Review Exam 5 (Ch.34)

A client with a diagnosis of end-stage renal disease received a kidney transplant 2 years ago that was deemed a success. During the most recent follow-up appointment, the nurse should prioritize the client for referral based on which statement?

"I'm feeling a bit under the weather these days and I'm a bit feverish." - suspectibe to infection

A client states, "I see my provider prescribed an glomerular filtration rate (GFR) to my usual blood work. Do you have to take an additional sample?" How should nurse respond?

"No additional sample is needed. The GFR can be calculated from your blood creatinine level."

With the increased risk of drug toxicity among chronically ill older adults, which statement by the nurse explains why the older adult's kidney is vulnerable to toxic injury?

"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney."

The nurse is preparing to assess a client who has just been admitted to the hospital with a diagnosis of prerenal failure. Which would the nurse expect the client to manifest? Select all that apply.

- Decreased urinary output - Increased BUN - BUN-to-serum creatinine ratio of greater than 20:1

The nurse knows that a client with chronic kidney disease (CKD) may experience which changes in skin integrity? Select all that apply.

- Pale skin - Brittle fingernails - Decreased perspiration *due to loss of erythropoietin activity

A client with chronic kidney disease (CKD) is anemic. The nurse will attempt to alleviate the anemia in order to prevent which of the following? Select all that apply.

- Tachycardia - Fatigue - Decreased myocardial oxygen

Intrarenal Kidney Injury - causes

- acute tubular necrosis(destroys tubular, inability to concrete urine)/acute renal injury *prolonged renal ischemia *exposure to nephrotoxic drugs, heavy metals, and organic solvents *obstructions *acute renal dz ( glomerulonephritis, pyelonephritis)

postrenal kidney injury - causes

- bilateral ureteral obstruction (kidney stone, turmor, BHP, nerve intervation, scar tissue, infections) - bladder outlet obstruction - urethral blockage *autoimmune dz (lupus),aging, liver dz, UTI's

postrenal kidney injury - s/s

- decreased urinary output *weak stream, pain/pressure, abdominal distention, strain, incomplete bladder emptying

Prerenal Kidney Injury - s/s

- decreased urine output - elevation of BUN, with a change in creatine

renal failure - treatment

- dialysis (hemodialysis and peritoneal) - transplant - dietary managment (protein restriction, carbs, fats, calories, potassium, sodium and fluid intake)

Prerenal Kidney Injury - causes

- hypovolemia (hemorrhage/trauma, dehydration, D/V, fluid loss from burn injury) - decreased vascular filling (anaphylactic shock, septic shock) causes vasodialation - heart failure - sepsis, drugs, diagnostic agents

renal failure - manifestations

- sodium and water balance - potassium balance - elimination of nitrogenous wastes - erythropoietin production - acid-base balance - activation of vitamin D - phosphate elmination

renal failure - prevention

- treating UTI's promptly - avoid meds with renal damaging potential - controlling blood pressure - controlling blood sugar with those with DM - stop smoking - monitor GFR

chronic renal disease - causes

1. DM, 2. HTN, PKD, obstructions of UT, glomerulonephritis, cancers, autoimmune disorders, dz of heart and lungs

Accumulation of nitrogenous wastes such as urea in the circulatory system is an early sigh of chronic kidney disease (CKD). The nurse knows that normal levels of urea in blood are approximately:

20 mg/dL (7.14 mmol/L)

Renal failure

A condition in which the kidneys fail to remove metabolic end products from the blood and are unable to regulate fluid, electrolyte, and pH balance. - acute: abrupt, reversible - chronic: slow, irreversible; recongized when progressed

A client has been diagnosed with chronic kidney disease (CKD). Which drug category is usually administered to treat coexisting conditions that manifest early in CKD?

Antihypertensive medications - hypertension is a s/s

Manifestations of childhood renal disease are varied and may differ from adult-onset renal failure. A school-aged child with chronic kidney disease may exhibit which manifestation?

Developmental delays such as uncoordinated gait and minimal fine motor skills

The nurse is instructing a client with advanced kidney disease (AKD) about a dietary regimen. Which restriction should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD?

Dietary protein - Proteins are broken down to form nitrogenous wastes, and reducing the amount of protein in the diet lowers the blood urea nitrogen and reduces symptoms.

A 1-year-old baby boy with renal dysplasia risks end-stage renal disease unless intervention occurs. Which treatment option is his care team most likely to reject?

Dietary restriction plus erythropoietin

A client is beginning to recover from acute tubular necrosis. During which phase of acute kidney injury will the nurse assess an increase in urine output?

Diuretic phase

A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is:

Dorsiflexion of hands and feet

The health care provider is reviewing laboratory results of a client. Select the diagnostic test that is considered the best measurement of overall kidney function.

Glomerular filtration rate (GFR) - estimated using the serum creatinine concentration.

A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?

Hypertension - increased vascular volume, increased peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins, and increased activity of the renin-angiotensin-aldosterone system.

Prerenal Kidney Injury - nursing interventions

IV fluids, transfusions of blood, vasoconstrictor

A client diagnosed with CKD has begun to experience periods of epistaxis (nosebleed) and has developed bruising of the skin and subcutaneous tissues. The nurse recognizes these manifestations as:

Impaired platelet function

A client with postrenal acute kidney injury (AKI) exhibits oliguria and edema with laboratory results revealing increased levels of urea, potassium, and creatinine. Based on these data, which phase of AKI is this client most likely experiencing?

Oliguric phase

A client with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which condition does the nurse suspect is common with this stage of kidney disease?

Pericarditis - occurs in many people with stage 5 CKD due to the uremia and prolonged dialysis.

While assessing a peritoneal dialysis client in the home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as:

Peritonitis - Potential problems with peritoneal dialysis include infection, catheter malfunction, dehydration, hyperglycemia, and hernia.

The nurse recognizes that acute renal injury is characterized by which of the following?

Rapid decline in renal function - BUN rises as nitrogenous wastes are not removed from the circulation. If the cause can be ameliorated, the injury is usually reversible. Most at risk are seriously ill clients; the mortality rate is between 40% and 90% in these clients.

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?

Serum creatinine

A client is to receive a radiocontrast media as part of a diagnostic scan. Which intervention is intended to reduce the nephrotoxic effects of the radiocontrast media?

increasing the normal saline intravenous infusion rate prior to the exam - because some decrease renal flow

A client with chronic kidney disease (CKD) will be managed with peritoneal dialysis. Which description of this type of dialysis is most accurate?

Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time.

The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents:

a loss of over half the client's normal kidney function. - 20 is normal

chronic renal disease

a pathophysiologic process that results in the loss of nephrons and a decline in renal function *hard to recongize because in early stages is asymptomic

Acute kidney injury occurs at a high rate in client who are critically ill and in the intensive care unit. What is the most common indicator of acute kidney injury?

azotemia and a decrease in the glomerular filtration rate (GFR)

postrenal kidney injury

obstruction of the urine outflow from the kidney

The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney injury?

client with prostatic hyperplasia - BHP, most common UT obstruction

Intrarenal Kidney Injury

direct damage to the structure of the kidney (ex. infection/e coli., renal inflammation, nephritis

Prerenal Kidney Injury

distruption of flow, resulting in decreased renal blood flow

renal failure - special population

elderly, pre-renal defiency dz

chronic renal failure - s/s

headaches, decreased ability to concentrate urine, polyuria, oliguria, increased BUN & serum creatinine, edema, decreased GFR, anemia, increased BP, weakness and fatigue

A client with CKD has a GFR of 28 mL/min/1.73 m2. When teaching the client about dietary modifications, the nurse should recommend:

identifying and limiting phosphorus intake. - Phosphorus intake should be limited in clients with CKD. Potassium should usually be limited, not increased. Low protein intake is beneficial, but adequate caloric intake must be ensured. Fluid restriction is usually required, but 200 to 300 mL/day is not likely adequate.

An 86-year-old client is being treated for dehydration and hyponatremia after curtailing fluid intake to prevent urinary incontinence. Given these findings, the nurse recognizes that this client is likely in what phase of acute kidney injury?

prerenal

renal failure - underlying causes

renal disease, systemic disease, urologic defects of non-renal origin

Intrarenal Kidney Injury - s/s

sharp decline in GFR