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c. high specific gravity.
A patient admitted with severe dehydra-
tion has a urine output of 380 ml over the
next 24 hours and elevated blood urea Rationale: The patient's renal failure has
nitrogen (BUN) and creatinine levels. A been caused by the prerenal problem of
finding that the nurse would expect when hypovolemia. Prerenal oliguria is char-
reviewing the patient's urinalysis is acterized by the ability of the kidneys
a. proteinuria. to concentrate urine, resulting in a high
b. bacteriuria. urine specific gravity. The urinalysis in in-
c. high specific gravity. trarenal failure would show proteins and
d. tubular casts. tubular casts. Bacteriuria would be typi-
cal of a urinary tract infection (UTI), not
renal failure.
b. initiate a 24-hour collection of the pa-
tient's urine.
To determine glomerular filtration rate
(GFR) for a patient with chronic kidney
disease, the nurse will plan to
a. schedule frequent blood urea nitrogen
Rationale: Creatinine clearance testing,
(BUN) tests.
the most accurate way to assess GFR,
b. initiate a 24-hour collection of the pa-
requires a 24-hour urine collection. BUN
tient's urine.
levels may increase for other reasons,
c. check the specific gravity on serial
such as dehydration, and are not as ac-
urine specimens.
curate in determining glomerular filtra-
d. use a bladder scanner to check for
tion. Urine-specific gravity testing and
residual urine.
monitoring residual urine would not be
useful in determining the GFR.
a. change the dressing
The client with chronic renal failure has
an indwelling abdominal catheter for
Rationale: Clients with peritoneal dialysis
peritoneal dialysis. The client spills water
catheters are at high risk for infection.
on the catheter dressing while bathing.
A wet dressing is a conduit for bacteria
The nurse should immediately:
to reach the catheter insertion site. The
a. change the dressing
nurse ensures that the dressing is kept
b. reinforce the dressing
dry at all times. Reinforcing the dressing
is not a safe practice to prevent infec-
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, tion in this circumstance. Flushing the
catheter is not indicated. Scrubbing the
c. flush the peritoneal dialysis catheter
catheter with povidone-iodine is done at
d. scrub the catheter with povidine-iodine
the time of connection or disconnection
of peritoneal dialysis.
The client with continuous ambulatory a. send fluid to the laboratory for culture
peritoneal dialysis (CAPD) has cloudy
dialysate. Which of the following is the
best initial nursing action?
a. send fluid to the laboratory for culture Rationale: cloudy diasylate indicates in-
b. administer antibiotic fection (peritonitis). Culture of the fluid
c. do nothing, this is expected must be done to determine the microor-
d. stop drainage of fluid ganism present.
Which of the following client responses
shows a correct understanding of con-
tinuous ambulatory peritoneal dialysis
(CAPD)?
a. I am expected to perform the proce-
a. I am expected to perform the proce-
dure at home
dure at home
b. the procedure lasts for one hour
c. I have to sit and raise my legs during
the procedure
d. I have to go to the hospital for this
procedure
A client has an arteriovenous (AV) fistula d. assess the fistula for the presence of
in place in the right upper extremity for a bruit and thrill every 4 hours
hemodialysis treatments. When planning
care for this client, which of the following
measures should the nurse implement to
promote client safely? Rationale: The presence of a thrill and
a. take blood pressures only on the right bruit indicates adequate blood flow
arm to ensure accuracy through the fistula. Pulse rate and quality
b. use the fistula for all venipunctures and are not good indicators of fistula paten-
intravenous infusions cy. Blood pressures should never be ob-
c. ensure that small clamps are attached tained on the arm with a fistula. Irrigation
to the AV fistula dressing of the fistula might damage the fistula,
d. assess the fistula for the presence of and typically only dialysis staff would ac-
a bruit and thrill every 4 hours cess the fistula.
The client with an external arteriovenous
shunt in place for hemodialysis is at risk