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WorksheetsChronic Kidney Disease
Total questions: 29
Worksheet time: 1hrs 14mins
Meet the Patient!
The client is an older adult with a long history of type 2 diabetes mellitus and hypertension. The client record notes a family history of polycystic kidney disease (PKD). The client was diagnosed with stage 4 chronic kidney disease (CKD) two years ago. The client calls the nephrology office to speak to the clinic nurse. The client reports loss of appetite, fatigue, nocturia, and occasional shortness of breath.
The client's current medications include a angiotension receptor blocker (ARB), a diuretic, and an oral diabetic medication. The client's most recent lab work (3 months ago) includes:
Hemoglobin: 10.5 g/dL (105 g/L)
Hematocrit: 30.0% (0.3 proportion of 1.0)
Creatinine: 2.25 mg/dL (171.56 mcmol/L)
Blood Urea Nitrogen (BUN): 25 mg/dL (8.92 mmol/L)
Glomerular Filtration Rate (GFR): 28 mL/min/1.73m2
Sodium: 132 mEq/L (132 mmol/L)
Potassium: 3.8 mEq/L (3.8 mmol/L)
Calcium: 8.9 mg/dL (2.23 mmol/L)
Phosphorus: 4.0 mg/dL (1.29 mmol/L)
Parathyroid Hormone (PTH): 98 pg/mL (98 ng/L)
The nurse reviews the client's medical history. What part of the medical history should the nurse consider relevant to the client's current history? (Select all that apply. One, some, or all options may be correct.)
Gender
Hypertension
Long term use of Furosemide
Polycystic Kidney Disease
Diabetes Mellitus
Which additional symptoms should the nurse ask about? (Select all that apply. One, some, or all options may be correct.)
Nausea
Clay-colored stool
Decreased attention span
Stridor
Itching
Based on the client's symptoms, what should the nurse suspect?
The client has anemia and may need to get a blood transfusion.
The client has a urinary tract infection and may need an antibiotic.
The client has a pneumonia and may need an inhaler.
The client has uremia and may need to start dialysis.
The nurse is teaching the client about progression of chronic kidney disease (CKD). Which evaluation statement documented by the nurse indicates the client's understanding of the disease process?
The client verbalizes understanding that their chronic kidney disease can be cured if diabetes and hypertension are controlled better.
The client understands that they will require a kidney transplant in order to live and they have a brother who will donate a kidney to them.
The client acknowledges that renal replacement therapy will need to be initiated immediately to rid the body of waste and maintain fluid balance.
The client understands that they are having a relapse of chronic kidney disease and requires dialysis until their kidneys have recovered.
The nurse contacts the healthcare provider (HCP) regarding the client's symptoms. The HCP orders laboratory testing.
The following diagnostic tests are performed and results are as follows:
Hemoglobin: 7.8 g/dL (78 g/L)
Hematocrit: 30% (0.30 proportion of 1.0)
Creatinine: 4.5 mg/dL (397.80 mcmol/L)
Blood urea nitrogen (BUN): 100 mg/dL (35.7 mmol/L)
Glomerular filtration rate (GFR): 9 mL/min/1.73m2
Sodium: 135 mEql/L (135 mmol/L)
Potassium: 5.5 mEq/L (5.5 mmol/L)
Calcium: 9.2 mg/dL (2.3 mmol/L)
Phosphorus: 5.5 mg/dL (1.78 mmol/L)
Parathyroid hormone: 182 pg/mL (182 mg/L)
Arterial blood gases: pH 7.35, PO2 96 mmHg, PCO2 30 mmHg, HCO3 18 mEq/L (18 mmol/L)
Which lab value would the nurse be most concerned about?
Glomerular filtration rate (GFR) of 9 mL/min/1.73m2.
Blood urea nitrogen (BUN) of 100 mg/dL (35.7 mmol/L).
Parathyroid hormone (PTH) of 182 pg/mL (182 ng/L).
Phosphorous of 5.5 mg/dL (1.78 mmol/L)
The client's hemoglobin level is 7.8 g/dL (78 g/L). What action should the nurse take?
Obtain a urine specimen to assess for hematuria.
Obtain an order to start an erythropoietin stimulating agent (ESA).
Continue to observe the client.
Send the client to the hospital for a blood transfusion.
The client's arterial blood gas (ABG) results are:
pH 7.35
PO2 96.0 mmHg
PCO2 30.0 mmHg
HCO3 18.0 mEq/L (18 mmol/L)
What is the correct interpretation of these ABGs?
Respiratory acidosis (compensated).
Respiratory alkalosis (compensated).
Metabolic acidosis (compensated).
Metabolic alkalosis (compensated).
The client's diagnostic tests support the medical diagnosis of end-stage renal disease (ESRD). The client is brought into the clinic to discuss laboratory results. The nurse assesses the client on arrival to the clinic. In addition to the client's report of fatigue, anorexia, dyspnea, and nocturia, the nurse's focused assessment findings include: +3 pedal edema, basilar crackles in both lungs, and clear, pale urine. The client's vital signs: temperature 98.8° F (37.1° C), heart rate 86 beats/minute, respirations 28 breaths/minute, and blood pressure 178/92 mmHg.
After the nurse completes the assessment, what findings are most important to report to the healthcare provider (HCP) ? (Select all that apply. One, some, or all options may be correct.)
Blood pressure of 178/92 mmHg.
Respiratory rate of 28 breaths per minute.
Bibasilar crackles.
Edema
Clear, pale urine.
The client receives prescriptions for the following medications:
Calcium acetate: 2 gelcaps (667 mg each) by mouth with each meal.
Ferrous sulfate: 1 tablet (65 mg) by mouth daily.
Epoetin alfa: 3900 units subcutaneously 3 times per week (dosed at 75 U/kg three times a week).
Glipizide: 10 mg by mouth daily 30 minutes before breakfast.
Furosemide: 40 mg by mouth twice daily.
Losartan: 50 mg by mouth twice daily.
Potassium chloride elixir: 40 mEq by mouth three times daily.
Which assessment finding indicates to the nurse that the desired outcome of the calcium acetate has been achieved?
Serum glucose of 90 mg/dL (5.0 mmol/L).
Serum phosphorous of 4.0 mg/dL (1.29 mmol/L).
Serum calcium level of 10.2 mg/dL (2.55 mmol/L).
Serum hemoglobin of 12 g/dL (120 g/L).
Which assessment should the nurse perform to determine if the desired outcome of the losartan has been achieved?
Apical pulse.
Blood pressure.
Intake and output.
Fingerstick glucose.
Which assessment data indicates to the nurse that the desired outcome of the epoetin alfa has been achieved?
Conjunctival sac returns to a reddish-pink color.
Consumed 100% of diet.
No evidence of edema.
Normoactive bowel sounds.
The client is admitted to an acute care facility for management of end-stage renal disease (ESRD). The nursing plan of care includes these nursing problems:
Excess fluid volume
Inpaired gas exchange
Decreased cardiac output
Inadequate nutrition
Risk for infection
Risk for injury
Fatigue
Anxiety
Constipation
Knowledge deficit
Based on these problems, which nursing intervention should be included in the client's plan of care?
Avoid any subcutaneous and intramuscular injections.
Encourage the client to ask questions and discuss fears about diagnosis.
Offer frequent high-protein snacks.
Encourage oral fluid intake.
The nurse notes that the ordered medications include potassium chloride elixir 40 mEq by mouth 2 times a day. Prior to administering the medication, the nurse monitors the client's serum potassium level, which is 6.5 mEq/L (6.5 mmol/L).
The nurse reports the serum potassium level to the healthcare provider's (HCP's) office nurse, who calls back and tells the nurse that the HCP wants the dose of potassium chloride reduced by half and changed to an oral tablet, rather than an elixir.
Which intervention is most important for the nurse to implement?
Ask the pharmacist to supply a tablet rather than an elixir since the client is on fluid restriction.
Hold the dose of potassium chloride and contact the HCP to report the serum potassium level.
Administer the dose of potassium chloride and document the serum potassium level in the medical record.
Calculate the milliliters of medication needed and record the amount on the fluid intake record.
Which intervention should the nurse implement?
Administer the prescribed tablet.
Request a faxed copy of the prescription.
Obtain the name of the office nurse.
Call and speak directly with the healthcare provider (HCP).
The nurse consults with the healthcare provider (HCP), who becomes angry, and tells the nurse that HCP orders should never be questioned. The HCP instructs the nurse to give the medication as ordered.
What action should the nurse take based on the response from the healthcare provider (HCP) phone call? (Select all that apply. One, some, or all options may be correct.)
Document both phone calls and the HCP's prescriptions.
Give the potassium chloride and document disagreement with carrying out prescription.
Notify the charge nurse and activate the chain of command.
Hold the potassium chloride.
Order another potassium level to confirm level is correct.
The nurse held the medication. The healthcare provider (HCP) calls and instructs the nurse to discontinue the potassium chloride. The HCP informs the nurse the client will need to start dialysis and he will be coming in to discuss this with the client.
The healthcare provider (HCP) and nurse discuss types of renal replacement therapy with the client. The HCP discusses the risk and benefits of hemodialysis, peritoneal dialysis, kidney transplantation, palliative care, and no treatment.
The nurse prepares and instructs the client for hemodialysis. Which statements by the client indicate the need for further education? (Select all that apply. One, some, or all options may be correct.)
Hemodialysis or peritoneal dialysis can be done at home.
Hemodialysis will help restore kidney function back to a normal level.
Bowel or bladder perforation may occur with hemodialysis catheter placement.
Hemodialysis requires a fistula or graft in the arm.
A dialyzer filters blood and removes waste products from the body.
What complication would the client be most concerned about if choosing peritoneal dialysis?
Abdominal infection/Peritonitis.
Osteoarthritis
Hepatitis B and C.
Hypertension
The client asks the nurse to clarify what palliative care involves. Which explanation provides the client the best education regarding palliative care? (Select all that apply. One, some, or all options may be correct.)
Palliative care provides relief from symptoms including pain.
Palliative care is the same thing as hospice.
Palliative care is aggressive treatment of end stage renal disease.
Palliative care supports holistic care and improves quality of life.
Palliative care minimizes the financial burden of end stage renal disease.
The client decides that hemodialysis is the preferred modality of renal replacement therapy. An arteriovenous (AV) graft is surgically placed in the right forearm, and a dual-lumen hemodialysis catheter is placed for temporary use until the permanent AV graft site heals.
While assessing the client's AV graft site, the nurse palpates a buzzing sensation directly over the graft.
The nurse documents the assessment of the arteriovenous (AV) graft. Which documentation best describes a properly functioning AV graft?
+4 bounding pulse palpated.
Bruit intact with palpation.
Thrill present and palpated.
Healthcare provider notified of graft occlusion.
Which intervention should the nurse ensure has been include in the client's plan of care? (Select all that apply. One, some, or all options may be correct.)
Instruct lab personnel to obtain blood specimens from the dual-lumen catheter.
Perform sterile dressing changes at the dual-lumen catheter site.
Empty and record the drainage from the graft tubing regularly.
Regularly rotate IV insertion sites above and below the graft site.
Assess the client's distal pulses and circulation in the arm with the access.
The nurse assesses the dialysis graft. Which assessment should be reported to the healthcare provider (HCP) immediately? (Select all that apply. One, some, or all options may be correct.)
Swelling in the arm where the graft is placed.
Yellow, purulent drainage from graft incision site.
Absence of a thrill over the graft site.
Capillary refill >10 seconds in the hand where the graft is placed.
Bruit ausculatated over the graft area.
The client is tolerating dialysis and discharge is scheduled. The nurse completes discharge teaching for the goal, "Client will manage diet effectively while receiving hemodialysis three times a week."
Which expected outcome should be included in the nurse's teaching plan?
Client will adhere to a low-protein diet.
Client will avoid canned and processed foods.
Client will identify the need to avoid fresh fruits and vegetables.
Client will identify the need to increase their fluid intake.
The nurse is teaching the patient about fluid management between dialysis treatments. Which instruction by the nurse is the most accurate?
Limit fluids in between treatments to minimize the amount of fluid that needs to be removed during dialysis.
Increase fluid intake between treatments to stay hydrated in between treatments.
Substitute ice chips for fluids to maintain hydration.
As long as you are still urinating, there is no need to restrict fluids.
After receiving hemodialysis for about a year, the client is scheduled to receive a kidney transplant from a family member. Following surgery, the client is transferred to the Surgical Intensive Care Unit (SICU). The client is drowsy but awakens easily. The incision is clean, dry, and intact. Vital signs are as follows: temperature 97.9° F (36.6° C), heart rate 78 beats/minute, respirations 16 breaths/minute, and blood pressure: 144/78 mmHg. Urine output is 50 mL per hour. There is a urinary drainage catheter in place. Point of care glucose level is 127.
Which is the priority nursing assessment during the first 24-hour postoperative period?
Vital signs.
Bowel sounds.
Urine Output
Pedal pulses
Which intervention should the nurse ensure is included in the plan of care during the immediate postoperative period?
Monitor the client's urinary output hourly using an urimeter.
Assess the client's surgical incision every shift.
Monitor the client's nasogastric tube every 4 hours.
Encourage the client to use the incentive spirometer daily.
The client's postoperative medications include immunosuppressive agents, which are used to reduce the risk of organ rejection.
Anti-thymocyte globulin (ATG): 4.5mg/kg IV x 1 dose
Methylprenisolone sodium succinate: 60 mg IV every 6 hours.
The nurse is preparing to give the client's medications. The anti-thymocyte globulin (ATG) comes in a vial with 25mg/10mL. the client weighs 132 lbs (60 kg). The Thymoglobulin will be infused over 6 hours. What rate should the nurse program on the infusion pump? (Enter the numerical value only. If rounding is necessary, round to the whole number.)
(a)
Which interventions are important to include in the client's plan of care while receiving multiple immunosuppressants? (Select all that apply. One, some, or all options may be correct.)
Instruct client to wear a mask when walking in the halls.
Instruct visitors that fresh flowers should not be taken into the room.
Change the IV site daily.
Reinforce, but do not routinely change any dressings.
Monitor immunosuppression drug levels regularly.
When the client is transferred from the SICU back to the Surgical Unit, the nurse receives a report on the client's condition. Report includes the following:
Vital Signs: temperature 100.5° F (38.1° C), heart rate 84 beats/minute, respirations 18 breaths/minute, blood pressure 108/76 mmHg.
Dressing dry and intact.
Pain level 2/10 with last pain medication 4 hours ago.
Most recent lab work:
BUN: 28 mg/dL (10 mmol/L)
Creatinine: 1.6 mg/dL (122.00 mcmol/L)
GFR: > 60 mL/min/1.73m2
Hemoglobin: 8.9 g/dL (89 g/L)
Potassium: 4.2 mEq/L (4.2 mmol/L)
The report includes orders that the client's IV needs to be converted to a saline lock and the urinary catheter needs to be removed after transfer to the Surgical Unit. The nurse on the Surgical Unit does a focused assessment, including vital signs, when the client arrived on the unit. Vital Signs: temperature 100.5° F (38° C), heart rate 102 beats/minute, respirations 20 breaths/minute, blood pressure 132/76 mmHg. The client reports incisional pain rated at a 6/10 from all the activity, and that the tape on the surgical dressing became loose during the transfer.
Which action should the nurse implement first?
Change the surgical dressing.
Administer an analgesic.
Convert the IV to a saline lock.
Remove the indwelling catheter.
Based on the nurse's assessment, which assessment data supports the decision to administer pain medication as the first intervention? (Select all that apply. One, some, or all options may be correct.)
Pain rating of 6/10.
Temperature of 100.5° F (38.1° C).
Heart rate of 102 beats/minute.
Respiratory rate of 20 breaths/minute.
Blood pressure of 132/76 mmHg.
Which action can be assigned to the unlicensed assistive personnel (UAP)?
Change the surgical dressing.
Administer an analgesic.
Convert the IV to a saline lock.
Measure the client's urinary output.
One week after surgery, the client is discharged home. Three days later, the client calls the transplant office to speak to the nurse. The client complains of abdominal pain that has become unbearable in the last couple of hours.
What is the best initial response by the nurse?
"Going home often causes anxiety, which can increase your pain."
"You may have developed a tolerance to your pain medication."
"Describe the location and type of pain you are having."
"The healthcare provider (HCP) will need to call you back later if you need more pain medication."
In response to the nurse's questions, the client admits to pain over the kidney area and cannot remember voiding during the last 24 hours.
Which instructions should the nurse give the client?
Instruct client to take prescribed diuretic and analgesic. When the client voids, the time and amount of urine should be recorded.
Advise the client to increase fluid intake and report any increase in weight.
Ask the client to monitor temperature and report a fever over 101° F (38.3° C).
Advise the client to come to the clinic right away for further evaluation.
The client returns to the clinic. Vital signs are: temperature 100.6° F (38.1° C), heart rate 88 beats/minute, respirations 24 breaths/minute, blood pressure 178/96 mmHg.
Lab work:
BUN: 56 mg/dL (19.99 mmol/L)
Creatinine: 1.9 mg/dL (144.88 mcmol/L)
Hemoglobin 9.6 g/dL (96 g/L)
Below therapeutic level of immunosuppression levels.
A renal scan is performed. Acute rejection of the kidney transplant is suspected.
What assessment data supports the diagnosis of acute organ rejection? (Select all that apply. One, some, or all options may be correct.)
Blood pressure of 178/96 mmHg.
Sub therapeutic immunosuppression levels.
Acute pain rated 6/10.
BUN of 56 mg/dL (19.99 mmol/L) and creatinine of 1.9 mg/dL (167.96 mcmol/L).
Temperature of 100.6° F (38.1° C).
The client is started on a regimen of high-dose immunosupressants. During the acute rejection period, the client's family member states to the nurse, "The client can't be having a rejection; I gave up my kidney. The doctors must have messed up something. I'll sue every one of them if this doesn't work."
What is the best response by the nurse?
"Don't blame the HCPs. They're doing everything possible."
"Why do you think the healthcare providers (HCPs) are at fault?"
"This is a very difficult time for you and your family."
"Your obvious anger will not help the client now."
The nurse recognizes that client's family member is grieving with their expression of anger.
What is the best nursing intervention for the family member's anger?
Educate the family member that this is a known complication of the procedure.
Encourage the family member to share frustration regarding the loss of the kidney
Share a story of another client who went through a similar experience.
Offer to call pastoral care for the family member.
