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Renal Critical Care Exam
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Renal Critical Care Exam Renal Critical Care Exam Renal Critical Care Exam
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Renal Critical Care ExamA client with AKI has a serum potassium level of 7.0 mEq/L. The nurse should plan which actions as a
priority. Select all that apply.
1. Place the client on a cardiac monitor
2. Notify the HCP
3. Put the client on NPO status except for ice chips
4. Review the client's medications to determine if any contain or retain potassium
5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration - VERIFIED
ANS 1, 2, 4
The potassium level is elevarted. The client is at risk for developing cardiac dysrhythmias and cardiac
arrest. Because of this the client should be placed on a cardiac monitor. The nurse should notify the HCP
and also review medications to determine if any contain potassium or are potassium retaining. The
client does not need to be put on NPO status. Fluid intake is not increased because it contributes to fluid
overload and would not affect the serum potassium level significantly.
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 priority action for the nurse is to:
(Select all that apply.)
1. Administer oxygen to the client.
2. Continue dialysis at a slower rate after checking the lines for air.
3. Notify the HCP and Rapid Response team.
4. Stop dialysis and turn the client on the left side with head lower than feet.
5. Bolus the client with 500 mL of normal saline to break up the air embolus. - VERIFIED ANS 1, 3, 4
,If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis
immediately, position the client so the air embolus is in the right side of the heart, notify the HCP and
Rapid Response Team, and administer oxygen as needed. Slowing the dialysis treatment or giving an IV
bolus will not correct the air embolus or prevent complications.
The client arrives at the ED with complaints of low abdominal pain and hematuria. The client is afebrile.
The nurse next assess the client to determine a history of which condition?
1. Pyelonephritis
2. Glomerulonephritis
3. Trauma to the bladder or abdomen
4. Renal cancer in the clients family - VERIFIED ANS 3
Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and
hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever and are thus not
applicable to the client described in the question. Renal cancer would not cause pain that is felt in the
low abdomen; rather, the pain would be in the flank area.
The nurse discusses plans for future treatment options with a client with symptomatic polycystic kidney
disease. Which treatment should be included in this discussion? Select all that apply.
1. Hemodialysis
2. Peritoneal dialysis
3. Kidney transplant
4. Bilateral nephrectomy
5. Intense immunosuppression therapy - VERIFIED ANS 1, 3, 4
Polycystic kidney disease is a genetic familial disease in which the kidneys enlarge with cysts that
rupture and scar the kidney, eventually resulting in end-stage renal disease. Treatment options include
,hemodialysis or kidney trasnplant. Clients usually undergo bilateral nephrectomy to remove the large,
painful, cyst-filled kidneys. Peritoneal dialysis is not an option due to the infected cysts. The condition
does not respond to immunosuppression.
A client is admitted to the ED following a fall from a horse and the HCP prescribes insertion of a urinary
catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse
should take which action?
1. Notify the HCP before performing the catheterization.
2. Use a small-sized catheter and an anesthetic gel as a lubricant.
3. Administer parenteral pain medication before inserting the catheter.
4. Clean the meatus with soap and water before opening the catheterization kit. - VERIFIED ANS 1
The presence of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse
notifies the HCP, knowing that the client should not be catheterized until the caues of the bleeding is
determined by diagnostic testing. The other options include performing the catheterization procedure
and therefore are incorrect.
The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating
hemodialysis. Which finding indicates that the fistula is patent?
1. Palpation of a thrill over the fistula
2. Presence of a radial pulse in the left wrist
3. Visualization of enlarged blood vessels at the fistula site
4. Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand - VERIFIED ANS 1
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. Enlarged visible blood vessels at
the fistula site are a normal observation but a not indicative of fistula patency. Although the presence of
, a radial pulse in the left wrist and capillary refill less than 3 seconds in the nail beds of the fingers on the
left hand indicate adequate circulation to the hand, they do not assess fistula patency.
A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which
manifestation of the disorder?
1. Hematuria and pyuria
2. Dysuria and proteinuria
3. Hematuria and urgency
4. Dysuria and penile discharge - VERIFIED ANS 4
Urethritis in the male client often results from chalmydial infection and is characterized by dysuria,
which is accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with
gonorrhea, diagnostic tests are done for both and include culture and rapid assays. Hematuria is not
associated with urethritis. Proteinuria is associated with kidney dysfunction.
The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical
examination?
1. Fever, diarrhea, groin pain, and ecchymosis
2. Nausea, painful scrotal edema, and ecchymosis
3. Fever, nausea, vomiting, and painful scrotal edema
4. Diarrhea, groin pain, testicular torsion, and scrotal edema - VERIFIED ANS 3
Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are
accompanied by fever, nausea and vomiting, and chills. Epididymitis most often is caused by infection,
although sometimes it can be caused by trauma. The remaining options do not present all of the
accurate manifestations.
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