Chronic renal failure

The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel. Which statement indicates that the client understands the teaching? "I'll take it every 4 hours around the clock." "I'll take it between meals and at bedtime." "I'll take it when I have an upset stomach." "I'll take it with meals and bedtime snacks."

Correct answer "I'll take it with meals and bedtime snacks." Feedback Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not administered to treat an upset stomach caused by hyperacidity in clients with chronic renal failure and therefore is not prescribed between meals.

The nurse warms the dialysis solution before use in peritoneal dialysis. What is the expected outcome of warming the solution? Encourage the removal of serum urea. Force potassium back into the cells. Add extra warmth to the body. Promote abdominal muscle relaxation.

Correct answer Encourage the removal of serum urea. Feedback The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance. Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations, but this is a secondary reason for warming the solution. The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.

A client is having peritoneal dialysis. During the exchange, the nurse observes that the solution draining from the client's abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. What clinical judgment should the nurse make about the blood-tinged drainage? It is expected with a permanent peritoneal catheter. It indicates abdominal blood vessel damage. It can indicate kidney damage. It is caused by too-rapid infusion of the dialysate.

Correct answer It indicates abdominal blood vessel damage. Feedback Because the client has a permanent catheter in place, blood-tinged drainage should not occur. Persistent blood-tinged drainage could indicate damage to the abdominal vessels, and the health care provider (HCP) should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too-rapid infusion of the dialysate can cause pain, not blood-tinged drainage.

Which should be included in the client's plan of care during dialysis therapy? Limit the client's visitors. Monitor the client's blood pressure. Pad the side rails of the bed. Keep the client on nothing-by-mouth (NPO) status.

Correct answer Monitor the client's blood pressure. Feedback Because hypotension is a complication associated with peritoneal dialysis, the nurse records intake and output, monitors vital signs, and observes the client's behavior. The nurse also encourages visiting and other diversional activities. A client on peritoneal dialysis does not need to be placed in a bed with padded side rails or kept on NPO status.

A client is receiving peritoneal dialysis. What should the nurse assess while the dialysis solution is dwelling in the client's abdomen? Assess for urticaria. Observe respiratory status. Check capillary refill time. Monitor electrolyte status.

Correct answer Observe respiratory status. Feedback During dwell time, the dialysis solution is allowed to remain in the peritoneal cavity for the time prescribed by the health care provider (HCP) (usually 20 to 45 minutes). During this time, the nurse should monitor the client's respiratory status because the pressure of the dialysis solution on the diaphragm can create respiratory distress. The dialysis solution would not cause urticaria or affect circulation to the fingers. The client's laboratory values are obtained before beginning treatment and are monitored every 4 to 8 hours during the treatment, not just during the dwell time.

A client with chronic renal failure is receiving hemodialysis three times a week. What should the nurse do to protect the fistula? Take the blood pressure in the arm with the fistula. Report the loss of a thrill or bruit on the arm with the fistula. Maintain a pressure dressing on the shunt. Start a second IV in the arm with the fistula.

Correct answer Report the loss of a thrill or bruit on the arm with the fistula. Feedback The nurse must always auscultate for a bruit and palpate for a thrill in the arm with the fistula and promptly report the absence of either a thrill or bruit to the health care provider (HCP) as it indicates an occlusion. The client should not have a pressure dressing on the shunt and should avoid wearing tight clothing or carrying heavy items such as purse over the area of the shunt to avoid restricting blood flow in the shunt. No procedures such as IV access, blood pressure measurements, or blood draws are done on an arm with a fistula as they could damage the fistula.

The nurse is discussing concerns about sexual activity with a client with chronic renal failure. Which strategy would be most useful? Help the client to accept that sexual activity will be decreased Suggest using alternative forms of sexual expression and intimacy Tell the client to plan rest periods after sexual activity. Refer the client to a counselor.

Correct answer Suggest using alternative forms of sexual expression and intimacy Feedback Altered sexual functioning commonly occurs in chronic renal failure and can stress marriages and relationships. Altered sexual functioning can be caused by decreased hormone levels, anemia, peripheral neuropathy, or medication. The client should not decrease or avoid sexual activity but instead should modify it. The client should rest before sexual activity. Unless the client provides additional information, it is not necessary to refer the client to counseling at this time.

Which teaching approach for the client with chronic renal failure who has difficulty concentrating due to high uremia levels would be most appropriate? Provide all needed teaching in one extended session. Validate the client's understanding of the material frequently. Conduct a one-on-one session with the client. Use video clips to reinforce the material as needed.

Correct answer Validate the client's understanding of the material frequently. Feedback Uremia can cause decreased alertness, so the nurse needs to validate the client's comprehension frequently. Because the client's ability to concentrate is limited, short lessons are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videos because the client may not be able to maintain alertness during the viewing of the videotape.

Aluminum hydroxide gel is prescribed for the client with chronic renal failure to take at home. What is the expected outcome of this drug? relieving the pain of gastric hyperacidity preventing Curling's stress ulcers binding phosphate in the intestine reversing metabolic acidosis

Correct answer binding phosphate in the intestine Feedback A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body's calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Antacids will not prevent Curling's stress ulcers and do not affect metabolic acidosis.

A client undergoing long-term peritoneal dialysis at home is currently experiencing a reduced outflow from the dialysis catheter. To determine if the catheter is obstructed, what should the nurse ask the client about experiencing recently? Diarrhea vomiting flatulence constipation

Correct answer constipation Feedback Constipation may contribute to reduced urine outflow in part because peristalsis facilitates drainage outflow. For this reason, bisacodyl suppositories can be used prophylactically, even without a history of constipation. Diarrhea, vomiting, and flatulence typically do not cause decreased outflow in a peritoneal dialysis catheter.

The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate? high-carbohydrate, high-protein high-calcium, high-potassium, high-protein low-protein, low-sodium, low-potassium low-protein, high-potassium

Correct answer low-protein, low-sodium, low-potassium Feedback Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the by-products of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high-carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/ day.

After completion of peritoneal dialysis, for which symptom should the nurse assess the client? hematuria weight loss hypertension increased urine output

Correct answer weight loss Feedback Weight loss is expected because of the removal of fluid. The client's weight before and after dialysis is one measure of the effectiveness of treatment. Blood pressure usually decreases because of the removal of fluid. Hematuria would not occur after completion of peritoneal dialysis. Dialysis only minimally affects the damaged kidneys' ability to manufacture urine.