NU142- Chapter 54: Management of Patients With Kidney Disorders

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse?

"Even a perfect match does not guarantee organ success."

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?

"Increase your carbohydrate intake."

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?

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

The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than ___________mL/kg/hr.

0.5

Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?

6

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?

A GFR of 30-59 mL/min/1.73 m2

A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client?

Anemia

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?

Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education?

Brief, hot daily showers

During hemodialysis, toxins and wastes in the blood are removed by which of the following?

Diffusion

The nurse recognizes which condition as an integumentary manifestation of chronic renal failure?

Gray-bronze skin color

A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess?

Hypertension

A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia?

Increase carbohydrates and limit protein intake.

What is a hallmark of the diagnosis of nephrotic syndrome?

Proteinuria

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.

Tall, peaked T waves

azotemia

abnormal concentration of nitrogenous waste products in the blood

glomerular filtration rate (GFR)

amount of plasma filtered through the glomeruli per unit of time

uremia

an excess of urea and other nitrogenous wastes in the blood

The nurse cares for a client diagnosed with chronic glomerulonephritis. The nurse will observe the client for the development of

anemia

nephrosclerosis

hardening of the renal arteries

Rejection of a transplanted kidney within 24 hours after transplant is termed

hyperacute rejection.

glomerulonephritis

inflammation of the glomerular capillaries

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder?

pH 7.20, PaCO2 36, HCO3 14-

hemodialysis

procedure during which a patient's blood is circulated through a dialyzer to remove waste products and excess fluid

peritoneal dialysis

procedure that uses the lining of the patient's peritoneal cavity as the semipermeable membrane for exchange of fluid and solutes

ultrafiltration

process whereby water is removed from the blood by means of a pressure gradient between the patient's blood and the dialysate

urinary casts

proteins secreted by damaged kidney tubules

A client has been diagnosed with acute glomerulonephritis. This condition causes:

proteinuria.

dialysate

the electrolyte solution that circulates through the dialyzer in hemodialysis and through the peritoneal membrane in peritoneal dialysis

anuria

total urine output less than 50 mL in 24 hours

acute tubular necrosis (ATN)

type of acute kidney injury in which there is damage to the kidney tubules

acute nephritic syndrome

type of kidney disease with glomerular inflammation

nephrotic syndrome

type of kidney disease with increased glomerular permeability and massive proteinuria

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:

weight loss.

Which of the following would a nurse classify as a prerenal cause of acute renal failure?

Septic shock

exchange

denotes a complete cycle including fill, dwell, and drain phases of peritoneal dialysis

polyuria

excessive urine production

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:

fatigue and weakness.

peritonitis

inflammation of the peritoneal membrane (lining of the peritoneal cavity)

interstitial nephritis

inflammation within the renal tissue

continuous cyclic peritoneal dialysis (CCPD)

method of peritoneal dialysis in which a peritoneal dialysis machine (cycler) automatically performs exchanges, usually while the patient sleeps

diffusion

movement of solutes (waste products) from an area of higher concentration to an area of lower concentration

arteriovenous graft

type of surgically created vascular access for dialysis by which a piece of biologic, semibiologic, or synthetic graft material connects the patient's artery to a vein

A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care?

Encourage use of incentive spirometer every 2 hours.

A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection?

Tenderness over transplant site

The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client?

Use an aseptic technique during the procedure.

Which of the following is the most accurate indicator of fluid loss or gain?

Weight

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level?

Administration of sodium polystyrene sulfonate [Kayexalate])

A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?

Hyperphosphatemia

The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client?

Keep the dialysis supplies in a clean area, away from children and pets

The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output?

Less than 400 mL

The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication?

With food

nephrotoxic

any substance, medication, or action that destroys kidney tissue

dialyzer

artificial kidney contains a semipermeable membrane through which particles of a certain size can pass

end-stage kidney disease (ESKD)

final stage of chronic kidney disease that results in retention of uremic waste products and the need for renal replacement therapies

chronic kidney disease

kidney damage or a decrease in the glomerular filtration rate lasting for 3 or more months

continuous ambulatory peritoneal dialysis (CAPD)

method of peritoneal dialysis whereby a patient manually performs exchanges or cycles throughout the day

osmosis

movement of water through a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration

acute kidney injury (AKI)

rapid loss of renal function due to damage to the kidneys formerly called acute kidney injury

arteriovenous fistula

type of vascular access for dialysis created by surgically connecting an artery to a vein

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?

Acute glomerulonephritis

A client is being cared for after a nephrectomy. Because of the incisional pain and restricted positioning, the client frequently suffers from breathing difficulty. Which measures should the nurse include in the care plan to relieve this distress? Select all that apply.

Help the client to breathe deeply and cough every 2 hours. Provide firm support for the incision when the client coughs.

Patient education regarding a fistulae or graft includes which of the following? Select all that apply.

Check daily for thrill and bruit. Avoid compression of the site. No IV or blood pressure taken on extremity with dialysis access. No tight clothing.

Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted.

Citrus fruits

The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take?

Hold the medications until after dialysis.

A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)?

Hydrating with saline intravenously before the test

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase?

Oliguria

During hemodialysis, excess water is removed from the blood by which of the following?

Osmosis

Which of the following occurs late in chronic glomerulonephritis?

Peripheral neuropathy

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?

Recent history of streptococcal infection

A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause?

Renal calculi

The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse?

Turn the client from side to side.

Which clinical finding should a nurse look for in a client with chronic renal failure?

Uremia

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?

White blood cell (WBC) count of 20,000/mm3

The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium?

Citrus fruits

effluent

term used to describe the drained fluid from a peritoneal dialysis exchange

oliguria

urine output less than 0.5 mL/kg/hr

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important?

Limiting fluid intake

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find?

Cola-colored urine

continuous renal replacement therapy (CRRT)

method used to replace normal kidney function in patients who are hemodynamically unstable by circulating the patient's blood through a hemofilter and returning it to the patient

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?

Tea-colored urine