520 AKI/CKD/ESRF

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? -Administration of sodium polystyrene sulfonate [Kayexalate]) -Administration of an insulin drip -Administration of sodium bicarbonate -Administration of a loop diuretic

Administration of sodium polystyrene sulfonate [Kayexalate])

A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client? -Pericarditis -Acidosis -Hyperkalemia -Anemia

Anemia

Which assessment maneuver does the nurse perform first when assessing the renal system at the same time as the abdomen? A. Abdominal percussion B. Abdominal auscultation C. Abdominal palpation D. Renal palpation

B. Abdominal auscultation

A client is going home after urography. Which instruction or precaution does the nurse teach this client? A. "Avoid direct contact with the urine for 24 hours until the radioisotope clears." B. "You may have some dribbling of urine for several weeks after this procedure." C. "Be sure to drink at least 3 liters of fluids today to help eliminate the dye faster." D. "Your skin may become slightly yellow from the dye used in this procedure."

C. "Be sure to drink at least 3 liters of fluids today to help eliminate the dye faster."

A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering: -Sorbitol -sodium polystyrene sulfonate (Kayexalate) -Calcium supplements -IV dextrose 50%

sodium polystyrene sulfonate (Kayexalate)

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: -a decreased serum phosphate level secondary to kidney failure. -an increased serum calcium level secondary to kidney failure. -metabolic alkalosis secondary to retention of hydrogen ions. -water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

A nurse cares for an acutely ill client. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill client is: -blood pressure. -edema. -pulse rate. -weight.

weight.

A client with decreased renal function is to receive a low-protein diet. The client asks the nurse why he needs this type of diet. The nurse would incorporate which reason into the response? -Lessen workload on the kidneys -Increase speed of treatment -Improve digestion -Improve blood circulation

Lessen workload on the kidneys

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI? -Diuresis -Recovery -Initiation -Oliguria

Oliguria

A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine level of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders? -Monitor the patient's electrolyte values every hour before the procedure. -Obtain a creatinine clearance by collecting a 24-hour urine specimen. -Preprocedure hydration and administration of acetylcysteine -Hemodialysis immediately prior to the CT scan

Preprocedure hydration and administration of acetylcysteine

What is a hallmark of the diagnosis of nephrotic syndrome? -Hyponatremia -Hypoalbuminemia -Hypokalemia -Proteinuria

Proteinuria

A client is scheduled to have renography (kidney scan). The client voices concern about discomfort during the procedure. Which is the nurse's best response? A. "Before the test, you will be given a sedative to reduce any pain." B. "A local anesthetic agent will be used, so you won't feel any pain." C. "No more discomfort is felt with the scan than with an ordinary x-ray." D. "The only pain will occur when you have your IV line started."

D. "The only pain will occur when you have your IV line started."

A client's urinalysis results reveal a urine osmolarity of 1200 mOsm/L. Which action by the nurse is most appropriate? A. Initiate a fluid restriction. B. Prepare to administer a diuretic. C. Institute seizure precautions. D. Encourage the client to increase fluid intake.

D. Encourage the client to increase fluid intake.

A client's urine specific gravity is 1.040. Which action by the nurse is best? A. Obtain a urine culture and sensitivity. B. Place the client on restricted fluids. C. Review the client's creatinine level. D. Increase the client's fluid intake.

D. Increase the client's fluid intake.

The nurse is reviewing a client's urinalysis and notes a positive glucose. Which action by the nurse is best? A. Document the finding and call the health care provider. B. Collect and send another urinalysis sample to the laboratory. C. Review the client's recent dietary selections. D. Perform a finger stick blood glucose on the client.

D. Perform a finger stick blood glucose on the client.

During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication? -Oliguria -Hypokalemia -Renal calculi -Dehydration

Dehydration

A patient is being treated in the ICU for neurogenic shock secondary to a spinal cord injury. Despite aggressive interventions, the patient's mean arterial pressure (MAP) has fallen to 55 mm Hg. The nurse should gauge the onset of acute kidney injury by referring to what laboratory findings? Select all that apply. -Urine specific gravity -Blood urea nitrogen (BUN) level -Creatinine level -Alkaline phosphatase level -Serum albumin level

-Urine specific gravity -Blood urea nitrogen (BUN) level -Creatinine level

the nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL? -500 mL -1,000 mL -750 mL -250 mL

1,000 mL

Renal failure can have prerenal, renal, or postrenal causes. A patient with acute kidney injury is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it? -Heart failure -Glomerulonephritis -Ureterolithiasis -Aminoglycoside toxicity

Heart failure

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? -Increase fat intake and limit carbohydrates. -Eliminate fat intake and increase protein intake. -Increase carbohydrates and limit protein intake. -Increase protein, carbohydrates, and fat intake.

Increase carbohydrates and limit protein intake.

The female client's urinalysis shows all the following results. Which does the nurse document as abnormal? A. pH 5.6 B. Ketone bodies present C. Specific gravity of 1.030 D. Two white blood cells per high-power field

B. Ketone bodies present

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? -History of osteoporosis -Recent history of streptococcal infection -History of hyperparathyroidism -Previous episode of acute pyelonephritis

Recent history of streptococcal infection

A client has an increased BUN/creatinine ratio. Which action by the nurse is most appropriate? A. Assess the client's dietary habits. B. Inquire about the use of NSAIDs. C. Hold the client's metformin (Glucophage). D. Notify the health care provider immediately.

A. Assess the client's dietary habits.

A client was admitted for a myocardial infarction and cardiogenic shock. Two days later, which laboratory test results does the nurse expect to see? A. Blood urea nitrogen (BUN) of 52 mg/dL B. Creatinine of 2.3 mg/dL C. BUN of 10 mg/dL D. BUN-creatinine ratio of 8:1

A. Blood urea nitrogen (BUN) of 52 mg/dL

A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan? -Keep the AV fistula site dry. -Assess the AV fistula for a bruit and thrill. -Keep the AV fistula wrapped in gauze. -Take the client's blood pressure in the left arm.

Assess the AV fistula for a bruit and thrill.

Which condition would trigger the release of antidiuretic hormone (ADH)? A. Overhydration B. Dehydration C. Hemorrhage D. Edema

B. Dehydration

A client's urine specific gravity is 1.018. Which is the nurse's best action? A. Ask the client for a 24-hour recall of liquid intake. B. Correct Document the finding in the client's chart. C. Obtain a specimen for culture. D. Notify the health care provider.

B. Document the finding in the client's chart.

Which condition is associated with oversecretion of renin? A. Alzheimer's disease B. Hypertension C. Diabetes mellitus D. Diabetes insipidus

B. Hypertension

Two hours after a closed percutaneous kidney biopsy, the client reports a dramatic increase in pain. What is the nurse's best first action? A. Reposition the client on the operative side. B. Administer the prescribed opioid analgesic. C. Assess the pulse rate and blood pressure. D. Check the Foley catheter for kinks.

C. Assess the pulse rate and blood pressure.

The nurse is palpating a client's kidneys. The client's right kidney is easily palpated, but the nurse cannot palpate the left kidney. What is the nurse's interpretation of this finding? A. The problem involves the right kidney. B. The problem involves the left kidney. C. Both kidneys are in the normal position. D. The client is at increased risk for kidney impairment.

C. Both kidneys are in the normal position.

To obtain a sterile urine specimen from a client with a Foley catheter, the nurse begins by applying a clamp to the drainage tubing distal to the injection port. What does the nurse do next? A. Clamp another section of the tube to create a fixed sample section for retrieval. B. Insert a syringe into the injection port and aspirate the quantity of urine required. C. Correct Clean the injection port cap of the drainage tubing with povidone-iodine solution. D. Withdraw 10 mL of urine and discard it; then withdraw 10 mL more for the sample.

C. Clean the injection port cap of the drainage tubing with povidone-iodine solution.

Which is the result of stimulation of erythropoietin production in the kidney tissue? A. Increased blood flow to the kidney B. Inhibition of vitamin D and loss of bone density C. Increased bone marrow production of red blood cells D. Inhibition of active transport of sodium and hyponatremia

C. Increased bone marrow production of red blood cells

A client scheduled to have intravenous urography has diabetes and is taking the antidiabetic agent metformin (Glucophage). What does the nurse tell this client? A. "Call your diabetes doctor and tell him or her that you are having an intravenous urogram performed using dye." B. "Do not take your metformin the morning of the test because you are not going to be eating anything and you could become hypoglycemic." C. "You must start on an antibiotic before this test because your risk of infection is greater as a result of your diabetes." D. "You must take your metformin immediately before the test is performed because the IV fluid and the dye contain significant amounts of sugar."

A. "Call your diabetes doctor and tell him or her that you are having an intravenous urogram performed using dye."

A patient has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the patient about what topic? -Allergy status -Typical diet -Psychosocial stressors -Current medication use

Current medication use

A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? -Structural damage occurred in the nephrons of the kidneys -Decrease in the blood flow through the kidneys -Blood clot formed in the kidneys interfered with the flow -Obstruction of urine flow from the kidneys

Decrease in the blood flow through the kidneys

The nursing assistant is using a bladder scanner on a client. Which action by the nursing assistant requires further education on the use of this device? A. Consistently choosing the female icon for all female clients B. Consistently choosing the male icon for all male clients C. Applying ultrasound gel to the scanning head and removing it when finished D. Taking at least two readings by using the aiming icon to place the scanning head.

A. Consistently choosing the female icon for all female clients

The nurse is reviewing a client's laboratory test results and notes a blood urea nitrogen (BUN) of 35 mg/dL and a creatinine of 1.0 mg/dL. What new order does the nurse anticipate? A. Increase the client's IV fluids. B. Prepare the client for dialysis. C. Place the client on a fluid restriction. D. Obtain urine for culture and sensitivity.

A. Increase the client's IV fluids.

A client's urinalysis results show a protein level of 1.8 mg/dL. Which action by the nurse is best? A. Inform the health care provider. B. Ask the client about his or her protein intake. C. Obtain the client's weight. D. Document the finding in the chart.

A. Inform the health care provider.

A client scheduled for intravenous urography informs the nurse of the following allergies. Which one does the nurse report to the health care provider immediately? A. Seafood B. Penicillin C. Bee stings D. Red food dye

A. Seafood

Which results are normal in a urinalysis? (Select all that apply.) A. Correct pH, 6 B. Correct Specific gravity, 1.015 C. Protein, 1.2 mg/dL D. Correct Glucose, negative E. Nitrate, small F. Leukocyte esterase, positive

A. pH, 6 B. Specific gravity, 1.015 D. Glucose, negative

A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? -Elevated serum creatinine -Hyperphosphatemia -Elevated urea and nitrogen -Hyperkalemia

Hyperphosphatemia

A nurse receives her client care assignment. Following the report, she should give priority assessment to the client: -with pinkish mucus discharge in the appliance bag 2 days after an ileal conduit. -who is experiencing mild pain from urolithiasis. -who has a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L 7 days after a kidney transplant. -who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L.

who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L