CH 34 Prep U

A 35-year-old client is diagnosed with acute kidney injury (AKI) and is started on hemodialysis. The client is concerned with the diagnosis and wants to know what to expect in the progression of this disorder. Which statement best addresses the client's concern?

"Acute kidney injury is abrupt in onset and often reversible if recognized early and treated appropriately."

A client with a diagnosis of end-stage renal disease received a kidney transplant 2 years ago that was deemed a success. During the most recent follow-up appointment, the nurse should prioritize the client for referral based on which statement?

"I'm feeling a bit under the weather these days and I'm a bit feverish."

With the increased risk of drug toxicity among chronically ill older adults, which statement by the nurse explains why the older adult's kidney is vulnerable to toxic injury?

"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney."

A geriatric nurse is caring for several clients. Which alterations in health should the nurse attribute to age-related physiologic changes?

A 78-year-old woman's GFR has been steadily declining over several years.

Which individual likely faces the greatest risk for the development of chronic kidney disease?

A client with a recent diagnosis of type 2 diabetes who does not monitor blood sugars or control diet

Sexual dysfunction in people with CKD is thought to be multifactorial. What are thought to be possible causes of sexual dysfunction in people with CKD?

Antihypertensive drugs Psychological factors Uremic toxins

A client has been diagnosed with chronic kidney disease (CKD). Which drug category is usually administered to treat coexisting conditions that manifest early in CKD?

Antihypertensive medications

The nurse is caring for a client who has had acute blood loss from ruptured esophageal varices. What does the nurse recognize is an early sign of prerenal failure?

Baseline urine output of 50 mL/hr that is now 10 mL/hr

A client with a history of chronic kidney disease (CKD) is experiencing increasing fatigue, lethargy, and activity intolerance. The care team has established that the client's glomerular filtration rate (GFR) remains at a low, but stable, level. Which laboratory assessments will most likely be prescribed to help determine the cause of these new symptoms?

Blood work for hemoglobin, red blood cells, and hematocrit

The parents of a child who has been diagnosed with chronic kidney disease (CKD) ask the nurse about manifestations of the disease. Which information is the most appropriate information to provide these parents?

Developmental delay Delayed cognitive development Secondary hyperparathyroidism Growth impairment

Which dermatologic problem most often accompanies chronic kidney disease (CKD)?

Dry skin and pruritus

A client is being treated for chronic kidney disease (CKD). One of the nurse's responsibilities is to explain to the client the need to keep her blood pressure under control. Why is blood pressure control so important in CKD clients?

Elevated blood pressure will exacerbate nephron loss and accelerate renal failure.

Glomerular filtration rate (GFR) is the best indicator of renal function. The nurse knows that GFR can vary with which factors?

Gender Age Body size Ethnicity

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?

serum creatinine

A client is to receive a radiocontrast media as part of a diagnostic scan. Which intervention is intended to reduce the nephrotoxic effects of the radiocontrast media?

Increasing the normal saline intravenous infusion rate prior to the exam

Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct?

Kidneys convert inactive vitamin D to its active form, calcitriol.

A nurse caring for a client with acute tubular necrosis (ATN) caused by myoglobinuria knows this may be caused by which finding in the client's medical history?

Muscle damage Hyperthermia Alcohol abuse Prolonged seizures

The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for:

Nephrotoxic acute tubular necrosis

The client with substance use disorder was found unconscious after overdosing on heroin 2 days prior. Because of prolonged pressure on the muscles the client has developed myoglobinuria, causing which complication?

Obstruction of the renal tubules with myoglobin and damaged tubular cells

A client in renal failure has marked decrease in renal blood flow caused by hypovolemia, the result of gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which form of acute renal injury does this client have?

Prerenal failure

When acute tubular necrosis (ATN) is suspected, the nurse will likely see which laboratory findings on the urinalysis report?

Protein Red blood cells Cast cells

The nurse recognizes that acute renal injury is characterized by which of the following?

Rapid decline in renal function

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?

Serum creatinine

Acute tubular necrosis (ATN) is the most common cause of intrinsic renal failure. What are the most common causes of ischemic ATN? Select all that apply.

Severe hypovolemia Burns Overwhelming sepsis

An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which early sign of prerenal injury?

Sharp decrease in urine output

A client has experienced severe hemorrhage and is in prerenal failure. The nurse anticipates the client's blood urea nitrogen (BUN) and serum creatinine laboratory results will be in which range?

The BUN-to-creatinine ratio is 20:1.

A client in renal failure has marked decrease in renal blood flow caused by hypovolemia, the result of gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which form of acute renal injury does this client have?

prerenal failure

A client with chronic kidney disease (CKD) will be managed with peritoneal dialysis. Which description of this type of dialysis is most accurate?

Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time.

The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents:

a loss of over half the client's normal kidney function.

Chronic kidney disease impacts many systems in the body. What is the most common hematologic disorder caused by CKD?

anemia

A new client presents with elevated BUN, systemic edema, a BP of 145/93 mm Hg, recurrent infections, and a GFR of 51 mL/min/1.73 m2. Which treatment should the nurse anticipate?

dialysis

The nurse is instructing a client with advanced kidney disease (AKD) about a dietary regimen. Which restriction should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD?

dietary protein

Several urine tests can be useful in establishing a diagnosis of acute renal failure (ARF). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which type of drug?

diuretics

A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?

hypertension

A client has acute pyelonephritis. The nurse will monitor the client for development of:

intrarenal failure

The nurse is providing dietary instruction for a client with chronic kidney disease (CKD) who is on hemodialysis. Which food would the nurse encourage the client to restrict?

lean meats

The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for:

nephrotoxic acute tubular necrosis

While assessing a peritoneal dialysis client in the home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as:

peritonitis

A client with chronic kidney disease reports having extreme fatigue, chest pressure when walking and trouble breathing when lying supine in bed. The client's current hemoglobin level is 8.3 g/dL (83 g/L). Which intervention(s) will likely be prescribed for this client during this visit? Select all that apply.

Increase in iron intake via food and supplementation Injection of an erythropoietin-stimulating agent

A client asks, "Why did my provider order a glomerular filtration rate (GFR) to my usual blood work?" The nurse's best response is based on the fact that GFR can estimate serum levels of which substance?

creatinine

A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is:

dorsiflexion of hands and feet