N402.21 & 22 Acute Renal Failure Notes & MCQs

**[N402.21 & 22 -- RENAL FAILURE (Notes)]** **LEARNING OUTCOMES:** 1. **Define renal failure** 2. **Identify different types of renal failure** 3. **Identify the causes of renal failure** 4. **Discuss the possible medical and nursing management** 5. **Identify the complications of renal f...

**[N402.21 & 22 -- RENAL FAILURE (Notes)]** **LEARNING OUTCOMES:** 1. **Define renal failure** 2. **Identify different types of renal failure** 3. **Identify the causes of renal failure** 4. **Discuss the possible medical and nursing management** 5. **Identify the complications of renal failure** **RENAL AND URINARY SYSTEMS:** 1. The function of the renal system is to maintain the body's state of homeostasis by: 1. Regulating fluid and electrolytes 2. Removing wastes products 3. Providing hormones involved in red blood cell production, bone metabolism, and control of blood pressure. **RENAL FAILURE:** 1. Renal failure is a systematic disease that results when the kidneys cannot remove the body's metabolic wastes or perform their regulatory functions. 2. Consequently, it disrupts endocrine & metabolic functions as well as fluid, electrolyte, and acid-base. **TYPES OF RENAL FAILURE:** 1. Acute Renal Failure (ARF). 2. Chronic Renal Failure (CRF) / End Stage Renal Disease (ESRD). **ACUTE RENAL FAILURE:** 1. Acute renal failure (ARF) is a sudden and almost complete loss of kidney function (decreased GFR) over a period of hours to days. 2. There is an accumulation of metabolic waste in the body. 3. **It manifests as either:** 1. **[Oliguria =]** urine less 400 ml/ day 2. **[Anuria=]** urine less 50 ml/day 3. Normal urine volume with high s. creatinine & high BUN (Blood Urea Nitrogen). 4. **CAUSES OF ARF:** 4. **[Prerenal]** - conditions occur as a result of impaired blood flow that leads to hypoperfusion of the kidney and a drop in the GFR. 5. **[Intrarenal]** - as a result of actual parenchymal damage to the glomeruli or kidney tubules. 6. **[Postrenal]** - as a result of an obstruction distal to the kidney. **PRERENAL CAUSES:** 1. Volume depletion states -- Hemorrhage, 2. Impaired cardiac performance -- M.I - Heart failure or Cardiac Shock 3. Vasodilation in sepsis or anaphylaxis **INTRARENAL CAUSES:** 1. Burns and crush injuries 2. Infections 3. Nephrotoxic agents 4. Severe transfusion reactions 5. Medications 6. Infiltrating tumors 7. Inflammation of the glomeruli 8. A major obstruction to blood flow **POSTRENAL CAUSES:** 1. **[Urinary tract obstruction, including:]** 1. Calculi 2. Tumors 3. Benign prostate hypertrophy 4. Blood clots **PREVENTING ACUTE RENAL FAILURE:** 1. Provide adequate hydration to patients at risk for dehydration. 2. Prevent and treat shock promptly with blood and fluid replacement. 3. Monitor central venous and arterial pressure and hourly urine output of critically ill patients to detect the onset of renal failure as early as possible. 4. Treat hypotension promptly. 5. Take precautions to ensure that the appropriate blood is administered to the correct patient in order to avoid severe transfusion reactions, which can precipitate renal failure. 6. Prevent and treat infections promptly. 7. Pay special attention to wounds, burns, and other precursors of sepsis. 8. Give care to patients with indwelling catheters to prevent infections from ascending in the urinary tract. **CHRONIC RENAL FAILURE:** 1. CRF or ESRD is a **progressive, irreversible** deterioration in renal function in which the body's ability to maintain metabolic fluid and electrolytes balance fails, resulting in **uremia** (high levels of urea in the blood) or **azotemia** (retention of urea and other nitrogenous wastes in the blood). **CAUSES OF CRF:** 1. **[Systemic diseases:]** 1. Diabetes Mellitus 2. Hypertension 3. Chronic glomerulonephritis 4. Pyelonephritis 5. Obstruction of the urinary tract 6. Hereditary lesions 7. Polycystic kidney disease 2. **[Vascular disorders:]** 8. infections 9. Medications or toxic agents. 3. **[Environmental and occupational agents:]** 10. Lead 11. Mercury 12. Chromium **PREVENTION OF CRF:** 1. To treat the underlying causes promptly (Diabetes and Hypertension), Including prevention of ARF. **PATHOPHYSIOLOGY:** 1. Renal function declines 2. The end product of protein metabolism accumulates in the blood 3. Uremia 4. Effects every system in the body 5. The decline in renal function and progression of CRF related to urinary excretion of protein and the presence of hypertension. **STAGES OF CRF:** 1. [**Stage 1** -- (**Reduced renal reserve**):] 1. 40% - 75% loss of nephron function 2. No symptoms 2. **[Stage 2 -- (Renal insufficiency):]** 3. 75% to 90% loss of nephron function. 4. S. creatinine ↑ 5. Blood urea nitrogen ↑ 6. Dilute urine 7. Anemia 8. Polyurea 9. Nocturia 3. **[Stage 3 -- (ESRD), final stage]** 10. Less than 10% nephron function remaining. 11. ↑creatinine 12. ↑BUN 13. Electrolyte imbalance **CLINICAL MANIFESTATIONS:** 1. **[Depends on:]** 1. Degree of renal impairment 2. Other underlying conditions 3. Patient's age. 2. Cardiovascular manifestations 3. Neurologic 4. Integumentary 5. Pulmonary 6. Gastrointestinal 7. Hematologic 8. Reproductive 9. Musculoskeletal **ASSESSMENT AND DIAGNOSTIC FINDINGS:** 1. Glomerular Filtration rate. 2. Creatinine clearance -- 24-hour urinalysis 3. S. creatinine ↑ = Azotemia 4. BUN ↑ = Azotemia 5. S. electrolytes ↑K, ↑ phosphate 6. CBC Anemia - ↓ erythropoietin 7. S. calcium ↓ca 8. Vitamin D 9. Urea 10. Protein 11. Ammonia level 12. Sodium bicarbonate 13. ECG **COMPLICATIONS:** 1. Hyperkalemia 2. Pericarditis 3. Pericardial effusion 4. Hypertension 5. Anemia 6. Bone Disease **MEDICAL MANAGEMENT:** 1. To maintain kidney function and homeostasis as long as possible. 2. Primarily with medication & diet therapy. 3. Dialysis may be needed to decrease the level of uremic waste products in the blood. **PHARMACOLOGIC THERAPY:** 1. Antihypertensives 2. Diuretics 3. Erythropoietin ( Epogen ) 4. Iron supplements 5. Phosphate 6. Calcium supplement 7. Antiseizure agents 8. Antacids 9. Sodium Bicarbonate supplements **MANAGEMENT:** 1. Adjustment of heparin to prevent clotting of the dialysis lines during HD treatment. 2. Frequent monitoring of hematocrit. 3. Periodic assessment of serum iron and transferrin level. 4. Monitor the patient's blood pressure and potassium level. 5. Adjustment of patient's antihypertensive therapy. **NUTRITIONAL THERAPY:** 1. Careful regulation of protein intake. 2. Fluid intake to balance fluid losses. 3. Sodium intake to balance sodium losses. 4. Some restriction to potassium. 5. Adequate calorie intake and vitamin supplementation. 6. Fluid allowances is 500-600ml more than the previous day's 24hour urine output. 7. Calories by carbohydrates and fat. 8. The GFR is used as an indicator of renal function and can be a guide to safe levels of protein consumption. **[\ ]OTHER THERAPY:** 1. Dialysis is usually initiated when the patient cannot maintain a reasonable lifestyle with conservative treatment. **INTERNAL ARTERIOVENOUS FISTULA:** 1. A fistula used for hemodialysis is a direct connection of an artery to a vein. Once the fistula is created it is a natural part of the body. 2. This is the preferred type of access because once the fistula properly matures and gets bigger and stronger, it provides access to good blood flow that can last for decades. After the fistula is surgically created, it can take weeks to months before the fistula matures and is ready to be used for hemodialysis. People with kidney disease can do exercises, including squeezing a rubber ball to strengthen the fistula before use. **INTERNAL ARTERIOVENOUS FISTULA AND GRAFT:** 1. An arteriovenous (AV) graft is created by connecting a vein to an artery using a soft plastic tube. 2. After the graft has healed, hemodialysis is performed by placing two needles, one on the arterial side and one on the venous side of the graft. The graft allows for increased blood flow. **A FISTULA IS THE "GOLD STANDARD" BECAUSE:** 1. It has a lower risk of infection than grafts or catheters 2. It has a lower tendency to clot than grafts or catheters 3. It allows for greater blood flow, increasing the effectiveness of hemodialysis as well as reducing treatment time 4. It stays functional for longer than other access types; in some cases, a well-formed fistula can last for decades 5. Fistulas are usually less expensive to maintain than synthetic accesses 6. While the AV fistula is the preferred access, there are some people who are unable to have a fistula. If the vascular system is greatly compromised, a fistula may not be attempted. Some people have had fistulas surgically created, but the fistula never matured; therefore, could not be used. 7. Some of the drawbacks of fistulas are: 8. A bulge at the access site that some people feel is unattractive 9. Taking several months to mature 10. Sometimes never mature at all **Nursing management:** 1. **[Nursing care is directed toward:]** 1. Assessing fluid status 2. Not to use the fistula site for checking the BP or collecting blood. 3. Identifying potential sources of imbalance 4. Implementing a dietary program to ensure proper nutritional intake within the limits of the treatment regimen. 5. Providing emotional support to the patient and the family. 6. Providing explanations and information to the patient and family concerning ESRD, treatment options, and potential complications. 7. Assess weight changes. Check weight daily. 8. Assess edema 9. Encourage alternating activity with rest. 10. Monitor serum levels of K, Cr., and Hb. 11. Check Vital signs according to the ward routine. 12. Instruct the patient not to take any medication that might cause a complication before the dialysis session, e.g., Antihypertensive drugs. 13. Observe for complications. **NURSING DIAGNOSIS:** 1. Fluid volume excess. 2. Altered nutrition -- less than body requirements. 3. Knowledge deficit 4. Activity intolerance 5. Low self-esteem. **[N402.21 & 22 -- RENAL FAILURE (MCQs)]** **1. Which of the following is NOT a function of the renal system?** A. Regulating fluid and electrolytes\ B. Removing waste products\ C. Providing hormones involved in blood pressure control\ D. Producing insulin **Answer:** D. Producing insulin **2. What is renal failure?** A. Inability of the kidneys to remove body wastes\ B. Sudden drop in blood pressure\ C. Chronic inflammation of the glomeruli\ D. An infection in the urinary tract **Answer:** A. Inability of the kidneys to remove body wastes **3. Which of the following is a cause of prerenal acute renal failure?** A. Nephrotoxic agents\ B. Hemorrhage\ C. Urinary tract obstruction\ D. Infections **Answer:** B. Hemorrhage **4. Which of the following is a symptom of acute renal failure?** A. Hypertension\ B. Increased urine output\ C. Oliguria (less than 400 mL of urine per day)\ D. Hypercalcemia **Answer:** C. Oliguria (less than 400 mL of urine per day) **5. Which stage of chronic renal failure is characterized by less than 10% of nephron function remaining?** A. Stage 1\ B. Stage 2\ C. Stage 3\ D. Stage 4 **Answer:** C. Stage 3 **6. Which of the following is a common cause of chronic renal failure?** A. Diabetes mellitus\ B. Burns and crush injuries\ C. Sepsis\ D. Hemorrhage **Answer:** A. Diabetes mellitus **7. What is the preferred type of access for hemodialysis?** A. Central venous catheter\ B. Arteriovenous (AV) fistula\ C. Peripheral intravenous catheter\ D. Peritoneal dialysis catheter **Answer:** B. Arteriovenous (AV) fistula **8. Which complication is commonly associated with chronic renal failure?** A. Hyperkalemia\ B. Hypotension\ C. Polycythemia\ D. Hypoglycemia **Answer:** A. Hyperkalemia **9. What is the main goal of medical management for renal failure?** A. Increase urine production\ B. Maintain kidney function and homeostasis as long as possible\ C. Reduce serum creatinine to zero\ D. Eliminate the need for dialysis **Answer:** B. Maintain kidney function and homeostasis as long as possible **10. Which of the following is a nursing intervention for a patient undergoing hemodialysis?** A. Administering antihypertensive medication right before dialysis\ B. Measuring weight changes daily\ C. Checking blood pressure using the AV fistula site\ D. Restricting all fluid intake **Answer:** B. Measuring weight changes daily **11. Which electrolyte is typically elevated in patients with chronic renal failure?** A. Sodium\ B. Calcium\ C. Phosphate\ D. Chloride **Answer:** C. Phosphate **12. Which of the following is NOT a complication of chronic renal failure?** A. Bone disease\ B. Anemia\ C. Hypercalcemia\ D. Pericarditis **Answer:** C. Hypercalcemia **13. Which of the following therapies is often initiated when a patient with chronic renal failure cannot maintain a reasonable lifestyle with conservative treatment?** A. Medication therapy\ B. Hemodialysis\ C. Nutritional therapy\ D. Surgery **Answer:** B. Hemodialysis **14. What is a major risk factor for developing postrenal acute renal failure?** A. Dehydration\ B. Cardiac arrest\ C. Urinary tract obstruction\ D. Sepsis **Answer:** C. Urinary tract obstruction **15. What is the term for a high level of urea in the blood?** A. Hypokalemia\ B. Anuria\ C. Uremia\ D. Polyuria **Answer:** C. Uremia **16. Which of the following is NOT a type of acute renal failure?** A. Prerenal\ B. Intrarenal\ C. Postrenal\ D. Transrenal **Answer:** D. Transrenal **17. What is the primary cause of intrarenal acute renal failure?** A. Dehydration\ B. Burns and crush injuries\ C. Urinary tract obstruction\ D. Hypovolemia **Answer:** B. Burns and crush injuries **18. What is the most common systemic cause of chronic renal failure?** A. Chronic infections\ B. Diabetes mellitus\ C. Polycystic kidney disease\ D. Obstructive nephropathy **Answer:** B. Diabetes mellitus **19. Which of the following lab values would indicate renal failure?** A. Increased serum creatinine and blood urea nitrogen (BUN)\ B. Decreased serum calcium and sodium\ C. Decreased creatinine clearance and increased hemoglobin\ D. Increased erythropoietin and normal potassium levels **Answer:** A. Increased serum creatinine and blood urea nitrogen (BUN) **20. Which condition is classified as a postrenal cause of acute renal failure?** A. Myocardial infarction\ B. Nephrotoxic agents\ C. Benign prostatic hypertrophy\ D. Sepsis **Answer:** C. Benign prostatic hypertrophy **21. What is the best way to prevent acute renal failure in patients at risk?** A. Administering diuretics frequently\ B. Providing adequate hydration\ C. Restricting protein intake\ D. Prescribing antibiotics preemptively **Answer:** B. Providing adequate hydration **22. Which of the following is the main goal of nutritional therapy for patients with renal failure?** A. Increase protein intake\ B. Maintain fluid and electrolyte balance\ C. Increase sodium and potassium intake\ D. Promote weight loss **Answer:** B. Maintain fluid and electrolyte balance **23. What is the primary hormone affected by kidney failure that leads to anemia?** A. Insulin\ B. Epinephrine\ C. Erythropoietin\ D. Parathyroid hormone **Answer:** C. Erythropoietin **24. Which of the following is considered a late-stage symptom of chronic renal failure?** A. Polyuria\ B. Nocturia\ C. Anuria\ D. Hypertension **Answer:** C. Anuria **25. Which condition is a major complication of end-stage renal disease (ESRD)?** A. Hypotension\ B. Hypokalemia\ C. Pericardial effusion\ D. Hypoglycemia **Answer:** C. Pericardial effusion **26. Which electrolyte imbalance is most common in patients with renal failure?** A. Hypokalemia\ B. Hyperkalemia\ C. Hypernatremia\ D. Hypocalcemia **Answer:** B. Hyperkalemia **27. Which of the following clinical signs is associated with the late stage of chronic renal failure?** A. Polyuria\ B. Oliguria\ C. Increased urine output\ D. Normal electrolyte levels **Answer:** B. Oliguria **28. Which medical therapy is used to prevent seizures in patients with renal failure?** A. Diuretics\ B. Antiseizure agents\ C. Erythropoietin\ D. Antacids **Answer:** B. Antiseizure agents **29. Which diagnostic test is most commonly used to assess kidney function in patients with renal failure?** A. Urinalysis\ B. Electrolyte panel\ C. Glomerular filtration rate (GFR)\ D. Complete blood count (CBC) **Answer:** C. Glomerular filtration rate (GFR) **30. Which complication should be monitored in patients undergoing hemodialysis?** A. Hypokalemia\ B. Hypercalcemia\ C. Blood clotting in dialysis lines\ D. Hypotension **Answer:** C. Blood clotting in dialysis lines **31. Which is NOT a prevention strategy for acute renal failure?** A. Monitoring hourly urine output\ B. Treating hypotension promptly\ C. Delaying treatment for shock\ D. Administering blood and fluids in dehydration **Answer:** C. Delaying treatment for shock **32. Which of the following can contribute to the development of chronic renal failure?** A. Acute infections\ B. Myocardial infarction\ C. Diabetes mellitus\ D. Central nervous system damage **Answer:** C. Diabetes mellitus **33. Which of the following is a sign of hyperkalemia in renal failure patients?** A. Muscle weakness\ B. Increased urine output\ C. Hypotension\ D. Hypernatremia **Answer:** A. Muscle weakness **34. What is the main advantage of using an arteriovenous (AV) fistula for hemodialysis?** A. Shorter maturation time compared to grafts\ B. Higher risk of infection\ C. Lower tendency to clot than grafts or catheters\ D. Easier to create than other types of access **Answer:** C. Lower tendency to clot than grafts or catheters **35. Which nursing intervention is essential for a patient with an AV fistula?** A. Regularly checking blood pressure using the fistula site\ B. Avoiding the use of the fistula for blood pressure measurements or blood collection\ C. Administering anticoagulants through the fistula\ D. Using the fistula for administering medications **Answer:** B. Avoiding the use of the fistula for blood pressure measurements or blood collection **36. Which of the following is NOT a complication of chronic renal failure (CRF)?** A. Hypertension\ B. Hyperkalemia\ C. Hypoglycemia\ D. Anemia **Answer:** C. Hypoglycemia **37. What is the primary goal of medical management in patients with chronic renal failure?** A. Increase urine output\ B. Maintain kidney function and homeostasis as long as possible\ C. Reduce fluid intake\ D. Increase protein consumption **Answer:** B. Maintain kidney function and homeostasis as long as possible **38. What is a key sign of end-stage renal disease (ESRD)?** A. High urine output\ B. Less than 10% nephron function remaining\ C. Normal blood urea nitrogen (BUN) levels\ D. Decreased serum potassium **Answer:** B. Less than 10% nephron function remaining **39. Which intervention helps prevent acute renal failure in patients with severe burns or crush injuries?** A. Administration of antibiotics\ B. Adequate fluid resuscitation\ C. Low-protein diet\ D. Diuretic administration **Answer:** B. Adequate fluid resuscitation **40. Which electrolyte imbalance is commonly seen in both acute and chronic renal failure?** A. Hypocalcemia\ B. Hypernatremia\ C. Hyperkalemia\ D. Hypokalemia **Answer:** C. Hyperkalemia **41. What dietary recommendation is generally made for patients with chronic renal failure?** A. Increase potassium intake\ B. High-protein diet\ C. Limit fluid intake\ D. Low-calorie diet **Answer:** C. Limit fluid intake **42. Which of the following is a clinical manifestation of uremia in renal failure patients?** A. Muscle spasms\ B. Decreased serum creatinine levels\ C. Increased creatinine and urea in the blood\ D. Increased urine output **Answer:** C. Increased creatinine and urea in the blood **43. Which of the following is a potential complication of hemodialysis?** A. Hypokalemia\ B. Hypercalcemia\ C. Pericarditis\ D. Hypernatremia **Answer:** C. Pericarditis **44. What is the primary function of erythropoietin in patients with renal failure?** A. Regulate blood pressure\ B. Stimulate red blood cell production\ C. Balance fluid and electrolytes\ D. Reduce potassium levels **Answer:** B. Stimulate red blood cell production **45. In the management of chronic renal failure, why are phosphate binders prescribed?** A. To prevent hypercalcemia\ B. To reduce phosphorus absorption\ C. To treat anemia\ D. To enhance protein metabolism **Answer:** B. To reduce phosphorus absorption **46. What is a key feature of Stage 3 chronic renal failure (end-stage renal disease)?** A. High urine output\ B. Severe electrolyte imbalance\ C. Normal serum creatinine levels\ D. 40% nephron function remaining **Answer:** B. Severe electrolyte imbalance **47. Which of the following nursing interventions is essential for managing fluid volume excess in patients with renal failure?** A. Monitor central venous pressure\ B. Encourage high fluid intake\ C. Increase dietary sodium\ D. Avoid weighing the patient daily **Answer:** A. Monitor central venous pressure **48. Which of the following conditions can lead to postrenal acute renal failure?** A. Glomerulonephritis\ B. Heart failure\ C. Urinary tract obstruction\ D. Sepsis **Answer:** C. Urinary tract obstruction **49. What is the main purpose of dialysis in renal failure patients?** A. Increase urine output\ B. Remove metabolic waste products from the blood\ C. Cure chronic renal failure\ D. Stimulate kidney function **Answer:** B. Remove metabolic waste products from the blood **50. Which nursing diagnosis is most appropriate for a patient with chronic renal failure and anemia?** A. Fluid volume deficit\ B. Activity intolerance\ C. Altered nutrition -- more than body requirements\ D. Knowledge deficit **Answer:** B. Activity intolerance **51. Which stage of chronic renal failure is characterized by a 75% to 90% loss of nephron function?** A. Stage 1 (Reduced renal reserve)\ B. Stage 2 (Renal insufficiency)\ C. Stage 3 (End-stage renal disease)\ D. Stage 4 **Answer:** B. Stage 2 (Renal insufficiency) **52. Which complication is most commonly associated with untreated hyperkalemia in renal failure patients?** A. Hypertension\ B. Cardiac arrhythmias\ C. Osteoporosis\ D. Fluid retention **Answer:** B. Cardiac arrhythmias **53. Which of the following interventions is NOT appropriate when managing a patient with an arteriovenous (AV) fistula for hemodialysis?** A. Assess the fistula for signs of infection\ B. Take blood pressure measurements on the arm with the fistula\ C. Encourage exercises like squeezing a rubber ball to strengthen the fistula\ D. Avoid using the fistula for blood draws **Answer:** B. Take blood pressure measurements on the arm with the fistula **54. Which dietary restriction is recommended for patients with high serum potassium levels due to renal failure?** A. Low-protein diet\ B. Low-potassium diet\ C. High-calcium diet\ D. High-sodium diet **Answer:** B. Low-potassium diet **55. Which of the following is a sign of fluid overload in patients with renal failure?** A. Hypotension\ B. Weight loss\ C. Edema\ D. Decreased blood pressure **Answer:** C. Edema **56. Which of the following is the hallmark feature of acute renal failure (ARF)?** A. Hypokalemia\ B. Sudden and complete loss of kidney function\ C. Increased urine output\ D. Low serum creatinine levels **Answer:** B. Sudden and complete loss of kidney function **57. Which of the following is a prerenal cause of acute renal failure (ARF)?** A. Urinary tract obstruction\ B. Nephrotoxic agents\ C. Hemorrhage\ D. Severe glomerulonephritis **Answer:** C. Hemorrhage **58. Which type of acute renal failure is caused by direct damage to the kidney tissue?** A. Prerenal\ B. Postrenal\ C. Intrarenal\ D. Functional renal failure **Answer:** C. Intrarenal **59. Which diagnostic test is used to estimate the kidney's filtration rate?** A. Serum creatinine\ B. Glomerular Filtration Rate (GFR)\ C. Blood urea nitrogen (BUN)\ D. Electrolyte panel **Answer:** B. Glomerular Filtration Rate (GFR) **60. In patients with chronic renal failure, which hormone plays a critical role in red blood cell production?** A. Epinephrine\ B. Erythropoietin\ C. Insulin\ D. Antidiuretic hormone **Answer:** B. Erythropoietin **61. Which of the following is NOT typically restricted in a patient with chronic renal failure?** A. Sodium\ B. Protein\ C. Potassium\ D. Carbohydrates **Answer:** D. Carbohydrates **62. What is the most common cardiovascular manifestation in patients with chronic renal failure?** A. Bradycardia\ B. Hypertension\ C. Tachycardia\ D. Low blood pressure **Answer:** B. Hypertension **63. Which condition is the primary cause of chronic renal failure in most patients?** A. Heart disease\ B. Diabetes mellitus\ C. Nephrotic syndrome\ D. Urinary tract infections **Answer:** B. Diabetes mellitus **64. Which of the following complications is a direct result of decreased erythropoietin production in chronic renal failure?** A. Anemia\ B. Hypertension\ C. Fluid overload\ D. Hyperkalemia **Answer:** A. Anemia **65. Which of the following is an appropriate intervention for a patient with fluid volume excess in renal failure?** A. Encourage high fluid intake\ B. Administer diuretics\ C. Increase sodium intake\ D. Limit the use of antihypertensive medications **Answer:** B. Administer diuretics **66. Which stage of chronic renal failure is characterized by asymptomatic loss of nephron function?** A. Stage 1 (Reduced renal reserve)\ B. Stage 2 (Renal insufficiency)\ C. Stage 3 (End-stage renal disease)\ D. Acute renal failure **Answer:** A. Stage 1 (Reduced renal reserve) **67. Which electrolyte imbalance is most life-threatening in patients with acute or chronic renal failure?** A. Hypernatremia\ B. Hypokalemia\ C. Hyperkalemia\ D. Hypocalcemia **Answer:** C. Hyperkalemia **68. Which type of dialysis involves the creation of a direct connection between an artery and a vein?** A. Peritoneal dialysis\ B. Hemodialysis with arteriovenous (AV) fistula\ C. Hemodialysis with AV graft\ D. Continuous venovenous dialysis **Answer:** B. Hemodialysis with arteriovenous (AV) fistula **69. Which clinical finding suggests an early onset of acute renal failure?** A. High urine output\ B. Oliguria (urine output less than 400 ml/day)\ C. Increased urine volume\ D. Low blood urea nitrogen (BUN) **Answer:** B. Oliguria (urine output less than 400 ml/day) **70. Which of the following should be avoided in patients with an arteriovenous (AV) fistula?** A. Physical activity\ B. Blood pressure measurement in the arm with the fistula\ C. Eating a low-sodium diet\ D. Encouraging the patient to squeeze a rubber ball **Answer:** B. Blood pressure measurement in the arm with the fistula **71. Which pharmacologic treatment is used to manage hyperkalemia in patients with renal failure?** A. Diuretics\ B. Calcium supplements\ C. Insulin and glucose infusion\ D. Phosphate binders **Answer:** C. Insulin and glucose infusion **72. What is the primary treatment for chronic renal failure once conservative measures are no longer effective?** A. Diuretic therapy\ B. Dialysis\ C. Antibiotic treatment\ D. Antihypertensive medication **Answer:** B. Dialysis **73. Which of the following nursing interventions is essential when monitoring a patient on dialysis?** A. Avoid weighing the patient daily\ B. Monitor blood pressure closely\ C. Encourage high protein intake\ D. Administer anticoagulants after dialysis **Answer:** B. Monitor blood pressure closely **74. In chronic renal failure, decreased production of which vitamin leads to bone disease?** A. Vitamin C\ B. Vitamin K\ C. Vitamin D\ D. Vitamin B12 **Answer:** C. Vitamin D **75. Which nursing diagnosis is appropriate for a patient with chronic renal failure experiencing fatigue and weakness?** A. Fluid volume deficit\ B. Activity intolerance\ C. Knowledge deficit\ D. Risk for infection **Answer:** B. Activity intolerance