Med-Surg Exam 2 (RENAL)||Newest
Exam With Over 150 Detailed
Questions And Correct Verified
Answers||Graded A+
1. The nurse is admitting a client diagnosed with acute renal failure (ARF). Which
question is most important for the nurse to ask during the admission interview?
1. "Have you recently traveled outside the United States?"
2. "Did you recently begin a vigorous exercise program?"
3. "Is there a chance you have been exposed to a virus?"
4. "What over-the-counter medications do you take regularly?" -CORRECT ANSWER 4.
Medications such as nonsteroidal
anti-inflammatory drugs (NSAIDs) and
some herbal remedies are nephrotoxic;
therefore, asking about medications is
appropriate.
2. The nurse is caring for a client diagnosed with ARF. Which laboratory values are
most
significant for diagnosing ARF?
1. BUN and creatinine.
2. WBC and hemoglobin.
3. Potassium and sodium.
4. Bilirubin and ammonia level. -CORRECT ANSWER 1. Blood urea nitrogen (BUN)
levels reflect
the balance between the production and
excretion of urea from the kidneys.
Creatinine is a by-product of the metabolism
of the muscles and is excreted by
the kidneys. Creatinine is the ideal substance
for determining renal clearance
because it is relatively constant in the
body and is the laboratory value most
significant in diagnosing renal failure.
3. The nurse is caring for a client diagnosed with rule-out ARF. Which condition
predisposes the client to developing prerenal failure?
1. Diabetes mellitus.
2. Hypotension.
3. Aminoglycosides.
,4. Benign prostatic hypertrophy. -CORRECT ANSWER 2. Hypotension, which causes a
decreased
blood supply to the kidney, is one of the
most common causes of prerenal failure
(before the kidney).
4. The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the
client is in the recovery period? Select all that apply.
1. Increased alertness and no seizure activity.
2. Increase in hemoglobin and hematocrit.
3. Denial of nausea and vomiting.
4. Decreased urine-specific gravity.
5. Increased serum creatinine level. -CORRECT ANSWER 1,2,3
5. The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which
collaborative treatment should the nurse anticipate for the client?
1. Administer a phosphate binder.
2. Type and crossmatch for whole blood.
3. Assess the client for leg cramps.
4. Prepare the client for dialysis. -CORRECT ANSWER 4. Normal potassium level is 3.5
to
5.5 mEq/L. A level of 6.8 mEq/L is life
threatening and could lead to cardiac
dysrhythmias. Therefore, the client may
be dialyzed to decrease the potassium
level quickly. This requires a health-care
provider order, so it is a collaborative
intervention.
6. The nurse is developing a plan of care for a client diagnosed with ARF. Which
statement is an appropriate outcome for the client?
1. Monitor intake and output every shift.
2. Decrease of pain by 3 levels on a 1-10 scale.
3. Electrolytes are within normal limits.
4. Administer enemas to decrease hyperkalemia. -CORRECT ANSWER 3. Renal failure
causes an imbalance of
electrolytes (potassium, sodium, calcium,
phosphorus). Therefore, the desired
client outcome is electrolytes within
normal limits.
7. The client diagnosed with ARF is admitted to the intensive care unit and placed on a
therapeutic diet. Which diet is most appropriate for the client?
1. A high-potassium and low-calcium diet.
2. A low-fat and low-cholesterol diet.
3. A high-carbohydrate and restricted-protein diet.
,4. A regular diet with six (6) small feedings a day. -CORRECT ANSWER 3.
Carbohydrates are increased to provide
for the client's caloric intake and protein
is restricted to minimize protein
breakdown and to prevent accumulation
of toxic waste products.
8. The client diagnosed with ARF is placed on bedrest. The client asks the nurse, "Why
do I have to stay in bed? I don't feel bad." Which scientific rationale supports the
nurse's response?
1. Bedrest helps increase the blood return to the renal circulation.
2. Bedrest reduces the metabolic rate during the acute stage.
3. Bedrest decreases the workload of the left side of the heart.
4. Bedrest aids in reduction of peripheral and sacral edema. -CORRECT ANSWER 2.
Bedrest reduces exertion and the
metabolic rate, thereby reducing
catabolism and subsequent release of
potassium and accumulation of
endogenous waste products (urea and
creatinine).
9. The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a
medical floor. Which nursing task is most appropriate for the nurse to delegate?
1. Collect a clean voided midstream urine specimen.
2. Evaluate the client's 8-hour intake and output.
3. Assist in checking a unit of blood prior to hanging.
4. Administer a cation-exchange resin enema. -CORRECT ANSWER 1. The UAP can
collect specimens.
Collecting a midstream urine specimen
requires the client to clean the perineal
area, to urinate a little, and then collect
the rest of the urine output in a sterile
container.
10. The client is admitted to the emergency department after a gunshot wound to the
abdomen. Which nursing intervention should the nurse implement first to prevent
ARF?
1. Administer normal saline IV.
2. Take vital signs.
3. Place client on telemetry.
4. Assess abdominal dressing. -CORRECT ANSWER 1. Preventing and treating shock
with
blood and fluid replacement will
prevent acute renal failure from
hypoperfusion of the kidneys.
Significant blood loss is expected in
, the client with a gunshot wound.
11. The UAP tells the nurse the client with ARF has a white crystal-like layer on top of
the skin. Which intervention should the nurse implement?
1. Have the assistant apply a moisture barrier cream to the skin.
2. Instruct the UAP to bathe the client in cool water.
3. Tell the UAP not to turn the client in this condition.
4. Explain this is normal and do not do anything for the client. -CORRECT ANSWER 2.
These crystals are uremic frost resulting
from irritating toxins deposited in the
client's tissues. Bathing in cool water
will remove the crystals, promote client
comfort, and decrease the itching
resulting from uremic frost.
12. The client diagnosed with ARF is experiencing hyperkalemia. Which medication
should the nurse prepare to administer to help decrease the potassium level?
1. Erythropoietin.
2. Calcium gluconate.
3. Regular insulin.
4. Osmotic diuretic. -CORRECT ANSWER 3. Regular insulin, along with glucose,
will drive potassium into the cells,
thereby lowering serum potassium
levels temporarily.
13. The nurse is caring for the client diagnosed with chronic kidney disease (CKD) who
is experiencing metabolic acidosis. Which statement best describes the scientific
rationale for metabolic acidosis in this client?
1. There is an increased excretion of phosphates and organic acids, which leads to an
increase in arterial blood pH.
2. A shortened life span of red blood cells because of damage secondary to dialysis
treatments in turn leads to metabolic acidosis.
3. The kidney cannot excrete increased levels of acid because they cannot excrete
ammonia or cannot reabsorb sodium bicarbonate.
4. An increase in nausea and vomiting causes a loss of hydrochloric acid and the
respiratory system cannot compensate adequately. -CORRECT ANSWER 3. This is the
correct scientific rationale
for metabolic acidosis occurring in the
client with CKD.
14. The nurse in the dialysis center is initiating the morning dialysis run. Which client
should the nurse assess first?
1. The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%.
2. The client who does not have a palpable thrill or auscultated bruit.
3. The client who is complaining of being exhausted and is sleeping.
Exam With Over 150 Detailed
Questions And Correct Verified
Answers||Graded A+
1. The nurse is admitting a client diagnosed with acute renal failure (ARF). Which
question is most important for the nurse to ask during the admission interview?
1. "Have you recently traveled outside the United States?"
2. "Did you recently begin a vigorous exercise program?"
3. "Is there a chance you have been exposed to a virus?"
4. "What over-the-counter medications do you take regularly?" -CORRECT ANSWER 4.
Medications such as nonsteroidal
anti-inflammatory drugs (NSAIDs) and
some herbal remedies are nephrotoxic;
therefore, asking about medications is
appropriate.
2. The nurse is caring for a client diagnosed with ARF. Which laboratory values are
most
significant for diagnosing ARF?
1. BUN and creatinine.
2. WBC and hemoglobin.
3. Potassium and sodium.
4. Bilirubin and ammonia level. -CORRECT ANSWER 1. Blood urea nitrogen (BUN)
levels reflect
the balance between the production and
excretion of urea from the kidneys.
Creatinine is a by-product of the metabolism
of the muscles and is excreted by
the kidneys. Creatinine is the ideal substance
for determining renal clearance
because it is relatively constant in the
body and is the laboratory value most
significant in diagnosing renal failure.
3. The nurse is caring for a client diagnosed with rule-out ARF. Which condition
predisposes the client to developing prerenal failure?
1. Diabetes mellitus.
2. Hypotension.
3. Aminoglycosides.
,4. Benign prostatic hypertrophy. -CORRECT ANSWER 2. Hypotension, which causes a
decreased
blood supply to the kidney, is one of the
most common causes of prerenal failure
(before the kidney).
4. The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the
client is in the recovery period? Select all that apply.
1. Increased alertness and no seizure activity.
2. Increase in hemoglobin and hematocrit.
3. Denial of nausea and vomiting.
4. Decreased urine-specific gravity.
5. Increased serum creatinine level. -CORRECT ANSWER 1,2,3
5. The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which
collaborative treatment should the nurse anticipate for the client?
1. Administer a phosphate binder.
2. Type and crossmatch for whole blood.
3. Assess the client for leg cramps.
4. Prepare the client for dialysis. -CORRECT ANSWER 4. Normal potassium level is 3.5
to
5.5 mEq/L. A level of 6.8 mEq/L is life
threatening and could lead to cardiac
dysrhythmias. Therefore, the client may
be dialyzed to decrease the potassium
level quickly. This requires a health-care
provider order, so it is a collaborative
intervention.
6. The nurse is developing a plan of care for a client diagnosed with ARF. Which
statement is an appropriate outcome for the client?
1. Monitor intake and output every shift.
2. Decrease of pain by 3 levels on a 1-10 scale.
3. Electrolytes are within normal limits.
4. Administer enemas to decrease hyperkalemia. -CORRECT ANSWER 3. Renal failure
causes an imbalance of
electrolytes (potassium, sodium, calcium,
phosphorus). Therefore, the desired
client outcome is electrolytes within
normal limits.
7. The client diagnosed with ARF is admitted to the intensive care unit and placed on a
therapeutic diet. Which diet is most appropriate for the client?
1. A high-potassium and low-calcium diet.
2. A low-fat and low-cholesterol diet.
3. A high-carbohydrate and restricted-protein diet.
,4. A regular diet with six (6) small feedings a day. -CORRECT ANSWER 3.
Carbohydrates are increased to provide
for the client's caloric intake and protein
is restricted to minimize protein
breakdown and to prevent accumulation
of toxic waste products.
8. The client diagnosed with ARF is placed on bedrest. The client asks the nurse, "Why
do I have to stay in bed? I don't feel bad." Which scientific rationale supports the
nurse's response?
1. Bedrest helps increase the blood return to the renal circulation.
2. Bedrest reduces the metabolic rate during the acute stage.
3. Bedrest decreases the workload of the left side of the heart.
4. Bedrest aids in reduction of peripheral and sacral edema. -CORRECT ANSWER 2.
Bedrest reduces exertion and the
metabolic rate, thereby reducing
catabolism and subsequent release of
potassium and accumulation of
endogenous waste products (urea and
creatinine).
9. The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a
medical floor. Which nursing task is most appropriate for the nurse to delegate?
1. Collect a clean voided midstream urine specimen.
2. Evaluate the client's 8-hour intake and output.
3. Assist in checking a unit of blood prior to hanging.
4. Administer a cation-exchange resin enema. -CORRECT ANSWER 1. The UAP can
collect specimens.
Collecting a midstream urine specimen
requires the client to clean the perineal
area, to urinate a little, and then collect
the rest of the urine output in a sterile
container.
10. The client is admitted to the emergency department after a gunshot wound to the
abdomen. Which nursing intervention should the nurse implement first to prevent
ARF?
1. Administer normal saline IV.
2. Take vital signs.
3. Place client on telemetry.
4. Assess abdominal dressing. -CORRECT ANSWER 1. Preventing and treating shock
with
blood and fluid replacement will
prevent acute renal failure from
hypoperfusion of the kidneys.
Significant blood loss is expected in
, the client with a gunshot wound.
11. The UAP tells the nurse the client with ARF has a white crystal-like layer on top of
the skin. Which intervention should the nurse implement?
1. Have the assistant apply a moisture barrier cream to the skin.
2. Instruct the UAP to bathe the client in cool water.
3. Tell the UAP not to turn the client in this condition.
4. Explain this is normal and do not do anything for the client. -CORRECT ANSWER 2.
These crystals are uremic frost resulting
from irritating toxins deposited in the
client's tissues. Bathing in cool water
will remove the crystals, promote client
comfort, and decrease the itching
resulting from uremic frost.
12. The client diagnosed with ARF is experiencing hyperkalemia. Which medication
should the nurse prepare to administer to help decrease the potassium level?
1. Erythropoietin.
2. Calcium gluconate.
3. Regular insulin.
4. Osmotic diuretic. -CORRECT ANSWER 3. Regular insulin, along with glucose,
will drive potassium into the cells,
thereby lowering serum potassium
levels temporarily.
13. The nurse is caring for the client diagnosed with chronic kidney disease (CKD) who
is experiencing metabolic acidosis. Which statement best describes the scientific
rationale for metabolic acidosis in this client?
1. There is an increased excretion of phosphates and organic acids, which leads to an
increase in arterial blood pH.
2. A shortened life span of red blood cells because of damage secondary to dialysis
treatments in turn leads to metabolic acidosis.
3. The kidney cannot excrete increased levels of acid because they cannot excrete
ammonia or cannot reabsorb sodium bicarbonate.
4. An increase in nausea and vomiting causes a loss of hydrochloric acid and the
respiratory system cannot compensate adequately. -CORRECT ANSWER 3. This is the
correct scientific rationale
for metabolic acidosis occurring in the
client with CKD.
14. The nurse in the dialysis center is initiating the morning dialysis run. Which client
should the nurse assess first?
1. The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%.
2. The client who does not have a palpable thrill or auscultated bruit.
3. The client who is complaining of being exhausted and is sleeping.
