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MS3 EXAM 3 PRACTICE QUESTIONS AND ANSWERS
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MS3 EXAM 3 PRACTICE QUESTIONS AND ANSWERS
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MS3 EXAM 3 PRACTICE QUESTIONS AND ANSWERSThe nurse caring for a client in the diuretic phase of acute renal failure (ARF) should
assess for manifestations of
a. dehydration.
b. hypertension.
c. hypokalemia.
d. metabolic acidosis.
A ~ A gradual or abrupt return to glomerular filtration and leveling of blood urea nitrogen
(BUN) level signal the diuretic phase. Urine output may be 1000 ml/day, which may lead
to dehydration.
Which is the most common cause of acute renal failure in children?
a. Pyelonephritis
b. Tubular destruction
c. Urinary tract obstruction
d. Severe dehydration
D ~ The most common cause of acute renal failure in children is dehydration or other
causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis
and tubular destruction are not common causes of acute renal failure. Obstructive
uropathy may cause acute renal failure, but it is not the most common cause.
List the GFR rates in the different stages of renal failure.
Stage 1 = <90 mL/min
Stage 2 = <60 mL/min
Stage 3 = <45 mL/min
Stage 4 = <30 mL/min
Stage 5 = <15 mL/min
A client with ARF is allowed a specific amount of fluid by mouth during 24 hours in order
to
a. compensate for insensible and measured fluid losses during the previous 24 hours.
b. equal the expected urine output for the next 24 hours.
c. prevent hyperkalemia, which could lead to serious cardiac dysrhythmia.
d. prevent the development of complicating hypostatic pneumonia.
A ~ Fluid replacement volumes are usually calculated on the basis of some fraction of
the previous days urine output plus an amount (e.g., 400 ml) to account for the usual
insensible loss that occurs during a 24-hour period.
What is the normal lab value for serum ALBUMIN?
3.5-5.5 g/dL
The nurse is conducting an admission assessment on a school-age child with acute
renal failure. Which are the primary clinical manifestations the nurse expects to find with
this condition?
a. Oliguria and hypertension
b. Hematuria and pallor
,c. Proteinuria and muscle cramps
d. Bacteriuria and facial edema
A ~ The principal feature of acute renal failure is oliguria; hypertension is a nonspecific
clinical manifestation. Hematuria and pallor, proteinuria and muscle cramps, and
bacteriuria and facial edema are not principal features of acute renal failure.
The nurse explains that a cation exchange resin such as Kayexalate will
a. decrease diastolic blood pressure.
b. stimulate diuresis by osmosis.
c. increase appetite by decreasing insulin degradation.
d. increase gastrointestinal potassium excretion.
D ~ Hyperkalemia is probably the most dangerous imbalance because of its contribution
to cardiac dysrhythmias and arrest. Cation exchange resins such as sodium polystyrene
sulfonate (Kayexalate) may be administered orally or rectally to facilitate excretion of
potassium from the gastrointestinal (GI) tract.
The nurse is caring for a child with acute renal failure. Which clinical manifestation
should the nurse recognize as a sign of hyperkalemia?
a. Dyspnea
b. Seizure
c. Oliguria
d. Cardiac arrhythmia
D ~ Hyperkalemia is the most common threat to the life of the child. Signs of
hyperkalemia include electrocardiograph anomalies such as prolonged QRS complex,
depressed ST segments, peaked T waves, bradycardia, or heart block. Dyspnea,
seizure, and oliguria are not manifestations of hyperkalemia.
What is the normal lab value for serum PHOSPHORUS?
2.4-4.1 mg/dL
A client with oliguric ARF would exhibit
a. a BUN/creatinine ratio of 30:1.
b. hematuria.
c. proteinuria.
d. a urine specific gravity of 1.001.
A ~ In oliguric ARF, urine production usually falls below 400 ml/day. The BUN/creatinine
ratio is significantly elevated, reaching levels of 10:1 to 40:1.
What is the Normal Osmolality of Urine?
300-900 mOsm/kg
When a child has chronic renal failure, the progressive deterioration produces a variety
of clinical and biochemical disturbances that eventually are manifested in the clinical
syndrome known as:
a. uremia.
b. oliguria.
,c. proteinuria.
d. pyelonephritis.
A ~ Uremia is the retention of nitrogenous products, producing toxic symptoms. Oliguria
is diminished urinary output. Proteinuria is the presence of protein, usually albumin, in
the urine. Pyelonephritis is an inflammation of the kidney and renal pelvis.
The nurse explains to a client's family that the most common overall manifestation of
ARF is that
a. expected urine output is altered.
b. the client's breath develops a fruity odor.
c. urine specific gravity is greater than 1.040.
d. urine develops a root beer color.
A ~ The most common overall manifestation of ARF is alteration in the expected urine
output. Usually this is oliguria or anuria, although polyuric ARF accounts for 30% of
cases.
What is the normal lab value for Serum Creatinine?
0.6-1.2 mg/dL
Which is a major complication in a child with chronic renal failure?
a. Hypokalemia
b. Metabolic alkalosis
c. Water and sodium retention
d. Excessive excretion of blood urea nitrogen
C ~ Chronic renal failure leads to water and sodium retention, which contributes to
edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of
blood urea nitrogen are complications of chronic renal failure.
A client has been on dialysis for 6 weeks. The family is complaining that instead of
feeling grateful at this second chance at life, the client has become irritable with them
and seems depressed. The most helpful response by the nurse would be
a. Depression is very common at this time; it is hard to adapt to the losses she feels.
b. I am surprised that your loved one doesn't feel happier about being alive.
c. This must be very hard on you for your loved one to be so unappreciative.
d. We can arrange a psychiatric consultation if you think it will help.
A ~ Clients are often happy and grateful as they start dialysis and begin to feel well for
the first time in a long time. But as the time goes by and the implication of the
permanent change to their lives becomes apparent, it is common for them to have
psychosocial difficulties, including depression. In fact, the suicide rate for dialysis clients
is estimated to be 100 times that of the general public. The other three options not only
do not give helpful information about what is happening but also are poor examples of
therapeutic communication.
What is the normal lab value for Urine Specific Gravity?
1.01-1.03
, Which clinical manifestation would be seen in a child with chronic renal failure?
a. Hypotension
b. Massive hematuria
c. Hypokalemia
d. Unpleasant uremic breath odor
D ~ Children with chronic renal failure have a characteristic breath odor resulting from
the retention of waste products. Hypertension may be a complication of chronic renal
failure. With chronic renal failure, little or no urinary output occurs. Hyperkalemia is a
concern in chronic renal failure.
While caring for a client in the oliguric phase of ARF, the nurses plan of care should
include
a. encouraging fluid intake to prevent dehydration.
b. increasing the client's protein intake to prevent muscle wasting.
c. maintaining reverse isolation to prevent infection.
d. meticulous skin care to prevent skin breakdown.
D ~ The poor systemic nutrition and edema accompanying renal failure may cause skin
breakdown. Meticulous skin care, frequent turning, and special mattresses are very
important. Clients may well be on fluid restrictions. They do not need reverse isolation.
Protein is often restricted as well.
What is the normal lab value for Urine pH?
4.8-7.5
Calcium carbonate is given with meals to a child with chronic renal disease. The
purpose of this is to:
a. prevent vomiting.
b. bind phosphorus.
c. stimulate appetite.
d. increase absorption of fat-soluble vitamins.
B ~ Oral calcium carbonate preparations combine with phosphorus to decrease
gastrointestinal absorption and the serum levels of phosphate. Serum calcium levels are
increased by the calcium carbonate, and vitamin D administration is necessary to
increase calcium absorption. Calcium carbonate does not prevent vomiting, stimulate
appetite, or increase the absorption of fat-soluble vitamins.
The nurse assesses the client for the electrolyte imbalance that tends to occur in the
earlier stages of chronic renal failure, which is
a. hypercalcemia.
b. hypocalcemia.
c. hypokalemia.
d. hyponatremia.
C ~ The tubular salt-wasting properties of some failing kidneys, in addition to vomiting
and diarrhea, may cause hyponatremia. Late in the disease the problem becomes
hypernatremia.
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