NURS 311- Pathphysiology- CH 34.- EAQs- Acute Kidney Injury and Chronic Kidney Disease
With the increased risk of drug toxicity among chronically ill older adults, which statement by the nurse explains why the older adult's kidney is vulnerable to toxic injury? "The health care provider does not always monitor for toxicity at each follow-up appointment." "Every drug dosage should be determined by client weight but most clients refuse to get on the scale." "The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney." "Prescribed medications may not be monitored as closely as they should be since Medicare does not reimburse for routine laboratory testing."
"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney."
A geriatric nurse is caring for several clients. Which alterations in health should the nurse attribute to age-related physiologic changes? A 78-year-old woman's GFR has been steadily declining over several years. A dipstick of an 80-year-old man's urine reveals protein is present. A 90-year-old woman's blood urea nitrogen (BUN) is rising. An 81-year-old man's serum creatinine level has increased sharply since his last blood work.
A 78-year-old woman's GFR has been steadily declining over several years.
The nurse is caring for a client who has had acute blood loss from ruptured esophageal varices. What does the nurse recognize is an early sign of prerenal failure? Baseline urine output of 50 mL/hr that is now 10 mL/hr Baseline blood pressure of 150/90 mm Hg that is now 130/80 mm Hg Foul smelling, cloudy urine Baseline heart rate of 100 bpm that has increased to 120 bpm
Baseline urine output of 50 mL/hr that is now 10 mL/hr
A new client presents with elevated BUN, systemic edema, a BP of 145/93 mm Hg, recurrent infections, and a GFR of 51 mL/min/1.73 m2. Which treatment should the nurse anticipate? Intravenous antibiotics Kidney transplant Dialysis Bone marrow transplant
Dialysis Explanation: These findings are suggestive of chronic kidney disease (CKD. , defined as kidney damage with a GFR less than 60 mL/min/1.73 m2 for 3 months or longer. Dialysis is a likely intervention. The disease is noninfectious, so antibiotics are not necessarily indicated. Dialysis would precede a transplant in nearly all circumstances. BMT is not a relevant intervention.
Which dermatologic problem most often accompanies chronic kidney disease (CKD)? Hirsutism and psoriasis Petechiae and purpura Alopecia and fungal rashes Dry skin and pruritus
Dry skin and pruritus
A client is being treated for chronic kidney disease (CKD). One of the nurse's responsibilities is to explain to the client the need to keep her blood pressure under control. Why is blood pressure control so important in CKD clients? Elevated blood pressure will exacerbate nephron loss and accelerate renal failure. Elevated blood pressure will result in greater amounts of urine formation and will over-tax renal function. Elevated blood pressure will slow the excretion of protein (proteinuria) and lead to a hypertrophic kidney. Elevated blood pressure will decrease pressure on the nephron with a corresponding decrease in GFR, leading to renal failure.
Elevated blood pressure will exacerbate nephron loss and accelerate renal failure.
A client is to begin peritoneal dialysis. The nurse knows that peritoneal dialysis may result in which complications? Select all that apply. Edema Hyperglycemia Dehydration Pain Catheter-related infection
Hyperglycemia Dehydration Catheter-related infection
Which conditions have the potential to cause chronic kidney disease? Select all that apply. Cardiomyopathy Hypertension Diabetes Glomerulonephritis
Hypertension Diabetes Glomerulonephritis
A client diagnosed with CKD has begun to experience periods of epistaxis and has developed bruising of the skin and subcutaneous tissues. The nurse recognizes these manifestations as: Decreased erythropoietin Increased erythropoietin Increased platelet production Impaired platelet function
Impaired platelet function
A client is to receive a radiocontrast media as part of a diagnostic scan. Which intervention is intended to reduce the nephrotoxic effects of the radiocontrast media? Administering one unit of packed red blood cells Increasing the normal saline intravenous infusion rate prior to the exam Administering ibuprofen 600 mg prior to the procedure Having the client take nothing by mouth
Increasing the normal saline intravenous infusion rate prior to the exam
In hemodialysis, access to the vascular system is most commonly through: Internal arteriovenous shunt Internal arteriovenous fistula External arteriovenous fistula External arteriovenous shunt
Internal arteriovenous fistula
A client sustained acute tubular injury approximately 2 hours ago. Which cause of acute kidney injury (AKI) would the nurse suspect the client is experiencing? Postrenal Prerenal Intrarenal Systemic
Intrarenal
Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct? Suppression of parathyroid hormone release is characteristic of CKD. Kidneys convert inactive vitamin D to its active form, calcitriol. Calcitriol stimulates release of parathyroid hormone (PTH). Calcitriol blocks gastrointestinal absorption of calcium
Kidneys convert inactive vitamin D to its active form, calcitriol.
A client in renal failure has marked decrease in renal blood flow caused by hypovolemia, the result of gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which form of acute renal injury does this client have? Intrarenal failure Chronic renal failure Postrenal failure Prerenal failure
Prerenal failure
A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which intervention would be most appropriate for the nurse to provide? Increase intake of fruit juice Restrict intake of dietary protein Increase intake of carbohydrates Restrict intake of dietary fat
Restrict intake of dietary protein
The GFR is considered to be the best measure of renal function. What is used to estimate the GFR? BUN Albumin level Serum protein Serum creatinine
Serum creatinine
An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which early sign of prerenal injury? Acute hypertensive crisis Excessive voiding of clear urine Intermittent periods of confusion Sharp decrease in urine output
Sharp decrease in urine output
A client receiving continuous ambulatory peritoneal dialysis (CAPD) treatments has excessive weight gain in the past 24 hours and tells the nurse excessive amounts of fluids were consumed while out with family. What change in the client's dialysis order will the nurse anticipate once relaying these findings to the health care provider? Preparing the client for a hemodialysis treatment Increasing the dialysate dwell time from 6 hours to 8 hours Reducing the volume of dialysate from 3 L to 1 L Switching the client from 2.5% to a 4.25% dextrose dialysate
Switching the client from 2.5% to a 4.25% dextrose dialysate
The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents: a loss of over half the client's normal kidney function. concentrated urine. that the kidneys are functioning normally. a need to increase water intake.
a loss of over half the client's normal kidney function.
A 45-year-old female is being treated for ovarian cancer. Her treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of: glomerulonephritis. anemia. nephrotoxic acute tubular necrosis (ATN). chronic renal failure (CRF).
nephrotoxic acute tubular necrosis (ATN).
