chapter 34 quiz 4

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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

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

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? -"The scarring on my flank where the surgery was done doesn't seem to be fading." -"I've noticed that my urine is a bit more concentrated than usual the last few days." -"I'm feeling a bit under the weather these days and I'm a bit feverish." -"I've decided to try eating less fat and carbohydrates than I have been."

"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 client has undergone a kidney transplant and voices concerns about organ rejection to the nurse. The most appropriate response by the nurse would be:

"You will be given medication to decrease the likelihood of your immune system attacking your new kidney."

A client is diagnosed with early chronic kidney disease (CKD). The nurse will recommend which actions to slow progression of renal damage? Select all that apply. -Blood glucose control -Angiotensin converting enzyme (ACE) inhibitor administration -Smoking cessation -High-protein diet -Blood pressure control

-Blood glucose control -Angiotensin converting enzyme (ACE) inhibitor administration -Smoking cessation -Blood pressure control High blood pressure creates elevated pressure in glomeruli, resulting in renal damage. Hyperglycemia fosters microalbuminuria and can add to the peripheral neuropathy of CKD. Smoking causes an increase in blood pressure and increased glomerular pressure and can cause endothelial cell dysfunction. Administration of an ACE inhibitor or angiotensin-II receptor blocker (ARB) will dilate the efferent renal arterioles, reducing pressure in the glomeruli. A low-protein diet is recommended in CKD, as protein metabolism will add to the circulating nitrogenous wastes.

The nurse knows that a client with chronic kidney disease (CKD) may experience which changes in skin integrity? Select all that apply. -Increased oil gland secretion -Decreased perspiration -Pale skin -Moist skin and mucous membranes -Brittle fingernails

-Decreased perspiration -Pale skin -Brittle fingernails In CKD, anemia due to loss of erythropoietin activity causes pale skin. Perspiration and oil secretion are decreased, leading to dry skin. Fingernails become brittle.

A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that this client will experience which manifestations? Select all that apply. -Decreased renal endocrine function -Decreased glomerular filtration -Hypophosphatemia -Decreased tubular reabsorption -Proliferation of nephrons

-Decreased renal endocrine function -Decreased glomerular filtration -Decreased tubular reabsorption Chronic kidney disease results in loss of nephrons, with a decrease in tubular reabsorption, glomerular filtration, and endocrine function. Phosphate accumulates in the blood, as the kidneys lose their ability to excrete this electrolyte.

Glomerular filtration rate (GFR) is the best indicator of renal function. The nurse knows that GFR can vary with which factors? Select all that apply. -Ethnicity -Age -Gender -Body size -Diet

-Ethnicity -Age -Gender -Body size GFR, the best indicator of overall renal function, varies with age, gender, body size, and ethnicity. Equations are available for calculating GFR based on serum creatinine and these variables. Diet, if it includes sufficient fluid intake to maintain hydration, should not affect GFR.

Older adults often have other chronic diseases that influence the early symptoms and signs of renal dysfunction. The nurse knows that which finding can be the dominant clinical events in older adults with early kidney disease? Select all that apply. -Oliguria -Discolored urine -Heart failure -Hypertension -Pruritus

-Heart failure -Hypertension In older adults, heart failure and hypertension may be the dominant presenting signs of chronic kidney disease (CKD). Oliguria and discolored urine are more characteristic of younger adults with CKD. Pruritus is a later effect of CKD.

A client has acute pyelonephritis. The nurse will monitor the client for development of: -Chronic kidney disease -Post-renal failure -Prerenal failure -Intrarenal failure

-Intrarenal failure Acute pyelonephritis, an active bacterial infection, can cause tubular cell necrosis and intrarenal failure. Acute pyelonephritis does not cause prerenal or post-renal failure or chronic kidney disease unless it is not treated.

A client with chronic kidney disease who has renal osteodystrophy should be assessed for which complications? Select all that apply. -Urosepsis -Kidney stones -Muscle weakness -Bone pain -Stress fractures

-Muscle weakness -Bone pain -Stress fractures Both types of renal osteodystrophy are manifested by abnormal absorption and defective bone remodeling. Renal osteodystrophy is typically accompanied by reductions in bone mass, alterations in bone microstructure, bone pain, and skeletal fracture. There are changes in bone turnover, mineralization, and bone volume, accompanied by bone pain and muscle weakness, risk of fractures, and other skeletal complications. Kidney stones and urosepsis are not associated with renal osteodystrophy.

The nurse will monitor which clients at risk for the development of chronic kidney disease (CKD)? Select all that apply. -Polycystic kidney disease -Systemic lupus erythematosus -Hyperlipidemia -Diabetes -Glomerulonephritis

-Polycystic kidney disease -Systemic lupus erythematosus -Diabetes -Glomerulonephritis Permanent renal damage can result from systemic lupus erythematosus, polycystic kidney disease, glomerulonephritis, or diabetes. Hypertension also is a frequent cause for CKD. Hyperlipidemia does not cause CKD but may develop in clients with CKD.

The nurse recognizes that acute renal injury is characterized by which of the following? -Decreased blood urea nitrogen (BUN) -Low incidence of mortality -Irreversible damage to nephrons -Rapid decline in renal function

-Rapid decline in renal function Acute renal injury is a rapid decline in kidney function. BUN rises as nitrogenous wastes are not removed from the circulation. If the cause can be ameliorated, the injury is usually reversible. Most at risk are seriously ill clients; the mortality rate is between 40% and 90% in these clients.

The nurse knows that a child with chronic kidney disease (CKD) may experience which manifestations? Select all that apply. -Intellectual disability -Severe growth deficit -Bladder incontinence -High bone turnover -Early sexual maturity

-Severe growth deficit -High bone turnover Childhood CKD is manifested by delays in growth and sexual maturity as a result of the uremic effects on endocrine function and bone growth. High bone turnover is related to secondary hyperparathyroidism. Intelligence and control of urinary tract function are not directly affected by renal failure.

A client with chronic kidney disease (CKD) is anemic. The nurse will attempt to alleviate the anemia in order to prevent which of the following? Select all that apply. -Hypersomnia -Tachycardia -Decreased myocardial oxygen -Increased blood viscosity -Fatigue

-Tachycardia -Decreased myocardial oxygen -Fatigue Uncorrected anemia provokes fatigue and insomnia, a decrease in blood viscosity, a decrease in myocardial oxygen supply, and tachycardia as the heart attempts to supply sufficient oxygen to the heart and brain.

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

10:1

Accumulation of nitrogenous wastes such as urea in the circulatory system is an early sigh of chronic kidney disease (CKD). The nurse knows that normal levels of urea in blood are approximately:

20 mg/dL (7.14 mmol/L)

Accumulation of nitrogenous wastes such as urea in the circulatory system is an early sigh of chronic kidney disease (CKD). The nurse knows that normal levels of urea in blood are approximately: -60 mg/dL (21.42 mmol/L) -100 mg/dL (35.70 mmol/L) -20 mg/dL (7.14 mmol/L) -80 mg/dL (28.56 mmol/L)

20 mg/dL (7.14 mmol/L) Normal levels of blood urea nitrogen are approximately 20 mg/dL or less. The level increases as CKD worsens and can go as high as 800 mg/dL (285.60 mmol/L).

A 1-year-old baby boy with renal dysplasia risks end-stage renal disease unless intervention occurs. Which of the following treatment options is his care team most likely to reject? A) Dietary restriction plus erythropoietin B) Continuous cyclic peritoneal dialysis C) Renal transplantation D) Continuous ambulatory peritoneal dialysis

A client is suspected to have chronic kidney disease (CKD). The nurse will use which glomerular filtration rate (GFR) to aid in this diagnosis?

60 mL/min/1.73 m2 or less for 3 months

Following the diagnosis of acute renal failure, the nurse knows that one of the earliest manifestations of residual tubular damage is which of the following lab/diagnostic results? A) Elevated blood urea nitrogen (BUN) B) Serum creatinine elevation C) Inability to concentrate urine D) Reduced glomerular filtration rate

The nurse is caring for a client with heart failure, which in turn is causing a prerenal problem. Which alteration in diagnostic studies does the nurse anticipate? -A BUN-Creatinine ratio of 5:1 -A BUN-Creatinine ratio of greater than 15:1 -A BUN-Creatinine ratio of less than 10:1 -A BUN-Creatinine ratio of 10:1

A BUN-Creatinine ratio of greater than 15:1 The normal BUN-creatinine ratio is approximately 10:1. Ratios greater than 15:1 represent prerenal conditions (including heart failure and upper gastrointestinal tract bleeding) that produce an increase in BUN, but not in creatinine. A ratio of less than 10:1 occurs in individuals with liver disease, those consuming a low-protein diet, or those receiving chronic dialysis, because BUN is more readily dialyzable than creatinine.

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

Anemia

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

Anemia The most common hematologic disorder that accompanies CKD is anemia.

A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor for which manifestations of this disorder? Select all that apply. -Hypercalcemia -Anemia -Right ventricular dysfunction -Osteodystrophy -Increased nitrogenous waste in blood

Anemia, Osteodystrophy, Increased nitrogenous waste in blood

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

Which clinical manifestation is the most common indicator of acute kidney injury?

Azotemia

Acute renal failure occurs at a high rate in seriously ill people who are in intensive care units. What is the most common indicator of acute renal failure?

Azotemia and a decrease in the GFR

Which of the following clients' diagnostic blood work is most suggestive of chronic kidney disease (CKD)? A) A client with high pH; low levels of calcium; and low levels of phosphate B) A client with low vitamin D levels; low calcitriol levels; and elevated parathyroid hormone (PTH) levels C) A client with low bone density; low levels of calcium; and low levels of phosphate D) A client with low potassium levels; low calcitriol levels; and increased PTH levels

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 heart rate of 100 bpm that has increased to 120 bpm -Baseline urine output of 50 mL/hr that is now 10 mL/hr -Baseline blood pressure of 150/90 mm Hg that is now 130/80 mm Hg -Foul smelling, cloudy urine

Baseline urine output of 50 mL/hr that is now 10 mL/hr The kidney normally responds to a decrease in the glomerular filtration rate with a decrease in urine output. Thus, an early sign of prerenal failure is a sharp decrease in urine output.

The nurse is caring for a client with chronic renal failure who is on hemodialysis three times a week. In order to treat hyperphosphatemia and hypocalcemia, which medication will the nurse administer to decrease absorption of phosphate from the gastrointestinal tract?

Calcium carbonate

A 35-year-old female ultramarathon runner is admitted to the hospital following a day-long, 50-mile race because her urinary volume is drastically decreased and her urine is dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis. Why is her urine red? A) Hematuria B) Hemoglobinuria C) Myoglobinuria D) Kidney bleeding

Calcium carbonate Early treatment of hyperphosphatemia and hypocalcemia is important to prevent or slow the development of skeletal complications. Milk products and other foods high in phosphorus content are restricted in the diet. Phosphate-binding antacids (aluminum salts, calcium carbonate, or calcium acetate) may be prescribed to decrease absorption of phosphate from the gastrointestinal tract.

The nurse caring for a group of clients should monitor which clients for the development of intrarenal failure? Select all that apply. -Client taking gentamicin for the treatment of a kidney infection -Client with septic shock from pneumonia -Client with lead poisoning -Client with acute glomerulonephritis -Client with a gastrointestinal hemorrhage

Client taking gentamicin for the treatment of a kidney infection, Client with septic shock from pneumonia, Client with lead poisoning, Client with acute glomerulonephritis

The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney failure?

Client with prostatic hyperplasia

The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney failure? -Client with severe hypovolemia -Client with prostatic hyperplasia -Client with acute pyelonephritis -Client with intratubular obstruction

Client with prostatic hyperplasia The most common cause of postrenal kidney failure is prostatic hyperplasia. Postrenal failure results from conditions that obstruct urine outflow. The obstruction can occur in the ureter, bladder, or urethra. Intratubular obstruction and acute pyelonephritis are intrarenal causes of kidney failure, and severe hypovolemia is a prerenal cause.

Control blood glucose and blood pressure

An 80-year-old client with diabetes has a GFR of 41 mL/min/1.73 m2. His physical and workup show uremia, azotemia, and elevated BUN. Which action should be done first to slow the decline of his kidney function? -Increase intravenous fluids -Control blood glucose and blood pressure -Do a kidney transplant -Restrict protein in the diet

Control blood glucose and blood pressure The client demonstrates evidence of CKD, and early management should focus on controlling blood sugars and blood pressure to slow the loss of renal function. Protein restriction could have adverse effects and may not be sufficient to slow the loss of function. Increasing IV fluids could exacerbate his symptoms and increase blood pressure. Kidney transplant would not be the first intervention attempted.

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? -Kidney transplant -Dialysis -Bone marrow transplant -Intravenous antibiotics

Dialysis These findings are suggestive of chronic kidney disease (CKD), defined as kidney damage with a GFR less than 60 mL/min/1.73 m2 for 3 months or longer. Dialysis is a likely intervention. The disease is noninfectious, so antibiotics are not necessarily indicated. Dialysis would precede a transplant in nearly all circumstances. BMT is not a relevant intervention.

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 42-year-old male has been diagnosed with renal failure secondary to diabetes mellitus and is scheduled to begin dialysis soon. Which of the following statements by the client reflects an accurate understanding of the process of hemodialysis? A) "It's stressful knowing that committing to dialysis means I can't qualify for a kidney transplant." B) "I know I'll have to go to a hospital or dialysis center for treatment." C) "Changing my schedule to accommodate 3 or 4 hours of hemodialysis each day will be difficult." D) "I won't be able to go about my normal routine during treatment."

As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by: -GFR decrease to 15 to 29 mL/minute/1.73 m2 -Diminished GFR to less than 15 mL/minute/1.73 m2 -Decrease in GFR of 60 to 89 mL/minute/1.73 m2 -Decrease in GFR to 30 to 59 mL/minute/1.73 m2

Decrease in GFR of 60 to 89 mL/minute/1.73 m2 Diminished renal reserve is characteristic of renal insufficiency, when labs remain normal but there is renal insufficiency. Only the second stage, formerly known as renal insufficiency, is characterized by a decrease in GFR of 60 to 89 mL/minute/1.73 m2. The other choices represent stage 3, 4, and 5, respectively.

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

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

Dorsiflexion of hands and feet

A client is beginning to recover from acute tubular necrosis. During which phase of acute kidney injury will the nurse assess an increase in urine output?

Diuretic phase

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 client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is: -Demyelination of nerve fibers -Dorsiflexion of hands and feet -Burning sensation in feet -Unsteady gait

Dorsiflexion of hands and feet Asterixis, which is involuntary dorsiflexion of hands and feet, can develop as CKD worsens. Burning sensation in feet, unsteady gait and demyelination of nerves can also accompany CKD, but are not part of asterixis.

A client with chronic kidney disease (CKD) is anemic. The nurse will attempt to alleviate the anemia in order to prevent which of the following? Select all that apply. -Fatigue -Tachycardia -Hypersomnia -Increased blood viscosity -Decreased myocardial oxygen

Fatigue, Tachycardia, Decreased myocardial oxygen

The health care provider is reviewing laboratory results of a client. Select the diagnostic test that is considered the best measurement of overall kidney function. -Blood urea nitrogen (BUN) -Urine albumin levels -Glomerular filtration rate (GFR) -Serum creatinine levels

Glomerular filtration rate (GFR) GFR is the best overall measure of kidney function. GFR is usually estimated using the serum creatinine concentration. Creatinine, a by-product of muscle metabolism, is produced at a fairly constant rate, is freely filtered in the glomerulus, and is not reabsorbed in the renal tubules. Essentially all of the creatinine filtered by the kidneys is lost in the urine; therefore, serum creatinine is an indirect measure of GFR. Proteinuria serves as a key adjunctive tool for measuring nephron injury and repair. Urine normally contains small amounts of protein. Blood tests for BUN and creatinine provide information regarding the ability to remove nitrogenous wastes from the blood.

A client sustained acute tubular injury approximately 2 hours ago. Which cause of acute kidney injury (AKI) would the nurse suspect the client is experiencing? -Prerenal -Intrarenal -Postrenal -Systemic

Intrarenal The intrarenal AKI is caused by acute tubular necrosis/acute renal injury. It is characterized by destruction of tubular epithelial cells with acute suppression of renal function. Prerenal AKI is characterized by a marked decrease in renal blood flow. Postrenal results from obstruction of urine outflow from the kidneys.

A client diagnosed with CKD has begun to experience periods of epistaxis and has developed bruising of the skin and subcutaneous tissues. The nurse recognizes these manifestations as:

Impaired platelet function

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

According to the Kidney Disease Outcome Quality Initiative (KDOQI) guidelines, in the first stage of kidney disease, the nurse will assess which finding?

Kidney damage with normal glomerular filtration rate (GFR)

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.

Reduced glomerular filtration rate (GFR), with a serum creatinine level that remains in the normal range, is associated with which factor of normal age-related change? -Calcium intake -Muscle mass -Drug tolerance -Renal perfusion

Muscle mass Serum creatinine level is directly related to muscle metabolism. Because muscle mass is reduced in older adults, the creatinine level does not increase as readily with a lower GFR. Drug tolerance and renal perfusion can affect the GFR, but the age-related normal creatinine level can also be present. Calcium intake is unrelated to creatinine levels or GFR.

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 with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which condition does the nurse suspect is common with this stage of kidney disease?

Pericarditis

A client has an obstructive urine outflow related to benign prostatic hyperplasia. Due to the inability to excrete adequate amounts of urine, which type of renal failure should the nurse closely monitor for?

Postrenal failure

Which symptom occurs in a client with chronic kidney disease (CKD) as a result of elevated serum phosphate levels and the development of phosphate crystals that occur with hyperparathyroidism? -Azotemia -Uremia -Pruritus -Asterixis

Pruritus

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

Rapid decline in renal function

A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which intervention would be most appropriate for the nurse to provide?

Restrict intake of dietary protein

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

Serum creatinine

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 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.

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

creatinine

A client diagnosed with CKD has begun to experience periods of epistaxis and has developed bruising of the skin and subcutaneous tissues. The nurse recognizes these manifestations as:

impaired platelet function

A 45-year-old female is being treated for ovarian cancer. Her treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of:

nephrotoxic acute tubular necrosis (ATN).

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

serum creatinine

A client has prerenal failure. The nurse knows that this type of failure is characterized by which relationship of blood urea nitrogen (BUN) to serum creatinine levels? -An elevated creatinine level and decreased BUN level -A BUN to creatinine level ratio of 20:1 -A BUN to creatinine level ratio of 10:1 -An elevated BUN level and decreased creatinine level

A BUN to creatinine level ratio of 20:1

A client has prerenal failure. The nurse knows that this type of failure is characterized by which relationship of blood urea nitrogen (BUN) to serum creatinine levels? -An elevated BUN level and decreased creatinine level -A BUN to creatinine level ratio of 10:1 -A BUN to creatinine level ratio of 20:1 -An elevated creatinine level and decreased BUN level

A BUN to creatinine level ratio of 20:1 In prerenal failure, glomerular filtration rate (GFR) decreases, allowing more filtered urea to be reabsorbed into the circulatory system. Creatinine is filtered but remains in the forming urine. Therefore, the BUN to creatinine ratio rises to 20:1. A ratio of 10:1 is normal.

Which of the following clients would be considered to have a significant risk of developing the prerenal form of acute renal failure? Select all that apply. A) A 22-year-old male who has lost large amounts of blood following a workplace injury B) A 41-year-old female who is admitted for intravenous antibiotic treatment of pyelonephritis C) A 79-year-old male with diagnoses of poorly controlled diabetes mellitus and heart failure D) A 20-year-old male who is admitted for treatment of an overdose of a nephrotoxic drug E) A 68-year-old male with a diagnosis of benign prostatic hyperplasia (BPH) F) An 80-year-old female who has been admitted for the treatment of dehydration and malnutrition

A C F

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

A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which intervention would be most appropriate for the nurse to provide? -Increase intake of carbohydrates -Restrict intake of dietary fat -Restrict intake of dietary protein -Increase intake of fruit juice

Restrict intake of dietary protein Early morning nausea is common in CKD. Nausea and vomiting often improve with the restriction of dietary protein and after initiation of dialysis and disappears after kidney transplant. The other actions will not improve the symptoms.

A 72-year-old client is scheduled for a kidney transplant. The nurse knows that which aspect of advanced age has a positive effect on the success of kidney transplant survival? -Psychological maturity -Decreased muscle mass -Reduction in T-lymphocyte function -Acceptance of immunosuppressive therapy

Reduction in T-lymphocyte function The general reduction in T-lymphocyte function with subsequent decrease in immune system activity that occurs with aging would foster transplant survival. The other options would not have a direct effect on rejection of the transplant. Acceptance of immunosuppressive therapy is not a specific characteristic of advanced age. Psychological maturity and decreased muscle mass have little to no effect on transplant survival.

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? -"You will need to have a renal transplant to live a productive, healthy life." -"Acute kidney injury is abrupt in onset and often reversible if recognized early and treated appropriately." -"Once your condition improves you can be placed on peritoneal dialysis for the rest of your life." -"The occurrence of acute kidney injury will always eventually result in chronic renal failure."

"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've decided to try eating less fat and carbohydrates than I have been." -"I'm feeling a bit under the weather these days and I'm a bit feverish." -"I've noticed that my urine is a bit more concentrated than usual the last few days." -"The scarring on my flank where the surgery was done doesn't seem to be fading."

"I'm feeling a bit under the weather these days and I'm a bit feverish." Clients who are taking immunosuppressants after a transplant are susceptible to infections, which require prompt treatment. Concentrated urine is not a sign of a problem and persistent scarring is inconsequential. Minor changes to diet should be assessed, but are not necessarily contraindicated.

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? -"Prescribed medications may not be monitored as closely as they should be since Medicare does not reimburse for routine laboratory testing." -"Every drug dosage should be determined by client weight but most clients refuse to get on the scale." -"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney." -"The health care provider does not always monitor for toxicity at each follow-up appointment."

"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney." Alterations in pharmacokinetics occur with advancing age and increase the likelihood of toxic reactions. The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney. The toxic effects, which cause some minor necrosis, are generally limited to the proximal tubule. In addition, the kidney is an important site for metabolic processes that transform relatively harmless agents into toxic metabolites. It would not necessarily be effective care to rely on medication therapy as only a last resort. Monitoring would not prevent toxicity but rather identify it earlier. Not all medications can be prescribed by a client's weight.

A client has undergone a kidney transplant and voices concerns about organ rejection to the nurse. The most appropriate response by the nurse would be: -"Your new kidney will continue to work fine as long as you do not drink any alcohol." -"Kidney transplantation is 100% successful, and there is no need for you to worry." -"There is no need to worry about rejection because the occurrence of rejection is low with kidney transplant." -"You will be given medication to decrease the likelihood of your immune system attacking your new kidney."

"You will be given medication to decrease the likelihood of your immune system attacking your new kidney."

The nurse caring for clients with chronic kidney disease (CKD) assesses for signs of renal osteodystrophy (skeletal damage). Which manifestations are characteristic of both high-bone-turnover and low-bone-turnover osteodystrophy? Select all that apply.

- Abnormal bone resorption - Defective bone remodeling

Which conditions have the potential to cause chronic kidney disease? Select all that apply.

- Hypertension - Diabetes - Glomerulonephritis

The diagnosis is chronic kidney disease (CKD). While caring for a client with CKD, the nurse will monitor for which neurologic signs and symptoms? Select all that apply.

- Loss of recent memory - Peripheral neuropathy - Restless legs syndrome - Burning sensation in feet

A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that which statements regarding CKD are correct? Select all that apply.

- Nephron destruction takes place over many months. - Signs and symptoms develop gradually. - Functioning nephrons compensate for those that are damaged. - There is a reduction in glomerular filtration rate (GFR) as nephrons are destroyed

A client is diagnosed with early chronic kidney disease (CKD). The nurse will recommend which actions to slow progression of renal damage? Select all that apply.

- Smoking cessation - Blood pressure control - Angiotensin converting enzyme (ACE) inhibitor administration - Blood glucose control

A client with chronic kidney disease (CKD) is anemic. The nurse will attempt to alleviate the anemia in order to prevent which of the following? Select all that apply.

- Tachycardia - Fatigue - Decreased myocardial oxygen

A client is suspected to have renal disease. The nurse would suggest which diagnostic determinations to confirm this diagnosis? Select all that apply.

- Urinary sediment of red and white cells - Ultrasonography - Measurement of cystatin C - Imaging studies

The health care provider is comparing results of a client's recent GFR measurement. Which result would be interpreted as normal? -135 to 145 mL/minute -100 to 110 mL/minute -70 to 115 mL/minute -120 to 130 mL/minute

-120 to 130 mL/minute The normal GFR, which varies with age, sex, and body size, is approximately 120 to 130 mL/minute/1.73 m2 for normal young healthy adults. A GFR below 60 mL/minute/1.73 m2 represents a loss of one half or more of the level of normal adult kidney function.

A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor this client for which gastrointestinal signs and symptoms? Select all that apply. -Anorexia -Metallic taste -Early morning nausea -Gastrointestinal ulceration -Decreased gastric secretion

-Anorexia -Metallic taste -Early morning nausea -Gastrointestinal ulceration Anorexia and nausea, especially in the early morning, occur with CKD. A metallic taste may exacerbate anorexia. Gastrointestinal ulceration and bleeding can develop. Increased levels of parathyroid hormone stimulate secretion of gastric acid.

Which conditions have the potential to cause chronic kidney disease? Select all that apply. -Diabetes -Glomerulonephritis -Hypertension -Cardiomyopathy

-Diabetes -Glomerulonephritis -Hypertension CKD can result from a number of conditions including diabetes, hypertension, glomerulonephritis as well as systemic lupus erythematosus, and polycystic kidney disease. These conditions slowly but steadily destroy renal tissue resulting in irreversible loss of function. Cardiomyopathies do not cause renal failure; they cause heart failure.

Many drugs and other nephrotoxic agents can induce nephrotic acute tubular necrosis (ATN). The nurse knows that these agents cause tubular injury by which mechanisms? Select all that apply. -Direct tubular damage -Renal vasodilation -Hyponatremia -Renal vasoconstriction -Intratubular obstruction

-Direct tubular damage -Renal vasoconstriction -Intratubular obstruction Drugs and other nephrotoxic agents induce ATN via renal vasoconstriction, direct damage, or obstruction. Renal vasodilation and hyponatremia are not direct causes of ATN.

A client diagnosed with chronic kidney disease (CKD) with GFR < 5 mL/min/1.73 m2 should be monitored for which fluid and electrolyte imbalance? Select all that apply. -Metabolic alkalosis -Hyperkalemia -Hypocalcemia -Polyuria -Hyponatremia

-Hyperkalemia -Hypocalcemia -Polyuria -Hyponatremia The failing kidneys lose ability to concentrate urine and to reabsorb sodium. Hyperkalemia develops late in CKD, as nephrons can no longer regulate potassium excretion and GFR < 5 mL/min/1.73 m2. Metabolic acidosis occurs when balance between sodium and bicarbonate is lost. Hypocalcemia develops as excretion of phosphate fails and blood levels of phosphate rise.

The nurse is preparing to assess a client who has just been admitted to the hospital with a diagnosis of prerenal failure. Which would the nurse expect the client to manifest? Select all that apply. -Increased BUN -BUN to serum creatinine ratio of 10:1 -Increased urinary output -Decreased BUN -BUN-to-serum creatinine ratio of greater than 20:1 -Decreased urinary output

-Increased BUN -BUN-to-serum creatinine ratio of greater than 20:1 -Decreased urinary output Prerenal injury is manifested by a sharp decrease in urine output and a disproportionate elevation of blood urea nitrogen (BUN) in relation to serum creatinine levels. Consequently, there also is a disproportionate elevation in the ratio of BUN to serum creatinine, from a normal value of 10:1 to a ratio greater than 20:1.

A hospital client with a diagnosis of chronic renal failure has orders for measurement of her serum electrolyte levels three times per week. Which of the following statements best captures the relationship between renal failure and sodium regulation? A) Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption. B) Renal clients often require a sodium-restricted diet to minimize the excretion load on remaining nephrons. C) Clients with renal failure often maintain high sodium levels because of decreased excretion. D) Restricting sodium intake helps to preserve nephron function and has the additional benefit of lowering blood pressure

Which of the following phenomena contributes to the difficulties with absorption, distribution, and elimination of drugs that are associated with kidney disease? A) Reductions in plasma proteins increase the amount of free drug and decrease the amount of protein-bound drug. B) Acute tubular necrosis is associated with impaired drug reabsorption through the tubular epithelium. C) Decreased retention by the kidneys often renders normal drug dosages ineffective. D) Dialysis removes active metabolites from circulation minimizing therapeutic effect.

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.

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. -An 81-year-old man's serum creatinine level has increased sharply since his last blood work. -A dipstick of an 80-year-old man's urine reveals protein is present. -A 90-year-old woman's blood urea nitrogen (BUN) is rising.

A 78-year-old woman's GFR has been steadily declining over several years. A gradual decrease in GFR is considered a normal age-related change. Increased creatinine or BUN would warrant follow up, as would the presence of protein in a client's urine.

The nurse is educating a client with chronic kidney disease (CKD). What is the recommended daily fluid intake for this client?

A daily fluid intake of 500 to 800 mL/day to maintain hydration

The nurse is educating a client with chronic kidney disease (CKD). What is the recommended daily fluid intake for this client? -No oral intake of fluids -A daily fluid intake of 500 to 800 mL/day to maintain hydration -Intake equal to daily urine output to maintain hydration -A minimum of 2000 mL/day to flush out the kidneys

A daily fluid intake of 500 to 800 mL/day to maintain hydration

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? -Antiarrhythmic medications -Nonsteroidal anti-inflammatory drugs (NSAIDs) -Antihypertensive medications -Opioid analgesics

Antihypertensive medications Hypertension is a common result of CKD, and the mechanisms that produce hypertension in CKD include increased vascular volume, elevation of peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins, and increased activity of the renin-angiotensin-aldosterone system. NSAIDs, opioids, and antiarrhythmics are not as frequently indicated for the treatment of CKD.

A nurse is collecting a urine specimen prior to measuring the albumin level in a client's urine. A colleague questions the rationale for the test, stating, "I thought albumin was related to liver function, not kidney function." How can the nurse best respond to this statement? A) "Urine should normally be free of any proteins, and albumin is one of the more common proteins to be excreted in chronic renal failure." B) "Urine albumin levels are useful for diagnosing diabetic kidney disease." C) "A urine dipstick test will tell us exactly how much albumin is being spilled by the client's kidneys." D) "A urine test for albumin allows us to estimate the client's GFR quite accurately."

Which of the following clinical findings among older adults is most unlikely to warrant further investigation and possible treatment? A) An 81-year-old male's serum creatinine level has increased sharply since his last blood work. B) A 78-year-old female's GFR has been steadily declining over several years. C) A 90-year-old female's blood urea nitrogen (BUN) is rising. D) An 80-year-old male whose urine dipstick reveals protein is present.

Which of the following data would a clinician consider as most indicative of acute renal failure? A) Alterations in blood pH; peripheral edema B) Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR) C) Decreased serum creatinine and blood urea nitrogen (BUN); decreased potassium and calcium levels D) Decreased urine output; hematuria; increased GFR

Which of the following medications would the nurse anticipate being prescribed for the renal failure patient who has hyperphosphatemia? A) Vitamin D (calcitriol) B) Calcium carbonate C) Levothyroxine (Synthroid) D) Sensipar (Cinacalcet)

Which of the following patients scheduled for an interventional radiology procedure requiring administration of radiocontrast dye would be considered at high risk for nephrotoxicity? Select all that apply. A) A 14-year-old with severe abdominal pain B) A 25-year-old with a history of glomerular nephritis who is complaining of severe flank pain C) A 67-year-old diabetic undergoing diagnostic testing for new-onset proteinuria D) A 45-year-old with elevated liver enzymes possibly due to fatty liver cirrhosis E) A 53-year-old male undergoing biopsy for a suspicious "spot" on his chest x-ray

B C

Blood work for hemoglobin, red blood cells, and hematocrit

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 white cells and differential -Blood work for hemoglobin, red blood cells, and hematocrit -Cystoscopy and ureteroscopy -Assessment of pancreatic exocrine and endocrine function

Blood work for hemoglobin, red blood cells, and hematocrit Anemia is a frequent and debilitating consequence of CKD. The anemia may be due to chronic blood loss, hemolysis, bone marrow suppression due to retained uremic factors, and decrease in red cell production due to impaired production of erythropoietin and iron deficiency. Pancreatic function is not typically affected by CKD, and endoscopic examination is less likely to reveal a cause of fatigue. An infectious etiology is possible and would be informed by white cell assessment, but this is less likely than anemia given the client's report of symptoms.

A family physician is providing care for a 61-year-old obese male who has a history of diabetes and hypertension. Blood work has indicated that the man has a GFR of 51 mL/minute with elevated serum creatinine levels. Which of the following statements will the physician most likely provide the client in light of these results? A) "We will regularly monitor your kidney function, but most likely your kidneys will be able to compensate on their own and intervention is not required." B) "You likely have chronic kidney disease, and there may be urine in your blood until it is controlled." C) "Your chronic kidney disease has likely been caused by your diabetes and high blood pressure." D) "You're in kidney failure, and I'll be starting dialysis treatment immediately."

The nurse assessing a renal failure patient for encephalopathy caused by high uremic levels may observe which of the following clinical manifestations? A) Severe chest pain with pericardial friction rub on auscultation B) Stiff immobile joints and contractures C) Loss of recent memory and inattention D) Pruritus with yellow hue to skin tone

A hospital client with a diagnosis of chronic renal failure has a prescription for measurement of serum electrolyte levels three times per week. Which statement best captures the relationship between renal failure and sodium regulation? -Restricting sodium intake helps to preserve nephron function and has the additional benefit of lowering blood pressure. -Clients with renal failure often maintain high sodium levels because of decreased excretion. -Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption. -Clients with renal failure often require a sodium-restricted diet to minimize the excretion load on remaining nephrons.

Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption. The compromised ability of the tubular nephrons to reabsorb sodium predisposes renal clients to low serum sodium levels. A sodium restriction is thus not normally indicated.

Which medical term describes a manifestation of bleeding disorders in clients with chronic kidney disease (CKD)?

Coagulopathies

Creatinine In clinical practice, GFR is usually estimated using the serum creatinine concentration. The presence of myoglobin or large amounts of protein in the urine is suggestive of renal failure. Serum blood urea nitrogen levels are clinically useful; however, GFR is not calculated from these values.

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

Dietary protein Restriction of dietary proteins may decrease the progress of renal impairment in people with advanced renal disease. Proteins are broken down to form nitrogenous wastes, and reducing the amount of protein in the diet lowers the blood urea nitrogen and reduces symptoms.

A 1-year-old baby boy with renal dysplasia risks end-stage renal disease unless intervention occurs. Which treatment option is his care team most likely to reject? -Continuous ambulatory peritoneal dialysis -Dietary restriction plus erythropoietin -Renal transplantation -Continuous cyclic peritoneal dialysis

Dietary restriction plus erythropoietin Renal transplantation and dialysis are recommended for children; of these, transplantation is the preferred treatment. Conservative measures are inappropriate in this age group because of the importance of fostering proper bone growth, especially in the first 2 years, and appropriate cognitive development, which is at risk due to issues such as uremic encephalopathy and the effect of renal failure upon the central nervous system of the developing child.

Diuretics Diuretics, which directly affect renal excretion of sodium, can alter the fractional excretion of sodium. The other drug types listed do not affect this parameter of renal function.

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

Dry skin and pruritus

Which dermatologic problem most often accompanies chronic kidney disease (CKD)? -Alopecia and fungal rashes -Petechiae and purpura -Dry skin and pruritus -Hirsutism and psoriasis

Dry skin and pruritus

Which dermatologic problem most often accompanies chronic kidney disease (CKD)? -Petechiae and purpura -Hirsutism and psoriasis -Dry skin and pruritus -Alopecia and fungal rashes

Dry skin and pruritus Dry, itchy skin is a common consequence of CKD. Petechiae, purpura, hirsutism, psoriasis, alopecia, and fungal rashes are not noted to accompany or result from CKD.

A child is diagnosed with chronic kidney disease (CKD). The nurse knows that which statements regarding supportive renal therapy in children are true? Select all that apply. -Early transplantation is the preferred treatment when considering long-term effects. -Peritoneal dialysis is generally most appropriate for children younger than 6. -Less immune system suppression is needed in children than in adults. -Corticosteroid therapy reduces the risk of growth retardation in children. -Children older than 12 years will benefit from hemodialysis.

Early transplantation is the preferred treatment when considering long-term effects., Peritoneal dialysis is generally most appropriate for children younger than 6., Children older than 12 years will benefit from hemodialysis.

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 result in greater amounts of urine formation and will over-tax renal function. -Elevated blood pressure will decrease pressure on the nephron with a corresponding decrease in GFR, leading to renal failure. -Elevated blood pressure will slow the excretion of protein (proteinuria) and lead to a hypertrophic kidney. -Elevated blood pressure will exacerbate nephron loss and accelerate renal failure.

Elevated blood pressure will exacerbate nephron loss and accelerate renal failure. Elevated blood pressure (hypertension) will damage the kidney further and accelerate the progress toward renal failure. There are increases in glomerular pressure and increases in proteinuria that further damage the glomerulus and the nephron, thereby accelerating nephron loss. CKD is marked by decreasing urine formation as the kidneys fail.

When educating a group of nursing students about the primary causes of chronic kidney disease (CKD) in Western societies, the nurse asks, "What do you think are the main causes of CKD in adults?" Which student answer(s) is deemed correct? Select all that apply. -Hypertension -Diabetes mellitus -Autoimmune diseases -Substance use disorder -Alcohol use disorder

Hypertension, Diabetes mellitus

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 nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display? -Hypertension -Impotence -Asterixis -Terry nails

Hypertension Hypertension is commonly an early manifestation of CKD. The mechanisms that cause the hypertension are multifactorial: they include increased vascular volume, increased peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins, and increased activity of the renin-angiotensin-aldosterone system. Impotence occurs in as many as 56% of males on dialysis. Terry nails are a dark band just behind the leading edge of a fingernail followed by a white band that occurs in the late stages. Asterixis, a sign of hepatic encephalopathy, is due to the inability of the liver to metabolize ammonia to urea.

A client diagnosed with CKD has begun to experience periods of epistaxis and has developed bruising of the skin and subcutaneous tissues. The nurse recognizes these manifestations as: -Increased platelet production -Increased erythropoietin -Impaired platelet function -Decreased erythropoietin

Impaired platelet function The coagulation disorders of CKD are mainly caused by platelet dysfunction. Platelet counts may be slightly decreased, and the bleeding time is prolonged because of abnormal adhesiveness and aggregation. Clinically, persons with CKD can experience epistaxis (nosebleeds), menorrhagia (excessive menstrual bleeding), gastrointestinal bleeding, and bruising of the skin and subcutaneous tissues.

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. -Educational handout on foods to help increase the blood platelet count -Type and crossmatch for an immediate blood transfusion -Dietary consult to focus on low phosphate foods and high fiber options -Increase in iron intake via food and supplementation -Injection of an erythropoietin-stimulating agent

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

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? -Administering one unit of packed red blood cells -Increasing the normal saline intravenous infusion rate prior to the exam -Administering ibuprofen 600 mg prior to the procedure -Having the client take nothing by mouth

Increasing the normal saline intravenous infusion rate prior to the exam Some drugs such as high-molecular-weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus, and nonsteroidal anti-inflammatory drugs can cause acute prerenal failure by decreasing renal blood flow. Administering intravenous saline can improve hydration and renal perfusion to decrease the toxic effects of the radiocontrast media.

In hemodialysis, access to the vascular system is most commonly through: -External arteriovenous shunt -External arteriovenous fistula -Internal arteriovenous shunt -Internal arteriovenous fistula

Internal arteriovenous fistula Access to the vascular system is accomplished through an external arteriovenous shunt (i.e., tubing implanted into an artery and a vein) or, more commonly, through an internal arteriovenous fistula (i.e., anastomosis of a vein to an artery, usually in the forearm).

A client sustained acute tubular injury approximately 2 hours ago. Which cause of acute kidney injury (AKI) would the nurse suspect the client is experiencing?

Intrarenal

Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct? -Calcitriol blocks gastrointestinal absorption of calcium. -Kidneys convert inactive vitamin D to its active form, calcitriol. -Suppression of parathyroid hormone release is characteristic of CKD. -Calcitriol stimulates release of parathyroid hormone (PTH).

Kidneys convert inactive vitamin D to its active form, calcitriol. Inactive vitamin D is converted to active calcitriol in the kidneys. Calcitriol enhances gastrointestinal absorption of calcium, and suppresses release of PTH. Elevated levels of PTH are characteristic of CKD as blood levels of phosphate rise and levels of calcium fall.

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 -Raw carrots -Whole grains -Fresh apples

Lean meats Dietary proteins may be restricted as a means of decreasing the progress of renal impairment in persons with advanced CKD. Proteins are broken down to form nitrogenous wastes and reducing the amount of protein in the diet lowers the blood urea nitrogen and reduces symptoms. With protein restriction, adequate calories in the form of carbohydrates and fat are essential to meet energy needs.

A client has a marked decrease in the glomerular filtration rate (GFR); lab values with high blood urea nitrogen (BUN), potassium, and creatinine levels; urine output less than 10 mL/hr; 3+ pitting edema in the lower extremities; and BP 170/95. Which phase of acute tubular necrosis (ATN) does the nurse identify the client is in based on assessment data? -Initiating phase -Maintenance phase -Recovery phase -Onset phase

Maintenance phase The maintenance phase of acute tubular necrosis is characterized by a marked decrease in the GFR, causing sudden retention of endogenous metabolites—such as urea, potassium, sulfate, and creatinine—that normally are cleared by the kidneys. Urine output usually is lowest at this point. Fluid retention gives rise to edema, water intoxication, and pulmonary congestion. If the period of oliguria is prolonged, hypertension frequently develops and with it signs of uremia.

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 -Postrenal failure -Ischemic acute tubular necrosis -Chronic kidney disease

Nephrotoxic acute tubular necrosis

The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for: -Postrenal failure -Ischemic acute tubular necrosis -Nephrotoxic acute tubular necrosis -Chronic kidney disease

Nephrotoxic acute tubular necrosis Pharmacologic agents that are directly toxic to the renal tubule include aminoglycosides (e.g., gentamicin), chemotherapeutic agents such as cisplatin and ifosfamide, and radiocontrast agents. Nephrotoxic agents cause tubular injury by inducing varying combinations of renal vasoconstriction, direct tubular damage, or intratubular obstruction. Postrenal failure results from obstruction of outflow of the kidneys. CKD and its treatment can interfere with the absorption, distribution, and elimination of drugs. Acute tubular necrosis (ATN) occurs most frequently in clients who have major trauma, severe hypovolemia, overwhelming sepsis, trauma, or burns.

A client is diagnosed with acute renal injury. The nurse will evaluate the client for which possible causes of this disorder? Select all that apply. -Hormonal imbalance -Nephrotoxic substances -Nonischemic reduced renal blood flow -Obstruction of urinary outflow -Ischemic injury

Nephrotoxic substances, Nonischemic reduced renal blood flow, Obstruction of urinary outflow, Ischemic injury

A 45-year-old client with chronic kidney disease (CKD) voices concern about her dialysis treatment. The client would like to work and spend time with her family. Which type of dialysis will best fit this client's lifestyle? -Continuous ambulatory peritoneal dialysis -Hemodialysis -Nocturnal intermittent peritoneal dialysis (NIPD) -Continuous cyclic peritoneal dialysis

Nocturnal intermittent peritoneal dialysis (NIPD) In NIPD, the client is given 10 hours of automatic cycling each night, with the abdomen left dry during the day. This is the most beneficial for this client. Individual preference, manual ability, lifestyle, knowledge of the procedure, and physiologic response to treatment are used to determine the type of dialysis that is used. Hemodialysis is generally three times a week for 3 to 4 hours a day. CAPD involves exchanging the dialysate four to six times per day. In CCPD, the last exchange remains in the abdomen during the day.

A client with postrenal acute kidney injury (AKI) exhibits oliguria and edema with laboratory results revealing increased levels of urea, potassium, and creatinine. Based on these data, which phase of AKI is this client most likely experiencing? -Oliguric phase -Diuretic phase -Onset phase -Recovery phase

Oliguric phase The oliguric phase of AKI is characterized by marked decrease in glomerular filtration rate (GFR), causing sudden retention of endogenous metabolites, such as urea, potassium, sulfate, and creatinine, that normally are cleared by the kidneys. The urine output is usually lowest at this point. Fluid retention gives rise to edema, water intoxication, and pulmonary congestion. AKI typically progresses through four phases: the onset phase, during which tubular injury is induced; the oliguric phase, during which the GFR falls, nitrogenous wastes accumulate, and urine output decreases; the diuretic phase when the kidneys try to heal and urine output increases; and the recovery phase, where tubular edema resolves and renal function improves. During recovery, there is normalization of fluid and electrolyte balance.

A client with postrenal acute kidney injury (AKI) exhibits oliguria and edema with laboratory results revealing increased levels of urea, potassium, and creatinine. Based on these data, which phase of AKI is this client most likely experiencing? -Onset phase -Diuretic phase -Oliguric phase -Recovery phase

Pericarditis Pericarditis occurs in many people with stage 5 CKD due to the uremia and prolonged dialysis. The manifestations of uremic pericarditis resemble those of viral pericarditis with all its potential complications, including cardiac tamponade. The presenting signs include mild to severe chest pain with respiratory accentuation and a pericardial friction rub. Fever is variable in the absence of infection and is more common in dialysis than uremic pericarditis.

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

Peritonitis Potential problems with peritoneal dialysis include infection, catheter malfunction, dehydration, hyperglycemia, and hernia. Bowel perforation can occur, but the fluid would be stool colored. The client may develop hyperglycemia; however, this will not cause the fluid to be cloudy. If bladder erosion had occurred, the fluid would look like urine and not be cloudy and white.

A client is diagnosed with a tumor in the urinary bladder. The nurse will monitor the client for: -Intrarenal failure -Prerenal failure -Chronic kidney disease -Postrenal failure

Postrenal failure Postrenal failure is due to blockage of urine outflow. The obstruction can be in the ureter, the bladder, or the urethra. A tumor in the bladder can obstruct outflow, and cause intrarenal failure.

Postrenal failure Postrenal failure results from obstruction of urine outflow from the kidneys. The obstruction can occur in the ureter, bladder, or urethra. Due to the increased urine not being able to be excreted due to the obstruction, retrograde pressure occurs throughout the tubules and nephrons, which ultimately damages the nephrons. Prostatic hyperplasia is the most common underlying problem.

An 86-year-old client is being treated for dehydration and hyponatremia after curtailing fluid intake to prevent urinary incontinence. Given these findings, the nurse recognizes that this client is likely in what phase of acute kidney injury?

Prerenal

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

Pruritus Pruritus is common in persons with CKD; it results from high phosphate levels and the development of phosphate crystals. Azotemia refers to elevated levels of nitrogenous wastes in the blood. Uremia is the accumulation of organic wastes in the blood. Asterixis, a sign of hepatic encephalopathy, is due to the inability of the liver to metabolize ammonia to urea

The nurse recognizes that acute renal injury is characterized by which of the following? -Irreversible damage to nephrons -Low incidence of mortality -Rapid decline in renal function -Decreased blood urea nitrogen (BUN)

Rapid decline in renal function Acute renal injury is a rapid decline in kidney function. BUN rises as nitrogenous wastes are not removed from the circulation. If the cause can be ameliorated, the injury is usually reversible. Most at risk are seriously ill clients; the mortality rate is between 40% and 90% in these clients.

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR? -BUN -Serum protein -Albumin level -Serum creatinine

Serum creatinine In clinical practice, GFR is usually estimated using the serum creatinine concentration. The other answers are not used to estimate the GFR.

The nurse assesses a client for prerenal failure. Which conditions increase the risk for developing this type of kidney failure? Select all that apply. -Severe dehydration -Glomerulonephritis -Severe burns -Prolonged renal ischemia -Septic shock

Severe dehydration, Severe burns, Septic shock

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

Sharp decrease in urine output Dehydration and its consequent hypovolemia can result in acute renal failure that is prerenal in etiology. The kidney normally responds to a decrease in GFR with a decrease in urine output. Thus, an early sign of prerenal injury is a sharp decrease in urine output. Post-renal failure is obstructive in etiology, and intrinsic (or intrarenal) renal failure is reflective of deficits in the function of the kidneys themselves.

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 10:1. -BUN elevates above 60 mg/dL (21.4 mmol/L) and creatinine decreases to <0.3 mg/dL (<27 µmol/L). -Creatinine level increase to 5 mg/dL (442 µmol/L) and BUN decreases to 4 mg/dL (1.4 mmol/L). -The BUN-to-creatinine ratio is 20:1.

The BUN-to-creatinine ratio is 20:1. Prerenal injury is manifested by a sharp decrease in urine output and a disproportionate elevation of blood urea nitrogen (BUN) in relation to serum creatinine levels. The kidney normally responds to a decrease in the glomerular filtration rate (GFR) with a decrease in urine output. An early sign of prerenal injury is a sharp decrease in urine output. A low GFR allows more time for small particles such as urea to be reabsorbed into the blood. Creatinine, which is larger and nondiffusible, remains in the tubular fluid, and the total amount of creatinine that is filtered, although small, is excreted in the urine. Consequently, there also is a disproportionate elevation in the ratio of BUN to serum creatinine, from a normal value of 10:1 to a ratio greater than 20:1.

The client's GFR does not increase after restoration of renal blood flow

A client with significant burns on his lower body has developed sepsis on the third day following his accident. Which manifestation would the nurse anticipate for an ischemic acute tubular necrosis rather than prerenal failure? -The client exhibits oliguria and frank hematuria -The client undergoes emergency hemodialysis that does not result in decreased BUN and creatinine -The client exhibits pulmonary and peripheral edema. -The client's GFR does not increase after restoration of renal blood flow

The client's GFR does not increase after restoration of renal blood flow

A 56-year-old woman has been diagnosed with CKD. She first went to the doctor due to complications of hypertension. How are hypertension and CKD related? -The mechanisms that produce hypertension in CKD are directly related to sporadic increases in the activity of the renin-angiotensin-aldosterone system. -The mechanisms that produce hypertension in CKD include an increased vascular volume and increased activity of the renin-angiotensin-aldosterone system. -The mechanisms that produce hypertension in CKD are due to decreases in vascular volume, elevation of peripheral vascular resistance, increased levels of renal vasodilator prostaglandins, and decreased activity of the renin-angiotensin-aldosterone system. -The mechanisms relate to increases in hydrostatic pressure on the renal vasculature that causes inflammation and irreversible damage.

The mechanisms that produce hypertension in CKD include an increased vascular volume and increased activity of the renin-angiotensin-aldosterone system. Hypertension commonly is an early manifestation of CKD. The mechanisms that produce hypertension in CKD are multifactorial: they include an increased vascular volume, elevation of peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins, and increased activity of the renin-angiotensin-aldosterone system.

A client with chronic kidney disease (CKD) will be managed with peritoneal dialysis. Which description of this type of dialysis is most accurate? -Vascular access is achieved through an internal arteriovenous fistula or an external arteriovenous shunt. -Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time. -Treatments typically occur three times each week for 3 to 4 hours. -The dialyzer is usually a hollow cylinder composed of bundles of capillary tubes.

Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time. In peritoneal dialysis, a sterile dialyzing solution is instilled into the peritoneum through a catheter over approximately 10 minutes. The solution remains ("dwells") in the peritoneal cavity for a determined time interval, then drains into a sterile bag. Shunts, fistulas, and artificial dialyzers are associated with hemodialysis, which is usually performed three times weekly. The frequency of peritoneal dialysis varies, but is normally performed more often than hemodialysis and can be done at home.

Client and family education regarding peritoneal dialysis should include assessing the client for: -bleeding around the arteriovenous fistula or an external arteriovenous shunt. -signs and symptoms of hypoglycemia such as weakness, irritability, and shakiness. -dehydration that may appear as dry mucous membranes or poor skin turgor. -muscle cramps associated with hypoparathyroidism.

dehydration that may appear as dry mucous membranes or poor skin turgor. Potential problems with peritoneal dialysis include infection, catheter malfunction, dehydration caused by excessive fluid removal, hyperglycemia, and hernia. The most serious complication is infection, which can occur at the catheter exit site, in the subcutaneous tunnel, or in the peritoneal cavity. In peritoneal dialysis, a sterile dialyzing solution is instilled through a catheter over a period of approximately 10 minutes. Then the solution is allowed to remain in the peritoneal cavity for a prescribed amount of time. Shunts, fistulas, and artificial dialyzers are associated with hemodialysis, which is usually performed three times weekly.

A client with chronic kidney disease has been admitted with increased shortness of breath and abnormal breath sounds (rales heard to scapular region of posterior back). The admission hemoglobin level is 7.8 g/dL. Vital signs are as follows: respiratory rate 30; BP 180/98; pulse 110. +3 pitting edema in lower extremities bilaterally. Knowing the correlation of hypertension and associated anemia, the nurse suspects this client has developed: -bone marrow atrophy. -worsening of kidney failure. -pulmonary hypertension. -heart failure.

heart failure Multiple factors lead to development of left ventricular dysfunction, including extracellular fluid overload, shunting of blood through an arteriovenous fistula for dialysis, and anemia. Anemia, in particular, has been correlated with the presence of left ventricular hypertrophy. These abnormalities, coupled with the hypertension that often is present, cause increased myocardial work and oxygen demand, with eventual development of heart failure. There is no indication that the client has developed pulmonary hypertension, further renal disease, or bone marrow issues.

A 45-year-old female is being treated for ovarian cancer. Her treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of: -nephrotoxic acute tubular necrosis (ATN). -glomerulonephritis. -anemia. -chronic renal failure (CRF).

nephrotoxic acute tubular necrosis (ATN) The development of nephrotoxic acute tubular necrosis is due to the concentration effect of the kidney. The prolonged exposure to the chemotherapy agent causes the ATN. The disease state would progress faster than the CRF, and the glomerulus would not be affected. Anemia is not related to this type of chemotherapy.

A 45-year-old female is being treated for ovarian cancer. Her treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of: -chronic renal failure (CRF). -glomerulonephritis. -nephrotoxic acute tubular necrosis (ATN). -anemia.

nephrotoxic acute tubular necrosis (ATN).

Following kidney transplantation, the patient is prescribed maintenance immunosuppressive therapy consisting of prednisone, azathioprine, and cyclosporine. Educating the patient about long-term maintenance on immunosuppressive therapy should include discussion of side effects that may include: (Select all that apply). A) cardiovascular complications. B) increased risk of developing cancer. C) nephrotoxicity of a newly transplanted kidney. D) development of moon face and buffalo hump. E) ringing or buzzing of the ears.

A B

Which of the following clinical manifestations would lead the nurse to suspect the renal failure patient is developing uremia? Select all that apply. A) Weakness and fatigue B) Lethargy and confusion C) Extreme itching D) Blood in urine E) Urine smell in the stool

A B C

A client has prerenal failure. The nurse knows that this type of failure is characterized by which relationship of blood urea nitrogen (BUN) to serum creatinine levels?

A BUN to creatinine level ratio of 20:1

Blood work for hemoglobin, red blood cells, and hematocrit

A client is in cardiogenic shock following a massive myocardial infarction. The client's family asks the nurse, "Why are the health care providers recommending dialysis since its the heart that is sick?" Which response by the nurse is most appropriate at this time? -"When a person has such a large heart attack, the kidneys suffer by developing clots which interfere with urine production." -"It looks like your loved one has been exposed to nephrotoxic drugs like a nonsteroidal anti-inflammatory drug (NSAID) prior to the heart attack." -"It looks like your family member has had a blockage in the ureters for quite some time and the heart attack has made it more difficult for the blood to be filtered by the kidney." -"When a person has a large heart attack and goes into shock due to heart failure, there is a decrease in renal perfusion which allows toxins to increase in the blood."

"When a person has a large heart attack and goes into shock due to heart failure, there is a decrease in renal perfusion which allows toxins to increase in the blood." Prerenal acute kidney injury (AKI) is characterized by a marked decrease in renal blood flow. It is reversible if the cause of the decreased renal blood flow can be identified and corrected before kidney damage occurs. Causes of prerenal AKI include heart failure and cardiogenic shock. This would call for temporary dialysis to filter the blood while the heart is healing. Intrarenal AKI is caused by acute tubular necrosis due to exposure to nephrotoxic drugs or prolonged ischemia. Postrenal AKI is caused by bilateral ureteral obstruction.

A nurse educator is performing client education with a 51-year-old man who has been recently diagnosed with chronic kidney disease. Which of the following statements by the client would the nurse most likely want to correct or clarify? A) "I'll be prone to anemia, since I'm not producing as much of the hormone that causes my bones to produce red blood cells." B) "My heart rate might go up because of my kidney disease, and my blood might be a lot thinner than it should be." C) "My kidney problems increase my chance of developing high blood pressure or diabetes." D) "I'll have a risk of either bleeding too easily or possibly clotting too quickly, though dialysis can help minimize these effects."

Manifestations of childhood renal disease are varied and may differ from adult-onset renal failure. A school-aged child with chronic kidney disease may exhibit which manifestation?

Developmental delays such as uncoordinated gait and minimal fine motor skills

A client is beginning to recover from acute tubular necrosis. During which phase of acute kidney injury will the nurse assess an increase in urine output? -Oliguric phase -Diuretic phase -Onset phase -Recovery phase

Diuretic phase The onset phase lasts hours/days and is the time from the onset of the precipitating event until tubular injury occurs. The oliguric phase is characterized by a marked decrease in glomerular filtration rate, causing sudden retention of endogenous metabolites, such as urea, potassium, sulfate, and creatinine. The diuretic phase occurs when the kidneys try to heal and one will see an increase/excessive output (diuresis) of dilute urine. The recovery phase is the period during which tubular edema resolves and renal function improves. There is normalization of fluid and electrolyte balance.

A child has received a kidney transplant at the age of 3. Knowing he will be on immunosuppressive agents like corticosteroids, the nurse should educate the parents about which long-term side effects? Select all that apply. -Hypertension -Frequent hematuria -Development of cataracts -Excess weight loss -Growth retardation

Hypertension, Development of cataracts, Growth retardation

A client with significant burns on his lower body has developed sepsis on the third day following his accident. Which manifestation would the nurse anticipate for an ischemic acute tubular necrosis rather than prerenal failure? -The client undergoes emergency hemodialysis that does not result in decreased BUN and creatinine -The client exhibits oliguria and frank hematuria -The client exhibits pulmonary and peripheral edema. -The client's GFR does not increase after restoration of renal blood flow

The client's GFR does not increase after restoration of renal blood flow In contrast to prerenal failure, the glomerular filtration rate (GFR) does not improve with the restoration of renal blood flow in acute renal failure caused by ischemic acute tubular necrosis. Edema, oliguria, and hematuria are not diagnostic of acute tubular necrosis (ATN), and hemodialysis does not normally fail to achieve a reduction in blood urea nitrogen (BUN) and creatinine.

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. -concentrated urine. -a need to increase water intake. -that the kidneys are functioning normally.

a loss of over half the client's normal kidney function. In clinical practice, GFR is usually estimated using the serum creatinine concentration. A GFR below 60 mL/minute/1.73 m2 represents a loss of one half or more of the level of normal adult kidney function. The GFR is not diagnostic for concentrated urine or the need to drink more water.

A student asks the nurse preceptor about a laboratory test called interleukin (IL)-18. Which statement by the nurse will assist the student in providing better care to clients with acute kidney injuries (AKI)? -"This is an inflammatory cytokine which is an early marker for ischemic AKI in the proximal tubule." -"This helps with the differentiation of kidney injury versus a rheumatic disease that is affecting the kidney." -"This is one of the new markers which helps confirm whether the kidney is trying to internally kill its own cells." -"This is one of the biomarkers which can help differentiate inflammation versus carcinoma in the kidney."

"This is an inflammatory cytokine which is an early marker for ischemic AKI in the proximal tubule."

A client with a recent diagnosis of renal failure requiring hemodialysis is being educated in the dietary management of the disease. Which statement by the client shows an accurate understanding of this component of treatment? Select all that apply. -"I'll increase the carbohydrates in my diet to provide sufficient energy." -"I've made a list of high-phosphate foods so that I can try to avoid them." -"I'm making a point of trying to eat lots of bananas and other food rich in potassium." -"I don't think I've been drinking enough, so I want to include 8 to 10 glasses of water each day." -"I'm going to try a high-protein, low-carbohydrate diet."

-"I'll increase the carbohydrates in my diet to provide sufficient energy." -"I've made a list of high-phosphate foods so that I can try to avoid them." Persons with chronic kidney disease (CKD) are usually encouraged to limit their dietary phosphorus as a means of preventing secondary hyperparathyroidism, renal osteodystrophy, and hypocalcemia. Excessive protein, potassium, and fluids can be detrimental in individuals whose kidney disease requires hemodialysis. Because protein intake is limited, carbohydrate consumption should increase to meet daily energy requirements.

A client who is suspected of having acute renal failure would first be assessed by which blood tests? Select all that apply. -CBC -Creatinine -Phosphorus -Blood urea nitrogen

-Creatinine -BUN Blood tests such as blood urea nitrogen and creatinine provide information about renal function. A complete blood count and phosphorus level would identify other problems.

The nurse is educating a client with chronic kidney disease (CKD). What is the recommended daily fluid intake for this client? -A minimum of 2000 mL/day to flush out the kidneys -No oral intake of fluids -A daily fluid intake of 500 to 800 mL/day to maintain hydration -Intake equal to daily urine output to maintain hydration

A daily fluid intake of 500 to 800 mL/day to maintain hydration Daily fluid intake of 500 to 800 mL/day will replace insensible water loss plus a quantity equal to the 24-hour urine output. Intake of 2000 mL will exceed the renal ability to excrete water and will lead to circulatory overload and edema.

The clinical nurse educator on a nephrology unit of a large, urban hospital is orientating recent nursing graduates to the unit. Which of the following teaching points about acute tubular necrosis (ATN) should the educator include in the orientation session? A) "The cardinal signs of ATN are oliguria and retention of potassium, creatinine, and sulfates." B) "Ureteral and bladder outlet obstructions are often contributors to ATN." C) "Trauma, burns, and major surgery are common precursors to ATN." D) "Tubular epithelial cells are sensitive to ischemia and toxins, and damage is irreversible."

To maintain hematocrit levels in people with kidney failure, the nurse should be prepared to A) arrange for frequent blood transfusions in an outpatient clinic. B) administer iron dextran intravenously. C) administer a subcutaneous injection of recombinant human erythropoietin (rhEPO). D) administer prenatal vitamins twice a day.

A client in the intensive care unit is receiving a blood transfusion. The client immediately developed a reddish-color urine flowing into the Foley bag. What is likely the cause of this red urine and what priority intervention should the nurse implement? -Trauma to the urethra can cause blood in the urine; increase the fluid intake by increasing IV flow rate. -Myoglobinuria causes urine color change and is associated with muscle destruction; call the health care provider immediately. -Hemoglobinuria indicating an acute hemolytic reaction; the transfusion must be stopped immediately. -Exposure to bacteria causing urinary tract infection with bleeding; contact health care provider for antibiotic prescription.

Hemoglobinuria indicating an acute hemolytic reaction; the transfusion must be stopped immediately. The onset of red urine during or shortly after a blood transfusion may represent hemoglobinuria indicating an acute hemolytic reaction. The priority of the nurse is to stop the transfusion, then call the laboratory and the health care provider. Myoglobinuria causes urine color change, usually brown in color, and is associated with muscle destruction. There is no indication that this occurred recently but if it occurs, the health care provider should be notified. Trauma with insertion of a catheter would cause bleeding at the time of the insertion and would not be associated with a blood transfusion. Severe kidney infections can cause bleeding but this would have been evident prior to hanging/infusing the blood.

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

A 35-year-old female ultramarathon runner is admitted to hospital following a day-long, 80-km race because her urinary volume is drastically decreased and her urine is dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis. Why is her urine red? -Myoglobinuria -Glomerular rupture -Hemoglobinuria -Renal corpuscle rupture

Myoglobinuria Myoglobinuria, which can cause acute tubular necrosis via intratubular obstruction, involves the leaching of myoglobin from skeletal muscle into the urine, bypassing the usual filtration by the glomerulus. Excess exercise and muscle trauma can contribute. While both hemoglobinuria and myoglobinuria discolor the urine, hemoglobinuria results from hemolysis following a reaction to a blood transfusion, whereas myoglobinuria involves muscle damage. A rupture does not cause this change.

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