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ORIGINAL 2024-2025 VERSION QUARANTEE PASS (Exam 4: Chronic Kidney Disease NCLEX ) QUESTIONS AND ANWERS 100%CORRECT
a
A patient is admitted to the hospital with CKD. The nurse understands that this condition is characterized by
a. progressive irreversible destruction of the kidneys
b. a rapid decrease in urine output with an elevated BUN
c. an increasing creatinine clearance with a decrease in urine output
d. prostration, somnolence, and confusion with coma and imminent death
a
b
d
Patients with CKD experience an increase incidence of cardiovascular disease related to Select all that apply
a. hypertension
b. vascular calcifications
c. a genetic predisposition
d. hyperinsulinemia causing dyslipidemia
e. increased high-density lipoprotein levels
a
An ESRD patient receiving HD is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, the nurse informs the patient that
a. successful transplantation usually provides a better quality of life than that offered by dialysis
b. if rejection of the transplanted kidney occurs, no further treatment for the renal failure is available
c. HD replaces the normal function of the kidneys, and patients do not have to live with the continual fear of rejection
d. the immunosuppressive therapy following transplantation makes the person ineligible to receive other forms of treatment if the kidney fails
c
d
e
To assess the patency of a newly placed arteriovenous graft for dialysis, the nurse should Select all that apply
a. monitor the BP in the affected arm
b. irrigate the graft daily with low-dose heparin
c. palpate the area of the graft to feel a normal thrill
d. listen with a stethoscope over the graft to detect a bruit
e. frequently monitor the pulses and neurovascular status distal to the graft
a
A major advantage of peritoneal dialysis is
a. the diet is less restricted and dialysis can be performed at home
b. the dialysate is biocompatible and causes no long-term consequences
c. high glucose concentrations of the dialysate causes a reduction in appetite, promoting weight loss
b. sensory neuropathy
c. vascular calcifications
d. calcium-phosphate skin deposits
e. uremic crystallization from high BUN
c
What causes the GI manifestation of stomatitis in the patient with CKD?
a. high serum sodium levels
b. irritation of the GI tract from creatinine
c. increased ammonia from bacterial breakdown of urea
d. iron salts, calcium-containing phosphate binders, and limited fluid intake
c
The patient with CKD is brought to the ED with Kussmaul respirations. What does the nurse know about CKD that could cause this patient's Kussmaul respirations?
a. uremic pleuritis is occurring
b. there is decreased pulmonary macrophage activity
c. they are caused by respiratory compensation for metabolic acidosis
d. pulmonary edema from HF and fluid overload is occurring
d
Which serum laboratory value indicates to the nurse that the patient's CKD is getting worse?
a. decreased BUN
b. decreased sodium
c. decreased creatinine
d. decreased calculated GFR
b
What is the most serious electrolyte disorder associated with kidney disease?
a. hypocalcemia
b. hyperkalemia
c. hyponatremia
d. hypermagnesemia
d
What is the most appropriate snack for the nurse to offer a patient with stage 4 CKD?
a. raisins
b. ice cream
c. dill pickles
d. hard candy
c. have the patient empty the bowel before the inflow phase
d. reposition the patient frequently and promote deep breathing
a
A man with ESRD is scheduled for HD following healing of an arteriovenous fistula. What should the nurse explain to him that will occur during dialysis?
a. he will be able to visit, read, sleep, or watch TV while reclining in a chair
b. he will be placed on a cardiac monitor to detect any adverse effects that may occur
c. the dialyzer will remove and hold part of his blood for 20-30 minutes to remove the waste products
d. a large catheter with two lumens will be inserted into the fistula to send blood to and return it from the dialyzer
d
A patient rapidly progressing toward ESRD asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that what is a contraindication to kidney transplantation?
a. hepatitis C infection
b. coronary artery disease
c. refractory hypertension
d. extensive vascular disease
a
During the immediate postoperative care of a recipient of a kidney transplant, what is a priority for the nurse to do?
a. regulate fluid intake hourly based on urine output
b. monitor urine-tinged drainage on abdominal dressing
c. medicate the patient frequently for incisional flank pain
d. remove the urinary catheter to evaluate the ureteral implant
a
A patient received a kidney transplant last month. Because of the effects of immunosuppressive drugs and CKD, what complication of transplantation should the nurse be assessing the patient for?
a. infection
b. rejection
c. malignancy
d. cardiovascular disease
b
The home care nurse visits a 34-yr-old woman receiving peritoneal dialysis. Which statement indicates a need for immediate follow-up by the nurse?
a. "Drain time is faster if I rub my abdomen."
b. "The fluid draining from the catheter is cloudy."
c. "The drainage is bloody when I have my period."
d. "I wash around the catheter with soap and water."
d
The nurse preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD). Which laboratory result will the nurse monitor to determine if the desired effect was achieved?
a. Sodium
b. Potassium
c. Magnesium
d. Phosphorus
b
A patient with a 25-year history of type 1 diabetes mellitus is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse notes newly developed hypertension and uncontrolled blood sugars. Which diagnostic study is most indicative of chronic kidney disease (CKD)?
a. Serum creatinine
b. Serum potassium
c. Microalbuminuria
d. Calculated glomerular filtration rate (GFR)
a
A 78-yr-old patient has stage 3 CKD and is being taught about a low-potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat?
a. Apple, green beans, and a roast beef sandwich
b. Granola made with dried fruits, nuts, and seeds
c. Watermelon and ice cream with chocolate sauce
d. Bran cereal with ½ banana and milk and orange juice
c
During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first?
a. Administer hypertonic saline.
b. Administer a blood transfusion.
c. Decrease the rate of fluid removal.
d. Administer antiemetic medications.
b
A 24-yr-old woman donated a kidney via a laparoscopic donor nephrectomy to a nonrelated recipient. The patient is experiencing significant pain and refuses to get up to walk. How should the nurse respond?
a. Have the transplant psychologist convince her to walk.
b. Encourage even a short walk to avoid complications of surgery.
c. Tell the patient that no other patients have ever refused to walk.
d. Tell the patient she is lucky she did not have an open nephrectomy.
a
c
e
Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD)? Select all that apply
a. Anemia
b. Dehydration
c. Hypertension
d. Hypercalcemia
e. Increased risk for fractures
a. Blood pressure
b. Phosphate level
c. Neurologic status
d. Creatinine clearance
c
Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess the
a. blood urea nitrogen (BUN) and creatinine.
b. blood glucose level.
c. patients bowel sounds.
d. level of consciousness (LOC).
a
The nurse has instructed a patient who is receiving hemodialysis about appropriate dietary choices. Which menu choice by the patient indicates that the teaching has been successful?
a. Scrambled eggs, English muffin, and apple juice
b. Oatmeal with cream, half a banana, and herbal tea
c. Split-pea soup, whole-wheat toast, and nonfat milk
d. Cheese sandwich, tomato soup, and cranberry juice
a
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
a. is much less likely to clot.
b. increases patient mobility.
c. can accommodate larger needles.
d. can be used sooner after surgery.
a
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?
a. Check the fistula site for a bruit and thrill.
b. Assess the rate and quality of the left radial pulse.
c. Compare blood pressures in the left and right arms.
d. Irrigate the fistula site with saline every 8 to 12 hours.
c
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. Increased calories are needed because glucose is lost during hemodialysis.
b. Unlimited fluids are allowed since retained fluid is removed during dialysis.
c. 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.
d
Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?
a. The patient slows the inflow rate when experiencing pain.
b. The patient leaves the catheter exit site without a dressing.
c. The patient plans 30 to 60 minutes for a dialysate exchange.
d. The patient cleans the catheter while taking a bath every day.
a
When the nurse is taking a history for a patient who is a possible candidate for a kidney transplant, which information about the patient indicates that the patient is not an appropriate candidate for transplantation?
b. Milk of magnesia 30 mL
c. Calcium phosphate (PhosLo)
d. Acetaminophen (Tylenol) 650 mg
c
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 giving the prescribed epoetin alfa (Procrit)?
a. Creatinine 1.2 mg/dL
b. Oxygen saturation 89%
c. Hemoglobin level 13 g/dL
d. Blood pressure 98/56 mm Hg
b
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?
a. Educate patient about fluid restrictions.
b. Check blood pressure before starting dialysis.
c. Assess for reasons for increase in predialysis weight.
d. Determine the ultrafiltration rate for the hemodialysis.
b
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?
a. The patient has an outflow volume of 1800 mL.
b. The patients peritoneal effluent appears cloudy.
c. The patient has abdominal pain during the inflow phase.
d. The patient complains of feeling bloated after the inflow.
c
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?
a. The urine output is 900 to 1100 mL/hr.
b. The blood urea nitrogen (BUN) and creatinine levels are elevated.
c. The patients central venous pressure (CVP) is decreased.
d. The patient has level 8 (on a 10-point scale) incisional pain.
c
During hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first?
a. Slow down the rate of dialysis.
b. Obtain blood to check the blood urea nitrogen (BUN) level.
c. Check the patients blood pressure.
d. Give prescribed PRN antiemetic drugs.
c
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?
a. Heart rate
b. Blood urea nitrogen (BUN) level
c. Urine output
d. Creatinine clearance
a. take the BP in the arm with the fistula
b. report the loss of a thrill or bruit on the arm with the fistula
c. maintain a pressure dressing on the shunt
d. start a second IV in the arm with the fistula
b
d
e
A client with chronic renal failure who receives hemodialysis 3 times a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? Select all that apply
a. drink fluids before eating solid foods
b. have limited amounts of fluids only when thirsty
c. limit activity
d. keep all dialysis appointments
e. eat smaller, more frequent meals
a
The dialysis solution is warmed before use in peritoneal dialysis primarily to
a. encourage the removal of serum urea
b. force potassium back into the cells
c. add extra warmth to the body
d. promote abdominal muscle relaxation
b
A client is receiving peritoneal dialysis. While the dialysis solution is dwelling in the client's abdomen, the nurse should
a. assess for urticaria
b. observe respiratory status
c. check capillary refill time
d. monitor electrolyte status
b
During the PD, the nurse observes that the solution draining from the client's abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. The nurse should recognize that the bleeding
a. is expected with a permanent peritoneal catheter
b. indicates abdominal blood vessel damage
c. can indicate kidney damage
d. is caused by too-rapid infusion of the dialysate
b
During PD, the nurse observes that the flow of dialysate stops before all the solution has drained out. The nurse should
a. have the client sit in a chair
b. turn the client from side to side
c. reposition the peritoneal catheter
d. have the client walk
