Med Surg Chapter 62

A patient with a history of hypertension is diagnosed with chronic kidney disease. When the patient asks the nurse how this occurred, which response by the nurse is the most appropriate?

"High blood pressure reduces renal blood flow and harms the kidney tissue, causing this diagnosis." Rationale: Longstanding hypertension leads to sclerosis and narrowing of renal arterioles and small arteries with subsequent reduction of blood flow. This leads to ischemia, glomerular destruction, and tubular atrophy.

The nurse is preparing to discharge a patient with chronic kidney disease. The nurse is teaching the patient and family about administering calcium acetate tablets by mouth with each meal at home. Which explanation about this medication is the most appropriate?

"The calcium acetate will lower your serum phosphate levels." Rationale: The patient with chronic kidney disease has elevated phosphate levels due to the inability of the damaged kidney to excrete this electrolyte. Calcium acetate, when given with meals, will bind serum phosphorus and therefore lower the serum level.

A patient with renal failure is receiving peritoneal dialysis. The nurse is explaining the process to the patient. Which statement would the nurse include in a discussion with the patient?

"The peritoneum acts as a semipermeable membrane through which wastes move by diffusion and osmosis." Rationale: The peritoneum acts as a semipermeable membrane, allowing substances to move from an area of high concentration (the blood) to an area of lower concentration (the dialysate). Metabolic waste products and excess water can be eliminated through osmosis and diffusion utilizing the peritoneum as the semipermeable membrane.

The nurse is caring for a patient with chronic kidney disease who is pale and experiencing fatigue. The nurse attributes these symptoms to anemia secondary to chronic kidney disease. The patient's spouse asks why the patient is anemic. Which response by the nurse is the most appropriate?

"There is a decreased production by the kidneys of the hormone erythropoietin, which is the cause of anemia." Rationale: Anemia is common in patients with renal disease. Among the factors causing the anemia are decreased production of erythropoietin by the kidneys and shortened red blood cell (RBC) life. Erythropoietin is involved in the stimulation of the bone marrow to produce RBCs.

The nurse instructs a patient with chronic kidney disease on the prescribed medication furosemide (Lasix). Which patient statement indicates that teaching has been effective?

"This pill will reduce the swelling in my body and get rid of the extra potassium." Rationale: Furosemide (Lasix) is a loop diuretic that may be prescribed to reduce extracellular fluid volume and edema. Diuretic therapy also can reduce hypertension and cause potassium wasting, lowering serum potassium levels.

The nurse is providing education to a patient who is diagnosed with renal carcinoma. The patient states, "My doctor says I am a stage I. What does that mean?" Which response by the nurse is most appropriate?

"Your cancer is limited to the renal capsule." Rationale: Stage I renal carcinoma is limited to the renal capsule.

A young school-age patient is in the hospital with acute kidney injury following a streptococcus infection. The parents are Spanish-speaking and speak little English. The parents, through an interpreter, ask the nurse what mistake they made that caused the child to be so sick. Which response by the nurse is the most appropriate?

"Your child's recent infection may have caused the renal failure." Rationale: Patients with streptococcus are at risk for kidney and cardiac sequelae.

The nurse is caring for a patient admitted with a diagnosis of acute kidney injury. The patient asks the nurse, "Are my kidneys failing? Will I need a kidney transplant?" Which response by the nurse is the most appropriate?

"Your condition can be reversed with prompt treatment and usually will not destroy the kidney." Rationale: Acute kidney injury is often resolved without the need for transplant if treatment is initiated quickly.

The nurse is administering peritoneal dialysis to a patient with acute kidney injury. The nurse notes the presence of a cloudy dialysate return. After notifying the health-care provider, which action by the nurse is the most appropriate?

Culture the dialysate return Rationale: The return should be clear. The presence of cloudy drainage might indicate peritonitis, and the nurse should culture the return in order to help identify the presence and type of organism that could be causing the infection.

A nurse evaluating the therapeutic effect of the drug sodium polystyrene sulfonate (Kayexalate) for a patient diagnosed with chronic kidney disease. Which therapeutic effect from the medication does the nurse anticipate?

Decreased serum potassium Rationale: The patient with chronic kidney disease is unable to excrete potassium, and therefore the drug sodium polystyrene sulfonate (Kayexalate) is utilized in order to exchange sodium for potassium in the large intestine, resulting in decreased serum potassium levels.

The nurse is caring for a patient who is diagnosed with acute kidney injury. When reviewing the patient's laboratory data, which finding indicates that a patient has met the expected outcomes?

Decreasing serum creatinine Rationale: Creatinine is the metabolic end product of creatinine phosphate and is excreted via the kidneys in relatively constant amounts.

A patient with frequent urinary tract infections is seen in the urology clinic and is at risk for acute kidney injury. The nurse reviews the patient's medical history. Which item supports the patient's being at risk for acute kidney injury? Select all that apply.

Dehydration, renal calculi, hypertension

The nurse is concerned that an older adult patient is at risk for developing acute kidney injury. Which information in the patient's history supports the nurse's concern? Select all that apply.

Diagnosed with hypotension, Recent aortic valve replacement surgery, Prescribed high doses of intravenous antibiotics

A patient with chronic kidney disease is experiencing manifestations of anemia. Based on this data, which treatment does the nurse anticipate for this patient?

Epoetin injections Rationale: Epoetin injections are used in the treatment of anemia caused by chronic kidney disease. This medication supplies a hormone typically created in the kidneys that signals the bone marrow to produce more red blood cells. In chronic kidney disease, this hormone production will be reduced

The nurse is providing care to a patient who is diagnosed with renal trauma. The patient is experiencing hematuria and contusions but has normal imaging studies. Which grade of renal trauma should the nurse document?

Grade 1 Rationale: Grade 1 renal trauma presents with hematuria and contusions; however, the patient will

The nurse is providing care to a patient who is diagnosed with renal trauma. The patient has a renal laceration that is greater than 1 cm in depth, but the laceration does not involve the collecting system. Which grade of renal trauma should the nurse document?

Grade 3 Rationale: Grade 3 renal trauma will present with renal lacerations greater than 1 cm in depth not involving the collecting system.

T he nurse is caring for an older adult patient diagnosed with chronic kidney disease. The patient reports no bowel movement in the past two days. Based on this data, which condition is the patient at an increased risk for developing?

Hyperkalemia Rationale: Constipation exacerbates hyperkalemia, and it is important to monitor CRF clients who already have impairment of potassium.

The nurse is providing care to a patient who may have polycystic kidney disease. Which is the first symptom the nurse should assess this patient for?

Hypertension Hypertension is the first symptom the nurse should assess for when a patient is suspected of having polycystic kidney disease.

While caring for a patient with chronic kidney disease, the nurse tracks the patient's serum albumin level. For which nursing diagnosis is the action most indicated?

Imbalanced Nutrition: Less Than Body Requirements Rationale: Interventions appropriate for the diagnosis of Imbalanced Nutrition: Less Than Body Requirements include monitoring laboratory values such as serum albumin.

The nurse is preparing to administer hemodialysis treatment for a patient with chronic kidney disease. Which laboratory values does the nurse anticipate prior to the patient's treatment? Select all that apply.

Increased blood urea nitrogen (BUN) & Increased creatinine

The nurse is planning care for the patient with acute kidney injury. The nurse plans the patient's care based on the nursing diagnosis of Excess Fluid Volume. Which assessment data supports this nursing diagnosis?

Pitting edema in the lower extremities Rationale: The patient in acute kidney injury will likely be edematous, as the kidneys are not producing urine.

A patient agrees to receive long-term hemodialysis to treat chronic kidney disease. For which surgical procedure should the nurse instruct this patient?

Placement of an arteriovenous fistula Rationale: For long-term vascular access needed for hemodialysis, an arteriovenous (AV) fistula is created. The fistula is created by surgical anastomosis of an artery and vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used for taking and replacing blood during dialysis.

During a home visit, the nurse is concerned that an older adult patient is developing chronic kidney disease. The patient has no history of cardiovascular disease. Which data in the patient's assessment caused the nurse to have this concern?

Progressive edema Rationale: The manifestations of chronic kidney disease often are missed in aging patients because edema may be attributed to heart failure or high blood pressure to preexisting hypertension.

A patient with acute kidney injury is complaining of a metallic taste in the mouth and has no appetite. Based on this data, which intervention by the nurse is the most appropriate?

Provide mouth care before meals Rationale: A metallic taste in the mouth is due to a build-up of uremia. The nurse should provide mouth care before meals to reduce this taste sensation and improve the patient's oral intake.

The nurse is planning care for a patient with chronic kidney disease and osteoporosis. After reviewing the patient's medical record, which is the priority nursing diagnosis for this patient?

Risk for Injury Rationale: The patient with chronic kidney disease with osteoporosis is at high risk for fractures; therefore, preventing injury is the priority nursing diagnosis.

The nurse is providing care for a patient diagnosed with chronic kidney disease who is experiencing hyperkalemia. When planning meals for this patient, which choice would be most appropriate for this patient?

Spaghetti and meat sauce, breadsticks Rationale: Spaghetti and meat sauce with breadsticks would be the most appropriate meal from the choices provided.

The nurse is caring for a patient from another country who was admitted with hypertension and chronic kidney disease. The patient is receiving hemodialysis three times a week. The nurse is assessing the client's diet, and the patient reports the use of salt substitutes. When teaching the patient to avoid salt substitute, which rationale supports this teaching point?

They can potentiate hyperkalemia Rationale: Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in clients with renal failure, and the use of salt substitutes will worsen hyperkalemia.