Chapter 31- Renal Failure My Nursing Test Banks

 

1.

An elderly male patient in the ICU is diagnosed with acute kidney injury. This patient demonstrates a decreased glomerular filtration rate and lowered urine sodium concentration, as well as increased BUN and serum creatinine levels. The nurse observes that the patient takes several minutes to empty his bladder when he uses the bathroom. His blood pressure and blood glucose levels are normal. What should the nurse suspect as the cause of this patients acute kidney injury?

A)

Tubular necrosis as a result of accumulation of radiocontrast dye in the renal tubular cells

B)

Obstruction of the flow of urine due to benign prostatic hypertrophy

C)

Lack of perfusion due to congestive heart failure

D)

Hypotension due to systemic inflammatory response to sepsis

2.

A patient develops toxic acute tubular necrosis (ATN) as a result of exposure to a radiocontrast dye. Which of the following should the nurse most expect to observe in this patient as this condition progresses beyond the onset phase?

A)

Normal potassium levels

B)

Duration of 7 to 14 days

C)

Normal urine concentrating function

D)

Normal urine volume

3.

A patient with acute kidney injury (AKI) demonstrates blue mottling of the skin in her fingers. What other finding would tend to indicate that the cause of this condition is intrarenal?

A)

Distended bladder

B)

Edema

C)

Strep throat infection

D)

Kinked Foley catheter

4.

A patient with acute kidney injury (AKI) demonstrates oliguria, a urine osmolality of 550 mOsm/kg H2O, increased urine specific gravity, urine sodium of 15 mEq/L, and a BUN:creatinine ratio of 23:1. Which of the following is a cause of AKI that would best fit with these findings?

A)

Congestive heart failure

B)

Nephrotoxicity due to aminoglycoside antibiotics

C)

Hypertension

D)

Retroperitoneal tumor

5.

A patient is concerned about her steadily worsening chronic kidney disease and asks the nurse at what point she will require dialysis or renal transplantation. Which of the following should the nurse mention?

A)

When your urine albumin-to-creatinine ratio is greater than 25 mg/g

B)

When your urine output is less than 0.5 mL/kg/h 6 h

C)

When your glomerular filtration rate (GFR) falls below 15 mL/min/1.73 m2

D)

When your urine osmolality is greater than 500 mOsm/kg H2O

6.

A patient with chronic kidney disease is receiving an ACE inhibitor. The nurse understands that this medication helps slow the progression of this disease through what process?

A)

It lowers the level of blood glucose.

B)

It prevents nephron hyperfiltration.

C)

It increases the urine output.

D)

It filters waste from the blood.

7.

A patient with prerenal acute kidney injury is oliguric. The nurse is administering an IV bolus to the patient. What should be of primary concern to the nurse while performing this task?

A)

Restricting the patients protein intake

B)

Monitoring the patients potassium level

C)

Evaluating the patient for signs of nephrotoxicity

D)

Preventing fluid overload

8.

A patient with acute kidney injury (AKI) complains of a headache. He vomits several times and breathes deeply and rapidly. His heart rate is 110 bpm, and his serum potassium level is elevated. The nurse recognizes in this patient which condition commonly associated with AKI?

A)

Fluid overload

B)

Anemia

C)

Metabolic acidosis

D)

Pericarditis

9.

A patient with chronic kidney disease has a serum potassium level of 5 mEq/L and no changes on the ECG. What is the proper nursing intervention?

A)

Administer sodium polystyrene as an enema.

B)

Administer IV calcium gluconate.

C)

Administer IV insulin and dextrose.

D)

Begin dialysis.

10.

A patient has been diagnosed with prerenal acute renal failure. What condition most likely caused this situation?

A)

Toxic levels of medications

B)

Poststreptococcal glomerulonephritis

C)

Severe sepsis and shock

D)

Benign prostatic hypertrophy

11.

The patient is in hypovolemic shock, with mean arterial pressures below 90 mm Hg and a very low urine output. An IV drip of norepinephrine is prescribed to keep blood pressure above 90 mm Hg. No other therapy is initiated. What effect on kidney function does the nurse expect?

A)

Improvement in renal perfusion secondary to improved blood pressure

B)

Reduction in urine output secondary to constriction of renal arteries

C)

Augmentation of water reabsorption from distal tubular fluid

D)

Decrease in urine sodium concentration to critically low levels

12.

In a patient with acute ischemic tubular necrosis, urine output has increased from below normal to very high. What is the nursing priority of care during this phase of renal failure?

A)

Restrict fluid intake

B)

Monitor serum potassium

C)

De-emphasize dialysis

D)

Monitor serum creatinine

13.

A patient with a history of diabetes mellitus has had a procedure using radiocontrast dye. The patients laboratory results include high urine sodium, urine with muddy-brown granular casts and tubular epithelial cells, and increased blood urea nitrogen (BUN) and serum creatinine. Renal ultrasonography is normal. Urine volume is normal. Which treatment does the nurse anticipate?

A)

Increased fluids

B)

Renal stent placement

C)

Irrigation of urinary catheter

D)

Diuretic therapy

14.

A patient in intensive care with acute tubular necrosis from a toxic ingestion has been started on renal replacement therapy. The family expresses concern that the patient will not be able to afford dialysis after discharge from the hospital. In responding to the family, what should the nurse consider?

A)

The family is in crisis and unable to respond rationally.

B)

Toxic acute tubular necrosis has a higher likelihood of complete healing.

C)

Since the patient is currently oliguric, renal replacement therapy is indicated.

D)

The patient is unlikely to survive this illness, so the cost of long-term dialysis is not an issue.

15.

A patient has just been diagnosed with type 2 diabetes mellitus. During teaching, what strategy should the nurse emphasize as protective of kidney cells?

A)

Monitoring glycosylated hemoglobin every 3 months

B)

Strict adherence to prescribed weight-loss diet

C)

Restriction of sodium-containing beverages and food

D)

Strict control of serum glucose levels with diet and medication

16.

A patient with chronic renal disease is involved in a motor vehicle crash and experiences severe hypovolemia. In caring for this patient in the CCU, which of the following is the most important for the nurse to monitor?

A)

Blood pressure

B)

Fluid volume recovery

C)

Urine output

D)

Cardiac dysrhythmias

17.

A patient has been diagnosed with chronic renal failure. What closely associated pathophysiologies should the nurse assess for? Select all that apply.

A)

Hypertension

B)

Arteriosclerotic disease

C)

Traumatic injury

D)

Type 2 diabetes mellitus

E)

Preeclampsia

F)

Type 1 diabetes mellitus

18.

A patient in oliguric renal failure is receiving IV furosemide (Lasix). What nursing assessment has the highest priority?

A)

Daily weights

B)

Intake and output

C)

Serum potassium

D)

Blood urea nitrogen

19.

A patient with chronic renal disease has mild metabolic acidosis with a pH 7.30 and bicarbonate level 16 mEq/L. What treatment does the nurse anticipate?

A)

IV sodium bicarbonate

B)

Reduction of respiratory rate

C)

Sodium citrate and citric acid (Bicitra)

D)

Massive IV fluids

20.

A patient with chronic renal failure also has chronic anemia, arteriosclerotic disease, and diabetes mellitus. The patient asks the nurse why the anemia is persisting. In answering the patients question, what should the nurse most consider?

A)

The patient most likely has preexisting chronic anemia.

B)

Erythropoietin is primarily produced in the kidney.

C)

The patient is receiving low-dose aspirin therapy.

D)

Chronic renal failure results in persistent uremia.

21.

The nurse is teaching a patient with chronic renal failure and diabetes mellitus about nutrition. What should be included?

A)

Calorie restriction based on ideal body weight is necessary.

B)

Sodium and potassium should be supplemented while on dialysis.

C)

Renal diet restrictions take the place of those for diabetes mellitus.

D)

Moderate protein restriction is recommended while otherwise healthy.

Answer Key

1.

B

2.

D

3.

C

4.

A

5.

C

6.

B

7.

D

8.

C

9.

A

10.

C

11.

B

12.

B

13.

A

14.

B

15.

D

16.

B

17.

A, B, D, F

18.

C

19.

C

20.

B

21.

D

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