1.SomeconditionsthatcontributetothedevelopmentofCKDmayincludethefollowingdiseaseprocesses.

Whichofthe
followingisleastlikelytobeadirectcauseofCKD?
a.

Chronicobstructivepulmonarydisease(COPD)

b.

Diabetesmellitus(type1and2)

c.

Systemiclupus

d.

Hypertension

2.Oneofthenegativesassociatedwithperitonealdialysisincludesproteinmalnutrition.Whatarethecausesofprotein
malnutrition?
a.

Lossofaminoacidsandproteininthedialysate

b.

Decreasedappetiteduetoglucoseloadfromdialysate

c.

Lackofproteinintakeduetohighcarbohydratediet

d.

aandb

3.Mostaluminumisproteinboundsothekidneysmaynotbeabletofilteritoutoftheblood.Itisthenstoredinvarioustissues
inthebody,includingthebrainandbone.Whatarethesymptomsofaluminumtoxicity?
a.

Nausea,vomiting,diarrhea,fever,chills,upperrespiratorytractinfection,elevatedwhitebloodcount,headache

b.

Behavioralchanges,memoryloss,slurredspeech,lackofenergy,lossofappetitebonedisease,dementia,anemia,constipation

c.

Jointpainandredness,gangreneoffingersandtoes,backpain,fractures,itching

d.

Nausea,vomiting,poorappetite,metallictaste,fetidbreath,GIbleeding,diarrhea,functionalconstipation

4.Manyfactorsaffectthesuccessfulremovaloftoxinsduringdialysis.Whichofthefollowingiscorrect?
a.

Lowertemperatureofdialysate=higheramountofsolutesremoved

b.

Slowerflowofdialysate=greaterremovalofsolutes

c.

Lowermolecularweightofsolutes=moresolutesremoved

d.

Greaterbloodflowrate=lesserremovalofsolutes

5.Whichofthefollowingbestdefinesconcentrationgradient?
a.

Thedifferenceinhydrostaticpressurebetweenthebloodandthedialysatesolution

b.

Themovementofsoluteparticlesfromthesideofhigherconcentrationtothesideoflowerconcentrationthroughthedialysis
membrane

c.

Therateofmovementthroughamembrane

d.

Theconcentrationofacertaintypeofparticleishigherononesideofamembranethanontheotherside

CertifiedDialysisNurse(CDN)AnswerKey
1.Answer:A
AlthoughmanyelderlypatientsmayalsosufferfromchronicobstructivepulmonarydiseaseitisnotconsideredadirectcauseofCKD.
Diabetesmellitus(bothtype1andtype2),systemiclupus,andhypertensionarealldiseasesthatcontributetothedevelopmentofCKD.
2.Answer:D
Someofthenegativesassociatedwithperitonealdialysis(PD)includeproteinmalnutritionandinadequatedialysis.Theprotein
malnutritionresultsfromthelossofaminoacidsandproteininthedialysate.Theappetiteisdecreasedbecauseoftheglucoseload
absorbedfromthedialysis.Thisfrequentlyresultsinhypertriglyceridemia,whichcausesweightgainfromthecaloricincrease(notfrom
ahighcarbohydratediet).
3.Answer:B
Sincealuminumisusuallystoredinthebrainorthebones,behavioralchanges,memoryloss,slurredspeech,lackofenergy,dementia,
andbonediseasearesymptomsofaluminumtoxicity.Anemia,constipation,andlossofappetitearealsorelatedtoanexcessiveamount
ofaluminuminthebody.Nausea,vomiting,diarrhea,fever,chills,upperrespiratorytractinfection,elevatedWBC,andheadachecould
besymptomsofinfluenzaormultipleotherinfectiousprocesses.Jointpainandredness,gangrene,backpain,fractures,anditchingare
classicsymptomsofosteodystrophy.Nausea,vomiting,metallictaste,fetidbreath,GIbleeding,diarrhea,andfunctionalconstipationare
theGIeffectsofuremia.
4.Answer:C
Thelowerthemolecularweightofthesolutes,thegreatertheamountofsolutesthatwillberemoved.Thehigherthetemperature,the
greatertheamountofsolutesremoved,thefastertheflowrateofthedialysate,thegreatertheremovalofsolutes,andthefastertheblood
flow,thegreatertheamountofsolutesremoved.
5.Answer:D
Concentrationgradientisthetermusedwhentheconcentrationofacertainparticleishigherononesideofamembranethanonthe
otherside.Transmembranepressure(TMP)referstothedifferenceinhydrostaticpressurebetweenthebloodandthedialysatesolution.
Diffusive,orconductivetransport,referstothemovementofsoluteparticlesfromthesideofhigherconcentrationtothesideoflower
concentrationthroughthedialysismembrane.Masstransferrate,orsoluteflux,referstotherateofmovementthroughamembrane.
1.Diabeticnephropathyresultsfromanelevationofbloodpressure,increasingtheworkloadoftheglomeruli.Theglomeruli
thickenandallowserumalbumintopassintotheurine.Whichofthefollowingsignsandsymptomsindicatediabetic
nephropathy?
a.

Edemaaroundtheeyesuponawakening,progressingtogeneralswellingofthelegsandbody

b.

Weightgain,malaise,fatigue,andfrothyurine

c.

Rustcoloredurine,weightloss,andbackpain

d.

AandC

e.

AandB

2.Whatstepsneedtobetakentodiagnoseandeliminatetheproblemofdialysateleakageduringperitonealdialysis?
a.

UseaDextrosticktoascertainthepresenceofglucose.

b.

Resuturetheexitsite,andstabilizeorreplacethecatheter.

c.

LDiscontinueperitonealdialysistoallowforhealing,ordecreasetheinfusiontimewiththepatientlyingontheleftside.

d.

BothAandBaretrue.

e.

BothBandCaretrue.

3.Certainprecautionsmustbefollowedwhenperformingdialysisonarecenttransplantrecipient.Allofthefollowing
statementsregardingdialysisfortheposttransplantpatientaretrueEXCEPT:
a.

Closeobservationisnecessaryforhypotensionbecauseoftheriskofinternalbleedinginfirst24hourspostsurgery;a
physicianmustbealertedifhypotensionoccurs.

b.

Hypotensionmustbeavoidedtopreventischemiaofthenewlytransplantedkidney,eveniffluidremovalduringdialysisis
compromised.

c.

Highdoseheparinmustbeusedtopreventpostoperativeclotting;

d.

Observationisnecessaryforelectrolyteimbalance,especiallyhyperkalemia.

4.Apatientisadmittedwiththefollowingsignsandsymptoms:edemaaroundtheeyesuponawakening,progressingtogeneral
swellingofthelegsandbody;weightgain;fatigue;headache;nausea;vomiting;frequenthiccoughs;anditching.Aurine
specimenisobtained,andtheurineisfrothy.Thepatienthasahistoryofinsulindependentdiabetes(type1diabetes),whichis
poorlycontrolled,andhighbloodpressure,andhisbloodworkcomesbackshowinganelevatedcholesterollevel.Whichofthe
followingdiseaseprocesseswouldyoususpect?
a.

Nephrosclerosis

b.

Diabeticnephropathy

c.

Polycystickidneydisease

d.

Amyloidosis

5.Damagedkidneyslosetheirabilitytoproduceerythropoietin,ahormonethatstimulatestheformationofredbloodcells.
Whatisusuallyprescribedtostimulateerythropoiesisinpatientswithchronickidneydisease?
a.

Epoetinalfa(Epogen,Procrit)

b.

CinacalcetHCl(Sensipar)

c.

Furosemide(Lasix)orbumetanide(Bumex)

d.

Sevelamerhydrochloride(Renagel)

CertifiedNephrologyNurse(CNN)AnswerKey
1.Answer:E
Symptomsandsignsofdiabeticnephropathyincludeedemaaroundtheeyesuponawakening,progressingtogeneralswellingofthelegs
andbody,weightgain,frothyurine,malaise,fatigue,nauseaandvomiting,headache,hiccoughs,andpruritus.Serumcreatinineand
bloodureanitrogenlevelselevateatthisstage.Theadditionaldiagnosisofretinopathymaybeevident.
2.Answer:D
Stepsthatneedtobetakeninclude:(1)useaDextrosticktoascertainthepresenceofglucose,(2)resuturetheexitsite,(3)discontinue
peritonealdialysisforaminimumof2weekstoallowhealing,(3)ifunabletostoptherapy,decreasevolumewithautomatedperitoneal
dialysisinsupineposition;and(4)stabilizeorreplacethecatheter.
3.Answer:C
Themainprecautionsthatmustbefollowedwhenperformingdialysisonarecenttransplantrecipientare:
(1)Observeforhypotensionasaresultoftheriskofinternalbleedinginfirst24hourspostsurgery,andthenalertthephysicianif
hypotensionoccurs.(2)Avoidhypotensiontopreventischemiaofthenewlytransplantedkidney,eveniffluidremovalduringdialysisis
compromised.(3)Maintaintheintegrityofthesurgicalincisionsite.(4)Useheparinfreeorminimalanticoagulationtherapyfornewly
postoperativepatientsandforthosewhohavehadapercutaneousrenalbiopsy.(5)Observeforanelectrolyteimbalance,especially
hyperkalemia.
4.Answer:B
DiabeticnephropathyisthemostcommoncauseofchronickidneydiseaseinWesterncountries.Itaffectsinsulindependentdiabetics,or
type1diabetes,andnoninsulindependentdiabetics,ortype2diabetes.Thosewithpoorlycontrolledbloodsugarlevels,uncontrolled
highbloodpressure,andelevatedcholesterollevelsareathighestrisk.Thisdiseaseprocessinvolvesanincreaseinthebloodflowtothe
kidney,causedbyhyperglycemia.Thisresultsinanelevationofbloodpressure,increasingtheworkloadoftheglomeruli.Theglomeruli
thickenandallowserumalbumintopassintotheurine(albuminuria).Thissignisdetectableonlybymedicaltestingandbeginsseveral
yearsbeforesymptomsareapparent.Atthisstage,kidneybiopsyconfirmsthediagnosis.Nephrosclerosisisthehardeningofthe
arteriolesofthekidneyscausedbyuncontrolledhighbloodpressure.Polycystickidneydiseaseisageneticdisorderinwhichfluidfilled
cystsreplacenormalhealthykidneytissue.Amyloidosisreferstoaconditioninwhichproteins(amyloidproteins)havebeenalteredand
becomeinsoluble,thendepositinvariousorgans.
5.Answer:A
Recombinanthumanerythropoietin,orepoetinalfa,(Epogen,Procrit)isusedtostimulateredbloodcellproductioninpatientswithend
staterenaldisease.CinacalcetHCl(Senispar)isadrugusedforloweringthelevelofparathyroidintheblood.Furosemide(Lasix)and
bumetanide(Bumex)arecommonlyuseddiuretics.Sevelamerhydrochloride(Renagel)isoneofthelatestdrugsusedforphosphate
binding.

1. There are two mechanisms of dialysis: diffusion and ultrafiltration. Which of the
following statements best describe ultrafiltration (convective transport)?
a. Hydrostatic or osmotic pressure forces water through a semipermeable membrane,
creating a "solvent drag," in which water carries solutes at or near their original
concentration.

b. Large molecules flow through the semipermeable membrane during "solvent drag."
c.

Particles in low concentration flow through the membrane to an area of high particle
concentration.

d. Solutes and catabolic wastes transfer into the blood from the high dialysate
concentration.
2. Which of the following dialyzers uses the rectangular cross section for basic blood
flow geometries?
a. Synthetic membranes
b. Parallel plate dialyzers
c.

Hollow fiber dialyzers

d. Cellulose membranes
3. Cellulose is a complex carbohydrate polymer, which is the main structural material
found in plant life. Membranes manufactured from cellulose are frequently used in
dialysis. What are the advantages and disadvantages of this type of membrane?
a. It is reusable, but it is expensive.
b. It is easy to use, but waste disposal is a problem.
c.

It is low cost, but it is bioincompatible with blood.

d. It is biocompatible, but it uses back filtration from dialysate to blood.

4. A peritoneal dialysis patient presents with complaints of abdominal pain, nausea,
and vomiting. He states that the solution he emptied from his dialysis outflow was
cloudy. What tests should the physician order at this time?
a. Peritoneal cell count
b. Culture of peritoneal effluent
c.

Stool culture

d. A and B
e. A and C
5. A patient is admitted for testing as a renal transplantation recipient. Upon
reviewing the blood work, the nurse notices that his blood type is B-. When
determining kidney compatibility for this patient, what are the factors involving blood
type that must be considered?
a. The kidney donor must be B-.

b. The kidney donor must be B, but the Rh (Rhesus) factor is not a consideration.
c.

Human leukocyte antigen (HLA) tests must be done.

d. Both A and B are true.

e. Both B and C are true.
Answers

1. A: Ultrafiltration occurs when hydrostatic pressure or an osmotic pressure forces water

through the semipermeable membrane. The water carries solutes, at or near their original
concentration, in a process called "solvent drag." Larger molecules remain, with the membrane
acting as a filter, or sieve. When the concentration of a certain type of particle is higher on one
side of a membrane than on the other side, a concentration gradient exists. In this situation,
particles in high concentration flow through the membrane to the low concentration side. Solutes
and catabolic waste products transfer from the blood where a high concentration exists into the
lower dialysate concentration.
2. B: There are two blood flow geometries, the rectangular cross section seen in parallel plate
dialyzers and the circular cross section found in hollow fiber dialyzers. Synthetic and cellulose are
descriptions of the materials used to produce the membranes used in dialysis.
3. C: The advantage of cellulose membrane usage is low cost; the disadvantage is that all
cellulose membranes have some bioincompatibility with blood. Synthetic membranes are
reusable and biocompatible. The disadvantages of synthetic membranes include their expense in
comparison to cellulose membranes, their high-water permeability that results in the need for
ultrafiltration, the absorption of protein to the membrane surface, and the risk of backfiltration
from dialysate to blood. There is no major disadvantage resulting from waste disposal problems.
4. D: One of the possible complications of peritoneal dialyses is an infection of the peritoneum
(peritonitis). The usual cause is a break in the closed system, allowing the entrance of
microorganisms into the peritoneal cavity. Signs and symptoms of this type of infection include:
cloudy effluent; abdominal pain; nausea and vomiting; peritoneal cell count greater than 100
white blood cells, more than 50% of which are neutrophils; and culture results, such as Gram +,
Gram-, multiple organisms, and fungi. Treatment involves prompt diagnosis, peritoneal flushes
with 1.5% dialysate, and intraperitoneal antibiotics with added heparin to prevent fibrin and
adhesion formation, (appropriate antibiotic based on culture results). A stool culture may be
applicable if the diagnosis of peritoneal infection is eliminated.
5. E: Transplant researchers have identified two main antigen systems: blood groups (ABO) and
human leukocyte antigen. The ABO blood groups are the first consideration when determining
organ compatibility with the recipient, with potential recipients divided by blood type. Rh
(Rhesus) factor does not affect solid organ transplantation.

Question 1
The nurse is monitoring a client receiving peritoneal dialysis and nurse notes that a clients outflow is less than the
inflow. Select actions that the nurse should take.

Place the client in good body alignment

Check the level of the drainage bag

Contact the physician

Check the peritoneal dialysis system for kinks

Reposition the client to his or her side

Question 2
The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at
risk for disequilibrium syndrome, the nurse assesses the client during dialysis for:

Hypertension, tachycardia, and fever

Hypotension, bradycardia, and hypothermia

Restlessness, irritability, and generalized weakness

Headache, deteriorating level of consciousness, and

twitching

Question 3
Which of the following is the most significant sign of peritoneal infection?

Cloudy dialysate fluid

Swelling in the legs

Poor drainage of the dialysate fluid

Redness at the catheter insertion site

Question 4
Which of the following factors causes the nausea associated with renal failure?

Oliguria

Gastric ulcers

Electrolyte imbalances

Accumulation of waste products

Question 5
To gain access to the vein and artery, an AV shunt was used for Mr. Roberto. The most serious problem with
regards to the AV shunt is:

Septicemia

Clot formation

Exsanguination

Vessel sclerosis

Question 6
The client with chronic renal failure tells the nurse he takes magnesium hydroxide (milk of magnesia) at home for
constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because:

MOM can cause magnesium toxicity

MOM is too harsh on the bowel

Metamucil is more palatable

MOM is high in sodium

Question 7
A client is admitted to the hospital and has a diagnosis of early stage chronic renal failure. Which of the following
would the nurse expect to note on assessment of the client?

Polyuria

Polydipsia

Oliguria

Anuria

Question 8
The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis.
The client is complaining of a headache and nausea and is extremely restless. Which of the following is the most
appropriate nursing action?

Notify the physician

Monitor the client

Elevate the head of the bed

Medicate the client for nausea

Question 9
The client with chronic renal failure is at risk of developing dementia related to excessive absorption of aluminum.
The nurse teaches that this is the reason that the client is being prescribed which of the following phosphate
binding agents?

Alu-cap (aluminum hydroxide)

Tums (calcium carbonate)

Amphojel (aluminum hydroxide)

Basaljel (aluminum hydroxide)

Question 10
The nurse assesses the client who has chronic renal failure and notes the following: crackles in the lung bases,
elevated blood pressure, and weight gain of 2 pounds in one day. Based on these data, which of the following
nursing diagnoses is appropriate?

Excess fluid volume related to the kidneys inability to

maintain fluid balance

Increased cardiac output related to fluid overload

Ineffective tissue perfusion related to interrupted arterial

blood flow

Ineffective therapeutic Regimen Management related to lack

of knowledge about therapy

Question 11
When caring for Mr. Robertos AV shunt on his right arm, you should:

Cover the entire cannula with an elastic bandage

Notify the physician if a bruit and thrill are present

User surgical aseptic technique when giving shunt care

Take the blood pressure on the right arm instead

Question 12
Dialysis allows for the exchange of particles across a semipermeable membrane by which of the following actions?

Osmosis and diffusion

Passage of fluid toward a solution with a lower solute

concentration

Allowing the passage of blood cells and protein molecules

through it

Passage of solute particles toward a solution with a higher

concentration

Question 13
The client with acute renal failure has a serum potassium level of 5.8 mEq/L. The nurse would plan which of the
following as a priority action?

Allow an extra 500 ml of fluid intake to dilute the electrolyte

concentration

Encourage increased vegetables in the diet

Place the client on a cardiac monitor

Check the sodium level

Question 14

A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the
following standard indicators to evaluate the clients status after dialysis?

Potassium level and weight

BUN and creatinine levels

VS and BUN

VS and weight

Question 15
Which of the following nursing interventions should be included in the clients care plan during dialysis therapy?

Limit the clients visitors

Monitor the clients blood pressure

Pad the side rails of the bed

Keep the client NPO

Question 16
The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is
important to maintain the dwell time for the dialysis at the prescribed time because of the risk of:

Infection

Hyperglycemia

Fluid overload

Disequilibrium syndrome

Question 17
A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis
(CAPD) program. The nurse should explain that the major advantage of this approach is that it:

Is relatively low in cost

Allows the client to be more independent

Is faster and more efficient than standard peritoneal dialysis

Has fewer potential complications than standard peritoneal

dialysis

Question 18
In planning teaching strategies for the client with chronic renal failure, the nurse must keep in mind the neurologic
impact of uremia. Which teaching strategy would be most appropriate?

Providing all needed teaching in one extended session

Validating frequently the clients understanding of the

material

Conducting a one-on-one session with the client

Using videotapes to reinforce the material as needed

Question 19
The client asks whether her diet would change on CAPD. Which of the following would be the nurses best
response?

Diet restrictions are more rigid with CAPD because

standard peritoneal dialysis is a more effective technique.

Diet restrictions are the same for both CAPD and standard
peritoneal dialysis.

Diet restrictions with CAPD are fewer than with standard

peritoneal dialysis because dialysis is constant.

Diet restrictions with CAPD are fewer than with standard

peritoneal dialysis because CAPD works more quickly.

Question 20
The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is
tachycardic, pale, and anxious. The nurse suspects air embolism. The nurse should:

Continue the dialysis at a slower rate after checking the lines

for air

Discontinue dialysis and notify the physician

Monitor vital signs every 15 minutes for the next hour

Bolus the client with 500 ml of normal saline to break up the

air embolism

Question 21
The nurse is assisting a client on a low-potassium diet to select food items from the menu. Which of the following
food items, if selected by the client, would indicate an understanding of this dietary restriction?

Cantaloupe

Spinach

Lima beans

Strawberries

Question 22
The client with chronic renal failure has an indwelling catheter for peritoneal dialysis in the abdomen. The client
spills water on the catheter dressing while bathing. The nurse should immediately:

Reinforce the dressing

Change the dressing

Flush the peritoneal dialysis catheter

Scrub the catheter with povidone-iodine

Question 23
The nurse helps the client with chronic renal failure develop a home diet plan with the goal of helping the client
maintain adequate nutritional intake. Which of the following diets would be most appropriate for a client with
chronic renal failure?

High carbohydrate, high protein

High calcium, high potassium, high protein

Low protein, low sodium, low potassium

Low protein, high potassium

Question 24
Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is
the purpose of giving this drug to a client with chronic renal failure?

To relieve the pain of gastric hyperacidity

To prevent Curlings stress ulcers

To bind phosphorus in the intestine

To reverse metabolic acidosis

Question 25
A client is diagnosed with chronic renal failure and told she must start hemodialysis. Client teaching would include
which of the following instructions?

Follow a high potassium diet

Strictly follow the hemodialysis schedule

There will be a few changes in your lifestyle

Use alcohol on the skin and clean it due to integumentary

changes

Question 26
The nurse is caring for a hospitalized client who has chronic renal failure. Which of the following nursing diagnoses
are most appropriate for this client? Select all that apply.

Excess Fluid Volume

Imbalanced Nutrition; Less than Body Requirements

Activity Intolerance

Impaired Gas Exchange

Pain

Question 27
The nurse teaches the client with chronic renal failure when to take the aluminum hydroxide gel. Which of the
following statements would indicate that the client understands the teaching?

Ill take it every 4 hours around the clock.

Ill take it between meals and at bedtime.

Ill take it when I have a sour stomach.

Ill take it with meals and bedtime snacks.

Question 28
The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment
the nurse notes that the clients temperature is 100.2. Which of the following is the most appropriate nursing
action?

Encourage fluids

Notify the physician

Monitor the site of the shunt for infection

Continue to monitor vital signs

Question 29
A client has a history of chronic renal failure and received hemodialysis treatments three times per week through
an arteriovenous (AV) fistula in the left arm. Which of the following interventions is included in this clients plan of
care?

Keep the AV fistula site dry

Keep the AV fistula wrapped in gauze

Take the blood pressure in the left arm

Assess the AV fistula for a bruit and thrill

Question 30
A client is undergoing peritoneal dialysis. The dialysate dwell time is completed, and the dwell clamp is opened to
allow the dialysate to drain. The nurse notes that the drainage has stopped and only 500 ml has drained; the
amount the dialysate instilled was 1,500 ml. Which of the following interventions would be done first?

Change the clients position

Call the physician

Check the catheter for kinks or obstruction

Clamp the catheter and instill more dialysate at the next

exchange time

Question 31
The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in
the nursing plan of care to prevent the major complication associated with peritoneal dialysis?

Monitor the clients level of consciousness

Maintain strict aseptic technique

Add heparin to the dialysate solution

Change the catheter site dressing daily

Question 32
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:

Just before dialysis

During dialysis

On return from dialysis

The day after dialysis

Question 33
A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of 200/100, a heart rate of
110, and a respiratory rate of 36. Oxygen saturation on room air is 89%. He complains of shortness of breath, and
+2 pedal edema is noted. His last hemodialysis treatment was yesterday. Which of the following interventions
should be done first?

Administer oxygen

Elevate the foot of the bed

Restrict the clients fluids

Prepare the client for hemodialysis

Question 34
A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis
for the treatment of chronic renal failure. Which finding indicates that the fistula is patent?

Absence of bruit on auscultation of the fistula

Palpation of a thrill over the fistula

Presence of a radial pulse in the left wrist

Capillary refill time less than 3 seconds in the nail beds of

the fingers on the left hand

Question 35
During the clients dialysis, the nurse observes that the solution draining from the abdomen is consistently blood
tinged. The client has a permanent peritoneal catheter in place. Which interpretation of this observation would be
correct?

Bleeding is expected with a permanent peritoneal catheter

Bleeding indicates abdominal blood vessel damage

Bleeding can indicate kidney damage

Bleeding is caused by too-rapid infusion of the dialysate

Question 36
The nurse is reviewing a list of components contained in the peritoneal dialysis solution with the client. The client
asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response knowing
that the glucose:

Prevents excess glucose from being removed from the client

Decreases risk of peritonitis

Prevents disequilibrium syndrome

Increases osmotic pressure to produce ultrafiltration.

Question 37
The main indicator of the need for hemodialysis is:

Ascites

Acidosis

Hypertension

Hyperkalemia

Question 38
Which of the following clients is at greatest risk for developing acute renal failure?

A dialysis client who gets influenza

A teenager who has an appendectomy

A pregnant woman who has a fractured femur

A client with diabetes who has a heart catheterization

Question 39
The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis
treatments. The nurse determines that the client best understands the information given if the client states to
record the daily:

Pulse and respiratory rate

Intake, output, and weight

BUN and creatinine levels

Activity log

Question 40
In a client in renal failure, which assessment finding may indicate hypocalcemia?

Headache

Serum calcium level of 5 mEq/L

Increased blood coagulation

Diarrhea

Question 41
The hemodialysis client with a left arm fistula is at risk for steal syndrome. The nurse assesses this client for which
of the following clinical manifestations?

Warmth, redness, and pain in the left hand

Pallor, diminished pulse, and pain in the left hand.

Edema and reddish discoloration of the left arm

Aching pain, pallor, and edema in the left arm.

Question 42
A client newly diagnosed with renal failure is receiving peritoneal dialysis. During the infusion of the dialysate the
client complains of abdominal pain. Which action by the nurse is most appropriate?

Slow the infusion

Decrease the amount to be infused

Explain that the pain will subside after the first few
exchanges

Stop the dialysis

Question 43
The dialysis solution is warmed before use in peritoneal dialysis primarily to:

Encourage the removal of serum urea

Force potassium back into the cells

Add extra warmth into the body

Promote abdominal muscle relaxation

Question 44
What is the primary disadvantage of using peritoneal dialysis for long term management of chronic renal failure?

The danger of hemorrhage is high

It cannot correct severe imbalances

It is a time consuming method of treatment

The risk of contracting hepatitis is high

Question 45
The client with an arteriovenous shunt in place for hemodialysis is at risk for bleeding. The nurse would do which of
the following as a priority action to prevent this complication from occurring?

Check the results of the PT time as they are ordered

Observe the site once per shift

Check the shunt for the presence of a bruit and thrill

Ensure that small clamps are attached to the AV shunt

dressing

Question 1
PARTIAL-CREDIT
The nurse is monitoring a client receiving peritoneal dialysis and nurse notes that a clients outflow is less than the
inflow. Select actions that the nurse should take.

Place the client in good body alignment

Check the level of the drainage bag
Contact the physician
Check the peritoneal dialysis system for kinks
Reposition the client to his or her side
Question 1 Explanation:
If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the clients position. Turning
the client to the other side or making sure that the client is in good body alignment may assist with outflow
drainage. The drainage bag needs to be lower than the clients abdomen to enhance gravity drainage. The
connecting tubing and the peritoneal dialysis system is also checked for kinks or twisting and the clamps on the
system are checked to ensure that they are open. There is no reason to contact the physician.

Question 2
CORRECT
The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at
risk for disequilibrium syndrome, the nurse assesses the client during dialysis for:

Hypertension, tachycardia, and fever

Hypotension, bradycardia, and hypothermia
Restlessness, irritability, and generalized weakness
Headache, deteriorating level of consciousness, and
twitching
Question 2 Explanation:
Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness,
nausea, and vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal
of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient
removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient,
causing brain swelling and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis
and is prevented by dialyzing for shorter times or at reduced blood flow rates.

Question 3

CORRECT
Which of the following is the most significant sign of peritoneal infection?

Cloudy dialysate fluid

Swelling in the legs
Poor drainage of the dialysate fluid
Redness at the catheter insertion site
Question 3 Explanation:
Cloudy drainage indicates bacterial activity in the peritoneum. Other signs and symptoms of infection are fever,
hyperactive bowel sounds, and abdominal pain. Swollen legs may be indicative of congestive heart failure. Poor
drainage of dialysate fluid is probably the result of a kinked catheter. Redness at the insertion site indicates local
infection, not peritonitis. However, a local infection that is left untreated can progress to the peritoneum.

Question 4
WRONG
Which of the following factors causes the nausea associated with renal failure?

Oliguria
Gastric ulcers
Electrolyte imbalances
Accumulation of waste products
Question 4 Explanation:
Although clients with renal failure can develop stress ulcers, the nausea is usually related to the poisons of
metabolic wastes that accumulate when the kidneys are unable to eliminate them. The client has electrolyte
imbalances and oliguria, but these dont directly cause nausea.

Question 5
WRONG
To gain access to the vein and artery, an AV shunt was used for Mr. Roberto. The most serious problem with
regards to the AV shunt is:

Septicemia
Clot formation
Exsanguination
Vessel sclerosis
Question 6

CORRECT
The client with chronic renal failure tells the nurse he takes magnesium hydroxide (milk of magnesia) at home for
constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because:

MOM can cause magnesium toxicity

MOM is too harsh on the bowel
Metamucil is more palatable
MOM is high in sodium
Question 6 Explanation:
Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause
severe neurologic problems. MOM is harsher than Metamucil, but magnesium toxicity is a more serious problem. A
client may find both MOM and Metamucil unpalatable. MOM is not high in sodium.

Question 7
WRONG
A client is admitted to the hospital and has a diagnosis of early stage chronic renal failure. Which of the following
would the nurse expect to note on assessment of the client?

Polyuria
Polydipsia
Oliguria
Anuria
Question 7 Explanation:
Polyuria occurs early in chronic renal failure and if untreated can cause severe dehydration. Polyuria progresses to
anuria, and the client loses all normal functions of the kidney. Oliguria and anuria are not early signs, and
polydipsia is unrelated to chronic renal failure.

Question 8
WRONG
The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis.
The client is complaining of a headache and nausea and is extremely restless. Which of the following is the most
appropriate nursing action?

Notify the physician

Monitor the client

Elevate the head of the bed

Medicate the client for nausea
Question 8 Explanation:
Disequilibrium syndrome may be due to the rapid decrease in BUN levels during dialysis. These changes can cause
cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs of disequilibrium
syndrome and appropriate treatments with anticonvulsant medications and barbituates may be necessary to
prevent a life-threatening situation. The physician must be notified.

Question 9
CORRECT
The client with chronic renal failure is at risk of developing dementia related to excessive absorption of aluminum.
The nurse teaches that this is the reason that the client is being prescribed which of the following phosphate
binding agents?

Alu-cap (aluminum hydroxide)

Tums (calcium carbonate)
Amphojel (aluminum hydroxide)
Basaljel (aluminum hydroxide)
Question 9 Explanation:
Phosphate binding agents that contain aluminum include Alu-caps, Basaljel, and Amphojel. These products are
made from aluminum hydroxide. Tums are made from calcium carbonate and also bind phosphorus. Tums are
prescribed to avoid the occurrence of dementia related to high intake of aluminum. Phosphate binding agents are
needed by the client in renal failure because the kidneys cannot eliminate phosphorus.

Question 10
CORRECT
The nurse assesses the client who has chronic renal failure and notes the following: crackles in the lung bases,
elevated blood pressure, and weight gain of 2 pounds in one day. Based on these data, which of the following
nursing diagnoses is appropriate?

Excess fluid volume related to the kidneys inability to

maintain fluid balance
Increased cardiac output related to fluid overload
Ineffective tissue perfusion related to interrupted arterial
blood flow
Ineffective therapeutic Regimen Management related to lack
of knowledge about therapy
Question 10 Explanation:

Crackles in the lungs, weight gain, and elevated blood pressure are indicators of excess fluid volume, a common
complication in chronic renal failure. The clients fluid status should be monitored carefully for imbalances on an
ongoing basis.

Question 11
CORRECT
When caring for Mr. Robertos AV shunt on his right arm, you should:

Cover the entire cannula with an elastic bandage

Notify the physician if a bruit and thrill are present
User surgical aseptic technique when giving shunt care
Take the blood pressure on the right arm instead
Question 12
CORRECT
Dialysis allows for the exchange of particles across a semipermeable membrane by which of the following actions?

Osmosis and diffusion

Passage of fluid toward a solution with a lower solute
concentration
Allowing the passage of blood cells and protein molecules
through it
Passage of solute particles toward a solution with a higher
concentration
Question 12 Explanation:
Osmosis allows for the removal of fluid from the blood by allowing it to pass through the semipermeable membrane
to an area of high concentrate (dialysate), and diffusion allows for passage of particles (electrolytes, urea, and
creatinine) from an area of higher concentration to an area of lower concentration. Fluid passes to an area with a
higher solute concentration. The pores of a semipermeable membrane are small, thus preventing the flow of blood
cells and protein molecules through it.

Question 13
CORRECT
The client with acute renal failure has a serum potassium level of 5.8 mEq/L. The nurse would plan which of the
following as a priority action?

Allow an extra 500 ml of fluid intake to dilute the electrolyte

concentration

Encourage increased vegetables in the diet

Place the client on a cardiac monitor
Check the sodium level
Question 13 Explanation:
The client with hyperkalemia is at risk for 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 may also assess the sodium level because sodium is another
electrolyte commonly measured with the potassium level. However, this is not a priority action at this time.

Question 14
CORRECT
A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the
following standard indicators to evaluate the clients status after dialysis?

Potassium level and weight

BUN and creatinine levels
VS and BUN
VS and weight
Question 14 Explanation:
Following dialysis, the clients vital signs are monitored to determine whether the client is remaining
hemodynamically stable. Weight is measured and compared with the clients predialysis weight to determine
effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not necessarily done after the
hemodialysis treatment has ended.

Question 15
CORRECT
Which of the following nursing interventions should be included in the clients care plan during dialysis therapy?

Limit the clients visitors

Monitor the clients blood pressure
Pad the side rails of the bed
Keep the client NPO
Question 15 Explanation:
Because hypotension is a complication of peritoneal dialysis, the nurse records intake and output, monitors VS, and
observes the clients behavior. The nurse also encourages visiting and other diversional activities. A client on PD
does not need to be placed in bed with padded side rails or kept NPO.

Question 16
CORRECT
The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is
important to maintain the dwell time for the dialysis at the prescribed time because of the risk of:

Infection
Hyperglycemia
Fluid overload
Disequilibrium syndrome
Question 16 Explanation:
An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of
absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when
receiving peritoneal dialysis.

Question 17
CORRECT
A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis
(CAPD) program. The nurse should explain that the major advantage of this approach is that it:

Is relatively low in cost

Allows the client to be more independent
Is faster and more efficient than standard peritoneal dialysis
Has fewer potential complications than standard peritoneal
dialysis
Question 17 Explanation:
The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers, home health care
personnel, and machines for life-sustaining treatment. The independence is a valuable outcome for some people.
CAPD is costly and must be done daily. Side effects and complications are similar to those of standard peritoneal
dialysis.

Question 18
CORRECT
In planning teaching strategies for the client with chronic renal failure, the nurse must keep in mind the neurologic
impact of uremia. Which teaching strategy would be most appropriate?

Providing all needed teaching in one extended session

Validating frequently the clients understanding of the

material
Conducting a one-on-one session with the client
Using videotapes to reinforce the material as needed
Question 18 Explanation:
Uremia can cause decreased alertness, so the nurse needs to validate the clients comprehension frequently.
Because the clients ability to concentrate is limited, short lesions are most effective. If family members are present
at the sessions, they can reinforce the material. Written materials that the client can review are superior to
videotapes, because the clients may not be able to maintain alertness during the viewing of the videotape.

Question 19
WRONG
The client asks whether her diet would change on CAPD. Which of the following would be the nurses best
response?

Diet restrictions are more rigid with CAPD because

standard peritoneal dialysis is a more effective technique.
Diet restrictions are the same for both CAPD and
standard peritoneal dialysis.
Diet restrictions with CAPD are fewer than with standard
peritoneal dialysis because dialysis is constant.
Diet restrictions with CAPD are fewer than with standard
peritoneal dialysis because CAPD works more quickly.
Question 19 Explanation:
Dietary restrictions with CAPD are fewer than those with standard peritoneal dialysis because dialysis is constant,
not intermittent. The constant slow diffusion of CAPD helps prevent accumulation of toxins and allows for a more
liberal diet. CAPD does not work more quickly, but more consistently. Both types of peritoneal dialysis are effective.

Question 20
CORRECT
The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is
tachycardic, pale, and anxious. The nurse suspects air embolism. The nurse should:

Continue the dialysis at a slower rate after checking the lines

for air
Discontinue dialysis and notify the physician
Monitor vital signs every 15 minutes for the next hour
Bolus the client with 500 ml of normal saline to break up the

air embolism
Question 20 Explanation:
If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, notify
the physician, and administer oxygen as needed.

Question 21
WRONG
The nurse is assisting a client on a low-potassium diet to select food items from the menu. Which of the following
food items, if selected by the client, would indicate an understanding of this dietary restriction?

Cantaloupe
Spinach
Lima beans
Strawberries
Question 21 Explanation:
Cantaloupe (1/4 small), spinach (1/2 cooked) and strawberries (1 cups) are high potassium foods and average 7
mEq per serving. Lima beans (1/3 c) averages 3 mEq per serving.

Question 22
CORRECT
The client with chronic renal failure has an indwelling catheter for peritoneal dialysis in the abdomen. The client
spills water on the catheter dressing while bathing. The nurse should immediately:

Reinforce the dressing

Change the dressing
Flush the peritoneal dialysis catheter
Scrub the catheter with povidone-iodine
Question 22 Explanation:
Clients with peritoneal dialysis catheters are at high risk for infection. A dressing that is wet is a conduit for
bacteria for bacteria to reach the catheter insertion site. The nurse assures 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 disconnecting of
peritoneal dialysis.

Question 23
CORRECT

The nurse helps the client with chronic renal failure develop a home diet plan with the goal of helping the client
maintain adequate nutritional intake. Which of the following diets would be most appropriate for a client with
chronic renal failure?

High carbohydrate, high protein

High calcium, high potassium, high protein
Low protein, low sodium, low potassium
Low protein, high potassium
Question 23 Explanation:
Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and
potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein
metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also
receive a high carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements
remain 1,000 to 2,000 mg/day.

Question 24
WRONG
Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is
the purpose of giving this drug to a client with chronic renal failure?

To relieve the pain of gastric hyperacidity

To prevent Curlings stress ulcers
To bind phosphorus in the intestine
To reverse metabolic acidosis
Question 24 Explanation:
A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the bodys calcium
stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind
phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem
associated with chronic renal failure. Antacids will not prevent Curlings stress ulcers and do not affect metabolic
acidosis.

Question 25
CORRECT
A client is diagnosed with chronic renal failure and told she must start hemodialysis. Client teaching would include
which of the following instructions?

Follow a high potassium diet

Strictly follow the hemodialysis schedule

There will be a few changes in your lifestyle

Use alcohol on the skin and clean it due to integumentary
changes
Question 25 Explanation:
To prevent life-threatening complications, the client must follow the dialysis schedule. Alcohol would further dry the
clients skin more than it already is. The client should follow a low-potassium diet because potassium levels
increase in chronic renal failure. The client should know hemodialysis is time-consuming and will definitely cause a
change in current lifestyle.

Question 26
PARTIAL-CREDIT
The nurse is caring for a hospitalized client who has chronic renal failure. Which of the following nursing diagnoses
are most appropriate for this client? Select all that apply.

Excess Fluid Volume

Imbalanced Nutrition; Less than Body Requirements
Activity Intolerance
Impaired Gas Exchange
Pain
Question 26 Explanation:
Appropriate nursing diagnoses for clients with chronic renal failure include excess fluid volume related to fluid and
sodium retention; imbalanced nutrition, less than body requirements related to anorexia, nausea, and vomiting;
and activity intolerance related to fatigue. The nursing diagnoses of impaired gas exchange and pain are not
commonly related to chronic renal failure

Question 27
CORRECT
The nurse teaches the client with chronic renal failure when to take the aluminum hydroxide gel. Which of the
following statements would indicate that the client understands the teaching?

Ill take it every 4 hours around the clock.

Ill take it between meals and at bedtime.
Ill take it when I have a sour stomach.
Ill take it with meals and bedtime snacks.
Question 27 Explanation:

Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or
immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not
administered to treat hyperacidity in clients with CRF and therefore is not prescribed between meals.

Question 28
WRONG
The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment
the nurse notes that the clients temperature is 100.2. Which of the following is the most appropriate nursing
action?

Encourage fluids
Notify the physician
Monitor the site of the shunt for infection
Continue to monitor vital signs
Question 28 Explanation:
The client may have an elevated temperature following dialysis because the dialysis machine warms the blood
slightly. If the temperature is elevated excessively and remains elevated, sepsis would be suspected and a blood
sample would be obtained as prescribed for culture and sensitivity purposes.

Question 29
CORRECT
A client has a history of chronic renal failure and received hemodialysis treatments three times per week through
an arteriovenous (AV) fistula in the left arm. Which of the following interventions is included in this clients plan of
care?

Keep the AV fistula site dry

Keep the AV fistula wrapped in gauze
Take the blood pressure in the left arm
Assess the AV fistula for a bruit and thrill
Question 29 Explanation:
Assessment of the AV fistula for bruit and thrill is important because, if not present, it indicates a non-functioning
fistula. No blood pressures or venipunctures should be taken in the arm with the AV fistula. When not being
dialyzed, the AV fistula site may get wet. Immediately after a dialysis treatment, the access site is covered with
adhesive bandages.

Question 30
CORRECT

A client is undergoing peritoneal dialysis. The dialysate dwell time is completed, and the dwell clamp is opened to
allow the dialysate to drain. The nurse notes that the drainage has stopped and only 500 ml has drained; the
amount the dialysate instilled was 1,500 ml. Which of the following interventions would be done first?

Change the clients position

Call the physician
Check the catheter for kinks or obstruction
Clamp the catheter and instill more dialysate at the next
exchange time
Question 30 Explanation:
The first intervention should be to check for kinks and obstructions because that could be preventing drainage.
After checking for kinks, have the client change position to promote drainage. Dont give the next scheduled
exchange until the dialysate is drained because abdominal distention will occur, unless the output is within
parameters set by the physician. If unable to get more output despite checking for kinks and changing the clients
position, the nurse should then call the physician to determine the proper intervention.

Question 31
CORRECT
The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in
the nursing plan of care to prevent the major complication associated with peritoneal dialysis?

Monitor the clients level of consciousness

Maintain strict aseptic technique
Add heparin to the dialysate solution
Change the catheter site dressing daily
Question 31 Explanation:
The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the
client receiving this treatment. Although option 4 may assist in preventing infection, this option relates to an
external site.

Question 32
CORRECT
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:

Just before dialysis

During dialysis
On return from dialysis

The day after dialysis

Question 32 Explanation:
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 a full day to resume the medication. This would lead to
ineffective control of the blood pressure.

Question 33
CORRECT
A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of 200/100, a heart rate of
110, and a respiratory rate of 36. Oxygen saturation on room air is 89%. He complains of shortness of breath, and
+2 pedal edema is noted. His last hemodialysis treatment was yesterday. Which of the following interventions
should be done first?

Administer oxygen
Elevate the foot of the bed
Restrict the clients fluids
Prepare the client for hemodialysis
Question 33 Explanation:
Airway and oxygenation are always the first priority. Because the client is complaining of shortness of breath and
his oxygen saturation is only 89%, the nurse needs to try to increase his levels by administering oxygen. The client
is in pulmonary edema from fluid overload and will need to be dialyzed and have his fluids restricted, but the first
interventions should be aimed at the immediate treatment of hypoxia. The foot of the bed may be elevated to
reduce edema, but this isnt the priority.

Question 34
CORRECT
A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis
for the treatment of chronic renal failure. Which finding indicates that the fistula is patent?

Absence of bruit on auscultation of the fistula

Palpation of a thrill over the fistula
Presence of a radial pulse in the left wrist
Capillary refill time less than 3 seconds in the nail beds of
the fingers on the left hand
Question 34 Explanation:
The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit.
The presence of a thrill and bruit indicate patency of the fistula. Although the presence of a radial pulse in the left

wrist and capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand are normal
findings, they do not assess fistula patency.

Question 35
CORRECT
During the clients dialysis, the nurse observes that the solution draining from the abdomen is consistently blood
tinged. The client has a permanent peritoneal catheter in place. Which interpretation of this observation would be
correct?

Bleeding is expected with a permanent peritoneal catheter

Bleeding indicates abdominal blood vessel damage
Bleeding can indicate kidney damage
Bleeding is caused by too-rapid infusion of the dialysate
Question 35 Explanation:
Because the client has a permanent catheter in place, blood tinged drainage should not occur. Persistent blood
tinged drainage could indicate damage to the abdominal vessels, and the physician should be notified. The bleeding
is originating in the peritoneal cavity, not the kidneys. Too rapid infusion of the dialysate can cause pain.

Question 36
CORRECT
The nurse is reviewing a list of components contained in the peritoneal dialysis solution with the client. The client
asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response knowing
that the glucose:

Prevents excess glucose from being removed from the client

Decreases risk of peritonitis
Prevents disequilibrium syndrome
Increases osmotic pressure to produce ultrafiltration.
Question 36 Explanation:
Increasing the glucose concentration makes the solution increasingly more hypertonic. The more hypertonic the
solution, the greater the osmotic pressure for ultrafiltration and thus the greater amount of fluid removed from the
client during an exchange.

Question 37
WRONG
The main indicator of the need for hemodialysis is:

Ascites

Acidosis
Hypertension
Hyperkalemia
Question 38
CORRECT
Which of the following clients is at greatest risk for developing acute renal failure?

A dialysis client who gets influenza

A teenager who has an appendectomy
A pregnant woman who has a fractured femur
A client with diabetes who has a heart catheterization
Question 38 Explanation:
Clients with diabetes are prone to renal insufficiency and renal failure. The contrast used for heart catherization
must be eliminated by the kidneys, which further stresses them and may produce acute renal failure. A teenager
who has an appendectomy and a pregnant woman with a fractured femur isnt at increased risk for renal failure. A
dialysis client already has end-stage renal disease and wouldnt develop acute renal failure.

Question 39
CORRECT
The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis
treatments. The nurse determines that the client best understands the information given if the client states to
record the daily:

Pulse and respiratory rate

Intake, output, and weight
BUN and creatinine levels
Activity log
Question 39 Explanation:
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 per
day.

Question 40
WRONG
In a client in renal failure, which assessment finding may indicate hypocalcemia?

Headache
Serum calcium level of 5 mEq/L
Increased blood coagulation
Diarrhea
Question 40 Explanation:
In renal failure, calcium absorption from the intestine declines, leading to increased smooth muscle contractions,
causing diarrhea. CNS changes in renal failure rarely include headache. A serum calcium level of 5 mEq/L indicates
hypercalcemia. As renal failure progresses, bleeding tendencies increase.

Question 41
CORRECT
The hemodialysis client with a left arm fistula is at risk for steal syndrome. The nurse assesses this client for which
of the following clinical manifestations?

Warmth, redness, and pain in the left hand

Pallor, diminished pulse, and pain in the left hand.
Edema and reddish discoloration of the left arm
Aching pain, pallor, and edema in the left arm.
Question 41 Explanation:
Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a
diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, which is due to tissue
ischemia. Warmth, redness, and pain more likely would characterize a problem with infection.

Question 42
WRONG
A client newly diagnosed with renal failure is receiving peritoneal dialysis. During the infusion of the dialysate the
client complains of abdominal pain. Which action by the nurse is most appropriate?

Slow the infusion

Decrease the amount to be infused
Explain that the pain will subside after the first few
exchanges
Stop the dialysis
Question 42 Explanation:

Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation;
however, the pain usually disappears after 1 to 2 weeks of treatment. The infusion amount should not be
decreased, and the infusion should not be slowed or stopped.

Question 43
WRONG
The dialysis solution is warmed before use in peritoneal dialysis primarily to:

Encourage the removal of serum urea

Force potassium back into the cells
Add extra warmth into the body
Promote abdominal muscle relaxation
Question 43 Explanation:
The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal
vessels, which increases urea clearance. Warmed dialyzing solution also contributes to client comfort by preventing
chilly sensations, but this is a secondary reason for warming the solution. The warmed solution does not force
potassium into the cells or promote abdominal muscle relaxation.

Question 44
WRONG
What is the primary disadvantage of using peritoneal dialysis for long term management of chronic renal failure?

The danger of hemorrhage is high

It cannot correct severe imbalances
It is a time consuming method of treatment
The risk of contracting hepatitis is high
Question 44 Explanation:
The disadvantages of peritoneal dialysis in long-term management of chronic renal failure is that is requires large
blocks of time. The risk of hemorrhage or hepatitis is not high with PD. PD is effective in maintaining a clients fluid
and electrolyte balance.

Question 45
CORRECT
The client with an arteriovenous shunt in place for hemodialysis is at risk for bleeding. The nurse would do which of
the following as a priority action to prevent this complication from occurring?

Check the results of the PT time as they are ordered

Observe the site once per shift

Check the shunt for the presence of a bruit and thrill

Ensure that small clamps are attached to the AV shunt
dressing
Question 45 Explanation:
An AV shunt is a less common form of access site but carries a risk for bleeding when it is used because two ends
of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are
joined. If accidental connection occurs, the client could lose blood rapidly. For this reason, small clamps are
attached to the dressing that covers the insertion site to use if needed. The shunt site should be assessed at least
every four hours.