AKI/CKD Complex

Which statement by the nurse regarding continuous ambulatory peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to this procedure?

"It is essential that you maintain aseptic technique to prevent peritonitis."

741. The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1.Palpation of a thrill over the fistula 2.Presence of a radial pulse in the left wrist 3.Absence of a bruit on auscultation of the fistula 4.Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand

1.

Steps to do when pt has CKD

1. Monitor K levels 2. Assess breath sounds 3. Turn every 2 hours 4. Offer emotional support

752. The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? 1.Infection 2.Hyperglycemia 3.Hypophosphatemia 4.Disequilibrium syndrome

2

737. A client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious and the nurse suspects air embolism. What is the priority nursing action? 1.Monitor vital signs every 15 minutes for the next hour. 2.Discontinue dialysis and notify the health care provider (HCP). 3.Continue dialysis at a slower rate after checking the lines for air. 4.Bolus the client with 500 mL of normal saline to break up the air embolus.

2. DISCONTINUE - very dangerous

749. A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 100.2° F. Which nursing action is most appropriate? 1.Encourage fluids. 2.Notify the health care provider. 3.Continue to monitor vital signs. 4.Monitor the site of the shunt for infection.

3. can have temp due to dialysis

747. A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess the client for which manifestations of this complication? 1.Warmth, redness, and pain in the left hand 2.Aching pain, pallor, and edema of the left arm 3.Edema and reddish discoloration of the left arm 4.Pallor, diminished pulse, and pain in the left hand

4

Which patient should be taught preventive measures for CKD by the nurse because this patient is most likely to develop CKD?

A 61-year-old Native American male with diabetes Correct

A 78-year-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?

Apple, green beans, and a roast beef sandwich Correct

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?

Continuous venovenous hemofiltration (CVVH) Correct

During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do for the patient?

Decrease the rate of fluid removal. Correct

Which assessment finding is a consequence of the oliguric phase of AKI?

Hyperkalemia

A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. What is an expected assessment finding for this patient during this early stage of recovery?

Large urine output

When caring for a patient during the oliguric phase of acute kidney injury (AKI), what is an appropriate nursing intervention?

Restrict fluids according to previous daily loss.

A patient with a history of end-stage kidney disease secondary to diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which assessments should the nurse prioritize before, during, and after his treatment?

blood pressure and fluid balance

The nurse knows the patient with AKI has entered the diuretic phase when what assessments occur (select all that apply)?

dehydration hypokalemia

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. The nurse should know that ultrafiltration in peritoneal dialysis is achieved by which method?

Increasing osmolality of the dialysate Correct

748. The nurse is reviewing a client's record and notes that the health care provider has documented that the client has a renal function disorder. On review of the laboratory results, the nurse most likely would expect to note which finding? 1.Elevated creatinine level 2.Decreased hemoglobin level 3.Decreased red blood cell count 4.Decreased white blood cell count

1

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 1.Check the level of the drainage bag. 2.Reposition the client to his or her side. 3.Contact the health care provider (HCP). 4.Place the client in good body alignment. 5.Check the peritoneal dialysis system for kinks. 6.Increase the flow rate of the peritoneal dialysis solution.

1, 2, 4, 5

736. A client with acute kidney injury has a serum potassium level of 6.0 mEq/L. The nurse should plan which action as a priority? 1.Check the sodium level. 2.Place the client on a cardiac monitor. 3.Encourage increased vegetables in the diet. 4.Allow an extra 500 mL of fluid intake to dilute the electrolyte concentration.

2 If inc K - can cause dysrhythmias

750. The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the most appropriate nursing action? 1.Monitor the client. 2.Elevate the head of the bed. 3.Medicate the client for nausea. 4.Notify the health care provider (HCP).

4

751. A client newly diagnosed with chronic kidney disease has just been started on peritoneal dialysis. During the infusion of the dialysate, the client complains of abdominal pain. Which action by the nurse is most appropriate? 1.Stop the dialysis. 2.Slow the infusion. 3.Decrease the amount to be infused. 4.Explain that the pain will subside after the first few exchanges.

4

755. The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? 1.Hypertension, tachycardia, and fever 2.Hypotension, bradycardia, and hypothermia 3.Restlessness, irritability, and generalized weakness 4.Headache, deteriorating level of consciousness, and twitching

4

The patient has a form of glomerular inflammation that is progressing rapidly. She is gaining weight, and the urine output is steadily declining. What is the priority nursing intervention?

Monitor the patient's cardiac status. Correct

The nurse preparing to administer a dose of calcium acetate (PhosLo) to a patient with chronic kidney disease (CKD) should know that this medication should have a beneficial effect on which laboratory value?

Phosphorus

The patient has had type 1 diabetes mellitus for 25 years and is now reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse finds that the patient has newly developed hypertension and difficulty with blood glucose control. The nurse should know that which diagnostic study will be most indicative of chronic kidney disease (CKD) in this patient?

calculated GFR

The patient was diagnosed with prerenal AKI. The nurse should know that what is most likely the cause of the patient's diagnosis?

dissecting abdominal aneurysm