Renal
The nurse is working on a medical-surgical nursing unit and is caring for several clients with chronic kidney disease. The nurse interprets that which client is best suited for peritoneal dialysis as a treatment option? A client with severe heart failure A client with a history of ruptured diverticula A client with a history of herniated lumbar disk A client with a history of 3 previous abdominal surgeries
A client with severe heart failure Peritoneal dialysis may be the treatment option of choice for clients with severe cardiovascular disease. Severe cardiac disease can be worsened by the rapid shifts in fluid, electrolytes, urea, and glucose that occur with hemodialysis. For the same reason, peritoneal dialysis may be indicated for the client with diabetes mellitus. Contraindications to peritoneal dialysis include diseases of the abdomen such as ruptured diverticula or malignancies; extensive abdominal surgeries; history of peritonitis; obesity; and a history of back problems, which could be aggravated by the fluid weight of the dialysate. Severe disease of the vascular system also may be a relative contraindication.
A client diagnosed with chronic kidney disease (CKD) is scheduled to begin hemodialysis. The nurse determines that which neurological and psychosocial manifestations, if exhibited by this client, are related to the CKD? Select all that apply. Agitation Euphoria Depression Withdrawal Labile emotions
Agitation Depression Withdrawal Labile emotions The client with CKD often experiences a variety of psychosocial changes. These changes are related to uremia and to the stress associated with living with a chronic disease that is life threatening. Euphoria is not part of the clinical picture for the client in renal failure. Clients with CKD may have labile emotions or personality changes and may exhibit withdrawal, depression, or agitation which are used as coping mechanisms for a major life change. Delusions and psychosis also can occur.
The nurse instructs a client with chronic kidney disease who is receiving hemodialysis about dietary modifications. The nurse determines that the client understands these dietary modifications if the client selects which items from the dietary menu? Cream of wheat, blueberries, coffee Sausage and eggs, banana, orange juice Bacon, cantaloupe melon, tomato juice Cured pork, grits, strawberries, orange juice
Cream of wheat, blueberries, coffee The diet for a client with chronic kidney disease who is receiving hemodialysis should include controlled amounts of sodium, phosphorus, calcium, potassium, and fluids, which is indicated in the correct option. The food items in the remaining options are high in sodium, phosphorus, or potassium.
The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, should the nurse identify as a risk factor for this disorder? Hypoglycemia Diabetes mellitus Coronary artery disease Orthostatic hypotension
Diabetes mellitus Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and presence of an indwelling urinary catheter or frequent catheterization. The conditions noted in the remaining options are not associated risk factors.
The nurse is reviewing a client's record and notes that the primary health care provider has documented that the client has chronic kidney disease. On review of the laboratory results, the nurse most likely would expect to note which finding? Elevated creatinine level Decreased hemoglobin level Decreased red blood cell count Increased number of white blood cells in the urine
Elevated creatinine level The creatinine level is the most specific laboratory test to determine renal function. The creatinine level increases when at least 50% of renal function is lost. A decreased hemoglobin level and red blood cell count are associated with anemia or blood loss and not specifically with decreased renal function. Increased white blood cells in the urine are noted with urinary tract infection.
The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? Hypertension, tachycardia, and fever Hypotension, bradycardia, and hypothermia Restlessness, irritability, and generalized weakness Headache, deteriorating level of consciousness, and twitching
Headache, deteriorating level of consciousness, and twitching Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates. Tachycardia and fever are associated with infection. Generalized weakness is associated with low blood pressure and anemia. Restlessness and irritability are not associated with disequilibrium syndrome.
The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? Peritonitis Hyperglycemia Hyperphosphatemia Disequilibrium syndrome
Hyperglycemia An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis. Peritonitis is a risk associated with breaks in aseptic technique. Hyperphosphatemia is an electrolyte imbalance that occurs with renal dysfunction. Disequilibrium syndrome is a complication associated with hemodialysis.
The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action? Monitor the client. Elevate the head of the bed. Assess the fistula site and dressing. Notify the primary health care provider (PHCP).
Notify the primary health care provider (PHCP). Disequilibrium syndrome may be caused by rapid removal of solutes from the body during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs and symptoms of disequilibrium syndrome, and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The PHCP must be notified. Monitoring the client, elevating the head of the bed, and assessing the fistula site are correct actions, but the priority action is to notify the PHCP.
The nurse reviews the electrolyte results of a client with chronic kidney disease and notes that the potassium level is 5.7 mEq/L (5.7 mmol/L). Which patterns would the nurse watch for on the cardiac monitor as a result of the laboratory value? Select all that apply. ST depression Prominent U wave Tall peaked T waves Prolonged ST segment Widened QRS complexes
Tall peaked T waves Widened QRS complexes The client with chronic kidney disease is at risk for hyperkalemia. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A serum potassium level greater than 5.0 mEq/L (5.0 mmol/L) indicates hyperkalemia. Electrocardiographic changes associated with hyperkalemia include flat P waves, prolonged PR intervals, widened QRS complexes, and tall peaked T waves. ST depression and a prominent U wave occurs in hypokalemia. A prolonged ST segment occurs in hypocalcemia.
The nurse has performed a nutritional assessment on a client with cystitis. The nurse should tell the client to consume which beverage to minimize recurrence of cystitis? Tea Water Coffee White wine
Water Water helps flush bacteria out of the bladder, and an intake of 6 to 8 glasses per day is encouraged. Caffeine and alcohol can irritate the bladder. Therefore, alcohol- and caffeine-containing beverages such as coffee, tea, and wine are avoided to minimize risk.
A client with chronic kidney disease (CKD) has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now presents with mental cloudiness, dementia, and complaints of bone pain. The nurse determines that these assessment data are compatible with which condition? Advancing uremia Phosphate overdose Folic acid deficiency Aluminum intoxication
Aluminum intoxication Aluminum hydroxide may be prescribed as a phosphate-binding agent. Aluminum intoxication can occur when there is an accumulation of aluminum, an ingredient in many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. It can be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body. It can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum. The data in the question are not specifically associated with the other conditions noted in the options.
The nurse is working with a client newly diagnosed with chronic kidney disease (CKD) to set up a schedule for hemodialysis. The client states, "This is impossible! How can I even think about leading a normal life again if this is what I'm going to have to do?" The nurse determines that the client is exhibiting which problem? Anger Projection Depression Withdrawal
Anger Psychosocial reactions to CKD and hemodialysis are varied and may include anger. Other reactions include personality changes, emotional lability, withdrawal, and depression. The individual client's response may vary depending on the client's personality and support systems. The client in this question is exhibiting anger. The client's behavior is not indicative of projection; in addition, the client's statement does not reflect withdrawal or depression.
The nurse is providing instructions regarding the complications of peritoneal dialysis. The nurse emphasizes that onset of peritonitis, a serious complication, is most likely to be associated with which clinical manifestation? Fever Fatigue Clear dialysate output Leaking around the catheter site
Fever The signs of peritonitis include fever, nausea, malaise, rebound abdominal tenderness, and cloudy dialysate output. Fatigue may be associated with peritonitis, but fever is the most likely sign. Leaking around the catheter site is not an indication of peritonitis.
A client recently diagnosed with chronic kidney disease requiring hemodialysis has an arteriovenous fistula for access. The client asks the nurse what complications can occur with the access site. What complications should the nurse inform the client about? Select all that apply. Hepatitis Infection Hypertension Muscle cramping Post-treatment blood clots
Hepatitis Infection Complications directly related to the access site for hemodialysis include hepatitis or infection as a result of poor infection control practices, as well as post-treatment blood loss from certain dialysis procedure practices and the removal of needles following the procedure. In addition, heparin is often given to prevent clotting of the access site; this can potentiate postdialysis bleeding. Hypotension from rapid removal of vascular volume can occur, as can muscle cramps from fluid shifting; however, these complications are not directly related to the access site.
The nurse is creating a plan of care for a client with chronic kidney disease and uremia. The nurse is developing interventions to assist in promoting an increased dietary intake while at the same time maintaining necessary dietary restrictions. Which action should the nurse include in the plan of care? Increase the amount of protein in the diet. Increase the amount of potassium in the daily diet. Maintain a diet high in calories with frequent snacks. Encourage the client to eat a large breakfast and smaller meals later in the day.
Maintain a diet high in calories with frequent snacks. Uremia usually is accompanied by nausea, anorexia, and an unpleasant taste in the mouth. Most clients experience more nausea and vomiting in the morning. Therefore, to maintain optimal nutrition, it is best for these clients to eat a diet that is high in calories with frequent snacks and a light breakfast in the morning and larger meals later in the day. Dietary management usually is aimed at restricting protein, sodium, and potassium.
A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 38.5° C (101.2° F). Which nursing action is most appropriate? Encourage fluid intake. Continue to monitor vital signs. Notify the primary health care provider. Monitor the site of the shunt for infection.
Notify the primary health care provider. A temperature of 101.2° F (38.5° C) is significantly elevated and may indicate infection. The nurse should notify the primary health care provider (PHCP). Dialysis clients cannot have fluid intake encouraged. Vital signs and the shunt site should be monitored, but the PHCP should be notified first.
The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? Palpation of a thrill over the fistula. Presence of a radial pulse in the left wrist. Visualization of enlarged blood vessels at the fistula site. Capillary refill less than 3 seconds in the nailbeds of the fingers on the left hand.
Palpation of a thrill over the fistula. The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Enlarged visible blood vessels at the fistula site are a normal observation but are not indicative of fistula patency. Although the presence of a radial pulse in the left wrist and capillary refill less than 3 seconds in the nailbeds of the fingers on the left hand indicate adequate circulation to the hand, they do not assess fistula patency.
The nurse is analyzing the posthemodialysis laboratory test results for a client with chronic kidney disease. The nurse interprets that the dialysis is having an expected but nontherapeutic effect if which value is decreased? Potassium Creatinine Phosphorus Red blood cell (RBC) count
Red blood cell (RBC) count Hemodialysis typically lowers the amounts of fluid, sodium, potassium, urea nitrogen, creatinine, uric acid, magnesium, and phosphate levels in the blood. Hemodialysis also worsens anemia because RBCs are lost during dialysis from blood sampling and anticoagulation and from residual blood left in the dialyzer. Although all of these results are expected, only the lowered RBC count is nontherapeutic and worsens the anemia already caused by the disease process
The nurse has provided instructions regarding home care measures for a client with acute pyelonephritis. Which statement by the client indicates a need for further teaching? "I should try to maintain an acid ash diet." "I should increase my fluid intake to 3 L per day." "I should take my daily dose of vitamin C to acidify the urine." "I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day."
"I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day." Clients with acute pyelonephritis should be instructed to try to maintain an acid ash diet, which may be of some benefit. Also, they should increase fluid intake to 3 L per day; this helps relieve dysuria and flushes bacteria out of the bladder. However, for clients with chronic pyelonephritis and renal dysfunction, an increase in fluid intake may be contraindicated. Medications such as vitamin C help acidify the urine. Juices such as cranberry, plum, and prune juice will leave an acid ash in the urine. Caffeine, alcohol, chocolate, and highly spiced foods are avoided to prevent potential bladder irritation.
The registered nurse is instructing a new nursing graduate about hemodialysis. Which statement made by the new nursing graduate indicates an understanding of the procedure for hemodialysis? Select all that apply. "Sterile dialysate must be used." "Dialysate contains metabolic waste products." "Heparin sodium is administered during dialysis." "Dialysis cleanses the blood of accumulated waste products." "Warming the dialysate increases the efficiency of diffusion."
"Heparin sodium is administered during dialysis." "Dialysis cleanses the blood of accumulated waste products." "Warming the dialysate increases the efficiency of diffusion." Heparin sodium is used during dialysis, and it inhibits the tendency of blood to clot when it comes in contact with foreign substances. Option 4 is the purpose of dialysis. The dialysate is warmed to approximately 100º F to increase the efficiency of diffusion and to prevent a decrease in the client's blood temperature. Dialysate is made from clear water and chemicals and is free from any metabolic waste products or medications. Bacteria and other microorganisms are too large to pass through the membrane; therefore, the dialysate does not need to be sterile.
The nurse is giving general instructions to a client receiving hemodialysis. Which statement would be most appropriatefor the nurse to include? "It is acceptable to eat whatever you want on the day before hemodialysis." "It is acceptable to exceed the fluid restriction on the day before hemodialysis." "Medications should be double-dosed on the morning of hemodialysis because of potential loss." "Several types of medications should be withheld on the day of dialysis until after the procedure."
"Several types of medications should be withheld on the day of dialysis until after the procedure." Many medications are dialyzable, which means that they are extracted from the bloodstream during dialysis. Therefore, many medications may be withheld on the day of dialysis until after the procedure. It is not typical for medications to be double-dosed because there is no way to be certain how much of each medication is cleared by dialysis. Clients receiving hemodialysis are not routinely taught that it is acceptable to disregard dietary and fluid restrictions.
A client with end-stage renal disease (ESRD) has the problem of ineffective coping. Which nursing interventions are appropriate in working with this client? Select all that apply. Acknowledge the client's feelings. Assess the client and family's coping patterns. Explore the meaning of the illness with the client. Set limits on mood swings and expressions of hostility. Give the client information when the client is ready to listen.
Acknowledge the client's feelings. Assess the client and family's coping patterns. Explore the meaning of the illness with the client. Give the client information when the client is ready to listen. Clients with ESRD are likely to experience mood swings or express hostility, anger, and depression, among other responses. The nurse should acknowledge the client's feelings, allow the client to express those feelings, and be supportive. Options 1, 2, 3, and 5 are helpful and appropriate interventions for the client. Setting limits for this client is not client focused, does not allow the client to express concerns, and is nontherapeutic in this situation.
A client with chronic kidney disease being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious, and the nurse suspects air embolism. What are the priority nursing actions? Select all that apply. Administer oxygen to the client. Continue dialysis at a slower rate after checking the lines for air. Notify the primary health care provider (PHCP) and Rapid Response Team. Stop dialysis, and turn the client on the left side with head lower than feet. Bolus the client with 500 mL of normal saline to break up the air embolus.
Administer oxygen to the client. Notify the primary health care provider (PHCP) and Rapid Response Team. Stop dialysis, and turn the client on the left side with head lower than feet. If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, position the client so the air embolus is in the right side of the heart, notify the PHCP and Rapid Response Team, and administer oxygen as needed. Slowing the dialysis treatment or giving an intravenous bolus will not correct the air embolism or prevent complications.
A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? Hematocrit of 33% (0.33) Platelet count of 400,000 mm3 (400 × 109/L) White blood cell count of 6000 mm3 (6.0 × 109/L) Blood urea nitrogen level of 15 mg/dL (5.4 mmol/L)
Hematocrit of 33% (0.33) Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hematocrit level is 42% to 52% (0.42 to 0.52) for males and 37% to 47% (0.37 to 0.47) for females. Therapeutic effect is seen when the hematocrit reaches between 30% and 33% (0.30 and 0.33). The normal platelet count is 150,000 to 400,000 mm3 (5 to 10 × 109/L). Platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin.
The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. Check the level of the drainage bag. Reposition the client to her or his side. Place the client in good body alignment. Check the peritoneal dialysis system for kinks. Contact the primary health care provider (PHCP). Increase the flow rate of the peritoneal dialysis solution.
Check the level of the drainage bag. Reposition the client to her or his side. Place the client in good body alignment. Check the peritoneal dialysis system for kinks. If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing and peritoneal dialysis system are also checked for kinks or twisting, and the clamps on the system are checked to ensure that they are open. There is no reason to contact the PHCP. Increasing the flow rate should not be done and also is not associated with the amount of outflow solution.
A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 38.5º C (101.2º F). Which nursing action is most appropriate? Encourage fluid intake. Continue to monitor vital signs. Notify the primary health care provider. Monitor the site of the shunt for infection.
Notify the primary health care provider. A temperature of 101.2º F (38.5º C) is significantly elevated and may indicate infection. The nurse should notify the primary health care provider (PHCP). Dialysis clients cannot have fluid intake encouraged. Vital signs and the shunt site should be monitored, but the PHCP should be notified first.
A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication? Warmth, redness, and pain in the left hand Ecchymosis and audible bruit over the fistula Edema and reddish discoloration of the left arm Pallor, diminished pulse, and pain in the left hand
Pallor, diminished pulse, and pain in the left hand Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, caused by tissue ischemia. Warmth and redness probably would characterize a problem with infection. Ecchymosis and a bruit are normal findings for a fistula.
The nurse is planning discharge teaching for a client newly diagnosed with chronic kidney disease (CKD). Which factor will enhance the educational process? Anxiety Memory deficits Presence of family Short attention span
Presence of family The client with CKD may have several barriers to learning. The presence of family members is helpful because they need to understand the disease and treatment and may help reinforce information with the client after the formal teaching session is over. Anxiety about the disease and its ramifications frequently interferes with learning. Physiological effects of the disease process also impair the client's mental functioning. Specifically, the client may exhibit a short attention span and have memory deficits. Mental functioning usually improves once hemodialysis has begun.
A client with an arteriovenous fistula in the left arm who is undergoing hemodialysis is at risk for infection. Which should the nurse formulate as the best outcome goal for this client problem? The client washes hands at least once per day. The client's temperature remains lower than 101º F (38.3º C). The client avoids blood pressure (BP) measurement in the left arm. The client's white blood cell (WBC) count remains within normal limits.
The client's white blood cell (WBC) count remains within normal limits. General indicators that the client is not experiencing infection include a temperature and WBC count within normal limits. The client also should use proper hand-washing technique as a general preventive measure. Hand washing once per day is insufficient. It is true that the client should avoid BP measurement in the affected arm; however, this would relate more closely to the problem of risk for injury.
