Diagnostic Tests
Urinary Disorders
Hemodialysis & Peritoneal Dialysis
Renal Disease
Miscellaneous
100
When preparing a patient for a radiologic procedure what allergy is important to assess for?
What is Contrast Dye, seafood, shellfish allergies
100

A patient develops urinary incontinence.  What additional information should the nurse gather to determine a potential cause of the incontinence? 

Potential causes of incontinence: UTI, trauma, menopause, medication that affect cognition or mobility, diabetes, vaginal delivery or prolapse, neurologic diseases, anxiety and stress levels, stool frequency (stool impaction can cause incontinence. (Iggy ch 61  p. 1329)

100
what is the primary purpose of dialysis?
To remove waste products and excess fluid therefore restoring balance.
100

What is most accurate indicator of fluid loss or gain in a renal patient?

What is Weight

it is important to weigh the patient daily at the same time, same scale, same amount of clothing. 

100

Why are diuretics sometimes given to patients with CKD? 

Diuretics such as furosemide and bumetanide are often given to help lower blood pressure and potassium levels. They also can increase urine output to manage fluid volume overload. 

Note: these are only given when urinary elimination is still present. 

200
removing transdermal patches and piercings is important to instruct in what procedure?
What is MRI
200

What assessment finding is often associated as a first symptom of urothelial cancers? 

First symptom is often the presence of blood in the urine (usually painless) 


Late symptoms: gross hematuria, flank pain, palpable mass.

200
A patient receiving hemodialysis had an AVF (arteriovenous Fistula) placed 3 weeks ago. You are assessing your patient in the morning name 2 important assessments and nursing care r/t a AVF.
Palpate fistula for a thrill no B/P or labs in affected arm monitor site for bleeding and s/s of infection make sure sign is posted on wall NO LABS OR B/P
200

What is the difference between acute and chronic pyelonephritis? 

Acute pyelonephritis presents like an infection. 

Chronic pyelonephritis looks like kidney failure. 

Rationale: chronic inflammation causes scar tissue which damages the kidney and its ability to filter waste products. 

200

Why is Epoetin (Epogen) given to a patient with ESRD?

To increase RBC production.

 Rationale: Kidneys that are damaged do not produce erythropoietin that stimulates RBC production hence they are often anemic. It is important to monitor Hgb levels and RBCs while on this med. High RBC levels can increase blood viscosity and cause HTN and increased risk of MI. 

300
When caring for a patient who is a post Arteriogram/Angiogram what is your priority assessment? a. monitor output b. restrict activity x 1 day c. monitor peripheral pulses d. monitor bleeding @ femoral artery
D. Monitor bleeding at femoral artery.
300
A patient is in your office states that they have had blood in their urine that does not cause pain. What would you infer based on this data?
The patient should be evaluated for a possible bladder neoplasm. Rationale: painless hematuria is a common s/s in patients with bladder neoplasms.
300

What intervention is done by the nurse in a patient receiving dialysis in order to determine if correct amount of fluid is removed from the patient?

Obtain a weight before and after dialysis. Rationale: Weight is way to determine the fluid status of the patient. Sometimes referred to as a "wet" or "dry" weight (before dialysis = wet weight and after dialysis= dry weight)

300

Which of the following lab values are increased in ESKD? (select all that apply)

a- creatinine

b- BUN

c- potassium

d- calcium

e- RBC/Hgb

f- GFR

Answers- creatinine, BUN, Potassium 

Calcium is decreased in ESKD r/t increased reabsorption of Ca+ from the bone. 

GFR is decreased in ESKD because the kidney are filtering less blood. 

300

During what stage of renal failure does a provider generally recommend starting a patient on dialysis? 

Stage 4

During this stage, the GFR is severely decreased 15-29), waste elimination is poor. The kidneys need help doing their job (filtering out bad). 

400
What is a major complication of a Renal biopsy?
Bleeding at the site.
400

A nurse is teaching a patient with ESKD who is receiving hemodialysis. How should the nurse address the patient's protein needs? (high or low protein diet)

High protein diet

Rationale: patients in ESKD or on dialysis need more protein r/t the loss of protein during dialysis. A person in early kidney disease will need a low protein diet to help preserve kidney function. GFR and the type of treatment the patient is receiving will guide safe levels of protein intake. 

400

A patient complains of not feeling good after dialysis. This is caused by a condition that delays the removal of waste from the brain. What is this condition called?

A patient complains of fatigue, headache and nausea after hemodialysis. What is the name of this condition?

What is Disequilibrium syndrome.

Rationale: caused from rapid reduction of electrolytes and other particles during hemodialysis. Severe symptoms of this syndrome=mental status changes, seizures or coma which are rare today. Slowing the HD rate can help prevent this syndrome. 

400

A patient is receiving calcium carbonate three times a day with meals. Why is this med ordered this way?

Calcium carbonate (Tums) is given at mealtimes to bind with phosphorous in foods thus lowering phosphorous levels via the colon (stool/ bowel movements). 

400

Patients are often given Kayexalate (sodium polystyrene sulfonate) who are in ESKD. Why is this given and what is its action?

Kayexalate lowers potassium levels in ESKD patients by binding to potassium and excreting through the GI tract.

500
A 24 hour urine is collected for creatinine clearance. What would the nurse expect to see if the kidneys are not functioning properly?
Creatinine clearance level would be low in impaired kidney function. Rationale: creatinine is "cleared" totally by kidneys. If not working you will see low urine cr levels and high serum cr levels.
500

A patient in ESKD is experiencing fluid overload. Which of the following assessment findings would indicate signs of fluid overload?  (select all that apply) 

A. bilateral pedal edema 

B. b/p 110/60

C. crackles in lung fields 

D. urine output 200 ml in 24 hours

E. generalized edema

Answers: 

A- pedal edema

C- crackles in lung fields

D- urine output 200 ml in 24 hrs.

E- generalized edema

 

500
While monitoring a patient at home perform peritoneal dialysis what assessment finding would alert you that the patient is developing an infection?
Cloudy dialysate fluid is returned.
500

Name 2 lab values that you will significantly see elevated when kidneys are unable to filter waste products adequately?

Elevation in BUN and serum creatinine 

Rationale: BUN measures urea which should be excreted by kidneys. BUN is NOT seen elevated in blood if the kidneys are doing their job. 

Creatinine: evaluates kidney function. Cr. is a by-product of the breakdown of muscle and is excreted by kidneys.When the kidneys are not doing their job, you will see higher creatinine levels in the blood. 

500

A nurse is reviewing a patients med list during a clinic visit. The patient states that they are currently taking 2 tabs of ibuprofen 800 mg 4 times a day for arthritis pain. What teaching should the nurse do with the client regarding this medication? 

Ibuprofen is a nephrotoxic medication. The maximum dose of ibuprofen used as an anti-inflammatory is 400-800 mg 4 times daily not to exceed 3200 mg/day. 

This patient is taking 2 of the 800 mg tablets with each dose 4 times a day which is 6400 mg. This is way too much. Patient needs education and provider should be notified for follow up. 

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