Online Nursing Practice Test about Renal Disorders (36-40)

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36. The client with acute renal failure has a serum potassium of 6.0 mEq/L. The nurse would plan which of the following as a priority action?

a) check the sodium level
b) place the client on a cardiac monitor
c) encourage increased vegetables in the diet
d) allow an extra 500 ml of fluid intake to dilute the electrolyte concentration

37. The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication:

a) during dialysis
b) just before dialysis
c) the day after dialysis
d) on return form dialysis



38. The client with chronic renal failure has an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter dressing while bathing. The nurse should immediately:

a) change the dressing
b) reinforce the dressing
c) flush the peritoneal dialysis catheter
d) scrub the catheter with povidine-iodine

39. The client hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale and anxious. The nurse suspects air embolism. The priority action for the nurse is to:

a) discontinue dialysis and notify the physician
b) monitor vital signs every 15 minutes for the next hour
c) continue dialysis at a slower rate after checking the lines for air
d) bolus the client with 500 ml of normal saline to break up the air embolus

40. The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the best understands the information if the client states to record daily the:

a) amount of activity
b) pulse and respiratory rate
c) intake and output and weight
d) blood urea nitrogen and creatinine levels





ANSWERS AND RATIONALE

36) B
- The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Vegetables are a natural source of potassium in the diet, and their use would not be increased. The nurse also may assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action of the nurse.

37) D
- Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and also from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting an entire day to resume the medication. This would lead to ineffective control of the blood pressure.

38) A
- Clients with peritoneal dialysis catheters are at high risk for infection. A wet dressing is a conduit for bacteria to reach the catheter insertion site. The nurse ensures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnection of peritoneal dialysis.

39) A
- If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, notify the physician, and administer oxygen as needed. Options B, C, and D are incorrect.

40) C
- The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording intake and output and measuring weight daily. Ideally, the hemodialysis client should not gain more than 0.5 kg of weight/day.


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