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Situation: Acute Renal Failure is a reversible clinical Rationale: Polyuria occurs early in chronic renal syndrome whereby there is sudden and pronounced loss of failure and, if untreated, can cause severe kidney function. The question below pertains to Renal...

Situation: Acute Renal Failure is a reversible clinical Rationale: Polyuria occurs early in chronic renal syndrome whereby there is sudden and pronounced loss of failure and, if untreated, can cause severe kidney function. The question below pertains to Renal dehydration. Polyuria progresses to anuria, and Failure both in Acute and Chronic Stages. the client loses all normal kidney functions. Oliguria and anuria are not early signs, and 1. During the diuretic phase of acute renal failure polydipsia is unrelated to chronic renal failure. which of the following should be most expected? TOS: Remembering A. There is an increased in urine output TID: Patient Care Competencies from 1 to 3 liters/ day. B. BUN increases C. Urinary output less than 400ml/24h. 4. The client newly diagnosed with chronic renal D. Creatinine started to normalized failure recently has begun hemodialysis. Knowing Rationale: Diuretic Phase last from 1-3 weeks that the client is at risk for disequilibrium syndrome, and the following are expected to happen: the nurse assesses the client during dialysis for: Increased in urine output from 1 to 3 liters/ day. A. Hypertension, tachycardia, and fever. Beginning recovery. Renal function gradually B. Hypotension, bradycardia, and hypothermia. improves. Recovery—may take 3-12 months. May C. Restlessness, irritability, and generalized have permanent reduction in functioning of 1%- weakness. 3%. D. Headache, deteriorating level of 2. The nurse is reviewing the client's record and notes consciousness, and twitching. that the physician has documented that the client Rationale: Disequilibrium syndrome is has a renal disorder. On review of the lab results, characterized by headache, mental confusion, the nurse most likely would expect to note which of decreasing level of consciousness, nausea, the following? vomiting, twitching, and possible seizure activity. A. Decreased hemoglobin level. Disequilibrium syndrome is caused by rapid B. Elevated BUN removal of solutes from the body during C. Decreased red blood cell count. hemodialysis. At the same time, the blood-brain D. Decreased white blood cell count. barrier interferes with the efficient removal of Rationale: Measuring the blood urea nitrogen wastes from brain tissue. As a result, water goes level is a frequently used laboratory test to into cerebral cells because of the osmotic determine renal function. The blood urea nitrogen gradient, causing brain swelling and onset of level starts to rise when the glomerular filtration symptoms. The syndrome most often occurs in rate falls below 40% to 60%. A decreased clients who are new to dialysis and is prevented by hemoglobin level and red blood cell count may be dialyzing for shorter times or at reduced blood flow noted if bleeding from the urinary tract occurs or if rates. erythropoietic function by the kidney is impaired. TOS: Analyzing An increased white blood cell count is most likely TID: Patient Care Competencies to be noted in renal disease. TOS: Understanding 5. Assessing the laboratory findings, which result TID: Patient Care Competencies would the nurse most likely expect to find in a client with chronic renal failure? A. BUN 10 to 30 mg/dl, potassium 4.0 mEq/L, 3. A client is admitted to the hospital with a diagnosis creatinine 0.5 to 1.5 mg/dl of early-stage chronic renal failure. Which of the B. Decreased serum calcium, blood pH 7.2, following should the nurse expect to note on client potassium 6.5 mEq/L assessment? C. BUN 15 mg/dl, increased serum calcium, A. Anuria. creatinine l.0 mg/dl B. Polyuria. D. BUN 35 to 40 mg/dl, potassium 3.5 mEq/L, C. Oliguria. pH 7.35, decreased serum calcium D. Polydypsia.  Rationale: Chronic renal failure is usually the end Rationale: Acute renal failure caused by result of gradual tissue destruction and loss of glomerulonephritis is classified as intrinsic or renal function. With the loss of renal function, the intrarenal failure. This form of acute renal failure is kidneys ability to regulate fluid and electrolyte and commonly manifested by hypertension, acid base balance results. The serum Ca tachycardia, oliguria, lethargy, edema, and other decreases as the kidneys fail to excrete signs of fluid overload. Acute renal failure from phosphate, potassium and hydrogen ions are prerenal causes is characterized by decreased retained. blood pressure or a recent history of the same, TOS: Remembering tachycardia, and decreased cardiac output and TID: Patient Care Competencies central venous pressure. Bradycardia is not part of the clinical picture for renal failure. TOS: Remembering Situation: An 38 year old male client is admitted with dark TID: Patient Care Competencies urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. A client was immediately rushed in Jose 9. The nurse is providing care for a patient who has Gregorio Medical Center. Immediate nursing and medical been admitted to the hospital for the treatment of care was administered to the client. nephrotic syndrome. What are priority nursing assessments in the care of this patient? 6. Based on the above situation, Which would most A. Assessment of pain and level of likely be in this client’s health history? consciousness A. Renal calculi B. Assessment of serum calcium and B. Renal trauma phosphorus levels C. Recent sore throat C. Blood pressure and assessment for D. Family history of acute glomerulonephritis orthostatic hypotension Rationale: The most common form of acute D. Daily weights and measurement of the glomerulonephritis is caused by group A beta- patient's abdominal girth hemolytic streptococcal infection elsewhere in the Rationale: Peripheral edema is characteristic of body. nephrotic syndrome, and a key nursing TOS: Remembering responsibility in the care of patients with the TID: Patient Care Competencies disease is close monitoring of abdominal girth, weights, and extremity size. Pain, level of consciousness, and orthostatic blood pressure are 7. In addition to the above clinical manifesttions. You less important in the care of patients with nephrotic would also know that client with acute syndrome. Abnormal calcium and phosphorus glomerulonephritis include which of the following levels are not commonly associated with the symptoms? diagnosis of nephrotic syndrome. A. Chills and flank pain TOS: Analyzing B. Oliguria and generalized edema C. Hematuria and proteinuria TID: Patient Care Competencies D. Dysuria and hypotension Situation: Nursing care management of client diagnosed Rationale: Hematuria and proteinuria indicate with urinary tract infection, urinary incontinence, and urinary acute glomerulonephritis. These finding result retention from increased permeability of the glomerular membrane due to the antigen-antibody reaction. 10. An older male patient visits his primary care Generalized edema is seen most often in provider because of burning on urination and nephrosis. production of urine that he describes as "foul TOS: Remembering smelling." The health care provider should assess TID: Patient Care Competencies the patient for what factor that may put him at risk for a urinary tract infection (UTI)? 8. A client with glomerulonephritis is at risk of A. High-purine diet developing acute renal failure. The nurse monitors B. Sedentary lifestyle the client for which sign of this complication? C. Benign prostatic hyperplasia (BPH) A. Bradycardia D. Recent use of broad-spectrum antibiotics B. Hypertension Rationale: BPH causes urinary stasis, which is a C. Decreased cardiac output predisposing factor for UTIs. A sedentary lifestyle D. Decreased central venous pressure and recent antibiotic use are unlikely to contribute  to UTIs, whereas a diet high in purines is would be a premature recommendation. Dietary associated with renal calculi. changes are not likely to influence the patient's TOS: Analyzing urinary continence. TID: Patient Care Competencies TOS: Analyzing TID: Patient Care Competencies 11. When developing a teaching plan to prevent urinary tract infection, which of the following should be included? 14. The nurse is reviewing the client's record and notes A. Wearing underwear made of synthetic that the physician has documented that the client material such as nylon has a renal disorder. On review of the lab results, B. Maintaining adequate fluid intake the nurse most likely would expect to note which of C. Keeping urine alkaline by avoiding acidic beverages the following? D. Avoiding urination before and after A. Decreased hemoglobin level. intercourse B. Elevated BUN Rationale: Fluid intake helps dilute urine and C. Decreased red blood cell count. minimize infection potential, bubble baths and D. Decreased white blood cell count. tight clothing may act as irritants, and emptying the Rationale: Measuring the blood urea nitrogen bladder fully with each urination prevents stasis. level is a frequently used laboratory test to Children and teens should wear cotton underwear, keep their urine acidic, and void before and after determine renal function. The blood urea nitrogen intercourse (if sexually active). level starts to rise when the glomerular filtration TOS: Remembering rate falls below 40% to 60%. A decreased TID: Patient Care Competencies hemoglobin level and red blood cell count may be noted if bleeding from the urinary tract occurs or if 12. Which of the following organisms is the most erythropoietic function by the kidney is impaired. common cause of urinary tract infection (UTI) in An increased white blood cell count is most likely children? to be noted in renal disease. A. Staphylococcus TOS: Analyzing B. Klebsiella C. Pseudomonas TID: Patient Care Competencies D. Escherichia coli Situation: A 53 year old patient admitted to a medical unit Rationale: coli is the most common organism with a chief complaint of weight loss, thirst and vomiting. associated with the development of UTI. Although The physician’s diagnosis is hypovolemia. Staphylococcus, Klebsiella, and Pseudomonas species may cause UTIs, the incidence of UTIs 15. This is a type of fluid imbalance occurs when the related to each is less than that for E. coli. loss of ECF volume exceeds the intake of fluids and TOS: Remembering when the water and electrolytes are lost in the same TID: Patient Care Competencies proportion? A. Fluid Volume Excess B. Fluid Volume Deficit 13. Eight months after the delivery of her first child, a C. Rehydration 31-year-old woman has sought care because of D. None of the above occasional incontinence that she experiences when Rationale: Fluid Volume Deficit- occurs when sneezing or laughing. Which measure should the loss of ECF volume exceeds the intake of fluids. nurse first recommend in an attempt to resolve the When the water and electrolytes are lost in the woman's incontinence? same proportion FVE also ccurs when there is A. Kegel exercises movement of fluid from the vascular system to the B. Use of adult incontinence pads other space. C. Intermittent self-catheterization TOS: Understanding D. Dietary changes including fluid restriction Rationale: Patients who experience stress TID: Enhancing Competencies incontinence frequently benefit from Kegel exercises (pelvic floor muscle exercises). The use 16. Clinical assessment of fluid volume deficit would be of incontinence pads does not resolve the confirmed if the nurses identify which of the problem, and intermittent self-catheterization following?  A. 1 lb weight loss B. Engorged neck vein 19. Which one of the following medications could C. Dry mucous membrane potentially exacerbate the problem of patient with D. Full bounding pulse FVD? Rationale: Dry mucous membranes is a clinical A. Synthroid sign of dehydration. Weight loss can be B. Digoxin associated with dehydration but is not a confirming C. Lasix sign. Engorged neck vein and bounding pulse are D. Insulin signs of fluid overload. Rationale: Lasix will contribute to fluid loss TOS: Remembering through its action as a diuretic TID: Enhancing Competencies TOS: Remembering TID: Enhancing Competencies 17. The client who has a diagnosis of fluid volume deficit was told to monitor his BUN and Creatinine. Situation: A 25 year old male client with a chef complaint of Which of the following is an expected result of the muscle cramps, weakness and diarrhea was admitted to the patient’s BUN and Creatinine level? medical unit. The laboratory finding revealed a serum A. The BUN will decrease and the creatinine will potassium level of 5.7 mEq/L which confirms the diagnosis increase of hyperkalemia. B. The BUN will increase and creatinine will decrease 20. A male client asks the nurse about the potassium C. Both the BUN and creatinine will increase her potassium level. The nurse noticed that the D. Both the BUN and creatinine will decrease patient’s potassium level is 5.7 mEq/L. The patient Rationale: Laboratory Findings- then asks the nurse about the factors that can Increase hemoglobin and cause an elevation of the potassium level. Which of hematocrit (due to decrease the following is the correct response from the plasma volume) nurse? Increase serum and urine A. The patient had a frequent episode of osmolality () diarrrhea Increase urine specific B. The patient had an over administration of gravity (due to kindey’s potassium sparing diuretics attempt to conserve water) C. The client had a frequent episodes of Decrease urine sodium (due vomiting to aldosterone secretion) D. The patient had an over administration of Increase BUN and corticosteroids Creatinine (due to Rationale: Potassium sparing diuretics reserves dehydration and decrease the potassium content in the body. Over renal perfusion) administration of this medication, the client may TOS: Understanding develop hyperkalemia or an elevation of the TID: Enhancing Competencies potassium. Options A, C and D are the contributing factors for hypokalemia. 18. Which of the following nursing diagnoses might TOS: Analyzing apply to a patient with fluid volume deficit? TID: Enhancing Competencie A. Altered urinary elimination B. Decreased cardiac output 21. A client was then admitted to the cardiac unit and C. Increased Cardiac output placed on telemetry. A nurse reviews the client’s D. Impaired physical mobility laboratory values and notes that the client’s Rationale: Decreased cardiac output is a nursing potassium level increases to 6.3 mEq/L. When diagnosis associated with isotonic fluid volume analyzing the cardiac rhythm, the nurse would deficit. Other appropriate nursing diagnosis expect to note which electrocardiogram (ECG) includes the following: finding? Altered tissue perfusion A. Sinus tachycardia with an extra U wave Potential for injury B. Sinus rhythm with a tall, peaked T wave Ineffective breathing pattern C. Sinus rhythm with a depressed ST segment TOS: Remembering D. Sinus tachycardia with a prolonged QT interval TID: Enhancing Competencies  Rationale: A potassium level of more than Rationale: Answer is letter B. One of the goal in 5.1mEq/L indicates hyperkalemia, which can be the client with hyprkalemia is to decrease or to detected on ECG by the presence of a tall, peaked eliminate the excess potassium. Lasix is given T wave. A U wave and a depressed ST segment because it is a potassium wasting diuretics that aid are present with hypokalemia. The prolonged PR in the excretion of potassium through urination. interval indicates a delay between conduction of TOS: Analyzing the atria to the ventricles. Widen QRS complex TID: Enhancing Competencie representing a depressed depolarization of the ventricular muscle cells. Tall and peaked T wave Client diagnosed with Calcium Imbalance indicating a prolonged depolarization of the ventricular cardiac muscle 25. This is a type of hyponatremia where water in the TOS: Analyzing body increases but sodium stays the same. TID: Enhancing Competencie A. Eudemic Hyponatremia B. Hypovolemic Hyponatremia 22. What is the serious clinical manifestation the client C. Hypervolemic Hyponatremia may experience having this potassium level? D. All of the above A. Paresthesia, muscle weakness and flaccid Rationale: Water in the body increases but paralysis sodium stays the same. Syndrome of B. Abdominal cramping Inappropriate Antidiuretic Hormone is a cause C. Oliguria there is also ADH retains water in the body D. Dysrrythmia diluting sodium. Rationale: Dangerous dysrrythmia begin to TOS: Remembering develop when the serum potassium level reaches TID: Enhancing Competencies 7.0 mEq/L. The skeletal and cardiac muscles become hypopolarized leading into dysrryhtmias. 26. A client has a serum calcium level of 7.2 mg/dl. TOS: Remembering During the physical examination, the nurse expects TID: Enhancing Competencie to assess which of the following: A. Trousseau’s Sign 23. A client is taking spirinolactone (Aldactone) to B. Hegar’s Sign control her hypertension. Her serumpotassium C. Homan’s Sign level is 6 mEq/L. For this client, the nurse’s priority D. Goodell’s Sign should be to assess her: Rationale: This client’s serum calcium level A. Electrocardiogram (ECG) results indicates hypocalcemia, an electrolyte imbalance B. Neuromuscular Function that causes Trousseau’s sign (carpopedal spasm C. Bowel Sounds induced by inflating the blood pressure cuff above D. Respiratiry Rate systolic pressure). Homans’ sign (pain on Rationale:. Although changes in all these findings dorsiflexion of the foot) indicates deep vein are seen in hyperkalemia, ECG results should thrombosis. Hegar’s sign (softening of the uterine take priority because changes can indicate isthmus) and Goodell’s sign (cervical softening) potentially lethal arrhythmias such as ventricular are probable signs of pregnancy. fibrillation. It wouldn’t be appropriate to assess the TOS: Evaluating client’s neuromuscular function, bowel sounds, or TID: Enhancing Competencies respiratory rate for effects of hyperkalemia. TOS: Analyzing 27. How does the nurse can assess the client for TID: Enhancing Competencie trousseau sign? A. Place a blood pressure cuff to the arm of 24. The physician ordered lasix to a client with a the client then inflate it 40 mmHg higher hyperkalemia. The nurse knows that the action of than the client’s systolic bp and note for lasix to the client condition is to? the palmar flexion A. Decrease potassium excretion through B. Place a blood pressure cuff to the arm of the urination client then inflate it 40mmHg lower than the B. Increase potassium excretion through client’s systolic bp and note for the palmar urination flexion C. Increase potassium absorption in the body C. Gently tap the client’s cheek and note for the D. Decrease potassium absorption in the body reaction  D. Ask the client to flex his hands TOS: Evaluating Rationale: Place a blood pressure cuff to the arm TID: Patient Care Competencies of the client then inflate it 40 mmHg higher than the client’s systolic bp and note for the palmar 31. A client comes to the emergency department flexion. with status asthmaticus. His respiratory rate is TOS: Applying 48 bpm, and he is wheezing. An BG analysis TID: Enhancing Competencies reveals pH of 7.52 Partial pressure of areterial CO2 (PaCO2) of 30 mmHg, PaO2 of 70mmhg 28. The nursing is assessing the client for chvostek and bicarbonate of 26 mEq/L. What disorder is sign. Which of the following findings is correct about indicated by these findings? chvostek sign? A. Metabolic Acidosis A. There is twitching and/or contracture of B. Respiratory Acidosis the facial muscles produced by tapping C. Metabolic Alkalosis on the facial nerve at a specific point on D. Respiratory Alkalosis the face. Rationale: Respiratory alkalosis results from B. There is a carpopedal spasm induced by alveolar hyperventilation. It’s marked by a inflating the blood pressure cuff above decrease in PaCO2 to less than 35 mm Hg systolic pressure and an increase in blood pH over 7.45. C. There is a presence of cervical softening Metabolic acidosis is marked by a decrease D. There is pain on dorsiflexion of the foot in HCO3? to less than 22 mEq/L, and a Rationale: Chvostek Sign There is twitching decrease in blood pH to less than 7.35. In and/or contracture of the facial muscles produced respiratory acidosis, the pH is less than 7.35 by tapping on the facial nerve at a specific point on and the PaCO2 is greater than 45 mm Hg. In the face. metabolic alkalosis, the HCO3 is greater than TOS: Applying 26 mEq/L and the pH is greater than 7.45 TID: Enhancing Competencies TOS: Evaluating TID: Patient Care Competencies 29. The nurse expects that calcium excretion is one of the interventions in order to eliminate the 32. A client has the following arterial blood gas values: calcium in the body. Which of the following pH 7.12, PaCO2 40 mmHg and HCO3 15 mEq/L. diuretics the nurse will expect to administer? These ABG values suggest which disorder? A. Thiazide diuretics A. Metabolic Alkalosis B. Potassium wasting diuretics B. Metabolic Acidosis C. Potassium sparing diuretic C. Respiratory Acidosis D. Loop diuretics D. Respiratory Alkalosis Rationale: Loop diuretics are recommended for Rationale: This client’s pH value is below treatment of hypercalcemia because it helps to normal, indicating acidosis. The HCO3- value eliminate the calcium through dieresis. Thiazide also is below normal, reflecting an overwhelming diuretics increases the reabsorption of calcium accumulation of acids or excessive loss of base, TOS: Understanding which suggests metabolic acidosis. The PaCO2 TID: Enhancing Competencie value is normal, indicating absence of respiratory compensation. These ABG values eliminate Acid- Base Imbalances respiratory alkalosis, respiratory acidosis, and metabolic alkalosis. 30. A pt's blood gases show a pH greater of 7.53 TOS: Evaluating & bicarbonate level of 36 mEq/L. The nurse realizes that the acid-base disorder this pt is TID: Patient Care Competencies demonstrating is which of the following? 33. The laboratory reports that the cells from the A. Respiratory acidosis patient’s tumor biopsy are Grade II. What should B. Metabolic acidosis the nurse know about this histologic grading? C. Respiratory alkalosis A. Cells are abnormal and moderately D. Metabolic alkalosis differentiated Rationale: Answer is letter D. Arterial blood B. Cells are very abnormal and poorly gases (ABGs) show a pH greater than 7.45 & differentiated bicarbonate level greater than 26 mEq/L C. Cells are immature, primitive, and when the pt is in metabolic alkalosis. undifferentiated  D. Cells differ slightly from normal cells and are TID: Enhanging Competencies well-differentiated Situation: A 30 year- old woman has been diagnosed with 37. A patient with polyarthralgia with joint swelling and early systemic lupus erythematosus (SLE). The nurse pain is being evaluated for systemic lupus preformed thorough physical assessment and provide erythematosus (SLE). The nurse knows that the quality nursing care. The questions below refer to SLE. serum test result that is the most specific for SLE is the presence of: 34. To monitor the client, knowing that which of the A. Rheumatoid factor. following is one of the initial characteristic sign of B. Anti-Smith antibody (Anti-Sm). SLE? C. Antinuclear antibody (ANA). A. Weight gain D. Lupus erythematosus (LE) cell prep. B. Subnormal temperature Rationale: The anti-Sm is antibody found almost C. Elevated RBC count exclusively in SLE. The other blood tests are also D. Butterfly rash on the face across the used in screening but are not as specific to SLE. bridge of the nose TOS: Understanding Rationale: Skin lesions or rash on the face across TID: Enabling Competencies the bridge of the nose and on the cheeks is an initial characteristic sign of SLE. Fever and weight loss may also occur. Anemia is most likely to occur later in SLE. TOS: Remembering TID: Patient care Competencies 35. The nurse findings in the physical assessment of the client reveals fatigue, acute hand and wrist pain and proteinuria. The patient is receiving Prednisone (Deltasone) 40 mg BID. Which action should be included in the plan of care of the client? A. Prepare for seizure precaution B. Reorient client to time and place C. Monitor client’s intake and output D. Place client on cardiac monitor Rationale: Lupus nephritis is a common complication of SLE and when the patient is taking corticosteroids, it is especially important to monitor renal function. There is no indication that the patient is experiencing any nervous system of cardiac problems with SLE. TOS: Applying TID: Empowering Competencies 36. The nurse reviews the medications of the client. Which of the following medications would the nurse expect to be prescribed? A. Antibiotic B. Antidiarrhea C. Corticosteroid D. Antiemetic Rationale: Treatment of SLE is based on the systems involved and symptoms. Treatment normally consists of anti- inflammatory drugs, corticosteroids and immunosuppressants. The incorrect options are not standard components of medication therapy for this disorder. TOS: Understanding