Chapter 46 NIU Nursing 315

The nurse provides education about maintenance hemodialysis (HD) for a group of nursing students and states that which is the leading cause of death for these patients?

Cardiovascular complications

A nursing student asks the nurse how continuous renal replacement therapy (CRRT) is different than hemodialysis (HD). Which information does the nurse provide?

With CRRT, no dialysate is required for solute removal

The nurse instructs a patient with hyperphosphatemia to avoid which food item?

Yogurt

The nursing instructor is teaching a nursing student about continuous renal replacement therapy (CRRT). Which statement by the student indicates effective learning?

"CRRT is provided over approximately 24 hours."

The registered nurse provides education for a nursing student about postoperative care of a kidney transplant recipient. Which statement made by the student indicates the need for further teaching?

"Every mL of urine output is replaced with 25 mL of fluids for the first 24 hours."

The nurse teaches a patient with acute kidney injury (AKI) about lifestyle modifications. Which actions by the patient indicate effective teaching?

Consuming less salt

The health care provider prescribes renal replacement therapy (RRT) to remove large volumes of fluid from a patient in the intensive care unit who is hemodynamically unstable. The nurse expects which treatment to be used for this patient?

Continuous venovenous hemofiltration (CVVH)

The nurse is caring for a patient who is receiving continuous renal replacement therapy (CRRT). Which interventions does the nurse include in the patient's plan of care? Select all that apply.

Document laboratory values daily. Obtain weight daily. Assess hemodynamic status hourly.

The nurse provides information to a nursing student about the administration of erythropoietin (EPO) therapy to a patient with chronic kidney disease (CKD). Which statement made by the student indicates effective learning?

EPO is given IV or subcutaneously, usually 2 or 3 times per week."

The nurse recognizes that which intervention will likely be included in a treatment plan for a patient with chronic kidney disease (CKD) who is undergoing peritoneal dialysis?

Encouraging consumption of 25 to 35 kcal/kg/day

Which protein recommendation would the nurse expect to incorporate into the plan of care based on the following assessment data?

Ensure 1.2 to 1.3 g/kg/day of protein.

Which clinical action plan is most appropriate for a patient in stage 3 of chronic kidney disease?

Evaluation and treatment of complications

The nurse planning care for a patient with acute kidney injury (AKI) recognizes that the interventions of highest priority are directly related to which nursing diagnosis?

Excess fluid volume

Which is an intrarenal cause of acute kidney injury?

Hemolytic blood transfusion reaction

The nurse receives a prescription for polystyrene sulfonate for a patient with significant hyperkalemia. Which assessment finding is a priority concern regarding safe administration of the medication?

Hypoactive bowel sounds

The nurse is administering hemodialysis to a patient with chronic kidney disease. For which common complication does the nurse carefully monitor in this patient?

Hypotension

The nurse is attending to a patient who is receiving hemodialysis for chronic kidney disease. The nurse observes for which complications? Select all that apply.

Hypotension Muscle cramps Hepatitis

Which are common causes of acute kidney injury? Select all that apply.

Hypovolemia Interstitial nephritis Decreased renovascular blood flow

The nurse reviews the plan of care for a patient with chronic kidney disease (CKD) who is undergoing hemodialysis and questions which item listed on the plan?

IV of 0.9% sodium chloride at 125 mL/hr

During hemodialysis, a patient reports nausea, headache, and chest pain to the nurse. The patient has a BP of 80/60 mm Hg. Which action does the nurse take?

Infuse normal saline solution

A patient undergoing hemodialysis reports stomach pain to the nurse. Which treatment strategies does the nurse expect to be beneficial to the patient? Select all that apply.

Infusion of mannitol solution Infusion of normal saline solution

The nurse educates a patient about the insertion of a catheter with a Dacron cuff for delivery of peritoneal dialysis. The nurse lists which benefit of this type of catheter?

It prevents the migration of microorganisms.

A patient presents with clinical manifestation of a long-term history of decreased urinary output and pedal edema. A diagnosis of chronic kidney failure is suspected. Which test will likely be necessary to provide a definitive diagnosis?

Kidney biopsy

Which condition is a result of severe metabolic acidosis in patients with acute kidney injury?

Kussmaul respirations

The nurse is notified that a patient with acute kidney injury has a very high potassium level. Which therapy does the nurse expect to be the most effective for this patient?

Performing hemodialysis

The nurse recognizes that which laboratory data is a significant indicator that a patient is responding positively to peritoneal dialysis (PD)?

Potassium of 4.1 mEq/L

A patient with chronic kidney disease is on peritoneal dialysis. The nurse suspects that the patient is experiencing peritonitis based on which assessment findings? Select all that apply.

Rebound tenderness Hyperactive bowel sounds White blood cell (WBC) count greater than 100 cells/μL Diarrhea

The nurse provides immediate postoperative care for a patient who received a kidney during transplant surgery. Which interventions does the nurse perform? Select all that apply.

Record central venous pressure. Monitor the patient for hyponatremia and hypokalemia. Notify the health care provider of a sudden decrease in urine output

When caring for a patient that is receiving hemodialysis, which is a priority action by the nurse?

Recording the vital signs every 30 to 60 minutes

Which event is a cause of prerenal acute kidney injury?

Reduced renal blood flow

Which are postrenal causes of acute kidney injury? Select all that apply.

Renal calculi Spinal cord disease Benign hypertrophic hyperplasia (BPH

Which continuous renal replacement therapy requires no fluid replacement?

Slow continuous ultrafiltration (SCUF)

A patient with acute kidney injury experiences rapid and deep respirations. The laboratory reports reveal a serum bicarbonate level of 12 mEq/L. Which treatment strategy does the nurse expect to be beneficial?

Sodium bicarbonate

The nursing instructor teaches a nursing student about permanent therapies for hyperkalemia associated with acute kidney injury. Which example given by the student indicates effective learning?

Sodium polystyrene sulfonate

A patient with acute kidney injury is being admitted to the hospital. Which prescriptions does the nurse anticipate? Select all that apply.

Sodium restriction Potassium restriction Phosphate-binding agents Fluid replacement

The nurse is caring for a patient who had a surgery for a left-arm arteriovenous fistula (AVF) in preparation for hemodialysis. Which precautionary step does the nurse take when caring for this patient?

Take BP measurements in the right arm only.

A patient with end-stage chronic kidney disease (CKD) is scheduled for hemodialysis. Which dietary recommendation does the nurse give to the patient?

Take folic acid supplementation

The nurse recognizes that which recommendation is appropriate for a patient with chronic kidney disease (CKD)?

Take phosphate binders with meals

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

phosphorus

The registered nurse is teaching a nursing student about the preoperative care for a patient before kidney transplantation. Which statement made by the student indicates effective learning?

"I will label the access site as 'Dialysis access, no procedures.'"

The nurse reviews the medical record of a patient with kidney disease in which fluid restriction has been prescribed. The nurse notes a urine output of 400 mL for the previous 24 hours. How much fluid will the nurse allocate to the patient? Record your answer as a whole number. ____ mL

1000 400+600 daily

A 70-year-old female patient weighs 50 kg and has a serum creatinine level of 1.4 mg/dL. Using the Cockcroft-Gault rule, what should the nurse document as the patient's glomerular filtration rate (GFR)? Record the answer using one decimal place. ____________ mL/min

29.5 The Cockcroft-Gault formula estimates GFR: [(140 - Age) x (weight in kilograms) x (0.85 if female)]/(72 x Creatinine (Cr) mg/dL) = GFR. Using this formula, a female patient of 70 years weighing 50 kg with serum creatinine level of 1.4 mg/dL has a GFR of 29.5 mL/min as shown by: (140 - 70 = 70) x (50) x (0.85) / (72 x (1.4 mg/dL = 100.8) = 29.5.

The nurse provides care for a patient with end-stage renal disease (ESRD) whose BP remains greater than 140/90 mm Hg despite adherence to treatment with full doses of three antihypertensive medications including a diuretic. The nurse expects that which treatment will be prescribed before the patient undergoes kidney transplantation?

Bilateral nephrectomy

While providing postoperative care for a live kidney donor, the nurse monitors the hematocrit levels to assess for which complication?

Bleeding

A patient with a glomerular filtration rate (GFR) of 35 mL/min develops dyspnea, excess fatigue, tachycardia, palpitations, and chest pain. The nurse expects which to be included in the plan for treatment?

Blood transfusion

The nurse recognizes that which patient is most likely to develop chronic kidney disease (CKD) and will benefit from education about preventive measures?

A 61-year-old Native American patient with diabetes

The nurse is caring for a patient undergoing peritoneal dialysis. Which finding does the nurse report to the health care provider that would indicate peritonitis?

Abdominal Pain

Which is the most common intrarenal cause of acute kidney injury (AKI)?

Acute glomerulonephritis

A patient who is hospitalized with sepsis is at risk of developing which renal pathology?

Acute tubular necrosis (ATN)

Which statement made by a nursing student indicates effective learning about which intervention is included in a plan of care for a patient with chronic kidney disease who is taking gluconate and calcium acetate?

Administer a stool softener

A patient with acute kidney injury is hospitalized, and the nurse observes that the patient's electrocardiogram (ECG) reading shows tall peaked T waves, ST segment depression, and widening of the QRS complex. Which nursing interventions are appropriate for inclusion in the patient's treatment plan? Select all that apply.

Administer sodium bicarbonate. Administer regular IV insulin. Administer IV calcium gluconate.

The nurse is planning an educational course about risk factors for chronic kidney disease (CKD). Which factors does the nurse identify as nonmodifiable risk factors? Select all that apply.

Age greater than 60 Family history of CKD

Which substance can pass through the peritoneal membrane?

Amino acids

When assessing a patient with chronic kidney disease (CKD), the nurse recognizes that which neurologic change is common as the disease progresses?

Apathy

The nurse performs a neurologic assessment on a patient with end-stage renal disease (ESRD) and expects which clinical manifestations? Select all that apply.

Asterixis Nocturnal leg cramps Restless leg syndrome

A patient with chronic kidney disease (CKD) who is not yet on dialysis experiences dyslipidemia. The nurse anticipates that which medication will be prescribed?

Atorvastatin

Which dietary intake guideline is appropriate for the nurse to recommend to a patient with pre-end-stage renal disease (ESRD)?

Calcium intake of 1000 to 1500 mg/day

A patient with a 25-year history of diabetes is hospitalized with uncontrolled hypertension. A diagnosis of chronic kidney disease (CKD) is suspected. The nurse identifies that which study is the most accurate indicator of the patient's kidney function?

Calculated glomerular filtration rate (GFR)

The nurse provides dietary education for a patient with chronic kidney disease (CKD) who receives peritoneal dialysis (PD). Which recommendations does the nurse include? Select all that apply.

Calories: 25 to 35 kcal/kg/day (includes calories from dialysate glucose absorption) Proteins: At least 1.2 g/kg of ideal body weight (IBW) Phosphate: 0.6 to 1.2 g/day

A patient is diagnosed with prerenal acute kidney injury (AKI). The nurse identifies that which is the greatest cause of the patient's condition?

Cardiogenic shock

During hemodialysis, the patient develops light-headedness and nausea. Which is a priority action by the nurse?

Decrease the rate of fluid removal

The nurse is teaching a nursing student about the development of anemia in patients with chronic kidney disease (CKD). The student correctly identifies which pathologic alteration as the cause of anemia in a patient with CKD?

Decreased production of erythropoietin

Which assessment finding of a patient with chronic kidney disease indicates to the nurse that hemodialysis is having the desired effect?

Decreased serum creatinine and phosphate levels

Which fluid restriction would the nurse expect to incorporate into the plan of care after reviewing the hand-off report for this patient's arrival to the unit?

Fluid restriction of 600 to 1000 mL plus urine output volume

The nursing student provides dietary education for a patient with acute kidney injury (AKI). The nurse intervenes when the student encourages the patient to increase the intake of which foods?

Foods rich in potassium

Which nursing interventions does the nurse include in the care plan of a patient with acute kidney injury? Select all that apply.

Give thorough skin care. Wash the mouth frequently. Change the patient's position frequently.

The nurse is caring for a patient with chronic kidney disease. Which electrolyte, if abnormal, can result in decreased mental status, absence of reflexes, and respiratory failure for this patient?

Magnesium

The nurse reviews the plan of care for a patient in fluid volume overload due to chronic kidney disease. Furosemide and bumetanide have been ineffective. The nurse anticipates a prescription for which medication that is an osmotic diuretic?

Mannitol

A patient is scheduled to undergo peritoneal dialysis (PD). Which is a high priority action that the nurse performs before starting the procedure?

Obtain the patients weight

Which is a clinical manifestation of acute kidney injury?

Oliguria

The nurse provides preoperative education for a patient who is being prepared to donate a kidney to a family member. The nurse explains the positioning during the scheduled surgery and states that the flank will be exposed laterally. The donor will undergo which procedure?

Open nephrectomy

The nurse assesses the fluid intake of patients who are undergoing hemodialysis and identifies that which patient is at risk of fluid overload?

Patient 3

The nurse is attending to a patient who is scheduled to receive a kidney transplant. How does the nurse explain the postoperative care to the patient? Select all that apply

The patency of the vascular access must be maintained. The kidney may not function immediately postoperatively. A urinary catheter will be placed preoperatively to monitor urinary output postoperatively

A patient with acute kidney injury is prescribed IV insulin and IV glucose. Which is the purpose of administering both insulin and dextrose?

To treat hyperkalemia with insulin and prevent hypoglycemia with glucose

Which condition does the nurse suspect in a patient with a glomerular filtration rate (GFR) of 10 mL/minute, a blood urea nitrogen (BUN) level of 23 mg/dL, a potassium level of 4 mEq/L, and a serum bicarbonate level of 20 mEq/L?

Uremia

Which condition does the nurse suspect in a patient with chronic kidney disease (CKD) who develops osteomalacia?

Uremic red eye

The nurse determines that a patient is experiencing oliguria based on which amount of urinary output?

Urinary output of 350 mL/day

A patient with kidney failure is scheduled for a diagnostic test in which a contrast media will be used. The nurse reviews the patient's history and notes diabetes and daily metformin use. The nurse reviews the patient's treatment plan and questions which item?

Use contrast media gadolinium for the test.

The nurse identifies that which drug should be used with caution in a patient with renal failure?

Vancomycin

A patient with end-stage kidney disease is receiving continuous ambulatory peritoneal dialysis. The patient has a fever the nurse suspects is due to peritonitis. The nurse assesses the patient for which other clinical manifestations associated with peritonitis? Select all that apply.

Vomiting Abdominal pain Cloudy peritoneal effluent

When preparing a patient for hemodialysis treatment, which assessments does the nurse complete to evaluate the patient's fluid status? Select all that apply.

Weight BP Lung sounds Peripheral edema

The patient with end-stage renal disease (ESRD) has decided to terminate dialysis treatments. Which is the best response by the nurse?

"I respect your decision but believe you need to discuss options with your health care provider. Would you like me to contact the health care provider to come speak with you?"

The nurse provides education for a patient with chronic kidney disease (CKD) who is experiencing constipation. The patient's BP is 145/95 mm Hg. Which statement made by the patient indicates effective learning?

"I should monitor my BP regularly at home."

The registered nurse is teaching a new graduate nurse about the parameters that are assessed in a patient with acute kidney injury who is undergoing dialysis. Which statement by the new graduate nurse indicates the need for further teaching?

"I will examine the patient's mouth for a change in color."

A patient with acute kidney injury who is experiencing hyperkalemia asks the nurse, "Why is IV insulin being prescribed? And will my blood sugar get too low?" How does the nurse respond? Select all that apply.

"Insulin may prevent serious cardiac problems." "Glucose will be administered concurrently to prevent hypoglycemia."

he registered nurse teaches a nursing student about parenteral nutrition (PN) for patients with kidney disease. Which statement by the student indicates the need for further teaching?

"It is given to patients with a functional gastrointestinal (GI) tract."

The registered nurse is teaching a nursing student about deceased donation of a kidney. Which statement made by the student indicates effective learning?

"Kidneys can be preserved for up to 72 hours."

Which statement by the nurse indicates an understanding of continuous renal replacement therapy (CRRT)?

"Solute removal can occur by convection."

The registered nurse teaches a nursing student about physiologic changes in the diuretic phase of a patient with acute kidney injury. Which statements made by the student indicate effective learning? Select all that apply.

"This phase may last for one to three weeks." "Hypotension can occur during this phase."

A patient with chronic kidney failure (CKD) has a paralytic ileus and laboratory findings of a serum potassium level of 7 mEq/L and a phosphate level of 3.5 mg/dL. The nurse anticipates that which medication will be prescribed?

10% calcium gluconate IV

The nurse is notified that a patient in renal failure has a potassium level of 6.3 mEq/L. The telemetry monitor is showing peaked T waves. The nurse obtains prescriptions from the health care provider and implements which one first?

Administer regular insulin IV

A patient has a glomerular filtration rate (GFR) of 50 mL/minute and a serum potassium level of 8 mEq/L. The nurse monitors the patient for which complication?

Cardiac dysrhythmias

he nurse performs an admission assessment of a patient with acute kidney injury. For which common complication does the nurse assess the patient?

Cardiac dysrhythmias

The nurse provides education for a patient who is receiving hemodialysis and states that, during the treatment, which substances move from the blood to the dialysate? Select all that apply.

Creatinine Phosphate

The nurse identifies that a patient with acute kidney injury (AKI) has entered the diuretic phase when which assessment findings are noted? Select all that apply.

Dehydration Hypokalemia

The nurse is preparing to perform peritoneal dialysis for a patient with chronic kidney disease. Which osmotic agent does the nurse obtain for the dialysis exchanges?

Dextrose

The nurse provides education to a group of nursing students about the individual Estimated Post-Transplant Survival (EPTS) score that each kidney transplant candidate receives. The nurse states that the score is based on which factors? Select all that apply.

Diabetes Age Length of time on dialysis Previous transplants

Which process involves movement of fluid and molecules across a semipermeable membrane from one compartment to another?

Dialysis

Which term describes the movement of solutes from a higher concentration area to a lower concentration area?

Diffusion

The nurse recognizes that which test helps to detect microalbuminuria in patients with chronic kidney disease (CKD)?

Dipstick test

The nurse is caring for a patient who was transferred to the emergency department with severe burns. The laboratory values reveal a serum creatinine level of 5.2 mg/dL, and the glomerular filtration rate (GFR) has decreased by 75%. Which stage of acute kidney failure is the patient exhibiting?

Failure

The nurse is performing peritoneal dialysis for a patient with chronic kidney disease. The prescribed amount of fluid is infused during which phase?

Fill

A patient with chronic kidney disease (CKD) experiences peripheral neuropathy, specifically asterixis. Which assessment finding does the nurse expect?

Hand tremors while extending the wrist

A patient with acute kidney injury is being treated for hypovolemia. After an IV infusion of fluids, the nurse observes that the patient has no urine output and a BP of 140/90 mm Hg. The nurse monitors the patient for which complication?

Heart failure

The nurse is providing care for a patient who is receiving hemodialysis treatments. The events involved in the dialysis procedure occur in which order?

Hemodialysis is performed by first inserting a large needle into the fistula to obtain access to a blood vessel. Next, blood from the patient's body goes to the dialyzer. In order to avoid clotting, heparin is added to the blood. After pumping the purified blood to the patient, the dialyzer is flushed with normal saline solution. Finally, the needles are removed, and firm pressure is applied to the access site to stop bleeding.

The nurse is performing hemodialysis for a patient with chronic kidney disease. The addition of which solution to the blood will prevent clotting during the procedure?

Heparin

The nurse monitors for which complications in a patient who is undergoing hemodialysis? Select all that apply.

Hepatitis Muscle cramps Disequilibrium syndrome

Which are complications of peritoneal dialysis? Select all that apply.

Hernias Peritonitis exit site infection

The nurse is caring for a patient who received a kidney transplant. Which parameters indicate a successful transplant? Select all that apply.

High BP is corrected. Blood sodium levels are decreased Serum creatinine levels are decreased.

The nurse monitors for which condition in patients with bilateral ureteral obstruction?

Hydronephrosis

Which assessment finding is a consequence of the oliguric phase of acute kidney injury (AKI)?

Hyperkalemia

Which clinical manifestation of acute kidney injury may cause changes in an electrocardiogram (ECG)?

Hyperkalemia

The nurse identifies that a patient with chronic kidney disease (CKD) is at risk for which electrolyte disturbance?

Hyperphosphatemia

The nurse, reviewing the lab results of a patient with acute kidney injury, recognizes which finding as indicative of diminished renal function associated with the diagnosis?

Increased serum urea; increased serum creatinine

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

Increasing osmolality of the dialysate

A patient arrives in the emergency department with a three-day history of swelling in the legs and difficulty breathing. The patient states, "I haven't urinated very much in the last 24 hours." The patent's serum creatinine level is 3.9 mg/dL. Which type of kidney injury does the nurse suspect?

Kidney failure

A patient reports reduced urine output and abdominal pain. The nurse suspects acute kidney injury and anticipates that which diagnostic test will be prescribed as an initial test to confirm the diagnosis?

Kidney ultrasound

The nurse provides postoperative care 18 hours after a patient received a kidney during transplant surgery. Which is an expected assessment finding for this patient during this stage of recovery?

Large urine output

The nurse is teaching a patient with chronic kidney disease about restricting phosphorous in the diet. The nurse determines the teaching was effective when the patient correctly identifies which examples of foods as high in phosphorous? Select all that apply

Milk Steak Cheese Pudding

Which intervention does the nurse perform for a patient who is on peritoneal dialysis?

Monitor for discharge at the exit site

A patient with chronic kidney disease experiences persistent uremia that can no longer be adequately treated with conservative medical management. The nurse expects a prescription for immediate dialysis if the patient experiences which uremic complications? Select all that apply.

Pericarditis Encephalopathy

A patient who has been on peritoneal dialysis for two years reports nausea, vomiting, diarrhea, and fluid discharge from the catheter exit site. The laboratory reports reveal an increased white blood cell (WBC) count. Which condition does the nurse suspect in the patient?

Peritonitis

A patient, hospitalized with a pulmonary embolism, has a three-day history of decreased cardiac output and hypotension. The nurse identifies that the patient is at risk for which renal complication?

Prerenal acute kidney injury (AKI)

The nurse provides education for a group of nursing students about prerenal causes of acute kidney injury and includes which information?

Prerenal oliguria is caused by decreased circulatory volume

The nurse identifies that a patient is in the oliguric phase of acute kidney injury (AKI) based on which assessment finding?

Reduced urine output to less than 400 mL/day

The nurse is providing care for a patient two days after kidney transplantation surgery. An appropriate roommate to cohort with the postoperative patient is the patient with which diagnosis?

Renal calculli

A patient with chronic kidney disease (CKD) is being administered 15 g sodium polystyrene sulfonate orally for hyperkalemia. Which intervention does the nurse perform?

Report peaked T waves on the electrocardiogram (ECG).

A patient with chronic kidney disease is prescribed regular peritoneal dialysis (PD). Which does the nurse inform the patient while teaching about PD?

Reposition frequently.

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

Restrict fluids according to previous daily loss

When reviewing the laboratory results of a patient with acute kidney injury (AKI), the nurse identifies that an increase in which level is an important diagnostic indicator in determining the severity of injury?

Serum creatinine

While caring for a patient who is undergoing peritoneal dialysis on a regular basis, the nurse observes redness and drainage at the exit site of the peritoneal catheter. Which does the nurse anticipate the culture results will reveal?

Staphylococcus aureus infection

A patient had the surgical creation of a subcutaneous arteriovenous fistula (AVF) for the administration of hemodialysis. The nurse monitors for which complication?

Steal syndrome

Which finding corresponds with nonoliguric acute kidney injury (AKI)?

Urinary output of 450 mL/day

A patient is in the diuretic phase of acute kidney injury. The nurse recalls that which events occur during this phase? Select all that apply.

Urine output increases There is a risk of hyponatremia.

A patient with chronic kidney failure is prescribed erythropoietin for treatment of anemia. The nurse would monitor the patient for indications of which adverse effect?

iron deficiency