NCLEX Practice Exam: Renal Failure & Dialysis, Part 1
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Renal Failure & Dialysis
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The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment the nurse notes that the client’s temperature is 100.2. Which of the following is the most appropriate nursing action?
Monitor the site of the shunt for infection
Notify the physician
Continue to monitor vital signs
Question 1 Explanation:
Continue to monitor vital signs The client may have an elevated temperature following dialysis because the dialysis machine warms the blood slightly. If the temperature is elevated excessively and remains elevated, sepsis would be suspected and a blood sample would be obtained as prescribed for culture and sensitivity purposes.
In a client in renal failure, which assessment finding may indicate hypocalcemia?
Increased blood coagulation
Serum calcium level of 5 mEq/L
Question 2 Explanation:
Diarrhea In renal failure, calcium absorption from the intestine declines, leading to increased smooth muscle contractions, causing diarrhea. CNS changes in renal failure rarely include headache. A serum calcium level of 5 mEq/L indicates hypercalcemia. As renal failure progresses, bleeding tendencies increase.
A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the client’s status after dialysis?
VS and BUN
VS and weight
Potassium level and weight
BUN and creatinine levels
Question 3 Explanation:
VS and weight Following dialysis, the client’s vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client’s predialysis weight to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has ended.
The nurse is reviewing a list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response knowing that the glucose:
Prevents excess glucose from being removed from the client.
Prevents disequilibrium syndrome
Decreases risk of peritonitis.
Increases osmotic pressure to produce ultrafiltration.
Question 4 Explanation:
Increases osmotic pressure to produce ultrafiltration. Increasing the glucose concentration makes the solution increasingly more hypertonic. The more hypertonic the solution, the greater the osmotic pressure for ultrafiltration and thus the greater amount of fluid removed from the client during an exchange.
A client newly diagnosed with renal failure is receiving peritoneal dialysis. During the infusion of the dialysate the client complains of abdominal pain. Which action by the nurse is most appropriate?
Stop the dialysis
Explain that the pain will subside after the first few exchanges
Decrease the amount to be infused
Slow the infusion
Question 5 Explanation:
Explain that the pain will subside after the first few exchanges Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however, the pain usually disappears after 1 to 2 weeks of treatment. The infusion amount should not be decreased, and the infusion should not be slowed or stopped.
A client is admitted to the hospital and has a diagnosis of early stage chronic renal failure. Which of the following would the nurse expect to note on assessment of the client?
Question 6 Explanation:
Polyuria Polyuria occurs early in chronic renal failure and if untreated can cause severe dehydration. Polyuria progresses to anuria, and the client loses all normal functions of the kidney. Oliguria and anuria are not early signs, and polydipsia is unrelated to chronic renal failure.
The nurse is assisting a client on a low-potassium diet to select food items from the menu. Which of the following food items, if selected by the client, would indicate an understanding of this dietary restriction?
Question 7 Explanation:
Lima beans Cantaloupe (1/4 small), spinach (1/2 cooked) and strawberries (1 ¼ cups) are high potassium foods and average 7 mEq per serving. Lima beans (1/3 c) averages 3 mEq per serving.
A client is undergoing peritoneal dialysis. The dialysate dwell time is completed, and the dwell clamp is opened to allow the dialysate to drain. The nurse notes that the drainage has stopped and only 500 ml has drained; the amount the dialysate instilled was 1,500 ml. Which of the following interventions would be done first?
Clamp the catheter and instill more dialysate at the next exchange time.
Check the catheter for kinks or obstruction.
Call the physician.
Change the client’s position.
Question 8 Explanation:
Check the catheter for kinks or obstruction. The first intervention should be to check for kinks and obstructions because that could be preventing drainage. After checking for kinks, have the client change position to promote drainage. Don’t give the next scheduled exchange until the dialysate is drained because abdominal distention will occur, unless the output is within parameters set by the physician. If unable to get more output despite checking for kinks and changing the client’s position, the nurse should then call the physician to determine the proper intervention.
A client has a history of chronic renal failure and received hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which of the following interventions is included in this client’s plan of care?
Assess the AV fistula for a bruit and thrill
Keep the AV fistula site dry.
Keep the AV fistula wrapped in gauze.
Take the blood pressure in the left arm
Question 9 Explanation:
Assess the AV fistula for a bruit and thrill Assessment of the AV fistula for bruit and thrill is important because, if not present, it indicates a non-functioning fistula. No blood pressures or venipunctures should be taken in the arm with the AV fistula. When not being dialyzed, the AV fistula site may get wet. Immediately after a dialysis treatment, the access site is covered with adhesive bandages.
The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of a headache and nausea and is extremely restless. Which of the following is the most appropriate nursing action?
Elevate the head of the bed
Notify the physician
Monitor the client
Medicate the client for nausea
Question 10 Explanation:
Notify the physician Disequilibrium syndrome may be due to the rapid decrease in BUN levels during dialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments with anticonvulsant medications and barbituates may be necessary to prevent a life-threatening situation. The physician must be notified.
The hemodialysis client with a left arm fistula is at risk for steal syndrome. The nurse assesses this client for which of the following clinical manifestations?
Pallor, diminished pulse, and pain in the left hand.
Edema and reddish discoloration of the left arm
Aching pain, pallor, and edema in the left arm.
Warmth, redness, and pain in the left hand.
Question 11 Explanation:
Pallor, diminished pulse, and pain in the left hand. Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, which is due to tissue ischemia. Warmth, redness, and pain more likely would characterize a problem with infection.
Dialysis allows for the exchange of particles across a semipermeable membrane by which of the following actions?
Passage of solute particles toward a solution with a higher concentration.
Passage of fluid toward a solution with a lower solute concentration
Osmosis and diffusion
Allowing the passage of blood cells and protein molecules through it.
Question 12 Explanation:
Osmosis and diffusion Osmosis allows for the removal of fluid from the blood by allowing it to pass through the semipermeable membrane to an area of high concentrate (dialysate), and diffusion allows for passage of particles (electrolytes, urea, and creatinine) from an area of higher concentration to an area of lower concentration. Fluid passes to an area with a higher solute concentration. The pores of a semipermeable membrane are small, thus preventing the flow of blood cells and protein molecules through it.
Which of the following factors causes the nausea associated with renal failure?
Accumulation of waste products
Question 13 Explanation:
Accumulation of waste products Although clients with renal failure can develop stress ulcers, the nausea is usually related to the poisons of metabolic wastes that accumulate when the kidneys are unable to eliminate them. The client has electrolyte imbalances and oliguria, but these don’t directly cause nausea.
The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis?
Monitor the clients level of consciousness
Maintain strict aseptic technique
Add heparin to the dialysate solution
Change the catheter site dressing daily
Question 14 Explanation:
Maintain strict aseptic technique The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although option 4 may assist in preventing infection, this option relates to an external site.
A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic renal failure. Which finding indicates that the fistula is patent?
Capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand.
Presence of a radial pulse in the left wrist
Absence of bruit on auscultation of the fistula.
Palpation of a thrill over the fistula
Question 15 Explanation:
Palpation of a thrill over the fistula The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Although the presence of a radial pulse in the left wrist and capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand are normal findings, they do not assess fistula patency.
A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of 200/100, a heart rate of 110, and a respiratory rate of 36. Oxygen saturation on room air is 89%. He complains of shortness of breath, and +2 pedal edema is noted. His last hemodialysis treatment was yesterday. Which of the following interventions should be done first?
Prepare the client for hemodialysis.
Restrict the client’s fluids
Elevate the foot of the bed
Question 16 Explanation:
Administer oxygen Airway and oxygenation are always the first priority. Because the client is complaining of shortness of breath and his oxygen saturation is only 89%, the nurse needs to try to increase his levels by administering oxygen. The client is in pulmonary edema from fluid overload and will need to be dialyzed and have his fluids restricted, but the first interventions should be aimed at the immediate treatment of hypoxia. The foot of the bed may be elevated to reduce edema, but this isn’t the priority.
Which of the following clients is at greatest risk for developing acute renal failure?
A teenager who has an appendectomy
A dialysis client who gets influenza
A pregnant woman who has a fractured femur
A client with diabetes who has a heart catherization
Question 17 Explanation:
A client with diabetes who has a heart catherization Clients with diabetes are prone to renal insufficiency and renal failure. The contrast used for heart catherization must be eliminated by the kidneys, which further stresses them and may produce acute renal failure. A teenager who has an appendectomy and a pregnant woman with a fractured femur isn’t at increased risk for renal failure. A dialysis client already has end-stage renal disease and wouldn’t develop acute renal failure.
The client with chronic renal failure is at risk of developing dementia related to excessive absorption of aluminum. The nurse teaches that this is the reason that the client is being prescribed which of the following phosphate binding agents?
Amphojel (aluminum hydroxide)
Tums (calcium carbonate)
Alu-cap (aluminum hydroxide)
Basaljel (aluminum hydroxide)
Question 18 Explanation:
Tums (calcium carbonate) Phosphate binding agents that contain aluminum include Alu-caps, Basaljel, and Amphojel. These products are made from aluminum hydroxide. Tums are made from calcium carbonate and also bind phosphorus. Tums are prescribed to avoid the occurrence of dementia related to high intake of aluminum. Phosphate binding agents are needed by the client in renal failure because the kidneys cannot eliminate phosphorus.
The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for:
Hypotension, bradycardia, and hypothermia
Headache, deteriorating level of consciousness, and twitching.
Hypertension, tachycardia, and fever
Restlessness, irritability, and generalized weakness
Question 19 Explanation:
Headache, deteriorating level of consciousness, and twitching. Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, and vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.
A client is diagnosed with chronic renal failure and told she must start hemodialysis. Client teaching would include which of the following instructions?
Use alcohol on the skin and clean it due to integumentary changes.
There will be a few changes in your lifestyle.
Follow a high potassium diet
Strictly follow the hemodialysis schedule
Question 20 Explanation:
Strictly follow the hemodialysis schedule To prevent life-threatening complications, the client must follow the dialysis schedule. Alcohol would further dry the client’s skin more than it already is. The client should follow a low-potassium diet because potassium levels increase in chronic renal failure. The client should know hemodialysis is time-consuming and will definitely cause a change in current lifestyle.
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