Exam 2 - Acute Renal Failure

The nurse is caring for a client diagnosed with ARF. Which laboratory values are most significant for diagnosing ARF? 1. BUN and creatinine 2. WBC and hemoglobin 3. Potassium and sodium 4. Bilirubin and ammonia level

*1. Blood urea nitrogen (BUN) levels reflect the balance between the production and excretion of urea from the kidneys. Creatinine is a by-product of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal substance for determining renal clearance because it is relatively constant in the body and is the laboratory value most significant in diagnosing renal failure.* 2. WBCs are monitored for infection, and hemoglobin is monitored for blood loss. 3. Potassium (intracellular) and sodium (interstitial) are electrolytes and are monitored for a variety of diseases or conditions not specific to renal function. Potassium levels will increase with renal failure, but the level is not a diagnostic indicator for renal failure. 4. Bilirubin and ammonia levels are laboratory values determining the function of the liver, not the kidneys.

The client is admitted to the emergency department after a gunshot wound to the abdomen. Which nursing intervention should the nurse implement first to prevent ARF? 1. Administer normal saline IV. 2. Take vital signs. 3. Place client on telemetry. 4. Assess abdominal dressing.

*1. Preventing and treating shock with blood and fluid replacement will prevent acute renal failure from hypoperfusion of the kidneys. Significant blood loss is expected in the client with a gunshot wound.* 2. Taking and evaluating the client's VS is an appropriate action, but regardless of the results, this will not prevent ARF. 3. Placing the client on telemetry is an appropriate action, but telemetry is an assessment tool for the nurse and will not prevent ARF. 4. Assessment is often the first action, but assessing the abdominal dressing will not help prevent ARF.

The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the client is in the recovery period? *Select all that apply.* 1. Increased alertness and no seizure activity 2. Increase in hemoglobin and hematocrit 3. Denial of nausea and vomiting 4. Decreased urine-specific gravity. 5. Increased serum creatinine level

*1. Renal failure affects almost every system in the body. Neurologically, the client may have drowsiness, headache, muscle twitching, and seizures. In the recovery period, the client is alert and has no seizure activity.* *2. In renal failure, levels of erythropoietin are decreased, leading to anemia. An increase in hemoglobin and hematocrit indicates the client is in the recovery period.* *3. Nausea, vomiting, and diarrhea are common in the client with ARF; therefore, an absence of these indicates the client is in the recovery period.* 4. The client in the recovery period has an increased urine-specific gravity. 5. The client in the recovery period has a decreased serum creatinine level.

The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a medical floor. Which nursing task is most appropriate for the nurse to delegate? 1. Collect a clean voided midstream urine specimen. 2. Evaluate the client's 8-hour intake and output. 3. Assist in checking a unit of blood prior to hanging. 4. Administer a cation-exchange resin enema.

*1. The UAP can collect specimens. Collecting a midstream urine specimen requires the client to clean the perineal area, to urinate a little, and then collect the rest of the urine output in a sterile container.* 2. The UAP can obtain the client's intake and output, but the nurse must evaluate the data to determine if interventions are needed or if interventions are effective. 3. 2 registered nurses must check the unit of blood at the bedside prior to administering it. 4. This is a medication enema and UAPs cannot administer medications. Also, for this to be ordered, the client must be unstable with an excessivey high serum potassium level.

The nurse is caring for a client diagnosed with rule-out ARF. Which condition predisposes the client to developing prerenal failure? 1. Diabetes mellitus 2. Hypotension 3. Aminoglycosides 4. Benign prostatic hypertrophy

1. DM is a disease that may lead to chronic renal failure. *2. Hypotension, which causes a decreased blood supply to the kidney, is one of the most common causes of prerenal failure (before the kidney).* 3. Nephrotoxic medications are a cause of intrarenal failure (directly to kidney). 4. Benign prostatic hypertrophy (BPH) is a cause of post renal failure (after the kidney).

The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level? 1. Erythropoietin 2. Calcium gluconate 3. Regular insulin 4. Osmotic diuretic

1. Erythropoietin is a chemical catalyst produced by the kidneys to stimulate RBC production; it does not affect potassium level. 2. Calcium gluconate helps protect the heart from the effect of high potassium levels. *3. Regular insulin, along with glucose, will drive potassium into the cells, thereby lowering serum potassium levels temporarily.* 4. A loop diuretic, not an osmotic diurectic, may be ordered to help decrease the potassium level.

The client diagnosed with ARF is placed on bedrest. The client asks the nurse, "Why do I have to stay in bed? I don't feel bad." Which scientific rationale supports the nurse's response? 1. Bedrest helps increase the blood return to the renal circulation. 2. Bedrest reduces the metabolic rate during the acute stage. 3. Bedrest decreases the workload of the left side of the heart. 4. Bedrest aids in reduction of peripheral and sacral edema.

1. Kidney function is improved about 40% when recumbent, but this is not the scientific rationale for bedrest in ARF. *2. Bedrest reduces exertion and the metabolic rate, thereby reducing catabolism and subsequent release of potassium and accumulation of endogenous waste products (urea and creatinine).* 3. This is a scientific rationale for prescribing bedrest in clients with heart failure. 4. This is not the scientific rationale for prescribing bedrest. The foot of the bed may be elevated to help decrease peripheral edema, and bedrest causes an increase in sacra edema.

The UAP tells the nurse the client with ARF has a white crystal-like layer on top of the skin. Which intervention should the nurse implement? 1. Have the assistant apply a moisture barrier cream to the skin. 2. Instruct the UAP to bathe the client in cool water. 3. Tell the UAP not to turn the client in this condition. 4. Explain this is normal and do not do anything for the client.

1. Moisture barrier cream will keep the crystals on the skin. *2. These crystals are uremic frost resulting from irritating toxins deposited in the client's tissues. Bathing in cool water will remove the crystals, promote client comfort, and decrease the itching resulting from uremic frost.* 3. The client should be turned every 2 hours or more frequently to prevent skin breakdown. 4. This may occur with ARF, and it does require a nursing intervention.

The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which collaborative treatment should the nurse anticipate for the client? 1. Administer a phosphate binder. 2. Type and crossmatch for whole blood. 3. Assess the client for leg cramps. 4. Prepare the client for dialysis.

1. Phosphate binders are used to treat elevated phosphorus levels, not elevated potassium levels. 2. Anemia is not the result of an elevated potassium level. 3. Assessment is an independent nursing action, which is appropriate for the elevated potassium level, but the question asks for a collaborative treatment. *4. Normal potassium level is 3.5 to 5.5 mEq/L. A level of 6.8 mEq/L is life threatening and could lead to cardiac dysrhythmias. Therefore, the client may be dialyzed to decrease the potassium level quickly. This requires a health-care provider order, so it is a collaborative intervention.*

Which client should the nurse consider at risk for developing acute renal failure? 1. The client diagnosed with essential hypertension 2. The client diagnosed with type 2 diabetes 3. The client who had an anaphylactic reaction 4. The client who had an autologous blood transfusion

1. The client diagnosed with essential hypertension is at risk for chronic renal failure. 2. The client diagnosed with type 2 diabetes is at risk for chronic renal failure. *3. Anaphylaxis leads to circulatory collapse, which decreases perfusion of the kidneys and can lead to acute renal failure.* 4. This is a transfusion of the client's own blood, which should not cause a reaction.

The client diagnosed with ARF is admitted to the intensive care unit and placed on a therapeutic diet. Which diet is most appropriate for the client? 1. A high-potassium and low-calcium diet. 2. A low-fat and low-cholesterol diet. 3. A high-carbohydrate and restricted-protein diet. 4. A regular diet with six (6) small feedings a day.

1. The diet is low potassium, and calcium is not restricted in ARF. 2. This is a diet recommended for clients with cardiac disease and atherosclerosis. *3. Carbohydrates are increased to provide for the client's caloric intake and protein is restricted to minimize protein breakdown and to prevent accumulation of toxic waste products.* 4. This client must be on a therapeutic diet, and small feedings are not required.

The client is in the intensive care department (ICD) after a motor-vehicle accident in which the client lost an estimated three (3) units of blood. Which action by the nurse could prevent the client from developing acute renal failure? 1. Take and document the client's vital signs every hour. 2. Assess the client's dressings every two (2) hours. 3. Check the client's urinary output every shift. 4. Maintain the client's blood pressure greater than 100/60.

1. The nurse taking vital signs and documenting them will not prevent acute renal failure because action is not initiated that will directly affect the client's health status because of the results of the data. The nurse must always initiate an intervention based on abnormal data assessed. 2. Assessing the clients dressing will allow the nurse to be aware of bleeding but does not prevent acute renal failure. 3. The urinary output is checked to ensure the kidneys are being perfused but there is no action that will maintain the perfusion in this option. *4. Maintaining the client's blood pressure to greater than 100/60 ensures perfusion of the kidneys. Acute renal failure occurs when the kidneys have not been adequately perfused. Vasopressor drips are used to maintain the BP.*

The nurse is developing a plan of care for a client diagnosed with ARF. Which statement is an appropriate outcome for the client? 1. Monitor intake and output every shift. 2. Decrease of pain by 3 levels on a 1-10 scale. 3. Electrolytes are within normal limits. 4. Administer enemas to decrease hyperkalemia.

1. This is a nursing intervention, not a client outcome. 2. This is a measurable client outcome, but acute renal failure does not cause pain. *3. Renal failure causes an imbalance of electrolytes (potassium, sodium, calcium, phosphorus). Therefore, the desired client outcome is electrolytes within normal limits.* 4. A Kayexalate resin enema may be administered to help decrease the potassium level, but this is an intervention, not a client outcome.

The nurse is admitting a client diagnosed with acute renal failure (ARF). Which question is most important for the nurse to ask during the admission interview? 1. "Have you recently traveled outside the United States?" 2. "Did you recently begin a vigorous exercise program?" 3. "Is there a chance you have been exposed to a virus?" 4. "What over-the-counter medications do you take regularly?"

1. Usually there are no diseases or conditions warranting this question when discussing ARF. 2. Vigorous exercise will not impede blood flow to the kidneys, leading to ARF. 3. Usually viruses do not cause ARF. *4. Medications such as NSAIDs and some herbal remedies are nephrotoxic; therefore, asking about medications is appropriate.*