EAQ AKI/CKD

A client develops kidney damage as a result of a transfusion reaction. What is the most significant clinical response that the nurse will assess when determining kidney damage?

3) Decreased urinary output. Rationale: Diminished renal function usually is evidenced by a decrease in urine output to less than 100 to 400 mL/24 hours. Glycosuria is unrelated to a transfusion reaction. Although blood in the urine and acute pain over the kidney are related to the renal system and are signs of an acute hemolytic reaction, their presence does not necessarily indicate kidney damage.

A client with the diagnosis of chronic kidney disease develops hypocalcemia. Which clinical manifestations should the nurse expect the client with hypocalcemia to exhibit? Select all that apply.

3) Fractures 4) Osteomalacia 5) Eye calcium deposits Rationale: Because of calcium loss from the bone, fractures, osteomalacia, and eye calcium deposits occur. Acidosis decreases calcium that binds to albumin, resulting in more ionized calcium (free calcium) in the blood. Lethargy and weakness are associated with hypercalcemia.

A client with acute kidney failure is fatigued and becomes lethargic. Upon reviewing the client's medical record, which finding does the nurse determine is the most likely cause of this change in symptoms?

4) An increased blood urea nitrogen level. Rationale: An increased blood urea nitrogen level, indicating uremia, is toxic to the central nervous system and causes fatigue and lethargy. Hyperkalemia is associated with muscle weakness, irritability, nausea, and diarrhea. Hypernatremia is associated with firm tissue turgor, oliguria, and agitation. Dehydration can cause fatigue, dry skin and mucous membranes, and rapid pulse and respiratory rates.

Which electrolyte deficiency triggers the secretion of renin?

1) Sodium Rationale: Low sodium ion concentration causes decreased blood volume, thereby resulting in decreased perfusion. Decreased blood volume triggers the release of renin from the juxtaglomerular cells. Deficiencies of calcium, chloride, and potassium do not stimulate the secretion of renin.

A client is diagnosed with acute tubular necrosis after sustaining a kidney trauma. Which laboratory result should the nurse anticipate while the client is in the oliguric phase?

2) Hyperkalemia Rationale: Hyperkalemia is the laboratory result that the nurse should anticipate while the client is in the oliguric phase of acute tubular necrosis (ATN). Hypernatremia, hypophosphatemia, and hypomagnesemia do not occur during this phase. The kidney is unable to reabsorb sodium in the ATN oliguric phase, so serum sodium is lost in the concentrated urine produced. Potassium, magnesium, and phosphorus are retained in the blood as urine levels of these electrolytes diminish. Also, hyperkalemia and metabolic acidosis occur together because the kidneys also cannot excrete hydrogen ions. As hydrogen ions shift into cells to compensate for the rising acidosis, they displace potassium ions out of cells and into serum, which worsens hyperkalemia. Hyperkalemia poses the greatest threat to life because its lethal range is relatively close to its maximum normal range, often indicating a need for dialysis.

The nurse instructs a client suspected of bladder cancer to discard the morning first-voided urine and to collect a fresh urine specimen. The nurse also sends the specimen to the laboratory within 1 hour of collection. Which diagnostic procedure requires this intervention?

3) Urine cytologic study. Rationale: For urine cytologic study, the morning's first voided specimen is not used because epithelial cells may change in appearance in the urine held in the bladder overnight. Therefore, urine cytologic study requires this intervention with a fresh urine sample. Residual urine tests, concentration tests, and protein determination tests do not require this intervention. Catheterization or bladder ultrasound equipment are used in a client prescribed with a residual urine test after the client has voided. The concentration test requires the client to fast after a given time in the evening and then three urine specimens are collected in hourly intervals. A dipstick may be used to test the protein levels in the urine.

A client is admitted to the hospital in the oliguric phase of acute kidney injury. The nurse estimates that the urine output for the last 12 hours is about 200 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. What does the nurse conclude about the amount of fluid prescribed?

3) It will compensate for both insensible and expected fluid output over the next 24 hours. Rationale: Insensible losses are 500 to 1000 mL in 24 hours, with an average of about 600 mL; the measured output is about 400 mL in 24 hours based on the available history (about 200 mL in 12 hours). Based on the history, the expected urinary output should be about 400 mL in the next 24 hours, far less than 900 mL. More than 900 mL daily is necessary to help prevent pneumonia and its associated fever. Hyperkalemia in acute kidney injury is caused by inadequate glomerular filtration and is not related to fluid intake.

A client is admitted to the hospital in the oliguric phase of acute kidney injury. The nurse estimates that the urine output for the last 12 hours is about 200 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. What does the nurse conclude about the amount of fluid prescribed?

3) It will compensate for both insensible and expected output over the next 24 hours. Rationale: nsensible losses are 500 to 1000 mL in 24 hours, with an average of about 600 mL; the measured output is about 400 mL in 24 hours based on the available history (about 200 mL in 12 hours). Based on the history, the expected urinary output should be about 400 mL in the next 24 hours, far less than 900 mL. More than 900 mL daily is necessary to help prevent pneumonia and its associated fever. Hyperkalemia in acute kidney injury is caused by inadequate glomerular filtration and is not related to fluid intake.

What is the action of vasopressin?

2) Reabsorbs water into the capillaries. Rationale: Vasopressin is also known as an antidiuretic hormone (ADH). It helps in the reabsorption of water into the capillaries. Aldosterone promotes sodium reabsorption. Natriuretic hormones promote tubular secretion of sodium. Erythropoietin stimulates bone marrow to make red blood cells (RBCs).

A nurse is assessing a client with a diagnosis of kidney failure for clinical indicators of metabolic acidosis. What should the nurse conclude is the reason metabolic acidosis develops with kidney failure?

1) Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate. Rationale: Bicarbonate buffering is limited, hydrogen ions accumulate, and acidosis results. The rate of respirations increases in metabolic acidosis to compensate for a low pH. The fluid balance does not significantly alter the pH. The retention of sodium ions is related to fluid retention and edema rather than to acidosis.

The registered nurse discusses normal renal function with the client. Which statement made by the client are correct regarding regulatory functions of the kidney? Select all that apply.

2) "They play a role in acid-base balance." 5) "They play a role in fluid and electrolyte balance. Rationale: Maintaining the acid-base balance of the body by selectively reabsorbing and secreting certain substances from the blood is a regulatory function of the kidneys. The kidneys also perform the regulatory function of electrolyte balance by regulating the reabsorption of certain electrolytes while eliminating others depending on their levels in the serum. The kidneys perform hormonal function by secreting a hormone called erythropoietin that aids in synthesis of red blood cells (erythropoiesis). Activation of vitamin D is a hormonal function of the kidneys. The kidneys perform hormonal function by secreting the hormone renin that assists in blood pressure control.

A client with acute kidney injury moves into the diuretic phase after 1 week of therapy. For which clinical indicators during this phase should the nurse assess the client? Select all that apply.

2) Dehydration 3) Hypovolemia Rationale: In the diuretic phase, fluid retained during the oliguric phase is excreted and may reach 3 to 5 L daily; dehydration and hypovolemia may occur unless fluids are replaced. Skin rash is not associated with the diuretic phase. Hyperkalemia develops in the oliguric phase when glomerular filtration is inadequate. Metabolic acidosis occurs in the oliguric, not diuretic, phase.

A nurse is caring for a client with chronic kidney failure. Which clinical findings should the nurse expect when assessing this client? Select all that apply.

2) Lethargy 4) Muscle twitching Rationale: Lethargy results from anemia, buildup of urea, and vitamin deficiencies. Muscle twitching results from excess nitrogenous wastes. Extensive nephron damage causes oliguria, not polyuria. Hypotension does not occur; the blood pressure is within the expected range or elevated as a result of increased total body fluid. Metabolic, not respiratory, acidosis occurs because of the kidneys' inability to excrete hydrogen and regulate sodium and bicarbonate levels.

A client with acute kidney injury states, "Why am I twitching and my fingers and toes tingling?" Which process should the nurse consider when formulating a response to this client?

2) calcium depletion Rationale: In kidney failure, as the glomerular filtration rate decreases, phosphorus is retained. As hyperphosphatemia occurs, calcium is excreted. Calcium depletion hypocalcemia causes tetany, which causes twitching and tingling of the extremities, among other symptoms. Acidosis, potassium retention, and sodium chloride depletion are not characterized by twitching and tingling of the extremities.

After reviewing the 24-hour urine collection reports of a client with kidney dysfunction, the nurse suspects diabetes mellitus. Which finding supports this suspicion?

4) Creatinine level: 40 mg/kg/24 hr. Rationale: Blood urea nitrogen (BUN) and serum creatinine levels are increased in clients with kidney dysfunction. This results in nausea, vomiting, increased fatigue, muscle cramps, and anemia, resulting in decreased breakdown of insulin. The normal range of creatinine lies between 14 and 26 mg/kg/24 hr. Therefore a creatinine level of 40 mg/kg/24 hr indicates diabetes mellitus. A calcium level of 500 mg/24 hr indicates hyperparathyroidism, sarcoidosis, calcium kidney stones, and hypercalcemia. A sodium level of 300 mEq/24 hr indicates hypokalemia and acute tubular necrosis. A urea nitrogen level of 30 g/24 hr indicates trauma, sepsis, or infection.Test-Taking Tip: Blood urea nitrogen (BUN) and serum creatinine are increased in clients with kidney dysfunctions. Use this information to answer the question.

After reviewing the urinalysis reports of a group of clients, a nurse suspects a client to have kidney disease. Which client's findings support the nurse's suspicion?

3) Client C (Serum creatinine: 2.5 mg/dL). Rationale: The normal range of serum creatinine lies between 0.6 and 1.2 mg/dL. The serum creatinine concentration of client C is 2.5 mg/dL, which is greater than the normal value, and indicates renal impairment. Therefore the laboratory findings of client C support the nurse's suspicion. A serum creatinine concentration of 1.1 mg/dL in client A is a normal finding. The normal range of blood urea nitrogen (BUN) is 10 to 20 mg/dL; therefore, the urinalysis reports for clients B and D are normal.

A nurse is caring for a client with acute kidney injury who is receiving a protein-restricted diet. The client asks why this diet is necessary. Which information should the nurse include in a response to the client's questions?

3) This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys. Rationale: The amount of protein permitted in the diet depends on the extent of kidney function; excess protein causes an increase in urea concentration, excess metabolic waste, and added stress on the kidneys, which should be prevented. Adequate calories are provided to prevent tissue catabolism that also results in an increase in metabolic waste products. In kidney failure the kidneys are unable to eliminate the waste products of a high-protein diet, which is to be avoided. The body is able to synthesize the nonessential amino acids. Urea is a waste product of protein metabolism; the body is able to synthesize the nonessential amino acids.Test-Taking Tip: Make educated guesses when necessary.

A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy?

4) "It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion." Rationale: Diffusion [1] [2] moves particles from an area of greater concentration to an area of lesser concentration; osmosis moves fluid from an area of lesser to an area of greater concentration of particles, thereby removing waste products into the dialysate, which is then drained from the abdomen. The principle of ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal dialysis uses the peritoneal membrane to indirectly cleanse the blood. Dialysate does not clear toxins in a short time; exchanges may occur four or five times a day.

A client is experiencing kidney failure. Which is the most serious complication for which the nurse must monitor a client with kidney failure?

4) Hyperkalemia Rationale: Decreased glomerular filtration leads to hyperkalemia, which may cause lethal dysrhythmias such as cardiac arrest. Anemia may occur but is not the most serious complication and should be treated in relation to the client's clinical manifestation; erythropoietin and iron supplements usually are used. Weight loss alone is not life threatening. Uremic frost, a layer of urea crystals on the skin, causes itching but it is not the most serious complication.

What does the nurse find in the laboratory report of a client who is suspected of having a urinary disorder and is on steroid therapy?

4) Increased blood urea nitrogen levels. Rationale: Steroid therapy may be used to treat urinary disorders; however, it may cause the blood urea nitrogen (BUN) levels to elevate. Increased red blood cell count occurs in polycythemia. Increased sodium does not occur with steroid use. An increase in serum creatinine levels indicates kidney impairment.