GU Prep U Chapter 48
The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number.
4000 A 1-kg weight gain is equal to 1,000 mL of retained fluid. 4 kg × 1,000 = 4,000. The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded.
Which of the following occurs late in chronic glomerulonephritis? Nosebleed Peripheral neuropathy Stroke Seizure
B Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.
As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur? Metabolic alkalosis Hyperphosphatemia Hypercalcemia Hypokalemia
B Changes include hyperphosphatemia due to its decreased renal excretion, hypocalcemia and decreased vitamin D activation, hyperkalemia due to decreased potassium excretion, and metabolic acidosis from decreased acid secretion by the kidney and inability to regenerate bicarbonate.
Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted. Butter Citrus fruits White rice Salad oils
B Dietary restrictions include foods and fluids containing potassium, such as bananas, citrus, tomatoes, melons, or those with phosphorus, which is found in dairy, beans, nuts legumes, and carbonated beverages. Caffeine is also restricted.
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? Diuresis Oliguria Restored glomerular function Acute tubular necrosis
B During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? Weight loss Fever Diuresis Absence of pain
B Fever is an indicator of infection or transplant rejection.
The nurse is caring for a client with blood loss from esophageal varices. Which assessment finding indicates that the client is exhibiting signs of acute kidney injury (AKI) related to the loss of volume? Urine output that has been <0.5 mL/kg/hr for several hours Cloudy urine with a foul odor An inability to initiate voiding Reports of acute flank pain
A Acute kidney injury (AKI), describes a range of acute-onset kidney disorders that can include mild impairment of kidney function progressing to acute kidney failure that requires renal replacement therapy. AKI is marked by an abrupt loss of kidney function (sudden increase of serum creatinine of 0.3 mg/dL within 48 hours or 1.5 times baseline serum creatinine over 1 week), decrease in glomerular filtration rate (GFR), and abrupt decline in urine output (<0.5 mL/kg/hr for 6 to 12 hours). Flank pain and pyuria are symptoms of pyelonephritis. Cloudy, foul-smelling urine is suggestive of a urinary tract infection.
A client who suffered hypovolemic shock during a cardiac incident has developed acute kidney injury. Which is the best nursing rationale for this complication? Decrease in the blood flow through the kidneys Obstruction of urine flow from the kidneys Structural damage occurred in the nephrons of the kidneys Blood clot formed in the kidneys interfered with the flow
A Acute kidney injury can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.
The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client? SpO2 at 90% with fine crackles in the lung bases Blood tinged drainage in Jackson-Pratt drainage tube Urine output of 35 to 40 mL/hour Pain of 3 out of 10, 1 hour after analgesic administration
A Altered Breathing Pattern and Ineffective Airway Clearance Risk are often challenges in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output is monitored to maintain a urine output of greater than 30 mL/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.
The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? Cola-colored urine Hyperalbuminemia Peripheral neuropathy Hypotension
A Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? Recent history of streptococcal infection History of osteoporosis History of hyperparathyroidism Previous episode of acute pyelonephritis
A Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? "It is appropriate to warm the dialysate in a microwave." "The effluent should be allowed to drain by gravity." "The infusion clamp should be open during infusion." "It is important to use strict aseptic technique."
A The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.
What is used to decrease potassium level seen in acute renal failure? Sodium polystyrene sulfonate Calcium supplements IV dextrose 50% Sorbitol
A The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute kidney injury. Which statement from the nurse best reflects the ability of the kidneys to recover from acute kidney injury? The kidneys can improve over a period of months. Kidney function will improve with transplant. Once on dialysis, the need will be permanent. Acute kidney injury tends to turn to end-stage failure.
A The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute kidney injury can progress to chronic renal failure.
The nurse is able to identify which condition as uremia? An excess of urea in the blood An excess of protein in the urine An excess of blood in the urine An excess of protein in the blood
A Uremia is an excess of urea and other nitrogenous wastes in the blood. Azotemia is the concentration of nitrogenous wastes in the blood. Hematuria is blood in the urine. Proteinuria is protein in the urine. Hyperproteinemia is an excess of protein in the blood.
Which clinical finding should a nurse look for in a client with chronic renal failure? Uremia Hypotension Polycythemia Metabolic alkalosis
A Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.
The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. Glomerular filtration rate (GFR) of 100 mL/min. BUN of 18 mg/dL. Serum creatinine of 1.2 mg/dL.
A kidneys due to a nonrenal cause. Over time, higher than normal blood levels of urea or other nitrogen-containing compounds will develop.
Compliance with a renal diet is a difficult lifestyle change for a client on hemodialysis. The nurse should reinforce nutritional information. Which teaching point(s) should be included? Select all that apply. Eat foods such as milk, fish, and eggs. Restrict fluids based on the previous day's output. Consume nonbiologic protein only. Increase potassium intake. Eat a variety of canned vegetables.
A, B With hemodialysis, protein restriction is necessary. At least half of all protein eaten should come from biologic sources such as eggs, meats, and plant-based groups. Sodium should be reduced. Canned vegetables are high in sodium. Potassium is restricted to decrease cardiac risk. The client's daily fluid intake should be based on the previous day's urine output.
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? Serum creatinine level of 1.2 mg/dl Urine output of 250 ml/24 hours Temperature of 100.2° F (37.8° C) Blood urea nitrogen (BUN) level of 22 mg/dl
B ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.
An athlete is thought to have sustained an injury to a kidney. The ER nurse caring for the client reviews the initial orders written by the primary health care provider and notes an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason? A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary. Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential. Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this client. There is great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations.
B Hematuria is the most common manifestation of renal trauma; its presence after trauma suggests renal injury. Hematuria may not occur, or it may be detectable only on microscopic examination. All urine should be saved and sent to the laboratory for analysis to detect RBCs and to evaluate the course of bleeding. Measuring intake and output is not a function of the laboratory. The laboratory does not save urine to test creatinine clearance at a later time. The laboratory does not monitor the urine for sodium or potassium concentrations.
An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? "The risk of peritonitis is greater with this type of dialysis." "This type of dialysis will provide more independence." "Peritoneal dialysis will require more work for you." "Peritoneal dialysis does not work well for every client."
B Once a treatment choice has been selected by the client, the nurse should support the client in that decision. Continuous cyclic peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients.
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: thrush and circumoral pallor. fatigue and weakness. dyspnea and cyanosis. nausea and vomiting.
B RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? Hyperkalemia Dehydration Crackles Hypertension
B The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.
When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic? Tobramycin Penicillin Gentamicin Neomycin
B The three nephrotoxic drugs are aminoglycerides.
The nurse is caring for a client with acute kidney injury (AKI) in the oliguric phase. Which is a priority for the nurse to monitor indicating fluid overload? Select all that apply. Weight loss Jugular vein distention Tenting skin turgor Hypertension Crackles
B, D, E Clients in the oliguric phase of AKI should be monitored for fluid volume overload symptoms since there is less urine output. These symptoms of fluid overload include: jugular vein distention, crackles, edema, weight gain (not loss), and hypertension. If this occurs, renal replacement therapy (RRT), such as dialysis, may be needed until kidney function returns. Tenting skin turgor would indicate possible dehydration, not fluid overload.
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? Nephrotic syndrome Chronic renal failure Acute glomerulonephritis Acute renal failure
C Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.
A change that occurs during chronic glomerulonephritis is termed metabolic alkalosis. hypophosphatemia. anemia. hypokalemia.
C Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur during chronic glomerulonephritis.
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. Prolonged ST segment Multiple spiked P waves Tall, peaked T waves Shortened QRS complex
C Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? Hypovolemia Ureteral calculus Glomerulonephritis Dysrhythmia
C Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? Hyperkalemia Elevated urea and nitrogen Hyperphosphatemia Elevated serum creatinine
C Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.
What is a hallmark of the diagnosis of nephrotic syndrome? Hyponatremia Hypokalemia Proteinuria Hyperalbuminemia
C Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.
The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? Keep the catheter stabilized to the abdomen, below the belt line. Clean the catheter insertion site daily with soap. Use an aseptic technique during the procedure. Wear a mask while handling any dialysate solutions.
C The client should be instructed to use an aseptic technique during the procedure. The client should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (clients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.
A client has been diagnosed with acute glomerulonephritis. This condition causes: polyuria. No option is correct. proteinuria. pyuria.
C The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided.
The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated? Obtaining blood samples from the left arm Palpating the fistula for a "thrill" Obtaining a blood pressure reading from the right arm Placing the client's watch on the left wrist
C The nurse assesses the vascular access for patency. The bruit, or "thrill," over the venous access site must be evaluated at least every shift. The nurse takes precautions to ensure that the extremity with the vascular access is not used for measuring blood pressure or for obtaining blood specimens; tight dressings, restraints, or jewelry over the vascular access must be avoided as well.
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan? Keep the AV fistula site dry. Take the client's blood pressure in the left arm. Assess the AV fistula for a bruit and thrill. Keep the AV fistula wrapped in gauze.
C The nurse needs to assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? Activity intolerance Impaired urinary elimination Risk for infection Toileting self-care deficit
C The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.
During hemodialysis, toxins and wastes in the blood are removed by which of the following? Ultrafiltration Filtration Diffusion Osmosis
C The toxins and wastes in the blood are removed by diffusion, in which particles move from an area of higher concentration in the blood to an area of lower concentration into the dialysate.
A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? Monitor temperature every 4 hours. Administer isotonic fluid therapy as ordered. Encourage use of incentive spirometer every 2 hours. Keep the drainage catheter below the level of insertion.
C To address the issue of ineffective breathing pattern, encouraging the use of incentive spirometer would be most appropriate to help increase alveolar ventilation. Administering isotonic fluid therapy would be appropriate for issues involving fluid loss such as bleeding or hemorrhage. Keeping the drainage catheter below the level of insertion would be appropriate to reduce the risk of obstruction leading to acute pain. Monitoring the temperature every 4 hours would be appropriate to reduce the client's risk for infection.
One of the roles of the nurse in caring for clients with chronic kidney disease is to help them learn to minimize and manage potential complications. This would include: limiting iron and folic acid intake. eating protein liberally. restricting sources of potassium. allowing liberal use of sodium.
C The nurse will teach the client to restrict sources of potassium, such as fresh fruits and vegetables, because hyperkalemia can cause life-threatening changes. The client will restrict sodium intake as ordered; doing so prevents fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken; iron and folic acid supplements are needed for red blood cell (RBC) production, and Epogen stimulates the bone marrow to produce RBCs. The client will restrict protein intake to foods that are complete proteins within prescribed limits; complete proteins provide positive nitrogen balance for healing and growth.
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? Blood glucose level of 200 mg/dl Potassium level of 3.5 mEq/L Hematocrit (HCT) of 35% White blood cell (WBC) count of 20,000/mm3
D An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? Pats skin dry after bathing Uses moisturizing creams Keeps nails trimmed short Brief, hot daily showers
D Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? Pneumonia caused by shallow breathing because of severe incisional pain Paralytic ileus caused by manipulation of the colon during surgery Abdominal distention owing to reflex cessation of intestinal peristalsis Hypovolemic shock caused by hemorrhage
D If bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack.
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: a decreased serum phosphate level secondary to kidney failure. metabolic alkalosis secondary to retention of hydrogen ions. an increased serum calcium level secondary to kidney failure. water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
D The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? Administration of sodium bicarbonate Administration of an insulin drip Administration of a loop diuretic Administration of sodium polystyrene sulfonate [Kayexalate])
D The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
What is a characteristic of the intrarenal category of acute kidney injury (AKI)? Decreased urine sodium Decreased creatinine High specific gravity Increased BUN
D The intrarenal category of acute kidney injury (AKI) encompasses an increased BUN, increased creatinine, a low-normal specific gravity of urine, and increased urine sodium. Intrarenal AKI is the result of actual parenchymal damage to the glomeruli or kidney tubules. Acute tubular necrosis (ATN), AKI in which there is damage to the kidney tubules, is the most common type of intrinsic AKI. Characteristics of ATN are intratubular obstruction, tubular back leak (abnormal reabsorption of filtrate and decreased urine flow through the tubule), vasoconstriction, and changes in glomerular permeability. These processes result in a decrease of GFR, progressive azotemia, and fluid and electrolyte imbalances.
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75% Increased serum levels of potassium, magnesium, and calcium Increased pH with decreased hydrogen ions Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL
D The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl. A BUN level of 100 mg/dl and a serum creatinine of 6.5 mg/dl are abnormally elevated results, reflecting CRF and the kidneys' decreased ability to remove nonprotein nitrogen waste from the blood. CRF causes decreased pH and increased hydrogen ions — not vice versa. CRF also increases serum levels of potassium, magnesium, and phosphorous, and decreases serum levels of calcium. A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls within the normal range of 60% to 75%.
Based on her knowledge of the primary cause of end-stage renal disease, the nurse knows to assess the most important indicator. What is that indicator? pH and HCO3 Blood pressure Urine protein Serum glucose
D The nurse would evaluate serum and urine levels of glucose because diabetes is the primary cause of renal failure.
The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output? Less than 50 mL 1.5 L 1.0 L Less than 400 mL
D The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The minimum amount of urine needed to rid the body of normal metabolic waste products is 400 mL. In this phase, uremic symptoms first appear and life-threatening conditions such as hyperkalemia develop.
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: "Dietary changes can reverse the damage that has occurred in your kidneys." "Genetic testing will determine the best treatment for your condition." "Draining of the cysts and antibiotic therapy will cure your disease." "As the disease progresses, you will most likely require renal replacement therapy."
D There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? Administer furosemide (Lasix) 20 mg IV Start hemodialysis after a temporary access is obtained. Start IV fluids with a normal saline solution bolus followed by a maintenance dose. Encourage oral fluids.
c The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.
