Ch 48 Management of Patients with Kidney Disorders (PrepU)

The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than ___________mL/kg/hr.

0.5 Oliguria is defined as urine output less than 0.5 mL/kg/hr.

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: A. "As the disease progresses, you will most likely require renal replacement therapy" B. "Dietary changes can reverse the damage that has occurred in your kidneys" C. "Draining of the cysts and antibiotic therapy will cure your disease" D. "Genetic testing will determine the best treatment for your condition"

A. "As the disease progresses, you will most likely require renal replacement therapy" There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.

What is used to decrease potassium level seen in acute renal failure? A. Sodium polystyrene sulfonate B. Sorbitol C. IV dextrose 50% D. Calcium supplements

A. Sodium polystyrene sulfonate The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.

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

A. Water and sodium retention secondary to a severe decrease in the glomerular filtration rate The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

Which of the following is the most accurate indicator of fluid loss or gain? A. Weight B. Urine output C. Caloric intake D. Body temperature

A. Weight The most accurate indicator of fluid loss or gain in an acutely ill patient is weight, as accurate intake and output and assessment of insensible losses may be difficult. Urine output, caloric intake, and body temperature would not be the most reliable indicator of fluid loss or gain.

The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply. A. Magnesium 1.5 mg/dL; mood changes and insomnia B. Calcium 7.5 mg/dL; hypotension and irritability C. Chloride 90 mEq/L; irritability and seizures D Potassium 6.4 mEq/L; dysrhythmias and abdominal distention E. Phosphate 5.0 mg/dL; tachycardia and nausea and emesis

B, D, E Decreased calcium, increased potassium, and increased phosphate levels are associated with ESKD, along with the signs and symptoms associated with these serum values. Decreased magnesium and chloride levels are not associated with ESKD.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? A. Serum potassium level of 4.9 mEq/L B. Serum sodium level of 135 mEq/L C. Temperature of 99.2 F (37.3 C) D. Urine output of 20 mL/hour

D. Urine output of 20 mL/hour Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? A. Blood urea nitrogen (BUN) level of 22 mg/dl B. Serum creatinine level of 1.2 mg/dl C. Temperature of 100.2 F (37.8 C) D. Urine output of 250 ml/24 hours

D. Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? A. "Even a perfect match does not guarantee organ success" B. "Immunosuppressive drugs guarantee organ success" C. "The doctor may decide to delay the use of immunosuppressant drugs" D. "Let's wait until after the surgery to discuss your treatment plan"

A. "Even a perfect match does not guarantee organ success" Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.

The nurse is able to identify which condition as uremia? A. An excess of urea in the blood B. An excess of protein in the blood C. An excess of blood in the urine D. An excess of protein in the urine

A. An excess of urea in the blood Uremia is an excess of urea and other nitrogenous wastes in the blood. Azotemia is the concentration of nitrogenous wastes in the blood. Hematuria is blood in the urine. Proteinuria is protein in the urine. Hyperproteinemia is an excess of protein in the blood.

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? A. Azotemia B. Proteinuria C. Hematuria D. Bacteremia

A. Azotemia The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.

The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? A. Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20 B. BUN of 18 mg/dL C. Serum creatinine of 1.2 mg/dL D. Glomerular filtration rate (GFR) of 100 mL/min

A. Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20 The normal BUN:Cr ratio is less than 15. Prerenal azotemia is caused by hypoperfusion of the kidneys due to a nonrenal cause. Over time, higher than normal blood levels of urea or other nitrogen-containing compounds will develop.

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? A. Cola-colored urine B. Left upper quadrant pain C. Pyruia D. Low blood pressure

A. Cola-colored urine Cola-colored urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis.

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

A. Decrease in the blood flow through the kidneys Acute kidney injury can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? A. Dehyration B. Hyperkalemia C. Crackles D. Hypertension

A. Dehydration The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.

A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate? A. Donors are selected from compatible living or deceased donors B. Donors must be relatives C. Donors with hypertension may qualify D. The client is placed on a transplant list at the local hospital

A. Donors are selected from compatible living or deceased donors Donors are selected from compatible living donors. Donors do not have to be relatives as long as they are compatible. Potential donors with a history of hypertension, malignant disease, or diabetes are excluded from donation. Each local hospital does not have its own transplant list, instead the client will be placed on a national computerized transplant waiting list.

An athlete is thought to have sustained an injury to a kidney. The ER nurse caring for the client reviews the initial orders written by the primary health care provider and notes an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason? A. Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential. B. Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this client C. A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary D. There is great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations,

A. Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential. Hematuria is the most common manifestation of renal trauma; its presence after trauma suggests renal injury. Hematuria may not occur, or it may be detectable only on microscopic examination. All urine should be saved and sent to the laboratory for analysis to detect RBCs and to evaluate the course of bleeding. Measuring intake and output is not a function of the laboratory. The laboratory does not save urine to test creatinine clearance at a later time. The laboratory does not monitor the urine for sodium or potassium concentrations.

A client with chronic kidney disease (CKD) has been receiving erythropoietin injections as prescribed. Which outcome would indicate to the nurse that this medication has been effective? A. Higher energy levels B. Absence of a paradoxical pulse C. Blood pressure within normal limits D. Bowel movements solid and formed

A. Higher energy levels Erythropoietin stimulates the bone marrow to produce more red blood cells. Higher energy levels indicate a lessening of the anemia the client was experiencing and indicates the medication is working. Lack of a paradoxical pulse indicates the absence of a pericardial effusion. Blood pressure within normal limits indicates treatment for hypertension has been effective. Formed and solid bowel movements indicate the potassium level is within normal limits.

When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic? A. Penicillin B. Gentamicin C. Tobramycin D. Neomycin

A. Penicillin The three nephrotoxic drugs are aminoglycerides.

A client has been diagnosed with acute glomerulonephritis. This condition causes: A. Proteinuria B. Pyuria C. Polyuria D. No option is correct

A. Proteinuria The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided.

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? A. pH 7.20, PaCO2 36, HCO3 14 B. pH 7.31, PaCO2 48, HCO3 24 C. pH 7.47, PaCO2 45, HCO3 33 D. pH 7.50, PaCO2 29, HCO3 22

A. pH 7.20, PaCO2 36, HCO3 14 Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.

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

A. sodium polystyrene sulfonate (Kayexalate) The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract. Sorbitol may be administered in combination with Kayexalate to induce a diarrhea-type effect (it induces water loss in the GI tract). If the client is hemodynamically unstable (low blood pressure, changes in mental status, dysrhythmia), IV dextrose 50%, insulin, and calcium replacement may be administered to shift potassium back into the cells.

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? A. "It is important to use strict aseptic technique" B. "It is appropriate to warm the dialysate in a microwave" C. "The infusion clamp should be open during infusion" D. "The effluent should be allowed to drain by gravity"

B. "It is appropriate to warm the dialysate in a microwave" The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? A. A GFR of 90 mL/min/1.73 m2 B. A GFR of 30-59 mL/min/1.73 m2 C. A GFR of 120 mL/min/1.73 m2 D. A GFR of 85 mL/min/1.73 m2

B. A GFR of 30-59 mL/min/1.73 m2 Stage 3 of chronic kidney disease is defined as having a GFR of 30-59 mL/min/1.73 m2

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? A. Acute renal failure B. Acute glomerulonephritis C. Chronic renal failure D. Nephrotic syndrome

B. Acute glomerulonephritis Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium? A. Butter B. Citrus fruits C. Cooked white rice D. Salad oils

B. Citrus fruits Foods and fluids containing potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee) are restricted.

The nurse recognizes which condition as an integumentary manifestation of chronic renal failure? A. Asterixis B. Gray-bronze skin color C. Tremors D. Seizures

B. Gray-bronze skin color Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.

What is a characteristic of the intrarenal category of acute kidney injury (AKI)? A. Decreased creatinine B. Increased BUN C. High specific gravity D. Decreased urine sodium

B. Increased BUN The intrarenal category of acute kidney injury (AKI) encompasses an increased BUN, increased creatinine, a low-normal specific gravity of urine, and increased urine sodium. Intrarenal AKI is the result of actual parenchymal damage to the glomeruli or kidney tubules. Acute tubular necrosis (ATN), AKI in which there is damage to the kidney tubules, is the most common type of intrinsic AKI. Characteristics of ATN are intratubular obstruction, tubular back leak (abnormal reabsorption of filtrate and decreased urine flow through the tubule), vasoconstriction, and changes in glomerular permeability. These processes result in a decrease of GFR, progressive azotemia, and fluid and electrolyte imbalances.

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? A. Encouraging coughing and deep breathing B. Limiting fluid intake C. Promoting carbohydrate intake D. Providing pain-relief measures

B. Limiting fluid intake During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and IV fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? A. Diuresis B. Oliguria C. Acute tubular necrosis D. Restored glomerular function

B. Oliguria During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.

What is a hallmark of the diagnosis of nephrotic syndrome? A. Hyponatremia B. Proteinuria C. Hyperalbuminemia D. Hypokalemia

B. Proteinuria Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.

Which of the following would a nurse classify as a prerenal cause of acute renal failure? A. Polycystic disease B. Septic shock C. Ureteral stricture D. Prostate hypertrophy

B. Septic shock Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias. Ureteral stricture and prostatic hypertrophy would be classified as postrenal causes. Polycystic disease is classified as an intrarenal cause of acute renal failure.

The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: A. 500 mL of fluid B. 1,000 mL of fluid C. 1,5000 mL of fluid D. 2,000 mL of fluid

C. 1,500 mL of fluid A 1-kg weight gain is equal to 1,000 mL of retained fluid.

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? A. Increase fat intake and limit carbohydrates B. Eliminate fat intake and increase protein intake C. Increase carbohydrates and limit protein intake D. Increase protein, carbohydrates, and fat intake

C. Increase carbohydrates and limit protein intake Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.

The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client? A. Wear a mask while handling any dialysate solutions B. Keep the catheter stabilized to the abdomen, below the belt line C. Keep the dialysis supplies in a clean area, away from children and pets D. Clean the catheter insertion site daily with soap

C. Keep the dialysis supplies in a clean area, away from children and pets It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output? A. 1.5 L B. 1.0 L C. Less than 400 mL D. Less than 50 mL

C. Less than 400 mL The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The minimum amount of urine needed to rid the body of normal metabolic waste products is 400 mL. In this phase, uremic symptoms first appear and life-threatening conditions such as hyperkalemia develop.

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

C. Recent history of streptococcal infection Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? A. Impaired urinary elimination B. Toileting self-care deficit C. Risk for infection D. Activity intolerance

C. Risk for infection The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client? A. Urine output of 35 to 40 mL/hour B. Pain of 3 out of 10, 1 hour after analgesic administration C. SpO2 at 90% with fine crackles in the lung bases D. Blood tinged drainage in Jackson-Pratt drainage tube

C. SpO2 at 90% with fine crackles in the lung bases Altered Breathing Pattern and Ineffective Airway Clearance Risk are often challenges in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output is monitored to maintain a urine output of greater than 30 mL/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.

The nurse is caring for a client with blood loss from esophageal varices. Which assessment finding indicates that the client is exhibiting signs of acute kidney injury (AKI) related to the loss of volume? A. An inability to initiate voiding B. Cloudy urine with a foul odor C. Urine output that has been <0.5 mL/kg/hr for several hours D. Reports of acute flank pain

C. Urine output that has been <0.5 mL/kg/hr for several hours Acute kidney injury (AKI), describes a range of acute-onset kidney disorders that can include mild impairment of kidney function progressing to acute kidney failure that requires renal replacement therapy. AKI is marked by an abrupt loss of kidney function (sudden increase of serum creatinine of 0.3 mg/dL within 48 hours or 1.5 times baseline serum creatinine over 1 week), decrease in glomerular filtration rate (GFR), and abrupt decline in urine output (<0.5 mL/kg/hr for 6 to 12 hours). Flank pain and pyuria are symptoms of pyelonephritis. Cloudy, foul-smelling urine is suggestive of a urinary tract infection.

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? A. Administration of an insulin drip B. Administration of a loop diuretic C. Administration of sodium bicarbonate D. Administration of sodium polystyrene sulfonate (Kayexalate)

D. Administration of sodium polystyrene sulfonate (Kayexalate) The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.

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? A. Keep the AV fistula site dry B. Keep the AV fistula wrapped in gauze C. Take the client's blood pressure in the left arm D. Assess the AV fistula for a bruit and a thrill

D. Assess the AV fistula for a bruit and a thrill The nurse needs to assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? A. Pats skin dry after bathing B. Uses moisturizing creams C. Keeps nails trimmed short D. Brief, hot daily showers

D. Brief, hot daily showers Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? A. Encourage oral fluids B. Administer furosemide (Lasix) 20 mg IV C. Start hemodialysis after a temporary access is obtained D. Start IV fluids with a normal saline solution bolus followed by a maintenance dose

D. Start IV fluids with a normal saline solution bolus followed by a maintenance dose The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute kidney injury. Which statement from the nurse best reflects the ability of the kidneys to recover from acute kidney injury? A. Once on dialysis, the need will be permanent B. Kidney function will improve with transplant C. Acute kidney injury tends to turn to end-stage failure D. The kidneys can improve over a period of months

D. The kidneys can improve over a period of months The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute kidney injury can progress to chronic renal failure.