KIDNEEEEYYYS
What is the most important nursing diagnosis for a patient in end-stage renal disease? Risk for injury Fluid volume excess Altered nutrition: less than body requirements Activity intolerance
Answer: Fluid volume excess Kidneys are unable to rid the body of excess fluids which results in fluid volume excess during ESRD.
13. Which drug is indicated for pain related to acute renal calculi? 1. Narcotic analgesics 2. Nonsteroidal anti-inflammatory drugs (NSAIDS) 3. Muscle relaxants 4. Salicylates
13. Answer: 1. Narcotic analgesics are usually needed to relieve the severe pain of renal calculi. Muscle relaxants are typically used to treat skeletal muscle spasms. NSAIDS and salicylates are used for their anti-inflammatory and antipyretic properties and to treat less severe pain.
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: a) "As the disease progresses, you will most likely require renal replacement therapy." b) "Dietary changes can reverse the damage that has occurred in your kidneys." c) "Genetic testing will determine the best treatment for your condition." d) "Draining of the cysts and antibiotic therapy will cure your disease."
"As the disease progresses, you will most likely require renal replacement therapy." Correct Explanation: There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.
The nurse is caring for a female patient who underwent a kidney transplant. The patient appears anxious and tearful and states "My body is going to reject the new kidney; I know I'm going to die." Which of the following is the best response by the nurse? a) "If your body rejects the kidney, you can go back on dialysis; you are not going to die." b) "I understand your concerns, let's talk about them." c) "Don't think like that; I'm certain you will be fine." d) "You've waited years for this transplant, you need to think positively."
"I understand your concerns, let's talk about them." Correct Explanation: The nurse must address the patient's concerns and encourage the patient to express her thoughts and concerns. The rejection of a transplanted kidney is of great concern to the patient, the family, and the health care team for many months. An important nursing function is the assessment of the patient's stress and coping. The nurse uses each visit with the patient to determine if the patient and family are coping effectively and the patient is adhering to the prescribed medication regimen. If indicated or requested, the nurse refers the patient for counseling. The other responses are nontherapeutic.
The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than ___________mL/kg/hr.
0.5 mL/kg/hr Correct Explanation: Oliguria is defined as urine output less than 0.5 mL/kg/hr.
10. Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient's teaching plan? 1. Rub the skin vigorously with a towel 2. Take frequent baths 3. Apply alcohol-based emollients to the skin 4. Keep fingernails short and clean
10. Answer: 4. Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation and breaks in the skin that increase the patient's risk of infection. Keeping fingernails short and clean helps reduce the risk of infection.
14. Which of the following causes the majority of UTI's in hospitalized patients? 1. Lack of fluid intake 2. Inadequate perineal care 3. Invasive procedures 4. Immunosuppression
14. Answer: 3. Invasive procedures such as catheterization can introduce bacteria into the urinary tract. A lack of fluid intake could cause concentration of urine, but wouldn't necessarily cause infection.
16. You expect a patient in the oliguric phase of renal failure to have a 24 hour urine output less than: 1. 200ml 2. 400ml 3. 800ml 4. 1000ml
16. Answer: 2. Oliguria is defined as urine output of less than 400ml/24hours.
18. A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs, sneezes, or lifts heavy objects? 1. Overflow 2. Reflex 3. Stress 4. Urge
18. Answer: 3. Stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-abdominal pressure, such as with coughing or sneezing.
19. Immediately post-op after a prostatectomy, which complications requires priority assessment of your patient? 1. Pneumonia 2. Hemorrhage 3. Urine retention 4. Deep vein thrombosis
19. Answer: 2. Hemorrhage is a potential complication. Urine retention isn't a problem soon after surgery because a catheter is in place. Pneumonia may occur if the patient doesn't cough and deep breathe. Thrombosis may occur later if the patient doesn't ambulate.
20. The most indicative test for prostate cancer is: 1. A thorough digital rectal examination 2. Magnetic resonance imaging (MRI) 3. Excretory urography 4. Prostate-specific antigen
20. Answer: 4. An elevated prostate-specific antigen level indicates prostate cancer, but it can be falsely elevated if done after the prostate gland is manipulated. A digital rectal examination should be done as part of the yearly screening, and then the antigen test is done if the digital exam suggests cancer. MRI is used in staging the cancer.
23. You're planning your medication teaching for your patient with a UTI prescribed phenazopyridine (Pyridium). What do you include? 1. "Your urine might turn bright orange." 2. "You need to take this antibiotic for 7 days." 3. "Take this drug between meals and at bedtime." 4. "Don't take this drug if you're allergic to penicillin."
23. Answer: 1. The drug turns the urine orange. It may be prescribed for longer than 7 days and is usually ordered three times a day after meals. Phenazopyridine is an azo (nitrogenous) analgesic; not an antibiotic.
24. Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient? 1. Dysuria, frequency, and urgency 2. Back pain, nausea, and vomiting 3. Hypertension, oliguria, and fatigue 4. Fever, chills, and right upper quadrant pain radiating to the back
24. Answer: 3. Mild to moderate HTN may result from sodium or water retention and inappropriate renin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia.
3. Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium). 1. If the urine turns orange-red, call the doctor. 2. Take phenazopyridine just before urination to relieve pain. 3. Once painful urination is relieved, discontinue prescribed antibiotics. 4. After painful urination is relieved, stop taking phenazopyridine.
3. Answer: 4. Pyridium is taken to relieve dysuria because is provides an analgesic and anesthetic effect on the urinary tract mucosa. The patient can stop taking it after the dysuria is relieved. The urine may temporarily turn red or orange due to the dye in the drug. The drug isn't taken before voiding, and is usually taken 3 times a day for 2 days.
The nurse is caring for a patient with CKD. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? __________________ a) 4,000
4,000 Correct Explanation: A 1-kg weight gain is equal to 1,000 mL of retained fluid. 4 kg × 1,000 = 4,000. The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded.
5. You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining? 1. Check for kinks in the outflow tubing. 2. Raise the drainage bag above the level of the abdomen. 3. Place the patient in a reverse Trendelenburg position. 4. Ask the patient to cough.
5. Answer: 1. Tubing problems are a common cause of outflow difficulties, check the tubing for kinks and ensure that all clamps are open. Other measures include having the patient change positions (moving side to side or sitting up), applying gentle pressure over the abdomen, or having a bowel movement.
6. What is the appropriate infusion time for the dialysate in your 38 y.o. patient with chronic renal failure? 1. 15 minutes 2. 30 minutes 3. 1 hour 4. 2 to 3 hours
6. Answer: 1. Dialysate should be infused quickly. The dialysate should be infused over 15 minutes or less when performing peritoneal dialysis. The fluid exchange takes place over a period ranging from 30 minutes to several hours.
7. A 30 y.o. female patient is undergoing hemodialysis with an internal arteriovenous fistula in place. What do you do to prevent complications associated with this device? 1. Insert I.V. lines above the fistula. 2. Avoid taking blood pressures in the arm with the fistula. 3. Palpate pulses above the fistula. 4. Report a bruit or thrill over the fistula to the doctor.
7. Answer: 2. Don't take blood pressure readings in the arm with the fistula because the compression could damage the fistula. IV lines shouldn't be inserted in the arm used for hemodialysis. Palpate pulses below the fistula. Lack of bruit or thrill should be reported to the doctor.
8. Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect? 1. Infection 2. Disequilibrium syndrome 3. Air embolus 4. Acute hemolysis
8. Answer: 2. Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the blood. This can lead to cerebral edema and increased intracranial pressure (ICP). Signs and symptoms include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.
9. Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps? 1. Increase the rate of dialysis 2. Infuse normal saline solution 3. Administer a 5% dextrose solution 4. Encourage active ROM exercises
9. Answer: 2. Treatment includes administering normal saline or hypertonic normal saline solution because muscle cramps can occur when the sodium and water are removed to quickly during dialysis. Reducing the rate of dialysis, not increasing it, may alleviate muscle cramps.
The patient with type 2 diabetes has a second UTI within one month of being treated for a previous UTI. Which medication should the nurse expect to teach the patient about taking for this infection? A. Ciprofloxacin (Cipro) B. Fosfomycin (Monurol) C. Nitrofurantoin (Macrodantin) D. Trimethoprim/sulfamethoxazole (Bactrim)
A. Ciprofloxacin (Cipro) This UTI is a complicated UTI because the patient has type 2 diabetes and the UTI is recurrent. Ciprofloxacin (Cipro) would be used for a complicated UTI. Fosfomycin (Monurol), nitrofurantoin (Macrodantin), and trimethoprim/sulfamethoxazole (Bactrim) should be used for uncomplicated UTIs.
The nurse teaches a 21-year-old female patient who came to the clinic to discuss interventions to prevent a recurrence of urinary tract infections. Which statement, if made by the patient, indicates that teaching was effective? A. "I will urinate before and after having intercourse." B. "I will use vinegar as a vaginal douche every week." C. "I should drink three 8-ounce glasses of water daily." D. "I can stop the antibiotics when symptoms disappear."
A. "I will urinate before and after having intercourse." The woman should empty her bladder before and after sexual intercourse. She should avoid vaginal douches and maintain adequate oral fluid intake (15 mL per pound of body weight). All of the antibiotics should be taken as prescribed even if symptoms are no longer present.
Which nursing diagnosis is a priority in the care of a patient with renal calculi? A. Acute pain B. Risk for constipation C. Deficient fluid volume D. Risk for powerlessness
A. Acute pain Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to result from urinary stones, whereas constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.
What is the nurse's priority when changing the appliance of a patient with an ileal conduit? A. Keep the skin free of urine. B. Inspect the peristomal area. C. Cleanse and dry the area gently. D. Affix the appliance to the faceplate.
A. Keep the skin free of urine The nurse's priority is to keep the skin free of urine because the peristomal skin is at high risk for damage from the urine if it is alkaline. The peristomal area will be assessed; the area will be gently cleaned and dried, and the appliance will be affixed to the faceplate if one is being used, but these are not as much of a priority as keeping the skin free of urine to prevent skin damage.
The urinalysis of a male patient reveals a high microorganism count. What data should the nurse use to determine the area of the urinary tract that is infected (select all that apply)? A. Pain location B. Fever and chills C. Mental confusion D. Urinary hesitancy E. Urethral discharge F. Post-void dribbling
A. Pain location C. Mental confusion Although all the manifestations are evident with urinary tract infections (UTIs), pain location is useful in differentiating among pyelonephritis, cystitis, and urethritis because flank pain is characteristic of pyelonephritis, but dysuria is characteristic of cystitis and urethritis. Urethral discharge is indicative of urethritis, not pyelonephritis or cystitis. Fever and chills and mental confusion are nonspecific indicators of UTIs. Urinary hesitancy and postvoid dribbling may occur with a UTI but may also occur with prostate enlargement in the male patient.
The nurse counsels a 64-year-old man on dietary restrictions to prevent recurrent uric acid renal calculi. Which foods should the nurse teach the patient to avoid? A. Venison, crab, and liver B. Spinach, cabbage, and tea C. Milk, yogurt, and dried fruit D. Asparagus, lentils, and chocolate
A. Venison, crab, and liver Foods high in purines (e.g., venison, crab, liver) should be avoided to prevent uric acid calculi formation. Foods high in calcium (e.g., milk, yogurt, dried fruit, lentils, chocolate) should be avoided to prevent calcium calculi formation. Foods high in oxalate (e.g., spinach, cabbage, tea, asparagus, chocolate) should be avoided to prevent oxalate calculi formation (see Table 46-12).
A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching? Take cool baths Avoid tampon use Avoid sexual activity Drink 8 to 10 eight-oz glasses of water daily
Answer: Drink 8 to 10 eight-oz glasses of water daily Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps flush the bacteria from the bladder. The patient should be instructed to void after sexual activity.
The most common early sign of kidney disease is: Sodium retention Elevated BUN level Development of metabolic acidosis Inability to dilute or concentrate urine
Answer: Elevated BUN Increased BUN is usually an early indicator of decreased renal function
The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following? a) Metabolic alkalosis b) Hypophosphatemia c) Anemia d) Hypokalemia
Anemia Correct Explanation: Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic glomerulonephritis
Which of the following is a change that occurs in chronic glomerulonephritis? a) Metabolic alkalosis b) Hypokalemia c) Anemia d) Hypophosphatemia
Anemia Correct Explanation: Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic glomerulonephritis.
A 22 y.o. patient with diabetic nephropathy says, "I have two kidneys and I'm still young. If I stick to my insulin schedule, I don't have to worry about kidney damage, right?" Which of the following statements is the best response? "You have little to worry about as long as your kidneys keep making urine." "You should talk to your doctor because statistics show that you're being unrealistic." "You would be correct if your diabetes could be managed with insulin." "Even with insulin, kidney damage is still a concern."
Answer: "Even with insulin, kidney damage is still a concern." Kidney damage is still a concern. Microavascular changes occur in both of the patient's kidneys as a complication of the diabetes. Diabetic nephropathy is the leading cause of end-stage renal disease. The kidneys continue to produce urine until the end stage. Nephropathy occurs even with insulin management.
2. You have a patient that might have a urinary tract infection (UTI). Which statement by the patient suggests that a UTI is likely? A. "I pee a lot." B. "It burns when I pee." C. "I go hours without the urge to pee." D. "My pee smells sweet."
Answer: "It burns when I pee." A common symptom of a UTI is dysuria. A patient with a UTI often reports frequent voiding of small amounts and the urgency to void. Urine that smells sweet is often associated with diabetic ketoacidosis.
3. Which patient is at greatest risk for developing a urinary tract infection (UTI)? A. A 35 y.o. woman with a fractured wrist B. A 20 y.o. woman with asthma C. A 50 y.o. postmenopausal woman D. A 28 y.o. with angina
Answer: A 50 y.o. postmenopausal woman Women are more prone to UTI's after menopause due to reduced estrogen levels. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli bacteria, which protect against infection. Angina, asthma and fractures don't increase the risk of UTI.
You are administering erythropoietin to the patient with CKF. Which of the following would be a sign of adverse reaction? SATA A) Seizure B) Hypertension C) Decreased u/o D) Improved exercise tolerance E) Head ache
Answer: A, B, and E. Seizures, Hypertension, HA, arthralgia, nausea, increased clotting of vascular access sites, seizures, and depletion of body iron stores are adverse effects of administering erythropoietin. Decreased u/o is a symptom of the disease process. Improved exercise tolerance would be a benefit of this medication.
The nurse is performing peritoneal dialysis and infuses 2 L of fluid into the patient. The drainage is measured to be only 1800 ml. What is the nurse's priority action? A) Raise the head of the bed B) Administer 02 C) Call the doctor D) Infuse 200 ml
Answer: A. Repositioning the patient, often by sitting the client up, can help facilitate draining. The nurse can also turn the patient from side to side. The patency of the catheter should be inspected by looking for kinks, closed clamps, or an air lock. If none of these methods help pull off the extra fluid the doctor should be notified. Administering O2 is not needed unless the patient shows signs of difficulty breathing. Infusing extra fluid would make the situation worse
The patient with hemodialysis for ESRD arrives to the clinic c/o DOE and fatigue. The vitals are as follows: BP 154/89 HR 78 RR 18 T 95.5 Spo2 90%. Upon auscultation crackles are noted in bases of lungs. The patient also states that he has been experiencing muscle aches. What is the first question the nurse should ask? A) Have you been following your dietary restrictions? B) Are you taking your blood pressure medication? C) How much activity are you getting in a day? D) Have you noticed any swelling at the dialysis site?
Answer: A. The crackles in the lungs, elevated blood pressure and muscle aches indicate that possibly the client has not been following his dietary restrictions and it has led to pulmonary edema, HTN and hyperkalemia. Although it is important to know if the patient is taking the blood pressure medication, all of the signs and symptoms indicate that something bigger is going on. Activity and swelling at the dialysis site are not priority questions.
Nurse Faith is preparing to teach the patient with CKF about dietary modifications. Which of the following aspects of the patient is most important for the nurse evaluate before teaching begins? A) Family Hx B) Attention span C) Uric Acid level D) Support system
Answer: B. Because CKF often affects and limits the attention span and ability to concentrate, it is important for the nurse to assess this before beginning teaching. Often teaching will need to be done in increments of 10-15 minute periods
Nurse Heather is looking over the patient chart and is preparing to administer erythropoietin to the patient with CKF. Which of the following pieces of information in the chart would cause Nurse Heather to question this order? A) Hgb of 9 B) Hx of uncontrolled HTN C) Pt. complains of fatigue D) Ferric Gluconate (Ferrlecit) is also ordered
Answer: B. Erythropoietin is used to treat anemia associated with chronic kidney disease. Uncontrolled HTN is a contraindication to this therapy because erythropoietin can severely raise BP. HGB of 9 is considered to be low, and would be an indication for the use of this medication. The HGB should not exceed 12. Fatigue is treated with this medication. Iron supplementation, ferric gluconate, is often ordered alongside erythropoietin to provide an adequate response.
The patient with ESRD arrives to the clinic ready for his peritoneal dialysis. He says "I am not very happy about being here today" This patient has a history of severe hypertension, heart failure, pulmonary edema, diabetes, A-fib, hyperlipidemia, CAD and has recently been diagnosed with osteoporosis. His vitals today are BP 145/70, HR 99, T 99.7 O2 94%. Which piece of patient data does the nurse need to pay most attention to right before beginning dialysis? A) The patient's anxiety B) Hx of diabetes C) BP 145/70 D) Hx of A-fib
Answer: B. It is important for the nurse to closely monitor the patient's glucose level because peritoneal dialysis uses solutions containing glucose. Insulin will probably need to be administered
The nurse is performing peritoneal dialysis exchange on the patient with CKF. This is the first peritoneal dialysis treatment. The nurse inspects the drainage. Which should the nurse report to the physician immediately? A) Bloody drainage B) More than 2 L of drainage C) Cloudy drainage D) Glucose in drainage
Answer: C. Cloudy drainage is abnormal as the drainage after peritoneal dialysis should be clear and colorless. Having bloody drainage after the insertion of a new catheter is normal and is expected on the first few exchanges. Having more than 2 L of drainage and have glucose in the drainage is to be expected.
You are working at a dialysis center and are taking care of Ms. Hector. She has a history of diabetes, CKF, and HTN. She says "I hate having to come here all the time. Can't I just do this stuff at home?" What is the nurse's best response? A) "Yes, home hemodialysis is an option for you. In fact, we can start setting you up within the next week" B) "In order to have hemodialysis you need to have friends or family to help you. Do you even have any friends?" C) "Home hemodialysis is a possibility but it will be necessary to inspect your home" D) "Because of your preexisting conditions, you would not be a good candidate for home dialysis"
Answer: C. Home dialysis is an option for some people, but requires extensive training, home inspection, and support system. It would not be feasible to set up Ms. Hector with home hemodialysis within the next week. Although she does have preexisting conditions, none of the ones listed would be a barrier to her performing home hemodialysis. Asking her if she has any friends is just plain mean.
You are teaching the patient starting hemodialysis. Which statement, if made by the patient, indicates the need for further teaching? A) "To protect my fistula I shouldn't wear tight fitting clothing on that side" B) "If I see any redness or swelling on the site I should call my doctor" C) "I shouldn't sleep on my side with the graft but it's ok to take a blood pressure on that arm" D) "I need to wait to take my medications until after my dialysis treatment"
Answer: C. It is not ok to take a blood pressure on the side with the dialysis site. The patient should also be taught to avoid tight fitting clothes, blood draws, iv insertions, carrying bags/pocketbooks, or sleeping on the affected side. Redness and swelling are signs of infection that should be reported to the doctor. Because hemodialysis can cause medication accumulation and toxicity patients are advised to take daily medications after dialysis treatment.
Your 60 y.o. patient with pyelonephritis and possible septicemia has had five UTIs over the past two years. She is fatigued from lack of sleep, has lost weight, and urinates frequently even in the night. Her labs show: sodium, 154 mEq/L; osmolarity 340 mOsm/L; glucose, 127 mg/dl; and potassium, 3.9 mEq/L. Which nursing diagnosis is priority? Fluid volume deficit related to osmotic diuresis induced by hyponatremia Fluid volume deficit related to inability to conserve water Altered nutrition: Less than body requirements related to hypermetabolic state Altered nutrition: Less than body requirements related to catabolic effects of insulin deficiency
Answer: Fluid volume deficit related to inability to conserve water
You are teaching the patient with chronic kidney disease about what symptoms to report to the doctor when outside of the hospital. Which statement, if made by the patient, indicates correct understanding? A) "I should call my doctor if my stomach starts feeling sick or my breath smells funny like pea" B) "Muscle weakness and abdominal cramps are a sign of worsening condition and I should report this to my doctor" C) "My doctor wants me to call him if I feel a vibrating or buzzing sensation over my hemodialysis graft. D) "I should call immediately if I see swelling at my dialysis port"
Answer: C. The patient should be taught to call the doctor if he/she does NOT find a thrill over this graft as this indicates that the graft may no longer by patent. Nausea/vomiting and uric breath (smells like urine/ammonia) should be reported to the physician as this is a sign of worsening renal function. Muscle weakness and abdominal cramps are signs of hyperkalemia which could lead to life threatening arrhythmias. Swelling or redness at the dialysis port would be a sign of infection which should be reported.
A patient with CKF arrives for his dialysis treatment complaining of muscle aches and digestive upset. He also says "my skin has been feeling itchy and gets red if I scratch too much" The patients vitals are BP 146/73 HR 89 RR 24 T 99.5 Spo2 94%. The nurse suspects which of the following? A) The patient is experiencing adverse reaction from his erythropoietin B) Most likely a clot has formed at the dialysis access, broken off, and spread systemically C) These signs indicate worsening CKF. Dialysis treatment may need to be adjusted D) The patient is experiencing a rejection reaction from the dialysis procedures
Answer: C. The patient's symptoms are indicative of rising uric acid levels in the blood stream, indicating that the dialysis treatment may need to be adjusted. These s/s are not indicative of erythropoietin adverse effects or emboli formation. Oh and I just made up rejection reaction so I'm pretty sure that's not a thing.
1. Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis? A. Jaundice and flank pain B. Costovertebral angle tenderness and chills C. Burning sensation on urination D. Polyuria and nocturia
Answer: Costovertebral angle tenderness and chills Costovertebral angle tenderness, flank pain, and chills are symptoms of acute pyelonephritis. Jaundice indicates gallbladder or liver obstruction. A burning sensation on urination is a sign of lower urinary tract infection.
The patient undergoing peritoneal dialysis complains of abdominal pain. The nurse notes the drainage to be cloudy. She also palpates rebound tenderness. Which complication does the nurse suspect? A) Leakage around catheter B) Internal Bleeding C) Hypertriglycerdemia D) Peritonitis
Answer: D. Peritonitis is the most serious complication of PD. It's symtpoms include rebound tendernece, cloudy drainage, low grade fever, abdominal pain, and rebound tenderness.
Nurse Shelby is preparing to administer selvemer hydrochloride (Renagel) to the patient with CKF (Chronic Kidney Disease). Which of the following does the nurse know to be true? A) This medication should be given on an empty stomach B) It is used to treat hyperphosphatemia C) To administer at bedtime D) Renagel can be used to help with hypercalcemia
Answer: D. Renegal is a phosphate binder and is used to help lower calcium levels. It is also given if the calcium-phosphorous product is elevated (over 55). Calcium and Phosphate binders should be given with food. This medication is not used to treat hyperphosphatemia. Remember, the calcium phosphorous balance is important with patients with CKF because if it is imbalanced it can lead to bone disease.
The nurse is taking care of the patient with chronic kidney disease. Which of the following meal trays would be the best for this patient? A) Whole grain roll with baked chicken and pea soup and milk B) Sandwich with smoked salmon lunchmeat, green beans, and banana pudding C) Baked ham, mashed potatoes, tomato soup and peanut butter cookies D) Low-sodium chicken noodle soup, apple slices, white-wheat roll, and rice
Answer: D. This tray contains a small amount of protein and an adequate amount of carbohydrates that are low in sodium and potassium. Although a whole-grain roll would be appropriate with baked chicken. Pea soup and the milk would be high in potassium and protein. Smoked meats are often high in sodium. Tomato soup and peanut butter would add extra potassium and protein to this patient's diet
Which sign indicated the second phase of acute renal failure? Daily doubling of urine output (4 to 5 L/day) Urine output less than 400 ml/day Urine output less than 100 ml/day Stabilization of renal function
Answer: Daily doubling of urine output (4 to 5 L/day) Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (dieresis) of acute renal failure.
Your patient has complaints of severe right-sided flank pain, nausea, vomiting and restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP 140/90 mmHg, Pulse 118 beats/min., respirations 33 breaths/minute, and temperature, 98.0F. Which subjective data supports a diagnosis of renal calculi? Pain radiating to the right upper quadrant History of mild flu symptoms last week Dark-colored coffee-ground emesis Dark, scant urine output
Answer: Dark, scant urine output Patients with renal calculi commonly have blood in the urine caused by the stone's passage through the urinary tract. The urine appears dark, tests positive for blood, and is typically scant.
What change indicates recovery in a patient with nephritic syndrome? Disappearance of protein from the urine Decrease in blood pressure to normal Increase in serum lipid levels Gain in body weight
Answer: Disappearance of protein from the urine With nephrotic syndrome, the glomerular basement membrane of the kidney becomes more porous, leading to loss of protein in the urine. As the patient recovers, less protein is found in the urine.
Clinical manifestations of acute glomerulonephritis include which of the following? Chills and flank pain Oliguria and generalized edema Hematuria and proteinuria Dysuria and hypotension
Answer: Hematuria and proteinuria Hematuria and proteinuria indicate acute glomerulonephritis. These finding result from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis.
Which cause of hypertension is the most common in acute renal failure? Pulmonary edema Hypervolemia Hypovolemia Anemia
Answer: Hypervolemia Acute renal failure causes hypervolemia as a result of overexpansion of extracellular fluid and plasma volume with the hypersecretion of rennin. Therefore, hypervolemia causes hypertension.
You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi? Increased calcium loss from the bones Decreased kidney function Decreased calcium intake High fluid intake
Answer: Increased calcium loss from the bones Bones lose calcium when a patient can no longer bear weight. The calcium lost from bones form calculi, a concentration of mineral salts also known as a stone, in the renal system.
Which of the following causes the majority of UTI's in hospitalized patients? Lack of fluid intake Inadequate perineal care Invasive procedures Immunosuppression
Answer: Invasive procedures Invasive procedures such as catheterization can introduce bacteria into the urinary tract. A lack of fluid intake could cause concentration of urine, but wouldn't necessarily cause infection.
A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments? Low-protein diet with unlimited amounts of water Low-protein diet with a prescribed amount of water No protein in the diet and use of a salt substitute No restrictions
Answer: Low-protein diet with a prescribed amount of water The patient should follow a low-protein diet with a prescribed amount of water. The patient requires some protein to meet metabolic needs. Salt substitutes shouldn't be used without a doctor's order because it may contain potassium, which could make the patient hyperkalemic. Fluid and protein restrictions are needed.
A patient with diabetes has had many renal calculi over the past 20 years and now has chronic renal failure. Which substance must be reduced in this patient's diet? Carbohydrates Fats Protein Vitamin C
Answer: Protein Because of damage to the nephrons, the kidney can't excrete all the metabolic wastes of protein, so this patient's protein intake must be restricted. A higher intake of carbs, fats, and vitamin supplements is needed to ensure the growth and maintenance of the patient's tissues.
5. An 18 y.o. student is admitted with dark urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. Which would most likely be in this student's health history? A. Renal calculi B. Renal trauma C. Recent sore throat D. Family history of acute glomerulonephritis
Answer: Recent sore throat The most common form of acute glomerulonephritis is caused by goup A beta-hemolytic streptococcal infection elsewhere in the body.
4. Which intervention do you plan to include with a patient who has renal calculi? A. Maintain bed rest B. Increase dietary purines C. Restrict fluids D. Strain all urine
Answer: Strain all urine All urine should be strained through gauze or a urine strainer to catch stones that are passed. The stones are then analyzed for composition. Ambulation may help the movement of the stone down the urinary tract. Encourage fluid to help flush the stones out.
Which statement correctly distinguishes renal failure from prerenal failure? A. With prerenal failure, vasoactive substances such as dopamine (Intropin) increase blood pressure B. With prerenal failure, there is less response to such diuretics as furosemide (Lasix) C. With prerenal failure, an IV isotonic saline infusion increases urine output D. With prerenal failure, hemodialysis reduces the BUN level
Answer: With prerenal failure, an IV isotonic saline infusion increases urine output Prerenal failure is caused by such conditions as hypovolemia that impairs kidney perfusion; giving isotonic fluids improves urine output. Vasoactive substances can increase blood pressure in both conditions.
Which of the following is the leading cause of death among patients undergoing maintenance hemodialysis? a) Coronary heart disease b) Stroke c) Heart failure d) Atherosclerotic cardiovascular disease
Atherosclerotic cardiovascular disease Correct Explanation: A leading cause of death among patients undergoing maintenance hemodialysis is atherosclerotic cardiovascular disease. Heart failure, coronary heart disease and angina pain, stroke, and peripheral vascular insufficiency may occur and may incapacitate the patient.
Which of the following is a term used to describe excessive nitrogenous waster in the blood, as seen in acute glomerulonephritis? a) Azotemia b) Hematuria c) Bacteremia d) Proteinuria
Azotemia Correct Explanation: The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.
Which of the following terms is used to describe the concentration of urea and other nitrogenous wastes in the blood? a) Azotemia b) Uremia c) Hematuria d) Proteinuria
Azotemia Explanation: Azotemia is the concentration of urea and other nitrogenous wastes in the blood. Uremia is an excess of urea and other nitrogenous wastes in the blood. Hematuria is blood in the urine. Proteinuria is protein in the urine.
An older male patient visits his primary care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for what factor that may put him at risk for a urinary tract infection (UTI)? A. High-purine diet B. Sedentary lifestyle C. Benign prostatic hyperplasia (BPH) D. Recent use of broad-spectrum antibiotics
C. Benign prostatic hyperplasia (BPH) BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, whereas a diet high in purines is associated with renal calculi.
The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? a) Hypotension b) Cola-colored urine c) Hyperalbuminemia d) Peripheral neuropathy
Cola-colored urine Correct Explanation: Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.
A patient is admitted to the hospital with severe renal colic. The nurse's first priority in management of the patient is to a.administer opioids as prescribed. b.obtain supplies for straining all urine. c.encourage fluid intake of 3 to 4 L/day. d.keep the patient NPO in preparation for surgery
Correct answer: a. administer opioids as prescribed Rationale: Pain management and patient comfort are primary nursing responsibilities in managing an obstructing stone and renal colic.
A patient with a ureterolithotomy returns from surgery with a nephrostomy tube in place. Postoperative nursing care of the patient includes a.encouraging the patient to drink fruit juices and milk. b.encouraging fluids of at least 2 to 3 L/day after nausea has subsided. c.irrigating the nephrostomy tube with 10 mL of normal saline solution as needed. d.notifying the physician if nephrostomy tube drainage is more than 30 mL/hr
Correct answer: b. encouraging fluids of at least 2 to 3 L/day after nausea has subsided Rationale: The nephrostomy tube is inserted directly into the renal pelvis and attached to connecting tubing for closed drainage. The catheter should never be kinked, compressed, or clamped. If the patient complains of excessive pain in the area, or if drainage around the tube is excessive, check the catheter for patency. If irrigation is ordered, strict aseptic technique is required. To prevent overdistention of the renal pelvis and renal damage, no more than 5 mL of sterile saline solution is gently instilled at one time. Infection and secondary stone formation are complications associated with the insertion of a nephrostomy tube. Patients should drink 2 to 3 L of fluid per day to reduce risk of infection and stone formation.
The nurse teaches the female patient who has frequent UTIs that she should a.take tub baths with bubble bath. b.urinate before and after sexual intercourse. c.take prophylactic sulfonamides for the rest of her life. d.restrict fluid intake to prevent the need for frequent voiding
Correct answer: b. urinate before and after sexual intercourse Rationale: When teaching a patient to prevent a recurrence of a urinary tract infection, the nurse should explain the importance of emptying the bladder before and after sexual intercourse.
In teaching a patient with pyelonephritis about the disorder, the nurse informs the patient that the organisms that cause pyelonephritis most commonly reach the kidneys through a.the bloodstream. b.the lymphatic system. c.a descending infection. d.an ascending infection
Correct answer: d. an ascending infection Rationale: The organisms that usually cause urinary tract infections (UTIs) are introduced via the ascending route from the urethra, and the infections originate in the perineum.
A patient has had a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucous shreds are seen in the drainage bag. The nurse should a.notify the physician. b.notify the charge nurse. c.irrigate the drainage tube. d.chart it as a normal observation
Correct answer: d. chart it as a normal observation Rationale: Patients with an ileal conduit have mucus in the urine. The mucus is secreted by intestinal mucosa, which is used to create the ileal conduit, in response to the irritating effect of urine.
The nurse is caring for a patient who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed which of the following? a) Chronic rejection b) Simple rejection c) Acute rejection d) Hyperacute rejection
Correct response: Hyperacute rejection Explanation: After a kidney transplant, rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years. A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized glomerular capillary thrombosis and necrosis. The term "simple" is not used in the categorization of types of rejection of kidney transplants.
The nurse is helping a patient to correctly perform peritoneal dialysis at home. The nurse must educate the patient about the procedure. Which educational information should the nurse provide to the patient? a) Keep the catheter stabilized to the abdomen, below the belt line b) Clean the catheter insertion site daily with soap c) Keep the dialysis supplies in a clean area, away from children and pets d) Wear a mask while handling any dialysate solutions
Correct response: Keep the dialysis supplies in a clean area, away from children and pets Explanation: It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a patient has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine (Betadine), not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.
Which nursing intervention should the nurse caring for the client with pyelonephritis implement? a) Straight catheterize the client every 4 to 6 hours. b) Restrict fluid intake to 1 liter per day. c) Teach client to increase fluid intake up to 3 liters per day. d) Administer acetaminophen (Tylenol).
Correct response: Teach client to increase fluid intake up to 3 liters per day. Explanation: The nurse teaches the client to increase fluid intake to promote renal blood flow and flush bacteria from the urinary tract.
A client is being treated for renal calculi and suspected hydronephrosis. Therefore, the nurse should maintain a record of the kidney's function. Which of the following measures can the nurse take to help achieve the objective? a) Monitor the client's intake and output. b) Palpate for a thrill over the vascular access. c) Inspect the skin over the fistula or graft for signs of infection. d) Note the nailbeds and mobility of the fingers.
Monitor the client's intake and output. Correct Explanation: Monitoring and recording the client's intake and output provides information about the kidneys' function. It also helps identify any arising complications such as hydronephrosis. This would be care for a hemodialysis patient.
The nurse is caring for a 73-year-old man patient with a history of benign prostatic hyperplasia and symptoms of a possible urinary tract infection. Which diagnostic finding would support this diagnosis? A. White blood cell count is 7500 cells/µL. B. Antistreptolysin-O (ASO) titer is 106 Todd units/mL. C. Glucose, protein, and ketones are present in the urine. D. Nitrites and leukocyte esterase are present in the urine.
D. Nitrites and leukocyte esterase are present in the urine. A diagnosis of urinary tract infection is suspected if there are nitrites (indicating bacteriuria), white blood cells (WBCs), and leukocyte esterase (an enzyme present in WBCs indicating pyuria). Presence of glucose and ketones indicate uncontrolled diabetes mellitus. An elevated WBC count (>11,000 cells/µL) indicates a bacterial infection. Antistreptolysin-O (ASO) titer is a blood test to measure antibodies against streptolysin O, a substance produced by group A Streptococcus bacteria.
The patient is wondering why anesthesia is needed when the lithotripsy being done is noninvasive. The nurse explains that the anesthesia is required to ensure the patient's position is maintained during the procedure. The nurse knows that this type of lithotripsy is called A. laser lithotripsy. B. electrohydraulic lithotripsy. C. percutaneous ultrasonic lithotripsy. D. extracorporeal shock-wave lithotripsy (ESWL).
D. extracorporeal shock-wave lithotripsy (ESWL) ESWL is noninvasive, but anesthesia is used to maintain the patient's position. The other types of lithotripsy are invasive. Laser lithotripsy uses an ureteroscope and small fiber to reach the stone. Electrohydraulic lithotripsy positions a probe directly on the stone; then continuous saline irrigation flushes are used to rinse the stone out. Percutaneous ultrasonic lithotripsy places an ultrasonic probe in the renal pelvis via a percutaneous nephroscope inserted through an incision in the flank.
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? a) Hypertension b) Dehydration c) Hyperkalemia d) Crackles
Dehydration Correct Explanation: The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.
During hemodialysis, toxins and wastes in the blood are removed by which of the following? a) Filtration b) Diffusion c) Ultrafiltration d) Osmosis
Diffusion Explanation: The toxins and wastes in the blood are removed by diffusion, in which particles move from an area of higher concentration in the blood to an area of lower concentration into the dialysate.
Ms. Linden is in end-stage chronic renal failure and is being added to the transplant list. You are explaining to her how donors are found for clients needing kidneys. You would be accurate in telling her which of the following? a) The client is placed on a transplant list at the local hospital. b) Donors with hypertension may qualify. c) Donors must be relatives. d) Donors are selected from compatible living donors.
Donors are selected from compatible living donors. Correct Explanation: Donors are selected from compatible living donors. Donors do not have to be relatives as long as they are compatible. Potential donors with a history of hypertension, malignant disease, or diabetes are excluded from donation. The client is placed on a national computerized transplant waiting list.
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a) Fever b) Diuresis c) Weight loss d) Absence of pain
Fever Correct Explanation: Fever is an indicator of infection or transplant rejection.
Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure? a) Urinary retention b) Activity intolerance c) Disturbed body image d) Fluid volume excess
Fluid volume excess Correct Explanation: The oliguric phase is characterized by fluid retention.
Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure? a) Dysrhythmia b) Ureteral calculus c) Glomerulonephritis d) Hypovolemia
Glomerulonephritis Correct Explanation: Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
Which of the following is an integumentary manifestation of chronic renal failure? a) Tremors b) Gray-bronze skin color c) Asterixis d) Seizures
Gray-bronze skin color Correct Explanation: Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.
A patient diagnosed with chronic renal failure is receiving continuous peritoneal dialysis (PD). The nurse instructs the patient about which of the following diet plans? a) Low-sodium diet b) High-protein diet c) High-calorie diet d) Low-protein diet
High-protein diet Correct Explanation: Because of protein loss with continuous PD, the patient is instructed to eat a high-protein, nutritious diet. The patient is also encouraged to increase his or her daily fiber intake to help prevent constipation, which can impede the flow of dialysate into or out of the peritoneal cavity. A low-protein diet is required to reduce the production of end products of protein metabolism that the kidneys are unable to excrete. Establishing a diet high in calories and low in protein, sodium, and potassium is essential for patients with acute renal failure.
The nurse is passing out medications on a medical-surgical unit. A male patient is preparing for hemodialysis. The patient is ordered to receive numerous medications including antihypertensives. Which of the following is the best action for the nurse to take? a) Administer the medications as ordered. b) Check with the dialysis nurse about the medications. c) Hold the medications until after dialysis. d) Ask the patient if he wants to take his medications.
Hold the medications until after dialysis. Correct Explanation: Antihypertensive therapy, often part of the regimen of patients on dialysis, is one example when communication, education, and evaluation can make a difference in patient outcomes. The patient must know when—and when not—to take the medication. For example, if an antihypertensive agent is taken on a dialysis day, hypotension may occur during dialysis, causing dangerously low blood pressure. Many medications that are taken once daily can be held until after dialysis treatment.
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? a) Increase protein, carbohydrates, and fat intake. b) Increase carbohydrates and limit protein intake. c) Eliminate fat intake and increase protein intake. d) Increase fat intake and limit carbohydrates.
Increase carbohydrates and limit protein intake. Correct Explanation: Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.
The client with acute renal failure progresses through four phases. Which of the following describes the initiation phase? a) Normal glomerular filtration and tubular function are restored. b) The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. c) It is accompanied by reduced blood flow to the nephrons. d) Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications.
It is accompanied by reduced blood flow to the nephrons. Correct Explanation: The initiation phase is accompanied by reduced blood flow to the nephrons. In the oliguric phase, fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. During the diuretic phase, excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. During the recovery phase, normal glomerular filtration and tubular function are restored.
A patient diagnosed AKI has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering which of the following? a) Calcium supplements b) Kayexalate c) Sorbitol d) IV dextrose 50%
Kayexalate Correct Explanation: The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract. Sorbitol may be administered in combination with Kayexalate to induce a diarrhea-type effect (it induces water loss in the GI tract). If the patient is hemodynamically unstable (low blood pressure, changes in mental status, dysrhythmia), IV dextrose 50%, insulin, and calcium replacement may be administered to shift potassium back into the cells.
A patient diagnosed with AKI has developed congestive heart failure. The patient has received 40 mg of intravenous pyelogram (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The patient's vital signs are stable. Which of the following health care orders should the nurse anticipate? a) Normal saline (NS) bolus of 500 mL b) Chest x-ray c) Mannitol (Osmitrol) 12.5 g IVP d) Lasix (Furosemide) 80 mg IVP
Lasix (Furosemide) 80 mg IVP Correct Explanation: Diuretic agents are often used to control fluid volume in patients with AKI. The patient's urine output indicates an inadequate response to the initial dosage of Lasix and the nurse should anticipate administering Lasix 80 mg IVP. Often in this situation, the initial dosage of Lasix is doubled. The patient is experiencing fluid overload, thus, a 500-mL bolus of NS would be contraindicated. There is no need to complete a chest x-ray. Mannitol is widely used in the management of cerebral edema and increased intracranial pressure (ICP) from multiple causes.
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? a) Recovery b) Initiation c) Oliguria d) Diuresis
Oliguria Correct Explanation: The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys, such as urea and creatinine. The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.
Which of the following is the hallmark of the diagnosis of nephrotic syndrome? a) Hyponatremia b) Hyperalbuminemia c) Hypokalemia d) Proteinuria
Proteinuria Correct Explanation: Proteinuria (predominantly albumin) exceeding 3.5 g/day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may also occur. Proteinuria and microscopic hematuria may persist for many months; in fact, 20% of patients have some degree of persistent proteinuria or decreased glomerular filtration rate (GFR) 1 year after presentation.
One of the roles of the nurse in caring for the clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include teaching which of the following? a) Limiting iron and folic acid intake b) Allowing liberal use of sodium c) Eating protein liberally d) Restricting sources of potassium usually found in fresh fruits and vegetables
Restricting sources of potassium usually found in fresh fruits and vegetables Correct Explanation: Restrict sources of potassium usually found in fresh fruits and vegetables. Hyperkalemia can cause life-threatening changes. Restrict sodium intake as ordered. Doing so prevents excess sodium and fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken. Iron and folic acid supplements are needed for RBC production. Epogen stimulates bone marrow to produce RBCs. Restrict protein intake to foods that are complete proteins within prescribed limits. Complete proteins provide positive nitrogen balance for healing and growth.
Which of the following is the most sensitive indicator of renal function? a) Potassium b) Blood urea nitrogen (BUN) c) Creatinine clearance d) Serum creatinine
Serum creatinine Correct Explanation: Serum creatinine is the more sensitive indicator of renal function because of its constant production in the body.
The nurse is performing acute intermittent peritoneal dialysis (PD) on a patient who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. Which of the following is the nurse's best action? a) Notify the health care provider. b) Turn the patient from side to side. c) Push the catheter further into the abdomen. d) Lower the head of the bed.
Turn the patient from side to side. Correct Explanation: If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the patient from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. Other measures to promote drainage include checking the patency of the catheter by inspecting for kinks, closed clamps, or an air lock.
The nurse is instructing a patient to perform continuous ambulatory peritoneal dialysis correctly at home. Which of the following educational information should the nurse provide to the patient? a) Clean the catheter insertion site daily with soap. b) Use an aseptic technique during the procedure. c) Keep the catheter stabilized to the abdomen, below the belt line. d) Wear a mask while handling any dialysate solutions.
Use an aseptic technique during the procedure. Correct Explanation: The patient should be instructed to use an aseptic technique during the procedure. The patient should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (patients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a patient has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine (Betadine), not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.
The nurse caring for the client with acute renal failure would question which of the following for the treatment of hyperkalemia? a) albuterol sulfate (Ventolin HFA) b) sodium polysterene sulfonate (Kayexalate) c) hypertonic glucose and insulin infusions d) lanthanum carbonate (Fosrenol)
You selected: lanthanum carbonate (Fosrenol) Correct Explanation: Hyperkalemia associated with acute renal failure may be treated wtih sodium polysterene sulfonate (Kayexalate), hypertonic glucose and insulin infusion, or albuterol sulfate (Ventolin HFA). Albuterol sulfate (Ventolin HFA) is used to treat hyperphosphatemia.
The nurse is caring for a client with end-stage kidney disease. What arterial blood gas results are most closely associated with this disorder? a) pH 7.47, PaCO2 45, HCO3 33- b) pH 7.31, PaCO2 48, HCO3 24- c) pH 7.20, PaCO2 36, HCO3 14- d) pH 7.50, PaCO2 29, HCO3 22-
pH 7.20, PaCO2 36, HCO3 14- Correct Explanation: Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.
The most accurate indicator of fluid loss or gain in an acutely ill patient is a) blood pressure. b) edema. c) pulse rate. d) weight.
weight. Correct Explanation: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. Blood pressure, pulse rate, and edema are not the most accurate indicator of fluid loss or gain.
As glomerular filtration decreases, which of the following occurs? Select all that apply. a) Creatinine clearance decreases b) BUN decreases c) Serum creatinine decreases d) Blood urea nitrogen (BUN) increases e) Serum creatinine increases
• Creatinine clearance decreases • Blood urea nitrogen (BUN) increases • Serum creatinine increases Correct Explanation: As glomerular filtration decreases, the serum creatinine and BUN levels increase; the creatinine clearance decreases.