Med/Surg Chapter 71-renal

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

"Avoid taking NSAIDs."

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

"Do you take any nonprescription medications?"

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

"I will take my stool softeners every day."

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

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

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

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

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

"Take blood pressure in the left arm."

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

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

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

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

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

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

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

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

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

Absence of lung crackles

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

Albumin level of 2 g/dL

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

Blood pressure

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

Check the serum potassium level.

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

Client diagnosed with renal calculi

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

Collect a sample to send to the laboratory.

A client's temperature after dialysis is 99° F (37.2° C) and was normal before dialysis. Which is the nurse's best action?

Continue to monitor the temperature.

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

Discussing with the client his or her acceptance of the disease

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

Draining of pericardial fluid with a needle

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

Feeling of urgency

During a hot summer day, an older adult client tells the clinic nurse, "I am not drinking or voiding that much these days." The nurse notes a heart rate of 100 beats/min and a blood pressure of 90/60 mm Hg. Which action does the nurse take first?

Give the client something to drink.

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

Hematoma at cannula insertion site

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

Herbs and spices

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

Hold all medications until after dialysis.

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

Increased dose of immune suppressive drugs

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

Intake and output

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

Nonoliguric

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

Obtain an oxygen saturation level.

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

Oliguric

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

Pericarditis

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

Place the client in high Fowler's position.

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

Prepare to administer phenytoin (Dilantin),

A client was just admitted to the emergency department for new-onset confusion. As the nurse starts the IV line, the client says he just finished a hemodialysis session. The IV site is bleeding briskly. What action by the nurse takes priority?

Prepare to administer protamine sulfate.

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

Psychiatric nurse practitioner

Which staff member does the charge nurse assign to care for a client newly diagnosed with chronic kidney disease?

Registered nurse who has taken care of this client before

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

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

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

Respiratory rate of 40 breaths/min

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

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

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

Send a specimen for culture and sensitivity.

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

Serum creatinine level of 1.9 mg/dL

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

Sodium

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

Start an IV of normal saline as ordered.

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

Using sterile technique when hooking up dialysate bags

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

Weight and blood pressure