NCLEX Q's AKI and CKD

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After the insertion of an arteriovenous graft (AVG) in the right
forearm, a patient complains of pain and coldness of the right
fingers. Which action should the nurse take?

a. ANS: B
Elevate the patients arm above the level of the heart. The patients complaints suggest the development of distal is-
b. chemia (steal syndrome) and may require revision of the AVG.
Report the patients symptoms to the health care provider. Elevation of the arm above the heart will decrease perfusion. Pain
c. and coolness are not normal after AVG insertion. Aspirin therapy
Remind the patient about the need to take a daily low-dose aspirin is not used to maintain grafts.
tablet.
d.
Educate the patient about the normal vascular response after AVG
insertion.
2. A patient with acute kidney injury (AKI) has an arterial blood pH
of 7.30. The nurse will assess the patient for
ANS: D
a.
Patients with metabolic acidosis caused by AKI may have Kuss-
vasodilation.
maul respirations as the lungs try to regulate carbon dioxide.
b.
Bounding pulses and vasodilation are not associated with meta-
poor skin turgor.
bolic acidosis. Because the patient is likely to have fluid retention,
c.
poor skin turgor would not be a finding in AKI.
bounding pulses.
d.
rapid respirations.
3. A patient with severe heart failure develops elevated blood urea
nitrogen (BUN) and creatinine levels. The nurse will plan care to
meet the goal of
ANS: C
The primary goal of treatment for acute kidney injury (AKI) is to
a.
eliminate the cause and provide supportive care while the kidneys
replacing fluid volume.
recover. Because this patients heart failure is causing AKI, the
b.
care will be directed toward treatment of the heart failure. For renal
preventing hypertension.
failure caused by hypertension, hypovolemia, or nephrotoxins, the
c.
other responses would be correct.
maintaining cardiac output.
d.
diluting nephrotoxic substances.
4. A patient who has acute glomerulonephritis is hospitalized with
acute kidney injury (AKI) and hyperkalemia. Which information will
the nurse obtain to evaluate the effectiveness of the prescribed
calcium gluconate IV?
ANS: C
a. The calcium gluconate helps prevent dysrhythmias that might be
Urine output caused by the hyperkalemia. The nurse will monitor the other
b. data as well, but these will not be helpful in determining the
Calcium level effectiveness of the calcium gluconate.
c.
Cardiac rhythm
d.
Neurologic status

5. A patient with stage 2 chronic kidney disease (CKD) is sched-

uled for an intravenous pyelogram (IVP). Which of these orders for
ANS: C
the patient will the nurse question?
The contrast dye used in IVPs is potentially nephrotoxic, and
concurrent use of other nephrotoxic medications such as the
a.
NSAIDs should be avoided. The suppository and NPO status are
NPO for 6 hours before IVP procedure
necessary to ensure adequate visualization during the IVP. IV
b.
fluids are used to ensure adequate hydration, which helps reduce
Normal saline 500 mL IV before procedure
the risk for contrast-induced renal failure.
c.
Ibuprofen (Advil) 400 mg PO PRN for pain

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d.
Dulcolax suppository 4 hours before IVP procedure
6. Which statement by a patient with stage 5 chronic kidney dis-
ease (CKD) indicates that the nurses teaching about management
of CKD has been effective?
ANS: C
a. The patient with end-stage renal disease is taught to measure
I need to try to get more protein from dairy products. urine output as a means of determining an appropriate oral fluid
b. intake. Erythropoietin is given to increase the red blood cell count
I will try to increase my intake of fruits and vegetables. and will not offer any benefit for immune function. Dairy products
c. are restricted because of the high phosphate level. Many fruits and
I will measure my urinary output each day to help calculate the vegetables are high in potassium and should be restricted in the
amount I can drink. patient with CKD.
d.
I need to take the erythropoietin to boost my immune system and
help prevent infection.
7. Which patient information will the nurse plan to obtain in order to
determine the effectiveness of the prescribed calcium carbonate
(Caltrate) for a patient with chronic kidney disease (CKD)?

a. ANS: B
Blood pressure Calcium carbonate is prescribed to bind phosphorus and prevent
b. mineral and bone disease in patients with CKD. The other data will
Phosphate level not be helpful in evaluating the effectiveness of calcium carbonate.
c.
Neurologic status
d.
Creatinine clearance
8. Before administering sodium polystyrene sulfonate (Kayex-
alate) to a patient with hyperkalemia, the nurse should assess the
ANS: C
a.
Sodium polystyrene sulfonate (Kayexalate) should not be given
blood urea nitrogen (BUN) and creatinine.
to a patient with a paralytic ileus (as indicated by absent bowel
b.
sounds) because bowel necrosis can occur. The BUN and creati-
blood glucose level.
nine, blood glucose, and LOC would not affect the nurses decision
c.
to give the medication.
patients bowel sounds.
d.
level of consciousness (LOC).
9. The nurse has instructed a patient who is receiving hemodialy-
sis about appropriate dietary choices. Which menu choice by the
patient indicates that the teaching has been successful?
ANS: A
Scrambled eggs would provide high-quality protein, and apple
a.
juice is low in potassium. Cheese is high in salt and phosphate,
Scrambled eggs, English muffin, and apple juice
and tomato soup would be high in potassium. Split-pea soup is
b.
high in potassium, and dairy products are high in phosphate.
Oatmeal with cream, half a banana, and herbal tea
Bananas are high in potassium, and the cream would be high in
c.
phosphate.
Split-pea soup, whole-wheat toast, and nonfat milk
d.
Cheese sandwich, tomato soup, and cranberry juice
10. Before administration of calcium carbonate (Caltrate) to a
patient with chronic kidney disease (CKD), the nurse should check
the laboratory value for ANS: D
If serum phosphate is elevated, the calcium and phosphate can
a. cause soft tissue calcification. The calcium carbonate should not
creatinine. be given until the phosphate level is lowered. Total cholesterol,
b. creatinine, and potassium values do not affect whether calcium
potassium. carbonate should be administered.
c.
total cholesterol.
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d.
serum phosphate.
11. Which information will be most useful to the nurse in evaluating
improvement in kidney function for a patient who is hospitalized
with acute kidney injury (AKI)?
ANS: D
a. GFR is the preferred method for evaluating kidney function. BUN
Blood urea nitrogen (BUN) level levels can fluctuate based on factors such as fluid volume status.
b. Urine output can be normal or high in patients with AKI and does
Urine output not accurately reflect kidney function. Creatinine alone is not an
c. accurate reflection of renal function.
Creatinine level
d.
Calculated glomerular filtration rate (GFR)
12. A patient needing vascular access for hemodialysis asks the
nurse what the differences are between an arteriovenous (AV)
fistula and a graft. The nurse explains that one advantage of the
fistula is that it
ANS: A
a. AV fistulas are much less likely to clot than grafts, although it takes
is much less likely to clot. longer for them to mature to the point where they can be used for
b. dialysis. The choice of an AV fistula or a graft does not have an
increases patient mobility. impact on needle size or patient mobility.
c.
can accommodate larger needles.
d.
can be used sooner after surgery.
13. When caring for a patient with a left arm arteriovenous fistula,
which action will the nurse include in the plan of care to maintain
the patency of the fistula?
ANS: A
a. The presence of a thrill and bruit indicates adequate blood flow
Check the fistula site for a bruit and thrill. through the fistula. Pulse rate and quality are not good indicators
b. of fistula patency. Blood pressures should never be obtained on
Assess the rate and quality of the left radial pulse. the arm with a fistula. Irrigation of the fistula might damage the
c. fistula, and typically only dialysis staff would access the fistula.
Compare blood pressures in the left and right arms.
d.
Irrigate the fistula site with saline every 8 to 12 hours.
14. When a patient who has had progressive chronic kidney
disease (CKD) for several years is started on hemodialysis, which
information about diet will the nurse include in patient teaching?

a.
ANS: C
Increased calories are needed because glucose is lost during
Once the patient is started on dialysis and nitrogenous wastes are
hemodialysis.
removed, more protein in the diet is encouraged. Fluids are still
b.
restricted to avoid excessive weight gain and complications such
Unlimited fluids are allowed since retained fluid is removed during
as shortness of breath. Glucose is not lost during hemodialysis.
dialysis.
Sodium and potassium intake continues to be restricted to avoid
c.
the complications associated with high levels of these electrolytes.
More protein will be allowed because of the removal of urea and
creatinine by dialysis.
d.
Dietary sodium and potassium are unrestricted because these
levels are normalized by dialysis.
15. Which action by a patient who is using peritoneal dialysis (PD)
indicates that the nurse should provide more teaching about PD?
ANS: D
a. Patients are encouraged to take showers rather than baths to
The patient slows the inflow rate when experiencing pain.
b.
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The patient leaves the catheter exit site without a dressing.
c.
avoid infections at the catheter insertion side. The other patient
The patient plans 30 to 60 minutes for a dialysate exchange.
actions indicate good understanding of peritoneal dialysis.
d.
The patient cleans the catheter while taking a bath every day.
16. When the nurse is taking a history for a patient who is a possi-
ble candidate for a kidney transplant, which information about the
patient indicates that the patient is not an appropriate candidate
for transplantation?
ANS: A
a.
Disseminated malignancies are a contraindication to transplanta-
The patient has metastatic lung cancer.
tion. The conditions of the other patients are not contraindications
b.
for kidney transplant.
The patient has poorly controlled type 1 diabetes.
c.
The patient has a history of chronic hepatitis C infection.
d.
The patient is infected with the human immunodeficiency virus.
17. The nurse is caring for a patient who had kidney transplan-
tation several years ago. Which assessment finding may indicate
that the patient is experiencing adverse effects to the prescribed
corticosteroid?
ANS: A
a. Aseptic necrosis of the weight-bearing joints can occur when
Joint pain patients take corticosteroids over a prolonged period. Increased
b. creatinine level, orthostatic dizziness, and tachycardia are not
Tachycardia caused by corticosteroid use.
c.
Postural hypotension
d.
Increase in creatinine level
18. Which data obtained when assessing a patient who had a
kidney transplant 8 years ago and who is receiving the immuno-
suppressants tacrolimus (Prograf), cyclosporine (Sandimmune),
and prednisone (Deltasone) will be of most concern to the nurse?
ANS: C
A nontender lump suggests a malignancy such as a lymphoma,
a.
which could occur as a result of chronic immunosuppressive ther-
The blood glucose is 144 mg/dL.
apy. The elevated glucose, moon face, and hypertension are pos-
b.
sible side effects of the prednisone and should be addressed, but
The patients blood pressure is 150/92.
they are not as great a concern as the possibility of a malignancy.
c.
There is a nontender lump in the axilla.
d.
The patient has a round, moonlike face.
19. A patient with chronic kidney disease (CKD) brings all home
medications to the clinic to be reviewed by the nurse. Which med-
ication being used by the patient indicates that patient teaching is
required?
ANS: B
a.
Magnesium is excreted by the kidneys, and patients with CKD
Multivitamin with iron
should not use over-the-counter products containing magnesium.
b.
The other medications are appropriate for a patient with CKD.
Milk of magnesia 30 mL
c.
Calcium phosphate (PhosLo)
d.
Acetaminophen (Tylenol) 650 mg
20. A patient with hypertension and stage 2 chronic kidney dis-
ease (CKD) is receiving captopril (Capoten). Before administra- ANS: B
tion of the medication, the nurse will check the patients Angiotensin-converting enzyme (ACE) inhibitors are frequently

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a.
glucose. used in patients with CKD because they delay the progression of
b. the CKD, but they cause potassium retention. Therefore, careful
potassium. monitoring of potassium levels is needed in patients who are at
c. risk for hyperkalemia. The other laboratory values also would be
creatinine. monitored in patients with CKD but would not affect whether the
d. captopril was given or not.
phosphate.
21. A new order for IV gentamicin (Garamycin) 60 mg BID is
received for a patient with diabetes who has pneumonia. When
evaluating for adverse effects of the medication, the nurse will plan
to monitor the patients
ANS: D
a. When a patient at risk for chronic kidney disease (CKD) receives
urine osmolality. a nephrotoxic medication, it is important to monitor renal function
b. with BUN and creatinine levels. The other laboratory values would
serum potassium. not be useful in determining the effect of the gentamicin.
c.
blood glucose level.
d.
blood urea nitrogen (BUN) and creatinine.
22. Which of the following information obtained by the nurse who is
caring for a patient with end-stage renal disease (ESRD) indicates
the nurse should consult with the health care provider before ANS: C
giving the prescribed epoetin alfa (Procrit)? High hemoglobin levels are associated with a higher rate of throm-
boembolic events and increased risk of death from serious car-
a. diovascular events (heart attack, heart failure, stroke) when EPO
Creatinine 1.2 mg/dL is administered to a target hemoglobin of >12 g/dL. Hemoglobin
b. levels higher than 12 g/dL indicate a need for a decrease in
Oxygen saturation 89% epoetin alfa dose. The other information also will be reported to
c. the health care provider, but will not affect whether the medication
Hemoglobin level 13 g/dL is administered.
d.
Blood pressure 98/56 mm Hg
23. In a patient with acute kidney injury (AKI) who requires he-
modialysis, a temporary vascular access is obtained by placing a
catheter in the left femoral vein. Which intervention will be included
in the plan of care? ANS: A
The patient with a femoral vein catheter must be on bed rest to
a. prevent trauma to the vein. Protein intake is likely to be increased
Place the patient on bed rest. when the patient is receiving dialysis. The retention catheter is
b. likely to remain in place because accurate measurement of output
Start continuous pulse oximetry. will be needed. There is no indication that the patient needs
c. continuous pulse oximetry.
Discontinue the retention catheter.
d.
Restrict the patients oral protein intake.
24. When the nurse is caring for a patient who has been admitted
with a severe crushing injury after an industrial accident, which
laboratory result will be most important to report to the health care
provider?
ANS: B
a. The hyperkalemia associated with crushing injuries may cause
Serum creatinine level 2.1 mg/dL cardiac arrest and should be treated immediately. The nurse also
b. will report the other laboratory values, but abnormalities in these
Serum potassium level 6.5 mEq/L are not immediately life threatening.
c.
White blood cell count 11,500/L
d.
Blood urea nitrogen (BUN) 56 mg/dL

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25. A patient with a history of benign prostatic hyperplasia (BPH)
is admitted with acute urinary retention and an elevated blood
urea nitrogen (BUN) and creatinine. Which of these prescribed
therapies should the nurse implement first?
ANS: B
The patients elevation in BUN is most likely associated with hy-
a.
dronephrosis caused by the acute urinary retention, so the inser-
Obtain renal ultrasound.
tion of a retention catheter is the first action to prevent ongoing
b.
postrenal failure for this patient. The other actions also are appro-
Insert retention catheter.
priate, but should be implemented after the retention catheter.
c.
Infuse normal saline at 50 mL/hour.
d.
Draw blood for complete blood count.
26. Which information about a patient who was admitted 10 days
previously with acute kidney injury (AKI) caused by dehydration
will be most important for the nurse to report to the health care
provider?
ANS: C
a.
The high urine output indicates a need to increase fluid intake to
The blood urea nitrogen (BUN) level is 67 mg/dL.
prevent hypovolemia. The other information is typical of AKI and
b.
will not require a change in therapy.
The creatinine level is 3.0 mg/dL.
c.
Urine output over an 8-hour period is 2500 mL.
d.
The glomerular filtration rate is <30 mL/min/1.73m2.
27. After noting lengthening QRS intervals in a patient with acute
kidney injury (AKI), which action should the nurse take first?
ANS: D
a. The increasing QRS interval is suggestive of hyperkalemia, so the
Document the QRS interval. nurse should check the most recent potassium and then notify
b. the patients health care provider. The BUN and creatinine will be
Notify the patients health care provider. elevated in a patient with AKI, but they would not directly affect
c. the electrocardiogram (ECG). Documentation of the QRS interval
Look at the patients current blood urea nitrogen (BUN) and crea- also is appropriate, but interventions to decrease the potassium
tinine levels. level are needed to prevent life-threatening bradycardia.
d.
Check the chart for the most recent blood potassium level.
28. When caring for a dehydrated patient with acute kidney injury
who is oliguric, anemic, and hyperkalemic, which of the following
prescribed actions should the nurse take first?
ANS: B
a. Since hyperkalemia can cause fatal cardiac dysrhythmias, the
Insert a urinary retention catheter. initial action should be to monitor the cardiac rhythm. Kayexalate
b. and Epogen will take time to correct the hyperkalemia and anemia.
Place the patient on a cardiac monitor. The catheter allows monitoring of the urine output, but does not
c. correct the cause of the renal failure.
Administer epoetin alfa (Epogen, Procrit).
d.
Give sodium polystyrene sulfonate (Kayexalate).

29. Which nursing action for a patient who has arrived for a
scheduled hemodialysis session is most appropriate for the RN
to delegate to a dialysis technician?
ANS: B
Dialysis technicians are educated in monitoring for blood pressure.
a.
Assessment, adjustment of the appropriate ultrafiltration rate, and
Educate patient about fluid restrictions.
patient teaching require the education and scope of practice of an
b.
RN.
Check blood pressure before starting dialysis.
c.
Assess for reasons for increase in predialysis weight.

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d.
Determine the ultrafiltration rate for the hemodialysis.
30. The RN observes an LPN/LVN carrying out all of the following
actions while caring for a patient with stage 2 chronic kidney
disease. Which action requires the RN to intervene?

a. ANS: C
The LPN/LVN administers erythropoietin subcutaneously. Oral phosphate binders should not be given at the same time
b. as iron because they prevent the iron from being absorbed. The
The LPN/LVN assists the patient to ambulate in the hallway. phosphate binder should be given with a meal and the iron given at
c. a different time. The other actions by the LPN/LVN are appropriate
The LPN/LVN gives the iron supplement and phosphate binder for a patient with renal insufficiency.
with lunch.
d.
The LPN/LVN carries a tray containing low-protein foods into the
patients room.
31. The nurse is assessing a patient who is receiving peritoneal
dialysis with 2 L inflows. Which information should be reported
immediately to the health care provider?
ANS: B
a. Cloudy appearing peritoneal effluent is a sign of peritonitis and
The patient has an outflow volume of 1800 mL. should be reported immediately so that treatment with antibiotics
b. can be started. The other problems can be addressed through
The patients peritoneal effluent appears cloudy. nursing interventions such as slowing the inflow and repositioning
c. the patient.
The patient has abdominal pain during the inflow phase.
d.
The patient complains of feeling bloated after the inflow.
32. Two hours after a kidney transplant, the nurse obtains all of
the following data when assessing the patient. Which information
is most important to communicate to the health care provider?
ANS: C
a.
The decrease in CVP suggests hypovolemia, which must be
The urine output is 900 to 1100 mL/hr.
rapidly corrected to prevent renal hypoperfusion and acute tubular
b.
necrosis. The other information is not unusual in a patient after a
The blood urea nitrogen (BUN) and creatinine levels are elevated.
transplant.
c.
The patients central venous pressure (CVP) is decreased.
d.
The patient has level 8 (on a 10-point scale) incisional pain.
33. A patient in the oliguric phase of acute renal failure has a
24-hour fluid output of 150 mL emesis and 250 mL urine. The
nurse plans a fluid replacement for the following day of ___ mL.

a.
ANS: C
400
Usually fluid replacement should be based on the patients mea-
b.
sured output plus 600 mL/day for insensible losses.
800
c.
1000
d.
1400
34. During hemodialysis, a patient complains of nausea and dizzi-
ness. Which action should the nurse take first?
ANS: C
a. The patients complaints of nausea and dizziness suggest hy-
Slow down the rate of dialysis. potension, so the initial action should be to check the BP. The other
b. actions also may be appropriate, based on the blood pressure
Obtain blood to check the blood urea nitrogen (BUN) level. obtained.
c.
Check the patients blood pressure.
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d.
Give prescribed PRN antiemetic drugs.
35. Which parameter will be most important for the nurse to
consider when titrating the IV fluid infusion rate immediately after
a patient has had kidney transplantation?
ANS: C
a.
Fluid volume is replaced based on urine output after transplant
Heart rate
because the urine output can be as high as a liter an hour.
b.
The other data will be monitored but are not the most important
Blood urea nitrogen (BUN) level
determinants of fluid infusion rate.
c.
Urine output
d.
Creatinine clearance
36. A patient complains of leg cramps during hemodialysis. The
nurse should first

a.
ANS: D
reposition the patient.
Muscle cramps during dialysis are caused by rapid removal of
b.
sodium and water. Treatment includes infusion of normal saline.
massage the patients legs.
The other actions do not address the reason for the cramps.
c.
give acetaminophen (Tylenol).
d.
infuse a bolus of normal saline.
The nurse is caring for a 68-yr-old man who had coronary artery
Restrict fluids based on urine output.
bypass surgery 3 weeks ago. During the oliguric phase of acute
kidney disease, which action would be appropriate to include in
Fluid intake is monitored during the oliguric phase. Fluid intake
the plan of care?
is determined by adding all losses for the previous 24 hours
plus 600 mL. Potassium and protein intake may be limited in the
Provide foods high in potassium.
oliguric phase to avoid hyperkalemia and elevated urea nitrogen.
Restrict fluids based on urine output.
Hemodialysis, not peritoneal dialysis, is indicated in acute kidney
Monitor output from peritoneal dialysis.
injury if dialysis is needed.
Offer high-protein snacks between meals.
Assess skin turgor to determine hydration status.
2.A 52-yr-old man with stage 2 chronic kidney disease is sched-
uled for an outpatient diagnostic procedure using contrast media.
Preexisting kidney disease is the most important risk factor for
Which priority action should the nurse perform?
the development of contrast-associated nephropathy and nephro-
toxic injury. If contrast media must be administered to a high-risk
Assess skin turgor to determine hydration status.
patient, the patient needs to have optimal hydration. The nurse
Insert a urinary catheter for the expected diuresis.
should assess the hydration status of the patient before the pro-
Evaluate the patient's lower extremities for edema.
cedure is performed. Indwelling catheter use should be avoided
Check the patient's urine for the presence of ketones.
whenever possible to decrease the risk of infection.
Cardiac dysrhythmias
3.A 56-yr-old woman with type 2 diabetes mellitus and chronic
kidney disease has a serum potassium level of 6.8 mEq/L. Which
Hyperkalemia is the most serious electrolyte disorder associated
finding will the nurse monitor for?
with kidney disease. Fatal dysrhythmias can occur when the serum
potassium level reaches 7 to 8 mEq/L. Fatigue and hypertriglyc-
1. Fatigue
eridemia may be present but do not require urgent intervention.
2. Hypoglycemia
Hypoglycemia is a complication related to diabetes control, not
3. Cardiac dysrhythmias
hyperkalemia. However, administration of insulin and dextrose is
4. Elevated triglycerides
an emergency treatment for hyperkalemia.

Aluminum hydroxide
4.A frail 72-yr-old woman with stage 3 chronic kidney disease is
cared for at home by her family. The patient has a history of tak-
Antacids (that contain magnesium and aluminum) should be
ing many over-the-counter medications. Which over-the-counter
avoided because patients with kidney disease are unable to ex-
medications should the nurse teach the patient to avoid?
crete these substances. Also, some antacids contain high levels
of sodium that further increase blood pressure. Acetaminophen
1. Aspirin
and aspirin (if taken for a short period of time) are usually safe
2. Acetaminophen
for patients with kidney disease. Antihistamines may be used, but
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3. Diphenhydramine combination drugs that contain pseudoephedrine may increase
4. Aluminum hydroxide blood pressure and should be avoided.
5.The home care nurse visits a 34-yr-old woman receiving peri- "The fluid draining from the catheter is cloudy."
toneal dialysis. Which statement indicates a need for immediate
follow-up by the nurse? The primary clinical manifestation of peritonitis is a cloudy peri-
toneal effluent. Blood may be present in the effluent of women
1. "Drain time is faster if I rub my abdomen." who are menstruating, and no intervention is indicated. Daily
2. "The fluid draining from the catheter is cloudy." catheter care may include washing around the catheter with soap
3. "The drainage is bloody when I have my period." and water. Drain time may be facilitated by gently massaging the
4. "I wash around the catheter with soap and water." abdomen
6.The nurse preparing to administer a dose of calcium acetate
Phosphorus
to a patient with chronic kidney disease (CKD). Which laboratory
result will the nurse monitor to determine if the desired effect was
Phosphorus and calcium have inverse or reciprocal relationships,
achieved?
meaning that when phosphorus levels are high, calcium levels
tend to be low. Therefore, administration of calcium should help
1. Sodium
to reduce a patient's abnormally high phosphorus level, as seen
2. Potassium
with CKD. Calcium acetate will not have an effect on sodium,
3. Magnesium
potassium, or magnesium levels
4. Phosphorus
Restrict fluids according to previous daily loss.
7. When caring for a patient during the oliguric phase of acute
Patients in the oliguric phase of AKI will have fluid volume excess
kidney injury (AKI), which nursing action is appropriate?
with potassium and sodium retention. Therefore, they will need
to have dietary sodium, potassium, and fluids restricted. Daily
1. Weigh patient three times weekly.
fluid intake is based on the previous 24-hour fluid loss (measured
2. Increase dietary sodium and potassium.
output plus 600 mL for insensible loss). The diet also needs to
3. Provide a low-protein, high-carbohydrate diet.
provide adequate, not low, protein intake to prevent catabolism.
4. Restrict fluids according to previous daily loss.
The patient should also be weighed daily, not just three times each
week
8.Which statement regarding continuous ambulatory peritoneal
dialysis (CAPD) would be most important when teaching a patient
"It is essential that you maintain aseptic technique to prevent
new to the treatment?
peritonitis."
1. "Maintain a daily written record of blood pressure and weight."
2. "It is essential that you maintain aseptic technique to prevent
Peritonitis is a potentially fatal complication of peritoneal dialysis,
peritonitis."
and thus it is imperative to teach the patient methods of prevention.
3. "You will be allowed a more liberal protein diet once you com-
Although the other teaching statements are accurate, they do not
plete CAPD."
have the potential for morbidity and mortality that peritonitis does
4. "Continue regular medical and nursing follow-up visits while
performing CAPD."
9.A patient with end-stage renal disease (ESRD) secondary to
diabetes mellitus has arrived at the outpatient dialysis unit for
Blood pressure and fluid balance
hemodialysis. Which assessments should the nurse perform as
a priority before, during, and after the treatment?
Although all of the assessments are relevant to the care of a
patient receiving hemodialysis, fluid removal during the procedure
1. Level of consciousness
will require monitoring blood pressure and fluid balance prior,
2. Blood pressure and fluid balance
during, and afte
3. Temperature, heart rate, and blood pressure
4. Assessment for signs and symptoms of infection
10.A patient is recovering in the intensive care unit (ICU) 24
hours after receiving a kidney transplant. What is an expected Large urine output
assessment finding during the earliest stage of recovery?
Patients frequently experience diuresis in the hours and days
1. Hypokalemia immediately following a kidney transplant. Electrolyte imbalances
2. Hyponatremia and signs of infection are unexpected findings that warrant prompt
3. Large urine output intervention
4. Leukocytosis with cloudy urine output
11.Which patient diagnosis or treatment is most consistent with Dissecting abdominal aortic aneurysm
prerenal acute kidney injury (AKI)?
A dissecting abdominal aortic aneurysm is a prerenal cause of AKI
1. IV tobramycin because it can decrease renal artery perfusion and therefore the
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2. Incompatible blood transfusion
3. Poststreptococcal glomerulonephritis
4. Dissecting abdominal aortic aneurysm
12. The patient has rapidly progressing glomerular inflammation.
Weight has increased and urine output is steadily declining. What
is the priority nursing intervention?
1. Monitor the patient's cardiac status.
2. Teach the patient about hand washing.
3. Obtain a serum specimen for electrolytes.
4. Increase direct observation of the patient.
13.A patient with a 25-year history of type 1 diabetes mellitus is
reporting fatigue, edema, and an irregular heartbeat. On assess-
ment, the nurse notes newly developed hypertension and uncon-
trolled blood sugars. Which diagnostic study is most indicative of
chronic kidney disease (CKD)?
1. Serum creatinine
2. Serum potassium
3. Microalbuminuria
4. Calculated glomerular filtration rate (GFR)
14.A 78-yr-old patient has stage 3 CKD and is being taught about Apple, green beans, and a roast beef sandwich
a low-potassium diet. The nurse knows the patient understands
the diet when the patient selects which foods to eat?
1. Apple, green beans, and a roast beef sandwich
2. Granola made with dried fruits, nuts, and seeds
3. Watermelon and ice cream with chocolate sauce
4. Bran cereal with ½ banana and milk and orange juice
15.Which patient has the most significant risk factors for CKD?
1. A 50-yr-old white woman with hypertension
2. A 61-yr-old Native American man with diabetes
3. A 40-yr-old Hispanic woman with cardiovascular disease
4. A 28-yr-old African American woman with a urinary tract infec- about 1.5 times more than non-Hispanics. African Americans have
tion
16.Diffusion, osmosis, and ultrafiltration occur in both hemodial-
ysis and peritoneal dialysis. Which strategy is used to achieve
ultrafiltration in peritoneal dialysis?
1. Increasing the pressure gradient
2. Increasing osmolality of the dialysate
3. Decreasing the glucose in the dialysate
4. Decreasing the concentration of the dialysate
17.During hemodialysis, the patient develops light-headedness
and nausea. What should the nurse do first?
1. Administer hypertonic saline.
glomerular filtrate rate. Aminoglycoside antibiotic administration,
a hemolytic blood transfusion reaction, and post-streptococcal
glomerulonephritis are intrarenal causes of AKI
Monitor the patient's cardiac status
The nurse's priority is to monitor the patient's cardiac status. With
the rapidly progressing glomerulonephritis, renal function begins
to fail and fluid, potassium, and hydrogen retention lead to hy-
pervolemia, hyperkalemia, and metabolic acidosis. Excess fluid
increases the workload of the heart, and hyperkalemia can lead to
life-threatening dysrhythmias. Teaching about hand washing and
observation of the patient are important nursing interventions but
are not the priority. Electrolyte measurement is a collaborative in-
tervention that will be done as ordered by the health care provider
Calculated glomerular filtration rate (GFR)
The best study to determine kidney function or CKD that would
be expected in the patient with diabetes is the calculated GFR
that is obtained from the patient's age, gender, race, and serum
creatinine. It would need to be abnormal for 3 months to establish
a diagnosis of CKD. A creatinine clearance test done with a blood
sample and a 24-hour urine collection is also important. Serum
creatinine is not the best test for CKD because the level varies with
different patients. Serum potassium levels could explain why the
patient has an irregular heartbeat. The finding of microalbuminuria
can alert the patient with diabetes about potential renal involve-
ment and potentially failing kidneys. However, urine albumin levels
are not used for diagnosis of CKD
When the patient selects an apple, green beans, and a roast
beef sandwich, the patient demonstrates understanding of the
low-potassium diet. Granola, dried fruits, nuts and seeds, milk
products, chocolate sauce, bran cereal, banana, and orange juice
all have elevated levels of potassium, at or above 200 mg per 1/2
cup
A 61-yr-old Native American man with diabetes
The nurse identifies the 61-yr-old Native American with diabetes
as the most at risk. Diabetes causes about 50% of CKD. This
patient is the oldest, and Native Americans with diabetes de-
velop CKD six times more frequently than other ethnic groups.
Hypertension causes about 25% of CKD. Hispanics have CKD
the highest rate of CKD because hypertension is significantly
increased in African Americans. A UTI will not cause CKD unless
it is not treated or UTIs occur recurrently
Increasing osmolality of the dialysate
Ultrafiltration in peritoneal dialysis is achieved by increasing the
osmolality of the dialysate with additional glucose. In hemodialy-
sis, the increased pressure gradient from increased pressure in
the blood compartment or decreased pressure in the dialysate
compartment causes ultrafiltration. Decreasing the concentration
of the dialysate in either peritoneal or hemodialysis will decrease
the amount of fluid removed from the blood stream
Decrease the rate of fluid removal
The patient is experiencing hypotension from a rapid removal of
vascular volume. The rate and volume of fluid removal will be
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 NCLEX Q's AKI and CKD
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decreased, and 0.9% saline solution may be infused. Hypertonic
2. Administer a blood transfusion.
saline is not used because of the high sodium load. A blood
3. Decrease the rate of fluid removal.
transfusion is not indicated. Antiemetic medications may help the
4. Administer antiemetic medications.
nausea but would not help the hypovolemia
Encourage even a short walk to avoid complications of surgery
18.A 24-yr-old woman donated a kidney via a laparoscopic donor
Because ambulating will improve bowel, lung, and kidney func-
nephrectomy to a nonrelated recipient. The patient is experiencing
tion with improved circulation, even a short walk with assistance
significant pain and refuses to get up to walk. How should the
should be encouraged after pain medication. The transplant psy-
nurse respond?
chologist or social worker's role is to determine if the patient is
emotionally stable enough to handle donating a kidney; post-
1. Have the transplant psychologist convince her to walk.
operative care is the nurse's role. Trying to shame the patient
2. Encourage even a short walk to avoid complications of surgery.
into walking by telling her that other patients have not refused
3. Tell the patient that no other patients have ever refused to walk.
and telling the patient she is lucky she did not have an open
4. Tell the patient she is lucky she did not have an open nephrec-
nephrectomy (implying how much more pain she would be having
tomy.
if it had been open) will not be beneficial to the patient or her
postoperative recovery
Continuous venovenous hemofiltration (CVVH)
19.The physician has decided to use renal replacement therapy to
remove large volumes of fluid from a patient who is hemodynam-
CVVH removes large volumes of water and solutes from the
ically unstable in the intensive care unit. The nurse should expect
patient over a longer period of time by using ultrafiltration and
which treatment to be used for this patient?
convection. HD three times per week would not be used for this
patient because fluid and solutes build up and then are rapidly
1. Hemodialysis (HD) three times per week
removed. With APD (used at night instead of during the day) fluid
2. Automated peritoneal dialysis (APD)
and solutes build up during the day and would not benefit this
3. Continuous venovenous hemofiltration (CVVH)
patient as much. CAPD will not as rapidly remove large amounts
4. Continuous ambulatory peritoneal dialysis (CAPD)
of fluid as CVVH can do
Anemia
Hypertension
20.Which findings will the nurse expect when caring for a patient Increased risk for fractures
with chronic kidney disease (CKD) (select all that apply.)?
When the kidney fails, erythropoietin in not excreted, so anemia
1. Anemia is expected. Hypocalcemia from chronic renal disease stimulates
2. Dehydration the parathyroid to release parathyroid hormone, causing calcium
3. Hypertension liberation from bones increasing the risk of pathological fracture.
4. Hypercalcemia Dehydration and hypercalcemia are not expected in chronic renal
5. Increased risk for fractures disease. Fluid volume overload and hypocalcemia are expected.
6. Elevated white blood cells Although impaired immune function should be expected, elevated
white blood cells would indicate inflammation or infection not
associated with chronic renal failure itself but a complication
21.Which assessment findings would alert the nurse that the
Dehydration
patient has entered the diuretic phase of acute kidney injury (AKI)
Hypokalemia
(select all that apply.)?
Urine output increases
1. Dehydration
The hallmark of entering the diuretic phase is the production of co-
2. Hypokalemia
pious amounts of urine. Dehydration, hypokalemia, and hypona-
3. Hypernatremia
tremia occur in the diuretic phase of AKI because the nephrons
4. BUN increases
can excrete wastes but not concentrate urine. Serum BUN and
5. Urine output increases
serum creatinine levels begin to decrease
6. Serum creatinine increases
1. ______________ is solely filtered from the bloodstream via the The answer is B. Creatinine is a waste product from muscle break-
glomerulus and is NOT reabsorbed back into the bloodstream but down and is removed from the bloodstream via the glomerulus of
is excreted through the urine. the nephron. It is the only substance that is solely filtered out of the
A. Urea blood but NOT reabsorbed back into the system. It is excreted out
B. Creatinine through the urine. This is why a creatinine clearance test is used
C. Potassium as an indicator for determining renal function and for calculating
D. Magnesium the glomerular filtration rate.

The answers are A and C. The glomerular filtration rate indicates

how well the glomerulus is filtering the blood. A normal GFR tends
to be 90 mL/min or higher. A GFR of 40 mL/min indicates that
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the kidney's ability to filter the blood is decreased. Therefore, the
2. A patient with acute renal injury has a GFR (glomerular filtration
kidneys will be unable to remove waste and excessive water from
rate) of 40 mL/min. Which signs and symptoms below may this
the blood...hence hypervolemia and an increased BUN level will
patient present with? Select all that apply:
present in this patient. The patient will experience HYPERkalemia
A. Hypervolemia
(not hypo) because the kidneys are unable to remove potassium
B. Hypokalemia
from the blood. In addition, an INCREASED creatinine level (not
C. Increased BUN level
decreased) will present because the kidneys cannot remove ex-
D. Decreased Creatinine level
cessive waste products, such as creatinine.
The answer is B. A normal creatinine clearance level in a fe-
male should be 85-125 mL/min (95-140 mL/min males). A crea-
3. You're assessing morning lab values on a female patient who tinine clearance level indicates the amount of blood the kidneys
is recovering from a myocardial infraction. Which lab value below can make per minute that contain no amounts of creatinine in
requires you to notify the physician? it. Remember creatinine is a waste product of muscle break-
A. Potassium level 4.2 mEq/L down. Therefore, the kidneys should be able to remove excessive
B. Creatinine clearance 35 mL/min amounts of it from the bloodstream. A patient who has experi-
C. BUN 20 mg/dL enced a myocardial infraction is at risk for pre-renal acute injury
D. Blood pH 7.40 due to decreased cardiac output to the kidneys from a damaged
heart muscle (the heart isn't able to pump as efficiently because
of ischemia). All the other labs values are normal.
4. A 55 year old male patient is admitted with a massive GI bleed. The answer is C. Pre-renal injury is due to decreased perfusion to
The patient is at risk for what type of acute kidney injury? the kidneys secondary to a cause (massive GI bleeding...patient
A. Post-renal is losing blood volume). This leads to a major decrease in kidney
B. Intra-renal function because the kidneys are deprived of nutrients to function
C. Pre-renal and the amount of blood it can filter. Pre-renal injury can eventually
D. Intrinsic renal lead to intrarenal damage where the nephrons become damaged.
5. Select all the patients below that are at risk for acute intra-renal
injury? The answers are: C, E, and F. These patients are at risk for an
A. A 45 year old male with a renal calculus. intra-renal injury, which is where there is damage to the nephrons
B. A 65 year old male with benign prostatic hyperplasia. of kidney. The patients in options A and B are at risk for POST-RE-
C. A 25 year old female receiving chemotherapy. NAL injury because there is an obstruction that can cause back
D. A 36 year old female with renal artery stenosis. flow of urine into the kidney, which can lead to decreased function
E. A 6 year old male with acute glomerulonephritis. of the kidney. The patient in option D is at risk for PRE-RENAL
F. An 87 year old male who is taking an aminoglycoside medication injury because there is an issue with perfusion to the kidney.
for an infection.
6. A patient with acute kidney injury has the following labs: GFR
92 mL/min, BUN 17 mg/dL, potassium 4.9 mEq/L, and creatinine The answer is D. This patient is in the recovery stage of AKI.
1 mg/dL. The patient's 24 hour urinary output is 1.75 Liters. Based The patient's labs and urinary output indicate the renal function
on these findings, what stage of AKI is this patient in? has returned to normal. Remember the recovery stages starts
A. Initiation when the GFR (glomerular filtration rate) has returned to normal
B. Diuresis (normal GFR 90 mL/min or higher), which will allow waste levels
C. Oliguric and electrolyte levels to be maintained.
D. Recovery
The answers are: B, C, and D. This patient is in the DIURESIS
7. A 36 year old male patient is diagnosed with acute kidney injury. stage of AKI. The nephrons are now starting to filter out waste
The patient is voiding 4 L/day of urine. What complication can arise but cannot concentrate the urine. There is now a high amount
based on the stage of AKI this patient is in? Select all that apply: of urea in the filtrate (because the nephrons can filter the urea
A. Water intoxication out of the blood) and this causes osmotic diuresis. Urinary output
B. Hypotension will be excessive (3 to 6 L/day). Therefore, the patient is at risk
C. Low urine specific gravity for hypotension, diluted urine (low urine specific gravity), and
D. Hypokalemia hypokalemia (waste potassium in the urine). The patient is not at
E. Normal GFR risk for water intoxication and will not have a normal GFR until the
recovery stage.
8. True or False: All patients with acute renal injury will progress
The answer is FALSE. Some patients will skip the oliguric stage
through the oliguric stage of AKI but not all patients will progress
of AKI and progress to the diuresis stage.
through the diuresis stage.
9. Which patient below with acute kidney injury is in the oliguric
stage of AKI:
The answer is A. During the oliguric stage of AKI the patient will
A. A 56 year old male who has metabolic acidosis, decreased
have a urinary output of 400 mL/day or LESS. This is due to
GFR, increased BUN/Creatinine, hyperkalemia, edema, and uri-
nary output 350 mL/day.
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B. A 45 year old female with metabolic alkalosis, hypokalemia,
normal GFR, increased BUN/creatinine, edema, and urinary out-
a decreased GRF (glomerular filtration rate), which will lead to
put 600 mL/day.
increased amounts of waste in the blood (increased BUN/Creati-
C. A 39 year old male with metabolic acidosis, hyperkalemia,
nine), metabolic acidosis (decreased excretion of hydrogen ions),
improving GFR, resolving edema, and urinary output 4 L/day.
hyperkalemia, hypervolemia (edema/hypertension), and urinary
D. A 78 year old female with respiratory acidosis, increased GFR,
output of <400 mL/day.
decreased BUN/creatinine, hypokalemia, and urinary output 550
mL/day.
10. You're developing a nursing care plan for a patient in the
diuresis stage of AKI. What nursing diagnosis would you include The answer is B. During the diuresis stage of AKI, the patient will
in the care plan? be losing an excessive amount of urine (3-6 Liters/day) and is at
A. Excess fluid volume risk for fluid volume deficient and electrolyte imbalance. The nurse
B. Risk for electrolyte imbalance must monitor the patient's electrolyte levels, especially potassium
C. Urinary retention (hypokalemia).
D. Acute pain
11. While educating a group of nursing students about the stages
of acute kidney injury, a student asks how long the oliguric stage
lasts. You explain to the student this stage can last? The answer is A. The oliguric stage can last 1-2 weeks. Regarding
A. 1-2 weeks the other stages of AKI: Initiation: few hours to several days,
B. 1-3 days diuresis: 1-3 weeks, and recovery: 12 months or more.
C. Few hours to 2 weeks
D. 12 months
The answer is C. The patient with AKI, especially in the olig-
12. A patient with AKI has a urinary output of 350 mL/day. In uric stage of AKI, should eat a low-protein, low-potassium, and
addition, morning labs showed an increased BUN and creatinine low-sodium diet. This is because the kidneys are unable to filter
level along with potassium level of 6 mEq/L. What type of diet out waste products, excessive water, and maintain electrolyte
ordered by the physician is most appropriate for this patient? balance. The patient will have a buildup of waste (BUN and cre-
A. Low-sodium, high-protein, and low-potassium atinine). Remember these waste products are the byproduct of
B. High-protein, low-potassium, and low-sodium protein (urea) and muscle breakdown (creatinine). So the patient
C. Low-protein, low-potassium, and low-sodium should avoid high-protein foods. In addition, the patient is at risk
D. High-protein and high-potassium for hyperkalemia and fluid overload (needs low-potassium and
sodium foods).
The answer is C. This is known as Stage 4 of CKD because the
GFR (glomerular filtration rate) for this stage is 15-29 mL/min
1. A 55 year old male patient is diagnosed with chronic kidney (patient's GFR is 25 mL/min). The other stage's criteria are as
disease. The patient's recent GFR was 25 mL/min. What stage of follows:
chronic kidney disease is this known as? Stage 1: Kidney damage with normal renal function GFR >90
A. Stage 1 ml/min but with proteinuria (3 months or more);
B. Stage 3 Stage 2: Kidney damage with mild loss of renal function GFR
C. Stage 4 60-89 ml/min with proteinuria (3 months or more);
D. Stage 5 Stage 3: Mild-to-severe loss of renal function GFR 30-59 mL/min;
Stage 4: Severe loss renal function GFR 15-29 mL/min;
Stage 5: End stage renal disease GRF less 15 mL/min
2. A patient with CKD has a low erythropoietin (EPO) level. The
patient is at risk for? The answer is B. EPO (erythropoietin) helps create red blood cells
A. Hypercalcemia in the bone marrow. The kidneys produce EPO and when the
B. Anemia kidneys are damaged in CKD they can decrease in the production
C. Blood clots of EPO. Therefore, the patient is at risk for anemia.
D. Hyperkalemia
3. A 65 year old male patient has a glomerular filtration rate of
55 mL/min. The patient has a history of uncontrolled hypertension
The answer is A. There are two types of drugs that can be used to
and coronary artery disease. You're assessing the new medication
treat hypertension and protect the kidneys in patients with CKD.
orders received for this patient. Which medication ordered by
These drugs include angiotensin converting enzyme inhibitors
the physician will help treat the patient's hypertension along with
(ACE inhibitors) and angiotensin receptor blockers (ARBs). The
providing a protective mechanism to the kidneys?
only drug listed here that is correct is Lisinopril. This drug is known
A. Lisinopril
as an ACE inhibitor. Metoprolol is a BETA BLOCKER. Amlodipine
B. Metoprolol
and Verapamil are calcium channel blockers.
C. Amlodipine
D. Verapamil

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4. Which patient below is NOT at risk for developing chronic kidney
disease?
A. A 58 year old female with uncontrolled hypertension. The answer is C. Options A, B, and D are all at risk for developing
B. A 69 year old male with diabetes mellitus. CKD. However, option C is not at risk for CKD.
C. A 45 year old female with polycystic ovarian disease.
D. A 78 year old female with an intrarenal injury.
5. A patient with Stage 5 CKD is experiencing extreme pruritus
and has several areas of crystallized white deposits on the skin.
The answer is B. This patient is experiencing uremic frost that oc-
As the nurse, you know this is due to excessive amounts of what
curs in severe chronic kidney disease. This is due to high amounts
substance found in the blood?
of urea in the blood being secreted via the sweat glands onto the
A. Calcium
skin, which will appear as white deposits on the skin. The patient
B. Urea
will experience itching with this.
C. Phosphate
D. Erythropoietin
6. Your patient with chronic kidney disease is scheduled for dial-
ysis in the morning. While examining the patient's telemetry strip,
you note tall peaked T-waves. You notify the physician who orders The answer is D. The patient's potassium level is extremely ele-
a STAT basic metabolic panel (BMP). What result from the BMP vated. A normal potassium level is 3.5-5.1 mEq/L. This patient is
confirms the EKG abnormality? experiencing hyperkalemia, which can cause tall peak T-waves.
A. Phosphate 3.2 mg/dL Remember in CKD (especially prior to dialysis), the patient will
B. Calcium 9.3 mg/dL experience electrolyte imbalances, especially hyperkalemia.
C. Magnesium 2.2 mg/dL
D. Potassium 7.1 mEq/L
7. You are providing education to a patient with CKD about calcium
acetate. Which statement by the patient demonstrates they under- The answers are B and D. Calcium acetate (also known as
stood your teaching about this medication? Select-all-that-apply: PhosLo) is a phosphate binder, which will help keep the patient's
A. "This medication will help keep my calcium level normal." phosphate level from becoming too high. It helps excrete the phos-
B. "I will take this medication with meals or immediately after." phate taken in the food by excreting it out of the stool. Therefore, it
C. "It is important I consume high amounts of oatmeal, poultry, should be taken with meals or immediately after. Option C is wrong
fish, and dairy products while taking this medication." because the patient should AVOID these types of foods high in
D. "This medication will help prevent my phosphate level from phosphate.
increasing."
8. While assessing morning labs on your patient with CKD. You The answer is B. A normal phosphate level is 2.7-4.5 mg/dL.
note the patient's phosphate level is 6.2 mg/dL. As the nurse, you This patient is experiencing HYPERphosphatemia. When hyper-
expect to find the calcium level to be? phosphatemia presents the calcium level DECREASES because
A. Elevated phosphate and calcium bind to each. When there is too much
B. Low phosphate in the blood it takes too much calcium with it and it
C. Normal decreases the calcium in the blood. Therefore, the nurse would
D. Same as the phosphate level expect to find the calcium level decreased.
9. A patient with stage 4 chronic kidney disease asks what type of The answer is A. The patient should follow this type of diet be-
diet they should follow. You explain the patient should follow a: cause protein breaks down into urea (remember patient will have
A. Low protein, low sodium, low potassium, low phosphate diet increased urea levels), low sodium to prevent fluid excess, low
B. High protein, low sodium, low potassium, high phosphate diet potassium to prevent hyperkalemia (remember glomerulus isn't
C. Low protein, high sodium, high potassium, high phosphate diet filtering out potassium/phosphate as it should), and low phosphate
D. Low protein, low sodium, low potassium, high phosphate diet to prevent hyperphosphatemia.
10. The kidneys are responsible for performing all the following
functions EXCEPT?
A. Activating Vitamin D The answer is D. The adrenal glands are responsible for maintain-
B. Secreting Renin ing cortisol production not the kidneys.
C. Secreting Erythropoietin
D. Maintaining cortisol production
A client, newly diagnosed with chronic renal failure, has recently
begun hemodialysis. The nurse, establishing the client's plan of
care, includes monitoring the client for disequilibrium syndrome.
Which of the following symptoms will the nurse assess the client
for? B
a. Headache, nausea, vomiting, altered level of consciousness,
and hypotension.
b. Headache, nausea, vomiting, altered level of consciousness
and hypertension.
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c. Muscle cramps, seizure activity
d. Chills, fever, shortness of breath and discolored urine
2. A nurse is evaluating a client's demonstration of peritoneal
dialysis. Which of the following actions by the client demonstrates
a need for further teaching?
a. Primes the tubing with solution and connects it to the peritoneal
catheter, taping connections.
B
b. Instills the dialysate into the abdominal cavity quickly and
clamps the tubing.
c. Checks the tubing and catheter for kinks.
d. Opens clams and allows the dialysate to drain by gravity after
the prescribed dwell time.
3. A client is admitted for emergency dialysis for newly diagnosed
chronic renal failure. The nurse recognizes that which of the fol-
lowing laboratory values poses the greatest risk to the client?
a. BUN 40 mg/ml C
b. Serum Creatinine 5.8
c. Potassium 7.0 mEq/L
d. pH 7.30
4. Hemodialysis rids the body of harmful waste. What else does
hemodialysis remove?
a. Extra protein and fat
D
b. Extra sodium and potassium
c. Extra insulin
d. Extra water and sodium
5. What is the filter called that functions as an artificial kidney in
hemodialysis?
a. Hemolyzer
B
b. Dialyzer
c. Nephrolyzer
d. Kidneyzer
6. How often must hemodialysis be performed in order to be
effective?
a. Every day
C
b. Twice a week
c. Three times a week
d. Four times a week and prn
7. What is a common side effect for hemodialysis?
a. Muscle cramps
b. Dizziness and weakness, hypotension D
c. Nausea and vomiting
d. All of the above.
8. Which dietary mineral must be limited for a person on hemodial-
ysis?
a. Iron
D
b. Zinc
c. Sodium
d. Potassium
9. In peritoneal dialysis, which anatomic area acts as the filter for
this method of dialysis?
a. The lining of the stomach
C
b. The lining of the small intestine
c. The lining of the peritoneum
d. The lining of the abdomen
10. What is the most common complication of peritoneal dialysis?
a. Urinary retension
b. Peritonitis B
c. Abdominal pain
d. Infiltration

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11. What dietary regime would the nurse encourage clients who
are receiving peritoneal dialysis to engage in?
a. High carbohydrate diet
B
b. High protein intake
c. Low fat, low sodium diet
d. High fat, high carbohydrate diet.
12. The enterostomal therapist is consulting with the surgeon
regarding placement of a urinary stoma. Which of the following
locations should be suggested?
a. Lower abdominal quadrants A
b. Pubic area
c. Rib margins
d. Umbilical area
13. The nurse would anticipate that a client with rhabdomyolysis
would exhibit which of the following manifestations?
a. Gross hematuria
D
b. Clear yellow urine
c. Dark amber urine
d. Brown-tinged urine
14. The nurse determines that which of the following types of
antibiotics being prescribed for one or more of a group of clients
is least likely to cause nephrotoxicity?
a. A cephalosporin C
b. An aminoglycoside
c. A penicillin
d. A sulfonamide
15. Mrs. K is in the diuretic phase of acute renal failure. During this
phase, the client is assessed for signs of:
a. Hyperkalemia
D
b. Metabolic acidosis
c. Hypertension
d. Hypovolemia
16. Mrs. V is a client with oliguric acute renal failure. Which of
the following clinical manifestations would be consistent with that
diagnosis?
a. Urine specific gravity of 1.001 B
b. BUN :Creatinine ratio of 30:1.
c. Proteinuria
d. Hematuria
17. Which of the following is the most common overall sign of acute
renal failure?
a. Urine develops a fruity odor
B
b. Expected urine output increases or decreases significantly
c. Urine specific gravity is greater than 1.040
d. Urine develops a root beer color and consistency
18. Which of the following electrolyte imbalances tends to occur
in the earlier stages of chronic renal failure?
a. Hypokalemia
C
b. Hypercalcemia
c. Hyponatremia
d. Hypocalcemia
19. Which of the following clients with chronic renal failure would
not be a candidate for peritoneal dialysis?
a. A 50 year old man with cardiovascular disease
C
b. A 45 year old woman with diabetes mellitus
c. A 10 year old child with congenital urethral strictures
d. A 70 year old woman with tuberculosis.
20. During peritoneal dialysis. Mrs. H's dialysate white blood cell
count is 150/mm and neutrophils are 60%. This would indicate that
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the client has developed
a. Anemia
b. Pylenephritis D
c. Bowel perforation
d. Peritonitis
21. The nurse notes in the first few exchanges during peritoneal
dialysis of Mrs H that the effluent is pink-tinged. Which of the
following is the most appropriate action?
a. Stop the dialysis immediately C
b. Notify the physician
c. Continue the dialysis and observe
d. Send a specimen of the effluent for culture.
22. The nurse is caring for Mr. P, a chronic dialysis patient who has
an arteriovenous fistula, Nursing care of the fistula should include:
a. Irrigating the fistula with heparin to prevent clotting
b. Frequent dressing changes to prevent infection C
c. Washing the fistula site with soap and water
d. Checking blood pressure in the arm with the fistula to see if
circulation is adequate.
23. Mr. U is a client recently receiving hemodialysis treatments.
Following a treatment, the client complains of a severe headache
and he appears somewhat confused. Which of the following initial
actions by the nurse is most appropriate?
D
a. Check the client's blood pressure
b. Administer oxygen
c. Encourage the client to drink fluids
d. Notify the physician immediately
24. The nurse is providing instructions to a client about continuous
ambulatory peritoneal dialysis (CAPD). Which of the following
information would be included in discussions with this client?
a. There are four daily cycles with an 8 hour dwell for one cycle
during the night.
b. A small, lightweight pump must be carried in a pocket or on a A
belt.
c. This eliminates the need for strict aseptic technique when han-
dling the catheter.
d. The procedure involves instilling 250-500 ml of fluid into the
abdomen at a time.
25. The nurse performing intermittent peritoneal dialysis notes
that the client's medical record shows that the client has not had a
bowel movement for 3 days. The nurse would be careful to assess
the client for which of the following manifestations related to this
information? C
a. Fluid leakage
b. Cloudy dialysate output
c. Reduced catheter outflow
d. Increased thirst
26. The nurse would encourage the client receiving peritoneal
dialysis to do which of the following to manage low back pain
associated with increased weight in the abdomen?
a. Lying down as much as possible D
b. Walking on surfaces with gradual inclines
c. Reducing voluntary fluid intake
d. Performing specified exercises

27. The nurse would monitor which of the following laboratory

values to monitor the effect of epoetin alpha being given to a client
with chronic renal failure? A
a. Hematocrit
b. BUN

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c. Leukocyte count
d. Serum Creatinine
28. The nurse is conducting peritoneal dialysis for a client with
renal failure. The drainage tubing had no outflow. Which of the
following actions should the nurse take first?
a. Notify the physician B
b. Check the tubing for kinks or obstruction
c. Try a more concentrated dialysate solution
d. Apply a 5 pound sandbag to the abdomen
29. Select the most correct statement related to peritoneal dialysis
treatments.
a. Procedures require a venous access site.
D
b. Dialysate is infused slowly over 20-30 minutes
c. Dialysate solution is allowed to dwell for 1 hour
d. Dialysate needs to be prewarmed before infusion.
30. Clients are monitored consistently throughout the peritoneal
dialysis procedure for all the following except:
a. Increased appetite
A
b. Color of dialysate
c. Chvostek's sign
d. Low potassium

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