Kidney

(ATI) A nurse is caring for a client with acute renal failure who is undergoing hemodialysis. What should the nurse consider when educating the client on healthy food choices? A. Increase dairy products to maintain phosphorus balance. B. Decrease total fat intake to 45% of daily calories. C. Decrease potassium intake to 40 mg/kg per day. D. Limit sodium intake to 4.5 g/day.

C. Decrease potassium intake to 40 mg/kg per day.

(ATI) A nurse is teaching a newly licensed nurse about hemodialysis for clients who have chronic kidney disease. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "Hemodialysis restores kidney function." B. "Hemodialysis requires the placement of a catheter into the peritoneal space." C. "Hemodialysis allows an unrestricted diet." D. "Hemodialysis returns a balance to serum electrolytes."

D. "Hemodialysis returns a balance to serum electrolytes."

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

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

A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)? Hydrating with saline intravenously before the test Administering sodium bicarbonate after the procedure Administering Garamycin (gentamicin) prophylactically Performing the test without contrast

Hydrating with saline intravenously before the test

A client diagnosed with acute kidney injury (AKI) has developed congestive heart failure. The client has received 40 mg of intravenous push (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The client's vital signs are stable. Which health care order should the nurse anticipate? Mannitol 12.5 g IVP Lasix 80 mg IVP Chest x-ray Normal saline bolus of 500 mL

Lasix 80 mg IVP Explanation: Diuretic agents are often used to control fluid volume in clients with acute kidney injury (AKI). The client's urine output indicates an inadequate response to the initial dosage of Lasix and the nurse should anticipate administering Lasix 80 mg IVP. Often in this situation, the initial dosage of Lasix is doubled.

PrepU The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply. Magnesium 1.5 mg/dL; mood changes and insomnia Chloride 90 mEq/L; irritability and seizures Phosphate 5.0 mg/dL; tachycardia and nausea and emesis Calcium 7.5 mg/dL; hypotension and irritability Potassium 6.4 mEq/L; dysrhythmias and abdominal distention

Phosphate 5.0 mg/dL; tachycardia and nausea and emesisCalcium 7.5 mg/dL; hypotension and irritabilityPotassium 6.4 mEq/L; dysrhythmias and abdominal distention

A patient is placed on hemodialysis for the first time. The patient complains of a headache with nausea and begins to vomit, and the nurse observes a decreased level of consciousness. What does the nurse determine has happened? The patient is experiencing a cerebral fluid shift. The patient is having an allergic reaction to the dialysate. Too much fluid was pulled off during dialysis. The dialysis was performed too rapidly.

The patient is experiencing a cerebral fluid shift.

PrepU The nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client's symptoms and urine specific gravity is anticipated? The specific gravity will be high. The specific gravity will be low The specific gravity will equal to one The specific gravity will be inversely proportional

The specific gravity will be high.

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

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

PrepU 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?"The effluent should be allowed to drain by gravity.""It is important to use strict aseptic technique.""It is appropriate to warm the dialysate in a microwave.""The infusion clamp should be open during infusion."

"It is appropriate to warm the dialysate in a microwave."

A patient has acute kidney injury (AKI) with a negative nitrogen balance. How much weight does the nurse expect the patient to lose? 2.0 kg/day 1.5 kg/day 1.0 kg/day 0.5 kg/day

0.5 kg/day Explanation: AKI causes severe nutritional imbalances (because nausea and vomiting contribute to inadequate dietary intake), impaired glucose use and protein synthesis, and increased tissue catabolism. The patient is weighed daily and loses 0.2 to 0.5 kg (0.5 to 1 lb) daily if the nitrogen balance is negative

(ATI) A nurse is assessing a client who has experienced a rapid loss of renal function and is determined to be in the prerenal stage of acute kidney injury (AKI). Which of the following findings should the nurse expect? (Select all that apply.) A. Reduced BUN level B. Elevated cardiac enzymes C. Reduced urine output D. Elevated serum creatinine level E. Increased sodium in the urine

C. Reduced urine output D. Elevated serum creatinine level

The nurse cares for a client diagnosed with chronic glomerulonephritis. The nurse will observe the client for the development of hypokalemia anemia. metabolic alkalosis hypophosphatemia

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

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI? Initiation Diuresis Recovery Oliguria

Oliguria

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? 1.Hypertension, tachycardia, and fever 2.Hypotension, bradycardia, and hypothermia 3.Restlessness, irritability, and generalized weakness 4.Headache, deteriorating level of consciousness, and twitching

4.Headache, deteriorating level of consciousness, and twitching

(ATI) A nurse is planning care for a client who has intrarenal AKI due to aminoglycoside antibiotic therapy. The client has a serum creatinine level of 5 milligrams per deciliter (mg/dL). Which of the following interventions should the nurse include in the plan? (Select all that apply.) A. Provide proteins from animal sources. B. Bathe the client with cool water. C. Ambulate the client four times daily. D. Weigh the client daily. E. Provide NSAIDs for pain.

A. Provide proteins from animal sources. B. Bathe the client with cool water. D. Weigh the client daily. E. Provide NSAIDs for pain. Intrarenal AKI can be caused by prolonged renal ischemia, infectious processes, and the use of nephrotoxic agents such as gentamicin, an aminoglycoside antibiotic. Clients who are ill, as well as those who have AKI, have increased protein catabolism. Because protein is required for healing, a registered dietitian is often consulted for the client who develops AKI. The amount of protein recommended for the client will vary depending upon whether or not the client requires dialysis. Regardless of whether or not dialysis is a part of the prescribed treatment for the client, the nurse should ensure that the protein the client consumes has a high-biologic value, consisting of animal sources that provide more protein per calorie than protein alternatives such as legumes. Processed proteins such as bacon, deli meats, and hot dogs should be avoided because of the high amount of sodium and phosphorus they contain. The client who has intrarenal AKI can develop pruritus resulting from the toxins that are deposited in the skin when they cannot be cleared through the kidneys. These toxins can result in itching and excoriation of the skin. The nurse should provide meticulous skincare to the client by keeping the client's skin clean and well-moisturized and using cool water to bathe the skin. The cool water will help decrease the itching and prevent drying of the skin, which can increase the itching the client experiences. A complication of AKI is fluid overload due to an inability of the kidneys to filter and excrete fluids. This can result in manifestations that include distention of the neck veins, a bounding pulse, pulmonary crackles, generalized and dependent edema, dyspnea, tachypnea, and decreased oxygen saturation levels. The nurse should weigh the client daily to monitor for the complication of fluid retention. In addition to daily weights, the nurse should maintain strict intake and output records, monitor laboratory results for indications of fluid and electrolyte imbalances, and should notify the provider of any deterioration in the client's status.

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? Limiting fluid intake Providing pain-relief measures Encouraging coughing and deep breathing Promoting carbohydrate intake

Limiting fluid intake

(ATI) A nurse is planning care for a client who has prerenal acute kidney injury (AKI) following an acute myocardial infarction. The client's urinary output is 60 mL in the past 2 hr, and blood pressure is 92/58 mm Hg. Which of the following interventions should the nurse anticipate a prescription for? A. A CT scan with contrast dye. B. Administer nitroprusside 0.3 mcg/kg/min intravenously. C. A fluid challenge with 0.9% sodium chloride solution. D. Addition of 40 mEq/L of potassium to IV fluids.

C. A fluid challenge with 0.9% sodium chloride solution. Prerenal AKI is the result of poor perfusion to the kidney. Perfusion is often increased through the use of fluid challenges if the client does not have preexisting fluid overload. A fluid challenge in the amount of 500 to 1,000 mL can be infused over 1 hr. During this time, the nurse should closely monitor the client's response and be prepared to slow or stop the infusion if manifestations of fluid overload occur such as neck vein distention, the development of crackles in the lungs, decreasing oxygen saturation, dyspnea, and tachycardia. Therapeutic responses to the fluid challenge include increases in blood pressure and urine outpu

A client is receiving hemodialysis for acute kidney failure. Which assessment finding(s) indicates to the nurse that the client is experiencing dialysis disequilibrium? Select all that apply. Confusion Vomiting Nausea Bleeding Headache

Confusion Vomiting Nausea Headache

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?

"This type of dialysis will provide more independence."

A client with chronic kidney disease being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious, and the nurse suspects air embolism. What are the priority nursing actions? Select all that apply. 1.Administer oxygen to the client. 2.Continue dialysis at a slower rate after checking the lines for air. 3.Notify the primary health care provider (PHCP) and Rapid Response Team. 4.Stop dialysis, and turn the client on the left side with head lower than feet. 5.Bolus the client with 500 mL of normal saline to break up the air embolus.

1.Administer oxygen to the client. 3.Notify the primary health care provider (PHCP) and Rapid Response Team. 4.Stop dialysis, and turn the client on the left side with head lower than feet.

The registered nurse is instructing a new nursing graduate about hemodialysis. Which statement made by the new nursing graduate indicates an understanding of the procedure for hemodialysis? Select all that apply. 1."Sterile dialysate must be used." 2."Dialysate contains metabolic waste products." 3."Heparin sodium is administered during dialysis." 4."Dialysis cleanses the blood of accumulated waste products." 5."Warming the dialysate increases the efficiency of diffusion."

3."Heparin sodium is administered during dialysis." 4."Dialysis cleanses the blood of accumulated waste products." 5."Warming the dialysate increases the efficiency of diffusion."

A client who is undergoing peritoneal dialysis calls the nurse at the renal unit and reports the presence of severe abdominal pain and diarrhea. The client also informs the nurse that the peritoneal dialysis returns are brown-tinged in color. Which would the nurse suspect? 1.Infection 2.An intact catheter 3.Bowel perforation 4.Bladder perforation

3.Bowel perforation Complications of a peritoneal catheter include infection, perforation of the bowel or bladder, and bleeding. Brown-tinged returns suggest bowel perforation, which usually is accompanied by severe abdominal pain and diarrhea. Cloudy or opaque returns suggest possible infection.

The nurse monitors the client for potential complications during dialysis but recognizes NOT to monitor for muscle cramping. hypertension. dysrhythmias. air embolism.

hypertension. The nurse should monitor for hypotension, not hypertension, during the treatment related to the removal of fluid. Muscle cramping may occur late in dialysis as fluid and electrolytes rapidly leave the extracellular space. Dysrhythmias may result from electrolyte and pH changes or removal of antiarrhythmic medications. Air embolism is rare, but could occur if air enters the vascular system.

A client with chronic kidney disease becomes confused and reports abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which lab value? Hypocalcemia Elevated white blood cells Hyperkalemia Elevated urea levels

Hyperkalemia Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany.

What is a characteristic of the intrarenal category of acute renal failure? Increased BUN High specific gravity Decreased urine sodium Decreased creatinine

Increased BUN 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

The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client? Keep the dialysis supplies in a clean area, away from children and pets Keep the catheter stabilized to the abdomen, below the belt line Wear a mask while handling any dialysate solutions Clean the catheter insertion site daily with soap

Keep the dialysis supplies in a clean area, away from children and pets It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action? 1.Monitor the client. 2.Elevate the head of the bed. 3.Assess the fistula site and dressing. 4.Notify the primary health care provider (PHCP).

Notify the primary health care provider (PHCP). Disequilibrium syndrome may be caused by rapid removal of solutes from the body during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs and symptoms of disequilibrium syndrome, and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The PHCP must be notified.

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? Acute tubular necrosis (ATN) diuresis oliguria Restoration of glomerular function

Oliguria Explanation: 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.

PrepU The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication? At bedtime with 8 ounces of fluid 2 hours after meals 2 hours before meals With food

With Food

1. A nurse is preparing to initiate peritoneal dialysis for a client who has chronic kidney disease. Which of the following actions should the nurse take? (Select all that apply.) A. Monitor the client's glucose levels. B. Report cloudy dialysate return. C. Warm the dialysate in a microwave oven. D. Assess the client for the presence of shortness of breath. E. Position the drainage bag lower than the client's abdomen. F. Maintain medical asepsis when accessing the catheter insertion site.

a,b,d,e

(ATI) A nurse is caring for a client with a hemodialysis shunt (AV fistula) in his right arm. Which of the following is a correct nursing action when caring for the client? A. Use the shunt to draw pre-dialysis labs B. Take the blood pressure in the left arm C. Keep the cannula patent by injecting heparin every 8 hours D. Gently palpate the shunt for a bruit

B. Take the blood pressure in the left arm

(ATI) A nurse is caring for a client who has a significant weight gain of 4 pounds (1.8 kg) in one day. Which of the following is the most likely cause? A. A ravenous appetite and bingeing on junk food B. The consumption of salty foods and snacks C. Fluid retention D. Renal clearance

C. Fluid retention

(ATI) A 10-year-old client with ESRD (end-stage renal disease) is receiving hemodialysis, and experiences chills. Which of the following is the most appropriate nursing intervention? A. Provide blankets or extra clothing B. Increase the temperature of the room C. Notify the physician immediately D. Stop dialysis

D. Stop dialysis The occurrence of chills during dialysis is a sign of bacteremia. It may be associated with fever, malaise, nausea, and vomiting. When this occurs, it is best to stop the transfusion before notifying the physician. Blood cultures are collected to determine the causative agent. Infection occuring during hemodialysis is usually the result of poor aseptic technique when handling equipment. Provision of blankets and increasing room temperature does not resolve chills due to infection

The nurse is performing assessment on a client with acute kidney injury who is in the oliguric phase. Which should the nurse expect to note? Select all that apply. 1.Increased serum creatinine level 2.A low and fixed specific gravity 3.Increased blood urea nitrogen (BUN) level 4.A urine output of 600 to 800 mL in a 24-hour period

1.Increased serum creatinine level 2.A low and fixed specific gravity 3.Increased blood urea nitrogen (BUN) level

A client with acute kidney injury progresses through four phases. Which describes the onset phase? Normal glomerular filtration and tubular function are restored. It is accompanied by reduced blood flow to the nephrons. The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications.

It is accompanied by reduced blood flow to the nephrons. Explanation: The onset phase is accompanied by reduced blood flow to the nephrons. In the oliguric phase, fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. During the diuretic phase, excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. During the recovery phase, normal glomerular filtration and tubular function are restored.