1.

If the patient has a decreased kidney function symptoms are reduced energy
level, metallic taste in the mouth, anorexia, nausea, pruritus, decreased ability to
concentrate, decreased urine output, and weight gain. True or False?

Answer: True

2. It is a condition occurs when the kidneys no longer work as they should to meet
your body's needs and it is also a progressive loss of kidney function that cannot
be healed.

Glomerulonephritis
Polycystic kidney disease
Chronic kidney disease
Urinary tract infection

Answer: Chronic kidney disease

3. What complication will happen if there is a decreased excretion, metabolic

acidosis, catabolism, and excessive intake (diet, medications, fluids)?

Pericarditis
Pericardial effusion
Hyperkalemia
Cardiac tamponade

Answer: Hyperkalemia

4. A patient with CKD is admitted to the hospital. The nurse is aware of the
condition is characterized by?

progressive irreversible destruction of the kidneys

a rapid decrease in urine output with an elevated BUN
an increasing creatinine clearance with a decrease in urine output
prostration, somnolence, and confusion with coma and imminent death

Answer: progressive irreversible destruction of the kidneys

5. An End Stage Renal Disease (ESRD) patient receiving hemodialysis is thinking

about requesting a kidney donation from a family member. The nurse tells the
patient that in order to help them decide about the  treatment, the nurse informs
the patient that

successful transplantation usually provides a better quality of life than that offered by
dialysis
if rejection of the transplanted kidney occurs, no further treatment for the renal failure
is available
HD replaces the normal function of the kidneys, and patients do not have to live with
the continual fear of rejection
the immunosuppressive therapy following transplantation makes the person ineligible
to receive other forms of treatment if the kidney fails

Answer: successful transplantation usually provides a better quality of life than that
offered by dialysis
6. What condition is called when there is a decreased erythropoietin production,
decreased RBC lifespan, bleeding in the GI tract from irritating toxins and ulcer
formation, and blood loss during hemodialysis.

Hypertension
Anemia
Bone disease
Vascular calcification

Answer: Anemia

7. To assess the patency of a newly placed arteriovenous graft for dialysis, the
nurse should? Select all that apply.

monitor the BP in the affected arm

irrigate the graft daily with low-dose heparin
palpate the area of the graft to feel a normal thrill
listen with a stethoscope over the graft to detect a bruit
frequently monitor the pulses and neurovascular status distal to the graft

Answer:

palpate the area of the graft to feel a normal thrill

listen with a stethoscope over the graft to detect a bruit
frequently monitor the pulses and neurovascular status distal to the graft

8. What are the nephrotoxic drugs? Select all that apply.

Amikacin
Morphine sulfate
Contrast medium
Digoxin
Sulfonamides
NSAIDs

Answer:

Amikacin
Contrast medium
Sulfonamides
NSAIDs

9. It is an accumulation of end-products of protein metabolism in the blood.

Anemia
Ammonia
Septicemia
Proteinemia

Answer: Ammonia
10. The nurse is preparing to assess a patient with chronic kidney disease (CKD).
Which assessment should the nurse make a priority?

History of autoimmune diseases

Presence and location of a peritoneal catheter
Vital signs, especially blood pressure
Presence of skin rashes

Answer: Presence and location of a peritoneal catheter

Rationale: In assessing a patient diagnosed with chronic kidney disease (CKD), it is

most important for the nurse to assess the presence, location, and patency of the
arteriovenous (AV) fistula, shunt, graft, or peritoneal catheter. These are lifelines for
the patient that provide the means for either hemodialysis or peritoneal dialysis, life-
sustaining treatments.

11. Which effect should the nurse be aware of as the least likely reason for
prescribing a loop diuretic?

To decrease extracellular fluid volume

To decrease serum phosphate levels
To reduce serum potassium levels
To reduce edema

Answer: To decrease serum phosphate levels

Rationale: Loop diuretics are used to reduce extracellular fluid volume and edema.
They also cause potassium wasting, thereby reducing serum potassium levels. Loop
diuretics do not decrease phosphorus levels; phosphate binders will decrease serum
phosphorus levels.

12. For a patient with chronic kidney disease receiving peritoneal dialysis, the nurse
sets the goal of preventing infection. Which intervention should the nurse choose
to achieve this goal?

Monitor the clarity of the dialysate return.

Allow all visitors access to visit the patient.
Monitor vital signs daily.
Use protective isolation.

Answer: Monitor the clarity of the dialysate return.

Rationale: The return of cloudy dialysate fluid may indicate the presence of
peritonitis, a common complication of peritoneal dialysis. Standard precautions and
good hand hygiene should be used with the patient; it is not necessary to place the
patient in protective isolation. Anyone who is obviously ill should not be permitted to
visit. Vital signs should be monitored every 4 hours.
13. The nurse speaks with a colleague about chronic kidney disease (CKD). The
nurse questions the colleague as to why it could occasionally be challenging or
delayed to diagnose CKD in older adult patients. Which response from a work
colleague demonstrates understanding?

"The manifestations of renal failure are often missed in older adults or attributed to
other conditions."
"Older adults normally produce more creatinine, so it is difficult to determine what is
an abnormal rise."
"Serum creatinine levels rise more quickly in older adults than in younger people."
"Older adults are less likely to have hypertension or diabetes."

Answer: "The manifestations of renal failure are often missed in older adults or
attributed to other conditions."

Rationale: The diagnosis of CKD in older adults is difficult because manifestations

are missed due to the normal signs of aging. In addition, symptoms are often
attributed to heart failure or preexisting hypertension. Serum creatinine levels rise
more slowly in older adults. They have less muscle mass so they produce less
creatinine; therefore, the creatinine may remain within normal limits. Diabetes and
hypertension often have been present for a long period in older adults.

14. Patient A is being treated for hemorrhagic shock had serum potassium level 4.0
mEq/L and a serum creatinine level of 2.2 mg/dL. Which intervention should the
nurse include in the treatment plan for this patient?

Administer a potassium replacement.

Report urine output of less than 30 mL/hr.
Remove the indwelling urinary catheter.
Administer intravenous gentamicin as prescribed.

Answer: Report urine output of less than 30 mL/hr.

Rationale: The patient's rising serum creatinine indicates developing renal

dysfunction. The nurse should monitor urine output and report a rate of less than 30
mL/hr so that early interventions can be implemented to help restore renal function.

15. It is an invasive procedure that evaluates renal artery stenosis, tumors, and
trauma. A catheter is threaded through the femoral artery, allowing for direct
injection of a radiopaque substance.

Intravenous pyelogram
Renal angiography
Magnetic Resonance imaging
KUB

Answer: Renal angiography

16. It is a procedure that renders the urine radiopaque as the contrast agent is
excreted in the urine. Abnormalities of the lumen, calculi, and masses can be
detected.

Renal angiography
Magnetic Resonance imaging
Intravenous pyelogram
KUB

Answer: Intravenous pyelogram

17. What causes the GI manifestation of stomatitis in the patient with CKD?

high serum sodium levels

irritation of the GI tract from creatinine
increased ammonia from bacterial breakdown of urea
iron salts, calcium-containing phosphate binders, and limited fluid intake

Answer: increased ammonia from bacterial breakdown of urea

18. The CKD patient is brought to the emergency department while breathing
Kussmaul. What understanding of CKD does the nurse have that could account
cause for this patient's Kussmaul respirations?

uremic pleuritis is occurring

there is decreased pulmonary macrophage activity
they are caused by respiratory compensation for metabolic acidosis
pulmonary edema from HF and fluid overload is occurring

Answer: they are caused by respiratory compensation for metabolic acidosis

19. What is the most crucial thing for the nurse to perform in order to prevent the
most typical serious Peritoneal dialysis complication?

infuse the dialysate slowly

use strict aseptic technique in the dialysis procedures
have the patient empty the bowel before the inflow phase
reposition the patient frequently and promote deep breathing

Answer: use strict aseptic technique in the dialysis procedures

20. A kidney transplant was performed on a patient last month. Due to the effects of
immunosuppressive drugs and CKD. What complication of transplantation
should the nurse be assessing the patient for? 

infection
rejection
malignancy
cardiovascular disease

Answer: infection
21. It is one of the procedure that a graphic recording of bladder filling pressure and
abdominal pressure during the filling and voiding cycle.

Renal angiography
Renal biopsy
Timed urine collection
Voiding Cystometrogram

Answer: Voiding Cystometrogram

22. The patient is for cystography. A radiopaque dye is to be instill via a catheter
directly into the bladder. What will you check to the patient before the
procedure?

Present health history

Diagnosis
Allergies
Assessment

Answer: Allergies

23. Patient B has end-stage renal disease (ESRD) secondary to diabetes mellitus.
Patient B arrived at the outpatient dialysis unit for hemodialysis. Which
assessments should the nurse perform as a PRIORITY before, during, and after
the treatment?

Level of consciousness
Blood pressure and fluid balance
Temperature, heart rate, and blood pressure
Assessment for signs and symptoms of infection

Answer: Blood pressure and fluid balance

24. The nurse notices excoriations on the skin of the patient with CKD while the
patient is undergoing dialysis. What pathophysiologic changes in CKD can
contribute to this finding? Select all that apply.

Dry skin
Sensory neuropathy
Vascular calcifications
Calcium-phosphate skin deposits
Uremic crystallization from high BUN

Answer:

Dry skin
Sensory neuropathy
Calcium-phosphate skin deposits

Rationale: Pruritus is common in patients receiving dialysis It causes scratching from

dry skin, sensory neuropathy, and calcium-phosphate deposition in the skin. Vascular
calcifications contribute to cardiovascular disease, not to itching skin. Uremic frost
rarely occurs without BUN levels greater than 200 mg/dL, which should not occur in a
patient on dialysis; urea crystallizes on the skin and also causes pruritis.
25. The patient with chronic renal disease is deciding between hemodialysis
(HD) and peritoneal dialysis (PD). What are the advantages of PD over HD?
Select all that apply. 

Less protein loss

Rapid fluid removal
Less cardiovascular stress
Decreased hyperlipidemia
Requires fewer dietary restrictions

Answer:

Less cardiovascular stress

Requires fewer dietary restrictions

Rationale:

Peritoneal dialysis is less stressful for the cardiovascular system and requires fewer
dietary restrictions. Peritoneal dialysis actually contributes to more protein loss and
increased hyperlipidemia. The fluid and creatinine removal are slower with peritoneal
dialysis than hemodialysis.

26. How many months will mature the arteriovenous fistula (AVF) before it can be
used?

2 to 3 months
6 to 8 months
1 to 2 months
3 to 5 months

Answer: 2 to 3 months

27. A subcutaneous arteriovenous (AV) graft in a patient receiving hemodialysis

develops a thrombus, requiring its removal. What kind of medical procedure is
most likely to be performed on the patient as they wait for a replacement graft or
fistula?

Peritoneal dialysis
Peripheral vascular access using radial artery
Silastic catheter tunneled subcutaneously to the jugular vein
Peripherally inserted central catheter (PICC) line inserted into subclavian vein

Answer: Silastic catheter tunneled subcutaneously to the jugular vein

Rationale: A more permanent, soft, flexible Silastic double-lumen catheter is used for
long-term access when other forms of vascular access have failed. These catheters
are tunneled subcutaneously and have Dacron cuffs that prevent infection from
tracking along the catheter.
28. What is the primary way that a nurse will evaluate the patency of an AVF?

Palpate for pulses distal to the graft site.

Auscultate for the presence of a bruit at the site.
Evaluate the color and temperature of the extremity.
Assess for the presence of numbness and tingling distal to the site.

Answer: Auscultate for the presence of a bruit at the site.

Rationale: A patent arteriovenous fistula (AVF) creates turbulent blood flow that can
be assessed by listening for a bruit or palpated for a thrill as the blood passes
through the graft. Assessment of neurovascular status in the extremity distal to the
graft site is important to determine that the graft does not impair circulation to the
extremity but the neurovascular status does not indicate whether the graft is open.

29. Potassium level of patient A on a medical unit is 7.2 mEq/L. What is the priority
nursing action should the nurse take?

Place the patient on a cardiac monitor

Check the patient's blood pressure (BP)
Instruct the patient to avoid high-potassium foods
Call the lab and request a redraw of the lab to verify results

Answer: Place the patient on a cardiac monitor.

Rationale: Dysrhythmias may occur with an elevated potassium level and are
potentially lethal. Monitor the rhythm while contacting the physician or calling the
rapid response team. Vital signs should be checked. Depending on the patient's
history and cause of increased potassium, instruct the patient about dietary sources
of potassium; however, this would not help at this point. The nurse may want to
recheck the value but until then the heart rhythm needs to be monitored.

30. A patient with chronic kidney disease (CKD) is concerned about having anemia.
How should the nurse explain the development of this health problem?

"Your kidneys are excreting more blood cells."

"Your kidneys are not producing a hormone that tells your body to make more blood
cells."
"You are retaining more fluid, so your blood is diluted."
"Your bone marrow is depressed because of low calcium levels."

Answer: "Your kidneys are not producing a hormone that tells your body to make
more blood cells."

Rationale: The kidneys produce erythropoietin, which stimulates red blood cell
production in the bone marrow. Erythropoietin production decreases in renal failure.
Low serum calcium levels in chronic renal failure lead to renal osteodystrophy, or
bone breakdown. In chronic renal failure, some red blood cells may be found in the
urine but not enough to cause anemia. Fluid overload is common in renal failure, but
it will not change the red blood cell count.