chapter 54 management of pt with kidney disorder

What is used to decrease potassium level seen in acute renal failure? Sodium polystyrene sulfonate Sorbitol IV dextrose 50% Calcium supplements

Correct response: Sodium polystyrene sulfonate Explanation: The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal trac

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? "It is important to use strict aseptic technique." "It is appropriate to warm the dialysate in a microwave." "The infusion clamp should be open during infusion." "The effluent should be allowed to drain by gravity."

Correct response: "It is appropriate to warm the dialysate in a microwave." Explanation: The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? Pats skin dry after bathing Uses moisturizing creams Keeps nails trimmed short Brief, hot daily showers TAKE ANOTHER QUIZ

Correct response: Brief, hot daily showers Explanation: Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? Hyperalbuminemia Peripheral neuropathy Cola-colored urine Hypotension

Correct response: Cola-colored urine Explanation: Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.

Rejection of a transplanted kidney within 24 hours after transplant is termed acute rejection. hyperacute rejection. chronic rejection. simple rejection.

Correct response: hyperacute rejection. Explanation: Hyperacute rejection may require removal of the transplanted kidney. Acute rejection occurs within 3 to 14 days of transplantation. Chronic rejection occurs after many years. The term simple is not used in the categorization of types of rejection of kidney transplants.

The ___ period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The minimum amount of urine needed to rid the body of normal metabolic waste products is 400 mL in 24 hours or 0.5 mL/kg/hr. In this phase, uremic symptoms first appear and life-threatening conditions such as hyperkalemia develop.

oliguria period

The initiation period begins with the initial insult and ends when....

when oliguria develops.

A change that occurs during chronic glomerulonephritis is termed hypokalemia. anemia. metabolic alkalosis. hypophosphatemia.

Correct response: anemia. Explanation: Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur during chronic glomerulonephritis.

Glomerulonephritis is an inflammatory response in the glomerular capillary membrane, and causes disruption of the renal filtration system. Although diagnostic urinalysis can reveal glomerulonephritis, many clients with glomerulonephritis exhibit: no symptoms. fever. headache. polyuria.

Correct response: no symptoms. Explanation: Many clients with glomerulonephritis have no symptoms. Early symptoms may be so slight that the client does not seek medical attention.

A client has been diagnosed with acute glomerulonephritis. This condition causes: proteinuria. pyuria. polyuria. No option is correct.

Correct response: proteinuria. Explanation: The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided.

The ___ period is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover. Laboratory values stabilize and eventually decrease. Although the volume of urinary output may reach normal or elevated levels, renal function may still be markedly abnormal. Because uremic symptoms may still be present, the need for expert medical and nursing management continues. The patient must be observed closely for dehydration during this phase; if dehydration occurs, the uremic symptoms are likely to increase.

diuresis period

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? Azotemia Proteinuria Hematuria Bacteremia

Correct response: Azotemia Explanation: The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? Diuresis Fever Absence of pain Weight loss

Correct response: Fever Explanation: Fever is an indicator of infection or transplant rejection.

Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? Glomerulonephritis Hypovolemia Ureteral calculus Dysrhythmia

Correct response: Glomerulonephritis Explanation: Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? Previous episode of acute pyelonephritis History of hyperparathyroidism Recent history of streptococcal infection History of osteoporosis

Correct response: Recent history of streptococcal infection Explanation: Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.

There are four phases of AKI:

initiation, oliguria, diuresis, and recovery.

The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL? 250 mL 500 mL 750 mL 1,000 mL

Correct response: 1,000 mL Explanation: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1-kg weight gain is equal to 1,000 mL of retained fluid.

What is a hallmark of the diagnosis of nephrotic syndrome? Hyponatremia Proteinuria Hyperalbuminemia Hypokalemia

Correct response: Proteinuria Explanation: Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.

The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? Wear a mask while handling any dialysate solutions. Keep the catheter stabilized to the abdomen, below the belt line. Use an aseptic technique during the procedure. Clean the catheter insertion site daily with soap.

Correct response: Use an aseptic technique during the procedure. Explanation: The client should be instructed to use an aseptic technique during the procedure. The client should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (clients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take? Administer the medications as ordered. Hold the medications until after dialysis. Check with the dialysis nurse about the medications. Ask if the client wants to take the medications.

Correct response: Hold the medications until after dialysis. Explanation: Antihypertensive therapy, often part of the regimen of clients on dialysis, is one example when communication, education, and evaluation can make a difference in client outcomes. The client must know when—and when not—to take the medication. For example, if an antihypertensive agent is taken on a dialysis day, hypotension may occur during dialysis, causing dangerously low blood pressure. Many medications that are taken once daily can be held until after dialysis treatment.

A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? Elevated urea levels Hyperkalemia Hypocalcemia Elevated white blood cells

Correct response: Hyperkalemia Explanation: Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.

A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? Elevated serum creatinine Hyperkalemia Hyperphosphatemia Elevated urea and nitrogen

Correct response: Hyperphosphatemia Explanation: Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.

A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? Increase fat intake and limit carbohydrates. Eliminate fat intake and increase protein intake. Increase carbohydrates and limit protein intake. Increase protein, carbohydrates, and fat intake.

Correct response: Increase carbohydrates and limit protein intake. Explanation: Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.

What is a characteristic of the intrarenal category of acute kidney injury (AKI)? Decreased creatinine Increased BUN High specific gravity Decreased urine sodium

Correct response: Increased BUN Explanation: The intrarenal category of acute kidney injury (AKI) encompasses an increased BUN, increased creatinine, a low-normal specific gravity of urine, and increased urine sodium. Intrarenal AKI is the result of actual parenchymal damage to the glomeruli or kidney tubules. Acute tubular necrosis (ATN), AKI in which there is damage to the kidney tubules, is the most common type of intrinsic AKI. Characteristics of ATN are intratubular obstruction, tubular back leak (abnormal reabsorption of filtrate and decreased urine flow through the tubule), vasoconstriction, and changes in glomerular permeability. These processes result in a decrease of GFR, progressive azotemia, and fluid and electrolyte imbalances.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? Impaired urinary elimination Toileting self-care deficit Risk for infection Activity intolerance

Correct response: Risk for infection Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? Encourage oral fluids. Administer furosemide (Lasix) 20 mg IV Start hemodialysis after a temporary access is obtained. Start IV fluids with a normal saline solution bolus followed by a maintenance dose.

Correct response: Start IV fluids with a normal saline solution bolus followed by a maintenance dose. Explanation: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.

Which of the following is the most accurate indicator of fluid loss or gain? Weight Urine output Caloric intake Body temperature

Correct response: Weight Explanation: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight, as accurate intake and output and assessment of insensible losses may be difficult. Urine output, caloric intake, and body temperature would not be the most reliable indicator of fluid loss or gain.