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Systems of Care 3 Acute Renal Failure and Chronic Kidney Disease Med-Surg Practice Questions

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1. The nurse preparing to administer a dose of Phoso to a patient with chronic kidney disease would interpret that this medication should have a beneficial effect on which of the following laboratory values of the patient? A. B. C. D. Sodium Potassium Magnesium Phosphorus

D: Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore administration of calcium should help to reduce a patients abnormally high phosphorus level, as seen with chronic kidney disease. 2. When caring for a patient during the oliguric phase of acute kidney injury, which of the following would be an appropriate nursing intervention? A. B. C. D. Weigh patient three times weekly. Increase dietary sodium and potassium. Provide a low-protein, high-carbohydrate diet. Restrict fluids according to previous daily loss.

D: Patients in the oliguric phase of acute kidney injury will have fluid volume excess with potassium and sodium retention; hence, they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 ml for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times a week. 3. Which of the following statements by the nurse regarding continuous ambulatory peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to this procedure?

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A. B. C. D.

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It is essential that you maintain aseptic technique to prevent peritonitis. You will be allowed a more liberal protein diet once you complete CAPD. It is important for you to maintain a daily written record of blood pressure and

weight. You will need to continue regular medical and nursing follow-up visits while performing CAPD. A: Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of preventing this from occurring. Although the other teaching statements are accurate, they do not have the potential for mortality as does the peritonitis, thus making that nursing action of highest priority. 4. A patient with a history of end-stage renal disease secondary to diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which of the following assessments should the nurse prioritize before, during, and after his treatment? A. B. C. D. Level of consciousness Blood pressure and fluid balance Temperature, heart rate, and blood pressure Assessment for signs and symptoms of infection

B: Although all of the assessments are relevant to the care of a patient receiving hemodialysis, the nature of procedure indicates a particular need to monitor patients blood pressure and fluid balance. 5. A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. Which of the following is an expected assessment finding for this patient during this early stage of recovery? A. B. C. D. Hypokalemia Hyponatremia Large urine output Leukocytosis with cloudy urine output

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C: Patients frequently experience diuresis in the hours and days immediately following a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention. 6. Which of the following assessment findings is a consequence of the oliguric phase of acute kidney injury (AKI)? A. B. C. D. Hypovolemia Hyperkalemia Hypernatremia Thrombocytopenia

B: In AKI the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased because of decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.