Medical Surgical Chapter 47 Acute Kidney Injury and Chronic Kidney Disease

Which finding indicates oliguria? 1 Urinary output of 350 mL/day 2 Urinary output of 450 mL/day 3 Urinary output of 550 mL/day 4 Urinary output of 650 mL/day

1 A urinary output rate of less than 400 mL/day indicates oliguria; thus a urinary output of 350 mL/day suggests oliguria. Urine outputs of 450, 550, or 650 mL/day are considered normal. Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer. Text Reference - p. 1103

Which is a clinical manifestation of acute kidney injury? 1 Oliguria 2 Uremia 3 Anemia 4 Pruritus

1 Oliguria is a sign of acute kidney injury. Uremia, anemia, and pruritus are signs of chronic kidney injury. Text Reference - p. 1103

The nurse instructs a patient with hyperphosphatemia to avoid what food item? 1 Yogurt 2 Soy sauce 3 Canned soup 4 Salad dressing

1 Yogurt is rich is phosphate and should be avoided by patients with hyperphosphatemia. The patient with hypernatremia and hypertension should avoid soy sauce, canned soups, and salad dressings because they are high in sodium. Text Reference - p. 1115

What are the postrenal causes of acute kidney injury? Select all that apply. 1 Renal calculi 2 Renal trauma 3 Prostate cancer 4 Kidney ischemia 5 Myoglobin release

1, 2, 3 Renal calculi, trauma, and prostate cancer are postrenal causes of acute kidney injury. Intrarenal causes of acute kidney injury include kidney ischemia and myoglobin released from muscle cells. Text Reference - p. 1103

A patient who has been on hemodialysis for several weeks asks the nurse what substances are being removed by the dialysis. What substances should the nurse tell the patient are passing through the membrane during hemodialysis? Select all that apply. 1 Red blood cells (RBCs) 2 Creatinine 3 Glucose 4 Bacteria 5 Sodium

2, 5 Creatinine, urea, uric acid, and electrolytes such as sodium and potassium are filtered by the semipermeable membrane during hemodialysis. RBCs do not pass through the semipermeable membrane during hemodialysis because of their molecular weight. Glucose does not pass through the semipermeable membrane during hemodialysis due to the osmotic difference of the dialysate. Bacteria do not pass through the semipermeable membrane during hemodialysis due to their high molecular weight. Text Reference - p. 1117

A 70-year-old female patient weighs 50 kg and has a serum creatinine level of 1.4 mg/dL. Using the Cockcroft-Gault rule, what should the nurse document as the patient's glomerular filtration rate (GFR)? Record the answer using one decimal place. ____________ mL/min

29.5 The Cockcroft-Gault formula estimates glomerular filtration rate (GFR): [(140 - Age) x (weight in kilograms) x (0.85 if female)]/(72 x Creatinine (Cr) mg/dL) = GFR. Using this formula, a female patient of 70 years weighing 50 kg with serum creatinine level of 1.4 mg/dL has a GFR of 29.5 mL/min as shown by ((140 - 70) x (50 kg) x 0.85 if female))/(72 x (1.4 mg/dL) = 29.5. Text Reference - p. 1112

Which substance can pass through the peritoneal membrane? 1 Glucose 2 Creatinine 3 Fatty acids 4 Amino acids

4 Peritoneal membranes allow the passage of amino acids, polypeptides, and plasma proteins. Glucose, creatinine, and fatty acids cannot permeate the peritoneal membrane. Text Reference - p. 1119

The nursing instructor is teaching a student nurse about the therapies for hyperkalemia associated with acute kidney injury. Which statement by the student nurse indicates effective learning? 1 "Insulin infusion is a permanent therapy." 2 "Sodium bicarbonate is a permanent therapy." 3 "Calcium gluconate infusion is a permanent therapy." 4 "Sodium polystyrene sulfonate is a permanent therapy."

4 Sodium polystyrene sulfonate is a cation-exchange resin that completely removes extra potassium; it is considered a permanent therapy. Insulin pushes potassium inside the cells, but with a decline in insulin levels, potassium exits the cell. Thus, insulin is a temporary therapy. Sodium bicarbonate and calcium gluconate are also considered temporary therapies because they shift potassium into the cells until their blood levels diminish, upon which potassium exits the cells. Text Reference - p. 1105

Which statement made by a nursing student indicates effective learning about what should be included on a plan of care for a patient with chronic kidney disease that is taking gluconate and calcium acetate? 1 Administer a stool softener. 2 Obtain consent for immediate dialysis. 3 Give both drugs at the same time. 4 Administer sodium polystyrene sulfonate

1 A patient with chronic kidney disease who is taking oral iron salts, such as ferrous gluconate, and phosphate binders, such calcium acetate, may develop constipation and need to take a stool softener. Dialysis does not provide relief from constipation in patients with chronic kidney disease. Oral iron supplements should not be given at the same time as calcium-containing phosphate binders because they prevent iron absorption. Sodium polystyrene sulfonate helps to treat hyperkalemia but does not provide relief from constipation. Text Reference - p. 1110

Which condition does the nurse suspect in a patient with a glomerular filtration rate (GFR) of 10 mL/minute, a blood urea nitrogen (BUN) level of 23 mg/dL, a potassium level of 4 mEq/L, and a serum bicarbonate level of 20 mEq/L? 1 Uremia 2 Hypertension 3 Dysrhythmias 4 Metabolic acidosis

1 A patient with glomerular filtration rate (GFR) of 10 mL/minute has chronic kidney disease (CKD), causing the BUN to rise above the normal BUN level of 6 to 20 mg/dL, which may be a result of uremia. Hypertension may result from hypernatremia in the patient with CKD; there is no sodium level information given. Dysrhythmias may occur in the patient with CKD due to hyperkalemia due to decreased excretion of potassium by the kidneys; however, this patient's potassium level of 4 mEq/L is a normal finding. An inability of the kidneys to excrete ammonia and generate bicarbonates leads to metabolic acidosis, indicated by a serum bicarbonate level lower than 15 mEq/L.; the patient's level is greater than 15 mEq/L. Text Reference - p. 1108

The nurse is planning an education program on chronic kidney disease. Which ethnic group would the nurse target for promoting this event? 1 African Americans 2 Asian descent 3 Caucasian males 4 Hispanics

1 African Americans are at the greatest risk for develop kidney disease. Those of Asian descent, Caucasian males, and Hispanics are not at as great a risk. Text Reference - p. 1108

The nursing instructor is teaching a student nurse about continuous renal replacement therapy (CRRT). Which statement by the student nurse indicates effective learning? 1 "CRRT is provided over approximately 24 hours." 2 "CRRT does not require the addition of an anticoagulant." 3 "CRRT cannot be used in conjunction with hemodialysis." 4 "CRRT has a faster blood flow rate than hemodialysis."

1 Continuous renal replacement therapy (CRRT) is a physiologic therapy that simulates kidney function day and night. CRRT is done either by cannulating an artery and a vein or by cannulating two veins. CRRT is provided continuously for approximately 24 hours. CRRT involves the flow of blood from the body through a filter and carries an increased risk of clotting; thus an anticoagulant must be added. CRRT can be performed along with hemodialysis. CRRT has a slower blood flow rate than intermittent hemodialysis. Text Reference - p. 1106

The nurse is preparing to perform peritoneal dialysis for a patient with chronic kidney disease. Which osmotic agent will the nurse obtain for the dialysis exchanges? 1 Dextrose 2 Normal saline 3 Icodextrin solution 4 Amino acid solution

1 Dextrose is the most commonly used osmotic agent used in peritoneal dialysis. Normal saline solution is not used in peritoneal dialysis. Icodextrin and amino acid solutions are used as alternatives to dextrose. Text Reference - p. 1118

A dialysis nurse is performing hemodialysis for a patient with chronic kidney disease. Which action by the nurse will prevent blood clotting during the procedure? 1 Addition of heparin to the blood 2 Addition of dextrose to the blood 3 Addition of icodextrin to the blood 4 Addition of saline solution to the blood

1 Heparin is added to the blood to prevent clotting when the patient's blood contacts a foreign substance. Dextrose and icodextrin are used as osmotic agents during dialysis. Saline solution is used to flush the dialyzer. Text Reference - p. 1121

Assessment findings of a patient with chronic kidney failure include a glomerular filtration rate (GFR) of 10 mL/min, numbness and burning sensation in the legs, and a blood urea nitrogen level (BUN) of 26 mg/dL. The nurse anticipates that which intervention will be included on the patient's plan of care? 1 Make a referral for dialysis. 2 Administer sodium polystyrene sulfonate. 3 Restrict sodium bicarbonate. 4 Provide a magnesium-containing antacid.

1 Numbness and burning sensation in the legs are manifestations of peripheral neuropathy caused by nitrogenous waste accumulation in the brain. A patient with a chronic kidney disease (CKD), increased blood urea nitrogen (BUN) levels, and a very low glomerular filtration rate of 10 mL/min should undergo dialysis to remove nitrogenous wastes and prevent fluid accumulation due to impaired excretion. Sodium polystyrene sulfonate treats hyperkalemia. Sodium bicarbonate treats metabolic acidosis. A patient with CKD must not take antacids containing magnesium or aluminum because they are excreted by the kidneys. Text Reference - p. 1110

While providing postoperative care for a live kidney donor, the nurse monitors the hematocrit levels. What rationale does the nurse provide to the patient for this action? 1 To assess for bleeding 2 To assess for impairment 3 To assess for hypokalemia 4 To assess for hyponatremia

1 Patients who have donated their kidney should be monitored for hematocrit levels to assess for bleeding. The nurse should monitor renal function to assess for impairment. The nurse should monitor for electrolytes to assess for hypokalemia and hyponatremia in kidney recipients. Text Reference - p. 1127

While caring for a patient with acute kidney injury, the nurse observes that the patient has hand tremors while extending the wrist. The patient's laboratory report shows a blood urea nitrogen (BUN) level of 123 mg/dL. Which action by the patient does the nurse suspect as the cause of this symptom? 1 Eating protein-rich food 2 Eating sodium-rich food 3 Eating potassium-rich food 4 Eating carbohydrate-rich food

1 Patients with acute kidney injury have impaired renal excretion cannot eliminate nitrogenous wastes; this will result in increased blood urea nitrogen (BUN) levels. Eating protein-rich food will increase the level of BUN and cause neurologic changes such as asterixis, which is characterized by flapping tremor upon extension of the wrist. A normal level of BUN is 120 mg/dL. Because the patient has asterixis and a BUN level of 125 mg/dL, the nurse suspects the consumption of protein-rich food to be the cause of this symptom. Text Reference - p. 1104

The nurse is caring for a patient with chronic kidney disease who is undergoing hemodialysis. What is an appropriate diet for this patient? 1 High-protein and low-calcium 2 Low-protein and low-potassium 3 High-protein and high-potassium 4 Low-protein and high-phosphorus

1 Patients with chronic kidney disease undergoing hemodialysis should consume a diet low in protein and potassium. Calcium needs to be maintained in the diet to help prevent hyperphosphatemia. High protein diets should be avoided because they cause uremic toxicity. High potassium in the diet needs to be avoided because the increased serum potassium level can result in cardiac disturbances. Text Reference - p. 1130

A patient complains of pedal edema. The laboratory reports show 0.4 mL/kg/hr of urine output for the past 12 hours. The patient has a history of acute glomerulonephritis. Which method is the best to confirm acute glomerulonephritis as a cause of acute kidney injury in this patient? 1 Kidney biopsy 2 Kidney ultrasound 3 Computed tomographic scan 4 Magnetic resonance imaging

1 Pedal edema and urine output less than 0.5 mL/kg/hr for 12 hours indicate acute kidney injury. Glomerulonephritis is one of the intrarenal causes of acute kidney injury. A kidney biopsy is the best method to confirm intrarenal causes of kidney injury. A kidney ultrasound is the first diagnostic test used to establish acute kidney injury. A computed tomography scan is used to identify lesions, masses, lesions, and vascular anomalies. Magnetic resonance imaging is not advised in patients with renal failure unless necessary due to the development of nephrogenic systemic fibrosis. Text Reference - p. 1105

Which continuous renal replacement therapy requires no fluid replacement? 1 Slow continuous ultrafiltration 2 Continuous venovenous hemodialysis 3 Continuous venovenous hemofiltration 4 Continuous venovenous hemodiafiltration

1 Slow continuous ultrafiltration is a simplified version of continuous venovenous hemofiltration. No fluid replacement is required in this process. Continuous venovenous hemodialysis removes both fluids and solutes and requires both dialysate and replacement fluid. Continuous venovenous hemofiltration removes both fluids and solutes and requires replacement fluid. Continuous venovenous hemodiafiltration removes both fluids and solutes and requires both dialysate and replacement fluid. Text Reference - p. 1123

The nursing instructor is teaching a student nurse about sodium polystyrene sulfonate. Which statement by the student nurse indicates the need for further teaching? 1 "The drug is effective in treating a paralytic ileus." 2 "It can be administered as an enema." 3 "The drug helps exchange potassium for sodium." 4 "It is mixed in water with sorbitol and then administered."

1 Sodium polystyrene sulfonate is used to correct hyperkalemia and is contraindicated in patients with a paralytic ileus because it causes bowel necrosis. Sodium polystyrene sulfonate can be administered in the form of an enema, which acts by exchanging potassium for sodium ions. It can also be administered after mixing it in water with sorbitol to facilitate the removal of potassium from the body. Text Reference - p. 1105

The nurse caring for a patient with heart failure notes the patient has decreased urine output of 200 mL/day. Which laboratory finding aids in the diagnosis of prerenal azotemia in this patient? 1 Elevated blood urea nitrogen (BUN) 2 Normal creatinine level 3 Decreased sodium level 4 Decreased potassium level

1 The patient with heart failure has a decreased circulating blood volume. This causes autoregulatory mechanisms to preserve blood flow to essential organs. Laboratory data for this patient will likely demonstrate an elevation in BUN, creatinine, and potassium. Prerenal azotemia results in a reduction in the excretion of sodium, increased sodium and water retention, and decreased urine output. Text Reference - p. 1102

The nurse recognizes that which intervention would help a patient with stage 5 chronic kidney disease who experiences restless leg syndrome, altered mental ability, seizures, coma, and a blood urea nitrogen (BUN) level of 35 mg/dL? 1 Refer the patient for dialysis. 2 Administer calcium phosphate binders. 3 Recommend that the patient receive a blood transfusion. 4 Administer 10% calcium gluconate intravenously

1 The patient's symptoms of restless leg syndrome, altered mental ability, and irritability are manifestations of neurologic complications due to accumulation of nitrogenous wastes in the brain and nervous system. The patient has seizures and coma due to the high blood urea nitrogen (BUN) level of 35 mg/dL. Therefore, dialysis would improve central nervous system functions and slow the neuropathies. Calcium phosphate binders are administered in a patient with hyperphosphatemia. A blood transfusion is not preferred to treat anemia unless the patient experiences an acute blood loss or symptomatic anemia. Intravenous administration of 10% calcium gluconate helps to reduce hyperkalemia in a patient. Text Reference - p. 1110

The nurse just received an urgent laboratory value on a patient in renal failure. The potassium level is 6.3. The telemetry monitor is showing peaked T waves. Which prescription from the primary health care provider should be implemented first? 1 Administer regular insulin intravenously (IV) 2 Restrict dietary potassium intake to 40 meq daily 3 Administer kayexalate enema 4 Educate the patient on dietary restriction of potassium

1 This patient is showing signs of hyperkalemia, which could be fatal and lead to myocardial damage. Regular insulin IV is needed to quickly force potassium into the cells. The kayexalate enema will take too long to excrete the potassium. Restricting oral intake and educating the patient will be needed when the crisis has resolved. Text Reference - p. 1112

When obtaining a health history for the patient with chronic kidney disease, the nurse notes the following medications on the patient's medication list. The patient will need further education on which medication? 1 Ibuprofen 2 Acetaminophen 3 Calcium supplements 4 Calcium acetate

1 Ibuprofen, and other nonsteroidal antiinflammatory drugs (NSAIDS), will cause further damage to the kidneys. Chronic kidney disease (CKD) patients should be taking Tylenol as prescribed for pain. CKD patients also could be consuming calcium supplements and PhosLo tablets as prescribed by the health care provider. Text Reference - p. 1107

A nurse is giving dietary advice to a patient who is on continuous ambulatory peritoneal dialysis for chronic renal failure. Which dietary instructions are appropriate for this patient? Select all that apply. 1 High-calorie foods 2 High-protein foods 3 High-potassium content 4 High-phosphorus content 5 High-fluid intake

1, 2 A chronic renal failure patient on continuous ambulatory peritoneal dialysis is encouraged to have a high-calorie diet to meet the increased demands of the body. A good amount of protein should be consumed to replace that lost during dialysis. Foods containing high amounts of potassium and phosphorus should be avoided in patients with chronic renal failure. High potassium can cause hyperkalemia and related complications, especially cardiac complications. High phosphorus may deteriorate bone health. Usually there is a modest restriction of fluids when the patient is on dialysis. Text Reference - p. 1115

A patient has end-stage kidney disease and is receiving hemodialysis. During dialysis the patient complains of nausea and a headache and appears confused. On examination, the nurse finds that the blood pressure is very low. What is the priority action by the nurse? Select all that apply. 1 Decrease the volume of fluids being removed. 2 Infuse 0.9% saline solution. 3 Infuse hypertonic glucose solution. 4 Avoid excess coagulation. 5 Transfuse blood, as ordered

1, 2 Hypotension is a complication of hemodialysis and may manifest as headache and nausea. The nurse should try to keep the intravascular volume adequate by decreasing the volume of fluids being removed and infusing 0.9% saline solution. Hypertonic glucose solutions are infused if the patient gets muscle cramps. Excess coagulation is avoided if the patient has blood loss. Blood is transfused if the patient has blood loss. Text Reference - p. 1122

The nurse recognizes that which intervention will likely be included in a treatment plan for a patient with chronic kidney disease (CKD) who is undergoing peritoneal dialysis? 1 Restricting potassium intake 2 Encouraging consumption of 25 to 35 kcal/kg/day 3 Avoiding iron supplements when taking erythropoietin 4 Calculating fluid restrictions based on urine output

2 A patient with chronic kidney disease (CKD) must maintain good nutrition and should be referred to a dietitian for nutritional education and guidance. To avoid calorie-protein malnutrition, the patient should consume 25 to 35 kcal/kg/day, which includes calories from dialysate glucose absorption. Potassium is usually not restricted for a patient undergoing peritoneal dialysis. The patient needs to take iron supplements when on erythropoietin to prevent iron deficiency. Fluid intake in the patient who is undergoing peritoneal dialysis should be unrestricted if weight and blood pressure are in control. Therefore, it is not dependent upon urine output. Text Reference - p. 1114

The nurse is attending to a patient who is undergoing peritoneal dialysis. The nurse assesses the patient is developing symptoms of respiratory distress. What nursing interventions are necessary to prevent further respiratory complications? Select all that apply. 1 Auscultate the lungs. 2 Frequently reposition the patient. 3 Promote deep-breathing exercises. 4 Increase the rate of infusion of the dialysate. 5 Place the patient in a low Fowler's position.

1, 2, 3 Auscultation is very important to find the cause of respiratory distress. Decreased areas of ventilation suggest the presence of atelectasis, whereas adventitious sounds may suggest fluid overload, retained secretions, or infection. Frequent positioning will promote equal ventilation to all parts of the lungs. Deep-breathing exercises could help to promote proper expansion of lungs. Rapid infusion would cause more pressure on the diaphragm. The patient should be placed in the semi-Fowler's position for peritoneal dialysis; this allows inflow of fluid while not impinging on the thoracic cavity. Text Reference - p. 1119

A patient with end-stage kidney disease is to begin continuous ambulatory peritoneal dialysis (CAPD). What are the preparations to be done by the nurse before starting the catheter insertion for this patient? Select all that apply. 1 Ask patient to empty the bladder and bowel. 2 Note the patient's weight. 3 Obtain a signed consent form. 4 Monitor for abnormal cardiac signs and symptoms. 5 Monitor for abnormal respiratory signs and symptoms

1, 2, 3 Preparation of the patient for catheter insertion includes emptying the bladder and bowel, weighing the patient, and obtaining a signed consent form. The bladder should be emptied to prevent accidental puncture of the bladder by the needle. Weighing the patient before and after the procedure is important to determine the effectiveness of dialysis. Because it is an invasive procedure, the nurse should explain about the risks and benefits, and informed consent should be obtained. Other factors are not contraindications for CAPD. Monitoring of cardiac and respiratory signs is essential but does not directly affect the procedure. Text Reference - p. 1118

A patient with chronic kidney disease is advised to undergo peritoneal dialysis (PD). What advantages of PD over hemodialysis should the nurse explain to the patient? Select all that apply. 1 It is a simple procedure. 2 It is home-based. 3 It requires special water systems. 4 It needs a vascular access device. 5 Equipment setup is simple

1, 2, 5 PD has many advantages over hemodialysis. The procedure is simple and home-based, with easy equipment setup. The patient can perform peritoneal dialysis. Because the dialysis is done through the peritoneal membrane, PD does not require a special water system or a vascular access device, as in hemodialysis. Text Reference - p. 1120

A patient with end-stage kidney disease is receiving continuous ambulatory peritoneal dialysis. The patient has a fever and the nurse suspects that it is due to peritonitis. For what are other manifestations that the nurse should monitor the patient? Select all that apply. 1 Vomiting 2 Abdominal pain 3 Bloody stools 4 Weight loss 5 Cloudy peritoneal effluent

1, 2, 5 Peritonitis may manifest as vomiting due to the inflammatory process in the peritoneum. The patient may have pain in the abdomen due to peritoneal irritation caused by the inflammatory process in the peritoneum. The primary clinical manifestations of peritonitis are abdominal pain and cloudy peritoneal effluent with a white blood cell (WBC) count greater than 100 cells/μL (more than 50% neutrophils). An activated immune response may attract WBCs, and an elevated level of WBC in the peritoneal fluid indicates peritonitis. Bloody stool or weight loss is not associated with peritonitis. Peritonitis may not cause hemorrhage; therefore, bloody stools may not be present. Weight loss is usually caused by malnutrition or fluid loss and therefore may not be seen in peritonitis; weight gain may occur due to fluid retention. Text Reference - p. 1119

The registered nurse is teaching a student nurse about physiologic changes in the diuretic phase of a patient with acute kidney disease. Which statement by the student nurse about the diuretic phase indicates effective learning? Select all that apply. 1 "The diuretic phase lasts for one to three weeks." 2 "Urine volume decreases in the diuretic phase." 3 "Hypovolemia occurs during the diuretic phase." 4 "The kidneys will have the ability to concentrate urine." 5 "The creatinine level increases drastically at the end of the diuretic phase."

1, 3 The diuretic phase lasts for one to three weeks and hypovolemia and hypotension occur due to increased urinary output. In the diuretic phase, urine output increases because of the renal tubules' inability to concentrate urine. At the end of the diuretic phase, the creatinine, blood urine nitrogen, and electrolyte levels return to normal. Text Reference - p. 1104

What are the complications of hemodialysis? Select all that apply. 1 Hepatitis 2 Hypertension 3 Muscle cramps 4 Light-headedness 5 Excess coagulation of blood

1, 3, 4 Hemodialysis is extracorporeal removal of waste products such as creatinine, urea, and free water from the blood during renal failure. The complications of hemodialysis include hepatitis, hypotension, muscle cramps, light-headedness and loss of blood. Hepatitis is common in patients who are undergoing dialysis due to the transmission of infection-causing organisms. Hypotension occurs due to rapid removal of vascular volume and decreased cardiac output. Muscle cramps are caused by hypotension, hypovolemia, or high ultrafiltration rate. Light-headedness is caused by a drop in blood pressure. Hemodialysis may cause hypotension and bleeding. Text Reference - p. 1122

What are the complications of peritoneal dialysis? Select all that apply. 1 Hernias 2 Hepatitis 3 Peritonitis 4 Hypotension 5 Exit site infection

1, 3, 5 Peritoneal dialysis is removal of waste products from the body when kidneys no longer work adequately. The complications of peritoneal dialysis include hernias, peritonitis, and exit site infection. Hernias are caused by increased intraabdominal pressure secondary to the dialysate infusion. Peritonitis results from contamination or from progression of an exit site or tunnel infection. Exit site infection is caused by infection of the peritoneal catheter. Hepatitis and hypotension are complications of hemodialysis. Text Reference - p. 1128

A patient with a history of end-stage kidney disease secondary to diabetes mellitus has presented to the outpatient dialysis unit for the scheduled hemodialysis. Which assessments should the nurse prioritize before, during, and after the treatment? 1 Level of consciousness 2 Blood pressure and fluid balance 3 Temperature, heart rate, and blood pressure 4 Assessment for signs and symptoms of infection

2 Although monitoring level of consciousness, temperature, heart rate, and blood pressure and assessing for signs of infection are relevant to the care of a patient receiving hemodialysis, the nature of the procedure indicates a particular need to monitor the patient's blood pressure and fluid balance. Text Reference - p. 1122

Hemodialysis is planned for a patient who has end-stage kidney disease. The patient is scheduled for the creation of an internal arteriovenous fistula and the placement of an external arteriovenous shunt to be used until the fistula heals. What postoperative nursing care is appropriate for this patient? Select all that apply. 1 Regularly check the positioning of the external shunt. 2 Check for signs and symptoms of respiratory complications. 3 Ensure that intravenous fluids are not infused in the arm with the shunt. 4 Cover the ends of the shunt cannula with a dressing. 5 Do not take blood pressure on the extremity with the shunt

1, 3, 5 The external shunt may come apart, external temperatures make clotting a potential hazard, and frequent handling increases the risk of infection. Infusions should not be in the extremity with the shunt or the fistula to avoid pressure from the tourniquet and to lessen the chance of phlebitis. Blood pressure readings should not be obtained in the extremity that has a shunt or fistula because of the pressure exerted on the circulatory system during the procedure. There are no respiratory complications of this procedure. The ends of the shunt cannula should be left exposed for rapid reconnection in the event of disruption. Test-Taking Tip: Being prepared reduces your stress or tension level and helps you maintain a positive attitude. Text Reference - p. 1120

The nurse is attending to a patient who is receiving hemodialysis for chronic kidney disease. For which complications should the nurse be observant in the patient? Select all that apply. 1 Hypotension 2 Renal calculi 3 Hepatitis type B 4 Bladder infection 5 Muscle cramps

1, 3, 5 The patient on hemodialysis may have decreased blood pressure due to rapid removal of blood. Hepatitis type B is a blood-borne infection, and hemodialysis poses a high risk for transmission of hepatitis B. Muscle cramps are a common complication of hemodialysis. Factors associated with the development of muscle cramps in hemodialysis include hypotension, hypovolemia, a high ultrafiltration rate (large interdialytic weight gain), and low-sodium dialysis solution. Hemodialysis does not increase the risk of development of renal calculi; people who are on bed rest or have low urine output may be at risk. Bladder infection is not related to dialysis. Text Reference - p. 1122

A nurse is delivering a lecture on organ donation. She is explaining about the selection criteria for kidney donors. What are the donor characteristics that the nurse should discuss with the group? Select all that apply. 1 Donors should not have diabetes. 2 Donors should be a first-degree relative of a recipient. 3 Donors should be approximately the same body size as the recipient. 4 Donors must have ABO compatibility with the recipient. 5 The donor and recipient should have matching leukocyte antigen complexes.

1, 4, 5 Diabetes is a major predisposing factor for development of kidney disease; hence, the donor should not be a diabetic. ABO compatibility is necessary for being a donor, although the exact blood type is not necessary. Human leukocyte antigen compatibility provides the most specific predictions of the body's tendency to accept or reject foreign tissue. Being a member of the same family is unsafe unless the family member has matching leukocyte antigen complexes. Being a member of the same family may increase the possibility of a match, but there is no guarantee that a family member will match. Differences in body size do not cause problems. Text Reference - p. 1124

The patient is in the diuretic phase of acute kidney injury. What education should the nurse provide to the patient regarding this phase? Select all that apply. 1 Urine output is increased. 2 The kidney has become fully functional. 3 The electrolyte imbalance will be normalized. 4 This phase will last no more than three weeks 5 There is a possibility that the fluid volume will be reduced in the body.

1, 4, 5 During the diuretic phase of acute kidney injury, daily urine output is usually around 1 to 3 L but may reach 5 L or more. Hypovolemia and hypotension can occur from massive fluid losses. The diuretic phase may last one to three weeks. Near the end of this phase, the patient's acid-base, electrolyte, and waste product (blood urea nitrogen, creatinine) values begin to normalize. Although urine output is increasing, the nephrons are still not fully functional. The high urine volume is caused by osmotic diuresis from the high urea concentration in the glomerular filtrate and the inability of the tubules to concentrate the urine. In this phase the kidneys have recovered their ability to excrete wastes, but not to concentrate the urine. Because of the large losses of fluid and electrolytes, the patient must be monitored for hyponatremia, hypokalemia, and dehydration. Text Reference - p. 1104

The nurse teaches safety measures to a patient with chronic kidney disease (CKD) who is experiencing constipation. The patient's blood pressure is 145/95 mm Hg. Which statement made by the patient indicates effective learning? 1 "I should eat three bananas after every meal." 2 "I should monitor my blood pressure regularly at home." 3 "I should rest in a prone position while recording my blood pressure." 4 "I should take magnesium-containing laxatives if I am experiencing constipation."

2 A patient with chronic kidney disease (CKD) and hypertension has to monitor blood pressure at home regularly. Controlling blood pressure helps to slow the incidence of atherosclerosis that further impairs kidney function. The patient with CKD has an elevated level of serum potassium and ingestion of bananas may aggravate the condition and lead to fatal dysrhythmias. The patient should be in supine position while measuring blood pressure, not in prone position. The patient may develop hypermagnesemia from taking magnesium-containing laxatives. Text Reference - p. 1113

The nurse recognizes that which recommendation is appropriate for a patient with chronic kidney disease (CKD)? 1 Eat prunes and raisins. 2 Take phosphate binders with meals. 3 Drink plenty of water. 4 Take calcium and iron supplements on an empty stomach.

2 A patient with chronic kidney disease who is prescribed phosphate binders, such as lanthanum carbonate, should take them with meals to reduce gastrointestinal side effects. The patient must avoid potassium-rich foods such as bananas, prunes, and raisins to prevent further aggravation of hyperkalemia. Patients with CKD have decreased urine output and fluid accumulation, so an appropriate fluid balance is important to prevent further complications such as edema and heart failure. The patient should take calcium supplements on an empty stomach for better absorption. Text Reference - p. 1116

A patient donated a kidney via a laparoscopic donor nephrectomy to a nonrelated recipient. The patient is experiencing a lot of pain and refuses to get up to walk. How should the nurse handle this situation? 1 Have the transplant psychologist convince the patient to walk. 2 Encourage even a short walk to avoid complications of surgery. 3 Tell the patient that no other patients have ever refused to walk. 4 Tell the patient that he or she is lucky it was not necessary to have an open nephrectomy.

2 Because ambulating will improve bowel, lung, and kidney function with improved circulation, even a short walk with assistance should be encouraged after pain medication. The transplant psychologist or social worker's role is to determine if the patient is emotionally stable enough to handle donating a kidney, whereas postoperative care is the nurse's role. Trying to shame the patient into walking by telling him or her that other patients have not refused and telling the patient he or she is lucky not to have had an open nephrectomy (implying how much more pain the patient would be having if it had been open) will not be beneficial to the patient or to the postoperative recovery. Text Reference - p. 1127

The nurse is caring for the patient receiving hemodialysis. What action by the nurse is a priority? 1 Checking the patient's skin condition 2 Recording the vital signs every 30 to 60 minutes 3 Recording the patient's weight during the procedure 4 Checking the blood pressure from the extremity with vascular acces

2 Blood pressure fluctuates during dialysis and a change in vital signs can indicate rapid changes in blood pressure. Therefore, the nurse should record the vital signs every 30 to 60 minutes during dialysis. The patient's skin condition should be assessed before dialysis for determining the site for vascular access. The patient's weight should be recorded before and after the procedure to determine the amount of fluid to be removed. Blood pressure should not be checked from the same extremity with vascular access because this may cause clotting of the vascular access. Text Reference - p. 1122

The nurse has the following tasks to perform. Which is an appropriate task to delegate to the unlicensed assistive personnel (UAP)? 1 Document intake and output on the patient performing bedside peritoneal dialysis 2 Obtain a finger stick blood sugar on the patient receiving hemodialysis 3 Ambulate the patient who is postoperative day one following a right-sided nephrectomy 4 Report the patient's potassium level of 5.2 to the primary health care provider

2 It is within the scope of practice of the UAP to obtain a finger stick blood glucose level. It is not within the UAP scope of practice to assess the intake and output during a peritoneal dialysis exchange. The patient postoperative day one will need a nursing assessment on his or her ability to ambulate, as well as a pain assessment. UAP do not report any results to health care providers. Text Reference - p. 1117

Which nursing interventions in a patient with kidney injury would be beneficial in providing safe and effective care? 1 Provide spicy food 2 Provide mouth care 3 Provide plenty of fluids 4 Provide ibuprofen if the patient experiences pain

2 Patients with acute kidney injury experience mucous membrane irritation because of the production of ammonia in the saliva. Therefore, the nurse should provide oral care to prevent stomatitis. Spicy food should be avoided because it may aggravate the irritation. Because the patient has renal impairment, fluid intake should be limited. Ibuprofen, a nonsteroidal antiinflammatory drug, is nephrotoxic and may worsen the kidney injury. Text Reference - p. 1107

What causes prerenal acute kidney injury? 1 Release of nephrotoxins 2 Reduced renal blood flow 3 Urine reflux into renal pelvis 4 Presence of extrarenal tumors

2 Prerenal acute kidney injury can be caused by a reduced flow of blood to the kidneys. A release of nephrotoxins is an intrarenal cause of acute kidney injury. Urine reflux into the renal pelvis and the presence of extrarenal tumors are postrenal causes of acute kidney injury. Text Reference - p. 1103

A patient has renal failure. The nurse, reviewing the lab results, recognizes which finding as indicative of the diminished renal function associated with the diagnosis? 1 Hypokalemia 2 Increased serum urea and serum creatinine 3 Anemia and decreased blood urea nitrogen 4 Increased serum albumin and hyperkalemia

2 Renal failure, whether acute or chronic, causes an increase in serum urea, creatinine, and blood urea nitrogen. Renal failure may also cause hyperkalemia and anemia and decrease serum albumin. However, it does not cause decreased blood urea nitrogen or increased serum albumin. Text Reference - p. 1102

A nurse planning care for a patient with acute renal failure recognizes that the interventions of highest priority are directly related to: 1 Ineffective coping 2 Excess fluid volume 3 Impaired gas exchange 4 Imbalanced nutrition: less than body requirements

2 The issue of excess fluid volume is the primary problem of acute renal failure and the highest priority for the nurse in this situation. The major problem with acute renal failure is altered fluid and electrolyte balance, which, if not managed, can lead to permanent renal damage, cardiac complications, and death. The nursing diagnosis of ineffective coping is due to the acute severity of the illness. The nursing diagnosis of impaired gas exchange is related to excess fluid volume, such as in the development of pulmonary edema. The nursing diagnosis of imbalanced nutrition, less than body requirements, is due to a decrease in appetite as a result of the acute renal failure. Text Reference - p. 1106

What is the term that describes the movement of solutes from a higher concentration area to a lower concentration area? 1 Osmosis 2 Diffusion 3 Dialysate 4 Ultrafiltration

2 The movement of solutes from an area of higher concentration to an area of lower concentration is called diffusion. Osmosis is the movement of solutes from an area of lower concentration to an area of higher concentration. Dialysate is a solution used in dialysis, into which substances from the blood move out. Ultrafiltration is a technique that removes low-molecular solutes such as water and fluid from the semipermeable membrane. Text Reference - p. 1117

A patient with chronic kidney disease is prescribed regular peritoneal dialysis (PD). What should the nurse inform the patient while teaching about PD? 1 Avoid high-protein diets. 2 Take potassium supplements. 3 Restrict fluid intake, as in hemodialysis. 4 Avoid powdered breakfast drinks

2 The patient undergoing regular peritoneal dialysis (PD) does not need to restrict potassium intake; instead, this patient may be prescribed oral potassium supplementation because of hypokalemia caused by dialysis. The patient need not restrict protein or fluid intake. The patient should include enough protein in the diet to compensate for loss of protein in dialysate. The patient may even take liquid or powdered breakfast drinks in case of inadequate protein intake. Patients on hemodialysis have a more restricted fluid intake than patients receiving peritoneal dialysis (PD). Text Reference - p. 1118

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. The nurse should know that ultrafiltration in peritoneal dialysis is achieved by which method? 1 Increasing the pressure gradient 2 Increasing osmolality of the dialysate 3 Decreasing the glucose in the dialysate 4 Decreasing the concentration of the dialysate

2 Ultrafiltration in peritoneal dialysis is achieved by increasing the osmolality of the dialysate with additional glucose. In hemodialysis the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration. Decreasing the concentration of the dialysate in either peritoneal or hemodialysis will decrease the amount of fluid removed from the blood stream. Text Reference - p. 1118

Routine urinalysis for a diabetic patient reveals moderate proteinuria. What further tests help to identify decreased kidney function at an early stage? Select all that apply. 1 Serum creatinine 2 Glomerular filtration rate (GFR) 3 Renal ultrasound 4 Evaluation of microalbuminuria 5 Magnetic resonance angiography (MRA)

2, 3, 4 If routine urinalysis indicates moderate to severe proteinuria, the preferred way of determining kidney functions is by assessing the GFR. An ultrasound of the kidneys is usually done to detect any obstructions and to determine the size of the kidneys. A patient with diabetes needs to have a further examination of the urine for microalbuminuria. The patient may not have an increase in serum creatinine until there is a decrease of 50% or more in kidney function. MRA study with the contrast media gadolinium is generally not advised unless the ultrasound or computed tomography (CT) does not provide the information needed. Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors. Text Reference - p. 1104

A patient with chronic kidney disease is at risk for anemia. Arrange the events in the order in which they lead to anemia caused by chronic kidney disease. 1. Bone marrow fibrosis 2. Elevated levels of parathyroid hormone (PTH) 3. Inhibition of erythropoiesis 4. Shortened survival of red blood cells (RBCs)

2, 3, 4, 1 Elevated levels of PTH, produced to compensate for low serum calcium levels, can inhibit erythropoiesis, shorten the survival of RBCs, and cause bone marrow fibrosis, which can result in a decrease in hematopoietic cells. Text Reference - p. 1109

The patient's glomerular filtration rate (GFR) is 15 mL/min. What are the treatment options the nurse would expect the health care provider to discuss with the patient? Select all that apply. 1 Nephrectomy 2 Hemodialysis 3 Peritoneal dialysis 4 Kidney transplant in place of dialysis 5 Continuous ambulatory peritoneal dialysis

2, 3, 5 Any dialysis option would be appropriate for the patient. A nephrectomy is not going to cure the chronic kidney disease, and it is unknown whether the kidney has a tumor or cancer with this question. Kidney placement in place of dialysis at this point is too late. Dialysis needs to begin while awaiting a kidney transplant. Text Reference - p. 1117

A patient with acute kidney injury has been admitted to the hospital, and the nurse observes the electrocardiogram (ECG) reading shows tall peaked T waves, ST depression, and QRS widening. What nursing interventions should the nurse perform for this patient?? Select all that apply. 1 Ensure potassium intake of 50 mEq/day. 2 Administer regular insulin intravenously. 3 Administer sodium bicarbonate. 4 Administer diuretics as ordered. 5 Administer calcium gluconate intravenously.

2, 3, 5 ECG readings for this patient are indicative of cardiac changes due to hyperkalemia induced by acute kidney injury. Regular insulin, administered intravenously, helps the potassium to move into the cells. Sodium bicarbonate corrects the acidosis and causes the potassium to shift into the cells. Calcium gluconate raises the threshold for excitation, protecting the heart. The potassium intake should be limited to 40 mEq/day. Diuretics are not effective in hyperkalemia. Text Reference - p. 1105

A patient with chronic kidney disease has developed uremic syndrome. What complications should the nurse anticipate due to an increase in blood urea levels? Select all that apply. 1 Anemia 2 Pericarditis 3 Hypertension 4 Pulmonary edema 5 Hemorrhagic tendencies

2, 5 Uremic pericarditis is one of the cardiac complications of chronic renal failure. Uremia can cause qualitative defects in platelet function, thereby predisposing the patient to hemorrhages. Anemia is caused by decreased production of erythropoietin from the kidneys. Hypertension is caused by sodium retention and increased extracellular fluid volume. Pulmonary edema could be a consequence of both fluid overload and hypertension. Text Reference - p. 1117

The registered nurse is teaching a student nurse about physiologic changes in a kidney transplant recipient. Which statement made by the student nurse indicates the need for further teaching? 1 "The urinary output of the patient can be 1 L/hour." 2 "There may be an imbalance in the electrolyte levels." 3 "Decrease in the urine output after surgery can be neglected." 4 "Normal saline solution is infused to treat metabolic acidosis."

3 A decrease in the urine output after healthy kidney transplantation indicates rejection, dehydration, or urinary leakage. This is a serious condition and should be reported to the primary health care provider. An increased urine output of 1 L/hour after kidney transplant indicates proper functioning of the transplanted kidney. Due to increased elimination, electrolyte imbalance can. Normal saline solution should be infused to the patient to rectify metabolic acidosis caused by delayed kidney function. Text Reference - p. 1127

The nurse provides information to a nursing student about the administration of erythropoietin (EPO) therapy to a patient with chronic kidney disease (CKD). Which statement made by the nursing student indicates effective learning? 1 "EPO benefits a patient with plasma ferritin concentrations less than 100 mg/mL." 2 "EPO should be administered in higher doses to a patient with low hemoglobin levels." 3 "EPO, iron, sucrose, and folic acid of 1 mg/day should be administered to patients undergoing hemodialysis." 4 "EPO can be safely given to a patient that takes an antihypertensive and maintains a blood pressure of 150/90 mm Hg."

3 A patient with chronic kidney disease (CKD) develops anemia due to decreased production of erythropoietin (EPO). Exogenous erythropoietin helps replenish the erythropoietin demand. Iron supplements for a patient with low plasma ferritin levels prevent the patient from developing an iron deficiency from the increased demand for iron to support erythropoiesis. A folic acid supplement is given to patients on hemodialysis because it is required for red blood cell (RBC) formation, and is removed by dialysis. A high dosage of EPO should be avoided for a patient with anemia because of increased risk of thromboembolic events and death from cardiovascular effects. The recommendation is to use the lowest possible dose of EPO to treat anemia. EPO should be avoided for a patient with uncontrolled hypertension because it exacerbates hypertension by increasing blood viscosity. Text Reference - p. 1113 Topics

What is a clinical manifestation of nephrogenic systemic fibrosis? 1 Pruritus 2 Urticaria 3 Scaling of skin 4 Hyperpigmentation

4 Signs of nephrogenic systemic fibrosis include hyperpigmentation of the skin, induration, and joint contractures. Pruritus, urticaria, and scaling of the skin are not clinical signs of nephrogenic systemic fibrosis. Text Reference - p. 1103

The nurse reviews the medical record of a patient with chronic kidney disease (CKD) and notes a history of taking cholecalciferal, a vitamin D level of 20 mg/mL, a calcium level of 13 mg/dL, and a phosphorous level of 5 mg/dL. Based on the laboratory results, the nurse anticipates that what medication will be prescribed? 1 Calcitriol 2 Calcium acetate 3 Sevelamer carbonate 4 Polystyrene sulfonate

3 A patient with chronic kidney disease (CKD) may have low vitamin D levels. Vitamin D supplementation using cholecalciferol is recommended for patients who have vitamin D levels less than 30 mg/dL, but it can cause hypercalcemia. The laboratory reports of the patient show a calcium level of 13 mg/dL and a phosphorous level of 5 mg/dL, which are higher than normal values (calcium 8.6 to 10.2 mg/dL and phosphorous 2.4 to 4.4 mg/dL). Therefore, the patient should be given non-calcium-based phosphate binders such as sevelamer carbonate to lower the phosphate levels. Calcitriol is an activated form of vitamin D, which is indicated for severe hypocalcemia in CKD. It may further aggravate hypercalcemia and hyperphosphatemia on administration. Calcium acetate is a calcium-based phosphate binder, which may further increase calcium levels, leading to hypercalcemia. Polystyrene sulfonate is a potassium-binding agent used in patients with severe hyperkalemia. Text Reference - p. 1113

The dialysis nurse is administering hemodialysis to a patient with chronic kidney failure. For what common complication should the nurse carefully monitor in this patient? 1 Hernias 2 Pneumonia 3 Hypotension 4 Lower back pain

3 A rapid removal of fluid results in reduced vascular volume, which can lead to a decreased cardiac output and decreased vascular resistance. Therefore, hemodialysis has the potential to cause hypotension during the process. Peritoneal dialysis is associated with hernias, lower back pain, and pneumonia, due to increased intraabdominal pressure while infusing the dialysate and decreased lung expansion caused by frequent upward displacement of the diaphragm. Text Reference - p. 1122

The nurse is caring for a patient with acute kidney injury and secondary hypertension. The urine output is 0.1 mL/kg/hr over 6 hours. The primary health care provider identifies atheroembolic renal disease. Which laboratory finding supports this conclusion? 1 Increased basophils 2 Increased monocytes 3 Increased eosinophils 4 Increased lymphocytes

3 An increased eosinophil level in the laboratory report is an indicator of atheroembolic renal disease, which supports the primary health care provider's conclusion. Increased levels of basophils, monocytes, and lymphocytes are not associated with atheroembolic renal disease. Test-Taking Tip: Patients with acute kidney injury have a risk of acquiring infection. Apply your knowledge and skill to answer the question. Text Reference - p. 1104

The nurse is caring for a patient with severe burns in the emergency department. His laboratory values reveal serum creatinine level of 5 mg/dL, and the glomerular filtration rate (GFR) has decreased by 75%. What stage of acute kidney failure is this patient exhibiting? 1 Risk 2 Injury 3 Failure 4 Loss

3 As per the RIFLE (Risk, Injury, Failure, Loss, and End-stage) classification for staging acute kidney injury, this patient is at the Failure stage. When the GFR has decreased by 25%, the patient is at the Risk stage. The patient with a GFR that has decreased by 50% is at the Injury stage. The patient with persistent acute kidney failure experiences a complete loss of kidney function and is at the Loss stage. Text Reference - p. 110

Which condition is seen in patients with bilateral ureteral obstruction? 1 Oliguria 2 Prostate cancer 3 Hydronephrosis 4 Diabetic gastroparesis

3 Bilateral ureteral obstruction results in dilation of the kidneys, which is called hydronephrosis. Oliguria is a sign of acute kidney injury. Prostate cancer is a postrenal cause of acute kidney injury. Diabetic gastroaresis is a manifestation of chronic kidney disease. Text Reference - p. 1103

The nursing instructor asks the student nurse about fluid and electrolyte changes that occur in a patient with an acute kidney injury. Which statement by the student nurse indicates effective learning? 1 "The patient will have hypokalemia." 2 "The patient will have hypernatremia." 3 "The patient will have increased serum creatinine levels." 4 "The patient will have decreased levels of blood urea nitrogen."

3 Creatinine is a waste product of muscle catabolism. Patients with acute kidney injury cannot remove body waste and it accumulates in the blood, which raises the serum creatinine level. Acute kidney injury is associated with an increased level of potassium, a decreased level of sodium, and a decreased level of blood urea nitrogen. Thus, the statements that the patient will have hypokalemia, hypernatremia, and decreased levels of blood urea nitrogen are incorrect. Text Reference - p. 1104

The nurse is educating a patient about the insertion of a catheter with a Dacron cuff for delivery of peritoneal dialysis. What rationale should the nurse provide detailing the benefit of this type of catheter? 1 To remove nonprotein solutes 2 To propel blood through the circuit 3 To prevent the migration of microorganisms 4 To act as a bridge between arterial and venous blood

3 Dacron cuffs acts as anchors and prevent the migration of microorganisms into the peritoneal cavity. Hemofilters in continuous renal replacement therapy (CRRT) remove nonprotein solutes and plasma water. Blood pumps are a part of CRRT; they are used to pump blood through the circuit. Grafts are used in hemodialysis to separate the blood from arteries and veins. Text Reference - p. 1118

The nurse recognizes that which medication is appropriate to give to patients with kidney failure? 1 Magnesium antacids 2 Aluminum preparations 3 Angiotensin receptor blockers 4 Nonsteroidal antiinflammatory agents

3 Hypertension is a common finding in a patient with kidney failure due to retention of sodium and water. This is treated with angiotensin receptor blockers. Magnesium antacids may aggravate hypermagnesemia in patients with kidney failure. Aluminum preparations should be used with caution in patients with chronic kidney disease because they are associated with bone diseases, such as osteomalacia. Nonsteroidal antiinflammatory agents are nephrotoxic, and should not be administered to patients with renal failure because they can cause acute kidney injury. Text Reference - p. 1113

A nurse has to determine the volume of fluid that must be administered to the patient with acute renal failure who is in the oliguric phase. The total urine output of the patient the previous day was 250 mL. What should be the fluid allocation for this patient on this day? Record your answer using a whole number. __ mL

850 The patient is at a risk of developing hypovolemia, and to prevent this, adequate fluid resuscitation should be done. To determine the volume for fluid resuscitation, the nurse adds together all losses during the previous 24 hours (e.g., urine, diarrhea, emesis, blood) and adds 600 mL for insensible losses (e.g., respiration, diaphoresis). Text Reference - p. 1105

A primary health care provider has ordered frequent magnetic resonance imaging using a gadolinium contrast agent in a patient with kidney failure. The patient reports darkness of the skin, joint pain, and limited joint movement. What condition does the nurse suspect? 1 Asterixis 2 Hydronephrosis 3 Nephrogenic systemic fibrosis 4 Contrast-induced nephropathy

3 Nephrogenic systemic fibrosis is caused by the administration of gadolinium to patients with kidney failure; signs include hyperpigmentation of the skin and joint contractures. Asterixis is characterized by a tremor-like condition upon stretching of the wrist. Hydronephrosis is caused by bilateral ureteral obstruction. Contrast-induced nephropathy is a kidney injury caused by the injection of contrast agents during surgery or diagnostic testing. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 1105

A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. What is an expected assessment finding for this patient during this early stage of recovery? 1 Hypokalemia 2 Hyponatremia 3 Large urine output 4 Leukocytosis with cloudy urine output

3 Patients frequently experience diuresis (a large volume of urine output) in the hours and days immediately following a kidney transplant. Hypokalemia, hyponatremia, and signs of infection are unexpected findings that warrant prompt intervention. Text Reference - p. 1127

Which statement about acute kidney injury is correct? 1 Parenchymal damage occurs in prerenal oliguria. 2 Prerenal azotemia results in increased sodium excretion. 3 Prerenal oliguria is caused by decreased circulatory volume. 4 Prerenal causes of acute kidney injury increase the glomerular filtration rate.

3 Prerenal oliguria is caused by a decrease in the circulatory volume due to dehydration and congestive cardiac failure. Parenchymal damage does not occur in prerenal oliguria. Prerenal azotemia results in decreased sodium excretion, which leads to increased sodium and water retention. Reduced systemic circulation is a prerenal cause that leads to a decrease in the blood flow to the kidneys. Therefore, the glomerular filtration rate also decreases. Text Reference - p. 1102

The registered nurse is teaching a student nurse about the criteria for a deceased donor to donate an organ. Which student nurse's statement indicates effective learning? 1 "Diabetes mellitus has no effect on organ transplant." 2 "Immunocompromised donors can donate their organs." 3 "Donors should be free from active intravenous drug abuse." 4 "Donors with compromised cardiovascular health can be included."

3 The deceased donor should be free from active intravenous drug use. Donors with a long history of diabetes mellitus, autoimmune disorders, and defective cardiovascular functions cannot donate organs. Text Reference - p. 1125

The student nurse is observing the administration of peritoneal dialysis by the dialysis nurse. What statement made by the student to the nurse demonstrates understanding about the dialysis process? 1 "The use of a hemofilter will return blood back to the patient." 2 "The Dacron cuff will return blood from the dialyzer back to the patient." 3 "The red catheter lumen will return blood from the dialyzer back to the patient." 4 "The blue catheter lumen will return blood from the dialyzer back to the patient."

4 A blue catheter lumen returns blood from the dialyzer back to the patient. A hemofilter is a part of the continuous renal replacement therapy (CRRT), which removes nonprotein solutes and plasma water. A Dacron cuff is used to fix the catheter in place in peritoneal dialysis. A red catheter lumen is used to withdraw blood from the patient and send it to the dialyzer for purification. Text Reference - p. 1121

A patient with a glomerular filtration rate (GFR) of 30 mL/min has a hemoglobin of 5 g/dL. The peripheral smear tests show that the red blood cells are normocytic and normochromic. The nurse suspects that which physiologic change led to this condition? 1 Reduced excretion of potassium 2 Increased extracellular fluid volume 3 Defective reabsorption of bicarbonate 4 Decreased production of erythropoietin

4 A patient with a glomerular filtration rate (GFR) of 30 mL/min has stage 3 chronic kidney disease (CKD). Normocytic normochromic anemia is common in patients with CKD due to reduced production of the erythropoietin hormone by the kidneys. Erythropoietin stimulates precursor cells in the bone marrow and helps in production of red blood cells. The patient with CKD may have a high serum potassium level, which can cause fatal dysrhythmias. An increase in extracellular fluid volume may lead to hypertension in patients with CKD. Metabolic acidosis may occur in CKD patients with defective reabsorption and regeneration of bicarbonate. Text Reference - p. 1109

The nurse recalls that the reason that patients with chronic kidney disease experience arterial stiffness is what? 1 Excessive sodium retention 2 Decrease in the sodium bicarbonate level 3 Increase in nitrogenous waste products 4 Excessive calcium deposition in vascular smooth layer

4 A patient with chronic kidney disease (CKD) may have arterial stiffness due to calcium deposition in the vascular smooth layer of the blood vessels. Excessive sodium retention causes extracellular fluid accumulation that leads to hypertension and edema. Decrease in the sodium bicarbonate level in the body leads to metabolic acidosis. Accumulation of the nitrogenous waste products leads to neurologic complications. Text Reference - p. 1110

The nurse reviews a plan of care for a patient with diagnosis of chronic kidney disease who is undergoing hemodialysis. Which part of the plan should the nurse question? 1 2-g sodium diet 2 Oxygen via nasal cannula at 4 L/min 3 Furosemide (Lasix) 40 mg PO twice a day 4 IV of 0.9% sodium chloride at 125 mL/hour

4 A patient with chronic kidney disease (CKD) should receive limited fluids because the kidneys are unable to remove excessive water. An IV solution of 0.9% sodium chloride at a rate of 125 mL/hr places this patient at high risk for complications such as fluid overload, electrolyte imbalance, and hypertension. A 2-g sodium diet, oxygen, and furosemide (Lasix) would be appropriate if prescribed for a patient with CKD. Text Reference - p. 1115

The nurse identifies that which drug should be used with caution in a patient with renal failure? 1 Cinacalcet 2 Paricalcitol 3 Gemfibrozil 4 Vancomycin

4 A patient with renal failure has a reduced ability to eliminate metabolites and drugs. Therefore, drugs like vancomycin, which are mainly excreted by the kidney, need to be used with caution and monitoring for accumulation and potential drug toxicity is necessary. Cinacalcet is a calcimimetic agent that helps to control secondary hyperparathyroidism. Paricalcitol is an active vitamin D supplement that helps to control elevated levels of parathyroid hormone and is used for treating secondary hyperparathyroidism in patients with end stage chronic kidney disease. Gemfibrozil helps to reduce triglyceride levels and increases high-density cholesterol in patients with chronic kidney disease. Text Reference - p. 1114

Which finding indicates nonoliguria? 1 Urinary output of 200 mL/day 2 Urinary output of 300 mL/day 3 Urinary output of 400 mL/day 4 Urinary output of 500 mL/day

4 A urine output greater than 400 mL/day is a sign of nonoliguria. Thus a urine output of 500 mL/day indicates nonoliguria. A urine output of 200 or 300 mL/day indicates oliguria. A urine output of 400 mL per day indicates that the patient is at risk for oliguria. Text Reference - p. 1103

A registered nurse is teaching a trainee nurse about the parameters to be assessed in a patient with acute kidney injury who is undergoing dialysis. Which statement by the trainee nurse indicates a need for further teaching? 1 "I should auscultate patient's lung sounds." 2 "I should record the patient's input and output." 3 "I should assess for any change in the patient's skin color." 4 "I should examine the patient's mouth for a change in color."

4 Acute kidney injury is associated with dry mouth and inflammation and is caused by increased levels of ammonia in the saliva. The nurse should examine the mouth for inflammation and dryness. Therefore, the trainee nurse's statement about examining the mouth for a change in color indicates a need for further teaching. Because of renal impairment, fluid can accumulate in the lungs and result in difficulty breathing. Therefore, the nurse should auscultate the patient's lung sounds. Recording the patient's input and output will help to determine the efficacy of the treatment. Acute kidney injury is also associated with hyperpigmentation; thus the nurse should assess for changes in the patient's skin color. Test-Taking Tip: Acute kidney injury is associated with increased amounts of nitrogenous waste in blood and secretions. Use this tip to answer the above question. Text Reference - p. 1106

The nurse performs an admission assessment of a patient with acute renal failure. For which common complication does the nurse assess the patient? 1 Polyphagia 2 Hypernatremia 3 Hypotensive shock 4 Cardiac dysrhythmias

4 Because the kidneys are not effectively removing waste products, including electrolytes, an increased potassium level (hyperkalemia) of more than 5.0 mEq/L is common in acute renal failure and places the patient at risk for cardiac arrhythmias. Patients usually experience anorexia, not an increase in hunger. Acute renal failure will likely manifest as hyponatremia. Hypotensive shock may be the result of a severe cardiac arrhythmia that is not treated. Text Reference - p. 1105

Which condition should the nurse suspect in a patient with chronic kidney disease (CKD) who develops osteomalacia? 1 Asterixis 2 Uremic frost 3 Gastroparesis 4 Uremic red eye

4 Chronic kidney disease mineral and bone disorder (CKD-MBD) is a common complication of CKD and results in both skeletal and extraskeletal complications. Osteomalacia is a skeletal complication. Calcium deposition in the eye may create irritation leading to uremic red eye, an extraskeletal complication. Asterixis (hand-flapping tremor) occurs due to motor neuropathy. Uremic frost is the crystallization of urea on the skin when blood urea nitrogen levels are elevated to 200 mg/dL. Gastroparesis (delayed gastric emptying) compounds the effect of malnutrition for patients with diabetes. Text Reference - p. 1111

The registered nurse is teaching a trainee nurse about the use of renal replacement therapy (RRT). Which statement by the trainee nurse indicates effective learning? 1 "RRT is performed in patients with hypokalemia." 2 "RRT is advised for patients with metabolic acidosis." 3 "RRT is recommended in patients with hypovolemia." 4 "RRT is recommended if there is a pericardial effusion."

4 Pericardial effusion is an abnormal accumulation of fluid inside the pericardial cavity; this condition is caused by increased blood volume. Renal replacement therapy (RRT) is recommended because the kidneys are unable to function properly. RRT is recommended in hyperkalemic, not hypokalemic, conditions. RRT does not alleviate the effects of metabolic acidosis. RRT is advised in patients with fluid overload, not hypovolemia. Test-Taking Tip: Renal replacement therapy is used in patients with impaired renal function, because the fluid volume increases in the body. Use this tip to answer the question. Text Reference - p. 1106

The nurse is caring for a patient undergoing peritoneal dialysis. What finding should the nurse report to the primary health care provider that would indicate peritonitis? 1 Oliguria 2 Hyperkalemia 3 Hyponatremia 4 Abdominal pain

4 Peritonitis is caused by either a Staphylococcus aureus or a Staphylococcus epidermidis infection. It is manifested by abdominal pain, cloudy peritoneal effluent, and increased white blood cell count. Oliguria, hyperkalemia, and hyponatremia are complications associated with acute kidney injury. Text Reference - p. 1119

The nurse preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD) should know that this medication should have a beneficial effect on which laboratory value? 1 Sodium 2 Potassium 3 Magnesium 4 Phosphorus

4 Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore, administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with CKD. Calcium acetate will not have an effect on sodium, potassium, or magnesium levels. Text Reference - p. 1113

Which condition is a result of severe metabolic acidosis in patients with acute kidney injury? 1 Asterixis 2 Proteinuria 3 Hydronephrosis 4 Kussmaul respirations

4 Severe acidosis causes a patient to take deep and rapid breaths—called Kussmaul respirations—in an effort to increase the exhalation of carbon dioxide. Asterixis is a neurologic change associated with acute kidney injury due to the accumulation of metabolic waste in the brain and nervous system. Dysfunction of the glomerular membrane due to acute kidney injury leads to proteinuria. Hydronephrosis refers to dilation of the kidneys and is a postrenal cause of acute kidney injury. Text Reference - p. 1104

A patient with chronic kidney disease has an arteriovenous (AV) graft in the right forearm. What is the nurse's priority in determining the patency of the graft? 1 Determine the range of motion of the right arm and shoulder 2 Observe for clubbing of the fingers on the right hand of the AV graft site 3 Compare radial pulses by checking the right and left pulses simultaneously 4 Check for a bruit by listening over the right arm AV graft site with a stethoscope

4 The arteriovenous (AV) graft is an artificial connection between an artery and vein to provide access for hemodialysis. Thrombosis may occur; therefore the need to determine patency is an essential assessment. Palpation of the site should indicate a thrill, which also indicates that the graft is patent. Listening over the AV graft should reveal a bruit sound, indicating patency. A bruit sounds similar to the impulse beat heard when measuring blood pressure. The arm that has the AV graft site should not be put through range-of-motion movements or exercises. Clubbing is not a complication observed in the fingers of a patient with an AV graft. Comparing the left radial pulse with the pulse on the AV graft site is not an accurate patency assessment procedure. Text Reference - p. 1120

Which is a manifestation of a mild form of acute kidney injury? 1 Increased urine output 2 Increased nitrogen level 3 Increased potassium level 4 Increased serum creatinine level

4 The mildest form of acute kidney injury is characterized by increased serum creatinine levels. Kidney injury is associated with decreased urine output, not increased urine output. Increased levels of potassium and nitrogen are characteristics of a severe form of acute kidney injury. Text Reference - p. 1102

A patient is being administered 15 g sodium polystyrene sulfonate (Kayexalate) orally for hyperkalemia. Which intervention should the nurse perform? 1 Observe the patient for iron overload. 2 Inform the patient that constipation is an expected side effect. 3 Provide magnesium-containing antacids. 4 Report peaked T waves in electrocardiogram (ECG)

4 The nurse should report changes to the health care provider in the ECG, such as peaked T waves and widened QRS complexes; dialysis may be required to remove excess potassium. Monitoring for iron overload is a consideration for blood transfusions, but not for administration of sodium polystyrene sulfonate. The nurse should warn the patient that this treatment will often cause diarrhea because the preparation contains sorbitol, a sugar alcohol that has an osmotic laxative action. Magnesium-containing antacids should not be prescribed for patients with chronic kidney disease because magnesium is excreted by the kidneys. Text Reference - p. 1112

The nurse recognizes that which medication is the most appropriate for a patient with chronic kidney disease (CKD) who has a glycosylated hemoglobin of 5%, blood pressure of 140/95 mm Hg, and whose urinalysis reveals the presence of protein? 1 A diuretic 2 A calcimimetic agent 3 A calcium channel blocker 4 An angiotensin receptor blocker

4 A patient with glycosylated hemoglobin of 5%, blood pressure of 140/95 mm Hg, and protein in the urine has hypertension with nondiabetic proteinuria. The patient can take angiotensin-receptor blockers and angiotensin-converting-enzyme (ACE) inhibitors. These medications help to decrease proteinuria and delay the progression of chronic kidney disease (CKD). Diuretics help control elevated blood pressure in patients with CKD but do not have an effect on proteinuria. Calcimimetic agents help to control secondary hyperparathyroidism by increasing the sensitivity of the calcium receptors in the parathyroid glands. They are not used for treatment of hypertension, diabetes, or proteinuria. Calcium channel blockers also do not have an effect on proteinuria. Text Reference - p. 1113