Porth's PrepU: Chapter 42: Acute Renal Injury and Chronic Kidney Disease

A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that which of the following statements regarding CKD are correct? Select all that apply.

-Nephron destruction takes place over many months. -Signs and symptoms develop gradually. -Functioning nephrons compensate for those that are damaged. -There is a reduction in glomerular filtration rate (GFR) as nephrons are destroyed

Accumulation of nitrogenous wastes such a urea in the circulatory system is an early sigh of chronic kidney disease (CKD). The nurse knows that normal levels of urea in blood are approximately which of the following?

20 mg/dL

A geriatric nurse is caring for several clients. Which alterations in clients' health should the nurse attribute to age-related physiologic changes?

A 78-year-old woman's GFR has been steadily declining over several years

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

Chronic kidney disease impacts many systems in the body. What is the number one hematologic disorder caused by CKD?

Anemia

A client with a diagnosis of chronic kidney disease (CKD) may require the administration of which of the following drugs to treat coexisting conditions that carry a high mortality?

Antihypertensive medications

The nurse is caring for a patient who has had acute blood loss from ruptured esophageal varices. Which of the following does the nurse recognize is an early sign of prerenal failure?

Baseline urine output of 50 mL/hr that is now 10 mL/hr

Select the body systems most commonly affected by chronic kidney disease in the elderly. Select all that apply.

Cardiovascular Cerebrovascular systems Skeletal

A client is diagnosed with decreased gomerular filtration rate but has no renal damage. The nurse recognizes that this can occur with which of the following? Select all that apply.

Cirrhosis Heart failure Removal of one kidney Dehydration

Anemia frequently occurs in clients with chronic kidney disease (CKD). The nurse will monitor these clients for which of the following contributors to anemia? Select all that apply.

Decreased erythropoietin production Anorexia Bone marrow suppression Chronic blood loss

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. What treatment should the nurse anticipate?

Dialysis

The nurse is instructing a patient with advanced kidney disease (AKD) about a dietary regimen. Which of the following restrictions should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD?

Dietary protein

Several urine tests can be useful in establishing a diagnosis of acute renal failure (ARF). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which of the following types of drugs?

Diuretics

A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is which of the following?

Dorsiflexion of hands and feet

Which of the following integumentary problems most often accompanies chronic kidney disease?

Dry skin and pruritus

A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?

Hypertension

A patient sustained acute tubular injury approximately 2 hours ago. Which of the following phases of this disorder does the nurse recognize that the patient is in at this time?

Initiating phase

Dietary restrictions placed on clients with chronic kidney disease (CKD) include limiting protein in their diet. The recommended sources of protein for clients with CKD include what source of protein?

Milk

The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for:

Nephrotoxic acute tubular necrosis

A drug abuser was found unconscious after shooting up heroin 2 days prior. Because of the pressure placed on the hip and arm, the client has developed rhabdomyolysis. The nurse knows this can:

Obstruct the renal tubules with myoglobin and damage tubular cells

While assessing a peritoneal dialysis client in his or her home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as:

Peritonitis

The nurse knows that one of the earliest manifestations of acute renal failure (ARF) is which of the following?

Polyuria

The nurse is reviewing the diagnosis of four male clients. Select the diagnosis that places the clients at risk for developing postrenal kidney failure.

Prostatic hyperplasia

When acute tubular necrosis (ATN) is suspected, the nurse will likely see which of the following laboratory findings on the urinalysis report? Select all that apply.

Protein Red blood cells Cast cells

Phosphate excretion is impaired in chronic kidney disease (CKD), resulting in high serum phosphate levels and the development of phosphate crystals. The nurse knows that which of the following symptoms may occur?

Pruritus

The nurse recognizes that acute renal injury is characterized by which of the following?

Rapid decline in renal function

Neuromuscular disorders can be triggered by CKD. For those clients on dialysis, approximately two thirds suffer from what peripheral neuropathy?

Restless legs syndrome

A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which would be the best instruction for the nurse to provide?

Restrict intake of dietary protein

The parents of a child who has been diagnosed with CKD ask the nurse about manifestations of the disease. Which is the most appropriate information for the nurse to provide? Select all that apply.

Secondary hyperparathyroidism Developmental delay Delayed cognitive development Growth impairment

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?

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 of the following early signs of prerenal injury?

Sharp decrease in urine output

A patient with chronic kidney disease (CKD) will be managed with peritoneal dialysis. The nurse will give the patient which of the following descriptions of this type of dialysis?

Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time

Bruising of the skin is a manifestation of bleeding disorders in patients with CKD.

True

The primary care provider for a newly admitted hospital patient has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The patient's GFR will be extrapolated from serum levels of:

creatinine

A client with CKD has a GFR of 28 mL/min/1.73 m2. When teaching the client about dietary modifications, the nurse should recommend:

identifying and limiting phosphorus intake

A client with a long-standing diagnosis of chronic kidney disease has been experiencing increasing fatigue, lethargy, and activity intolerance in recent weeks. His care team has established that his GFR remains at a low, but stable, level. Which of the following assessments is most likely to inform a differential diagnosis?

Blood work for hemoglobin, red blood cells, and hematocrit

A patient in renal failure has marked decrease in renal blood flow caused by hypovolemia, caused by gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which of the following forms of acute renal injury does this patient have?

Prerenal failure

Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which of the following statements regarding vitamin D is correct?

Kidneys convert inactive vitamin D to its active form, calcitriol

An 86-year-old female patient is admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to prevent urinary incontinence. The patient's most recent laboratory results are suggestive of acute renal failure. The nurse recognizes that this patient has which type of failure?

Prerenal

The nurse knows that a child with chronic kidney disease (CKD) may experience which of these manifestations? Select all that apply.

Severe growth deficit High bone turnover