Acute Kidney Injury - Questions
A patient in the oliguric phase after an acute kidney injury has had a 250-mL urine output and an emesis of 100 mL in the past 24 hours. What is the patient's fluid restriction for the next 24 hours?
ANS: 950 mL The general rule for calculating fluid restrictions is to add all fluid losses for the previous 24 hours, plus 600 mL for insensible losses: (250 + 100 + 600 = 950 mL).
Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis (select all that apply)? a.Avoid commercial salt substitutes. b.Restrict fluid intake to 1000 mL daily. c.Take phosphate binders with each meal. d.Choose high-protein foods for most meals. e.Have several servings of dairy products daily.
ANS: A, C, D Patients who are receiving peritoneal dialysis should have a high-protein diet. Phosphate binders are taken with meals to help control serum phosphate and calcium levels. Commercial salt substitutes are high in potassium and should be avoided. Fluid intake is not limited unless weight and blood pressure are not controlled. Dairy products are high in phosphate and usually are limited.
A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft? a.A fistula is much less likely to clot. b.A fistula increases patient mobility. c.A fistula can accommodate larger needles. d.A fistula can be used sooner after surgery.
ANS:A Arteriovenous (AV) fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or patient mobility.
A 52-yr-old man with stage 2 chronic kidney disease is scheduled for an outpatient diagnostic procedure using contrast media. Which priority action should the nurse perform? a.Assess skin turgor to determine hydration status. b.Insert a urinary catheter for the expected diuresis. c.Evaluate the patient's lower extremities for edema. d.Check the patient's urine for the presence of ketones.
ANS:A Preexisting kidney disease is the most important risk factor for the development of contrast-associated nephropathy and nephrotoxic injury. If contrast media must be administered to a high-risk patient, the patient needs to have optimal hydration. The nurse should assess the hydration status of the patient before the procedure is performed. Indwelling catheter use should be avoided whenever possible to decrease the risk of infection.
Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before administering the medication, the nurse should assess the a.bowel sounds. b.blood glucose. c.blood urea nitrogen (BUN). d.level of consciousness (LOC).
ANS:A Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not affect the nurse's decision to give the medication.
A 42-yr-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first? a.Insert a urinary retention catheter. b.Place the patient on a cardiac monitor. c.Administer epoetin alfa (Epogen, Procrit). d.Give sodium polystyrene sulfonate (Kayexalate).
ANS:B Because hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. Kayexalate and Epogen will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output but does not correct the cause of the renal failure.
The patient has rapidly progressing glomerular inflammation. Weight has increased and urine output is steadily declining. What is the priority nursing intervention? a.Monitor the patient's cardiac status. b.Teach the patient about hand washing. c.Obtain a serum specimen for electrolytes. d.Increase direct observation of the patient.
ANS:A The nurse's priority is to monitor the patient's cardiac status. With the rapidly progressing glomerulonephritis, renal function begins to fail and fluid, potassium, and hydrogen retention lead to hypervolemia, hyperkalemia, and metabolic acidosis. Excess fluid increases the workload of the heart, and hyperkalemia can lead to life-threatening dysrhythmias. Teaching about hand washing and observation of the patient are important nursing interventions but are not the priority. Electrolyte measurement is a collaborative intervention that will be done as ordered by the health care provider.
A 72-yr-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first? a.Insert urethral catheter. b.Obtain renal ultrasound. c.Draw a complete blood count. d.Infuse normal saline at 50 mL/hour.
ANS:A The patient's elevation in BUN is most likely associated with hydronephrosis caused by the acute urinary retention, so the insertion of a retention catheter is the first action to prevent ongoing postrenal failure for this patient. The other actions also are appropriate but should be implemented after the retention catheter.
When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula? a.Auscultate for a bruit at the fistula site. b.Assess the quality of the left radial pulse. c.Compare blood pressures in the left and right arms. d.Irrigate the fistula site with saline every 8 to 12 hours.
ANS:A The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.
A 78-yr-old patient has stage 3 CKD and is being taught about a low-potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat? a.Apple, green beans, and a roast beef sandwich b.Granola made with dried fruits, nuts, and seeds c.Watermelon and ice cream with chocolate sauce d.Bran cereal with ½ banana and milk and orange juice
ANS:A When the patient selects an apple, green beans, and a roast beef sandwich, the patient demonstrates understanding of the low-potassium diet. Granola, dried fruits, nuts and seeds, milk products, chocolate sauce, bran cereal, banana, and orange juice all have elevated levels of potassium, at or above 200 mg per 1/2 cup.
Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury (AKI) (select all that apply.)? a.Dehydration b.Hypokalemia c.Hypernatremia d.BUN increases e.Urine output increases f.Serum creatinine increases
ANS:A,B,E The hallmark of entering the diuretic phase is the production of copious amounts of urine. Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes but not concentrate urine. Serum BUN and serum creatinine levels begin to decrease.
Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD) (select all that apply.)? a.Anemia b.Dehydration c.Hypertension d.Hypercalcemia e.Increased risk for fractures f.Elevated white blood cells
ANS:A,C,E When the kidney fails, erythropoietin in not excreted, so anemia is expected. Hypocalcemia from chronic renal disease stimulates the parathyroid to release parathyroid hormone, causing calcium liberation from bones increasing the risk of pathological fracture. Dehydration and hypercalcemia are not expected in chronic renal disease. Fluid volume overload and hypocalcemia are expected. Although impaired immune function should be expected, elevated white blood cells would indicate inflammation or infection not associated with chronic renal failure itself but a complication.
A patient with end-stage renal disease (ESRD) secondary to diabetes mellitus has arrived at the outpatient dialysis unit for hemodialysis. Which assessments should the nurse perform as a priority before, during, and after the treatment? a.Level of consciousness b.Blood pressure and fluid balance c.Temperature, heart rate, and blood pressure d.Assessment for signs and symptoms of infection
ANS:B Although all of the assessments are relevant to the care of a patient receiving hemodialysis, fluid removal during the procedure will require monitoring blood pressure and fluid balance prior, during, and after.
Before administration of captopril to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patient's a.glucose. b.potassium. c.creatinine. d.phosphate.
ANS:B Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not affect whether the captopril was given or not.
A 24-yr-old woman donated a kidney via a laparoscopic donor nephrectomy to a nonrelated recipient. The patient is experiencing significant pain and refuses to get up to walk. How should the nurse respond? a.Have the transplant psychologist convince her to walk. b.Encourage even a short walk to avoid complications of surgery. c.Tell the patient that no other patients have ever refused to walk. d.Tell the patient she is lucky she did not have an open nephrectomy.
ANS:B 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; postoperative care is the nurse's role. Trying to shame the patient into walking by telling her that other patients have not refused and telling the patient she is lucky she did not have an open nephrectomy (implying how much more pain she would be having if it had been open) will not be beneficial to the patient or her postoperative recovery.
Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a.Blood pressure b.Phosphate level c.Neurologic status d.Creatinine clearance
ANS:B Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in patients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium carbonate.
A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L inflows. Which information should the nurse report promptly to the health care provider? a.The patient has an outflow volume of 1800 mL. b.The patient's peritoneal effluent appears cloudy. c.The patient's abdomen appears bloated after the inflow. d.The patient has abdominal pain during the inflow phase.
ANS:B Cloudy-appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.
A patient has arrived for a scheduled hemodialysis session. Which nursing action is most appropriate for the registered nurse (RN) to delegate to a dialysis technician? a.Teach the patient about fluid restrictions. b.Check blood pressure before starting dialysis. c.Assess for causes of an increase in predialysis weight. d.Determine the ultrafiltration rate for the hemodialysis.
ANS:B Dialysis technicians are educated in monitoring for blood pressure. Assessment, adjustment of the appropriate ultrafiltration rate, and patient teaching require the education and scope of practice of an RN.
Which information in a patient's history indicates to the nurse that the patient is not an appropriate candidate for kidney transplantation? a.The patient has type 1 diabetes. b.The patient has metastatic lung cancer. c.The patient has a history of chronic hepatitis C infection. d.The patient is infected with human immunodeficiency virus.
ANS:B Disseminated malignancies are a contraindication to transplantation. The conditions of the other patients are not contraindications for kidney transplant.
The nurse is caring for a 68-yr-old man who had coronary artery bypass surgery 3 weeks ago. During the oliguric phase of acute kidney disease, which action would be appropriate to include in the plan of care? a. Provide foods high in potassium. b. Restrict fluids based on urine output. c. Monitor output from peritoneal dialysis. d. Offer high-protein snacks between meals.
ANS:B Fluid intake is monitored during the oliguric phase. Fluid intake is determined by adding all losses for the previous 24 hours plus 600 mL. Potassium and protein intake may be limited in the oliguric phase to avoid hyperkalemia and elevated urea nitrogen. Hemodialysis, not peritoneal dialysis, is indicated in acute kidney injury if dialysis is needed.
The nurse is titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation. Which parameter will be most important for the nurse to consider? a.Heart rate b.Urine output c.Creatinine clearance d.Blood urea nitrogen (BUN) level
ANS:B Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a liter an hour. The other data will be monitored but are not the most important determinants of fluid infusion rate.
When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of a.persistent skin tenting b.rapid, deep respirations. c.hot, flushed face and neck. d.bounding peripheral pulses.
ANS:B Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI.
Which statement regarding continuous ambulatory peritoneal dialysis (CAPD) would be most important when teaching a patient new to the treatment? a."Maintain a daily written record of blood pressure and weight." b."It is essential that you maintain aseptic technique to prevent peritonitis." c."You will be allowed a more liberal protein diet once you complete CAPD." d."Continue regular medical and nursing follow-up visits while performing CAPD."
ANS:B Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of prevention. Although the other teaching statements are accurate, they do not have the potential for morbidity and mortality that peritonitis does.
The nurse is assessing a patient 4 hours after a kidney transplant. Which information is most important to communicate to the health care provider? a.The urine output is 900 to 1100 mL/hr. b.The patient's central venous pressure (CVP) is decreased. c.The patient has a level 7 (0- to 10-point scale) incisional pain. d.The blood urea nitrogen (BUN) and creatinine levels are elevated.
ANS:B The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant.
A 62-yr-old female patient has been hospitalized for 4 days with acute kidney injury (AKI) caused by dehydration. Which information will be most important for the nurse to report to the health care provider? a.The creatinine level is 3.0 mg/dL. b.Urine output over an 8-hour period is 2500 mL. c.The blood urea nitrogen (BUN) level is 67 mg/dL. d.The glomerular filtration rate is less than 30 mL/min/1.73 m2.
ANS:B The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The other information is typical of AKI and will not require a change in therapy.
A 25-yr-old male patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider? a.Serum creatinine level of 2.1 mg/dL b.Serum potassium level of 6.5 mEq/L c.White blood cell count of 11,500/µL d.Blood urea nitrogen (BUN) of 56 mg/dL
ANS:B The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately. The nurse also will report the other laboratory values, but abnormalities in these are not immediately life threatening.
Which patient has the most significant risk factors for CKD? a.A 50-yr-old white woman with hypertension b.A 61-yr-old Native American man with diabetes c.A 40-yr-old Hispanic woman with cardiovascular disease d.A 28-yr-old African American woman with a urinary tract infection
ANS:B The nurse identifies the 61-yr-old Native American with diabetes as the most at risk. Diabetes causes about 50% of CKD. This patient is the oldest, and Native Americans with diabetes develop CKD six times more frequently than other ethnic groups. Hypertension causes about 25% of CKD. Hispanics have CKD about 1.5 times more than non-Hispanics. African Americans have the highest rate of CKD because hypertension is significantly increased in African Americans. A UTI will not cause CKD unless it is not treated or UTIs occur recurrently.
A 74-yr-old patient who is progressing to stage 5 chronic kidney disease asks the nurse, "Do you think I should go on dialysis? Which initial response by the nurse is best? a."It depends on which type of dialysis you are considering." b."Tell me more about what you are thinking regarding dialysis." c."You are the only one who can make the decision about dialysis." d."Many people your age use dialysis and have a good quality of life."
ANS:B The nurse should initially clarify the patient's concerns and questions about dialysis. The patient is the one responsible for the decision, and many people using dialysis do have good quality of life, but these responses block further assessment of the patient's concerns. Referring to which type of dialysis the patient might use only indirectly responds to the patient's question.
Which intervention will be included in the plan of care for a patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein? a.Start continuous pulse oximetry. b.Restrict physical activity to bed rest. c.Restrict the patient's oral protein intake. d.Discontinue the urethral retention catheter.
ANS:B The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.
During routine hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first? a.Slow down the rate of dialysis. b.Check the blood pressure (BP). c.Review the hematocrit (Hct) level. d.Give prescribed PRN antiemetic drugs.
ANS:B The patient's complaints of nausea and dizziness suggest hypotension, so the initial action should be to check the BP. The other actions may also be appropriate based on the blood pressure obtained.
The home care nurse visits a 34-yr-old woman receiving peritoneal dialysis. Which statement indicates a need for immediate follow-up by the nurse? a."Drain time is faster if I rub my abdomen." b."The fluid draining from the catheter is cloudy." c."The drainage is bloody when I have my period." d."I wash around the catheter with soap and water."
ANS:B The primary clinical manifestation of peritonitis is a cloudy peritoneal effluent. Blood may be present in the effluent of women who are menstruating, and no intervention is indicated. Daily catheter care may include washing around the catheter with soap and water. Drain time may be facilitated by gently massaging the abdomen.
The nurse is planning care for a patient with severe heart failure who has developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary treatment goal in the plan will be a.augmenting fluid volume. b.maintaining cardiac output. c.diluting nephrotoxic substances. d.preventing systemic hypertension.
ANS:B The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient's heart failure is causing AKI, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct.
Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. Which strategy is used to achieve ultrafiltration in peritoneal dialysis? a.Increasing the pressure gradient b.Increasing osmolality of the dialysate c.Decreasing the glucose in the dialysate d.Decreasing the concentration of the dialysate
ANS:B 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.
A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? a.Increased calories are needed because glucose is lost during hemodialysis. b.More protein is allowed because urea and creatinine are removed by dialysis. c.Dietary potassium is not restricted because the level is normalized by dialysis. d.Unlimited fluids are allowed because retained fluid is removed during dialysis.
ANS:B When the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.
A 38-yr-old patient who had a kidney transplant 8 years ago is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone . Which assessment data will be of most concern to the nurse? a.Skin is thin and fragile. b.Blood pressure is 150/92. c.A nontender axillary lump. d.Blood glucose is 144 mg/dL.
ANS:C A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of chronic immunosuppressive therapy. The elevated glucose, skin change, and hypertension are possible side effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of a malignancy.
Which assessment finding may indicate that a patient is experiencing adverse effects to a corticosteroid prescribed after kidney transplantation? a.Postural hypotension b.Recurrent tachycardia c.Knee and hip joint pain d.Increased serum creatinine
ANS:C Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not caused by corticosteroid use.
The physician has decided to use renal replacement therapy to remove large volumes of fluid from a patient who is hemodynamically unstable in the intensive care unit. The nurse should expect which treatment to be used for this patient? a.Hemodialysis (HD) three times per week b.Automated peritoneal dialysis (APD) c.Continuous venovenous hemofiltration (CVVH) d.Continuous ambulatory peritoneal dialysis (CAPD)
ANS:C CVVH removes large volumes of water and solutes from the patient over a longer period of time by using ultrafiltration and convection. HD three times per week would not be used for this patient because fluid and solutes build up and then are rapidly removed. With APD (used at night instead of during the day) fluid and solutes build up during the day and would not benefit this patient as much. CAPD will not as rapidly remove large amounts of fluid as CVVH can do.
A 37-yr-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function? a.Urine volume b.Creatinine level c.Glomerular filtration rate (GFR) d.Blood urea nitrogen (BUN) level
ANS:C GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status and protein intake. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.
A 55-yr-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication? a.Creatinine 1.6 mg/dL b.Oxygen saturation 89% c.Hemoglobin level 13 g/dL d.Blood pressure 98/56 mm Hg
ANS:C High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when erythropoietin (EPO) is administered to a target hemoglobin of greater than 12 g/dL. Hemoglobin levels higher than 12 g/dL indicate a need for a decrease in epoetin alfa dose. The other information also will be reported to the health care provider but will not affect whether the medication is administered.
A 56-yr-old woman with type 2 diabetes mellitus and chronic kidney disease has a serum potassium level of 6.8 mEq/L. Which finding will the nurse monitor for? a.Fatigue b.Hypoglycemia c.Cardiac dysrhythmias d.Elevated triglycerides
ANS:C Hyperkalemia is the most serious electrolyte disorder associated with kidney disease. Fatal dysrhythmias can occur when the serum potassium level reaches 7 to 8 mEq/L. Fatigue and hypertriglyceridemia may be present but do not require urgent intervention. Hypoglycemia is a complication related to diabetes control, not hyperkalemia. However, administration of insulin and dextrose is an emergency treatment for hyperkalemia.
Before administration of calcium carbonate to a patient with chronic kidney disease (CKD), the nurse should check laboratory results for a.potassium level. b.total cholesterol. c.serum phosphate. d.serum creatinine.
ANS:C If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. Calcium carbonate should not be given until the phosphate level is lowered. Total cholesterol, creatinine, and potassium values do not affect whether calcium carbonate should be administered.
The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required? a.Acetaminophen b.Calcium phosphate c.Magnesium hydroxide d.Multivitamin with iron
ANS:C Magnesium is excreted by the kidneys, and patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD.
A licensed practical/vocational nurse (LPN/LVN) is caring for a patient with stage 2 chronic kidney disease. Which observation by the RN requires an intervention? a.The LPN/LVN administers the erythropoietin subcutaneously. b.The LPN/LVN assists the patient to ambulate out in the hallway. c.The LPN/LVN administers the iron supplement and phosphate binder with lunch. d.The LPN/LVN carries a tray containing low-protein foods into the patient's room.
ANS:C Oral phosphate binders should not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder should be given with a meal and the iron given at a different time. The other actions by the LPN/LVN are appropriate for a patient with renal insufficiency.
Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a.The patient leaves the catheter exit site without a dressing. b.The patient plans 30 to 60 minutes for a dialysate exchange. c.The patient cleans the catheter while taking a bath each day. d.The patient slows the inflow rate when experiencing abdominal pain.
ANS:C Patients are encouraged to take showers rather than baths to avoid infections at the catheter insertion side. The other patient actions indicate good understanding of peritoneal dialysis.
A patient is recovering in the intensive care unit (ICU) 24 hours after receiving a kidney transplant. What is an expected assessment finding during the earliest stage of recovery? a.Hypokalemia b.Hyponatremia c.Large urine output d.Leukocytosis with cloudy urine output
ANS:C Patients frequently experience diuresis in the hours and days immediately following a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.
Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's teaching has been successful? a.Split-pea soup, English muffin, and nonfat milk b.Oatmeal with cream, half a banana, and herbal tea c.Poached eggs, whole-wheat toast, and apple juice d.Cheese sandwich, tomato soup, and cranberry juice
ANS:C Poached eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup is high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and cream is high in phosphate.
A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV? a.Urine volume b.Calcium level c.Cardiac rhythm d.Neurologic status
ANS:C The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate.
During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first? a.Administer hypertonic saline. b.Administer a blood transfusion. c.Decrease the rate of fluid removal. d.Administer antiemetic medications.
ANS:C The patient is experiencing hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased, and 0.9% saline solution may be infused. Hypertonic saline is not used because of the high sodium load. A blood transfusion is not indicated. Antiemetic medications may help the nausea but would not help the hypovolemia.
Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective? a."I need to get most of my protein from low-fat dairy products." b."I will increase my intake of fruits and vegetables to 5 per day." c."I will measure my urinary output each day to help calculate the amount I can drink." d."I need to take erythropoietin to boost my immune system and help prevent infection."
ANS:C The patient with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.
After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take? a.Teach the patient about normal AVG function. b.Remind the patient to take a daily low-dose aspirin tablet. c.Report the patient's symptoms to the health care provider. d.Elevate the patient's arm on pillows to above the heart level.
ANS:C The patient's complaints suggest the development of distal ischemia (steal syndrome) and may require revision of the AVG. Elevation of the arm above the heart will further decrease perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts.
A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin 60 mg IV BID. The nurse will monitor for adverse effects of the medication by evaluating the patient's a.blood glucose. b.urine osmolality. c.serum creatinine. d.serum potassium.
ANS:C When a patient at risk for chronic kidney disease (CKD) receives a potentially nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in assessing for the adverse effects of the gentamicin.
Which patient diagnosis or treatment is most consistent with prerenal acute kidney injury (AKI)? a.IV tobramycin b.Incompatible blood transfusion c.Poststreptococcal glomerulonephritis d.Dissecting abdominal aortic aneurysm
ANS:D A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can decrease renal artery perfusion and therefore the glomerular filtrate rate. Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction, and post-streptococcal glomerulonephritis are intrarenal causes of AKI.
A frail 72-yr-old woman with stage 3 chronic kidney disease is cared for at home by her family. The patient has a history of taking many over-the-counter medications. Which over-the-counter medications should the nurse teach the patient to avoid? a.Aspirin b.Acetaminophen c.Diphenhydramine d.Aluminum hydroxide
ANS:D Antacids (that contain magnesium and aluminum) should be avoided because patients with kidney disease are unable to excrete these substances. Also, some antacids contain high levels of sodium that further increase blood pressure. Acetaminophen and aspirin (if taken for a short period of time) are usually safe for patients with kidney disease. Antihistamines may be used, but combination drugs that contain pseudoephedrine may increase blood pressure and should be avoided.
A patient complains of leg cramps during hemodialysis. The nurse should a.massage the patient's legs. b.reposition the patient supine. c.give acetaminophen (Tylenol). d.infuse a bolus of normal saline.
ANS:D Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.
When caring for a patient during the oliguric phase of acute kidney injury (AKI), which nursing action is appropriate? a.Weigh patient three times weekly. b.Increase dietary sodium and potassium. c.Provide a low-protein, high-carbohydrate diet. d.Restrict fluids according to previous daily loss.
ANS:D Patients in the oliguric phase of AKI will have fluid volume excess with potassium and sodium retention. Therefore, they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times each week.
The nurse preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD). Which laboratory result will the nurse monitor to determine if the desired effect was achieved? a.Sodium b.Potassium c.Magnesium d.Phosphorus
ANS:D 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.
A patient with a 25-year history of type 1 diabetes mellitus is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse notes newly developed hypertension and uncontrolled blood sugars. Which diagnostic study is most indicative of chronic kidney disease (CKD)? a.Serum creatinine b.Serum potassium c.Microalbuminuria d.Calculated glomerular filtration rate (GFR)
ANS:D The best study to determine kidney function or CKD that would be expected in the patient with diabetes is the calculated GFR that is obtained from the patient's age, gender, race, and serum creatinine. It would need to be abnormal for 3 months to establish a diagnosis of CKD. A creatinine clearance test done with a blood sample and a 24-hour urine collection is also important. Serum creatinine is not the best test for CKD because the level varies with different patients. Serum potassium levels could explain why the patient has an irregular heartbeat. The finding of microalbuminuria can alert the patient with diabetes about potential renal involvement and potentially failing kidneys. However, urine albumin levels are not used for diagnosis of CKD.
A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first? a.Notify the patient's health care provider. b.Document the QRS interval measurement. c.Review the chart for the patient's current creatinine level. d.Check the medical record for the most recent potassium level.
ANS:D The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval is also appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening dysrhythmias.
After receiving change-of-shift report, which patient should the nurse assess first? a.Patient who is scheduled for the drain phase of a peritoneal dialysis exchange b.Patient with stage 4 chronic kidney disease who has an elevated phosphate level c.Patient with stage 5 chronic kidney disease who has a potassium level of 3.4 mEq/L d.Patient who has just returned from having hemodialysis and has a heart rate of 124/min
ANS:D The patient who has tachycardia after hemodialysis may be bleeding or excessively hypovolemic and should be assessed immediately for these complications. The other patients also need assessments or interventions but are not at risk for life-threatening complications.
