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NMNC 4510 Concept Synthesis Exam | Questions, Answers and Rationales

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NMNC 4510 Concept Synthesis Exam | Questions, Answers and Rationales Which statement explains why metabolic acidosis develops with kidney failure? 1. Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate 2. Depressed respiratory rate due to metabolic wastes, causing car...

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NMNC 4510 Concept Synthesis Exam

Which statement explains why metabolic acidosis develops with kidney failure?

1. Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate

2. Depressed respiratory rate due to metabolic wastes, causing carbon dioxide retention

3. Inability of the renal tubules to reabsorb water to dilute the acid contents of blood

4. Impaired glomerular filtration, causing retention of sodium and metabolic waste
products

Rationale:
Bicarbonate buffering is limited, hydrogen ions accumulate, and acidosis results. The
rate of respirations increases in metabolic acidosis to compensate for a low pH. The
fluid balance does not significantly alter the pH. The retention of sodium ions is related
to fluid retention and edema rather than to acidosis.

A client is admitted to the hospital in the oliguric phase of acute kidney injury. The
client's urine output for the past 12 hours was 200 mL. The nurse notes a prescription
for 900 mL of oral fluids over the next 24 hours. Which interpretation of the amount of
prescribed fluid would the nurse make?

1. It equals the expected urinary output for the next 24 hours.

2. It will prevent the development of pneumonia and a high fever.

3. It will compensate for both insensible and expected output over the next 24 hours.

4. It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias.

Rationale:
Insensible losses are 500 mL to 1000 mL in 24 hours, with an average of about 600 mL;
the measured output is about 400 mL in 24 hours based on the available history (about
200 mL in 12 hours). Based on the history, the expected urinary output should be about
400 mL in the next 24 hours, far less than 900 mL. More than 900 mL daily is necessary
to help prevent pneumonia and its associated fever. Hyperkalemia in acute kidney injury
is caused by inadequate glomerular filtration and is not related to fluid intake.

Which complication is the most serious for a client with kidney failure?

,1. Anemia
2. Weight loss
3. Uremic frost
4. Hyperkalemia

Rationale:
Decreased glomerular filtration leads to hyperkalemia, which may cause lethal
dysrhythmias such as cardiac arrest. Anemia may occur but is not the most serious
complication and should be treated in relation to the client's clinical manifestation;
erythropoietin and iron supplements usually are used. Weight loss alone is not life
threatening. Uremic frost, a layer of urea crystals on the skin, causes itching, but it is not
the most serious complication.

A client with a history of chronic kidney disease is hospitalized. Which assessment
findings would alert the nurse to suspect kidney insufficiency?

1. Facial flushing
2. Edema and pruritus
3. Dribbling after voiding
4. Diminished force of urination

Rationale:
The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema
results from fluid overload caused by impaired urine production. Pallor, not flushing,
occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a
urinary pattern that is not caused by chronic kidney disease; this may occur with
prostate problems. Diminished force and caliber of stream occur with an enlarged
prostate, not kidney disease.

A client who has chronic kidney failure is to be treated with continuous ambulatory
peritoneal dialysis (CAPD). Which statement by the client indicates understanding of the
therapy?

1. "It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration."

2. "It exchanges and cleanses blood by correction of electrolytes and excretion of
creatinine."

3. "It decreases the need for immobility because it clears toxins in short and intermittent
periods."
4. "It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis
and diffusion."

Rationale:
Diffusion moves particles from an area of greater concentration to an area of lesser
concentration; osmosis moves fluid from an area of lesser to an area of greater

,concentration of particles, thereby removing waste products into the dialysate, which is
then drained from the abdomen. The principle of ultrafiltration involves a pressure
gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal
dialysis uses the peritoneal membrane to indirectly cleanse the blood. Dialysate does
not clear toxins in a short time; exchanges may occur four or five times a day.

Which hormone influences kidney function?

1. Renin
2. Bradykinin
3. Aldosterone
4. Erythropoietin

Rationale:
Released from the adrenal cortex, aldosterone influences kidney function. Renin,
bradykinin, and erythropoietin are kidney hormones.

Which process is a function of the kidney hormones?

1. Prostaglandin increases blood flow and vascular permeability.

2. Bradykinin regulates intrarenal blood flow via vasodilation or vasoconstriction.

3. Renin raises blood pressure because of angiotensin and aldosterone secretion.

4. Erythropoietin promotes calcium absorption in the gastrointestinal tract tract.

Rationale:
Renin is a kidney hormone that raises blood pressure as a result of angiotensin and
aldosterone secretion. Prostaglandin is a kidney hormone that regulates intrarenal blood
flow via vasodilation or vasoconstriction. Bradykinin is a kidney hormone that increases
blood flow and vascular permeability. Erythropoietin is a kidney hormone that stimulates
the bone marrow to make red blood cells.

Which information would the nurse include in response to a client's questioning a
protein-restricted dietary change required for his or her acute kidney injury?

1. "A high-protein intake ensures an adequate daily supply of amino acids to
compensate for losses."

2. "Essential and nonessential amino acids are necessary in the diet to supply materials
for tissue protein synthesis."

3. "This diet supplies only essential amino acids, reducing the amount of metabolic
waste products, thus decreasing stress on the kidneys."

, 4. "Currently, your body is unable to synthesize amino acids, so the nitrogen for amino
acid synthesis must come from the dietary protein."

Rationale:
The amount of protein permitted in the diet depends on the extent of kidney function;
excess protein causes an increase in urea concentration, excess metabolic waste, and
added stress on the kidneys. The restricted protein diet prevents overburdening the
client's kidneys at this time. When experiencing acute kidney injury, the kidneys are
unable to eliminate the waste products of a high-protein diet. The body is able to
synthesize the nonessential amino acids. Urea is a waste product of protein
metabolism; the body is able to synthesize the nonessential amino acids.

A client with acute kidney injury is moved into the diuretic phase after 1 week of therapy.
During this phase, which clinical indicators would the nurse assess? Select all that
apply. One, some, or all responses may be correct.

1. Skin rash
2. Dehydration
3. Hypovolemia
4. Hyperkalemia
5. Metabolic acidosis

Rationale:
In the diuretic phase, excretion of fluids retained during the oliguric phase occurs and
may reach 3 to 5 L daily; unless fluid replacement occurs, dehydration and hypovolemia
is a potential. Skin rash is not associated with the diuretic phase. Hyperkalemia
develops in the oliguric phase when glomerular filtration is inadequate. Metabolic
acidosis occurs in the oliguric, not diuretic, phase.

The nurse providing postoperative care for a client who had kidney surgery reviews the
client's urinalysis report. Which urinary finding indicates the need to notify the primary
health care provider?

1. Acidic pH
2. Glucose negative
3. Bacteria negative
4. Presence of large proteins

Rationale:
The glomeruli are not permeable to large proteins such as albumin or red blood cells,
and finding them in the urine is abnormal; the nurse would report their presence to the
primary health care provider to modify the client's treatment plan.

The primary health care provider for a client with chronic kidney disease prescribed
immediate hemodialysis for the first time. Which clinical manifestation indicates the
need for immediate hemodialysis in this client?

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