Ch 63 (Q&A only)

A client comes into the emergency department with a serum creatinine of 2.2 mg/dL (1944 mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What question would the nurse ask first when taking this client's history?

"Have you been taking any aspirin, ibuprofen, or naproxen recently?"

The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates that more teaching is needed?

"I am thrilled that I can continue to eat fast food."

A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD). Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.)

"I need to ask for an antibiotic when scheduling a dental appointment." "I'll need to check my blood sugar often to prevent hypoglycemia." "The dose of my pain medication may have to be adjusted." "I should watch for bleeding when taking my anticoagulants."

The nurse is teaching a client how to increase the flow of dialysate into the peritoneal cavity during dialysis. Which statement by the client demonstrates a correct understanding of the teaching? aline if the flow stops."

"I should take a stool softener every morning to avoid constipation."

A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are correct regarding PD? (Select all that apply.)

"You will not need vascular access to perform PD." "There is less restriction of protein and fluids." "You have flexible scheduling for the exchanges."

The nurse is teaching assistive personnel (AP) about fluid restriction for a client who has acute kidney injury (AKI). The client's 24-hour urinary output is 120 mL. How much fluid would the client be allowed to have over the next 24 hours?

620 mL

A client is undergoing hemodialysis. The client's blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions would the nurse perform to maintain blood pressure? (Select all that apply.)

Adjust the rate of extracorporeal blood flow. Place the patient in the Trendelenburg position. Administer a 250-mL bolus of normal saline.

The charge nurse is orienting a new nurse about care for an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe?

Administering intravenous fluids through the AV fistula

A 70-kg adult client with chronic kidney disease (CKD) is on a 40-g protein diet. The patient has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would be of most concern to the nurse?

Albumin level of 2.5 g/dL (3.63 mcmol/L).

The nurse is caring for a client with a new diagnosis of chronic kidney disease. Which priority complications would the nurse anticipate? (Select all that apply.)

Anemia. Hypertension. Dysrhythmias. Heart failure.

A client is started on continuous venovenous hemofiltration (CVVH). Which finding would require immediate action by the nurse?

Blood pressure of 76/58 mm Hg.

A client with chronic kidney disease (CKD) has an elevated serum phosphorus level. What drug would the nurse anticipate to be prescribed for this client?

Calcium acetate

The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the nurse assess first upon initial rounding?

Client with Kussmaul respirations.

The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for postrenal acute kidney injury (AKI)? (Select all that apply.)

Client with prostate cancer. Client with blood clots in the urinary tract. Client with ureterolithiasis.

A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm Hg. The primary health care provider prescribed 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client starts to develop shortness of breath. What is the nurse's priority action?

Decrease the rate of the IV infusion.

The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI). Which condition would the nurse expect to find in the patient's recent history?

Dehydration

A client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse?

Discuss what the treatment regimen means to the client.

A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this patient's care?

Electrolyte and fluid imbalance.

A marathon runner comes into the clinic and states "I have not urinated very much in the last few days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is most appropriate?

Give the client a bottle of water immediately.

The nurse administers epoetin alfa to a client who has chronic kidney disease (CKD). Which laboratory test value would the nurse monitor to determine this drug's effectiveness?

Hemoglobin.

A nurse reviews the laboratory values of a client who returned from kidney transplantation 12 hours ago: Sodium 136 mEq/L (135 mmol/L). Potassium 5 mEq/L (5 mmol/L). Blood urea nitrogen (BUN) 44 mg/dL (15.7 mmol/L). Serum creatinine 2.5 mg/dL (221 mcmol/L). What initial intervention would the nurse anticipate?

Increase the dose of immunosuppression.

A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The nurse is teaching the client's spouse about the renal-specific formulation for the enteral solution compared to standard formulas. What components would be discussed in the teaching plan? (Select all that apply.)

Lower sodium. Lower potassium. Higher calories

A client is placed on fluid restriction because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client's fluid balance is stable at this time?

No adventitious sounds in the lungs

A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What is the priority action by the nurse?

Obtain a sample of the effluent and send to the laboratory.

A client is taking furosemide 40 mg/day for management of early chronic kidney disease (CKD). To assess the therapeutic effect of the medication, what action of the nurse is best?

Obtain daily weights of the client.

A client has a serum potassium level of 6.5 mEq/L (6.5 mmol/L), a serum creatinine level of 2 mg/dL (176 mcmol/L), and a urine output of 350 mL/day. What is the best action by the nurse?

Place the client on a cardiac monitor immediately.

A client with diabetes mellitus type 2 has been well controlled with metformin. The client is scheduled for magnetic resonance imaging (MRI) scan with contrast. What priority would the nurse take at this time?

Tell the client to withhold metformin for 24 hours before the MRI.

A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery. Which findings by the nurse would prompt immediate action to prevent acute kidney injury? (Select all that apply.)

Urine output of 100 mL in 4 hours. Large amount of sediment in the urine. Blood pressure of 90/60 mm Hg.