NCLEX Urinary/Renal Function/Disorder and Electrolyte Imbalance

NCLEX Urinary/Renal Function/Disorder and Electrolyte Imbalance Leave the first rating Students also studied Terms in this set (90) Science MedicineNephrology Save Fluid and Electrolytes NCLEX Quest...33 terms Alex_Hassiepen Preview ABG Practice Questions 23 terms annakatekeyPreview

RENAL NCLEX QUESTIONS

40 terms melissa_g_ziarno Preview Urinary 50 terms Con A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the

client's risk of:

• a decreased serum phosphate level secondary to

kidney failure.

• an increased serum calcium level secondary to kidney

failure.

• water and sodium retention secondary to a severe

decrease in the glomerular filtration rate.

• metabolic alkalosis secondary to retention of

hydrogen ions.

• water and sodium retention secondary to a severe decrease in the glomerular

filtration rate.Explanation: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.Which is the correct term for the ability of the kidneys to clear solutes from the plasma?

a) Glomerular filtration rate (GFR)

b) Renal clearance

c) Specific gravity

d) Tubular secretion

• Renal Clearance

Explanation: Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. GFR is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.

A client is admitted with nausea, vomiting, and diarrhea.His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?

a) Start I.V. fluids with a normal saline solution bolus

followed by a maintenance dose.

b) Administer furosemide (Lasix) 20 mg I.V.

c) Encourage oral fluids.

d) Start hemodialysis after a temporary access is

obtained.

• Start IV fluids with normal saline solution bolus followed by a maintenance

dose.Explanation: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure?

a) Increased red blood cell count

b) Decreased serum potassium level

c) Increased serum calcium level

d) Increased serum creatinine level

• Increased serum creatinine level

Explanation: In renal failure, laboratory blood tests reveal elevations in BUN,

creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?

a) Serum sodium level of 135 mEq/L

b) Serum potassium level of 4.9 mEq/L

c) Temperature of 99.2° F (37.3° C)

d) Urine output of 20 ml/hour

• Urine output of 20 ml/hour

Explanation: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?

• "The effluent should be allowed to drain by gravity."
• "It is important to use strict aseptic technique."
• "The infusion clamp should be open during infusion."
• "It is appropriate to warm the dialysate in a

microwave."

• It is appropriate to warm the dialysate in a microwave

Explanation: The dialysate should be warmed in a commercial warmer and never

in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?

a) History of hyperparathyroidism

b) History of osteoporosis

c) Recent history of streptococcal infection

d) Previous episode of acute pyelonephritis

• Recent hx of streptococcal infection

Explanation: Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.A client presents at the testing center for an intravenous pyelogram. What question should the nurse ask to ensure the safety of the client?

• "Have you any artificial joints?"
• "Do you have a pacemaker?"
• "Do you have any allergies?"
• "Who has come with you today?"
• Do you have any allergies?

Explanation: Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood.

The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply.

a) Vitamin D synthesis

b) Secretion of prostaglandins

c) Vitamin B production

d) Secretion of insulin

e) Regulation of blood pressure

• Vitamin D synthesis
• Secretion of prostaglandins
• Regulation of blood pressure

Explanation: Functions of the kidney include secretion of prostaglandins,

regulation of blood pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body does not produce Vitamin B.A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the

kidneys' ability to remove a substance from the plasma in:

• 1 hour.
• 24 hours.
• 1 minute.
• 30 minutes.
• 1 minute

Explanation: The creatinine clearance test determines the kidneys' ability to

remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?

a) Impaired urinary elimination

b) Toileting self-care deficit

c) Risk for infection

d) Activity intolerance

• Risk for infection

Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?

a) Check for thrill or bruit over the access site.

b) Warm the solution to body temperature.

c) Inspect the catheter insertion site for infection.

d) Add the prescribed drug to the dialysate.

• Check for thrill or bruit over the access site. When preparing a client for

hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency. Inspecting the catheter insertion site for infection, adding the prescribed drug to the dialysate, and warming the solution to body temperature would be necessary when preparing a client for peritoneal dialysis.A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?

a) Therapeutic index

b) GI absorption rate

c) Liver function studies

d) Creatinine clearance

• Creatinine clearance

The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.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) Nephrotic syndrome

d) Chronic renal failure

• 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.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

a) Urine output of 250 ml/24 hours

b) Temperature of 100.2° F (37.8° C)

c) Serum creatinine level of 1.2 mg/dl

d) Blood urea nitrogen (BUN) level of 22 mg/dl

• Urine output of 250 ml/24 hours

ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find?

a) Decreased blood urea nitrogen (BUN)

b) Decreased potassium

c) Increased serum albumin

d) Increased serum creatinine

• Increased serum creatinine

In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.Retention of which electrolyte is the most life-threatening effect of renal failure?

a) Potassium

b) Calcium

c) Phosphorous

d) Sodium

• Potassium

Retention of potassium is the most life-threatening effect of renal failure.Nursing management of the client with a urinary tract

infection should include:

a) Teaching the client to douche daily

b) Discouraging caffeine intake

c) Administering morphine sulfate

d) Instructing the client to limit fluid intake

• Discouraging caffeine intake

Strategies for preventing urinary tract infection include proper perineal hygiene, increased fluid intake, avoiding urinary tract irritants (including caffeine), and establishing a frequent voiding regimen.The most common presenting objective symptoms of a urinary tract infection in older adults, especially in those with dementia, include?

a) Hematuria

b) Change in cognitive functioning

c) Back pain

d) Incontinence

• Change in cognitive functioning

The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these patients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.Which of the following would be included in a teaching plan for a patient diagnosed with a urinary tract infection?

a) Drink coffee or tea to increase diuresis

b) Use tub baths as opposed to showers

c) Void every 4 to 6 hours

d) Drink liberal amount of fluids

• Drink liberal amounts of fluids

Patients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The patient should shower instead of bathe in a tub because bacteria in the bath water may enter the urethra.