AKI & CKD practice

A week after kidney transplantation the client develops a temperature of 101° F, the blood pressure is elevated, and the kidney is tender. The x-ray film results indicate that the transplanted kidney is enlarged. Based on these assessment findings, the nurse would suspect which of the following? A. Acute rejection B. Chronic rejection C. Kidney infection D. Kidney obstruction

A Acute rejection most often occurs in the first two weeks after transplant. Clinical manifestations include fever, malaise, elevated white blood cell count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Chronic rejection occurs gradually during a period of months to years. Although kidney infection or obstruction can occur, the symptoms presented in the question do not relate specifically to these disorders.

The nurse is performing an assessment on a client who has returned from the dialysis unit following dialysis. The client is complaining of a headache and nausea and is extremely restless. Which of the following is the most appropriate nursing action? A. Notify the physician. B. Monitor the client. C. Elevate the head of the bed. D. Medicate the client for nausea.

A Disequilibrium syndrome may be due to the rapid decrease in blood urea nitrogen levels during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments with anticonvulsive medications and barbituates may be necessary to prevent a life-threatening situation. The physician must be notified.

A client is admitted to the hospital and has a diagnosis of early stage chronic renal failure. Which of the following would the nurse expect to note on assessment of the client? A. Polyuria B. Polydypsia C. Oliguria D. Anuria

A Polyuria occurs early in chronic renal failure and if untreated can cause severe dehydration. Polyuria progresses to anuria, and client loses all normal functions of the kidney. Oliguria and anuria are not early signs, and polydipsia is unrelated to chronic renal failure.

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the dwell time for the dialysis at the prescribed time because of the risk of A. infection. B. hyperglycemia. C. fluid overload. D. disequilibrium syndrome.

B An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis.

The client with chronic renal failure has an indwelling catheter for peritoneal dialysis in the abdomen. The client spills water on the catheter dressing while bathing. The nurse should immediately A. reinforce the dressing. B. change the dressing. C. flush the peritoneal dialysis catheter. D. scrub the catheter with povidine-iodine.

B Clients with peritoneal dialysis catheters are at high risk for infection. A dressing that is wet is a conduit for bacteria to reach the catheter insertion site. The nurse assures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidine-iodine is done at the time of connection or disconnection of peritoneal dialysis.

The client with crush injury to the right lower leg develops acute renal failure. The nurse interprets that this type of renal failure is due to A. prerenal causes. B. renal causes. C. postrenal causes. D. extrarenal causes.

B Crush injuries may cause acute tubular necrosis from the accumulation of large amounts of myoglobin and hemoglobin that are released from damaged muscle and blood cells. This type of renal failure is said to be due to renal causes; that is, conditions that interfere with the perfusion of blood to the kidney. Postrenal causes include conditions that cause urinary obstruction distal to the kidney. The cause and the type of renal failure determines the interventions used in treatment to a certain extent.

The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air embolism. The nurse should A. Continue dialysis at a slower rate after checking the lines for air. B. Discontinue dialysis and notify the physician. C. Monitor vital signs every fifteen minutes for the next hour. D. Bolus the client with 500 mL normal saline to break up the air embolus.

B If the client experiences air embolism during hemodialysis, the nurse should terminate dialysis immediately, notify the physician, and administer oxygen as needed.

The client with chronic renal failure is at risk of developing dementia related to excessive absorption of aluminum. The nurse teaches the client that this is the reason that the client is being prescribed which of the following phosphate-binding agents? A. Alu-Cap (aluminum hydroxide) B. Tums (calcium carbonate) C. Amphojel (aluminum hydroxide) D. Basaljel (Aluminum hydroxide)

B Phosphate-binding agents that contain aluminum include Alu-Caps, Amphojel, and Basaljel. These products are made from aluminum hydroxide. Tums are made from calcium carbonate and also bind phosphorus. Tums are prescribed to avoid the occurrence of dementia related to high intake of aluminum. Phosphate-binding agents are needed by the client in renal failure because the kidneys cannot eliminate phosphorus.

The hemodialysis client with a left arm fistula is at risk for steal syndrome. The nurse assesses this client for which of the following manifestations? A. Warmth, redness, and pain in the left hand B. Pallor, diminished pulse, and pain in the left hand C. Edema and reddish discoloration of the left arm D. Aching pain, pallor, and edema of the left arm

B Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, which is due to tissue ischemia. Warmth, redness, and pain more likely would characterize a problem with infection.

The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the client best understands the information given if the client states to record daily the A. pulse and respiratory rate. B. intake and output and weight. C. blood urea nitrogen and creatinine levels. D. activity log.

B The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording intake and output and measuring weight daily. Ideally, the hemodialysis client should not gain more than 0.5 kg of weight per day.

The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? A. Monitor the client's level of consciousness. B. Maintain strict aseptic technique. C. Add heparin to the dialysate solution. D. Change the catheter site dressing daily.

B The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although option D may assist in preventing infection, this option relates to an external site. Options A and C are unrelated to the major complication of peritoneal dialysis.

A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for treatment of chronic renal failure. Which finding indicates that the fistula is patent? A. Absence of a bruit on auscultation of the fistula B. Palpation of a thrill over the fistula C. Presence of a radial pulse in the left wrist D. Capillary refill less than three seconds in the nail beds of the fingers on the left hand

B The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Although the presence of a radial pulse in the left wrist and capillary refill less than three seconds in the nail beds of the fingers on the left hand are normal findings, they do not assess fistula patency.

The nurse is caring for a client following a kidney transplant. The client develops oliguira. Which of the following would the nurse anticipate to be prescribed as the treatment for the oliguria? A. Encourage fluid intake B. Administration of diuretics C. Irrigation of the Foley catheter D. Restricting fluids

B To increase urinary output, diuretics and osmotic agents are administered. The client should be monitored closely because fluid overload can cause hypertension, congestive heart failure, and pulmonary edema. Fluid intake would not be encouraged or restricted. Irrigation of the Foley catheter would not assist in alleviating this oliguria.

The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication A. just before dialysis. B. during dialysis. C. on return from dialysis. D. the day after dialysis.

C Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and also from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting a full day to resume the medication. This would lead to ineffective control of the blood pressure.

The nurse is assisting a client on a low-potassium diet to select food items from the menu. Which of the following food items, if selected by the client, would indicate an understanding of this dietary restriction? A. Cantaloupe B. Spinach C. Lima beans D. Strawberries

C Cantaloupe (¼ small), spinach (½ cup cooked) and strawberries (1 and ¼ cups) are high potassium foods and average 7 mEq per serving. Lima beans (1/3 cup) averages 3 mEq per serving.

A client newly diagnosed with renal failure is receiving peritoneal dialysis. During the infusion of the dialysate the client complains of abdominal pain. Which action by the nurse is most appropriate? A. Slow the infusion. B. Decrease the amount to be infused. C. Explain that the pain will subside after the first few exchanges. D. Stop the dialysis.

C Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however, the pain usually disappears after one to two weeks of treatment. The infusion amount should not be decreased, and the infusion should not be slowed or stopped.

The client with acute renal failure has a serum potassium level of 5.8 mEq/L. The nurse would plan which of the following as a priority action? A. Allow an extra 500 mL fluid intake to dilute the electrolyte concentration. B. Encourage increased vegetables in the diet. C. Place the client on a cardiac monitor. D. Check the sodium level.

C The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this the client should be placed on a cardiac monitor. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Vegetables are a natural source of potassium in the diet, and their use would not be increased. The nurse also may assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action of the nurse.

The client with an arteriovenous shunt in place for hemodialysis is at risk for bleeding. The nurse would do which of the following as a priority action to prevent this complication from occurring? A. Check the results of the prothrombin time as they are ordered. B. Observe the site once per shift. C. Check the shunt for the presence of bruit and thrill. D. Ensure that small clamps are attached to the arteriovenous shunt dressing.

D An arteriovenous shunt is a less common form of access site but carries a risk for bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also should be assessed at least every four hours.

The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for A. hypertension, tachycardia, and fever. B. hypotension, bradycardia, and hypothermia. C. restlessness, irritability, and generalized weakness. D. headache, deteriorating level of consciousness, and twitching.

D Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the client's status after dialysis? A. Potassium level and weight B. Blood urea nitrogen and creatinine levels C. Vital signs and blood urea nitrogen D. Vital signs and weight

D Following dialysis, the client's vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client's predialysis weight to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has been ended.

The nurse is reviewing the list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response knowing that the glucose A. prevents excess glucose from being removed from the client. B. decreases the risk of peritonitis. C. prevents disequilibrium syndrome. D. increases osmotic pressure to produce ultrafiltration.

D Increasing the glucose concentration makes the solution increasingly more hypertonic. The more hypertonic the solution, the greater the osmotic pressure for ultrafiltration and thus the greater the amount of fluid removed from the client during an exchange.

The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment the nurse notes that the client's temperature is 100.2° F. Which of the following is the most appropriate nursing action? A. Encourage fluids. B. Notify the physician. C. Monitor the site of the shunt for infection. D. Continue to monitor vital signs.

D The client may have an elevated temperature following dialysis because the dialysis machine warms the blood slightly. If the temperature is elevated excessively and remains elevated, sepsis would be suspected and a blood sample would be obtained as prescribed for culture and sensitivity determinations.