1.

Dialysis allows for the exchange of particles across a semipermeable

membrane by which of the following actions?

1. Osmosis and diffusion

2. Passage of fluid toward a solution with a lower solute concentration
3. Allowing the passage of blood cells and protein molecules through it.
4. Passage of solute particles toward a solution with a higher concentration.

2. A client is diagnosed with chronic renal failure and told she must start

hemodialysis. Client teaching would include which of the following
instructions?

1. Follow a high potassium diet

2. Strictly follow the hemodialysis schedule
3. There will be a few changes in your lifestyle.
4. Use alcohol on the skin and clean it due to integumentary changes.

3. 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?

1. Change the client’s position.

2. Call the physician.
3. Check the catheter for kinks or obstruction.
4. Clamp the catheter and instill more dialysate at the next exchange time.

4. 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?

1. Administer oxygen
2. Elevate the foot of the bed
3. Restrict the client’s fluids
4. Prepare the client for hemodialysis.
5. 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 client’s plan
of care?

1. Keep the AV fistula site dry.

2. Keep the AV fistula wrapped in gauze.
3. Take the blood pressure in the left arm
4. Assess the AV fistula for a bruit and thrill

6. Which of the following factors causes the nausea associated with renal

failure?

1. Oliguria
2. Gastric ulcers
3. Electrolyte imbalances
4. Accumulation of waste products

7. Which of the following clients is at greatest risk for developing acute renal

failure?

1. A dialysis client who gets influenza

2. A teenager who has an appendectomy
3. A pregnant woman who has a fractured femur
4. A client with diabetes who has a heart catheterization

8. In a client in renal failure, which assessment finding may indicate

hypocalcemia?

1. Headache
2. Serum calcium level of 5 mEq/L
3. Increased blood coagulation
4. Diarrhea

9. 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?
1. Absence of bruit on auscultation of the fistula.
2. Palpation of a thrill over the fistula
3. Presence of a radial pulse in the left wrist
4. Capillary refill time less than 3 seconds in the nail beds of the fingers on the left
hand.

10. 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?

1. Alu-cap (aluminum hydroxide)

2. Tums (calcium carbonate)
3. Amphojel (aluminum hydroxide)
4. Basaljel (aluminum hydroxide)

11. 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:

1. Hypertension, tachycardia, and fever

2. Hypotension, bradycardia, and hypothermia
3. restlessness, irritability, and generalized weakness
4. Headache, deteriorating level of consciousness, and twitching.

12. A client with chronic renal failure has completed a hemodialysis

treatment. The nurse would use which of the following standard indicators to
evaluate the client’s status after dialysis?

1. Potassium level and weight

2. BUN and creatinine levels
3. VS and BUN
4. VS and weight.

13. 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?
1. Warmth, redness, and pain in the left hand.
2. Pallor, diminished pulse, and pain in the left hand.
3. Edema and reddish discoloration of the left arm
4. Aching pain, pallor, and edema in the left arm.

14. 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?

1. Polyuria
2. Polydipsia
3. Oliguria
4. Anuria

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

1. Encourage fluids
2. Notify the physician
3. Monitor the site of the shunt for infection
4. Continue to monitor vital signs

16. 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?

1. Notify the physician

2. Monitor the client
3. Elevate the head of the bed
4. Medicate the client for nausea

17. 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?
1. Cantaloupe
2. Spinach
3. Lima beans
4. Strawberries

18. 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:

1. Prevents excess glucose from being removed from the client.

2. Decreases risk of peritonitis.
3. Prevents disequilibrium syndrome
4. Increased osmotic pressure to produce ultrafiltration.

19. 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?

1. Monitor the client’s level of consciousness

2. Maintain strict aseptic technique
3. Add heparin to the dialysate solution
4. Change the catheter site dressing daily

20. 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?

1. Slow the infusion

2. Decrease the amount to be infused
3. Explain that the pain will subside after the first few exchanges
4. Stop the dialysis

21. 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:
1. Infection
2. Hyperglycemia
3. Fluid overload
4. Disequilibrium syndrome

22. 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?

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

2. Encourage increased vegetables in the diet
3. Place the client on a cardiac monitor
4. Check the sodium level

23. 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:

1. Just before dialysis

2. During dialysis
3. On return from dialysis
4. The day after dialysis

24. 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:

1. Reinforce the dressing

2. Change the dressing
3. Flush the peritoneal dialysis catheter
4. Scrub the catheter with povidone-iodine

25. 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:

1. Continue the dialysis at a slower rate after checking the lines for air
2. Discontinue dialysis and notify the physician
3. Monitor vital signs every 15 minutes for the next hour
4. Bolus the client with 500 ml of normal saline to break up the air embolism.

26. 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:

1. Pulse and respiratory rate

2. Intake, output, and weight
3. BUN and creatinine levels
4. Activity log

27. 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?

1. Check the results of the PT time as they are ordered.

2. Observe the site once per shift
3. Check the shunt for the presence of a bruit and thrill
4. Ensure that small clamps are attached to the AV shunt dressing.

28. The nurse is monitoring a client receiving peritoneal dialysis and nurse
notes that a client’s outflow is less than the inflow. Select actions that the
nurse should take.

1. Place the client in good body alignment

2. Check the level of the drainage bag
3. Contact the physician
4. Check the peritoneal dialysis system for kinks
5. Reposition the client to his or her side.

29. 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?
1. Excess fluid volume related to the kidney’s inability to maintain fluid balance.
2. Increased cardiac output related to fluid overload.
3. Ineffective tissue perfusion related to interrupted arterial blood flow.
4. Ineffective Therapeutic Regimen Management related to lack of knowledge about
therapy.

30. 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.

1. Excess Fluid Volume

2. Imbalanced Nutrition; Less than Body Requirements
3. Activity Intolerance
4. Impaired Gas Exchange
5. Pain.

31. What is the primary disadvantage of using peritoneal dialysis for long-
term management of chronic renal failure?

1. The danger of hemorrhage is high.

2. It cannot correct severe imbalances.
3. It is a time consuming method of treatment.
4. The risk of contracting hepatitis is high.

32. The dialysis solution is warmed before use in peritoneal dialysis primarily
to:

1. Encourage the removal of serum urea.

2. Force potassium back into the cells.
3. Add extra warmth into the body.
4. Promote abdominal muscle relaxation.

33. During the client’s 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?
1. Bleeding is expected with a permanent peritoneal catheter
2. Bleeding indicates abdominal blood vessel damage
3. Bleeding can indicate kidney damage.
4. Bleeding is caused by too-rapid infusion of the dialysate.

34. Which of the following nursing interventions should be included in the

client’s care plan during dialysis therapy?

1. Limit the client’s visitors

2. Monitor the client’s blood pressure
3. Pad the side rails of the bed
4. Keep the client NPO.

35. 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?

1. To relieve the pain of gastric hyperacidity

2. To prevent Curling’s stress ulcers
3. To bind phosphorus in the intestine
4. To reverse metabolic acidosis.

36. 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?

1. “I’ll take it every four (4) hours around the clock.”

2. “I’ll take it between meals and at bedtime.”
3. “I’ll take it when I have a sour stomach.”
4. “I’ll take it with meals and bedtime snacks.”

37. 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:

1. MOM can cause magnesium toxicity

2. MOM is too harsh on the bowel
3. Metamucil is more palatable
4. MOM is high in sodium

38. 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?

1. Providing all needed teaching in one extended session.

2. Validating frequently the client’s understanding of the material.
3. Conducting a one-on-one session with the client.
4. Using videotapes to reinforce the material as needed.

39. 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?

1. High carbohydrate, high protein

2. High calcium, high potassium, high protein
3. Low protein, low sodium, low potassium
4. Low protein, high potassium

40. 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:

1. Is relatively low in cost

2. Allows the client to be more independent
3. Is faster and more efficient than standard peritoneal dialysis
4. Has fewer potential complications than standard peritoneal dialysis

41. The client asks whether her diet would change on CAPD. Which of the
following would be the nurse’s best response?

1. “Diet restrictions are more rigid with CAPD because standard peritoneal dialysis
is a more effective technique.”
2. “Diet restrictions are the same for both CAPD and standard peritoneal dialysis.”
3. “Diet restrictions with CAPD are fewer than with standard peritoneal dialysis
because dialysis is constant.”
4. “Diet restrictions with CAPD are fewer than with standard peritoneal dialysis
because CAPD works more quickly.”

42. Which of the following is the most significant sign of peritoneal infection?

1. Cloudy dialysate fluid

2. Swelling in the legs
3. Poor drainage of the dialysate fluid
4. Redness at the catheter insertion site

43. The main indicator of the need for hemodialysis is:

1. Ascites
2. Acidosis
3. Hypertension
4. Hyperkalemia

44. 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:

1. Septicemia
2. Clot formation
3. Exsanguination
4. Vessel sclerosis

45. When caring for Mr. Roberto’s AV shunt on his right arm, you should:

1. Cover the entire cannula with an elastic bandage

2. Notify the physician if a bruit and thrill are present
3. User surgical aseptic technique when giving shunt care
4. Take the blood pressure on the right arm instead

Answers and Rationale

1. Answer: 1. Osmosis and diffusion

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.

 Option B: Fluid passes to an area with a higher solute concentration.

 Option C: The pores of a semipermeable membrane are small, thus
preventing the flow of blood cells and protein molecules through it.
2. Answer: 2. Strictly follow the hemodialysis schedule

To prevent life-threatening complications, the client must follow the dialysis

schedule.

 Option A: The client should follow a low-potassium diet because

potassium levels increase in chronic renal failure.
 Option C: The client should know hemodialysis is time-consuming and will
definitely cause a change in current lifestyle.
 Option D: Alcohol would further dry the client’s skin more than it already
is.
3. Answer: 3. Check the catheter for kinks or obstruction.

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. Don’t 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 client’s position, the nurse should then call the
physician to determine the proper intervention.

4. Answer: 1. Administer oxygen

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.
  Option B: The foot of the bed may be elevated to reduce edema, but this
isn’t the priority.
 Options C and D: 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.
5. Answer: 4. Assess the AV fistula for a bruit and thrill

Assessment of the AV fistula for bruit and thrill is important because, if not present,
it indicates a non-functioning fistula.

 Option A: When not being dialyzed, the AV fistula site may get wet.
 Option B: Immediately after a dialysis treatment, the access site is covered
with adhesive bandages.
 Option C: No blood pressures or venipunctures should be taken in the
arm with the AV fistula.
6. Answer: 4. Accumulation of waste products

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.

 Options A and C: The client has electrolyte imbalances and oliguria, but
these don’t directly cause nausea.
7. Answer: 4. A client with diabetes who has a heart catheterization

Clients with diabetes are prone to renal insufficiency and renal failure. The contrast
used for heart catheterization must be eliminated by the kidneys, which further
stresses them and may produce acute renal failure. A dialysis client already has
end-stage renal disease and wouldn’t develop acute renal failure.

 Options B and C: A teenager who has an appendectomy and a pregnant

woman with a fractured femur isn’t at increased risk for renal failure.
8. Answer: 4. Diarrhea

In renal failure, calcium absorption from the intestine declines, leading to increased
smooth muscle contractions, causing diarrhea.
  Option A: CNS changes in renal failure rarely include headache.
 Option B: A serum calcium level of 5 mEq/L indicates hypercalcemia.
 Option C: As renal failure progresses, bleeding tendencies increase.
9. Answer: 2. Palpation of a thrill over the fistula

The nurse assesses the patency of the fistula by palpating for the presence of a
thrill or auscultating for a bruit.

 Option A: The presence of a thrill and bruit indicate patency of the fistula.
 Options C and D: 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.
10. Answer: 2. Tums (calcium carbonate)

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.

11. Answer: 4. Headache, deteriorating level of consciousness and twitching.

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.

12. Answer: 4. VS and weight.

Following dialysis, the client’s vital signs are monitored to determine whether the
client is remaining hemodynamically stable. Weight is measured and compared
with the client’s predialysis weight to determine the effectiveness of fluid
extraction.

 Options A, B, and C: Laboratory studies are done as per protocol but are
not necessarily done after the hemodialysis treatment has ended.
13. Answer: 2. Pallor, diminished pulse, and pain in the left hand.

Steal syndrome results from vascular insufficiency after the 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.

 Option A: Warmth, redness, and pain more likely would characterize a

problem with infection.
14. Answer: 1. Polyuria

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.

 Options B, C, and D: Oliguria and anuria are not early signs, and polydipsia
is unrelated to chronic renal failure.
15. Answer: 4. Continue to monitor vital signs

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.

16. Answer: 1. Notify the physician

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 barbiturates may
be necessary to prevent a life-threatening situation. The physician must be notified.
17. Answer: 3. Lima beans

Lima beans (1/3 c) averages three (3) mEq per serving.

 Option A: Cantaloupe (1/4 small)

 Option B: Spinach (1/2 cooked)
 Option D: Strawberries (1 ¼ cups) are high potassium foods and average 7
mEq per serving.
18. Answer: 4. Increases osmotic pressure to produce ultrafiltration.

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.

19. Answer: 2. Maintain strict aseptic technique

The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique

is required in caring for the client receiving this treatment. Although option D may
assist in preventing infection, this option relates to an external site.

20. Answer: 3. Explain that the pain will subside after the first few exchanges

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.

21. Answer: 2. Hyperglycemia

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.

22. Answer: 3. Place the client on a cardiac monitor

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.

 Option A: Fluid intake is not increased because it contributes to fluid

overload and would not affect the serum potassium level significantly.
 Option B: Vegetables are a natural source of potassium in the diet, and
their use would not be increased.
 Option D: 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.
23. Answer: 3. On return from dialysis

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.

24. Answer: 2. Change the dressing

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.

 Option A: Reinforcing the dressing is not a safe practice to prevent

infection in this circumstance.
 Option C: Flushing the catheter is not indicated.
 Option D: Scrubbing the catheter with povidone-iodine is done at the time
of connection or disconnecting of peritoneal dialysis.
25. Answer: 2. Discontinue dialysis and notify the physician

If the client experiences air embolus during hemodialysis, the nurse should

terminate dialysis immediately, notify the physician, and administer oxygen as
needed.

26. Answer: 2. Intake, output, and weight

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.

27. Answer: 4. Ensure that small clamps are attached to the AV shunt
dressing.

An AV shunt is a less common form of access site but carries a risk of 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.

 Option B: The shunt site should be assessed at least every four hours.
28. Answer: 1, 2, 4, 5.

If outflow drainage is inadequate, the nurse attempts to stimulate outflow by

changing the client’s 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 client’s 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.

29. Answer: 1. Excess fluid volume related to the kidney’s inability to maintain
fluid balance.

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

30. Answer: 1, 2, 3.

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.
  Options D and E: The nursing diagnoses of impaired gas exchange and
pain are not commonly related to the chronic renal failure.
31. Answer: 3. It is a time-consuming method of treatment.

The disadvantages of peritoneal dialysis in the long-term management of chronic

renal failure is that requires large blocks of time.

 Options A and D:  The risk of hemorrhage or hepatitis is not high with PD.
 Option B: PD is effective in maintaining a client’s fluid and electrolyte
balance.
32. Answer: 1. Encourage the removal of serum urea.

The main reason for warming the peritoneal dialysis solution is that the warm
solution helps dilate peritoneal vessels, which increases urea clearance.

 Options B and D: The warmed solution does not force potassium into the
cells or promote abdominal muscle relaxation.
 Option C: Warmed dialyzing solution also contributes to client comfort by
preventing chilly sensations, but this is a secondary reason for warming
the solution.
33. Answer: 2. Bleeding indicates abdominal blood vessel damage

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.

 Option C: The bleeding is originating in the peritoneal cavity, not the

kidneys.
 Option D: Too rapid infusion of the dialysate can cause pain.
34. Answer: 2. Monitor the client’s blood pressure

Because hypotension is a complication of peritoneal dialysis, the nurse records

intake, and output, monitors VS, and observes the client’s behavior.

 Option A: The nurse also encourages visiting and other diversional

activities.
  Options C and D: A client on PD does not need to be placed in bed with
padded side rails or kept NPO.
35. Answer: 3. To bind phosphorus in the intestine

A client in renal failure develops hyperphosphatemia that causes a corresponding

excretion of the body’s 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.

 Option A: Gastric hyperacidity is not necessarily a problem associated with

chronic renal failure.
 Options B and D: Antacids will not prevent Curling’s stress ulcers and do
not affect metabolic acidosis.
36. Answer: 4. “I’ll take it with meals and bedtime snacks.”

Aluminum hydroxide gel is administered to bind the phosphates in ingested foods

and must be given with or immediately after meals and snacks.

 Option A: There is no need for the client to take it on a 24-hour schedule.

 Options B and C: It is not administered to treat hyperacidity in clients with
CRF and therefore is not prescribed between meals.
37. Answer: 1. MOM can cause magnesium toxicity

Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium
can accumulate and cause severe neurologic problems.

 Option B: MOM is harsher than Metamucil, but magnesium toxicity is a

more serious problem.
 Option C: A client may find both MOM and Metamucil unpalatable.
 Option D: MOM is not high in sodium.
38. Answer: 2. Validating frequently the client’s understanding of the
material.

Uremia can cause decreased alertness, so the nurse needs to validate the client’s
comprehension frequently.
  Option A: Because the client’s ability to concentrate is limited, short
lesions are most effective.
 Option C: If family members are present at the sessions, they can
reinforce the material.
 Option D: 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.
39. Answer: 3. Low protein, low sodium, low potassium

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. Reducing
sodium in the diet helps to control high blood pressure. It also keeps one from
being thirsty and prevents the body from holding onto extra fluid. Too much
potassium can build up when the kidneys no longer function well. It can cause an
irregular heartbeat or a heart attack.

40. Answer: 2. Allows the client to be more independent

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.

 Option A: CAPD is costly and must be done daily.

 Option D: Side effects and complications are similar to those of standard
peritoneal dialysis.
41. Answer: 3. “Diet restrictions with CAPD are fewer than with standard
peritoneal dialysis because dialysis is constant.”

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.

42. Answer: 1. Cloudy dialysate fluid

Cloudy drainage indicates bacterial activity in the peritoneum. Other signs and
symptoms of infection are fever, hyperactive bowel sounds, and abdominal pain.

 Option B: Swollen legs may be indicative of congestive heart failure.

 Option C: Poor drainage of dialysate fluid is probably the result of a kinked
catheter.
 Option D: Redness at the insertion site indicates local infection, not
peritonitis. However, a local infection that is left untreated can progress to
the peritoneum.
43. Answer: 4. Hyperkalemia

44. Answer: 3. Exsanguination

45. Answer: 3. User surgical aseptic technique when giving shunt care