SG CHAPTER 63: Concepts of Care for Patients with Acute Kidney Injury and Chronic Kidney Disease

1. A nurse is completing the admission assessment of a client who has renal calculi. Which of the following findings should the nurse expect? A. Bradycardia B. diaphoresis C. Nocturia d. Bradypnea

1. A. Tachycardia is a manifestation associated with a client who has renal calculi. B. CORRECT: diaphoresis is a manifestation associated with a client who has renal calculi. C. Oliguria is a manifestation associated with a client who has renal calculi. d. Tachypnea is a manifestation associated with a client who has renal calculi. NCLEX® Connection: Physiological Adaptation, Pathophysiology

2. A nurse is reviewing discharge instructions with a client who had spontaneous passage of a calcium phosphate renal calculus. Which of the following instructions should the nurse include in the teaching? (select all that apply.) A. Limit intake of food high in animal protein. B. reduce sodium intake. C. strain urine for 48 hr. d. report burning with urination to the provider. e. increase fluid intake to 3 L/day.

2. A. CORRECT: The client should limit the intake of food high in animal protein, which contains calcium phosphate. B. CORRECT: The client should limit intake of sodium, which affects the precipitation of calcium phosphate in the urine. C. The client does not need to continue straining urine once the calculus has passed. d. CORRECT: The client should report burning with urination to the provider because this can indicate a urinary tract infection. e. CORRECT: The client should increase fluid intake to 2 to 3 L/day. A decrease in fluid intake can cause dehydration, which increases the risk of calculi formation. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures

3. A nurse is teaching a client who is scheduled for extracorporeal shock wave lithotripsy (esWL). Which of the following statements by the client indicates understanding of the teaching? A. "i will be fully awake during the procedure." B. "Lithotripsy will reduce my chances of having stones in the future." C. "i will report any bruising that occurs to my doctor." d. "straining my urine following the procedure is important."

3. A. The client receives moderate (conscious) sedation for this procedure. The client is not fully awake. B. Lithotripsy does not decrease the recurrence rate of renal calculi. The procedure breaks the calculi into fragments so they will pass into urine. C. Bruising is an expected finding following lithotripsy and does not need to be reported to the provider. d. CORRECT: A client is instructed to strain urine following lithotripsy to verify that the calculi have passed. NCLEX® Connection: Basic Care and Comfort, Nutrition and Oral Hydration

4. A nurse is caring for a client who has a left renal calculus and an indwelling urinary catheter. Which of the following assessment findings is the priority for the nurse to report to the provider? A. Flank pain that radiates to the lower abdomen B. Client report of nausea C. Absent urine output for 1 hr d. Blood WBC count 15,000/mm3

4. A. Flank pain radiating to the lower abdomen is a finding associated with renal calculi, but there is another finding that is a greater risk to the client. B. Client report of nausea is a finding associated with renal calculi, but there is another finding that is a greater risk to the client. C. CORRECT: The greatest risk to this client is damage to the kidney resulting from obstruction of urine flow by the renal calculus. Therefore, the priority finding to report to the provider is anuria. d. An elevated serum WBC is a finding associated with renal calculus and can indicate a urinary tract infection, but there is another finding that is a greater risk to the client. NCLEX® Connection: Physiological Adaptation, Unexpected Response to Therapies

5. A nurse is completing discharge instructions with a client who has spontaneously passed a calcium oxalate calculus. To decrease the chance of recurrence, the nurse should instruct the client to avoid which of the following foods? (select all that apply.) A. red meat B. Black tea C. Cheese d. Whole grains e. spinach

5. A. A client who has renal calculi composed of calcium phosphate, struvite, uric acid, or cysteine should limit intake of animal protein. ✅B. CORRECT: A client who has renal calculi composed of calcium oxalate should avoid intake of black tea because it is a source of oxalate. C. A client who has renal calculi composed of calcium phosphate or struvite should limit intake of dairy products. d. A client who has renal calculi composed of struvite should limit intake of whole grains. ✅e. CORRECT: A client who has renal calculi composed of calcium oxalate should avoid intake of spinach because it is a source of oxalate. NCLEX® Connection: Reduction of Risk Potential,

18. For which condition does the nurse suspect a client with chronic kidney disease (CKD) is a

✅ C As CKD worsens and acid retention increases, increased respiratory action is needed to keep the blood pH normal. The respiratory system adjusts or compensates for the increased blood hydrogen ion levels (acidosis or decreased pH) by increasing the rate and depth of breathing to excrete carbon dioxide through the lungs. This breathing pa

8. Based on the Kidney Disease: Improving Global Outcomes classification (KDIGO), how will the nurse interpret this client data (serum creatinine increases 1.5 times over baseline with urine output of less than 0.5 mL/kg/hr for 6 hours or longer)? A. Stage 1 B. Stage 2 C. Stage 3 D. End-stage kidney disease

✅ A Based on the Kidney Disease: Improving Global Outcomes classification (KDIGO), a value of serum creatinine increases 1.5 times over baseline with urine output of less than 0.5 mL/kg/hr for 6 hours or longer indicates stage 1. See Table 63.2 in your text for information on the other stages for this system.

3. When prerenal and postrenal causes of acute kidney injury occur, how does the nurse expect a client's kidneys to compensate? Select all that apply. A. Constricting of blood vessels in the kidneys B. Restricting of secretion of glucocorticoids C. Releasing antidiuretic hormone (ADH) D. Crushing then passing fragments of kidney stones E. Dilating of peripheral arteries throughout the body F. Activating the renin-angiotensin-aldosterone pathway

✅ A, C, F When prerenal or postrenal causes of AKI occur, the kidneys compensate by three responses: constricting kidney blood vessels, activating the renin-angiotensin-aldosterone pathway, and releasing antidiuretic hormone (ADH)

6. Which assessment questions are most appropriate for the nurse to ask a client at risk for acute kidney injury (AKI)? Select all that apply. A. "Have you noticed any changes in your urine's appearance, frequency, or volume?" B. "Have you experienced any leakage of urine when coughing or laughing?" C. "Do you weigh yourself and have you noticed any unexpected weight loss?" D. "Do you have a history of diabetes, hypertension, or peripheral vascular disease?" E. "Do you use any nonsteroidal anti-inflammatory drugs regularly?" F. "Have you had and recent surgeries, traumas, or transfusions?"

✅ A, D, E, F The nurse asks about any noted changes in urine, as well as any exposure to nephrotoxic substances or drugs. Other important information from the client's medical history includes surgeries, trauma, transfusions, and chronic conditions such as diabetes, hypertension, and peripheral vascular disease. For additional essential topic, see the History section on AKI in your text.

9. When a client is in the diuretic phase of acute kidney injury (AKI), what priority action will the nurse take? A. Assessing for hypertension and fluid overload B. Monitoring for hypovolemia and electrolyte loss C. Adjusting the dosage of diuretic medications D. Balancing diuretic therapy with intake and output

✅ B For the client in the diuretic phase of AKI, the nurse plans care that focuses on fluid and electrolyte replacement and monitoring. Onset of polyuria can signal the start of recovery from AKI.

42. Why will the nurse immediately notify the nephrology health care provider if a client develops hypotension and diuresis postoperatively after a kidney transplant? A. These problems place the client at risk for hypervolemia and dehydration. B. Dehydration with hypotension reduces perfusion and oxygen to the new kidney. C. These assessment findings are indicators of a possible serious acute infection. D. Increased work by the kidney for diuresis results in excessive buildup of cellular toxins that damage the new kidney's tubules.

✅ B If hypotension or excessive diuresis (e.g., unanticipated urine output 500 to 1000 mL greater than intake over 12 to 24 hours or other goal for intake and output) is present, respond by notifying the nephrology health care provider because hypotension reduces perfusion and oxygen to the new kidney, threatening the kidney's survival.

1. Which criteria does the nurse understand are included in the current definition of acute kidney injury (AKI)? Select all that apply. A. Signs and symptoms of fluid overload such as peripheral edema and crackles in the lungs B. Urine volume of less than 0.5 mL/kg/hr for 6 hours C. Presence of polyuria, nocturia, and very dilute pale yellow urine D. Increase in serum creatinine by 0.3 mg/dL (26.2 μmol/L) or more within 48 hours E. Hypotension and tachycardia with progressively decreased amounts of urine F. Increase in serum creatinine to 1.5 times or more from baseline in the previous 7 days

✅ B, D, F The most current definition of AKI is an increase in serum creatinine by 0.3 mg/dL (26.2 μmol/L) or more within 48 hours; or an increase in serum creatinine to 1.5 times or more from baseline, which is known or presumed to have occurred in the previous 7 days; or a urine volume of less than 0.5 mL/kg/hr for 6 hours.

5. Which condition will the nurse recognize increases the risk for a client with benign prostatic hyperplasia (BPH) to develop? A. Perfusion reduction (prerenal failure) B. Intrinsic or intrarenal failure C. Urine flow obstruction (postrenal failure) D. End-stage kidney disease

✅ C BPH (enlarged prostate gland) increases the client's risk for urine flow obstruction leading to postrenal failure because the prostate gland surrounds and puts pressure on the urethra.

19. Which instruction will the nurse give an assistive personnel (AP) to prevent harm when providing care to a client who has osteodystrophy? A. Assist the client with feeding for all meals. B. Gently wash the client's skin with a mild soap and rinse well. C. Assist the client with ambulation to the toilet every 2 hours. D. Use a lift sheet when moving or lifting the client.

✅ D Clients with osteodystrophy have thin, fragile bones that are at risk for fractures with even slight trauma. When lifting or moving a client with fragile bones, the AP is instructed to use a lift sheet rather than pulling the client.

33. How does the nurse best interpret a condition when a client is undergoing hemodialysis (HD) and develops symptoms including headache, nausea, vomiting, and fatigue? A. Mild dialysis disequilibrium syndrome B. Adverse reaction to the dialysate solution C. Transient symptoms in a client new to hemodialysis D. Expected manifestations of end-stage kidney disease

✅. A Dialysis disequilibrium syndrome may develop during HD or after HD has been completed. It is characterized by mental status changes and can include seizures or coma, although this severity of disequilibrium syndrome is rare with today's HD practice. A mild form of disequilibrium syndrome includes symptoms of nausea, vomiting, headaches, fatigue, and restlessness. It is thought to be the result of a rapid reduction in electrolytes and other particles.

29. For which client conditions does the nurse expect the possibility of emergent hemodialysis (HD)? Select all that apply. A. Severe uncontrollable hypertension B. Pericarditis C. Symptomatic hyperkalemia with ECG changes D. Myocardial infarction E. Pulmonary edema F. Some drug overdoses

✅. A, B, C, E, F Some indications for emergent dialysis include: pulmonary edema; severe uncontrollable hypertension; symptomatic hyperkalemia with ECG changes; other severe electrolyte or acid-base disturbances; some drug overdoses; and pericarditis.

2. For which causes will the nurse monitor clients for development of intrarenal (intrinsic) acute kidney injury (AKI)? Select all that apply. A. Glomerulonephritis B. Bladder cancer C. Exposure to nephrotoxins D. Embolism in renal blood vessels E. Severe dehydration F. Kidney stones

✅. A, C, D Examples of disorders causing intrinsic renal AKI include allergic disorders, embolism or thrombosis of the renal vessels, and nephrotoxic agents. Severe dehydration causes prerenal failure. Bladder cancer and kidney stones cause postrenal failure. For additional causes, see Table 63.4 Diseases and Conditions That Contribute to Acute Kidney Injury in your text.

30. What are the criteria used for selection of clients for hemodialysis (HD)? Select all that apply. A. Client values and preferences B. Client's family member or partner who is willing to learn about HD C. Irreversible kidney failure when other therapies are unacceptable or ineffective D. No disorders that would seriously complicate HD E. Expected ability to continue or resume roles at home, work, or school F. Insurance plan will cover costs of procedures

✅. A, C, D, E Selection criteria for HD include: irreversible kidney failure when other therapies are unacceptable or ineffective; no disorders that would seriously complicate HD; client values and preferences; and expected ability to continue or resume roles at home, work, or school.

32. What is the nurse's best response when a client asks how often and for how long he or she will have to go for hemodialysis (HD)? A. "It varies and you will need to discuss this with your nephrology health care provider for specific instructions." B. "Most clients require about 12 hours per week, which is usually divided into three 4-hour treatments." C. "If you follow the diet and fluid therapies you will spend less time in dialysis, about 8 hours each week." D. "Many clients prefer to have home treatment dialysis that occurs every night while sleeping."

✅. B The best answer the nurse can provide this client is the most common treatment. Most clients receive three 4-hour treatments over the course of a week. The nurse provides additional information for some clients with ongoing urine production, who may need only two 5- to 6-hour treatments a week. If a client gains large amounts of fluid, a longer HD treatment time may be needed to remove the fluid without hypotension or other severe side effects.

43. What does the nurse expect the nephrology health care provider to prescribe when a post kidney transplant client develops oliguria, elevated temperature of 100° F (37.8° C), increased blood pressure, and signs of fluid retention 9 days after the surgery? A. Immediate removal of the transplanted kidney B. Increased doses of immunosuppressive drugs C. Immediate return to either hemodialysis or peritoneal dialysis D. Antibiotic therapy until infection symptoms are resolved

✅. B These symptoms within the time frame of a week or more indicate that the client may be having an acute rejection. The treatment for acute rejection is increased dosages of immunosuppressive drugs. Immunosuppressive drugs protect the transplanted organ. These drugs include corticosteroids, inhibitors of T-cell proliferation and activity (azathioprine, mycophenolic acid, cyclosporine, and tacrolimus), mTOR inhibitors (to disrupt stimulatory T-cell signals), and monoclonal antibodies.

31. Which gastrointestinal changes does the nurse expect to find when assessing a client with uremia? A. Increased salivation B. Halitosis C. Stomatitis D. Anorexia E. Nausea and vomiting F. Hiccups

✅. B, C, D, E, F Uremia affects the entire GI system. The flora of the mouth change with uremia. The mouth contains the enzyme urease, which breaks down urea into ammonia. The ammonia generated remains and then causes halitosis (uremic fetor) and stomatitis (mouth inflammation). Anorexia, nausea, vomiting, and hiccups are common in clients with uremia. For more information about uremic changes in the body, see chart 63.2 Key Features of Uremia.

37. Which actions will the nurse take to check the peritoneal dialysis system of a client when the dialysate outflow is slow? Select all that apply. A. Ensuring that the drainage bag is elevated above the client's abdomen B. Inspecting the tubing to ensure there is no kinking or twisting C. Making sure that clamps are open and unclamped D. Repositioning the client to the other side and ensuring good body alignment E. Instructing the client to stand up at the bedside and cough F. Placing the client in a supine low-Fowler position

✅. B, C, D, F When PD outflow drainage is slow, actions that can help improve flow include: ensuring that the drainage bag is lower than the client's abdomen to enhance gravity drainage; inspecting the connection tubing and PD system for kinking or twisting; and ensuring that clamps are open. If outflow drainage is still inadequate, reposition the client to stimulate outflow. Turning the client to the other side or ensuring that he or she is in good body alignment may help. Having the client in a supine low- Fowler position reduces abdominal pressure. Increased abdominal pressure from si

36. Which priority teaching will the nurse provide to the client receiving peritoneal dialysis (PD) when the effluent becomes cloudy? A. The change means that more waste products are being removed from the blood. B. The presence of cloudiness is an early sign of an infection called peritonitis and is very serious. C. Effluent cloudiness is the result of eating foods that contain too much protein and electrolytes. D. The effluent is expected to be cloudy because it has spent time (dwelled) in the abdomen, in close contact with the intestines.

✅. B. The nurse teaches the client to recognize indications of peritonitis (e.g., cloudy dialysate outflow [effluent], fever, abdominal tenderness, abdominal pain, general malaise, nausea, and vomiting). Cloudy or opaque effluent is the earliest indication of peritonitis. The client is taught to examine all effluent for color and clarity to detect peritonitis early and to report indications of peritonitis immediately to the nephrology health care provider.

38. What is the best method for the nurse to monitor the weight of a client who is receiving peritoneal dialysis (PD)? A. Calculating the client's dry weight by comparing daily weights to baseline weights B. Determining dry weight by comparing the client's weight to a standard weight chart C. Checking the weight after a drain and before the next fill to monitor the dry weight D. Weighing the client daily and subtracting dialysate volume to determine dry weight

✅. C The client's actual weight is his or her "dry weight". For a client receiving PD, dry weight is checked after a drain and before the next fill. The client is always weighed on the same scale, with the same amount of clothes.

39. What is the nurse's best action when a client receiving PD has slightly less outflow than inflow? A. Placing the client on an oral fluid intake restriction B. Notifying the nephrology health care provider C. Recording the difference as intake on the flow sheet D. Instructing the client to stand and walk then measuring the next outflow

✅. C When outflow is less than inflow, the difference is retained by the client during dialysis and it is counted as fluid intake.

41. For how many hours will the nurse instruct the assistive personnel (AP) to check the hourly urine output of a postoperative client who had a kidney transplant? A. 8 hours B. 12 hours C. 24 hours D. 48 hours

✅. D A postoperative client who had a kidney transplant has a urinary catheter in place for accurate measurements of urine output and decompression of the bladder. Decompression prevents stretch on sutures and ureter a

35. What does the nurse expect when comparing a client's posthemodialysis weight and blood pressure with predialysis data? A. Blood pressure is increased and weight is decreased B. Blood pressure and weight are slightly increased C. Blood pressure and weight are the same D. Blood pressure and weight are decreased

✅. D Posthemodialysis, the nurse obtains vital signs and weight for comparison with predialysis measurements. After dialysis, the nurse expects blood pressure and weight to be reduced as a result of fluid removal.

34. What instructions will the nurse give to the assistive personnel (AP) regarding care of a client with an arteriovenous fistula? A. Assess for bleeding at the needle insertion sites every 2 hours. B. Monitor the client's distal pulses and capillary refill for circulation. C. Palpate the dialysis site for thrills and auscultate for a bruit every 4 hours. D. Avoid taking blood pressure readings on the client's arm with the arteriovenous fistula.

✅. D The AP's scope of practice includes taking and recording vital signs. For a hemodialysis client, checking blood pressure includes not taking blood pressure readings using the extremity in which the vascular access is placed. Assessment, monitoring, palpation, and auscultation are more advanced skills performed by the professional registered nurse. For more information on care of a client's arteriovenous fistula, see Best Practice for Patient Safety & Quality Care Caring for the Patient With an Arteriovenous Fistula or Arteriovenous Graft in your text.

17. When the nurse reviews the laboratory results and finds that a client with chronic kidney disease (CKD) has a serum potassium level of 8 mEq/L (mmol/L), which assessment will be completed before notifying the health care provider? A. Cardiac rhythm B. Respiratory rate and depth C. Tremors of the hands D. Change in urine appearance

✅A Normal potassium level is within 3.5 to 5 mEq/L (mmol/L). With CKD, high potassium (K+) levels can develop quickly, reaching 7 to 8 mEq/L (mmol/L) or greater. Life-threatening changes in cardiac rate and rhythm result from K+ elevation because of abnormal depolarization and repolarization.

14. What is the nurse's priority action when the health care provider orders IV fluids at a rate of 1 mL/kg/hr for 12 hours prior to a CT scan with contrast media for a client who weighs 152 lbs? A. Set the IV pump to deliver fluid at 69 mL/hr. B. Set the IV pump to deliver fluid at 152 mL/hr. C. Call the health care provider for clarification of the order. D. Ask the radiologist for clarification of the order.

✅A The nurse calculates the client's weight in kilograms (152 lb divided by 2.2 = 69 kg). Then the nurse sets the IV pump to run at 69 mL/hr.

25. Which nutritional supplements does the nurse expect the health care provider will prescribe for a client with chronic kidney disease? Select all that apply. A. Water-soluble vitamins B. Calcium C. Iron D. Magnesium E. Vitamin D F. Phosphorus

✅A, B, C, E The nurse expects the health care provider to prescribe daily vitamin and mineral supplements for most clients with CKD. Low-protein diets are also low in vitamins, and water-soluble vitamins are removed from the blood during dialysis. Anemia also is a problem in clients with CKD because of the limited iron content of low-protein diets and decreased kidney production of erythropoietin. Thus, supplemental iron is needed. Calcium and vitamin D supplements may be needed, depending on the client's serum calcium levels and bone status.

10. Which are the goals of nutritional support for a client with acute kidney injury (AKI) when the nurse collaborates with the registered dietitian nutritionist (RDN)? Select all that apply. A. Maintaining or improving nutritional status B. Creating a program for weight loss C. Preserving lean body mass D. Restoring or maintaining fluid balance E. Preserving kidney function F. Preventing end-state kidney disease

✅A, C, D, E Nutrition support goals in AKI are to provide sufficient nutrients to maintain or improve nutrition status, preserve lean body mass, restore or maintain fluid balance, and preserve kidney function.

40. Which client conditions will the nurse recognize as absolute contraindications to receiving a kidney transplant? Select all that apply. A. Breast cancer and metastasis to the lungs B. Type 2 diabetes controlled with diet and exercise C. Urinary tract infection D. Active treatment for peptic ulcer disease E. Chemical dependency F. Living related donor

✅A, C, E Absolute contraindications to kidney transplant include active cancer, current infection, active psychiatric illness, active substance abuse, and nonadherence with dialysis or medical regimen.

21. What urinalysis findings does the nurse expect when a client is in the early stage of chronic kidney disease? Select all that apply. A. Proteinuria B. Increased specific gravity C. Red blood cells (RBCs) D. Increased urine osmolarity E. White blood cells (WBCs) F. Glucosuria

✅A, C, E, F In the early stages of CKD, the nurse expects the urinalysis may show protein, glucose, red blood cells (RBCs) and white blood cells (WBCs), and decreased or fixed specific gravity. Urine osmolarity is usually decreased. As CKD progresses, urine output decreases dramatically, and osmolarity then increases.

16. Which electrolyte imbalance does the nurse expect when a client is in the early phase of chronic kidney disease (CKD)? A. Hyperkalemia B. Hyponatremia C. Hypercalcemia D. Hypokalemia

✅B Early in CKD, the nurse expects the client's laboratory values to reveal hyponatremia (sodium depletion) because there are fewer healthy kidney nephrons to reabsorb sodium.

20. For which emergency procedure does the nurse prepare when a client with chronic kidney disease develops chest pain, tachycardia, low-grade fever, friction rub, and muffled heart tones? A. Hemodialysis B. Removal of pericardial fluid C. Cardioversion D. Endotracheal intubation

✅B The client's signs and symptoms suggest pericarditis which often occurs in CKD and can cause tamponade. Treatment of tamponade, which is a medical emergency, requires immediate removal of pericardial fluid (pericardiocentesis) by placement of a needle, catheter, or drainage tube into the pericardium.

26. What is the nurse's first action when a client with chronic kidney disease (CKD) develops restlessness, anxiousness, shortness of breath, a rapid heart rate, frothy sputum, and crackles in the bases of the lungs? A. Facilitating transfer to the intensive care unit for aggressive treatment B. Placing the client's head of bed in the high-Fowler position C. Monitoring vital signs and assessing the lungs every 15 minutes D. Administering an IV loop diuretic such as furosemide

✅B The nurse recognizes this client's symptoms as indicators of pulmonary edema. First, the client is placed in a high-Fowler position and given oxygen to improve gas exchange. Then health care provider or Rapid Response Team is notified for treatment and management of pulmonary edema.

23. The nurse collaborates with the registered dietician nutritionist (RDN) to teach a client about which recommendations for management of chronic kidney disease? Select all that apply. A. Reducing calories B. Controlling protein intake C. Limiting fluid intake D. Restricting potassium E. Increasing sodium F. Restricting phosphorus

✅B, C, D, F The nurse collaborates with the RDN to teach the client about diet changes that are needed as a result of CKD. Common changes include control of protein intake; fluid intake limitation; restriction of potassium, sodium, and phosphorus intake; taking vitamin and mineral supplements; and consuming enough calories to meet metabolic need.

15. Which outcome statement indicates to the nurse that the goal of giving a client IV therapy after a diagnostic imaging test with contrast media has been met? A. Lung sounds are clear and there are no signs or symptoms of fluid overload. B. The client has no signs or symptoms of contrast-induced immune response. C. Urine output is 150 mL/hr for 6 hours after the use of the contrast agent. D. Urine output is 0.5mL/kg/hr for 6 hours and the client remains euvolemic.

✅C A common desired outcome for clients undergoing a procedure with contrast medium is a urine output of 150 mL/hr for the first 6 hours after administration of the contrast agent.

13. Which type of medication does the nurse expect the health care provider to prescribe for a client with acute kidney injury to improve blood flow to the kidneys? A. Loop diuretics B. Phosphate binders C. Calcium channel blockers D. Erythropoietin-stimulating agents

✅C Calcium channel blockers can improve the GFR and blood flow within the kidney. They also help to control blood pressure.

28. Which client will the nurse consider most likely to be a candidate for continuous kidney replacement therapy (CKRT) using venovenous hemofiltration? A. 65-year-old with fluid volume overload B. 55-year-old who needs long-term management C. 45-year-old who is critically ill and unstable D. 35-year-old with a peritoneal infection

✅C Clients who need continuous kidney replacement therapy (CKRT) are hospitalized and are too unstable to tolerate the changes in blood pressure that occur with intermi

4. Which health promotion teaching will the nurse stress to healthy adults to prevent harm from acute kidney injury (AKI)? A. Check your blood pressure every day. B. Find out if you have a family history of diabetes. C. Avoid dehydration by drinking 2 to 3 liters of water daily. D. Have annual testing for blood urea nitrogen (BUN), creatinine, protein, and glucose.

✅C Dehydration (severe blood volume depletion) reduces perfusion and can lead to AKI even in adults who have no known kidney problems. The nurse urges all healthy adults to avoid dehydration by drinking 2 to 3 liters of water daily.

12. For a client diagnosed with acute kidney injury (AKI), the nurse considers questions an order for which diagnostic test? A. Ultrasonography B. Kidney-ureter-bladder x-ray (KUB) C. Computed tomography with contrast D. Kidney biopsy

✅C The client's diagnosis is AKI. To complete the CT with contrast, the client will be injected with a contrast dye, which is nephrotoxic, therefore the nurse considers questioning that diagnostic test.

7. Which laboratory results will the nurse monitor when a client is receiving IV gentamicin? Select all that apply. A. Platelet count B. Hemoglobin and hematocrit C. Blood urea nitrogen (BUN) D. Prothrombin time E. Creatinine F. Gentamicin peak and trough levels

✅C, E, F If a client is receiving a known nephrotoxic drug, the nurse will closely monitor laboratory values, including BUN, creatinine, and drug (gentamicin) peak and trough levels, for indications of reduced kidney function.

24. To avoid harm and prevent osteodystrophy, which intracollaborative action does the nurse implement? A. Encouraging high-quality protein foods B. Administering iron supplements twice a day C. Encouraging extra milk with meals and snacks D. Administering phosphate binders with each meal

✅D Phosphorus restriction for control of phosphorus levels is started early in CKD to avoid renal osteodystrophy. The nurse administers phosphate binders at mealtime to increase their effectiveness in slowing or preventing the absorption of dietary phosphorus.

11. Which client does the nurse understand has the greatest risk of developing acute kidney injury (AKI)? A. 23-year-old female who was recently treated for a urinary tract infection B. 32-year-old female who is pregnant and has gestational diabetes C. 49-year-old male who is obese and has a history of skin cancer D. 73-year-old male who has hypertension and peripheral vascular disease

✅D Risk factors for AKI include shock, cardiac surgery, hypotension, prolonged mechanical ventilation, and sepsis. Older adults or adults with diabetes, hypertension, peripheral vascular disease, liver disease, or CKD are at higher risk of AKI if hospitalized. The client in option D is an older adult with two important risk factors. Thus, he is at highest risk of AKI development

22. Which laboratory result will the nurse expect when a client with chronic kidney disease reports fatigue, lethargy with weakness, and mild shortness of breath with dizziness when rising to a standing position? A. Low blood glucose B. Low white blood cell count C. Low blood urea nitrogen (BUN) D. Low hemoglobin/hematocrit

✅D The client's symptoms suggest anemia which is common in clients in the later stages of CKD and makes symptoms worse. The causes of anemia include a decreased production of erythropoietin by the kidneys which causes reduced red blood cell (RBC) production and low hemoglobin and hematocrit levels.

27. Which drug will the nurse avoid administering to a client with chronic kidney disease (CKD) to prevent harm? A. Opioids B. Antibiotics C. Oral antihyperglycemics D. Magnesium antacids

✅D The nurse questions a prescription for magnesium-containing antacids for clients with CKD because they cannot excrete magnesium and need to avoid any additional intake and build- up of magnesium. To avoid hypermagnesemia, the nurse teaches clients with kidney disease to avoid antacids containing magnesium.