, Exam 5 432

A client with a decreased glomerular filtration rate asks how to prevent further damage to the kidneys. Which is the nurse's best response?

"Avoid taking NSAIDs."

A client is admitted to the hospital with a serum creatinine level of 2 mg/dL. When taking the client's history, which question does the nurse ask first?

"Do you take any nonprescription medications?"

Which assessment parameter does the nurse monitor in a client with chronic kidney disease to determine fluid and sodium retention status?

Weight and blood pressure

A client who is 2 days post-femoral vein cannulation begins to have difficulty with outflow of blood during dialysis. For which complication does the nurse assess?

Hematoma at cannula insertion site

A client has end-stage kidney disease (ESKD). Which food selection by the client demonstrates understanding of a low-sodium, low-potassium diet?

Herbs and spices

The RN has assigned a client with a newly placed arteriovenous (AV) fistula in the right arm to an LPN. Which information about the care of this client is most important for the RN to provide to the LPN?

"Take blood pressure in the left arm."

A client who has chronic kidney disease is being discharged from the hospital after receiving treatment for a hip fracture. Which information is most important for the nurse to provide to the client before discharge?

"Take your aluminum hydroxide (Nephrox) with meals."

A client with acute kidney failure and on dialysis asks how much fluid will be permitted each day. Which is the nurse's best response?

"You can drink an amount equal to your urine output, plus 700 mL."

A client with chronic kidney disease states that he will be going to the dentist for a planned tooth extraction. Which is the nurse's best response?

"You should receive prophylactic antibiotics before any dental procedure."

Which response by a client indicates an understanding of measures to facilitate the flow of peritoneal dialysate fluid?

"I will take my stool softeners every day."

A client has a brain abscess and is receiving phenytoin (Dilantin). The spouse questions the use of the drug, saying the client does not have a seizure disorder. What response by the nurse is best?

"Increased pressure from the abscess can cause seizures."

A client asks the nurse, "What are the advantages of peritoneal dialysis over hemodialysis?" Which response by the nurse is accurate? (Select all that apply.)

"It will give you greater freedom in your scheduling." "You do not need a machine to do it." "You will have fewer dietary restrictions."

A client had an embolic stroke and is having an echocardiogram. When the client asks why the provider ordered "a test on my heart," how should the nurse respond?

"Most of these types of blood clots come from the heart."

Which statement by a client who has undergone kidney transplantation indicates a need for more teaching?

"My new kidney is working fine. I do not need to take medications any longer."

The nurse is providing dietary teaching to a client who was just started on peritoneal dialysis (PD). Which instruction does the nurse provide to this client regarding protein intake?

"You will need more protein now because some protein is lost by dialysis."

A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The nurse is teaching the client's spouse about the kidney-specific formulation for the enteral solution compared to standard formulas. What components should be discussed in the teaching plan? (Select all that apply.)

- Lower sodium -Lower potassium -Higher calories

A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery. Which findings by the nurse should prompt immediate action to prevent acute kidney injury? (Select all that apply.)

- Urine output of 100 mL in 4 hours - Large amount of sediment in the urine -Blood pressure of 90/60 mm Hg

A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD). Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.)

-"I need to ask for an antibiotic when scheduling a dental appointment." -"I'll need to check my blood sugar often to prevent hypoglycemia.". -"The dose of my pain medication may have to be adjusted." -"I should watch for bleeding when taking my anticoagulants."

The nurse is teaching a client with diabetes mellitus how to prevent or delay chronic kidney disease (CKD). Which client statements indicate a lack of understanding of the teaching? (Select all that apply.)

-"My weight should be maintained at a body mass index of 30." -"I can continue to take an aspirin every -"I really only need to drink a couple of glasses of water each day."

A client is undergoing hemodialysis. The client's blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions should the nurse perform to maintain blood pressure? (Select all that apply.)

-Adjust the rate of extracorporeal blood flow. -Place the client in the Trendelenburg position. -Administer a 250-mL bolus of normal saline.

A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are accurate regarding PD? (Select all that apply.)

-You will not need vascular access to perform PD." -"There is less restriction of protein and fluids." -"You have flexible scheduling for the exchanges."

when caring for a patient with a left arm aterinvenoous fistula, which action will the nurse include in the plan of care to maintain patency of fistula?

-asusclate for bruit @ the fistula site

The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for post-renal acute kidney injury (AKI)? (Select all that apply.)

-man with prostate cancer -woman with blood clots in the urinary tract -client with uterolithiasis

The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which condition would the nurse expect to find in the client's recent HX?

-myocardial infaction

which menu choice by the patient who is receiving hemodialysis indicates the nrise teaching has been successful?

-poached eggs -whole what toast -apple juice

After a craniotomy, the nurse assesses the client and finds dry, sticky mucous membranes and restlessness. The client has IV fluids running at 75 mL/hr. What action by the nurse is best?

. Assess the client's sodium level.

A nurse is caring for a client after a stroke. What actions may the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)

. Check and document oxygen saturation every 1 to 2 hours. Position the client supine with the head in a neutral midline position.

A client in the emergency department is having a stroke. The client weighs 225 pounds. After the initial bolus of t-Pa, at what rate should the nurse set the IV pump? (Record your answer using a decimal rounded to the nearest tenth.) ____ mL/hr

1.4 mL/hr

A client in the emergency department is having a stroke and the provider has prescribed the tissue plasminogen activator (t-PA) alteplase (Activase). The client weighs 146 pounds. How much medication will this client receive? (Record your answer using a whole number.) _____ mg

60 mg

A nurse is providing community screening for risk factors associated with stroke. Which client would the nurse identify as being at highest risk for a stroke?

A 27-year-old heavy cocaine user

A nursing student studying traumatic brain injuries (TBIs) should recognize which facts about these disorders? (Select all that apply.)

A client with a moderate trauma may need hospitalization. A client with a Glasgow Coma Scale score of 3 has severe TBI. The terms "mild TBI" and "concussion" have similar meanings.

Which finding in the first 24 hours after kidney transplantation requires immediate intervention? A. Abrupt decrease in urine output B. Blood-tinged urine C. Incisional pain D. Increase in urine output

A. Abrupt decrease in urine output An abrupt decrease in urine output may indicate complications such as rejection, acute kidney injury, thrombosis, or obstruction. Blood-tinged urine, incisional pain, and an increase in urine output are expected findings after kidney transplantation.

A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? A. Auscultate for pericardial friction rub. B. Assess for crackles. C. Monitor for decreased peripheral pulses. D. Determine if the client is able to ambulate.

A. Auscultate for pericardial friction rub. The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST-segment elevation. Crackles and tachycardia are symptomatic of fluid overload; fever is not present. Although the nurse will monitor pulses, and ambulation is important to prevent weakness and deep vein thrombosis, these are not pertinent to the constellation of symptoms of pericarditis that the client presents with.

A client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? A. Avoiding venipuncture and blood pressure measurements in the affected arm B. Modifications to allow for complete rest of the affected arm C. How to assess for a bruit in the affected arm D. How to practice proper nutrition

A. Avoiding venipuncture and blood pressure measurements in the affected arm Compression of vascular access causes decreased blood flow and may cause occlusion; if this occurs, dialysis will not be possible. The arm should be exercised to encourage venous dilation, not rested. The client can palpate for a thrill; a stethoscope is not needed to auscultate the bruit at home. The nurse should take every opportunity to discuss nutrition, even as it relates to wound healing, but loss of the graft or fistula by compression or occlusion must take priority because lifesaving dialysis cannot be performed.

The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? A. Client with chronic kidney failure who was just admitted with shortness of breath B. Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted C. Client with azotemia whose blood urea nitrogen and creatinine are increasing D. Client receiving peritoneal dialysis who needs help changing the dialysate bag

A. Client with chronic kidney failure who was just admitted with shortness of breath The dyspnea of the client with chronic kidney failure may indicate pulmonary edema and should be assessed immediately. The client with kidney insufficiency is stable and assessment can be performed later. The client with azotemia requires assessment and possible interventions, but is not at immediate risk for life-threatening problems. The client receiving peritoneal dialysis can be seen last because it is a slow process and the client has no urgent needs.

To prevent pre-renal acute kidney injury, which person is encouraged to increase fluid consumption? A. Construction worker B. Office secretary C. Schoolteacher D. Taxicab driver

A. Construction worker Physical labor and working outdoors, especially in warm weather, cause diaphoresis and place the construction worker at risk for dehydration and pre-renal azotemia. The office secretary and schoolteacher work indoors and, even without air conditioning, will not lose as much fluid to diaphoresis as someone performing physical labor. The taxicab driver, even without air conditioning, will not experience diaphoresis and fluid loss like the construction worker.

When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends that the client select which food? A. Eggs B. Ham C. Eggplant D. Macaroni

A. Eggs Suggested protein-containing foods for a client on peritoneal dialysis are milk, meat, and eggs. Although a protein, ham is high in sodium, which should be avoided. Vegetables and pasta contain mostly carbohydrates. Peritoneal dialysis clients are allowed 1.2 to 1.5 g of protein/kg/day because protein is lost with each exchange.

Which clients are at risk for acute kidney injury (AKI)? (Select all that apply.) A. Football player in preseason practice B. Client who underwent contrast dye radiology C. Accident victim recovering from a severe hemorrhage D. Accountant with diabetes E. Client in the intensive care unit on high doses of antibiotics F. Client recovering from gastrointestinal influenza

A. Football player in preseason practice B. Client who underwent contrast dye radiology C. Accident victim recovering from a severe hemorrhage E. Client in the intensive care unit on high doses of antibiotics F. Client recovering from gastrointestinal influenza To prevent AKI, all people should be urged to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis, or when recovering from an illness that reduces kidney blood flow, such as influenza. Contrast media may cause acute renal failure, especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause AKI. Certain antibiotics may cause nephrotoxicity. Diabetes may cause acute kidney failure superimposed on chronic kidney failure.

Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? A. Increased blood urea nitrogen (BUN) B. Increased creatinine level C. Pale-colored urine D. Decreased sodium level

A. Increased blood urea nitrogen (BUN) An increase in BUN can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment. Urine that is pale in color is diluted; an increase in fluids is not necessary. Sodium is increased, not decreased, with dehydration.

The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication? A. Nonsteroidal anti-inflammatory drugs (NSAIDs) B. Angiotensin-converting enzyme (ACE) inhibitors C. Opiates D. Calcium channel blockers

A. Nonsteroidal anti-inflammatory drugs (NSAIDs) NSAIDs may be nephrotoxic to a client with acute kidney disease, and should be avoided. ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opiates may be used by clients with kidney disease if severe pain is present; however, excretion may be delayed. Calcium channel blockers can improve the glomerular filtration rate and blood flow within the kidney.

An 84-year-old male client is being admitted after surgery to remove a section of his bowel (colectomy) following a diagnosis of colon cancer. His urine output from an indwelling urinary catheter after 3 hours in the postanesthesia care unit plus the amount in the bag on admission to the medical-surgical unit totals 100 mL. The urine is cloudy and dark yellow. He also has a history of hypertension. After evaluating the patency of the collection device, what is the most appropriate action for the nurse to perform? A. Notify the health care provider of the low urine output. B. Increase the rate of intravenous fluids until urine output is 0.5 mL/kg/hr. C. Continue to assess the client and re-evaluate urine output in 4 hours. D. Ask about his typical voiding patterns and about any previous episodes of urinary problems.

A. Notify the health care provider of the low urine output. Rationale: The lowest acceptable urine output to avoid acute kidney injury (AKI) is 0.5 mL/kg/hr, which, in this 70-kg man, is about 35 mL/hr or a total of at least 105 mL. Surgery places clients at risk for both hypo- and hypervolemia. Waiting an additional 4 hours to obtain 6-hour trend data delays the prompt assessment and intervention necessary to avoid AKI. It is not appropriate to increase fluid rate, and it is unlikely the client is ready to take oral fluid this soon after surgery on the gastrointestinal tract. Voiding is not an issue with a urinary collection device.

While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) A. Obtain the client's pre-hemodialysis weight. B. Check the arteriovenous (AV) fistula for a thrill and bruit. C. Document the amount the client drinks throughout the shift. D. Auscultate the client's lung sounds every 4 hours. E. Explain the components of a low-sodium diet.

A. Obtain the client's pre-hemodialysis weight. C. Document the amount the client drinks throughout the shift. Obtaining the client's weight and documenting oral fluid intake are routine tasks that can be performed by UAP. Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN.

The nurse assists a client with acute kidney injury (AKI) to modify the diet in which ways? (Select all that apply.) A. Restricted protein B. Liberal sodium C. Restricted fluids D. Low potassium E. Low fat

A. Restricted protein C. Restricted fluids D. Low potassium Breakdown of protein leads to azotemia and increased blood urea nitrogen. Fluid is restricted during the oliguric stage. Potassium intoxication may occur, so dietary potassium is also restricted. Sodium is restricted during AKI because oliguria causes fluid retention. Fats may be used for needed calories when proteins are restricted.

A client with acute kidney injury is placed on a fluid restriction. To determine whether outcomes related to fluid balance are being met, the nurse assesses for which finding?

Absence of lung crackles

A nurse cares for older clients who have traumatic brain injury. What should the nurse understand about this population? (Select all that apply.)

Admission can overwhelm the coping mechanisms for older clients These clients are more susceptible to systemic and wound infections. Other medical conditions can complicate treatment for these clients

When evaluating the effects of a low-protein diet in a client with chronic kidney disease, the nurse is most concerned with which result?

Albumin level of 2 g/dL

The nurse working in the emergency department assesses a client who has symptoms of stroke. For what modifiable risk factors should the nurse assess? (Select all that apply.)

Alcohol intake High-fat diet Obesity Smoking

After a stroke, a client has ataxia. What intervention is most appropriate to include on the client's plan of care?

Ambulate only with a gait belt.

A nursing student studying the neurologic system learns which information? (Select all that apply.)

An aneurysm is a ballooning in a weakened part of an arterial wall. Intracerebral hemorrhage is bleeding directly into the brain. Reduced perfusion from vasospasm often makes stroke worse

The nurse is providing a client with a peritoneal dialysis exchange. The nurse notes the presence of cloudy peritoneal effluent. Which action by the nurse is most appropriate?

Collect a sample to send to the laboratory.

A client has meningitis following brain surgery. What comfort measures may the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)

Applying a cool washcloth to the head Assisting the client to a position of comfort Keeping voices soft and soothing Maintaining low lighting in the room

A client has a shoulder injury and is scheduled for a magnetic resonance imaging (MRI). The nurse notes the presence of an aneurysm clip in the client's record. What action by the nurse is best?

Ask the client how long ago the clip was placed.

A client has a small-bore feeding tube (Dobhoff tube) inserted for continuous enteral feedings while recovering from a traumatic brain injury. What actions should the nurse include in the client's care? (Select all that apply.)

Assess tube placement per agency policy . Keep the head of the bed elevated at least 30 degrees. Listen to lung sounds at least every 4 hours. Run continuous feedings on a feeding pump.

A client with a stroke has damage to Broca's area. What intervention to promote communication is best for this client?

Assess whether or not the client can write.

A client in the emergency department is having a stroke and needs a carotid artery angioplasty with stenting. The client's mental status is deteriorating. What action by the nurse is most appropriate?

Attempt to find the family to sign a consent

The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? A. "Should we filter air circulation?" B. "Can we use less radiographic contrast dye?" C. "Should we add low-dose dobutamine?" D. "Should we decrease IV rates?"

B. "Can we use less radiographic contrast dye?" Contrast dye is severely nephrotoxic, and other options can be used in its place. Air circulation and low-dose dopamine are not associated with nephrotoxicity. Pre-renal status results from decreased blood flow to the kidney, such as fluid loss or dehydration; IV fluids can correct this.

A client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? A. "I'll talk to the health care provider and have your name removed from the waiting list." B. "You sound frustrated with the situation." C. "You're right, the wait is endless for some people." D. "I'm sure you'll get a phone call soon that a kidney is available."

B. "You sound frustrated with the situation." Acknowledging the client's frustration reflects the feelings the client is having and offers assistance and support. Talking to the health care provider and removing the client from the waiting list does not allow the nurse to hear more and perhaps offer therapeutic listening or a solution to the problem. Telling the client that the wait is endless for some people cuts the client off from sharing his or her concerns and accentuates the negative aspects of the situation. The waiting time for kidney matches is increasing due to a shortage of organs; the nurse should not offer false hope by suggesting that the client will get a phone call soon.

When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which actions must the nurse take? (Select all that apply.) A. Check brachial pulses daily. B. Auscultate for a bruit every 8 hours. C. Teach the client to palpate for a thrill over the site. D. Elevate the arm above heart level. E. Ensure that no blood pressures are taken in that arm.

B. Auscultate for a bruit every 8 hours. C. Teach the client to palpate for a thrill over the site. E. Ensure that no blood pressures are taken in that arm. A bruit or swishing sound, and a thrill or buzzing sensation upon palpation should be present in this client, indicating patency of the fistula. No blood pressure, venipuncture, or compression, such as lying on the fistula, should occur. Distal pulses and capillary refill should be checked, and for a forearm fistula, the radial pulse is checked—the brachial pulse is proximal. Elevating the arm increases venous return, possibly collapsing the fistula.

Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? A. Consuming a low-calcium diet B. Avoiding peas, nuts, and legumes C. Drinking cola beverages only once daily D. Increasing dairy products enriched with vitamin D

B. Avoiding peas, nuts, and legumes Kidney failure causes hyperphosphatemia; this client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes. Calcium should not be restricted; hyperphosphatemia results in a decrease in serum calcium and demineralization of the bone. Cola beverages and dairy products are high in phosphorus, contributing to hypocalcemia and bone breakdown.

Which signs and symptoms indicate rejection of a transplanted kidney? (Select all that apply.) A. Blood urea nitrogen (BUN) 21 mg/dL, creatinine 0.9 mg/dL B. Crackles in the lung fields C. Temperature of 98.8° F (37.1° C) D. Blood pressure of 164/98 mm Hg E. 3+ edema of the lower extremities

B. Crackles in the lung fields D. Blood pressure of 164/98 mm Hg E. 3+ edema of the lower extremities Signs and symptoms of fluid retention (e.g., crackles in the lung fields and 3+ edema of the lower extremities) indicate transplant rejection. Increased blood pressure is also a symptom of transplant rejection. Increasing BUN and creatinine are symptoms of rejection; a BUN of 21 mg/dL and a creatinine of 0.9 mg/dL reflect normal values. Fever, not normothermia, is symptomatic of transplant rejection.

A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? A. Adherence to therapy B. Handwashing C. Monitoring for low-grade fever D. Strict clean technique

B. Handwashing The most important infection control measure for the client receiving immune-suppressive therapy is handwashing. Adherence to therapy and monitoring for low-grade fever are important, but are not infection control measures. The nurse should practice aseptic technique for this client, not simply clean technique.

A 60-year-old African-American client is newly diagnosed with mild chronic kidney disease (stage 2 CKD). She has a history of diabetes, and her current A1C is 8.0%. She asks the nurse whether any of the following factors could have caused this problem. Which factor should the nurse indicate may have influenced the development of CKD? A. She heavily salted her food as a child and teenager but added no extra salt to her food as an adult. B. Her chronic hyperglycemia caused blood vessel changes in the kidney that can damage kidney tissue. C. Her paternal grandparents had type 2 diabetes and hypertension. D. She drinks 2 cups of coffee water daily.

B. Her chronic hyperglycemia caused blood vessel changes in the kidney that can damage kidney tissue. Rationale: Diabetic nephropathy is the most common cause of end-stage renal disease (ESRD) needing dialysis. Managing hyperglycemia delays the onset and progression of CKD. This level of caffeine intake would not lead to either kidney damage or hypertension. The fact that she has reduced her salt intake during adulthood would only help prevent hypertensive kidney disease. The family history of type 2 diabetes and hypertension is a potential risk factor, but her own diabetes and lack of glycemic control manifested by the elevated A1C have a more direct and great adverse effect on kidney function.

Which medication is most effective in slowing the progression of kidney failure in a client with chronic kidney disease? A. Diltiazem (Cardizem) B. Lisinopril (Zestril) C. Clonidine (Catapres) D. Doxazosin (Cardura)

B. Lisinopril (Zestril) Angiotensin-converting enzyme inhibitors such as lisinopril appear to be the most effective drugs to slow the progression of kidney failure. Calcium channel blockers such as diltiazem may indirectly prevent kidney disease by controlling hypertension, but are not specific to slowing progression of kidney disease. Vasodilators such as clonidine and doxazosin control blood pressure, but do not specifically protect from kidney disease.

When caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter, which assessment finding does the nurse report to the provider? A. Mild discomfort at the insertion site B. Temperature 100.8° F C. 1+ ankle edema D. Anorexia

B. Temperature 100.8° F Infection is a major complication of temporary catheters. All symptoms of infection, including fever, must be reported to the provider because the catheter may have to be removed. Mild discomfort at the insertion site is expected with a subclavian hemodialysis catheter. During acute injury, oliguria with resulting fluid retention is expected. Rising blood urea nitrogen may result in anorexia, nausea, and vomiting.

A client has a traumatic brain injury. The nurse assesses the following: pulse change from 82 to 60 beats/min, pulse pressure increase from 26 to 40 mm Hg, and respiratory irregularities. What action by the nurse takes priority?

Call the provider or Rapid Response Team

A client has a subarachnoid bolt. What action by the nurse is most important?

Balancing and recalibrating the device

A client is 12 hours post-kidney transplantation. The nurse notes that the client has put out 2000 mL of urine in 10 hours. Which assessment does the nurse carry out first?

Blood pressure

A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? A. "Your diseased kidneys will be removed at the same time the transplant is performed." B. "The new kidney will be placed directly below one of your old kidneys." C. "It is essential for you to wash your hands and avoid people who are ill." D. "You will receive dialysis the day before surgery and for about a week after."

C. "It is essential for you to wash your hands and avoid people who are ill." Anti-rejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential. Unless severely infected, the client's kidneys are left in place and the graft is placed in the iliac fossa. Dialysis is performed the day before surgery; after the surgery, the new kidney should begin to make urine.

Discharge teaching has been provided for a client recovering from kidney transplantation. Which information indicates that the client understands the instructions? A. "I can stop my medications when my kidney function returns to normal." B. "If my urine output is decreased, I should increase my fluids." C. "The anti-rejection medications will be taken for life." D. "I will drink 8 ounces of water with my medications."

C. "The anti-rejection medications will be taken for life." Immune-suppressant therapy must be taken for life to prevent organ rejection. Adherence to immunosuppressive drugs is crucial to survival for clients with transplanted kidneys. Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria is a symptom of transplant rejection; the transplant team should be contacted immediately if this occurs. It is not necessary to take anti-rejection medication with 8 ounces of water.

The nurse is completing documentation for a client with acute kidney injury who is being discharged today. The nurse notices that the client has a serum potassium level of 5.8 mEq/L. Which is the priority nursing action? A. Asking the client to drink an extra 500 mL of water to dilute the electrolyte concentration and then re-checking the serum potassium level B. Encouraging the client to eat potassium-binding foods and to contact his or her primary care provider within 24 hours. C. Checking the remaining values on the electrolyte panel and informing the provider of all results before the client is discharged. D. Applying a cardiac monitor and evaluating the client's muscle strength and muscle irritability.

C. Checking the remaining values on the electrolyte panel and informing the provider of all results before the client is discharged. Rationale: Repeating the laboratory test is a reasonable option, but the provider must make this decision after being informed about the context, including the results of the entire electrolyte panel, which will also have information about renal function (creatinine and blood urea nitrogen). Although the potassium level is slightly elevated, it is not a value commonly associated with cardiac dysrhythmias or skeletal muscle changes. Although additional fluid intake may dilute some electrolytes, potassium is not generally altered by plasma volume. There are no foods that specifically bind potassium and, depending on the rapidity of the rise in serum potassium, waiting a day may result in harm to the patient.

A client with end-stage kidney disease has been put on fluid restrictions. Which assessment finding indicates that the client has not adhered to this restriction? A. Blood pressure of 118/78 mm Hg B. Weight loss of 3 pounds during hospitalization C. Dyspnea and anxiety at rest D. Central venous pressure (CVP) of 6 mm Hg

C. Dyspnea and anxiety at rest Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse should assist the client in correlating symptoms of fluid overload with nonadherence to fluid restriction. Nonadherence to fluid restriction results in fluid volume excess and higher blood pressures; 118/78 mm Hg is a normal blood pressure. Excess fluid intake and fluid retention are manifested by an elevated CVP (>8 mm Hg) and weight gain, not weight loss.

A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 liter of normal saline infused over 2 hours. Which staff member should be assigned to care for the client? A. RN who has floated from pediatrics for this shift B. LPN/LVN with experience working on the medical unit C. RN who usually works on the general surgical unit D. New graduate RN who just finished a 6-week orientation

C. RN who usually works on the general surgical unit The nurse with experience in taking care of surgical clients will be most capable of monitoring the client receiving rapid fluid infusions, who is at risk for complications such as pulmonary edema and acute kidney failure. The pediatric float RN and the new graduate RN will have less experience in caring for this type of client. The LPN/LVN should not be assigned to a client requiring IV therapy and who is at high risk for complications.

A client is in the emergency department reporting a brief episode during which he was dizzy, unable to speak, and felt like his legs were very heavy. Currently the client's neurologic examination is normal. About what drug should the nurse plan to teach the client?

Clopidogrel (Plavix)

While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action should the nurse implement first? A. Instruct the client to deep-breathe and cough. B. Document the effluent as output. C. Turn the client to the opposite side. D. Re-position the catheter.

C. Turn the client to the opposite side. With peritoneal dialysis, usually 1 to 2 L of dialysate is infused by gravity into the peritoneal space. The fluid dwells in the peritoneal cavity for a specified time, then drains by gravity into a drainage bag. The dialyzing fluid is called peritoneal effluent on outflow. The outflow should be a continuous stream after the clamp is completely open. Potential causes of flow difficulty include constipation, kinked or clamped connection tubing, the client's position, fibrin clot formation, and catheter displacement. If inflow or outflow drainage is inadequate, re-position the client to stimulate inflow or outflow. Turning the client to the other side or ensuring that he or she is in good body alignment may help. Instructing the client to deep-breathe and cough will not promote dialysate drainage. Increased abdominal pressure from coughing contributes to leakage at the catheter site. The nurse needs to measure and record the total amount of outflow after each exchange. However, the nurse should re-position the client first to assist with complete dialysate drainage. An x-ray is needed to identify peritoneal dialysis catheter placement. Only the physician re-positions a displaced catheter.

Which factor represents a sign or symptom of digoxin toxicity? A. Serum digoxin level of 1.2 ng/mL B. Polyphagia C. Visual changes D. Serum potassium of 5.0 mEq/L

C. Visual changes Visual changes, anorexia, nausea, and vomiting are symptoms of digoxin toxicity. A digoxin level of 1.2 ng/mL is normal (0.5 to 2.0 ng/mL). Polyphagia is a symptom of diabetes. Although hypokalemia may predispose to digoxin toxicity, this represents a normal, not low, potassium value.

A client has end-stage kidney disease (ESKD). The nurse observes tall, peaked T waves on the client's cardiac monitor. Which action by the nurse is best?

Check the serum potassium level.

Which client is most at risk for developing postrenal kidney failure?

Client diagnosed with renal calculi

A nurse is caring for four clients who might be brain dead. Which client would best meet the criteria to allow assessment of brain death?

Client in a coma for 2 weeks from a motor vehicle crash

A nurse is caring for four clients in the neurologic/neurosurgical intensive care unit. Which client should the nurse assess first?

Client receiving tissue plasminogen activator (t-PA) who has a change in respiratory pattern and rate

A nurse is working with many stroke clients. Which clients would the nurse consider referring to a mental health provider on discharge? (Select all that apply.)

Client who exhibits extreme emotional lability Client with an initial National Institutes of Health (NIH) Stroke Scale score of 38 Client who has a past hospitalization for a suicide attempt Client who is unable to walk or eat 3 weeks post-stroke

The nurse is caring for four clients with traumatic brain injuries. Which client should the nurse assess first?

Client who has a temperature of 102° F (38.9° C)

A nurse is caring for four clients in the neurologic intensive care unit. After receiving the hand-off report, which client should the nurse see first?

Client with a Glasgow Coma Scale score that was 10 and is now is 8

A nurse is seeing many clients in the neurosurgical clinic. With which clients should the nurse plan to do more teaching? (Select all that apply.)

Client with an aneurysm coil placed 2 months ago who is taking ibuprofen (Motrin) for sinus headaches Client with an aneurysm clip who states that his family is happy there is no chance of recurrence

A client is scheduled to have dialysis in 30 minutes and is due for the following medications: vitamin C, B-complex vitamin, and cimetidine (Tagamet). Which action by the nurse is best?

Hold all medications until after dialysis.

A client is being treated for kidney failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle? A. "All of this is new. What can't you do?" B. "Are you afraid of dying?" C. "How are you doing this morning?" D. "What concerns do you have about your kidney disease?"

D. "What concerns do you have about your kidney disease?" Asking the client about any concerns is open-ended and specific to the client's concerns. Asking the client to explain what he or she can't do implies inadequacy on the client's part. Asking the client if he or she is afraid of dying is too direct and would likely cause the client to be anxious. Asking the client how he or she is doing is too general and does not encourage the client to share thoughts on a specific topic.

Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? A. Hematocrit of 26.7% B. Potassium within normal range C. Absence of spontaneous fractures D. Less fatigue

D. Less fatigue Treatment of anemia with erythropoietin will result in increased hemoglobin and hematocrit (H&H) and decreased shortness of breath and fatigue. A hematocrit value of 26.7% is low; erythropoietin should restore the hematocrit to at least 36% to be effective. Erythropoietin causes more red blood cells to be produced, increasing H&H, not potassium. Calcium supplements and phosphate binders prevent renal osteodystrophy; erythropoietin treats anemia.

Which problem excludes a client hoping to receive a kidney transplant from undergoing the procedure? A. History of hiatal hernia B. Presence of diabetes and glycosylated hemoglobin of 6.8% C. History of basal cell carcinoma on the nose 5 years ago D. Presence of tuberculosis

D. Presence of tuberculosis Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with the immune suppressants that are required to prevent rejection. A client with a history of hiatal hernia is not exempt from undergoing a kidney transplant. Good control of diabetes is a positive point, and would not exclude the client from transplantation. Basal cell carcinoma is considered curable and occurred 5 years ago, consistent with appropriate candidates for transplantation.

When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider immediately? A. Pulse oximetry reading of 95% B. Sinus bradycardia, rate of 58 beats/min C. Blood pressure of 148/90 mm Hg D. Temperature of 101.2° F (38.4° C)

D. Temperature of 101.2° F (38.4° C) Peritonitis is the major complication of PD, caused by intra-abdominal catheter site contamination; meticulous aseptic technique must be used when caring for PD equipment. A pulse oximetry reading of 95% is a normal saturation. Although a heart rate of 58 beats/min is slightly bradycardic, the provider can be informed upon visiting the client. Clients with kidney failure tend to have slightly higher blood pressures due to fluid retention; this is not as serious as a fever.

A client with a traumatic brain injury is agitated and fighting the ventilator. What drug should the nurse prepare to administer?

Dexmedetomidine (Precedex)

A nurse has applied to work at a hospital that has National Stroke Center designation. The nurse realizes the hospital adheres to eight Core Measures for ischemic stroke care. What do these Core Measures include? (Select all that apply.

Discharging the client on a statin medication Providing and charting stroke education Preventing venous thromboembolism

A client has been missing some scheduled hemodialysis sessions. Which intervention is most important for the nurse to implement?

Discussing with the client his or her acceptance of the disease

A client who is admitted to the hospital with a history of kidney disease begins to have difficulty breathing. Vital signs are as follows: blood pressure, 90/70 mm Hg; heart rate, difficult to feel peripheral pulses. His heart sounds are difficult to hear. Which intervention does the nurse prepare for?

Draining of pericardial fluid with a needle

A client is being prepared for a mechanical embolectomy. What action by the nurse takes priority?

Ensure that informed consent is on the chart.

A client is in the clinic for a follow-up visit after a moderate traumatic brain injury. The client's spouse is very frustrated, stating that the client's personality has changed and the situation is intolerable. What action by the nurse is best?

Explain that personality changes are common following brain injuries.

A client has been diagnosed with acute postrenal kidney injury. Which assessment finding does the nurse assess most carefully for?

Feeling of urgency

a 37 year old female patient is hospitalized wtih AKI. which info will be most useful for the nurse in ovulating improvement in kidney function?

GFR

A client experiences impaired swallowing after a stroke and has worked with speech-language pathology on eating. What nursing assessment best indicates that a priority goal for this problem has been met?

Has clear lung sounds on auscultation

A client who had a severe traumatic brain injury is being discharged home, where the spouse will be a full-time caregiver. What statement by the spouse would lead the nurse to provide further education on home care?

I know I can take care of all these needs by myself."

A client who underwent kidney transplantation 7 days ago has developed the following signs: urine output, 50 mL/12 hr; temperature, 102.2° F (39° C); lethargy; serum creatinine, 2.1 mg/dL; blood urea nitrogen (BUN), 54 mg/dL; and potassium, 5.6 mEq/L. Which initial intervention does the nurse anticipate for this client?

Increased dose of immune suppressive drugs

A student nurse is preparing morning medications for a client who had a stroke. The student plans to hold the docusate sodium (Colace) because the client had a large stool earlier. What action by the supervising nurse is best?

Inform the student that the docusate should be given.

A client is taking furosemide (Lasix). To detect a common adverse effect, the nurse obtains which assessment as a priority?

Intake and output

. A nurse is dismissing a client from the emergency department who has a mild traumatic brain injury. What information obtained from the client represents a possible barrier to self-management? (Select all that apply.)

Is allergic to acetaminophen (Tylenol) Lives alone and is new in town with no friends Plans to have a beer and go to bed once home

. The nurse assesses a client's Glasgow Coma Scale (GCS) score and determines it to be 12 (a 4 in each category). What care should the nurse anticipate for this client?

Needs frequent re-orientation

A client has a serum creatinine level of 2 mg/dL and a urine output of 1000 mL/day. How does the nurse categorize the client's kidney injury?

Nonoliguric

A client had an embolectomy for an arteriovenous malformation (AVM). The client is now reporting a severe headache and has vomited. What action by the nurse takes priority?

Notify the Rapid Response Team

A client in the intensive care unit is scheduled for a lumbar puncture (LP) today. On assessment, the nurse finds the client breathing irregularly with one pupil fixed and dilated. What action by the nurse is best?

Notify the provider of the findings immediately

A client with acute kidney injury had normal assessments 1 hour ago. Now the nurse finds that the client's respiration rate is 44 breaths/min and the client is restless. Which assessment does the nurse perform?

Obtain an oxygen saturation level.

A client has a serum creatinine level of 2.5 mg/dL, a serum potassium level of 6 mmol/L, an arterial pH of 7.32, and a urine output of 250 mL/day. Which phase of acute kidney failure is the client experiencing?

Oliguric

A client has an intraventricular catheter. What action by the nurse takes priority?

Perform hand hygiene before client care

The nurse is assessing a client with acute kidney injury and hears the following sound when auscultating the lungs. For what complication does the nurse plan care? (Click the media button to hear the audio clip.)

Pericarditis

A client hospitalized for worsening kidney injury suddenly becomes restless and agitated. Assessment reveals tachycardia and crackles bilaterally at the bases of the lungs. Which is the nurse's first intervention?

Place the client in high Fowler's position.

A client's mean arterial pressure is 60 mm Hg and intracranial pressure is 20 mm Hg. Based on the client's cerebral perfusion pressure, what should the nurse anticipate for this client?

Poor prognosis and cognitive function

During hemodialysis, a client with chronic kidney disease develops headache, nausea, vomiting, and restlessness. After notifying the health care provider, which action by the nurse is most appropriate?

Prepare to administer phenytoin (Dilantin),

Assessment findings reveal that a client with chronic kidney disease is refusing to take prescribed medications because of the "cost." The client also is having difficulty performing activities of daily living and prefers to sleep most of the day. To which health care team member does the nurse refer the client?

Psychiatric nurse practitioner

Which intervention is most important for the nurse to implement in a client after kidney transplant surgery?

Remove the indwelling (Foley) catheter as soon as possible.

The nurse is caring for a client with chronic kidney disease who has developed uremia. Which assessment finding does the nurse correlate with this problem?

Respiratory rate of 40 breaths/min

A client with chronic kidney disease is scheduled to be given the following medications: digoxin (Lanoxin) and epoetin alfa (Epogen). The client reports nausea and vomiting and wishes to wait to take the medications. Which action by the nurse is most appropriate?

Review today's potassium level and notify the health care provider.

A client has a traumatic brain injury and a positive halo sign. The client is in the intensive care unit, sedated and on a ventilator, and is in critical but stable condition. What collaborative problem takes priority at this time?

Risk for acquiring an infection

A nurse receives a report on a client who had a left-sided stroke and has homonymous hemianopsia. What action by the nurse is most appropriate for this client?

Rotate the client's meal tray when the client stops eating.

When providing care for a client receiving peritoneal dialysis, the nurse notices that the effluent is cloudy. Which intervention is most important for the nurse to carry out?

Send a specimen for culture and sensitivity.

A client with chronic hypertension is seen in the clinic. Which assessment indicates that the client's hypertension is not under control?

Serum creatinine level of 1.9 mg/dL

A client is receiving continuous arteriovenous hemofiltration (CAVH). Which laboratory value does the nurse monitor most closely?

Sodium

A client is admitted with a 3-day history of vomiting and diarrhea. The client's vital signs are blood pressure, 85/60 mm Hg; and heart rate, 105 beats/min. Which intervention by the nurse takes priority?

Start an IV of normal saline as ordered.

A nurse assesses a client with the National Institutes of Health (NIH) Stroke Scale and determines the client's score to be 36. How should the nurse plan care for this client?

The client will need near-total care.

A client with a stroke is being evaluated for fibrinolytic therapy. What information from the client or family is most important for the nurse to obtain?

Time of symptom onset

The nurse is caring for a client who is receiving peritoneal dialysis (PD). Which nursing intervention has the greatest priority when a dialysis exchange is performed?

Using sterile technique when hooking up dialysate bags

The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe?

administering IV fluids through the AV flistua

A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would give the nurse the most concern?

albumin level of 2.5

A client has a long history of hypertension. Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)?

angiotensin-converting enzyme (ACE) inhibitor

8. A client in the intensive care unit is started on continuous venovenous hemofiltration (CVVH). Which finding is the cause of immediate action by the nurse?

blood pressure of 76/58

sodium polystrene sulfonante (kayelaxate) is ordered for a patient with hyperkalemia. before administering the med, the nurse should access the?

bowel sounds

a 42 year old patient admitted with AKI due to dehydration has okguira, anemia & hyperkalemia. which prescribed actions should the nurse first take?

cardiac monitor

during routine hemodiyalsis, the 68 year old PT complains of nausea & dizzy. which action should the nurse first take?

check PT BP

A client with chronic kidney disease (CKD) is experiencing nausea, vomiting, visual changes, and anorexia. Which action by the nurse is best?

check the pT digoxin level

9. The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess first upon initial rounding?

client with kussamul resperatioins

The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse?

dialysis works by the movement of wastes form lower to higher concentration

A male client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse?

dicuss what the treatment regimen means to him

A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this client's care?

electrolyte & fluid imbalance

A marathon runner comes into the clinic and states "I have not urinated very much in the last few days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is the priority?

give the pt a bottle of water immediately

A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mL/dL. What question should the nurse ask first when taking this client's history?

have you been taking any aspirin, ibuprofen, or naproxen recently?

A nurse is caring for a client who is scheduled for a dose of cefazolin and vitamins at this time. Hemodialysis for this client is also scheduled in 60 minutes. Which action by the nurse is best?

hold all medications since both cefazolin & vitamins are dialyzable

The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates more teaching is needed?

i am thrilled that i can continue to eat fast food

The nurse is teaching a client how to increase the flow of dialysate into the peritoneal cavity during dialysis. Which statement by the client demonstrates a correct understanding of the teaching?

i should take a stool softener every morning to avoid constipation

A nurse reviews these laboratory values of a client who returned from kidney transplantation 12 hours ago: Sodium 136 mEq/L Potassium 5 mEq/L Blood urea nitrogen (BUN) 44 mg/dL Serum creatinine 2.5 mg/dL What initial intervention would the nurse anticipate?

increase the dose of immunspressive

A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulomnary edema?

maintain a balanced intake & output

The nurse is taking the vital signs of a client after hemodialysis. Blood pressure is 110/58 mm Hg, pulse 66 beats/min, and temperature is 99.8° F (37.6° C). What is the most appropriate action by the nurse?

monitor the PT temp

A client is placed on fluid restrictions because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client's fluid balance is stable at this time?

no adventitious sounds in the lungs

A client is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect the positive effect of the medication, what action of the nurse is best?

obtain daily weights of the pt

A client has just had a central line catheter placed that is specific for hemodialysis. What is the most appropriate action by the nurse?

place a heparin/saline dwell after hemodyalsis

A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, and a urine output of 350 mL/day. What is the best action by the nurse?

place the pT on a cardiac monitor immedatley

A client is assessed by the nurse after a hemodialysis session. The nurse notes bleeding from the client's nose and around the intravenous catheter. What action by the nurse is the priority?

prepare protamine sulfate for admin

The charge nurse of the medical-surgical unit is making staff assignments. Which staff member should be assigned to a client with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub?

registered nurse who was assigned the same client yesterday

A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurse's priority action?

slow down the norma saline infusion

A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What is the priority action by the nurse?

take a sample of the effluent & send to lab

27. A client is recovering from a kidney transplant. The client's urine output was 1500 mL over the last 12-hour period since transplantation. What is the priority assessment by the nurse?

taking BP

26. A client with chronic kidney disease states, "I feel chained to the hemodialysis machine." What is the nurse's best response to the client's statement?

tell me more about your feelings regarding hemodialysis treatment