Dialysis evolve questions
The physician has prescribed renal replacement therapy to remove large volumes of fluid from a patient who is hemodynamically unstable in the intensive care unit. The nurse should expect which treatment to be used for this patient? 1 Automated peritoneal dialysis (APD) 2 Hemodialysis (HD) three times per week 3 Continuous venovenous hemofiltration (CVVH) 4 Continuous ambulatory peritoneal dialysis (CAPD)
Continuous venovenous hemofiltration (CVVH) CVVH removes large volumes of water and solutes from the patient over a longer period of time by using ultrafiltration and convection. HD three times per week would not be used for this patient because fluid and solutes build up and then are removed rapidly. With APD (used at night instead of during the day) fluid and solutes build up during the day and would not benefit this patient as much. CAPD will not remove as rapidly large amounts of fluid as CVVH can do.
A patient who has been on hemodialysis for several weeks asks the nurse what substances are being removed by the dialysis. What substances should the nurse tell the patient are passing through the membrane during hemodialysis? Select all that apply. 1 Glucose 2 Bacteria 3 Creatinine 4 Phosphate 5 Red blood cells (RBCs)
Creatinine Phosphate Creatinine, urea, uric acid, and electrolytes such as phosphate and potassium are filtered by the semipermeable membrane during hemodialysis. RBCs do not pass through the semipermeable membrane during hemodialysis because of their molecular weight. Glucose does not pass through the semipermeable membrane during hemodialysis due to the osmotic difference of the dialysate. Bacteria do not pass through the semipermeable membrane during hemodialysis due to their high molecular weight.
Which assessment finding of a patient with chronic kidney disease indicates to the nurse that hemodialysis is having the desired effect? 1 Decreased hematocrit and diuresis 2 Decreased serum creatinine and weight loss 3 Increased potassium level and improved appetite 4 Decreased white blood cell count and diaphoresis
Decreased serum creatinine and weight loss One of the main purposes of hemodialysis is removal of creatinine, other waste products, and water. Fluid loss may be measured by weighing the patient before and after the dialysis treatment and also by measuring the serum creatinine. The other answer options are inaccurate and/or incomplete. Hemodialysis will decrease potassium. It may also increase hematocrit and improve appetite. Hemodialysis will not produce diuresis and has no direct effect on WBC count or diaphoresis.
The nurse is preparing to perform peritoneal dialysis for a patient with chronic kidney disease. Which osmotic agent will the nurse obtain for the dialysis exchanges? 1 Dextrose 2 Normal saline 3 Icodextrin solution 4 Amino acid solution
Dextrose Dextrose is the most commonly used osmotic agent used in peritoneal dialysis. Normal saline solution is not used in peritoneal dialysis. Icodextrin and amino acid solutions are used as alternatives to dextrose.
The nurse is attending to a patient who is undergoing peritoneal dialysis. The nurse assesses the patient is developing symptoms of respiratory distress. What nursing interventions are necessary to prevent further respiratory complications? Select all that apply. 1 Elevate the head of the bed. 2 Frequently reposition the patient. 3 Promote deep-breathing exercises. 4 Place the patient in a low Fowler's position. 5 Increase the rate of infusion of the dialysate.
Elevate the head of the bed. Frequently reposition the patient. Promote deep-breathing exercises. Elevating the head of the bed can prevent further complications and ease breathing. Decreased areas of ventilation suggest the presence of atelectasis, whereas adventitious sounds may suggest fluid overload, retained secretions, or infection. Frequent positioning will promote equal ventilation to all parts of the lungs. Deep-breathing exercises could help to promote proper expansion of lungs. Rapid infusion would cause more pressure on the diaphragm. The patient should be placed in the semi-Fowler's position for peritoneal dialysis; this allows inflow of fluid while not impinging on the thoracic cavity.
What are the complications of peritoneal dialysis? Select all that apply. 1 Hernias 2 Hepatitis 3 Peritonitis 4 Hypotension 5 Exit site infection
Hernias Peritonitis Exit site infection Peritoneal dialysis is removal of waste products from the body when kidneys no longer work adequately. The complications of peritoneal dialysis include hernias, peritonitis, and exit site infection. Hernias are caused by increased intraabdominal pressure secondary to the dialysate infusion. Peritonitis results from contamination or from progression of an exit site or tunnel infection. Exit site infection is caused by infection of the peritoneal catheter. Hepatitis and hypotension are complications of hemodialysis.
Which intervention should the nurse perform for a patient with acute kidney injury who is on hemodialysis? 1 Monitor bilirubin levels 2 Monitor the color of feces 3 Monitor blood glucose levels 4 Monitor for discharge at access site
Monitor for discharge at access site The nurse should monitor the access site for discharge because any discharge indicates infection. Patients with liver disorders should have their bilirubin levels monitored. Kidney injury is not associated with changes in bilirubin. The color of fecal matter and blood glucose levels do not need to be monitored.
A patient had the surgical creation of an arteriovenous graft for the administration of hemodialysis. For what complication should the dialysis nurse monitor during hemodialysis? 1 Hernia 2 Bronchitis 3 Pneumonia 4 Steal syndrome
Steal syndrome The creation of arteriovenous access for hemodialysis causes arterial blood to shift to other areas, which can lead to vascular insufficiency. This condition is called steal syndrome. Hernias occur due to increased abdominal pressure caused by dialysate infusion. Patients undergoing peritoneal dialysis may develop bronchitis and pneumonia due to decreased lung expansion caused by repeated upward displacement of the diaphragm.
A patient with chronic kidney disease is prescribed regular peritoneal dialysis (PD). What should the nurse inform the patient while teaching about PD? Avoid high-protein diets. Take potassium supplements. Avoid powdered breakfast drinks. Restrict fluid intake, as in hemodialysis.
Take potassium supplements. The patient undergoing regular peritoneal dialysis (PD) does not need to restrict potassium intake; instead, this patient may be prescribed oral potassium supplementation because of hypokalemia caused by dialysis. The patient need not restrict protein or fluid intake. The patient should include enough protein in the diet to compensate for loss of protein in dialysate. The patient may even take liquid or powdered breakfast drinks in case of inadequate protein intake. Patients on hemodialysis have a more restricted fluid intake than patients receiving peritoneal dialysis (PD).
While providing postoperative care for a live kidney donor, the nurse monitors the hematocrit levels. What rationale does the nurse provide to the patient for this action? 1 To assess for bleeding 2 To assess for impairment 3 To assess for hypokalemia 4 To assess for hyponatremia
To assess for bleeding Patients who have donated their kidney should be monitored for hematocrit levels to assess for bleeding. The nurse should monitor renal function to assess for impairment. The nurse should monitor for electrolytes to assess for hypokalemia and hyponatremia in kidney recipients.
Which substance can pass through the peritoneal membrane? glucose creatinine fatty acids amino acids
amino acids Peritoneal membranes allow the passage of amino acids, polypeptides, and plasma proteins. Glucose, creatinine, and fatty acids cannot permeate the peritoneal membrane.
The registered nurse is teaching a student nurse about physiologic changes in a kidney transplant recipient. Which statement made by the student nurse indicates the need for further teaching? 1 "The urinary output of the patient can be 1 L/hour." 2 "There may be an imbalance in the electrolyte levels." 3 "Decrease in the urine output after surgery can be neglected." 4 "Normal saline solution is infused to treat metabolic acidosis."
"Decrease in the urine output after surgery can be neglected." A decrease in the urine output after healthy kidney transplantation indicates rejection, dehydration, or urinary leakage. This is a serious condition and should be reported to the primary health care provider. An increased urine output of 1 L/hour after kidney transplant indicates proper functioning of the transplanted kidney. Due to increased elimination, electrolyte imbalance can occur. Normal saline solution should be infused to the patient to rectify metabolic acidosis caused by delayed kidney function.
Which statement by the nurse regarding continuous ambulatory peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to this procedure? "It is essential that you maintain aseptic technique to prevent peritonitis." "You will be allowed a more liberal protein diet once you complete CAPD." "It is important for you to maintain a daily written record of blood pressure and weight." "You will need to continue regular medical and nursing follow-up visits while performing CAPD."
"It is essential that you maintain aseptic technique to prevent peritonitis." Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of preventing this from occurring by use of aseptic technique. Although the nurse will teach a patient that he or she may be allowed more protein, the importance of maintaining a weight and blood pressure record, and keeping follow-up appointments, these statements do not have the potential for morbidity and mortality as does peritonitis, thus making that statement of highest priority.
The registered nurse is teaching the advantages of continuous renal replacement therapy (CRRT) over hemodialysis. Which statement made by the student nurse about CRRT indicates need for further teaching? 1 "Large volumes of fluid can be removed during CRRT." 2 "The hemodialysis nurse might not monitor CRRT." 3 "The chances of hypotension are higher in CRRT than in hemodialysis." 4 "The equipment used for CRRT is not as complex as that of hemodialysis."
"The chances of hypotension are higher in CRRT than in hemodialysis." Continuous renal replacement therapy (CRRT) has lower chances of hypotension compared to hemodialysis. Therefore the nurse's statement, "The chances of hypotension are higher in CRRT than in hemodialysis," indicates a need for further teaching. CRRT can remove large volumes of fluid over days versus hemodialysis, which takes only for several hours. CRRT does not require monitoring by a hemodialysis nurse. CRRT equipment is less complicated than hemodialysis equipment.
The nurse is caring for a patient undergoing peritoneal dialysis. What finding should the nurse report to the primary health care provider that would indicate peritonitis? 1 Oliguria 2 Hyperkalemia 3 Hyponatremia 4 Abdominal pain
Abdominal pain Peritonitis is caused by either a Staphylococcus aureus or a Staphylococcus epidermidis infection. It is manifested by abdominal pain, cloudy peritoneal effluent, and increased white blood cell count. Oliguria, hyperkalemia, and hyponatremia are complications associated with acute kidney injury.
The nurse is preparing a patient for peritoneal dialysis. What nursing action is appropriate at this time? 1 Inducing vomiting in the patient 2 Recording the patient's blood pressure 3 Measuring patient's blood glucose levels 4 Have the patient empty the bladder and bowel
Have the patient empty the bladder and bowel The nurse should ensure that the patient's bladder and bowels are empty before inserting a catheter to prevent an accidental puncture and mixing of the dialysate with bowel contents. Induction of vomiting is not predialysis care. The nurse does not need to record the patient's blood pressure and blood glucose levels immediately prior to peritoneal dialysis.
The nurse is caring for a patient with chronic kidney disease. The patient's glomerular filtration rate (GFR) is 15 mL/min. What are the treatment options the nurse would expect the health care provider to discuss with the patient? Select all that apply. 1 Nephrectomy 2 Hemodialysis 3 Peritoneal dialysis 4 Kidney transplant in place of dialysis 5 Continuous ambulatory peritoneal dialysis
Hemodialysis Peritoneal dialysis Continuous ambulatory peritoneal dialysis Any dialysis option would be appropriate for the patient. A nephrectomy is not going to cure the chronic kidney disease, and it is unknown whether the kidney has a tumor or cancer with this question. Kidney placement in place of dialysis at this point is too late. Dialysis needs to begin while awaiting a kidney transplant.
While caring for a patient who has undergone hemodialysis, the nurse finds profuse bleeding at the access site. What does the nurse suspect has occurred to increase bleeding? 1 Heparin treatment 2 Scratching the access site 3 Increase in blood pressure 4 Infection at the access site
Heparin treatment Bleeding is a common complication of hemodialysis due to heparinization. Clotting problems, dialysis membrane rupture, and high doses of heparin cause bleeding problems. Scratching the access site, increased blood pressure, and infection at the access site will not cause profuse bleeding.
The nurse is attending to a patient who has received a kidney transplant. What parameters would indicate a successful transplant? Select all that apply. 1 High blood pressure is corrected. 2 Blood sodium levels are decreased. 3 Serum potassium levels are elevated. 4 The specific gravity of urine increases. 5 Serum creatinine levels are decreased.
High blood pressure is corrected. Blood sodium levels are decreased. Serum creatinine levels are decreased. The patient with end-stage kidney disease may have hypertension due to fluid retention; the hypertension is corrected after a successful transplant through adequate urine output. The serum creatinine levels decrease as the transplanted kidney starts eliminating the nitrogenous wastes. After the transplant, the sodium levels should be corrected as the fluid balance returns to normal. As more urine is produced by the transplanted kidney, the specific gravity and concentration of the urine will decrease. Following a transplant, the serum potassium levels are corrected as fluid balance is restored.
The dialysis nurse is administering hemodialysis to a patient with chronic kidney failure. For what common complication should the nurse carefully monitor in this patient? 1 Hernias 2 Pneumonia 3 Hypotension 4 Lower back pain
Hypotension A rapid removal of fluid results in reduced vascular volume, which can lead to a decreased cardiac output and decreased vascular resistance. Therefore hemodialysis has the potential to cause hypotension during the process. Peritoneal dialysis is associated with hernias, lower back pain, and pneumonia, due to increased intraabdominal pressure while infusing the dialysate and decreased lung expansion caused by frequent upward displacement of the diaphragm.
During hemodialysis, the patient reports nausea, headache, and chest pain to the nurse. The patient has a blood pressure of 80/60 mm Hg. Which nursing action would be most beneficial to the patient? 1 Infusing normal saline solution 2 Infusing 5% w/v dextrose solution 3 Administering ondansetron (Zofran) 4 Administering acetaminophen (Paracetamol)
Infusing normal saline solution The rapid removal of large amount of body fluids results in hypotension. The decrease in blood pressure is manifested by nausea, vomiting, headache, and chest pain. Infusing normal saline solution will restore the volume of body fluid and help relieve the symptoms. Dextrose solution is infused in patients with hypoglycemia to restore the glucose levels in the body. Ondansetron (Zofran) and acetaminophen (Paracetamol) are antiemetic and analgesic drugs respectively, which can be administered to temporarily relieve negative side effects of hemodialysis.
A patient with chronic kidney disease is advised to undergo peritoneal dialysis (PD). What advantages of PD over hemodialysis should the nurse explain to the patient? Select all that apply. 1 It is home-based. 2 It is a simple procedure. 3 Equipment setup is simple. 4 It requires special water systems. 5 It needs a vascular access device.
It is home-based. It is a simple procedure. Equipment setup is simple. PD has many advantages over hemodialysis. The procedure is simple and home-based, with easy equipment setup. The patient can perform peritoneal dialysis. Because the dialysis is done through the peritoneal membrane, PD does not require a special water system or a vascular access device, as in hemodialysis.
The nurse teaches a patient receiving peritoneal dialysis (PD) the reason for the addition of glucose to the dialysis solution before it is instilled into the peritoneal cavity. What should the nurse explain to the patient? Select all that apply. 1 It removes excess fluid from the blood. 2 It forces potassium back into the cells, thereby decreasing serum levels. 3 It creates a pressure difference between blood and the dialysis solution. 4 It helps prevent cardiac dysrhythmias by speeding up the removal of excess potassium. 5 It encourages removal of serum urea by preventing constriction of peritoneal blood vessels.
It removes excess fluid from the blood. It creates a pressure difference between blood and the dialysis solution. In PD, excess fluid is removed by increasing the osmolality of the dialysate (osmotic gradient) through the addition of glucose. Excess water is removed when there is an osmotic gradient or pressure gradient across the membrane. The addition of glucose does not affect the shift of potassium into the cells. Excess serum potassium is removed by dialyzing with a potassium-free solution, not glucose. Heating the dialysate encourages removal of serum urea by dilatation of peritoneal blood vessels.
A patient has undergone successful kidney transplantation but develops a sudden rapid decrease in urine output five days after the surgery. What are the factors that the nurse should suspect to have caused this condition? Select all that apply. Leakage of urine Rejection of kidney Overdose of steroids Obstruction in the urinary catheter Inadequate administration of fluids
Leakage of urine Rejection of kidney Obstruction in the urinary catheter Inadequate administration of fluids A sudden decrease in urine output in the early postoperative period is a cause for concern. It may be caused by dehydration, rejection, a urine leak, or obstruction. Inadequate administration of fluids may cause dehydration. Decreased urine output is a sign of organ rejection. A common cause of early obstruction is a blood clot in the urinary catheter. An overdose of steroids does not cause decreased urine output.
The nurse is educating a donor who is willing to donate a kidney to a family member. The nurse explains the positioning during the procedure and describes that the flank will be exposed. For what surgical procedure will the nurse prepare the donor? 1 Cholecystectomy 2 Open nephrectomy 3 Ureteroneocystostomy 4 Laparoscopic nephrectomy
Open nephrectomy In an open nephrectomy, the donor is placed in the lateral decubitus position on the operating table so that the flank is exposed laterally. A cholecystectomy is the removal of the gall bladder. Tunneling the donor's ureter through the bladder mucosa is called a ureteroneocystostomy. A laparoscopic nephrectomy is a minimally invasive surgery associated with the removal of a kidney.
A patient with chronic kidney disease has developed uremic syndrome. What complications should the nurse anticipate due to an increase in blood urea levels? Select all that apply. 1 Anemia 2 Pericarditis 3 Hypertension 4 Pulmonary edema 5 Hemorrhagic tendencies
Pericarditis Hemorrhagic tendencies Uremic pericarditis is one of the cardiac complications of chronic renal failure. Uremia can cause qualitative defects in platelet function, thereby predisposing the patient to hemorrhages. Anemia is caused by decreased production of erythropoietin from the kidneys. Hypertension is caused by sodium retention and increased extracellular fluid volume. Pulmonary edema could be a consequence of both fluid overload and hypertension.
A patient who has been on peritoneal dialysis for two years reports nausea, vomiting, diarrhea, and fluid discharge from the catheter exit to the nurse. The laboratory reports reveal an increased white blood cell count (WBC). Which condition does the nurse suspect in the patient? 1 Hernia 2 Peritonitis 3 Intraperitoneal bleeding 4 Displacement of diaphragm
Peritonitis Symptoms of nausea, vomiting, diarrhea, fever, clear exudate from the exit site, and an increased white blood cell count are the clinical manifestations of peritonitis. It occurs due to the infection of Staphylococcus aureus or Staphylococcus epidermidis. A hernia is caused by increased dialysate pressure. Fresh blood in the discharge from the catheter exit site indicates intraperitoneal bleeding. Displacement of the diaphragm causes pulmonary complications such as bronchitis and pneumonia.
The nurse is caring for the patient receiving hemodialysis. What action by the nurse is a priority? 1 Checking the patient's skin condition 2 Recording the vital signs every 30 to 60 minutes 3 Recording the patient's weight during the procedure 4 Checking the blood pressure from the extremity with vascular access
Recording the vital signs every 30 to 60 minutes Blood pressure fluctuates during dialysis and a change in vital signs can indicate rapid changes in blood pressure. Therefore the nurse should record the vital signs every 30 to 60 minutes during dialysis. The patient's skin condition should be assessed before dialysis for determining the site for vascular access. The patient's weight should be recorded before and after the procedure to determine the amount of fluid to be removed. Blood pressure should not be checked from the same extremity with vascular access because this may cause clotting of the vascular access.
Hemodialysis is planned for a patient who has end-stage kidney disease. The patient is scheduled for the creation of an internal arteriovenous fistula and the placement of an external arteriovenous shunt to be used until the fistula heals. What postoperative nursing care is appropriate for this patient? Select all that apply. 1 Cover the ends of the shunt cannula with a dressing. 2 Regularly check the positioning of the external shunt. 3 Do not take blood pressure on the extremity with the shunt. 4 Check for signs and symptoms of respiratory complications. 5 Ensure that intravenous fluids are not infused in the arm with the shunt.
Regularly check the positioning of the external shunt. Do not take blood pressure on the extremity with the shunt. Ensure that intravenous fluids are not infused in the arm with the shunt. The external shunt may come apart, external temperatures make clotting a potential hazard, and frequent handling increases the risk of infection. Infusions should not be in the extremity with the shunt or the fistula to avoid pressure from the tourniquet and to lessen the chance of phlebitis. Blood pressure readings should not be obtained in the extremity that has a shunt or fistula because of the pressure exerted on the circulatory system during the procedure. There are no respiratory complications of this procedure. The ends of the shunt cannula should be left exposed for rapid reconnection in the event of disruption.
A patient with end-stage kidney disease is receiving continuous ambulatory peritoneal dialysis. The patient has a fever and the nurse suspects that it is due to peritonitis. The nurse should assess the patient for what other clinical manifestations associated with peritonitis? Select all that apply. 1 Vomiting 2 Weight loss 3 Bloody stools 4 Abdominal pain 5 Cloudy peritoneal effluent
Vomiting Abdominal pain Cloudy peritoneal effluent Peritonitis may manifest as vomiting due to the inflammatory process in the peritoneum. The patient may have pain in the abdomen due to peritoneal irritation caused by the inflammatory process in the peritoneum. The primary clinical manifestations of peritonitis are abdominal pain and cloudy peritoneal effluent with a white blood cell (WBC) count greater than 100 cells/L (more than 50% neutrophils). An activated immune response may attract WBCs, and an elevated level of WBC in the peritoneal fluid indicates peritonitis. Bloody stool or weight loss is not associated with peritonitis. Peritonitis may not cause hemorrhage; therefore, bloody stools may not be present. Weight loss is usually caused by malnutrition or fluid loss and therefore may not be seen in peritonitis; weight gain may occur due to fluid retention.
