabetic patient is admitted for evaluation of renal function because of recent fatigue, weakness, and elevated BUN and serum creatinine levels. While obtaining a nursing history, the nurse identifies an early symptom of renal insufficiency when the patient states,

• "I get up several times every night to urinate."
• "I wake up in the night feeling short of breath."
• "My memory is not as good as it used to be."
• "My mouth and throat are always dry and sore."
• "I get up several times every night to urinate."

R: Polyuria occurs early in chronic kidney disease (CKD) as a result of the inability of the kidneys to concentrate urine. The other symptoms would be expected later in the progression of CKD.A patient is diagnosed with stage 3 CKD. The patient is treated with conservative management, including erythropoietin injections. After teaching the patient about management of CKD, the nurse determines teaching has been effective when the patient states,

• "I will measure my urinary output each day to help

calculate the amount I can drink."

• "I need to take the erythropoietin to boost my immune

system and help prevent infection."

• "I need to try to get more protein from dairy products."
• "I will try to increase my intake of fruits and

vegetables."

• "I will measure my urinary output each day to help calculate the amount I can

drink." R: The patient with CKD who is not receiving dialysis is generally taught to restrict fluids. The patient would need to measure urine output and then add 600 ml for insensible losses to calculate an appropriate oral intake. Erythropoietin is given to increase red blood cell count and will not offer any benefit for immune function.Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.

A patient with CKD has a nursing diagnosis of disturbed sensory perception related to central nervous system changes induced by uremic toxins. An appropriate nursing intervention for this problem is to

• convey a caring attitude and foster the nurse-patient

relationship.

• keep the patient on bed rest to avoid possible falls or

other injuries.

• ensure restricted protein intake to prevent nitrogenous

product accumulation.

• provide an opportunity for the patient to discuss

concerns about the condition.

• ensure restricted protein intake to prevent nitrogenous product accumulation.

R: Uremia is caused by the products of protein breakdown, and protein restriction is used to decrease uremia. Because the primary cause of the patient's disturbed sensory perception is the uremia, conveying a caring attitude and providing opportunities for the patient to discuss concerns will not be as helpful as protein restriction. Although safety is a concern for the patient, bed rest is likely to promote weakness. The patient should be supervised when out of bed.As the nurse reviews a diet plan with a patient with diabetes and renal insufficiency, the patient states that with diabetes and kidney failure there is nothing that is good to eat. The patient says, "I am going to eat what I want; I'm going to die anyway!" The best nursing diagnosis for this patient is

a. imbalanced nutrition: more than required related to

knowledge deficit about appropriate diet.

• risk for noncompliance related to feelings of anger.
• grieving related to actual and perceived losses.
• risk for ineffective health maintenance related to

complexity of therapeutic regimen.

• grieving related to actual and perceived losses.

R: The patient's statements that there is nothing that is good to eat and that death is unavoidable indicate grieving about the losses being experienced as a result of the diabetes and chronic kidney disease (CKD). The patient data do not indicate knowledge deficit, anger, or the complexity of the therapeutic program as being issues for this patient.Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess

• the BUN and creatinine.
• the blood glucose level.
• the patient's bowel sounds.
• the level of consciousness (LOC).
• the patient's bowel sounds.

R: Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient

with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not impact on the nurse's decision to give the medication.The nurse has instructed a patient who is receiving hemodialysis about dietary management. Which diet choices by the patient indicate that the teaching has been successful?

• Scrambled eggs, English muffin, and apple juice
• Cheese sandwich, tomato soup, and cranberry juice
• Split-pea soup, whole-wheat toast, and nonfat milk
• Oatmeal with cream, half a banana, and herbal tea
• Scrambled eggs, English muffin, and apple juice

R: Scrambled eggs would provide high-quality protein, and apple juice is low in

potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.To determine glomerular filtration rate (GFR) for a patient with chronic kidney disease, the nurse will plan to

• schedule frequent blood urea nitrogen (BUN) tests.
• initiate a 24-hour collection of the patient's urine.
• check the specific gravity on serial urine specimens.
• use a bladder scanner to check for residual urine.
• initiate a 24-hour collection of the patient's urine.

R: Creatinine clearance testing, the most accurate way to assess GFR, requires a 24-hour urine collection. BUN levels may increase for other reasons, such as dehydration, and are not as accurate in determining glomerular filtration. Urine- specific gravity testing and monitoring residual urine would not be useful in determining the GFR.

A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it

• can accommodate larger needles.
• increases patient mobility.
• is much less likely to clot.
• can be used sooner after surgery.
• is much less likely to clot.

R: AV fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not impact on needle size or patient mobility.In preparation for hemodialysis, a patient has an AV native fistula created in the left forearm. When caring for the fistula postoperatively, the nurse should

• check the fistula site for a bruit and thrill.
• assess the rate and quality of the left radial pulse.
• compare blood pressures in the left and right arms.
• irrigate the fistula site daily with low-dose heparin.
• check the fistula site for a bruit and thrill.

R: The presence of a thrill and bruit indicates adequate blood flow through the

fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.A patient begins hemodialysis after having had conservative management of chronic kidney disease. The nurse explains that one dietary regulation that will be changed when hemodialysis is started is that

• unlimited fluids are allowed since retained fluid is

removed during dialysis.

• increased calories are needed because glucose is lost

during hemodialysis.

• more protein will be allowed because of the removal

of urea and creatinine by dialysis.

• dietary sodium and potassium are unrestricted

because these levels are normalized by dialysis.

• more protein will be allowed because of the removal of urea and creatinine by

dialysis.

R: Once the patient is started on dialysis and nitrogenous wastes are removed,

more protein in the diet is allowed. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.A patient with diabetes who has chronic kidney disease (CKD) is considering using continuous ambulatory peritoneal dialysis (CAPD). In discussing this treatment option with the patient, the nurse informs the patient that

• patients with diabetes who use CAPD have fewer

dialysis-related complications than those on hemodialysis.

• home CAPD requires more extensive equipment than

does home hemodialysis.

• CAPD is contraindicated for patients who might

eventually want a kidney transplant.

• dietary restrictions are stricter for patients using CAPD

than for those having hemodialysis.

• patients with diabetes who use CAPD have fewer dialysis-related complications

than those on hemodialysis.

R: Patients with diabetes have better control of blood pressure, less

hemodynamic instability, and fewer problems with retinal hemorrhages when using peritoneal dialysis than when using hemodialysis. CAPD is less expensive and has fewer dietary restrictions than hemodialysis. CAPD is not a contraindication for a kidney transplant.The nurse is assessing a patient who is receiving peritoneal dialysis with 2-L inflows. Which information should be reported immediately to the health care provider?

• The patient complains of feeling bloated after the

inflow.

• The patient's peritoneal effluent appears cloudy.
• The patient has abdominal pain during the inflow

phase.

• The patient has an outflow volume of 1600 ml.
• The patient's peritoneal effluent appears cloudy.

R: Cloudy-appearing peritoneal effluent is a sign of peritonitis and should be

reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.

In the immediate postoperative period, the nurse caring for a patient who is a recipient of a kidney transplant would expect that fluid therapy would involve administration of IV fluids

• to be determined hourly, based on every milliliter of

urine output.

• at a minimum rate of 100 ml/hr to perfuse the kidney.
• titrated to keep blood pressure within a normal range.
• at a rate to keep urine clear and without blood clots.
• to be determined hourly, based on every milliliter of urine output.

R: Fluid volume is replaced based on urine output after transplant because the

urine output can be as high as a liter an hour. Fluid infusion rate is titrated rather than being at a set rate. Blood pressure and urine appearance are not the major parameters considered when titrating fluid infusion.Two hours after a kidney transplant, the nurse obtains all these data when assessing the patient. Which information is most important to communicate to the health care provider?

• The BUN and creatinine levels are elevated.
• The urine output is 900 to 1100 ml/hr.
• The patient's central venous pressure (CVP) is

decreased.

• The patient has level 8 (on a 10-point scale) incision

pain when coughing.

• The patient's central venous pressure (CVP) is decreased.

R: The decrease in CVP suggests hypovolemia, which must be rapidly corrected

to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant.A patient with acute renal failure (ARF) requires hemodialysis and temporary vascular access is obtained by placing a catheter in the left femoral vein. The nurse will plan to

• restrict the patient's oral protein intake.
• discontinue the retention catheter.
• place the patient on bed rest.
• start continuous pulse oximetry.
• place the patient on bed rest.

R: The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.A patient complains of leg cramps during hemodialysis.The nurse should

• give acetaminophen (Tylenol).
• infuse a bolus of normal saline.
• massage the patient's legs.
• reposition the patient.
• infuse a bolus of normal saline.

R: Muscle cramps during dialysis are caused by rapid removal of sodium and

water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.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:

• dull and aching in the costovetebal area
• aching and camplike thoughout the abdomen
• sharp and radiating posteriorly to the spinal column
• excruciating, wavelike, and radiating toward the

genitalia

• excruciating, wavelike, and radiating toward the genitalia