Chapter 46 - Acute & chronic kidney injury (Med Surg) EAQ's

The nursing instructor is teaching a student nurse about continuous renal replacement therapy (CRRT). Which statement by the student nurse indicates effective learning? 1 "CRRT is provided over approximately 24 hours." 2 "CRRT has a faster blood flow rate than hemodialysis." 3 "CRRT does not require the addition of an anticoagulant." 4 "CRRT cannot be used in conjunction with hemodialysis."

1 - "CRRT is provided over approximately 24 hours." Continuous renal replacement therapy (CRRT) is a physiologic therapy that simulates kidney function day and night. CRRT is done either by cannulating an artery and a vein or by cannulating two veins. CRRT is provided continuously for approximately 24 hours. CRRT involves the flow of blood from the body through a filter and carries an increased risk of clotting; thus an anticoagulant must be added. CRRT can be performed along with hemodialysis. CRRT has a slower blood flow rate than intermittent hemodialysis. Text Reference - p. 1074

Which statements made by the nurse indicate an understanding of patient care during hemodialysis? Select all that apply. 1 "I should auscultate the lungs." 2 "I should record the body temperature." 3 "I should check the mouth for bad breath." 4 "I should monitor the level of consciousness." 5 "I should monitor the access site for discharge."

1 - "I should auscultate the lungs." 2 - "I should record the body temperature." 4 - "I should monitor the level of consciousness." 5 - "I should monitor the access site for discharge." Patients receiving hemodialysis (HD) are typically volume overloaded, so the nurse should assess respiratory status, including auscultation of the lungs. Microbes from the access site can enter the body, therefore the nurse should monitor both the site and body temperature as a means of assessing for infection. Accumulation of waste in the blood (blood urea nitrogen) affects mental functioning; thus the nurse should monitor the patient's level of consciousness. The mouth is assessed to detect inflammation and dryness, not bad breath. Text Reference - p. 1096

The nursing instructor is evaluating the statements of a student nurse about medication safety for patients with acute kidney injury. Which statement by the student nurse indicates effective learning? 1 "I should warn the patient about the use of over-the-counter-drugs." 2 "I should suggest that patients limit the course of antibiotics prescribed." 3 "I should instruct patients to go for a follow-up medical checkup every six months." 4 "I should instruct patients to take antihypertensives if their blood pressure increases."

1 - "I should warn the patient about the use of over-the-counter-drugs." Over-the-counter drugs are harmful to the kidneys for patients with preexisting kidney disease and may worsen the symptoms. For example, acetaminophen causes nephrotoxicity and, if overused, may cause kidney failure. An antibiotic course should be completed and not limited because the patient may develop resistance. Patients with renal impairment should visit the health care center regularly to help in the early detection or treatment of further complications associated with chronic kidney disease. Angiotensin-converting enzyme inhibitors are used as antihypertensives and should be taken only when prescribed by a health care provider because of the side effect of hyperkalemia. Text Reference - p. 1074

The registered nurse is teaching a student nurse about physiologic changes in the diuretic phase of a patient with acute kidney disease. Which statement by the student nurse about the diuretic phase indicates effective learning? Select all that apply. 1 "The diuretic phase lasts for one to three weeks." 2 "Urine volume decreases in the diuretic phase." 3 "Hypovolemia occurs during the diuretic phase." 4 "The kidneys will have the ability to concentrate urine." 5 "The creatinine level increases drastically at the end of the diuretic phase."

1 - "The diuretic phase lasts for one to three weeks." 3 - "Hypovolemia occurs during the diuretic phase." The diuretic phase lasts for one to three weeks and hypovolemia and hypotension occur due to increased urinary output. In the diuretic phase, urine output increases because of the renal tubules' inability to concentrate urine. At the end of the diuretic phase, the creatinine, blood urine nitrogen, and electrolyte levels return to normal. Text Reference - p. 1072

Which statement made by a nursing student indicates effective learning about what should be included on a plan of care for a patient with chronic kidney disease that is taking gluconate and calcium acetate? 1 Administer a stool softener. 2 Give both drugs at the same time. 3 Obtain consent for immediate dialysis. 4 Administer sodium polystyrene sulfonate.

1 - Administer a stool softener. A patient with chronic kidney disease who is taking oral iron salts, such as ferrous gluconate, and phosphate binders, such calcium acetate, may develop constipation and need to take a stool softener. Dialysis does not provide relief from constipation in patients with chronic kidney disease. Oral iron supplements should not be given at the same time as calcium-containing phosphate binders because they prevent iron absorption. Sodium polystyrene sulfonate helps to treat hyperkalemia but does not provide relief from constipation. Text Reference - p. 1081

A patient with acute kidney injury has been admitted to the hospital, and the nurse observes the electrocardiogram (ECG) reading shows tall peaked T waves, ST depression, and QRS widening. What nursing interventions should the nurse perform for this patient? Select all that apply. 1 Administer sodium bicarbonate. 2 Administer diuretics as ordered. 3 Ensure potassium intake of 50 mEq/day. 4 Administer regular insulin intravenously. 5 Administer calcium gluconate intravenously.

1 - Administer sodium bicarbonate. 4 - Administer regular insulin intravenously. 5 - Administer calcium gluconate intravenously. ECG readings for this patient are indicative of cardiac changes due to hyperkalemia induced by acute kidney injury. Regular insulin, administered intravenously, helps the potassium to move into the cells. Sodium bicarbonate corrects the acidosis and causes the potassium to shift into the cells. Calcium gluconate raises the threshold for excitation, protecting the heart. The potassium intake should be limited to 40 mEq/day. Diuretics are not effective in hyperkalemia. Text Reference - p. 1073

A patient has stage 3 chronic kidney disease (CKD) and is being taught about a low potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat? 1 Apple, green beans, and a roast beef sandwich 2 Granola made with dried fruits, nuts, and seeds 3 Watermelon and ice cream with chocolate sauce 4 Bran cereal with a half of a banana, milk, and orange juice

1 - Apple, green beans, and a roast beef sandwich When the patient selects an apple, green beans, and a roast beef sandwich, the patient demonstrates understanding of the low potassium diet. Granola, dried fruits, nuts and seeds, milk products, chocolate sauce, bran cereal, banana, and orange juice all have elevated levels of potassium, at or above 200 mg per 0.5 cup. Text Reference - p. 1083

A patient is in end-stage renal failure. What are the signs and symptoms that the nurse is likely to find while assessing neurologic function? Select all that apply. 1 Asterixis 2 Nocturnal leg cramps 3 Restless leg syndrome 4 Hypertonicity of muscles 5 Hyperexaggerated deep tendon reflexes

1 - Asterixis 2 - Nocturnal leg cramps 3 - Restless leg syndrome Individuals with advanced stage 5 chronic kidney disease may complain of restless legs syndrome, described as "bugs crawling inside the leg." Muscle twitching, jerking, asterixis (hand-flapping tremor), and nocturnal leg cramps also occur. Eventually, motor involvement may lead to bilateral footdrop, muscular weakness and atrophy, and loss of deep tendon reflexes. There is slowing down of conduction in the peripheral nerves; therefore, hyperexaggerated reflexes and hypertonicity will not be found. Text Reference - p. 1078

The nurse is teaching a patient with acute kidney injury about lifestyle modifications. Which actions by the patient indicate effective teaching? 1 Consuming less salt 2 Eating foods rich in protein 3 Increase intake of fluids 4 Consuming potassium-rich foods

1 - Consuming less salt Sodium causes fluid and water retention and thereby increases blood volume; thus, the patient should consume less salt. Patients with renal impairment should decrease protein intake because proteins break down into urea, which is dangerous if it accumulates in the brain. Increasing the intake of fluid will increase the volume of fluid in the body. Because the kidney function is impaired, excess fluid cannot be eliminated and it accumulates in the body, leading to edema and congestive cardiac failure. Kidney disease is associated with hyperkalemia; thus eating potassium-rich food will worsen the condition and may lead to cardiac arrhythmia. Text Reference - p. 1074

The nurse knows the patient with acute kidney injury (AKI) has entered the diuretic phase when what assessments occur? Select all that apply. 1 Dehydration 2 Hypokalemia 3 Hypernatremia 4 Serum creatinine increases 5 Blood urea nitrogen (BUN) increases

1 - Dehydration 2 - Hypokalemia Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes, but not concentrate urine. Therefore the serum BUN and serum creatinine levels also begin to decrease. Text Reference - p. 1072

A 72-year-old African American male with a history of chronic hypertension, coronary artery disease, and type II diabetes presents to the emergency room with complaints of shortness of breath and difficulty urinating. Upon review of test results, what is the best indicator of acute renal failure? 1 Elevated serum creatinine levels 2 Elevated serum blood urea nitrogen (BUN) 3 Elevated serum pH on the arterial blood gases (ABGs) 4 Hydronephrosis on the computed tomography (CT) scan

1 - Elevated serum creatinine levels The best indicator of level of renal functioning is the serum creatinine level. Elevated creatinine levels indicate renal failure. Hydronephrosis, or swelling of the kidney, may occur with obstructive processes such as renal calculi, but this is not an exclusive indicator of renal function. Elevated serum BUN levels may result from a variety of problems, including dehydration, severe injury, catabolic states, gastrointestinal (GI) bleeding, or renal failure. An elevated pH indicates acid-base imbalance, not necessarily renal failure. Text Reference - pp. 1071-1072

Which clinical manifestation of acute kidney injury may cause changes in an electrocardiogram? 1 Hyperkalemia 2 Fluid overload 3 Hyponatremia 4 Metabolic acidosis

1 - Hyperkalemia Acute or rapid development of hyperkalemia affects the heart and causes electrocardiographic changes such as peaked T waves, widening of the QRS complex, and ST-segment depression. Fluid overload may lead to pulmonary edema and heart failure. Uncontrolled hyponatremia may lead to the development of cerebral edema. Metabolic acidosis causes Kussmaul respirations. Text Reference - p. 1072

The nurse identifies that if a patient with chronic kidney disease (CKD) consumes baked beans, sweet potatoes, canned mushrooms, and chocolates, the patient is at risk for what condition? 1 Hyperkalemia 2 Hypernatremia 3 Hypermagnesemia 4 Hyperphosphatemia

1 - Hyperkalemia Baked beans, sweet potatoes, canned mushrooms, and chocolates are rich in potassium. Hyperkalemia, or an abnormally high potassium level, is observed in patients with chronic kidney disease (CKD) with consumption of these foods. Hypernatremia occurs due to retention of sodium, aggravated by sodium-rich foods such as pickles. Hypermagnesemia, an increase in serum magnesium levels, is an electrolyte disturbance seen in the patients with CKD aggravated by intake of milk of magnesia and magnesium-containing laxatives. Hyperphosphatemia is aggravated by consumption of meat and dairy products in patients with CKD. Text Reference - p. 1083

While caring for a patient with an acute kidney injury, the patient complains of severe weakness and palpitations. The electrocardiogram reveals widening of the QRS complex and an elevated T wave. What complication does the nurse suspect in this patient? 1 Hyperkalemia 2 Hypercalcemia 3 Hypernatremia 4 Hyperchloremia

1 - Hyperkalemia Hyperkalemia is associated with electrocardiographic changes like T-wave elevation, widening of the QRS complex, and ST-segment depression. A short QT interval and a small ST segment indicate hypercalcemia. Hypernatremia is characterized by a flat T wave. A depressed T wave is a characteristic of hyperchloremia. Text Reference - p. 1072

What are the common causes of acute kidney injury? Select all that apply. 1 Hypovolemia 2 Interstitial nephritis 3 Increased cardiac output 4 Decreased renovascular blood flow 5 Increased peripheral vascular resistance

1 - Hypovolemia 2 - Interstitial nephritis 4 - Decreased renovascular blood flow Acute kidney injury is defined as rapid loss of kidney function. The common causes of acute renal injury are prerenal, intrarenal, and postrenal. One cause of acute kidney injury is hypovolemia, which is associated with dehydration, diarrhea, burns, and hemorrhage. Interstitial nephritis, which is associated with allergies and infections, is another cause of acute kidney injury. Decreased renovascular blood flow, which is associated with embolism and renal artery thrombosis, is another cause of acute kidney injury. Decreased cardiac output, which is associated with cardiac dysrhythmias and cardiogenic shock, is also a cause of acute kidney injury. Decreased peripheral vascular resistance, which is associated with neurologic injury and septic shock, is another cause of acute kidney injury. Text Reference - p. 1070

A diabetic patient comes to the emergency department with complaints of facial puffiness for the past three days, swelling in the legs, and difficulty breathing. The laboratory report states the blood glucose level as 260 mg/dL and the serum creatinine level as 3.9 mg/dL. What does the nurse suspect from these findings? 1 Kidney failure 2 Injury to the kidneys 3 Loss of kidney function 4 End-stage kidney disease

1 - Kidney failure Facial puffiness for three days, swelling in the legs, and difficulty breathing indicate fluid overload and edema. The normal range of serum creatinine is 0.7 to 1.3 mg/dL. Serum creatine levels increase threefold in patients with kidney failure. Because the patient has a serum creatinine level of 3.9 mg/dL, the nurse suspects kidney failure. In kidney injury, the serum creatinine level increases twofold. A complete loss of kidney function for more than four weeks indicates a loss of kidney function. Complete loss of kidney function for more than three months is a characteristic of end-stage kidney disease. Text Reference - pp. 1071-1072

Assessment findings of a patient with chronic kidney failure include a glomerular filtration rate (GFR) of 10 mL/min, numbness and burning sensation in the legs, and a blood urea nitrogen level (BUN) of 26 mg/dL. The nurse anticipates that which intervention will be included on the patient's plan of care? 1 Make a referral for dialysis. 2 Restrict sodium bicarbonate. 3 Administer sodium polystyrene sulfonate. 4 Provide a magnesium-containing antacid.

1 - Make a referral for dialysis. Numbness and burning sensation in the legs are manifestations of peripheral neuropathy caused by nitrogenous waste accumulation in the brain. A patient with a chronic kidney disease (CKD), increased blood urea nitrogen (BUN) levels, and a very low glomerular filtration rate of 10 mL/min should undergo dialysis to remove nitrogenous wastes and prevent fluid accumulation due to impaired excretion. Sodium polystyrene sulfonate treats hyperkalemia. Sodium bicarbonate treats metabolic acidosis. A patient with CKD must not take antacids containing magnesium or aluminum because they are excreted by the kidneys. Text Reference - p. 1078

The nurse is teaching a patient with chronic kidney disease about restricting phosphorous in the diet. The nurse determines the teaching was effective when the patient correctly identifies which examples of foods as high in phosphorous? Select all that apply. 1 Milk 2 Steak 3 Cheese 4 Pudding 5 White bread

1 - Milk 2 - Steak 3 - Cheese 4 - Pudding In general, foods that contain more than 160 mg of phosphorous per serving are considered high in phosphorous and should be avoided. Pudding is high in phosphorous. Meats such as beef or chicken are considered high in phosphorous. Milk and dairy products like cheese are also high in phosphorous and should be avoided. White bread is not considered high in phosphorous. Text Reference - pp. 182-183

The patient has a form of glomerular inflammation that is progressing rapidly. The patient is gaining weight, and the urine output is declining steadily. What is the priority nursing intervention? 1 Monitor the patient's cardiac status. 2 Teach the patient about hand washing. 3 Increase direct observation of the patient. 4 Obtain a serum specimen for electrolytes.

1 - Monitor the patient's cardiac status. The nurse's priority is to monitor the patient's cardiac status. With the rapidly progressing glomerulonephritis, renal function begins to fail and fluid, potassium, and hydrogen retention lead to hypervolemia, hyperkalemia, and metabolic acidosis. Excess fluid increases the workload of the heart, and hyperkalemia can lead to life-threatening dysrhythmias. Teaching about hand washing and observation of the patient are important nursing interventions but are not the priority. Electrolyte measurement is a collaborative intervention that will be done as prescribed by the health care provider. Text Reference - p. 1076

Which is a clinical manifestation of acute kidney injury? 1 Oliguria 2 Uremia 3 Anemia 4 Pruritus

1 - Oliguria Oliguria is a sign of acute kidney injury. Uremia, anemia, and pruritus are signs of chronic kidney injury. Text Reference - pp. 1071-1072

Which nursing interventions should the nurse include in the care plan of a patient with acute kidney failure? Select all that apply. 1 Perform skin care. 2 Wash the mouth frequently. 3 Change the patient's position frequently. 4 Encourage the patient to eat potassium-rich foods. 5 Encourage the patient to drink plenty of fruit juices.

1 - Perform skin care. 2 - Wash the mouth frequently. 3 - Change the patient's position frequently. Patients with kidney disease have an increased amount of ammonia in their saliva, which may cause mucosal irritation and inflammation. Therefore the nurse should wash the patient's mouth frequently. The nurse should give the patient good skin care to avoid scaly or dry skin. The nurse should frequently change the patient's position to prevent pressure ulcers. Renal impairment is associated with hyperkalemia; thus giving the patient potassium-rich foods may worsen the patient's condition and thus should not be included in the patient's care plan. The nurse should instruct the patient to restrict intake of fluid in the form of juices and water to prevent fluid overload and edema. Text Reference - p. 1075

The nurse is caring for a patient who is a recent recipient of a kidney transplant. Which interventions should the nurse perform in the immediate postoperative period? Select all that apply. 1 Record central venous pressure. 2 Replace urine output with fluids for the first five hours. 3 Monitor the patient for hyponatremia and hypokalemia. 4 Report for urine output more than 500 mL in the initial phase. 5 Notify the health care provider of a sudden decrease in urine output.

1 - Record central venous pressure. 3 - Monitor the patient for hyponatremia and hypokalemia. 5 - Notify the health care provider of a sudden decrease in urine output. The nurse caring for the kidney transplant recipient should record central venous pressure readings in order to monitor postoperative fluid status. The patient should be monitored for hyponatremia and hypokalemia, which are often associated with rapid diuresis. The health care provider should be notified in case of a sudden decrease in urine output in the early postoperative period; it may be due to dehydration, rejection, a urine leak, or obstruction. Urine output during this phase may be as high as 1 L/hr and may gradually decrease as the blood urea nitrogen (BUN) and serum creatinine levels return toward normal. Urine output is replaced with fluids mL for mL hourly for the first 12 to 24 hours. Dehydration must be avoided to prevent subsequent renal hypoperfusion and renal tubular damage. Text Reference - p. 1095

The nurse recognizes that which intervention would help a patient with stage 5 chronic kidney disease who experiences restless leg syndrome, altered mental ability, seizures, coma, and a blood urea nitrogen (BUN) level of 35 mg/dL? 1 Refer the patient for dialysis. 2 Administer calcium phosphate binders. 3 Administer 10% calcium gluconate intravenously. 4 Recommend that the patient receive a blood transfusion.

1 - Refer the patient for dialysis. The patient's symptoms of restless leg syndrome, altered mental ability, and irritability are manifestations of neurologic complications due to accumulation of nitrogenous wastes in the brain and nervous system. The patient has seizures and coma due to the high blood urea nitrogen (BUN) level of 35 mg/dL. Therefore dialysis would improve central nervous system functions and slow the neuropathies. Calcium phosphate binders are administered in a patient with hyperphosphatemia. A blood transfusion is not preferred to treat anemia unless the patient experiences an acute blood loss or symptomatic anemia. Intravenous administration of 10% calcium gluconate helps to reduce hyperkalemia in a patient. Text Reference - p. 1078

What are the postrenal causes of acute kidney injury? Select all that apply. 1 Renal calculi 2 Renal trauma 3 Prostate cancer 4 Kidney ischemia 5 Myoglobin release

1 - Renal calculi 2 - Renal trauma 3 - Prostate cancer Renal calculi, trauma, and prostate cancer are postrenal causes of acute kidney injury. Intrarenal causes of acute kidney injury include kidney ischemia and myoglobin released from muscle cells. Text Reference - p. 1070

The patient with an acute kidney injury is being admitted. Which prescriptions by the primary health care provider should the nurse anticipate? Select all that apply. 1 Sodium restriction 2 Potassium restriction 3 Phosphate binding agents 4 Encourage fluid replacement 5 Intermittent straight catheterization

1 - Sodium restriction 2 - Potassium restriction 3 - Phosphate binding agents 4 - Encourage fluid replacement The patient with acute kidney injury is at risk for kidney failure. Close monitoring of fluid and electrolyte balance is a key nursing assessment, so the nurse will anticipate fluid replacement, potassium restriction, sodium restriction, and phosphate binding agents to be prescribed. There will be no prescription for intermittent straight catheterizations, because this places the patient at risk for a urinary tract infection (UTI). Text Reference - pp. 1073-1074

A patient with acute kidney injury is prescribed intravenous (IV) insulin and IV dextrose (glucose). What is the purpose of administering insulin and dextrose? 1 Treat hyperkalemia with insulin and prevent hypoglycemia with glucose. 2 Manage hyperglycemia with insulin and prevent hypoglycemia with glucose. 3 Prevent metabolic acidosis with insulin and restore metabolic activity with glucose. 4 Promote renal absorption of sodium with glucose and to prevent hyponatremia with insulin.

1 - Treat hyperkalemia with insulin and prevent hypoglycemia with glucose. The purpose of administering insulin and dextrose is to lower the serum potassium level. Insulin works by pushing the potassium back into the cells, and glucose prevents hypoglycemia. Hyperglycemia may be managed with insulin but not dextrose simultaneously. Insulin does not prevent metabolic acidosis nor does glucose restore metabolic activity. Glucose does not promote renal absorption of sodium, and insulin does not prevent hyponatremia. Text Reference - p. 1073

Which condition does the nurse suspect in a patient with a glomerular filtration rate (GFR) of 10 mL/minute, a blood urea nitrogen (BUN) level of 23 mg/dL, a potassium level of 4 mEq/L, and a serum bicarbonate level of 20 mEq/L? 1 Uremia 2 Hypertension 3 Dysrhythmias 4 Metabolic acidosis

1 - Uremia A patient with glomerular filtration rate (GFR) of 10 mL/minute has chronic kidney disease (CKD), causing the BUN to rise above the normal BUN level of 6 to 20 mg/dL, which may be a result of uremia. Hypertension may result from hypernatremia in the patient with CKD; there is no sodium level information given. Dysrhythmias may occur in the patient with CKD due to hyperkalemia due to decreased excretion of potassium by the kidneys; however, this patient's potassium level of 4 mEq/L is a normal finding. An inability of the kidneys to excrete ammonia and generate bicarbonates leads to metabolic acidosis, indicated by a serum bicarbonate level lower than 15 mEq/L.; the patient's level is greater than 15 mEq/L. Text Reference - p. 1076

Which finding indicates oliguria? 1 Urinary output of 350 mL/day 2 Urinary output of 450 mL/day 3 Urinary output of 550 mL/day 4 Urinary output of 650 mL/day

1 - Urinary output of 350 mL/day A urinary output rate of less than 400 mL/day indicates oliguria; thus a urinary output of 350 mL/day suggests oliguria. Urine outputs of 450, 550, or 650 mL/day are considered normal. Text Reference - p. 1071

The patient is in the diuretic phase of acute kidney injury. What education should the nurse provide to the patient regarding this phase? Select all that apply. 1 Urine output is increased. 2 The kidney has become fully functional. 3 The electrolyte imbalance will be normalized. 4 This phase will last no more than three weeks 5 There is a possibility that the fluid volume will be reduced in the body.

1 - Urine output is increased. 4 - This phase will last no more than three weeks 5 - There is a possibility that the fluid volume will be reduced in the body. During the diuretic phase of acute kidney injury, daily urine output is usually around 1 to 3 L but may reach 5 L or more. Hypovolemia and hypotension can occur from massive fluid losses. The diuretic phase may last one to three weeks. Near the end of this phase, the patient's acid-base, electrolyte, and waste product (blood urea nitrogen, creatinine) values begin to normalize. Although urine output is increasing, the nephrons are still not fully functional. The high urine volume is caused by osmotic diuresis from the high urea concentration in the glomerular filtrate and the inability of the tubules to concentrate the urine. In this phase the kidneys have recovered their ability to excrete wastes, but not to concentrate the urine. Because of the large losses of fluid and electrolytes, the patient must be monitored for hyponatremia, hypokalemia, and dehydration. Text Reference - p. 1072

The nurse instructs a patient with hyperphosphatemia to avoid what food item? 1 Yogurt 2 Soy sauce 3 Canned soup 4 Salad dressing

1 - Yogurt Yogurt is rich is phosphate and should be avoided by patients with hyperphosphatemia. The patient with hypernatremia and hypertension should avoid soy sauce, canned soups, and salad dressings because they are high in sodium Text Reference - pp. 1082-1083

The nurse finds from the patient's record that the previous day's urine output was 400 mL. The patient is on a fluid restriction. How much fluid will the nurse allocate to the patient? Record your answer as a whole number. ____ mL

1000ml The rule for calculating fluid restriction is to add all losses for the previous 24 hours plus an additional 600 mL for insensible losses such as respiration and diaphoresis. The patient's water loss for the previous 24 hours was 400 mL so this amount plus 600 mL should be allocated. Thus the nurse should allocate 1000 mL of fluid. Text Reference - p. 1073

The nurse teaches safety measures to a patient with chronic kidney disease (CKD) who is experiencing constipation. The patient's blood pressure is 145/95 mm Hg. Which statement made by the patient indicates effective learning? 1 "I should eat three bananas after every meal." 2 "I should monitor my blood pressure regularly at home." 3 "I should rest in a prone position while recording my blood pressure." 4 "I should take magnesium-containing laxatives if I am experiencing constipation."

2 - "I should monitor my blood pressure regularly at home." A patient with chronic kidney disease (CKD) and hypertension has to monitor blood pressure at home regularly. Controlling blood pressure helps to slow the incidence of atherosclerosis that further impairs kidney function. The patient with CKD has an elevated level of serum potassium and ingestion of bananas may aggravate the condition and lead to fatal dysrhythmias. The patient should be in supine position while measuring blood pressure, not in prone position. The patient may develop hypermagnesemia from taking magnesium-containing laxatives. Text Reference - p. 1081

The registered nurse is teaching a student nurse about parenteral nutrition in patients with kidney disease. Which statement by the student nurse indicates the need for further teaching? 1 "Fat emulsion intravenous infusions can be given." 2 "It is given to patients with functional gastrointestinal tract." 3 "The patient needs daily hemodialysis when on parenteral nutrition." 4 "Concentrated formulas of parenteral nutrition can be given to patients with renal failure."

2 - "It is given to patients with functional gastrointestinal tract." Parenteral nutrition is given to patients who have a nonfunctional gastrointestinal tract. Fat emulsion intravenous infusions can be given as a source for non-protein calories. Patients on parenteral nutrition require daily hemodialysis to remove excess fluids. Patients with kidney failure can receive concentrated formulas of parenteral nutrition because they minimize fluid volume. Text Reference - p. 1074

The nurse teaches a new graduate nurse about the plan of care for a patient with chronic kidney disease (CKD) and anemia. The nurse notes that the anemia was caused by acute blood loss and that the patient is scheduled to receive a blood transfusion. Which statement made by the new graduate indicates effective learning? 1 "The patient should take iron orally and also phosphate binders." 2 "Multiple blood transfusions may lead to iron overload in the patient." 3 "Erythropoietin treatment helps patients with iron deficiency anemia." 4 "Blood transfusions should be avoided in patients with symptomatic anemia."

2 - "Multiple blood transfusions may lead to iron overload in the patient." A patient with anemia from acute blood loss can be given blood transfusions. The patient may develop iron overload after multiple transfusions because one unit of blood contains 250 mg of iron. Oral administration of iron and phosphate binders prevents absorption of iron because calcium binds with iron. Blood transfusion is avoided in the patient with anemia unless the patient experiences acute blood loss or dyspnea, excess fatigue, tachycardia, palpitations, and chest pain that present with symptomatic anemia. Erythropoietin therapy may lead to iron deficiency because it increases demand for iron in the body to support erythropoiesis. Text Reference - pp. 1081-1082

The nursing instructor is teaching a student nurse about sodium polystyrene sulfonate. Which statement by the student nurse indicates the need for further teaching? 1 "It can be administered as an enema." 2 "The drug is effective in treating a paralytic ileus." 3 "The drug helps exchange potassium for sodium." 4 "It is mixed in water with sorbitol and then administered."

2 - "The drug is effective in treating a paralytic ileus." Sodium polystyrene sulfonate is used to correct hyperkalemia and is contraindicated in patients with a paralytic ileus because it causes bowel necrosis. Sodium polystyrene sulfonate can be administered in the form of an enema, which acts by exchanging potassium for sodium ions. It can also be administered after mixing it in water with sorbitol to facilitate the removal of potassium from the body. Text Reference - p. 1074

Which patient is most likely to develop chronic kidney disease (CKD) and should be taught preventive measures by the nurse? 1 A 50-year-old white female with hypertension 2 A 61-year-old Native American male with diabetes 3 A 40-year-old Hispanic female with cardiovascular disease 4 A 28-year-old African American female with a urinary tract infection

2 - A 61-year-old Native American male with diabetes It is especially important that the nurse should teach CKD prevention to the 61-year-old Native American with diabetes. This patient is at highest risk because diabetes causes about 50% of CKD. This patient is the oldest, and Native Americans with diabetes develop CKD six times more frequently than other ethnic groups. Hypertension causes about 25% of CKD. Hispanics have CKD about 1.5 times more than non-Hispanics. African Americans have the highest rate of CKD because hypertension is increased significantly in African Americans. A urinary tract infection (UTI) will not cause CKD unless it is not treated or occurs recurrently. Text Reference - p. 1076

The nurse just received an urgent laboratory value on a patient in renal failure. The potassium level is 6.3. The telemetry monitor is showing peaked T waves. Which prescription from the primary health care provider should be implemented first? 1 Administer kayexalate enema 2 Administer regular insulin intravenously (IV) 3 Restrict dietary potassium intake to 40 meq daily 4 Educate the patient on dietary restriction of potassium

2 - Administer regular insulin intravenously (IV) This patient is showing signs of hyperkalemia, which could be fatal and lead to myocardial damage. Regular insulin IV is needed to quickly force potassium into the cells. The kayexalate enema will take too long to excrete the potassium. Restricting oral intake and educating the patient will be needed when the crisis has resolved. Text Reference - p. 1080

The nurse reviews lab tests that have been prescribed for a patient in acute renal failure. Which is the best indicator of renal function? 1 Potassium 2 Creatinine 3 BUN (blood urea nitrogen) 4 ALT (alanine aminotransferase)

2 - Creatinine Creatinine is the best indicator of renal function. Creatinine is a waste product of the skeletal muscles and is excreted through the kidneys. In renal failure, the kidneys are unable to excrete creatinine, leading to a serum level greater than the normal range of 0.2 to 1.0 mL/dL. Potassium excretion and regulation are impaired in acute renal failure, and potassium may therefore be increased. However, potassium may be increased for reasons other than renal disease, whereas increased creatinine is specific to renal disease. Blood urea nitrogen (BUN) is also used to measure kidney function, but other disorders such as dehydration may cause an increase in BUN. Alanine aminotransferase (ALT) is related to liver dysfunction, not renal dysfunction. Text Reference - p. 1072

A nurse planning care for a patient with acute renal failure recognizes that the interventions of highest priority are directly related to what? 1 Ineffective coping 2 Excess fluid volume 3 Impaired gas exchange 4 Imbalanced nutrition: less than body requirements

2 - Excess fluid volume The issue of excess fluid volume is the primary problem of acute renal failure and the highest priority for the nurse in this situation. The major problem with acute renal failure is altered fluid and electrolytes, which, if not managed, can lead to permanent renal damage, cardiac complications, and death. The nursing diagnosis of ineffective coping is due to the acute severity of the illness. The nursing diagnosis of impaired gas exchange is related to excess fluid volume, such as in the development of pulmonary edema. The nursing diagnosis of imbalanced nutrition, less than body requirements, is due to a decrease in appetite as a result of the acute renal failure. Text Reference - p. 1074

The student nurse is preparing a dietary chart for a patient with acute kidney injury. Which foods included by the nurse in the diet chart need correction? 1 Foods rich in fiber 2 Foods rich in potassium 3 Foods rich in fatty acids 4 Foods rich in carbohydrates

2 - Foods rich in potassium Hyperkalemia is a complication associated with acute kidney injury. Foods rich in potassium will further increase the potassium level in the blood; these foods should not be included in the patient's diet plan. Foods rich in fiber do not cause any harm to the patient's health and can be included. Fats and carbohydrates provide adequate energy; foods rich in fatty acids and carbohydrates can be included in the patient's diet. Text Reference - p. 1074

A nurse is giving dietary advice to a patient who is on continuous ambulatory peritoneal dialysis for chronic renal failure. Which dietary instructions are appropriate for this patient? Select all that apply. 1 High-fluid intake 2 High-calorie foods 3 High-protein foods 4 High-potassium content 5 High-phosphorus content

2 - High-calorie foods 3 - High-protein foods A chronic renal failure patient on continuous ambulatory peritoneal dialysis is encouraged to have a high-calorie diet to meet the increased demands of the body. A good amount of protein should be consumed to replace that lost during dialysis. Foods containing high amounts of potassium and phosphorus should be avoided in patients with chronic renal failure. High potassium can cause hyperkalemia and related complications, especially cardiac complications. High phosphorus may deteriorate bone health. Usually there is a modest restriction of fluids when the patient is on dialysis. Text Reference - p. 1082

Which assessment finding is a consequence of the oliguric phase of acute kidney injury (AKI)? 1 Hypovolemia 2 Hyperkalemia 3 Hypernatremia 4 Thrombocytopenia

2 - Hyperkalemia In AKI the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased because of decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI. Text Reference - p. 1072

The nurse suspects that which electrolyte abnormality is the cause of edema in a patient with chronic kidney disease? 1 Hyperkalemia 2 Hyponatremia 3 Hypermagnesemia 4 Hyperphosphatemia

2 - Hyponatremia Hyponatremia is a decrease in serum sodium levels. Improper functioning of the kidneys impairs sodium excretion, which leads to sodium and water retention resulting in edema. Hyperkalemia can cause cardiac dysrhythmias. Hypermagnesemia may lead to absence of reflexes, decreased mental status, and hypotension. Hyperphosphatemia decreases serum calcium levels and reduces the kidney's ability to activate vitamin D. Text Reference - p. 1077

A patient has renal failure. The nurse, reviewing the lab results, recognizes which finding as indicative of the diminished renal function associated with the diagnosis? 1 Hypokalemia 2 Increased serum urea and serum creatinine 3 Anemia and decreased blood urea nitrogen 4 Increased serum albumin and hyperkalemia

2 - Increased serum urea and serum creatinine Renal failure, whether acute or chronic, causes an increase in serum urea, creatinine, and blood urea nitrogen. Renal failure may also cause hyperkalemia and anemia and decrease serum albumin. However, it does not cause decreased blood urea nitrogen or increased serum albumin. Text Reference - p. 1072

The nurse should monitor for which adverse effect of erythropoietin in patients with kidney failure? 1 Paralytic ileus 2 Iron deficiency 3 Hyperparathyroidism 4 Systemic lupus erythematosus

2 - Iron deficiency Erythropoietin (EPO) helps replenish EPO stores in the body and promotes erythropoiesis in a patient with kidney failure. A side effect of EPO is iron deficiency anemia from increased demand for iron to support erythropoiesis. Paralytic ileus is a side effect of sodium polystyrene sulfonate administered for the treatment of hyperkalemia. Hyperparathyroidism occurs in the patient with end stage renal failure. Systemic lupus erythematosus leads to chronic renal failure. Text Reference - p. 1082

The patient's laboratory report reveals the glomerular filtration rate (GFR) is decreased by 75%. What does the nurse suspect from the patient's findings? 1 Kidney injury 2 Kidney failure 3 Risk of kidney injury 4 Loss of kidney function

2 - Kidney failure The Rifle classification for staging of acute kidney injury utilizes percentages of loss of GFR to define stages of kidney injury. Risk of kidney injury is defined by a GFR decrease by 25%. Kidney injury is defined by a GFR decrease by 50%. Kidney failure is defined by a GFR decrease by 75%. Loss of kidney function is defined by loss of kidney function > 4 weeks. Text Reference - p. 1071

A patient complains of reduced urine output and abdominal pain. The primary health care provider suspects acute kidney injury. Which diagnostic test will the health care provider suggest as an initial test to confirm the diagnosis? 1 Renal biopsy 2 Kidney ultrasound 3 Computed topographic scan 4 Magnetic resonance imaging

2 - Kidney ultrasound Aside from blood tests, the health care provider will first order a kidney ultrasound because it does not involve exposure to contrast agents. A renal biopsy is the best method for confirmation of intrarenal causes of acute kidney injury; however, it is not the preliminary test used to diagnose acute kidney injury. A computed tomographic scan can identify lesions, masses, obstructions, and vascular anomalies, but it is not primarily used to establish a diagnosis of acute kidney injury. Magnetic resonance imaging will be suggested later to examine the abnormalities in detail. Text Reference - p. 1105

Which nursing intervention is appropriate for a patient during the oliguric phase of an acute kidney injury (AKI)? 1 Provide spicy food 2 Provide mouth care 3 Provide plenty of fluids 4 Provide ibuprofen as needed for pain

2 - Provide mouth care Patients with acute kidney injury experience mucous membrane irritation caused by the production of ammonia in the saliva. Therefore the nurse should provide frequent oral care to prevent stomatitis. Spicy food should be avoided because it may aggravate the oral irritation. During the oliguric phase of AKI, the patient is typically volume overloaded because of impaired renal function and decreased urine output, therefore fluid intake should be limited. Ibuprofen, a nonsteroidal antiinflammatory drug, is nephrotoxic and may worsen the kidney injury. Text Reference - p. 1075

What causes prerenal acute kidney injury? 1 Release of nephrotoxins 2 Reduced renal blood flow 3 Urine reflux into renal pelvis 4 Presence of extrarenal tumors

2 - Reduced renal blood flow Prerenal acute kidney injury can be caused by a reduced flow of blood to the kidneys. A release of nephrotoxins is an intrarenal cause of acute kidney injury. Urine reflux into the renal pelvis and the presence of extrarenal tumors are postrenal causes of acute kidney injury. Text Reference - p. 1070

The nurse is providing care for a patient who underwent kidney transplantation surgery two days ago. An appropriate roommate to cohort with the postoperative patient is the patient with what diagnosis? 1 Hepatitis C 2 Renal calculi 3 Osteomyelitis 4 Bronchial pneumonia

2 - Renal calculi A patient who has had a kidney transplant will be undergoing immunosuppressive therapy and ideally should be in a private room. However, if a roommate is necessary, someone with renal calculi would be least likely to possess an infectious organism that could be spread to the immunocompromised transplant patient. A patient with hepatitis C, osteomyelitis, or bronchial pneumonia is not an appropriate roommate because of the risk of infection. Text Reference - p. 1095

Routine urinalysis for a diabetic patient reveals moderate proteinuria. What further tests help to identify decreased kidney function at an early stage? Select all that apply. 1 Serum creatinine 2 Renal ultrasound 3 Glomerular filtration rate (GFR) 4 Evaluation of microalbuminuria 5 Magnetic resonance angiography (MRA)

2 - Renal ultrasound 3 - Glomerular filtration rate (GFR) 4 - Evaluation of microalbuminuria If routine urinalysis indicates moderate to severe proteinuria, the preferred way of determining kidney functions is by assessing the GFR. An ultrasound of the kidneys is usually done to detect any obstructions and to determine the size of the kidneys. A patient with diabetes needs to have a further examination of the urine for microalbuminuria. The patient may not have an increase in serum creatinine until there is a decrease of 50% or more in kidney function. MRA study with the contrast media gadolinium is generally not advised unless the ultrasound or computed tomography (CT) does not provide the information needed. Text Reference - p. 1079

A patient has a glomerular filtration rate (GFR) of 70 mL/minute, a blood pressure of 140/100 mm Hg, and fluid accumulation in the legs. To help prevent heart failure, the nurse should provide the patient with which instruction? 1 Limit protein intake. 2 Restrict sodium to 2 g/day. 3 Take vitamin D supplements. 4 Avoid magnesium-containing laxatives.

2 - Restrict sodium to 2 g/day. A patient with a glomerular filtration rate of 70 mL/min has stage 2 chronic kidney disease. A blood pressure of 140/100 mm Hg along with fluid accumulation in the legs indicates that the patient has hypertension and edema. Patients with increased blood urea nitrogen levels should limit protein intake to prevent neurologic complications. High sodium retention may lead to heart failure, so the patient should restrict sodium intake to 2 grams per day. Patients with low vitamin D levels or hypocalcemia should take vitamin D supplements. Patients with hypermagnesemia should avoid taking magnesium-containing laxatives. Text Reference - p. 1077

A patient with acute kidney injury has rapid and deep respirations. The laboratory reports reveal a serum bicarbonate level of 12 mEq/L. Which treatment strategy does the nurse expect to be beneficial? 1 Regular insulin 2 Sodium bicarbonate 3 Phosphate-binding agents 4 Sodium polystyrene sulfonate

2 - Sodium bicarbonate A normal serum bicarbonate level is 15 mEq/L. Decreased levels of serum bicarbonate are observed in patients with kidney failure, which results in metabolic acidosis. Rapid and deep respirations are the characteristics features of Kussmaul respirations, which are a manifestation of metabolic acidosis. Sodium bicarbonate is a base that counteracts metabolic acidosis; thus, sodium bicarbonate will help to treat the patient. Regular insulin and sodium polystyrene sulfonate are used to treat hyperkalemia. Hyperphosphatemia is managed with phosphate-binding agents. Text Reference - p. 1072

A 70-year-old female patient weighs 50 kg and has a serum creatinine level of 1.4 mg/dL. Using the Cockcroft-Gault rule, what should the nurse document as the patient's glomerular filtration rate (GFR)? Record the answer using one decimal place. ____________ mL/min

29.5ml/min The Cockcroft-Gault formula estimates glomerular filtration rate (GFR): [(140 - Age) x (weight in kilograms) x (0.85 if female)]/(72 x Creatinine (Cr) mg/dL) = GFR. Using this formula, a female patient of 70 years weighing 50 kg with serum creatinine level of 1.4 mg/dL has a GFR of 29.5 mL/min as shown by ((140 - 70) x (50 kg) x 0.85 if female))/(72 x (1.4 mg/dL) = 29.5. Text Reference - p. 1083

The nurse provides information to a nursing student about the administration of erythropoietin (EPO) therapy to a patient with chronic kidney disease (CKD). Which statement made by the nursing student indicates effective learning? 1 "EPO benefits a patient with plasma ferritin concentrations less than 100 mg/mL." 2 "EPO should be administered in higher doses to a patient with low hemoglobin levels." 3 "EPO, iron, sucrose, and folic acid of 1 mg/day should be administered to patients undergoing hemodialysis." 4 "EPO can be safely given to a patient that takes an antihypertensive and maintains a blood pressure of 150/90 mm Hg."

3 - "EPO, iron, sucrose, and folic acid of 1 mg/day should be administered to patients undergoing hemodialysis." A patient with chronic kidney disease (CKD) develops anemia due to decreased production of erythropoietin (EPO). Exogenous erythropoietin helps replenish the erythropoietin demand. Iron supplements for a patient with low plasma ferritin levels prevent the patient from developing an iron deficiency from the increased demand for iron to support erythropoiesis. A folic acid supplement is given to patients on hemodialysis because it is required for red blood cell (RBC) formation, and is removed by dialysis. A high dosage of EPO should be avoided for a patient with anemia because of increased risk of thromboembolic events and death from cardiovascular effects. The recommendation is to use the lowest possible dose of EPO to treat anemia. EPO should be avoided for a patient with uncontrolled hypertension because it exacerbates hypertension by increasing blood viscosity. Text Reference - pp. 1081-1082

The nursing instructor asks the student nurse about fluid and electrolyte changes that occur in a patient with an acute kidney injury. Which statement by the student nurse indicates effective learning? 1 "The patient will have hypokalemia." 2 "The patient will have hypernatremia." 3 "The patient will have increased serum creatinine levels." 4 "The patient will have decreased levels of blood urea nitrogen."

3 - "The patient will have increased serum creatinine levels." Creatinine is a waste product of muscle catabolism. Patients with acute kidney injury cannot remove body waste, and it accumulates in the blood, which raises the serum creatinine level. Acute kidney injury is associated with an increased level of potassium (hyperkalemia), a decreased level of sodium (hyponatremia), and an increased level of blood urea nitrogen. Thus the statements that the patient will have hypokalemia, hypernatremia, and decreased levels of blood urea nitrogen are incorrect. Text Reference - p. 1069

The patient admitted with sepsis is at risk of developing what renal pathology? 1 Nephritis 2 Glomerular nephritis 3 Acute tubular necrosis 4 Chronic kidney disease

3 - Acute tubular necrosis Acute tubular necrosis is a result of an acute shock on the renal system and is recoverable, but the patient is likely to develop acute kidney impairment (AKI). Nephritis is an acute infection of the nephrons. Glomerular nephritis develops into chronic kidney disease and is not a result of sepsis. Text Reference - p. 1071

The nurse is planning an educational course on risk factors for chronic kidney disease. Which factors should the nurse identify as nonmodifiable risk factors? Select all that apply. 1 Hypertension 2 Type II diabetes 3 Age greater than 60 4 Exposure to nephrotoxic drugs 5 Family history of chronic kidney disease (CKD)

3 - Age greater than 60 5 - Family history of chronic kidney disease (CKD) Family history of chronic kidney disease and age greater than 60 are risk factors out of the patient's control. The patient can make lifestyle changes to reduce high blood pressure and decrease blood glucose. The patient has a choice to take drugs that are considered to be nephrotoxic. Text Reference - p. 1081

The nurse recognizes that which medication is appropriate to give to patients with kidney failure? 1 Magnesium antacids 2 Aluminum preparations 3 Angiotensin receptor blockers 4 Nonsteroidal antiinflammatory agents

3 - Angiotensin receptor blockers Hypertension is a common finding in a patient with kidney failure due to retention of sodium and water. This is treated with angiotensin receptor blockers. Magnesium antacids may aggravate hypermagnesemia in patients with kidney failure. Aluminum preparations should be used with caution in patients with chronic kidney disease because they are associated with bone diseases, such as osteomalacia. Nonsteroidal antiinflammatory agents are nephrotoxic and should not be administered to patients with renal failure because they can cause acute kidney injury. Text Reference - p. 1081

When assessing the mental status of a patient in acute renal failure, the nurse recognizes that abnormal findings are most likely caused by what? 1 Anger related to denial of chronic illness 2 Delirium related to hypoxia of brain cells 3 Confusion related to an increased urea level 4 Aggression related to possible underlying comorbidities

3 - Confusion related to an increased urea level In renal disease, urea is not filtered out of the blood by the kidneys and therefore accumulates in the blood. This results in toxicity to brain tissue, causing confusion. Anger is a possible emotional reaction, but it does not manifest as a change of mental status. Delirium related to hypoxia of brain cells is not a complication seen with acute renal failure. Aggression is not necessarily related to acute renal failure. Text Reference - pp. 1076, 1078

The nurse is teaching a student nurse about the development of anemia in patients with chronic kidney disease (CKD). The student nurse correctly identifies which pathologic alteration as the cause of anemia in a patient with CKD? 1 Poor absorption of calcium 2 Elevated serum creatinine levels 3 Decreased production of erythropoietin 4 Accumulation of circulating phosphorous

3 - Decreased production of erythropoietin Erythropoietin is a hormone secreted by the kidney that stimulates the production of red blood cells. Decreased levels of erythropoietin results in anemia in the patient with CKD. Elevated serum creatinine levels indicate impaired renal function. Calcium is poorly absorbed due to decreased vitamin D conversion; however, this does not result in anemia. Accumulation of circulating serum phosphorous is problematic for the CKD patient, but it does not result in anemia. Text Reference - p. 1077

The nurse is caring for a patient with severe burns in the emergency department. His laboratory values reveal serum creatinine level of 5 mg/dL, and the glomerular filtration rate (GFR) has decreased by 75%. What stage of acute kidney failure is this patient exhibiting? 1 Risk 2 Injury 3 Failure 4 Loss

3 - Failure As per the RIFLE (Risk, Injury, Failure, Loss, and End-stage) classification for staging acute kidney injury, this patient is at the Failure stage. When the GFR has decreased by 25%, the patient is at the Risk stage. The patient with a GFR that has decreased by 50% is at the Injury stage. The patient with persistent acute kidney failure experiences a complete loss of kidney function and is at the Loss stage. Text Reference - p. 1071

A patient with acute kidney injury has hypovolemia. After an intravenous infusion of fluids, the nurse observes that the patient has no urine output and a blood pressure of 140/90 mm Hg. Which risk does the nurse anticipate in this patient? 1 Gall stones 2 Lung failure 3 Heart failure 4 Liver damage

3 - Heart failure Heart failure is caused by an increase in the circulatory volume. An observation of a lack of urine output and increased blood pressure indicates a buildup of fluid in the body, and the patient is at risk of heart failure. Gallstones are caused by increased levels of cholesterol in the bile or an inability of the gallbladder to empty properly. Conditions such as pneumonia and chronic obstructive pulmonary disease decrease the amounts of air and blood that enter and exit the lungs, causing lung failure. Increased levels of liver enzymes are signs of liver damage. Text Reference - p. 1072

The nurse must monitor for which condition in patients with bilateral ureteral obstruction? 1 Oliguria 2 Benign prostatic hyperplasia 3 Hydronephrosis 4 Diabetic gastroparesis

3 - Hydronephrosis Bilateral ureteral obstruction results in dilation of the kidneys, which is called hydronephrosis. Hydronephrosis, if left untreated, can result in acute kidney injury (AKI). Oliguria is associated with AKI, regardless of the etiology. Benign prostatic hyperplasia (BPH) is a post renal cause of hydronephrosis and potentially AKI. Diabetic gastroparesis is a manifestation of chronic kidney disease. Text Reference - p. 1071

The nurse receives an order to administer polystyrene sulfate to a patient with significant hyperkalemia. Which assessment finding is a priority concern regarding safe administration of polystyrene sulfate? 1 Complaints of nausea 2 Apical pulse of 55 bpm 3 Hypoactive bowel sounds 4 Complaints of palpitations

3 - Hypoactive bowel sounds The priority concern in this situation is hypoactive bowel sounds. Before administering polystyrene sulfate, the nurse should auscultate bowel sounds. If the findings indicate hypoactivity, the medication should help, and the healthcare provider should be notified as fluid shifts caused by the medication may result in bowel necrosis. Nausea, palpitations, and bradycardia are signs and symptoms of hyperkalemia, and so the polystyrene should be administered promptly. Text Reference - p. 1080

A patient with acute kidney injury has been prescribed insulin to treat hyperkalemia. The patient is worried about the consequences of taking intravenous insulin. What should the nurse explain to console this patient? Select all that apply. 1 Insulin would improve kidney function. 2 The potassium levels would be normalized. 3 Insulin administration could prevent serious cardiac problems. 4 Glucose would be administered simultaneously to prevent hypoglycemia. 5 Insulin will reduce the toxins in your blood by lowering your metabolic rate.

3 - Insulin administration could prevent serious cardiac problems. 4 - Glucose would be administered simultaneously to prevent hypoglycemia. Hyperkalemia is one of the most lethal complications of acute kidney injury and can lead to life-threatening cardiac dysrhythmias. Insulin administration causes influx of potassium ions into the cells, thereby normalizing the potassium levels temporarily and preventing dysrhythmias. Glucose is administered simultaneously with insulin to prevent hypoglycemia in this intervention. Insulin does not decrease the levels of toxins nor does it affect the kidney function. Text Reference - p. 1073

A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. What is an expected assessment finding for this patient during this early stage of recovery? 1 Hypokalemia 2 Hyponatremia 3 Large urine output 4 Leukocytosis with cloudy urine output

3 - Large urine output Patients frequently experience diuresis (a large volume of urine output) in the hours and days immediately following a kidney transplant. Hypokalemia, hyponatremia, and signs of infection are unexpected findings that warrant prompt intervention. Text Reference - p. 1095

A primary health care provider has ordered frequent magnetic resonance imaging using a gadolinium contrast agent in a patient with kidney failure. The patient reports darkness of the skin, joint pain, and limited joint movement. What condition does the nurse suspect? 1 Asterixis 2 Hydronephrosis 3 Nephrogenic systemic fibrosis 4 Contrast-induced nephropathy

3 - Nephrogenic systemic fibrosis Nephrogenic systemic fibrosis is caused by the administration of gadolinium to patients with kidney failure; signs include hyperpigmentation of the skin and joint contractures. Asterixis is characterized by a tremor-like condition upon stretching of the wrist. Hydronephrosis is caused by bilateral ureteral obstruction. Contrast-induced nephropathy is a kidney injury caused by the injection of contrast agents during surgery or diagnostic testing. Text Reference - p. 1073

The nurse assesses the fluid intake of patients who are undergoing hemodialysis and identifies that which patient is at risk of fluid overload? 1 Patient 1 2 Patient 2 3 Patient 3 4 Patient 4

3 - Patient 3 A patient receiving hemodialysis has diminished urine output, and fluid restriction is important to reduce fluid overload and retention. The recommended fluid intake depends on the daily urine output. Generally, 600 mL (from insensible loss) plus an amount equal to the previous day's urine output is acceptable for a patient receiving hemodialysis. Patient 3, whose previous day's urine output is 720 mL, should receive only 1320 mL (600 + 720) of fluids. Therefore 1400 mL of fluid intake in Patient 3 leads to fluid overload and retention. Patient 1, whose previous urine output is 500 mL, can receive up to 1100 mL of fluids. Patient 2, whose previous urine output is 660 mL, can receive up to 1260 mL of fluids. Patient 4, whose urine output is 850 mL, can receive up to 1450 mL of fluids. Text Reference - p. 1082

The nurse is caring for a patient with acute kidney injury. Upon reviewing the laboratory reports of the patient, the nurse learns that the patient has a very high level of potassium. Which therapy does the nurse expect to be the most effective in this patient? 1 Restricting the diet 2 Infusing regular insulin 3 Performing hemodialysis 4 Infusing sodium bicarbonate

3 - Performing hemodialysis Hemodialysis is the most effective therapy for patients with hyperkalemia because it removes potassium ions in a short amount of time. Dietary restrictions are used to prevent recurrent elevations, but they are not used for acute elevations. Infusions of insulin and sodium bicarbonate are also beneficial but require more time to return the potassium levels to normal. Text Reference - p. 1074

Which statement about acute kidney injury is correct? 1 Parenchymal damage occurs in prerenal oliguria. 2 Prerenal azotemia results in increased sodium excretion. 3 Prerenal oliguria is caused by decreased circulatory volume. 4 Prerenal causes of acute kidney injury increase the glomerular filtration rate.

3 - Prerenal oliguria is caused by decreased circulatory volume. Prerenal oliguria is caused by a decrease in the circulatory volume due to dehydration and congestive cardiac failure. Parenchymal damage does not occur in prerenal oliguria. Prerenal azotemia results in decreased sodium excretion, which leads to increased sodium and water retention. Reduced systemic circulation is a prerenal cause that leads to a decrease in the blood flow to the kidneys. Therefore the glomerular filtration rate also decreases. Text Reference - p. 1070

Which nursing intervention should the nurse implement while preparing a high-risk patient with contrast-induced nephropathy for magnetic resonance imaging? 1 Give low-fat foods 2 Give low-calorie foods 3 Provide plenty of fluids 4 Provide a high-protein diet

3 - Provide plenty of fluids Contrast agents accumulate in the nephrons, causing their death and resulting in renal failure. Therefore patients who have a high risk of contrast-induced nephropathy should be well hydrated. Fatty foods are rich in calories and should be given to provide energy. High-calorie foods should be included in a patient's diet. A high-protein diet causes increased levels of nitrogenous waste in the blood. Therefore a low-protein diet should be given to this patient. Text Reference - p. 1073

While caring for a patient with kidney failure, the patient has three episodes of vomiting and diarrhea. Which action should the nurse perform as a priority? 1 Administer antiemetic. 2 Record the blood pressure. 3 Record the volume of fluid lost. 4 Administer water with a high salt content

3 - Record the volume of fluid lost. The nurse should record the volume of fluid lost as a priority because replacement must be done to prevent tubular damage. The nurse should not administer drugs without consulting the primary health care provider. The blood pressure should be recorded to check for hypovolemia, but this action can also be performed later. The nurse should not administer salty water because it can induce vomiting. Text Reference - p. 1074

The nurse reviews the medical record of a patient with chronic kidney disease (CKD) and notes a history of taking cholecalciferal, a vitamin D level of 20 mg/mL, a calcium level of 13 mg/dL, and a phosphorous level of 5 mg/dL. Based on the laboratory results, the nurse anticipates that what medication will be prescribed? 1 Calcitriol 2 Calcium acetate 3 Sevelamer carbonate 4 Polystyrene sulfonate

3 - Sevelamer carbonate A patient with chronic kidney disease (CKD) may have low vitamin D levels. Vitamin D supplementation using cholecalciferol is recommended for patients who have vitamin D levels less than 30 mg/dL, but it can cause hypercalcemia. The laboratory reports of the patient show a calcium level of 13 mg/dL and a phosphorous level of 5 mg/dL, which are higher than normal values (calcium 8.6 to 10.2 mg/dL and phosphorous 2.4 to 4.4 mg/dL). Therefore the patient should be given non-calcium-based phosphate binders such as sevelamer carbonate to lower the phosphate levels. Calcitriol is an activated form of vitamin D, which is indicated for severe hypocalcemia in CKD. It may further aggravate hypercalcemia and hyperphosphatemia on administration. Calcium acetate is a calcium-based phosphate binder, which may further increase calcium levels, leading to hypercalcemia. Polystyrene sulfonate is a potassium-binding agent used in patients with severe hyperkalemia. Text Reference - p. 1081

A patient with end-stage chronic kidney disease is scheduled for hemodialysis. What recommendation should the nurse give to the patient? 1 Drink more fluids 2 Eat protein-rich foods 3 Take folic acid supplementation 4 Take phosphate supplementation

3 - Take folic acid supplementation The patient with chronic kidney disease (CKD) who has a very low glomerular filtration rate (GFR), such as 10 mL/min, requires dialysis. Folic acid, which is required for red blood corpuscles maturation, is water soluble and depleted during dialysis. A supplement can prevent anemia. A patient with CKD has low urine output and fluid retention, so fluid intake should be restricted. Protein-rich foods should be restricted in a patient with CKD to prevent neurologic complications. A patient with CKD has a low rate of phosphate excretion and may develop hyperphosphatemia, so additional phosphate is not recommended. Text Reference - p. 1078

The nurse recognizes that which recommendation is appropriate for a patient with chronic kidney disease (CKD)? 1 Drink plenty of water. 2 Eat prunes and raisins. 3 Take phosphate binders with meals. 4 Take calcium and iron supplements together on an empty stomach.

3 - Take phosphate binders with meals. A patient with chronic kidney disease who is prescribed phosphate binders, such as lanthanum carbonate, should take them with meals to reduce gastrointestinal side effects. The patient must avoid potassium-rich foods such as bananas, prunes, and raisins to prevent further aggravation of hyperkalemia. Patients with CKD have decreased urine output and fluid accumulation, so an appropriate fluid balance is important to prevent further complications such as edema and heart failure. The patient should take calcium supplements on an empty stomach for better absorption, but not at the same time as iron supplements. Text Reference - p. 1081

The patient with end-stage renal disease (ESRD) has decided to terminate dialysis treatments. Which is the best response by the nurse? 1 "You cannot stop now; you have so much to live for." 2 "Are you sure this is the right decision? How about if I ask a psychiatrist to come speak with you?" 3 "I respect your decision. Would you like me to ask the health care provider for a palliative care consult?" 4 "I respect your decision, but believe you need to discuss options with your health care provider. Would you like me to page the health care provider to come speak with you?"

4 - "I respect your decision, but believe you need to discuss options with your health care provider. Would you like me to page the health care provider to come speak with you?" The patient has the right to end treatment. This decision must be made with the health care provider. Telling the patient he or she has too much to live for may be giving false reassurance. The nurse has no right questioning the decision or calling a psychiatrist at this point. Text Reference - p. 1097

A registered nurse is teaching a trainee nurse about the parameters to be assessed in a patient with acute kidney injury who is undergoing dialysis. Which statement by the trainee nurse indicates a need for further teaching? 1 "I should auscultate patient's lung sounds." 2 "I should record the patient's input and output." 3 "I should assess for any change in the patient's skin color." 4 "I should examine the patient's mouth for a change in color."

4 - "I should examine the patient's mouth for a change in color." Acute kidney injury is associated with dry mouth and inflammation and is caused by increased levels of ammonia in the saliva. The nurse should examine the mouth for inflammation and dryness. Therefore the trainee nurse's statement about examining the mouth for a change in color indicates a need for further teaching. Because of renal impairment, fluid can accumulate in the lungs and result in difficulty breathing. Therefore the nurse should auscultate the patient's lung sounds. Recording the patient's input and output will help to determine the efficacy of the treatment. Acute kidney injury is also associated with hyperpigmentation; thus the nurse should assess for changes in the patient's skin color. Text Reference - p. 1075

Which statement by the nurse indicates an understanding of the indications for renal replacement therapy (RRT)? 1 "RRT is indicated for patients with hypokalemia." 2 "RRT is effective for patients with metabolic acidosis." 3 "RRT is recommended for patients with hypovolemia." 4 "RRT is recommended in the case of pericardial effusion."

4 - "RRT is recommended in the case of pericardial effusion." Pericardial effusion is an abnormal accumulation of fluid inside the pericardial cavity; this condition is caused by increased blood volume. Renal replacement therapy (RRT) is recommended because the kidneys are unable to function properly. RRT is recommended in hyperkalemic, not hypokalemic, conditions. RRT does not alleviate the effects of metabolic alkalosis. RRT is advised in patients with fluid overload, not hypovolemia. Text Reference - p. 1074

The nursing instructor is teaching a student nurse about the therapies for hyperkalemia associated with acute kidney injury. Which statement by the student nurse indicates effective learning? 1 "Insulin infusion is a permanent therapy." 2 "Sodium bicarbonate is a permanent therapy." 3 "Calcium gluconate infusion is a permanent therapy." 4 "Sodium polystyrene sulfonate is a permanent therapy."

4 - "Sodium polystyrene sulfonate is a permanent therapy." Sodium polystyrene sulfonate is a cation-exchange resin that completely removes extra potassium; it is considered a permanent therapy. Insulin pushes potassium inside the cells, but with a decline in insulin levels, potassium exits the cell. Thus insulin is a temporary therapy. Sodium bicarbonate and calcium gluconate are also considered temporary therapies because they shift potassium into the cells until their blood levels diminish, upon which potassium exits the cells. Text Reference - pp. 1073-1074

The nurse is planning an education program on chronic kidney disease. Which ethnic group would the nurse target for promoting this event? 1 Hispanics 2 Asian descent 3 Caucasian males 4 African Americans

4 - African Americans African Americans are at the greatest risk for developing kidney disease. Those of Asian descent, Caucasian males, and Hispanics are not at as great a risk. Text Reference - p. 1076

The nurse recognizes that which medication is the most appropriate for a patient with chronic kidney disease (CKD) who has a glycosylated hemoglobin of 5%, blood pressure of 140/95 mm Hg, and whose urinalysis reveals the presence of protein? 1 A diuretic 2 A calcimimetic agent 3 A calcium channel blocker 4 An angiotensin receptor blocker

4 - An angiotensin receptor blocker A patient with glycosylated hemoglobin of 5%, blood pressure of 140/95 mm Hg, and protein in the urine has hypertension with nondiabetic proteinuria. The patient can take angiotensin receptor blockers and angiotensin-converting enzyme (ACE) inhibitors. These medications help to decrease proteinuria and delay the progression of chronic kidney disease (CKD). Diuretics help control elevated blood pressure in patients with CKD but do not have an effect on proteinuria. Calcimimetic agents help to control secondary hyperparathyroidism by increasing the sensitivity of the calcium receptors in the parathyroid glands. They are not used for treatment of hypertension, diabetes, or proteinuria. Calcium channel blockers also do not have an effect on proteinuria. Text Reference - p. 1081

Which dietary intake guideline is appropriate for the nurse to recommend to a patient with pre-end-stage renal failure? 1 Sodium intake of 2 to 4 g/day 2 Protein intake of 1.2 g/kg/day 3 Calorie intake of 25 kcal/kg/day 4 Calcium intake of 1000 to 1500 mg/day

4 - Calcium intake of 1000 to 1500 mg/day A patient with kidney failure must maintain good nutrition with supplements. Calcium intake of 1000 to 1500 mg/day is beneficial in the patient with pre-end-stage kidney disease to prevent hypocalcemia. Sodium intake should be individualized, or 1 to 3 g/day is appropriate for patients with pre-end-stage kidney disease. Sodium intake of 2 to 4 g/day is beneficial for patients with peritoneal dialysis. Protein intake should be restricted to 0.6 to 1 g/day for patients with pre-end-stage kidney disease. Protein intake of 1.2 g/kg/day is preferred for patients with hemodialysis. Calorie intake of 25 kcal/kg/day will not be sufficient for patients with pre-end-stage kidney disease. Calorie intake of 30 to 35 kcal/kg/day is recommended for this patient. Text Reference - p. 1082

The nurse performs an admission assessment of a patient with acute renal failure. For which common complication does the nurse assess the patient? 1 Polyphagia 2 Hypernatremia 3 Hypotensive shock 4 Cardiac dysrhythmias

4 - Cardiac dysrhythmias Because the kidneys are not effectively removing waste products, including electrolytes, an increased potassium level (hyperkalemia) of more than 5.0 mEq/L is common in acute renal failure and places the patient at risk for cardiac arrhythmias. Patients usually experience anorexia, not an increase in hunger (polyphagia). Acute renal failure will likely manifest as hyponatremia. Hypotensive shock may be the result of a severe cardiac arrhythmia that is not treated. Text Reference - p. 1073

A patient with a glomerular filtration rate (GFR) of 30 mL/min has a hemoglobin of 5 g/dL. The peripheral smear tests show that the red blood cells are normocytic and normochromic. The nurse suspects that which physiologic change led to this condition? 1 Reduced excretion of potassium 2 Increased extracellular fluid volume 3 Defective reabsorption of bicarbonate 4 Decreased production of erythropoietin

4 - Decreased production of erythropoietin A patient with a glomerular filtration rate (GFR) of 30 mL/min has stage 3 chronic kidney disease (CKD). Normocytic normochromic anemia is common in patients with CKD due to reduced production of the erythropoietin hormone by the kidneys. Erythropoietin stimulates precursor cells in the bone marrow and helps in production of red blood cells. The patient with CKD may have a high serum potassium level, which can cause fatal dysrhythmias. An increase in extracellular fluid volume may lead to hypertension in patients with CKD. Metabolic acidosis may occur in CKD patients with defective reabsorption and regeneration of bicarbonate. Text Reference - p. 1077

The patient was diagnosed with prerenal acute kidney injury (AKI). The nurse should know that what is most likely the cause of the patient's diagnosis? 1 Intravenous (IV) tobramycin 2 Incompatible blood transfusion 3 Poststreptococcal glomerulonephritis 4 Dissecting abdominal aortic aneurysm

4 - Dissecting abdominal aortic aneurysm A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can decrease renal artery perfusion and therefore the glomerular filtrate rate. Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction, and poststreptococcal glomerulonephritis are intrarenal causes of AKI. Text Reference - p. 1070

The nurse caring for a patient with heart failure notes the patient has decreased urine output of 200 mL/day. Which laboratory finding aids in the diagnosis of prerenal azotemia in this patient? 1 Normal creatinine level 2 Decreased sodium level 3 Decreased potassium level 4 Elevated blood urea nitrogen (BUN)

4 - Elevated blood urea nitrogen (BUN) The patient with heart failure has a decreased circulating blood volume. This causes autoregulatory mechanisms to preserve blood flow to essential organs. Laboratory data for this patient will likely demonstrate an elevation in BUN, creatinine, and potassium. Prerenal azotemia results in a reduction in the excretion of sodium, increased sodium and water retention, and decreased urine output. Text Reference - p. 1069

The nurse recalls that the reason that patients with chronic kidney disease experience arterial stiffness is what? 1 Excessive sodium retention 2 Increase in nitrogenous waste products 3 Decrease in the sodium bicarbonate level 4 Excessive calcium deposition in vascular smooth layer

4 - Excessive calcium deposition in vascular smooth layer A patient with chronic kidney disease (CKD) may have arterial stiffness due to calcium deposition in the vascular smooth layer of the blood vessels. Excessive sodium retention causes extracellular fluid accumulation that leads to hypertension and edema. Decrease in the sodium bicarbonate level in the body leads to metabolic acidosis. Accumulation of the nitrogenous waste products leads to neurologic complications. Text Reference - p. 1078

What is an intrarenal cause of acute kidney injury? 1 Renal artery thrombosis 2 Neuromuscular disorders 3 Benign prostatic hyperplasia 4 Hemolytic blood transfusion reaction

4 - Hemolytic blood transfusion reaction Hemolytic blood transfusion reaction is an intrarenal cause of acute kidney injury. Renal artery thrombosis is a prerenal cause of acute kidney injury. Neuromuscular disorders and benign prostatic hyperplasia are postrenal causes of acute kidney injury. Text Reference - p. 1070

The nurse identifies that a patient with chronic kidney disease is at risk for which electrolyte disturbance? 1 Hypokalemia 2 Hyponatremia 3 Hypercalcemia 4 Hyperphosphatemia

4 - Hyperphosphatemia A patient with chronic kidney disease (CKD) has hyperphosphatemia due to a decrease in elimination of phosphate by the kidneys. Hyperkalemia, rather than hypokalemia, is a serious electrolyte disturbance that occurs in the patient with CKD. Hypernatremia, rather than hyponatremia, leads to hypertension and fluid retention in a patient with CKD. Hypocalcemia, not hypercalcemia, occurs in the later stages of CKD due to the inability to absorb calcium in the absence of active vitamin D. Text Reference - pp. 1078-1079

Which is a manifestation of a mild form of acute kidney injury? 1 Increased urine output 2 Increased nitrogen level 3 Increased potassium level 4 Increased serum creatinine level

4 - Increased serum creatinine level The mildest form of acute kidney injury is characterized by increased serum creatinine levels. Kidney injury is associated with decreased urine output, not increased urine output. Increased levels of potassium and nitrogen are characteristics of a severe form of acute kidney injury. Text Reference - p. 1072

Which condition is a result of severe metabolic acidosis in patients with acute kidney injury? 1 Asterixis 2 Proteinuria 3 Hydronephrosis 4 Kussmaul respirations

4 - Kussmaul respirations Severe acidosis causes a patient to take deep and rapid breaths—called Kussmaul respirations—in an effort to increase the exhalation of carbon dioxide. Asterixis is a neurologic change associated with acute kidney injury due to the accumulation of metabolic waste in the brain and nervous system. Dysfunction of the glomerular membrane due to acute kidney injury leads to proteinuria. Hydronephrosis refers to dilation of the kidneys and is a postrenal cause of acute kidney injury. Text Reference - p. 1072

The nurse is caring for a patient with chronic kidney disease. Which electrolyte, if abnormal, can result in decreased mental status, absence of reflexes, and respiratory failure for this patient? 1 Sodium 2 Calcium 3 Potassium 4 Magnesium

4 - Magnesium A patient with hypermagnesemia, or an increase in the level of magnesium in the body, may have absence of reflexes, decreased mental status, cardiac dysrhythmias, hypotension, and respiratory failure. Sodium retention contributes to edema, hypertension, and heart failure in a patient with chronic kidney disease. Patients with hypocalcaemia are at an increased risk for fractures. Hyperkalemia, or abnormally high potassium levels, is a serious electrolyte disorder in a patient with chronic renal failure that can lead to fatal dysrhythmias. Text Reference - p. 1077

The nurse preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD) should know that this medication should have a beneficial effect on which laboratory value? 1 Sodium 2 Potassium 3 Magnesium 4 Phosphorus

4 - Phosphorus Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with CKD. Calcium acetate will not have an effect on sodium, potassium, or magnesium levels. Text Reference - p. 1081

When caring for a patient during the oliguric phase of acute kidney injury (AKI), what is an appropriate nursing intervention? 1 Weigh patient three times weekly. 2 Increase dietary sodium and potassium. 3 Provide a low-protein, high-carbohydrate diet. 4 Restrict fluids according to previous daily loss.

4 - Restrict fluids according to previous daily loss. Patients in the oliguric phase of acute kidney injury will have fluid volume excess with potassium and sodium retention. Therefore they will need to have dietary sodium, potassium, and fluids restricted. The patient also should be weighed daily, not just three times each week. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. Text Reference - p. 1073

Which condition should the nurse suspect in a patient with chronic kidney disease (CKD) who develops osteomalacia? 1 Asterixis 2 Uremic frost 3 Gastroparesis 4 Uremic red eye

4 - Uremic red eye Chronic kidney disease mineral and bone disorder (CKD-MBD) is a common complication of CKD and results in both skeletal and extraskeletal complications. Osteomalacia is a skeletal complication. Calcium deposition in the eye may create irritation leading to uremic red eye, an extraskeletal complication. Asterixis (hand-flapping tremor) occurs due to motor neuropathy. Uremic frost is the crystallization of urea on the skin when blood urea nitrogen levels are elevated to 200 mg/dL. Gastroparesis (delayed gastric emptying) compounds the effect of malnutrition for patients with diabetes. Text Reference - p. 1079

Which finding indicates nonoliguria? 1 Urinary output of 200 mL/day 2 Urinary output of 300 mL/day 3 Urinary output of 400 mL/day 4 Urinary output of 500 mL/day

4 - Urinary output of 500 mL/day A urine output greater than 400 mL/day is a sign of nonoliguria. Thus a urine output of 500 mL/day indicates nonoliguria. A urine output of 200 or 300 mL/day indicates oliguria. A urine output of 400 mL per day indicates that the patient is at risk for oliguria. Text Reference - p. 1071

The nurse identifies that which drug should be used with caution in a patient with renal failure? 1 Cinacalcet 2 Paricalcitol 3 Gemfibrozil 4 Vancomycin

4 - Vancomycin A patient with renal failure has a reduced ability to eliminate metabolites and drugs. Therefore, drugs like vancomycin, which are mainly excreted by the kidney, need to be used with caution and monitoring for accumulation and potential drug toxicity is necessary. Cinacalcet is a calcimimetic agent that helps to control secondary hyperparathyroidism. Paricalcitol is an active vitamin D supplement that helps to control elevated levels of parathyroid hormone and is used for treating secondary hyperparathyroidism in patients with end stage chronic kidney disease. Gemfibrozil helps to reduce triglyceride levels and increases high-density cholesterol in patients with chronic kidney disease. Text Reference - p. 1082

A nurse has to determine the volume of fluid that must be administered to the patient with acute renal failure who is in the oliguric phase. The total urine output of the patient the previous day was 250 mL. What should be the fluid allocation for this patient on this day? Record your answer using a whole number. __ mL

850ml The patient is at a risk of developing hypovolemia, and to prevent this, adequate fluid resuscitation should be done. To determine the volume for fluid resuscitation, the nurse adds together all losses during the previous 24 hours (e.g., urine, diarrhea, emesis, blood) and adds 600 mL for insensible losses (e.g., respiration, diaphoresis). So for this patient, the fluid allocation would be 850 mL. Text Reference - p. 1073