Question

A nurse is providing discharge teaching to a client who will be performing continuous ambulatory peritoneal dialysis (CAPD) at home. Which of the following statements from the client indicates an understanding of this type of dialysis management? (Select all that apply.)

Answer 1

Correct Answers:

"I must wash my hands every time before I connect the tubing to the catheter in my stomach."
I will weigh myself daily and keep track of my weight in my dialysis record."
"I will check my blood pressure and follow the instructions related to changes I might need to do based on the results."

Rationale :

✅ "I must wash my hands every time before I connect the tubing to the catheter in my stomach."

🔹 Infection Prevention: Hand hygiene is the #1 defense against peritonitis, a serious complication of CAPD.

🔹 Protocol Adherence: Proper handwashing before catheter handling reduces bacterial contamination risk.

🔹 Patient Safety: Strict aseptic technique is non-negotiable for home-based dialysis success.

✅ "I will weigh myself daily and keep track of my weight in my dialysis record."

🔹 Fluid Balance: Daily weights detect hypervolemia (fluid overload) or hypovolemia (dehydration).

🔹 Treatment Adjustment: Weight trends guide dialysate concentration selection (e.g., 1.5% vs. 4.25% glucose).

🔹 Early Warning: Sudden weight gain may indicate ultrafiltration failure or worsening edema.

✅ "I will check my blood pressure and follow the instructions related to changes I might need to do based on the results."

🔹 Hypertension Control: CAPD patients often struggle with fluid-related BP spikes.

🔹 Hypotension Risk: Over-ultrafiltration can cause low BP, requiring dialysate adjustments.

🔹 Self-Management: BP logs help clinicians tailor diet/fluid restrictions and dialysis prescriptions.

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Answer 2

Correct Answers:

Pruritus
Slurred speech
Bone pain

Rationale :

🟧 Pruritus (Itching)

🔹Caused by uremic toxin buildup and hyperphosphatemia.

🔹Common due to calcium-phosphate imbalances and dry skin.

🔹Often resistant to treatment until dialysis begins.

🟧 Bone Pain

🔹Results from renal osteodystrophy (calcium/vitamin D dysregulation).

🔹Linked to secondary hyperparathyroidism and phosphate retention.

🔹May lead to fractures if untreated.

🟧Slurred Speech (Uremic Encephalopathy)

🔹Occurs due to toxin accumulation (e.g., urea, creatinine) affecting the CNS.

🔹Indicates advanced uremia, requiring urgent dialysis.

🔹May progress to seizures or coma if untreated.

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Answer 3

Correct Answers:

Hyperkalemia

Rationale :

🔶 Prerenal acute kidney injury (AKI) typically leads to hyperkalemia due to impaired kidney function, which results in reduced potassium excretion.

🔶 Elevated BUN and creatinine are typical signs of AKI but are not as specific as hyperkalemia in this case.

🔶 Potassium imbalances in AKI may lead to cardiac arrhythmias and require urgent management.

🔶 Monitoring and correction of potassium levels are a priority to avoid serious complications.

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Answer 4

Correct Answers:

Blood urea nitrogen (BUN) 200 mg/dL

Rationale :

🔷 Elevated BUN (200 mg/dL) suggests acute kidney injury (AKI), particularly prerenal AKI, where impaired renal perfusion leads to reduced filtration.

🔷 Magnesium levels and serum osmolality are not as directly related to kidney injury in this context.

🔷 A creatinine level of 1.8 mg/dL may be slightly elevated but does not indicate severe AKI on its own.

🔷 BUN is often more sensitive to fluid shifts and renal perfusion.

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Answer 5

Correct Answers:

Fever
Urinary urgency
Gastrointestinal upset
Flank pain

Rationale :

🔹 Flank Pain

⬖ Classic symptom of renal calculi, often severe and colicky (comes in waves).

⬖ Caused by ureteral obstruction and stretching of the renal capsule.

⬖ May radiate to the groin or lower abdomen (ureteral colic).

🔹 Urinary Urgency

⬖ Occurs due to irritation of the bladder/urethra by the passing stone.

⬖ Often accompanied by dysuria (painful urination).

⬖ May mimic a UTI, but without infection.

🔹 Gastrointestinal Upset (Nausea/Vomiting)

⬖ Caused by shared nerve pathways (renointestinal reflex) between kidneys and GI tract.

⬖ Common with severe pain (autonomic nervous system response).

⬖ May lead to dehydration, worsening stone risk.

🔹 Fever

⬖ Not typical for simple renal calculi, but alarming if present.

⬖ Suggests infection (pyelonephritis or obstructed UTI)—a medical emergency.

⬖Requires urgent antibiotics + possible drainage (e.g., stent/nephrostomy).

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Answer 6

Correct Answers:

Coldness and numbness distal to the fistula site

Rationale :

🔷 Venous insufficiency occurs when the fistula is obstructed or thrombosed, leading to reduced blood flow to the distal extremities.

🔷 The coldness and numbness indicate a lack of adequate circulation, which is a serious complication of an arteriovenous fistula.

🔷 Other symptoms, such as a raised red rash or foul-smelling drainage, would indicate an infection, not venous insufficiency.

🔷 Prompt evaluation and intervention can prevent irreversible damage to the fistula and loss of access for dialysis.

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Answer 7

Correct Answers:

"The kidneys continue to enlarge due to the cysts growing, which increases the girth of your abdomen."

Rationale :

🍃 Polycystic kidney disease (PKD) causes the growth of fluid-filled cysts in the kidneys, leading to increased kidney size and abdominal distension.

🍃 This response explains the underlying pathophysiology of abdominal girth increase in PKD, where cysts progressively enlarge over time.

🍃 Kidney infections or ureteral obstruction may also contribute to the abdominal distention but are secondary in this case.

🍃 Monitoring for cyst growth and renal function is essential to managing PKD progression.

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Answer 8

Correct Answers:

Serum creatinine 6 mg/dL

Rationale :

🟦 Serum creatinine is a direct measure of kidney function, and a level of 6 mg/dL is markedly elevated, indicating acute kidney injury (AKI).

🟦 Normal serum creatinine levels range from 0.6 to 1.3 mg/dL, so a level of 6 mg/dL reflects significant renal impairment.

🟦 Elevated BUN and potassium can also suggest AKI, but serum creatinine is a more specific indicator of renal function decline.

🟦 Regular monitoring of creatinine and GFR is key in managing AKI and preventing further kidney damage.

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Answer 9

Correct Answers:

Purulent dialysate outflow

Rationale :

🟧 Purulent dialysate outflow is a sign of peritonitis, a serious complication of peritoneal dialysis (PD).

🟧 This condition results from bacterial infection in the peritoneal cavity, leading to pain, fever, and cloudy outflow.

🟧 Blood-tinged outflow is common after the initial infusion but does not indicate infection.

🟧 Prompt antibiotic therapy and removal of the catheter are required to treat peritonitis and prevent systemic infection.

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Answer 10

Correct Answers:

Dehydration

Rationale :

🔷 Dehydration is a major risk factor for renal calculi (kidney stones) because insufficient fluid intake causes concentrated urine, which promotes the crystallization of minerals.

🔷 This leads to the formation of stones, often composed of calcium oxalate or uric acid.

🔷 Obesity, protein in the urine, and iron deficiency are not direct causes of stone formation.

🔷 Increasing fluid intake helps prevent stone recurrence by diluting urine and preventing crystal aggregation.

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RN ATI MedSurg Exam V

No.

1 :
A nurse is providing discharge teaching to a client who will be performing continuous ambulatory peritoneal dialysis (CAPD) at home. Which of the following statements from the client indicates an understanding of this type of dialysis management? (Select all that apply.)

2 :
A nurse is caring for a client who has end-stage renal disease (ESRD). Which of the following are expected findings? (Select all that apply.).

3 :
A nurse is reviewing the laboratory test results from a client who has prerenal acute kidney injury (AKI). Which of the following electrolyte imbalances should the nurse expect?

4 :
A nurse is monitoring an older adult female client who had a myocardial infarction (MI) for the development of acute kidney injury (AKI). Which of the following findings should the nurse identify as indicating an increased risk of AKI?

5 :
A nurse is caring for a client admitted with renal calculus. Which of the following assessment findings should the nurse associate with renal calculi? (Select all that apply).

6 :
A nurse is providing discharge teaching to a client who has a new arteriovenous fistula in the right forearm. Which of the following manifestations should the nurse include in the teaching as possible indications of venous insufficiency?

7 :
A nurse is caring for a client who has polycystic kidney disease (PKD). The client is admitted to the hospital for renal calculi and reports that their abdomen has been getting bigger. Which of the following statements by the nurse is the best explanation for the increase in abdominal girth?

8 :
A nurse is reviewing laboratory findings for four clients. Which of the following clients has manifestations of acute kidney injury?

9 :
A nurse is caring for a client who is undergoing initial peritoneal dialysis. Which of the following should the nurse report immediately to the provider?

10 :
A nurse is teaching a client who has urolithiasis (renal calculi). The nurse should explain that which of the following conditions can increase the risk for renal calculi?

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RN ATI MedSurg Exam V

No.

1 : A nurse is providing discharge teaching to a client who will be performing continuous ambulatory peritoneal dialysis (CAPD) at home. Which of the following statements from the client indicates an understanding of this type of dialysis management? (Select all that apply.)

2 : A nurse is caring for a client who has end-stage renal disease (ESRD). Which of the following are expected findings? (Select all that apply.).

3 : A nurse is reviewing the laboratory test results from a client who has prerenal acute kidney injury (AKI). Which of the following electrolyte imbalances should the nurse expect?

4 : A nurse is monitoring an older adult female client who had a myocardial infarction (MI) for the development of acute kidney injury (AKI). Which of the following findings should the nurse identify as indicating an increased risk of AKI?

5 : A nurse is caring for a client admitted with renal calculus. Which of the following assessment findings should the nurse associate with renal calculi? (Select all that apply).

6 : A nurse is providing discharge teaching to a client who has a new arteriovenous fistula in the right forearm. Which of the following manifestations should the nurse include in the teaching as possible indications of venous insufficiency?

7 : A nurse is caring for a client who has polycystic kidney disease (PKD). The client is admitted to the hospital for renal calculi and reports that their abdomen has been getting bigger. Which of the following statements by the nurse is the best explanation for the increase in abdominal girth?

8 : A nurse is reviewing laboratory findings for four clients. Which of the following clients has manifestations of acute kidney injury?

9 : A nurse is caring for a client who is undergoing initial peritoneal dialysis. Which of the following should the nurse report immediately to the provider?

10 : A nurse is teaching a client who has urolithiasis (renal calculi). The nurse should explain that which of the following conditions can increase the risk for renal calculi?

1 :
A nurse is providing discharge teaching to a client who will be performing continuous ambulatory peritoneal dialysis (CAPD) at home. Which of the following statements from the client indicates an understanding of this type of dialysis management? (Select all that apply.)

2 :
A nurse is caring for a client who has end-stage renal disease (ESRD). Which of the following are expected findings? (Select all that apply.).

3 :
A nurse is reviewing the laboratory test results from a client who has prerenal acute kidney injury (AKI). Which of the following electrolyte imbalances should the nurse expect?

4 :
A nurse is monitoring an older adult female client who had a myocardial infarction (MI) for the development of acute kidney injury (AKI). Which of the following findings should the nurse identify as indicating an increased risk of AKI?

5 :
A nurse is caring for a client admitted with renal calculus. Which of the following assessment findings should the nurse associate with renal calculi? (Select all that apply).

6 :
A nurse is providing discharge teaching to a client who has a new arteriovenous fistula in the right forearm. Which of the following manifestations should the nurse include in the teaching as possible indications of venous insufficiency?

7 :
A nurse is caring for a client who has polycystic kidney disease (PKD). The client is admitted to the hospital for renal calculi and reports that their abdomen has been getting bigger. Which of the following statements by the nurse is the best explanation for the increase in abdominal girth?

8 :
A nurse is reviewing laboratory findings for four clients. Which of the following clients has manifestations of acute kidney injury?

9 :
A nurse is caring for a client who is undergoing initial peritoneal dialysis. Which of the following should the nurse report immediately to the provider?

10 :
A nurse is teaching a client who has urolithiasis (renal calculi). The nurse should explain that which of the following conditions can increase the risk for renal calculi?