Acute Renal Failure

The nurse is developing a plan of care for a client diagnosed with ARF. Which statement is an appropriate outcome for the client? 1. Monitor intake and output every shift. 2. Decrease of pain by 3 levels on a 1-10 scale. 3. Electrolytes are within normal limits. 4. Administer enemas to decrease hyperkalemia.

3. Electrolytes are within normal limits. Rational: Renal failure causes an imbalance of electrolytes (potassium, sodium, calcium, phosphorus). Therefore, the desired client outcome is electrolytes within normal limits.

The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which collaborative treatment should the nurse anticipate for the client? 1. Administer a phosphate binder. 2. Type and crossmatch for whole blood 3. Assess the client for leg cramps 4. Prepare the client for dialysis.

4. Prepare the client for dialysis. Rationale: Normal potassium level is 3.5-5.5 mEq/L. A level of 6.8 mEq/L is life threatening and could lead to cardiac dysrhythmias. Therefore, the client may be dialyzed to decrease the potassium level quickly. This requires a health-care provider order, so it is a collaborative intervention.

The client is admitted to the emergency department after a gunshot wound to the abdomen. Which nursing intervention should the nurse implement first to prevent ARF? 1. Administer normal saline IV 2. Take vital signs 3. Place client on telemetry 4. Assess abdominal dressing

1. Administer normal saline IV Rationale: Preventing and treating shock with blood and fluid replacement will prevent acute renal failure from hypoperfusion of the kidneys. Significant blood loss is expected in the client with a gunshot wound.

The nurse is caring for a client diagnosed with ARF. Which laboratory values are most significant for diagnosing ARF? 1. BUN and creatinine 2. WBC and hemoglobin 3. Potassium and sodium 4. Bilirubin and ammonia level

1. BUN and creatinine Rationale: Blood urea nitrogen levels reflect the balance between the production and excretion of urea from the kidneys. Creatinine is a by-product of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal substance for determining renal clearance because it is relatively constant in the body and is the laboratory value most significant in diagnosing renal failure.

The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a medical floor. Which nursing task is most appropriate for the nurse to delegate? 1. Collect a clean voided midstream urine specimen 2. Evaluate the client's 8 hour intake and output 3. Assist in check a unit of blood prior to hanging 4. Administer a cation-exchange resin enema

1. Collect a clean voided midstream urine specimen Rationale: The UAP can collect specimens. Collecting a midstream urine specimen requires the client to clean the perineal area, to urinate a little, and then collect the rest of the urine output in a sterile container.

The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the client is in the recovery period? Select all that apply. 1. Increased alertness and no seizure activity. 2. Increase in hemoglobin and hematocrit. 3. Denial of nausea and vomiting 4. Decreased urine-specific gravity 5 Increased serum creatinine level

1. Increased alertness and no seizure activity. 2. Increase in hemoglobin and hematocrit. 3. Denial of nausea and vomiting Rationales: 1. Renal failure affects almost every system in the body. Neurologically, the client may have drowsiness, headache, muscle twitching, and seizures. In the recovery period, the client is alert and has no seizure activity. 2. In renal failure, levels of erythropoietin are decreased, leading to anemia. An increase in hemoglobin and hematocrit indicates the client is in the recovery period. 3. Nausea, vomiting, and diarrhea are common in the client with ARF; therefore, an absence of these indicates the client is in the recovery period.

The client diagnosed with ARF is placed on bedrest. The client asks the nurse, "Why do I have to stay in bed? I don't feel bad." Which scientific rationale supports the nurse's response? 1. Bedrest helps increase the blood return to the renal circulation. 2. Bedrest reduces the metabolic rate during the acute stage. 3. Bedrest decreases the workload of the left side of the heart 4. Bedrest aids in reduction of peripheral and sacral edema

2. Bedrest reduces the metabolic rate during the acute stage. Rationale: Bedrest reduces exertion and the metabolic rate, thereby reducing catabolism and subsequent release of potassium and accumulation of endogenous waste products (urea and creatinine).

The nurse is caring for a client diagnosed with rule-out ARF. Which condition predisposes the client to developing prerenal failure? 1. Diabetes mellitus. 2. Hypotension. 3. Aminoglycosides 4. Benign prostatic hypertrophy

2. Hypotension. Rationale: Hypotension, which causes a decreased blood supply to the kidney, is one of the most common causes of prerenal failure (before the kidney).

The UAP tells the nurse the client with ARF has a white crystal-like layer on top of the skin. Which intervention should the nurse implement? 1. Have the assistant apply a moisture barrier cream to the skin. 2. Instruct the UAP to bathe the client in cool water. 3. Tell the UAP not to turn in the client in this condition 4. Explain this is normal and do not do anything for the client

2. Instruct the UAP to bathe the client in cool water. Rationale: These crystals are uremic frost resulting from irritating toxins deposited in the client's tissues. Bathing in cool water will remove the crystals, promote client comfort, and decrease the itching resulting from uremic frost.

The client diagnosed with ARF is admitted to the intensive care unit and placed on a therapeutic diet. Which diet is most appropriate for the client? 1. A high-potassium and low-calcium diet 2. A low-fat and low=cholesterol diet 3. A high-carbohydrate and restricted protein diet 4. A regular diet with six small feedings a day.

3. A high-carbohydrate and restricted protein diet Rationale: Carbohydrates are increased to provide for the client's caloric intake and protein is restricted to minimize protein breakdown and to prevent accumulation of toxic waste products.

The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level? 1. Erythropoietin 2. Calcium gluconate 3. Regular insulin 4. Osmotic diuretic

3. Regular insulin Rationale: Regular insulin, along with glucose, will drive potassium into the cells, thereby lowering serum potassium levels temporarily.

The nurse is admitting a client diagnosed with acute renal failure (ARF). Which question is most important for the nurse to ask during the admission interview? 1. Have you recently traveled outside the United States? 2. Did you recently begin a vigorous exercise program? 3. Is there a chance you have been exposed to a virus? 4. What OTC medications do you take regularly?

4. What OTC medications do you take regularly? Rationale: Medications such as nonsteroidal anti-inflammatory drugs and some herbal remedies are nephrotoxic; therefore, asking about medications is appropriate