1

After the insertion of an arteriovenous graft (AVG) in c. "I need to get most of my protein from low-fat dairy
the right forearm, a 54-year-old patient complains of diluting nephrotoxic substances. products."
pain and coldness of the right fingers. Which action d. b.
should the nurse take? preventing systemic hypertension. b. "I will increase my intake of fruits and vegetables to
a. maintaining cardiac output 5 per day."
Teach the patient about normal AVG function. A patient who has acute glomerulonephritis is c.
b. hospitalized with hyperkalemia. Which information "I will measure my urinary output each day to help
Remind the patient to take a daily low-dose aspirin will the nurse monitor to evaluate the effectiveness calculate the amount I can drink."
tablet. of the prescribed calcium gluconate IV? d.
c. a. "I need to take erythropoietin to boost my immune
Report the patient's symptoms to the health care Urine volume system and help prevent infection." c. i will
provider. b. measure my urinary output each day to help
d. Calcium level calculate the amount I can drink
Elevate the patient's arm on pillows to above the c. Which information will the nurse monitor in order to
heart level. c. report the patient's symptoms to Cardiac rhythm determine the effectiveness of prescribed calcium
the healthcare provider d. carbonate (Caltrate) for a patient with chronic kidney
When a patient with acute kidney injury (AKI) has an Neurologic status c. cardiac rhythm disease (CKD)?
arterial blood pH of 7.30, the nurse will expect an A 48-year-old patient with stage 2 chronic kidney a.
assessment finding of disease (CKD) is scheduled for an intravenous Blood pressure
a. pyelogram (IVP). Which order for the patient will the b.
persistent skin tenting nurse question? Phosphate level
b. a. c.
rapid, deep respirations. NPO for 6 hours before procedure Neurologic status
c. b. d.
bounding peripheral pulses. Ibuprofen (Advil) 400 mg PO PRN for pain Creatinine clearance b. phosphate level
d. c. Sodium polystyrene sulfonate (Kayexalate) is
hot, flushed face and neck. b. rapid, deep Dulcolax suppository 4 hours before procedure ordered for a patient with hyperkalemia. Before
respirations d. administering the medication, the nurse should
The nurse is planning care for a patient with severe Normal saline 500 mL IV infused before procedure assess the
heart failure who has developed elevated blood urea b. ibuprofen 400 mg PO PRN for pain a.
nitrogen (BUN) and creatinine levels. The primary Which statement by a 62-year-old patient with stage bowel sounds.
collaborative treatment goal in the plan will be 5 chronic kidney disease (CKD) indicates that the b.
a. nurse's teaching about management of CKD has blood glucose.
augmenting fluid volume. been effective? c.
b. a. blood urea nitrogen (BUN).
maintaining cardiac output. d.

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level of consciousness (LOC). a. bowel sounds Blood urea nitrogen (BUN) level c. glomerular Unlimited fluids are allowed because retained fluid is
Which menu choice by the patient who is receiving filtration rate removed during dialysis.
hemodialysis indicates that the nurse's teaching has A patient will need vascular access for hemodialysis. c.
been successful? Which statement by the nurse accurately describes More protein is allowed because urea and creatinine
a. an advantage of a fistula over a graft? are removed by dialysis.
Split-pea soup, English muffin, and nonfat milk a. d.
b. A fistula is much less likely to clot. Dietary potassium is not restricted because the level
Oatmeal with cream, half a banana, and herbal tea b. is normalized by dialysis. c. more protein is
c. A fistula increases patient mobility. allowed because urea and creatinine are removed
Poached eggs, whole-wheat toast, and apple juice c. by dialysis
d. A fistula can accommodate larger needles. Which action by a 70-year-old patient who is using
Cheese sandwich, tomato soup, and cranberry juice d. peritoneal dialysis (PD) indicates that the nurse
c. poached eggs, whole-wheat toast, and A fistula can be used sooner after surgery. a. should provide more teaching about PD?
apple juice a fistula is much less likely to clot a.
Before administration of calcium carbonate (Caltrate) When caring for a patient with a left arm The patient leaves the catheter exit site without a
to a patient with chronic kidney disease (CKD), the arteriovenous fistula, which action will the nurse dressing.
nurse should check laboratory results for include in the plan of care to maintain the patency of b.
a. the fistula? The patient plans 30 to 60 minutes for a dialysate
potassium level. a. exchange.
b. Auscultate for a bruit at the fistula site. c.
total cholesterol. b. The patient cleans the catheter while taking a bath
c. Assess the quality of the left radial pulse. each day.
serum phosphate. c. d.
d. Compare blood pressures in the left and right arms. The patient slows the inflow rate when experiencing
serum creatinine. c. serum phosphate d. abdominal pain. c. the patient cleans the catheter
A 37-year-old female patient is hospitalized with Irrigate the fistula site with saline every 8 to 12 hours while taking a bath each day
acute kidney injury (AKI). Which information will be a. auscultate for a bruit at the fistula site Which information in a patient's history indicates to
most useful to the nurse in evaluating improvement A 64-year-old male patient who has had progressive the nurse that the patient is not an appropriate
in kidney function? chronic kidney disease (CKD) for several years has candidate for kidney transplantation?
a. just begun regular hemodialysis. Which information a.
Urine volume about diet will the nurse include in patient teaching? The patient has type 1 diabetes.
b. a. b.
Creatinine level Increased calories are needed because glucose is The patient has metastatic lung cancer.
c. lost during hemodialysis. c.
Glomerular filtration rate (GFR) b. The patient has a history of chronic hepatitis C
d. infection.

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d. Multivitamin with iron a.

The patient is infected with the human b. Creatinine 1.6 mg/dL
immunodeficiency virus. b. the patient has Magnesium hydroxide b.
metastatic lung cancer c. Oxygen saturation 89%
Which assessment finding may indicate that a Acetaminophen (Tylenol) c.
patient is experiencing adverse effects to a d. Hemoglobin level 13 g/dL
corticosteroid prescribed after kidney Calcium phosphate (PhosLo) b. magnesium d.
transplantation? hydroxide Blood pressure 98/56 mm Hg c. hemoglobin level
a. Before administration of captopril (Capoten) to a 13 g/dL
Postural hypotension patient with stage 2 chronic kidney disease (CKD), Which intervention will be included in the plan of
b. the nurse will check the patient's care for a male patient with acute kidney injury (AKI)
Recurrent tachycardia a. who has a temporary vascular access catheter in the
c. glucose. left femoral vein?
Knee and hip joint pain b. a.
d. potassium. Start continuous pulse oximetry.
Increased serum creatinine c. knee and hip c. b.
joint pain creatinine. Restrict physical activity to bed rest.
A 38-year-old patient who had a kidney transplant 8 d. c.
years ago is receiving the immunosuppressants phosphate. b. potassium Restrict the patient's oral protein intake.
tacrolimus (Prograf), cyclosporine (Sandimmune), A patient with diabetes who has bacterial pneumonia d.
and prednisone (Deltasone). Which assessment is being treated with IV gentamicin (Garamycin) 60 Discontinue the urethral retention catheter. b.
data will be of most concern to the nurse? mg IV BID. The nurse will monitor for adverse effects restrict physical activity to bedrest
a. of the medication by evaluating the patient's A 25-year-old male patient has been admitted with a
The blood glucose is 144 mg/dL. a. severe crushing injury after an industrial accident.
b. blood glucose. Which laboratory result will be most important to
There is a nontender axillary lump. b. report to the health care provider?
c. urine osmolality. a.
The patient's skin is thin and fragile. c. Serum creatinine level 2.1 mg/dL
d. serum creatinine. b.
The patient's blood pressure is 150/92. b. there is d. Serum potassium level 6.5 mEq/L
a non-tender axillary lump serum potassium. c. serum creatinine c.
The nurse in the dialysis clinic is reviewing the home A 55-year-old patient with end-stage kidney disease White blood cell count 11,500/µL
medications of a patient with chronic kidney disease (ESKD) is scheduled to receive a prescribed dose of d.
(CKD). Which medication reported by the patient epoetin alfa (Procrit). Which information should the Blood urea nitrogen (BUN) 56 mg/dL b. serum
indicates that patient teaching is required? nurse report to the health care provider before giving potassium levell 6.5
a. the medication?

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A 72-year-old patient with a history of benign
prostatic hyperplasia (BPH) is admitted with acute
urinary retention and elevated blood urea nitrogen
(BUN) and creatinine levels. Which prescribed
therapy should the nurse implement first?
a.
Insert urethral catheter.
b.
Obtain renal ultrasound.
c.
Draw a complete blood count.
d.
Infuse normal saline at 50 mL/hour. a. insert
urethral catheter
A 62-year-old female patient has been hospitalized
for 8 days with acute kidney injury (AKI) caused by
dehydration. Which information will be most
important for the nurse to report to the health care
provider?
a.
The creatinine level is 3.0 mg/dL.
b.
Urine output over an 8-hour period is 2500 mL.
c.
The blood urea nitrogen (BUN) level is 67 mg/dL.
d.
The glomerular filtration rate is <30 mL/min/1.73m2.
b. urine output over an 8 hour period is 2500
ml
A patient with acute kidney injury (AKI) has longer
QRS intervals on the electrocardiogram (ECG) than
were noted on the previous shift. Which action
should the nurse take first?
a.
Notify the patient's health care provider.
b.
Document the QRS interval measurement.
c.
Check the medical record for most recent potassium
level.
d.
Check the chart for the patient's current creatinine
level. c. document the QRS interval measurement
A 42-year-old patient admitted with acute kidney
injury due to dehydration has oliguria, anemia, and
hyperkalemia. Which prescribed actions should the
nurse take first?
a.
Insert a urinary retention catheter.
b.
Place the patient on a cardiac monitor.
c.
Administer epoetin alfa (Epogen, Procrit).
d.
Give sodium polystyrene sulfonate (Kayexalate) b.
place the patient on a cardiac monitor
A patient has arrived for a scheduled hemodialysis
session. Which nursing action is most appropriate
for the registered nurse (RN) to delegate to a
dialysis technician?
a.
Teach the patient about fluid restrictions.
b.
Check blood pressure before starting dialysis.
c.
Assess for causes of an increase in predialysis
weight.
d.
Determine the ultrafiltration rate for the
hemodialysis. b. check blood pressure before
starting dialysis
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A licensed practical/vocational nurse (LPN/LVN) is
caring for a patient with stage 2 chronic kidney
disease. Which observation by the RN requires an
intervention?
a.
The LPN/LVN administers the erythropoietin
subcutaneously.
b.
The LPN/LVN assists the patient to ambulate out in
the hallway.
c.
The LPN/LVN administers the iron supplement and
phosphate binder with lunch.
d.
The LPN/LVN carries a tray containing low-protein
foods into the patient's room. c. the LPN
administers the iron supplement and phosphate
binder with lunch
A female patient with chronic kidney disease (CKD)
is receiving peritoneal dialysis with 2 L inflows.
Which information should the nurse report
immediately to the health care provider?
a.
The patient has an outflow volume of 1800 mL.
b.
The patient's peritoneal effluent appears cloudy.
c.
The patient has abdominal pain during the inflow
phase.
d.
The patient's abdomen appears bloated after the
inflow. b. the patient's peritoneal effluent appears
cloudy
The nurse is assessing a patient 4 hours after a
kidney transplant. Which information is most
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important to communicate to the health care d. Patient with stage 4 chronic kidney disease who has
provider? Blood urea nitrogen (BUN) level b. urine output an elevated phosphate level
a. A patient complains of leg cramps during c.
The urine output is 900 to 1100 mL/hr. hemodialysis. The nurse should first Patient with stage 5 chronic kidney disease who has
b. a. a potassium level of 3.4 mEq/L
The patient's central venous pressure (CVP) is massage the patient's legs. d.
decreased. b. Patient who has just returned from having
c. reposition the patient supine. hemodialysis and has a heart rate of 124/min d.
The patient has a level 7 (0 to 10 point scale) c. patient who has just returned from having
incisional pain. give acetaminophen (Tylenol). hemodialysis and has a heart rate of 124/min
d. d. Which information will be included when the nurse is
The blood urea nitrogen (BUN) and creatinine levels infuse a bolus of normal saline. d. infuse a bolus of teaching self-management to a patient who is
are elevated. b. the patient's central venous saline receiving peritoneal dialysis (select all that apply)?
pressure is decreased A 74-year-old who is progressing to stage 5 chronic a.
During routine hemodialysis, the 68-year-old patient kidney disease asks the nurse, "Do you think I Avoid commercial salt substitutes.
complains of nausea and dizziness. Which action should go on dialysis? Which initial response by the b.
should the nurse take first? nurse is best? Drink 1500 to 2000 mL of fluids daily.
a. a. c.
Slow down the rate of dialysis. "It depends on which type of dialysis you are Take phosphate-binders with each meal.
b. considering." d.
Check patient's blood pressure (BP). b. Choose high-protein foods for most meals.
c. "Tell me more about what you are thinking regarding e.
Review the hematocrit (Hct) level. dialysis." Have several servings of dairy products daily.
d. c. a,c,d
Give prescribed PRN antiemetic drugs. b. check "You are the only one who can make the decision
patient's blood pressure about dialysis."
The nurse is titrating the IV fluid infusion rate d.
immediately after a patient has had kidney "Many people your age use dialysis and have a
transplantation. Which parameter will be most good quality of life."
important for the nurse to consider? After receiving change-of-shift report, which patient
a. should the nurse assess first?
Heart rate a.
b. Patient who is scheduled for the drain phase of a
Urine output peritoneal dialysis exchange
c. b.
Creatinine clearance

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