ch 71 Care of Patients with Acute Kidney Injury and Chronic Kidney Disease

55. A patient is diagnosed with renal osteodys- trophy. What does the nurse instruct the unli- censed assistive personnel (UAP) to do in rela- tion to this patient's diagnosis? a. Assist the patient with toileting every 2 hours. b. Gently wash the patient's skin with a mild soap and rinse well. c. Handle the patient gently because of risk for fractures. d. Assist the patient with eating because of loss of coordination

55. cc. Handle the patient gently because of risk for fractures.

56. A patient with CKD develops severe chest pain, an increased pulse, low-grade fever, and a pericardial friction rub with a cardiac dys- rhythmia and muffled heart tones. The nurse immediately alerts the health care provider and prepares for which emergency procedure? a. Pericardiocentesis b. Continuous venovenous hemofiltration c. Kidney dialysis d. Cardiopulmonary resuscitation

56. aa. Pericardiocentesis

57. All patients with hypertension or diabetes should have yearly screenings for which factor ? a. Creatinine b. BUN c. Glycosuria d. Microalbuminuria

57. d d. Microalbuminuria

58. The nurse is assessing a patient with kidney failure. What is an early neurologic manifesta- tion of kidney failure that could potentially be resolved with dialysis? a. Lethargy b. Unequal pupils c. Severe motor impairment d. Unilateral weakness

58. aa. Lethargy

59. The night shift nurse sees a patient with kidney failure sitting up in bed. The patient states, "I feel a little short of breath at night or when I get up to walk to the bathroom." What assess- ment does the nurse do? a. Check for orthostatic hypertension be- cause of potential volume depletion. b. Auscultate the lungs for crackles which indicate fluid overload . c. Check the pulse and blood pressure for possible decreased cardiac output. d. Assess for normal sleep pattern and need for a PRN sedative.

59. b b. Auscultate the lungs for crackles which indicate fluid overload

Removes water and electrolytes

aContinuous arteriovenous hemofiltration (CAVH)

89. The nurse is providing postdialysis care for a patient. In comparing vital signs and weight measurements to the predialysis data, what does the nurse expect to find? a. Blood pressure and weight are reduced. b. Blood pressure is increased and weight is reduced. c. Blood pressure and weight are similar to predialysis measurements . d. Blood pressure is low and weight is the same.

aa. Blood pressure and weight are reduced.

Infusion of four 2 L exchanges of di- alysate; exchanges occur 7 days a week

aa. Continuous ambulatory peritoneal dialysis (CAPD)

A patient is undergoing a dialysis treatment and exhibits a progression of symptoms which include headache, nausea, and vomiting; de- creased level of consciousness; and seizure activity. How does the nurse interpret these symptoms? a. Dialysis disequilibrium syndrome b. Expected manifestations in ESKD c. Transient symptoms in a new dialysis pa- tient d. Adverse reaction to the dialysa

aa. Dialysis disequilibrium syndrome

. Which disorder may mimic the presentation of prerenal azotemia? a. Heart failure b. Diabetes mellitus c. Pneumonia d. Compartment syndrome

aa. Heart failure

Nephrons compensate

aa. Stage 1 chronic kidney disease

Primary reduction in function

aa. Stage 1 chronic kidney disease

A patient with AKI is anorexic and refuses to eat. The nurse notifies the health care provider to obtain an order for which intervention? a. Normal saline to prevent dehydration b. Nutritional consult for a calculated diet c. Total parenteral nutrition (TPN) with ap- propriate laboratory monitoring d. Nasogastric tube for enteral feedings

c c. Total parenteral nutrition (TPN) with ap- propriate laboratory monitoring

When pressure in the kidney tubules exceeds glomerular pressure, glomerular filtration _____________.

stops

he nurse is assessing a patient with kidney injury and notes a marked increase in the rate and depth of breathing. The nurse recognizes this as Kussmaul respiration, which is the body's attempt to compensate for which condi- tion? a. Hypoxia b. Alkalosis c. Acidosis d. Hypoxemia

54. c c. Acidosis

The nurse has obtained a urine specimen from a patient and has used a dipstick to test the urine. Which abnormal finding is the earliest sign of kidney tubular damage? a. Presence of blood b. Presence of leukocytes c. Presence of glucose d. Decreased urine specific gravity

14. dd. Decreased urine specific gravity

A patient with AKI has a high rate of catabo- lism. What is this related to? a. Increased levels of catecholamines, corti- sol, and glucagon b. Inability to excrete excess electrolytes c. Conversion of body fat into glucose d. Presence of retained nitrogenous wastes

29. aa. Increased levels of catecholamines, corti- sol, and glucagon

Requires a double-lumen venous cath- eter

33. b, Continuous arteriovenous hemodialysis and filtration (CAVHD) c Continuous venovenous hemofiltration (CVVH)

83. The home health nurse is evaluating the home setting for a patient who wishes to have in- home hemodialysis. What is important to have in the home setting to support this therapy? a. Specialized water treatment system to pro- vide a safe, clean water supply b. Large dust-free space to accommodate and store the dialysis equipment c. Modified electrical system to provide high voltage to power the equipment d. Specialized cooling system to maintain strict temperature control

. 83. a. Specialized water treatment system to pro- vide a safe, clean water supply

1. Which problems occur with acute kidney in- jury? (Select all that apply.) a. Deficient fluid volume b. Acid-base abnormalities c. Loss of kidney hormone function d. Excess fluid volume e. Buildup of nitrogen-based wastes

1. b, c, d, e b. Acid-base abnormalities c. Loss of kidney hormone function d. Excess fluid volume e. Buildup of nitrogen-based wastes

10. The nurse is talking to an older adult male patient who is reasonably healthy for his age, but has benign prostatic hyperplasia (BPH). Which condition does the BPH potentially place him at risk for? a. Prerenal azotemia b. Postrenal azotemia c. Acute tubular necrosis d. Acute glomerulonephritis

10. b b. Postrenal azotemia

Empty bag and tubing are folded be- neath clothing until they are used for outflow

100. bb. Continuous connect system

11. Which combination of drugs is the most neph- rotoxic? a. Angiotensin-converting enzyme (ACE) inhibitors and aspirin b. Angiotensin II receptor blockers and ant- acids c. Aminoglycoside antibiotics and NSAIDs d. Calcium channel blockers and antihista- mines

11. c c. Aminoglycoside antibiotics and NSAIDs

12. The nurse is caring for a patient with the nonoliguric form of acute kidney injury (AKI). Which factor contributes to the prognosis for this patient? a. The clinical manifestations are more read- ily and easily observed . b. Attentive nursing care has resulted in the patient having the nonoliguric form. c. The urine output remains nearly normal and the treatment is less complicated. d. The nonoliguric form occurs in younger people who have better baseline health.

12. c c. The urine output remains nearly normal and the treatment is less complicated.

13. A patient with AKI secondary to which factor has the worst prognosis and the lowest chance for recovery? a. Radiographic contrast dye b. Glomerulonephritis c. Kidney stone d. Dehydration

13. aa. Radiographic contrast dye

A patient is in the diuretic phase of AKI. Dur- ing this phase, what is the nurse mainly con- cerned about? a. Assessing for hypertension and fluid over- load b. Monitoring for hypovolemia and electro- lyte loss c. Adjusting the dosage of diuretic medica- tions d. Balancing diuretic therapy with intake

16. cc. Adjusting the dosage of diuretic medica- tions

16. The nurse is assessing a patient with AKI. The nurse notes bladder distention and the patient reports "feeling the urge to urinate." Urine sodium level is 40 mEq/L; specific gravity of 1.010. How does the nurse interpret these find- ings? a. Prerenal azotemia b. Intrarenal AKI c. Postrenal azotemia d. Oliguric phase

17. dd. Oliguric phase

17. A patient has been diagnosed with AKI, but the cause is uncertain. The nurse prepares pa- tient education material about which diagnos- tic test? a. Flat plate of the abdomen b. Renal ultrasonography c. Computed tomography d. Kidney biopsy

18. b b. Renal ultrasonography

19. A patient with prerenal azotemia is adminis- tered a fluid challenge. In evaluating response to the therapy, which outcome indicates that the goal was met? a. Patient reports feeling better and indicates an eagerness to go home. b. Patient produces urine soon after the ini- tial bolus. c. The therapy is completed without adverse effects. d. The health care provider orders a diuretic when the challenge is completed.

19. b b. Patient produces urine soon after the ini- tial bolus.

2. The community health nurse is designing pro- grams to reduce kidney problems and kidney injury among the general public. In order to do so, the nurse targets health promotion and compliance with therapy for people with which conditions? a. Diabetes mellitus and hypertension b. Frequent episodes of sexually transmitted disease c. Osteoporosis and other bone diseases d. Gastroenteritis and poor eating habits

2. a a. Diabetes mellitus and hypertension

20. The nurse is caring for a patient with AKI and notes a trend of increasing elevated BUN lev- els. How does the nurse interpret this informa- tion? a. Breakdown of muscle for protein which leads to an increase in azotemia b. Sign of urinary retention and decreased urinary output c. Expected trend that can be reversed by in- creasing dietary protein d. Ominous sign of impending irreversible kidney failure

20. a a. Breakdown of muscle for protein which leads to an increase in azotemia

21. The nurse is caring for a patient with prerenal azotemia. What are the primary treatment goals in the initial phase that prevents perma- nent kidney damage for this patient? (Select all that apply.) a. Correct blood volume. b. Increase blood pressure. c. Manage kidney infections. d. Relieve the obstruction. e. Improve cardiac output.

21. a, b, e a. Correct blood volume. b. Increase blood pressure. e. Improve cardiac output.

22. A patient sustained extensive burns and deple- tion of vascular volume. The nurse expects which changes in vital signs and urinary func- tion? a. Decreased urine output, postural hypoten- sion, tachycardia b. Increased urine output, bounding pulses, tachycardia c. Bradycardia, hypertension, polyuria d. Dysrhythmias, hypertension, oliguria

22. aa. Decreased urine output, postural hypoten- sion, tachycardia

3. The nurse is taking a history of a patient at risk for kidney failure. What does the nurse ask the patient about during the interview? (Select all that apply.) a. Exposure to nephrotoxic chemicals b. Recent weight loss c. History of diabetes mellitus, hypertension, systemic lupus erythematosus d. Recent surgery, trauma, or transfusions e. Leakage of urine when coughing or laugh- ing f. Use of antibiotics, NSAIDs, or ACE inhibi- tors

23. a, c, d, f

26. Which symptoms does the nurse expect to see in the patient with intrarenal AKI? (Select all that apply.) a. Oliguria/anuria b. Hypotension c. Shortness of breath d. Jugular vein distention e. Decreased central pressure f. Weight loss g. Crackles h. Nausea and anorexia

26. a, c, d, g, h a. Oliguria/anuria c. Shortness of breath d. Jugular vein distention g. Crackles h. Nausea and anorexia

27. The nurse is caring for a patient with signs and symptoms of prerenal azotemia. A fluid chal- lenge is performed to promote kidney perfu- sion by doing what? a. Administering normal saline 500 to 1000 mL infused over 1 hour b. Administering drugs to suppress aldoste- rone release c. Instilling warm, sterile normal saline into the bladder d. Having the patient drink several large glasses of water

27. aa. Administering normal saline 500 to 1000 mL infused over 1 hour

28. A patient has AKI related to nephrotoxic acute tubular necrosis (ATN). In order to maintain cell integrity, improve glomerular filtration rate (GFR), and improve blood flow to the kidneys, which medication does the nurse anticipate the health care provider will prescribe? a. Digoxin b. Alpha-adrenergic blockers c. Beta blockers d. Calcium channel blockers

28. dd. Calcium channel blockers

3. What are common causes of prerenal azote- mia? (Select all that apply.) a. Urethral cancer b. Heart failure c. Athletes (such as a marathon runner) d. Sepsis e. Shock

3. b, d, e b. Heart failure d. Sepsis e.

A patient with AKI is receiving total parenteral nutrition (TPN). What is the goal of TPN? Preserve lean body mass Promote tubular reabsorption Create a negative nitrogen balance Prevent infection

31. aPreserve lean body mass

Requires placement of arterial and ve- nous catheter

32. a Continuous arteriovenous hemofiltration (CAVH)

Uses pump

34. c Continuous venovenous hemofiltration (CVVH)

Arterial pressure of at least 60 mm Hg

35. a Continuous arteriovenous hemofiltration (CAVH)

Uses dialysate to remove nitrogenous waste

38. b Continuous arteriovenous hemodialysis and filtration (CAVHD)

Excessive waste products

39. c c. End-stage kidney disease

1. A patient's laboratory results show an elevated creatinine level. The patient's history reveals no risk factors for kidney disease. Which question does the nurse ask the patient to shed further light on the laboratory result? a. "How many hours of sleep did you get the night before the test?" b. "How much fluid did you drink before the test?" c. "Did you take any type of antibiotics be- fore taking the test?" d. "When and how much did you last urinate before having the tes

51. c c. "Did you take any type of antibiotics be- fore taking the test?"

The nurse is reviewing a patient's laboratory results. In the early phase of CKD, what does the nurse expect to see? Higher than normal potassium Lower than normal sodium Higher than normal calcium Lower than normal phosphorus

52. b Lower than normal sodium

4. A patient can develop intrarenal kidney injury from which causes? (Select all that apply.) a. Vasculitis b. Renal artery stenosis or thrombosis c. Heart failure d. Exposure to nephrotoxins e. Kidney stones

4. a, b, d a. Vasculitis b. Renal artery stenosis or thrombosis d. Exposure to nephrotoxins

Dialysis

41. c c. End-stage kidney disease

Stress of illness can rapidly compro- mise this stage

45. a a. Stage 1 chronic kidney disease

Severe fluid overload

46. cc. End-stage kidney disease

Severe electrolyte and acid-base imbal- ances

47. cc. End-stage kidney disease

Renal osteodystrophy

48. c c. End-stage kidney disease

The nurse is taking a history on a patient with diabetes and hypertension. Because of the patient's high risk for developing kidney problems, which early sign of chronic kidney disease (CKD) does the nurse assess for? a. Decreased output with subjective thirst b. Urinary frequency of very small amounts c. Pink or blood-tinged urine d. Increased output of very dilute urine

49. dd. Increased output of very dilute urine

15. The nurse is caring for a patient receiving gen- tamicin. Because this drug has potential for nephrotoxicity, which laboratory results does the nurse monitor? (Select all that apply.) a. Blood urea nitrogen (BUN) b. Creatinine c. Drug peak and trough levels d. Prothrombin time (PT) e. Platelet count f. Hemoglobin and hematocrit

5. a, b, c a. Blood urea nitrogen (BUN) b. Creatinine c. Drug peak and trough levels

Postrenal azotemia can result from which con- ditions? (Select all that apply.) a. Sepsis b Urethral cancer c. Kidney stones d. Exposure to nephrotoxins e. Atony of the bladder

5. b, c, e b Urethral cancer c. Kidney stones e. Atony of the bladder

Acute kidney injury may occur with the loss of ________% of nephrons.

50

0. Increased BUN and creatinine, hyperkalemia, and hypernatremia are all characteristics of which stage of kidney disease? a. Stage 1 CKD b. Mild CKD c. Moderate CDK d. End-stage kidney disease

50. dd. End-stage kidney disease

A patient with CKD has a potassium level of 8 mEq/L. The nurse notifies the health care pro- vider after assessing for which sign/symptom? Cardiac dysrhythmias Respiratory depression Tremors or seizures Decreased urine output

53. aCardiac dysrhythmias

What does the breath often smell like in a pa- tient with CKD? a. Fruit b. Feces c. Urine d. Blood

60. c c. Urine

61. The patient with CKD reports chronic fatigue and lethargy with weakness and mild shortness of breath with dizziness when rising to a stand- ing position. In addition, the nurse notes pale mucous membranes. Based on the patient's illness and the presenting symptoms, which laboratory result does the nurse expect to see? a. Low hemoglobin and hematocrit b. Low white cell count c. Low blood glucose d. Low oxygen saturation

61. aa. Low hemoglobin and hematocrit

2. The nurse is assessing the skin of a patient with ESKD. Which clinical manifestation is consid- ered a sign of very advanced disease? a. Ecchymoses b. Sallowness c. Pallor d. Uremic frost

62. dd. Uremic frost

65. A patient receives dialysis therapy and the health care provider has ordered sodium re- striction to 3 g daily. What does the nurse teach the patient? a. Add only small amounts of salt at the table or during cooking. b. Foods high in sodium (e.g., processed foods, fast foods) should be strictly avoid- ed. c. Herbs and spices can be used in place of salt to enhance food flavor. d. Bland foods with very minimal amounts of spicing are the best choice.

65. cc. Herbs and spices can be used in place of salt to enhance food flavor

66. In order to assist a patient in the prevention of osteodystrophy, which intervention does the nurse perform? a. Administer phosphate binders. b. Encourage the patient to eat high-quality protein foods. c. Assist the patient to ambulate and exercise several times a day . d. Encourage the patient to drink extra milk at mealtimes.

66. a a. Administer phosphate binders.

68. The nurse is caring for a patient with ESKD and dialysis has been initiated. Which drug order does the nurse question? a. Erythropoietin b. Diuretic c. ACE inhibitor d. Calcium channel blocker

68. b b. Diuretic

he nurse is evaluating a patient's treatment response to erythropoietin (Epogen). Which hematocrit reading indicates that the goal is being met? a. 10% b. 30% c. 50% d. At baseline

72. b b. 30%

73. A patient has been receiving erythropoietin (Epogen). Which statement by the patient indicates that the therapy is producing the de- sired effect? a. "I can do my housework with less fatigue." b. "I have been passing more urine than I was before." c. "I have less pain and discomfort now." d. "I can swallow and eat much better than before."

73. a a. "I can do my housework with less fatigue."

74. Which behavior is the strongest indicator that a patient with ESKD is not coping well with the illness and may need a referral for psycho- logical counseling? a. Displays irritability when the meal tray arrives b. Refuses to take one of the drugs because it causes nausea c. Repeatedly misses dialysis appointments d. Seems distracted when the health care pro- vider talks about the prognosis

74. c c. Repeatedly misses dialysis appointments

75. A patient with CKD is restless, anxious, and short of breath. The nurse hears crackles that begin at the base of the lungs. The pulse rate is increased and the patient has frothy, blood- tinged sputum. What does the nurse do next? a. Facilitate transfer to the ICU for aggressive treatment. b. Place the patient in a high-Fowler's posi- tion. c. Monitor vital signs and assess breath sounds. d. Administer a loop diuretic such as furose- mide (Lasix).

75. bb. Place the patient in a high-Fowler's posi- tion.

he nurse is caring for a patient with CKD. The family asks about when renal replacement therapy will begin. What is the nurse's best re- sponse? a. "As early as possible to prevent further damage in stage I. " b. "When there is reduced kidney function and metabolic wastes accumulate." c. "When the kidneys are unable to maintain a balance in body functions." d. "It will be started with diuretic therapy to enhance the remaining function."

78. c c. "When the kidneys are unable to maintain a balance in body functions

As a result of kidney failure, excessive hydro- gen ions cannot be excreted. With acid reten- tion, the nurse is most likely to observe what type of respiratory compensation? a. Cheyne-Stokes respiratory pattern b. Increased depth of breathing c. Decreased respiratory rate and depth d. Increased arterial carbon dioxide levels

80. bb. Increased depth of breathing

84. The nursing student is explaining principles of hemodialysis to the nursing instructor. Which statement by the student indicates a need for additional study and research on the topic? a. "Dialysis works as molecules from an area of higher concentration move to an area of lower concentration." b. "Blood and dialyzing solution flow in op- posite directions across an enclosed semi- permeable membrane." c. "Excess water, waste products, and excess electrolytes are removed from the blood." d. "Bacteria and other organisms can also pass through the membran

84. d d. "Bacteria and other organisms can also pass through the membran

A patient and family are trying to plan a sched- ule that coordinates with the patient's dialysis regimen. The patient asks, "How often will I have to go and how long does it take?" What is the nurse's best response? a. "If you are compliant with the diet and fluid restrictions, you spend less time in dialysis; about 12 hours a week." b. "Most patients require about 12 hours per week; this is usually divided into three 4-hour treatments." c. "It varies from patient to patient. You will have to call your health care provider for specific instructions." d. "If you gain a large amount of fluid weight, a longer treatment time may be needed to prevent severe side effects."

85. b b. "Most patients require about 12 hours per week; this is usually divided into three 4-hour treatments."

87. The nurse is caring for a patient with an arte- riovenous shunt. What instructions are given to the UAP regarding the care of this patient? a. Palpate for thrills and auscultate for bruits every 4 hours. b. Check for bleeding at needle insertion sites. c. Assess the patient's distal pulses and circu- lation. d. Do not take blood pressure readings in the arm with the shunt.

87. dd. Do not take blood pressure readings in the arm with the shunt.

88. The nurse is assessing a patient's extremity with an arteriovenous graft. The nurse notes a thrill and a bruit, and the patient reports numbness and a cool feeling in the fingers. How does the nurse interpret this information in regards to the shunt? a. It is functional and symptoms are expect- ed. b. It is functional but the patient has "steal syndrome." c. It is directing the blood flow in the wrong direction. d. It is not functional and therefore causing numbness.

88. b b. It is functional but the patient has "steal syndrome."

A patient has returned to the medical-surgical unit after having a dialysis treatment. The nurse notes that the patient is also scheduled for an invasive procedure on the same day. What is the primary rationale for delaying the procedure for 4 to 6 hours? a. The patient was heparinized during dialy- sis . b. The patient will have cardiac dysrhythmias after dialysis. c. The patient will be incoherent and unable to give consent. d. The patient needs routine medications that were delayed.

92. aa. The patient was heparinized during dialy- sis

he nurse alerts the health care provider about changes in a patient's condition and the pa- tient is diagnosed with dialysis disequilibrium syndrome. The nurse prepares to assist in the administration of which treatment? a. IV normal saline fluid bolus b. Diuretics and antihypertensives c. Barbiturates and anticonvulsants d. Morphine and anticoagulants

93. cc. Barbiturates and anticonvulsants

Which patient with kidney problems is the best candidate for peritoneal dialysis (PD)? a. Patient with peritoneal adhesions b. Patient with a history of extensive abdomi- nal surgery c. Patient with peritoneal membrane fibrosis d. Patient with a history of difficulty with an- ticoagulants

94. dd. Patient with a history of difficulty with an- ticoagulants

Place the sequence of steps of PD in the correct order using the numbers 1 through 3. Fluid stays in the cavity for a specified time prescribed by the health care provider. 1 to 2 L of dialysate is infused by gravity over a 10- to 20-minute period. Fluid flows out of the body by gravity into a drainage bag.

95. a.2 b. 1 c. 3 1 to 2 L of dialysate is infused by gravity over a 10- to 20-minute period. Fluid stays in the cavity for a specified time prescribed by the health care provider. Fluid flows out of the body by gravity into a drainage bag.

he extra opening of the system in- creases the risk for infection

99. c c. Disconnect system

he nurse is caring for a patient who had hy- povolemic shock secondary to trauma in the emergency department (ED) 2 days ago. Based on the pathophysiology of hypovolemia and prerenal azotemia, what does the nurse assess every hour? a. Urinary output b. Presence of edema c. Urine color d. Presence of pain

a a. Urinary output

Which are the most accurate ways to monitor kidney function in the patient with CKD? (Se- lect all that apply.) a. Monitoring intake and output b. Checking urine specific gravity c. Reviewing BUN and serum creatinine lev- els d. Reviewing x-ray reports e. Consulting the dietitian's notes

a, b, c a. Monitoring intake and output b. Checking urine specific gravity c. Reviewing BUN and serum creatinine lev- els

Hypertension

a, b, c a. Stage 1 chronic kidney disease b. Mild chronic kidney disease c. End-stage kidney disease

he nurse is assessing a patient with uremia. Which gastrointestinal changes does the nurse expect to find? (Select all that apply.) a. Halitosis b. Hiccups c. Anorexia d. Nausea e. Vomiting f. Salivation g. Stomatitis

a, b, c, d, e, g a. Halitosis b. Hiccups c. Anorexia d. Nausea e. Vomiting g. Stomatitis

In collaboration with the registered dietitian, the nurse teaches the patient about which diet recommendations for management of CKD? (Select all that apply.) . Controlling protein intake b. Limiting fluid intake c. Restricting potassium d. Increasing sodium e. Restricting phosphoru s f. Eating enough calories to meet metabolic need g. Avoiding vitamin supplements

a, b, c, e, f a. Controlling protein intake b. Limiting fluid intake c. Restricting potassium e. Restricting phosphorus f. Eating enough calories to meet metabolic need

A patient with CKD is taking digoxin. Which signs of digoxin toxicity does the nurse vigi- lantly monitor for? (Select all that apply.) a. Nausea and vomiting b. Visual change s c. Respiratory depression d. Restlessness or confusion e. Headache or fatigue f. Tachycardia

a, b, d, e, f a. Nausea and vomiting b. Visual changes d. Restlessness or confusion e. Headache or fatigue f. Tachycardia

82. Which patients with CKD are candidates for hemodialysis? (Select all that apply. ) a. Patient with fluid overload who does not respond to diuretics b. Patient with medication-controlled hyper- tension c. Patient with severe neurologic problems d. Patient with a decreased attention span and decreased cognition e. Patient with worsening anemia and pruri- tus

a, c, d, e a. Patient with fluid overload who does not respond to diuretics c. Patient with severe neurologic problems d. Patient with a decreased attention span and decreased cognition e. Patient with worsening anemia and pruri- tus

The nurse is caring for a patient in the ICU who sustained blood loss during a traumatic accident. In order to assess for prerenal azote- mia, which signs and symptoms does the nurse observe for? (Select all that apply.) a. Hypotension b. Bradycardia c. Decreased urine output d. Decreased cardiac output e. Increased central venous pressure f. Lethargy

a, c, d, f a. Hypotension c. Decreased urine output d. Decreased cardiac output f. Lethargy

he nurse is caring for a patient with CKD. The nurse anticipates that dosage adjustments will be made for which drugs? (Select all that ap- ply.) a. Antibiotics b. Opioids c. Insulin d. NSAIDs e. Oral antidiabetics

a, c, e a. Antibiotics c. Insulin e. Oral antidiabetics

76. Which patients are candidates for CAVH? (Se- lect all that apply.) a. Patient with fluid volume overload b. Patient who needs long-term management c. Hemodynamically unstable patient d. Patient who is ready for discharge to home e. Patient who is resistant to diuretics

a, c, e a. Patient with fluid volume overload c. Hemodynamically unstable patient e. Patient who is resistant to diuretics

67. The nurse prepares to administer medica- tions to a patient with CKD. The nurse calls the health care provider as a reminder that the patient might need which nutritional supple- ments? (Select all that apply.) a. Iron b. Magnesium c. Phosphorus d. Calcium e. Vitamin D f. Water-soluble vitamins

a, d, e, f a. Iron d. Calcium e. Vitamin D f. Water-soluble vitamins

he nurse monitors a CKD patient's daily weights because of the risk for fluid retention. What instructions does the nurse give to the UAP? a. Weigh the patient daily at the same time each day, same scale, with the same amount of clothing. b. Weigh the patient daily and add 1 kilo- gram of weight for the intake of each liter of fluid. c. Weigh the patient in the morning before breakfast and weigh the patient at night just before bedtime. d. Ask the patient what his or her normal weight is and then weigh the patient before and after each voiding.

aa. Weigh the patient daily at the same time each day, same scale, with the same amount of clothing.

77. As a patient with ESKD experiences isosthenuria, what must the nurse be alert for? a. The diuretic stage b. Fluid volume overload c. Dehydration d. Alkalosis

b b. Fluid volume overload

The nurse is caring for a patient with an arte- riovenous fistula. What is included in the nurs- ing care for this patient? (Select all that apply.) a. Keep small clamps handy by the bedside. b. Encourage routine range-of-motion exer- cises. c. Avoid venipuncture or IV administration on the arm with the access device. d. Instruct the patient to carry heavy objects to build muscular strength. e. Assess for manifestations of infection at needle sites. f. Instruct the patient to sleep on the side with the affected arm in the dependent po- sition.

b, c, e b. Encourage routine range-of-motion exer- cises. c. Avoid venipuncture or IV administration on the arm with the access device. e. Assess for manifestations of infection at needle sites.

Increased BUN and creatinine

b, cc. End-stage kidney disease

When shock or other problems cause an acute reduction in blood flow to the kidneys, how do the kidneys compensate? (Select all that apply.) a. Constrict blood vessels in the kidneys b. Activate the renin-angiotensin-aldosterone pathway c. Release beta-blockers d. Constrict blood vessels in the kidneys e. Release antidiuretic hormones

b, d, e b. Activate the renin-angiotensin-aldosterone pathway d. Constrict blood vessels in the kidneys e. Release antidiuretic hormones

isk of air embolus

cContinuous venovenous hemofiltration (CVVH)

96. The health care provider has ordered intra- peritoneal heparin for a patient with a new PD catheter to prevent clotting of the catheter. What does the nurse advise the patient to do? a. Watch for signs of bleeding such as bruis- ing or bleeding from the gums. b. Make a follow-up appointment for coagu- lation studies. c. Be aware that intraperitoneal heparin does not affect clotting times. d. Be aware that heparin will be given with a small subcutaneous needle.

cc. Be aware that intraperitoneal heparin does not affect clotting times

nurse notes an abnormal laboratory test finding for a patient with CKD and alerts the health care provider. The nurse also consults with the registered dietitian because an exces- sive dietary protein intake is directly related to which factor? a. Elevated serum creatinine level b. Protein presence in the urine c. Elevated BUN level d. Elevated serum potassium level

cc. Elevated BUN level

90. The nurse is assessing a patient who has just returned from hemodialysis. What is an unex- pected finding that warrants notification of the health care provider? a. Feeling of malaise b. Nausea and anorexia c. Muscle cramps in the legs d. Bleeding at the access site

dd. Bleeding at the access site

Combines osmotic pressure gradients with true dialys

e e. Intermittent peritoneal dialysis (IPD)