Kidneys - Prep U/Test Bank

The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number.

4000 mL Rationale: A 1-kg weight gain is equal to 1,000 mL of retained fluid. 4 kg × 1,000 = 4,000. The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded.

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

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

What is a characteristic of the intrarenal category of acute renal failure? A. Decreased creatinine B. Increased BUN C. High specific gravity D. Decreased urine sodium

B. Increased BUN Rationale: The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? A. Perform deep-breathing exercises vigorously. B. Wear a mask when performing exchanges. C. Auscultate the lungs frequently. D. Avoid carrying heavy items.

B. Wear a mask when performing exchanges. Rationale: The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.

A change that occurs during chronic glomerulonephritis is termed A. hypokalemia. B. anemia. C. metabolic alkalosis. D. hypophosphatemia.

B. anemia. Rationale: Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur during chronic glomerulonephritis.

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: A. hematuria. B. weight loss. C. increased urine output. D. increased blood pressure.

B. weight loss. Rationale: Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching? A. "I inherited this disorder from one of my parents." B. "The cysts can get quite large in size." C. "As long as I have one normal kidney, I should be fine." D. "If renal failure develops, I may need to consider dialysis."

C. "As long as I have one normal kidney, I should be fine." Rationale: Polycystic kidney disease is characterized by the formation of multiple cysts on both kidneys. Polycystic kidney disease is inherited as an autosomal dominant trait. The fluid-filled cysts can cause great enlargement of the kidneys and interfere with kidney function, which can eventually lead to renal failure.

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

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

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

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

A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause? A. Acute pyelonephritis B. Osmotic dieresis. C. Dysrhythmias D. Renal calculi

D. Renal calculi Rationale: Postrenal ARF is the result of an obstruction that develops anywhere from the collecting ducts of the kidney to the urethra. This results from ureteral blockage, such as from bilateral renal calculi or benign prostatic hypertrophy (BPH).

The nurse is planning client teaching for a client with end-stage kidney disease who is scheduled for the creation of a fistula. The nurse should teach the client what information about the fistula? A. "A vein and an artery in your arm will be attached surgically." B. "The arm should be immobilized for 4 to 6 days." C. "One needle will be inserted into the fistula for each dialysis treatment." D. "The fistula can be used 5 to 7 days after the surgery for dialysis treatment."

A. "A vein and an artery in your arm will be attached surgically." Rationale: The fistula joins an artery and a vein, either side-to-side or end-to-end. This access will need several weeks to "mature" before it can be used. The client is encouraged to perform exercises to increase the size of the affected vessels (e.g., squeezing a rubber ball for forearm fistulas). Two needles will be inserted into the fistula for each dialysis treatment.

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

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

A client with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis? A. "Hemodialysis is a treatment option that is usually required three times a week." B. "Hemodialysis is a program that will require you to commit to daily treatment." C. "This will require you to have surgery and a catheter will need to be inserted into your abdomen." D. "Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again."

A. "Hemodialysis is a treatment option that is usually required three times a week." Rationale: Hemodialysis is the most commonly used method of dialysis. Clients receiving hemodialysis must undergo treatment for the rest of their lives or until they undergo successful kidney transplantation. Treatment usually occurs three times a week for at least 3 to 4 hours per treatment. Peritoneal dialysis, not hemodialysis, requires placement of a catheter inserted into the abdomen.

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

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

The nurse is caring for a client who has returned to the postsurgical suite after postanesthetic recovery from a nephrectomy. The nurse's most recent assessment reveals increased sedation, shortness of breath, hypotension, and low urine output over the last 2 hours. What is the nurse's best response? A. Assess the client for signs of bleeding and inform the primary provider. B. Perform a full neurological assessment and notify the primary care provider. C. Increase the frequency of taking vital signs, monitor urine output, and notify the provider. D. Palpate the client's torso bilaterally for flank pain and notify the primary care provider.

A. Assess the client for signs of bleeding and inform the primary provider. Rationale: Bleeding is a major complication of kidney surgery, and if missed can lead to hypovolemic (decreased volume of circulating blood) and hemorrhagic shock. Bleeding can be suspected when the client experiences fatigue, shortness of breath, and urine output of less than 400 mL within 24 hours. The postoperative client is monitored closely and these findings should be reported to the primary care provider. Ruling out the complication of the life-threatening condition of bleeding is the priority decision for this client. Performing a full neurological assessment will be warranted after the priority complications of surgery are ruled out. Increasing the monitoring of vital signs and urine output are just small parts of assessing the client for bleeding. Palpating the client's torso for flank pain may increase the client's pain and does not (in itself) address the most common cause of the client's signs and symptoms

The nurse is caring for a client postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize? A. Assessment of the quantity of the client's urine output B. Assessment of the client's incision C. Assessment of the client's abdominal girth D. Assessment for flank or abdominal pain

A. Assessment of the quantity of the client's urine output Rationale: After kidney transplantation, the nurse should perform all of the listed assessments. However, oliguria is considered to be more suggestive of rejection than changes to the client's abdomen or incision.

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

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

The nurse is caring for a client whose acute kidney injury (AKI) resulted from a prerenal cause. Which condition most likely caused this client's health problem? A. Burns B. Glomerulonephritis C. Ureterolithiasis D. Pregnancy

A. Burns Rationale: AKI has categories that identify causation. These are prerenal, intrarenal, and postrenal. Prerenal AKI results from hypoperfusion of the kidney caused by volume depletion. Common causes are burns, hemorrhage, gastrointestinal losses, sepsis, and shock. Glomerulonephritis and ureterolithiasis (kidney stones) are associated with intrarenal causes. Pregnancy is linked to postrenal AKI (obstructions distal to the kidney).

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? A. Calcium B. Magnesium C. Phosphorus D. Sodium

A. Calcium Rationale: Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.

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

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

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

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

A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client's diet to maximize the therapeutic effect and minimize the risks of complications. The client's diet should include which of the following modifications? Select all that apply. A. Decreased protein intake B. Decreased sodium intake C. Increased potassium intake D. Fluid restriction E. Vitamin D supplementation

A. Decreased protein intake B. Decreased sodium intake D. Fluid restriction Rationale: Restricting dietary protein decreases the accumulation of nitrogenous wastes, reduces uremic symptoms, and may even postpone the initiation of dialysis for a few months. Restriction of fluid is also part of the dietary prescription because fluid accumulation may occur. As well, sodium is usually restricted to 2 to 3 g/day. Potassium intake is usually limited, not increased, and there is no particular need for vitamin D supplementation.

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

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

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

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

Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? A. Glomerulonephritis B. Hypovolemia C. Ureteral calculus D. Dysrhythmia

A. Glomerulonephritis Rationale: Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.

The nurse is assessing a client suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? A. Hematuria B. Precipitous decrease in serum creatinine levels C. Hypotension unresolved by fluid administration D. Glucosuria

A. Hematuria Rationale: The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Glucosuria does not normally accompany glomerulonephritis, and hypertension is much more likely than hypotension.

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

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

A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess? A. Hypertension B. Extremity pain C. Fever D. Periorbital edema

A. Hypertension Rationale: Hypertension is present in approximately 75% of clients with polycystic kidney disease at the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and abdominal pain also may be noted based on the size and effects of the cysts. Fever would suggest an infection. Periorbital edema is noted with acute glomerulonephritis.

A client with end-stage renal disease receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action? A. Inform the health care provider and assess the client for signs of infection. B. Flush the peritoneal catheter with normal saline. C. Remove the catheter promptly and have the catheter tip cultured. D. Administer a bolus of IV normal saline as prescribed.

A. Inform the health care provider and assess the client for signs of infection. Rationale: Peritonitis is the most common and serious complication of peritoneal dialysis. The first sign of peritonitis is cloudy dialysate drainage fluid, so prompt reporting to the primary provider and rapid assessment for other signs of infection are warranted. Administration of an IV bolus is not necessary or appropriate and the health care provider would determine whether removal of the catheter is required. Flushing the catheter does not address the risk for infection.

The nurse has identified the nursing diagnosis of "Risk for Infection" in a client who undergoes peritoneal dialysis. What nursing action best addresses this risk? A. Maintain aseptic technique when administering dialysate. B. Wash the skin surrounding the catheter site with soap and water prior to each exchange. C. Add antibiotics to the dialysate as prescribed. D. Administer prophylactic antibiotics by mouth or IV as prescribed.

A. Maintain aseptic technique when administering dialysate. Rationale: Aseptic technique is used to prevent peritonitis and other infectious complications of peritoneal dialysis. It is not necessary to cleanse the skin with soap and water prior to each exchange. Antibiotics may be added to dialysate to treat infection, but they are not used to prevent infection.

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

A. Penicillin Rationale: The three nephrotoxic drugs are aminoglycerides.

Which of the following occurs late in chronic glomerulonephritis? A. Peripheral neuropathy B. Nosebleed C. Stroke D. Seizure

A. Peripheral neuropathy Rationale: Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.

The nurse is caring for a client's status after a motor vehicle accident. The client has developed AKI. What are the nurse's roles in caring for this client? Select all that apply. A. Providing emotional support for the family B. Monitoring for complications C. Participating in emergency treatment of fluid and electrolyte imbalances D. Providing nursing care for primary disorder (trauma) E. Directing nutritional interventions

A. Providing emotional support for the family B. Monitoring for complications C. Participating in emergency treatment of fluid and electrolyte imbalances D. Providing nursing care for primary disorder (trauma) Rationale: The nurse has an important role in caring for the client with AKI. The nurse monitors for complications, participates in emergency treatment of fluid and electrolyte imbalances, assesses the client's progress and response to treatment, and provides physical and emotional support. Additionally, the nurse keeps family members informed about the client's condition, helps them understand the treatments, and provides psychological support. Although the development of AKI may be the most serious problem, the nurse continues to provide nursing care indicated for the primary disorder (e.g., burns, shock, trauma, obstruction of the urinary tract). The nurse does not direct the client's nutritional status; the dietitian and the health care provider normally collaborate on directing the client's nutritional status.

The nurse is caring for a client who has just returned to the postsurgical unit following renal surgery. When assessing the client's output from surgical drains, the nurse should physically assess what parameter(s)? Select all that apply. A. Quantity of output B. Color of the output C. Visible characteristics of the output D. Specific gravity of the output E. Potential hydrogen (pH) of the output

A. Quantity of output B. Color of the output C. Visible characteristics of the output Rationale: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Decreased or absent drainage from the surgical drains are reported and may indicate obstruction. Specific gravity and pH are not normally assessed at the bedside but are sent to the lab if needed. Those two tests are not part of the recommendations.

A nurse is providing education to the family of a client beginning peritoneal dialysis. The family ask questions concerning catheter placement and stabilization. Which information will the nurse provide about the cuffs? Select all that apply. A. The cuffs are constructed of Dacron polyester material. B. The cuffs will help stabilize the catheter. C. The cuffs prevent the dialysate from leaking. D. The cuffs provide a barrier against microorganisms. E. The cuffs will absorb the dialysate.

A. The cuffs are constructed of Dacron polyester material. B. The cuffs will help stabilize the catheter. C. The cuffs prevent the dialysate from leaking. D. The cuffs provide a barrier against microorganisms. Rationale: Most catheters used for peritoneal dialysis have two cuffs, which are made of Dacron polyester. The cuffs stabilize the catheter, limit movement, prevent leaks, and provide a barrier against microorganisms. They do not absorb dialysate.

The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to take what action? A. Wash hands carefully and frequently. B. Ensure immediate function of the donated kidney. C. Instruct the client to wear a face mask. D. Bar visitors from the client's room.

A. Wash hands carefully and frequently. Rationale: The nurse ensures that the client is protected from exposure to infection by hospital staff, visitors, and other clients with active infections. Careful handwashing is imperative; face masks may be worn by hospital staff and visitors to reduce the risk for transmitting infectious agents while the client is receiving high doses of immunosuppressants. Visitors may be limited, but are not normally barred outright. Ensuring kidney function is vital, but does not prevent infection.

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

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

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

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

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

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

A client has been diagnosed with acute glomerulonephritis. This condition causes: A. proteinuria. B. pyuria. C. polyuria. D. No option is correct.

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

One of the roles of the nurse in caring for clients with chronic kidney disease is to help them learn to minimize and manage potential complications. This would include: A. restricting sources of potassium. B. allowing liberal use of sodium. C. limiting iron and folic acid intake. D. eating protein liberally.

A. restricting sources of potassium. Rationale: The nurse will teach the client to restrict sources of potassium, such as fresh fruits and vegetables, because hyperkalemia can cause life-threatening changes. The client will restrict sodium intake as ordered; doing so prevents fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken; iron and folic acid supplements are needed for red blood cell (RBC) production, and Epogen stimulates the bone marrow to produce RBCs. The client will restrict protein intake to foods that are complete proteins within prescribed limits; complete proteins provide positive nitrogen balance for healing and growth.

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

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

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

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

A 76-year-old client with ESKD has been told by the health care provider that it is time to consider hemodialysis until a transplant can be found. The client tells the nurse about feeling unsure about undergoing a kidney transplant. What would be an appropriate response for the nurse to make? A. "The decision is certainly yours to make, but be sure not to make a mistake." B. "Kidney transplants in peoples your age are as successful as they are in younger clients." C. "I understand your hesitancy to commit to a transplant surgery. Success is relatively rare." D. "Have you talked this over with your family?"

B. "Kidney transplants in peoples your age are as successful as they are in younger clients." Rationale: Although there is no specific age limitation for renal transplantation, concomitant disorders (e.g., coronary artery disease, peripheral vascular disease) have made it a less common treatment for the older adult. However, the success rate of the surgery is comparable to that for younger clients. The other listed options either belittle the client or give the client misinformation

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

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

The nurse coming on shift on the medical unit is taking a report on four clients. What client does the nurse know is at the greatest risk of developing ESKD? A. A client with a history of polycystic kidney disease B. A client with diabetes mellitus and poorly controlled hypertension C. A client who is morbidly obese with a history of vascular disorders D. A client with severe chronic obstructive pulmonary disease

B. A client with diabetes mellitus and poorly controlled hypertension Rationale: Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may cause ESKD. A client with more than one of these risk factors is at the greatest risk for developing ESKD. Therefore, the client with diabetes and hypertension is likely at highest risk for ESKD.

The critical care nurse is monitoring the client's urine output and drains following renal surgery. What should the nurse promptly report to the primary care provider? A. Increased pain on movement B. Absence of drain output C. Increased urine output D. Blood-tinged serosanguineous drain output

B. Absence of drain output Rationale: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Decreased or absent drainage is promptly reported because it may indicate obstruction that could cause pain, infection, and disruption of the suture lines. Reporting increased pain on movement has nothing to do with the scenario described. Increased urine output and serosanguineous drainage are expected.

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

B. Calcium 7.5 mg/dL; hypotension and irritability D. Potassium 6.4 mEq/L; dysrhythmias and abdominal distention E. Phosphate 5.0 mg/dL; tachycardia and nausea and emesis Rationale: Decreased calcium, increased potassium, and increased phosphate levels are associated with ESKD, along with the signs and symptoms associated with these serum values. Decreased magnesium and chloride levels are not associated with ESKD.

Compliance with a renal diet is a difficult lifestyle change for a client on hemodialysis. The nurse should reinforce nutritional information. Which teaching point(s) should be included? Select all that apply. A. Consume nonbiologic protein only. B. Eat foods such as milk, fish, and eggs. C. Eat a variety of canned vegetables. D. Increase potassium intake. E. Restrict fluids based on the previous day's output.

B. Eat foods such as milk, fish, and eggs. E. Restrict fluids based on the previous day's output. Rationale: With hemodialysis, protein restriction is necessary. At least half of all protein eaten should come from biologic sources such as eggs, meats, and plant-based groups. Sodium should be reduced. Canned vegetables are high in sodium. Potassium is restricted to decrease cardiac risk. The client's daily fluid intake should be based on the previous day's urine output.

A client is being treated for AKI and the client daily weights have been ordered. The nurse notes a weight gain of 3 pounds (1.4 kg) over the past 48 hours. What nursing diagnosis is suggested by this assessment finding? A. Imbalanced nutrition: More than body requirements B. Excess fluid volume C. Sedentary lifestyle D. Adult failure to thrive

B. Excess fluid volume Rationale: If the client with AKI gains or does not lose weight, fluid retention should be suspected. Short-term weight gain is not associated with excessive caloric intake or a sedentary lifestyle. Failure to thrive is not associated with weight gain.

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met the expected outcomes? A. Diuresis B. Fever C. Absence of pain D. Weight loss

B. Fever Rationale: Fever is an indicator of infection or transplant rejection.

A nurse is assessing a client with acute renal failure. What medications should the nurse identify as a nephrotoxic drug? Select all that apply. A. Penicillin B. Gentamycin C. Tobramycin D. Neomycin E. Ceftriaxone

B. Gentamycin C. Tobramycin D. Neomycin Rationale: The kidneys are sensitive to the metabolic byproducts from aminoglycosides such as gentamycin, tobramycin, and neomycin. Penicillin and ceftriaxone are not known to be nephrotoxic.

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

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

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

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

A client is brought to the renal unit from the PACU status postresection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this client? A. Increasing oral intake B. Managing postoperative pain C. Managing dialysis D. Increasing mobility

B. Managing postoperative pain Rationale: The client requires frequent analgesia during the postoperative period and assistance with turning, coughing, use of incentive spirometry, and deep breathing to prevent atelectasis and other pulmonary complications. Increasing oral intake and mobility are not priority nursing actions in the immediate postoperative care of this client. Dialysis is not necessary following kidney surgery

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

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

A client is scheduled for a CT scan of the abdomen with contrast. The client has a baseline creatinine level of 2.3 mg/dL (203 mol/L). In preparing this client for the procedure, the nurse anticipates what orders? A. Monitor the client's electrolyte values every hour before the procedure. B. Provide adequate hydration before the procedure C. Start hemodialysis immediately prior to the CT scan D. Obtain a creatinine clearance by collecting a 24-hour urine specimen.

B. Provide adequate hydration before the procedure Rationale: Radiocontrast-induced nephropathy is a major cause of hospital-acquired acute kidney injury. Baseline levels of creatinine greater than 2 mg/dL (177 mol/L) identify the client as being at high risk. Preprocedure hydration the day prior to the test is effective in prevention. The nurse would not monitor the client's electrolytes every hour pre-procedure because this would not change the client's risk factors. To decrease this risk factor, an intervention is needed. Nothing in the scenario indicates the need for hemodialysis. A creatinine clearance is not necessary prior to a CT scan with contrast.

An inpatient client with acute kidney injury (AKI) has moderate edema to both legs. What resulting skin conditions would increase the client's likelihood of skin breakdown? Select all that apply. A. Atopic dermatitis B. Pruritus C. Psoriasis D. Urticaria E. Excoriation

B. Pruritus E. Excoriation Rationale: The skin may be dry or susceptible to breakdown as a result of edema. Excoriation and itching (pruritus) may result from the deposits of irritating toxins in the client's tissue due to AKI. Prevention recommendations include bathing in cool water, assisting or encouraging frequent turning and repositioning as well as keeping the skin clean and moisturized. Clients should be instructed to keep nails trimmed to help prevent scratches. Atopic dermatitis or eczema has strong genetic links and is commonly associated with asthma and hay fever. Eczema results in red, dry, and itchy patches of skin. Urticaria or hives are raised, red welts that suddenly appear on the skin and are usually caused by an allergic reaction. Psoriasis is a chronic skin condition characterized by thick red patches or plaques of skin covered with white or silvery scales. Psoriasis is usually linked to an autoimmune response.

A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action? A. Advance the catheter 2 to 4 cm further into the peritoneal cavity. B. Reposition the client to facilitate drainage. C. Aspirate from the catheter using a 60-mL syringe. D. Infuse 50 mL of additional dialysate.

B. Reposition the client to facilitate drainage. Rationale: If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the client from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. It would be unsafe to aspirate or to infuse more dialysate.

A client on the medical unit has a documented history of polycystic kidney disease (PKD). What principle should guide the nurse's care of this client? A. The disease is self-limiting and cysts usually resolve spontaneously in the fifth or sixth decade of life. B. The client's disease is incurable and the nurse's interventions will be supportive. C. The client will eventually require surgical removal of his or her renal cysts. D. The client is likely to respond favorably to lithotripsy treatment of the cysts.

B. The client's disease is incurable and the nurse's interventions will be supportive. Rationale: Nursing actions focus on support and symptom control. It is not self-limiting and is not treated surgically or with lithotripsy.

A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate? A. "Try washing clothes with a strong detergent to ensure that all impurities are gone." B. "When you shower, use really warm water and an antibacterial soap." C. "Keep your showers brief, patting your skin dry after showering." D. "Liberally apply alcohol to the areas of your skin where you itch the most."

C. "Keep your showers brief, patting your skin dry after showering." The client with pruritus needs to keep the skin clean and dry. The client should take brief showers with tepid water, pat the skin dry, use moisturizing lotions or creams, and avoid scratching. In addition, the client should use a mild laundry detergent to wash clothes and an extra rinse cycle to remove all detergent or add 1 tsp vinegar per quart of water to the rinse cycle to remove any detergent residue.

An older adult client diagnosed with cancer is admitted to the oncology unit for surgical treatment. The client has been on chemotherapeutic agents to decrease tumor size prior to the planned surgery. The nurse caring for the client is aware that what precipitating factors in this client may contribute to acute kidney injury (AKI)? Select all that apply. A. Anxiety and agitation B. Low body mass index (BMI) C. Age-related physiologic changes D. Chronic systemic disease E. Nothing by mouth (NPO) status

C. Age-related physiologic changes D. Chronic systemic disease E. Nothing by mouth (NPO) status Rationale: Changes in kidney function with normal aging increase the susceptibility of older clients to kidney dysfunction and kidney injury. In addition, the presence of chronic, systemic diseases increases the risk of AKI. This client was on chemotherapeutic agents that frequently cause nausea and vomiting, which contribute to dehydration. Older adult clients taking medications may cause alterations in renal flow and clearance. The client was made NPO prior to surgery, making them more susceptible to AKI even with parenteral fluids. A low BMI and anxiety are not risk factors for acute renal disease.

The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform the health care provider that the client may be exhibiting signs of acute kidney injury (AKI)? A. An inability to initiate voiding for 2 days. B. The urine is cloudy and has visible sediment with a foul odor. C. Average urine output has been 10 mL/hr for several hours. D. Client reports left-sided flank pain.

C. Average urine output has been 10 mL/hr for several hours. Rationale: Oliguria (<400 mL/day of urine or 0.5 mL/kg an hour over 6 hours) is the most common clinical situation seen in AKI. The client's inability to void and/or urine hesitancy is typically seen with kidney stones, prostate problems, and/or a urinary tract infection (UTI). Urine that has visible sediment and is cloudy and foul smelling is more suggestive of a UTI. Acute flank pain is sometimes seen in AKI. Generally, flank pain has some connection to a variety of kidney diseases like acute glomerular inflammation and polycystic kidney disease.

The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take? A. Administer the medications as ordered. B. Hold the medications until after dialysis is completed. C. Check with the nephrologist to determine the best course of action. D. Ask if the client wants to take the medications.

C. Check with the nephrologist to determine the best course of action. Rationale: The nurse evaluates medications given close to or during dialysis that may promote complications. If an antihypertensive agent is taken prior to dialysis, profound hypotension may result. However, withholding blood pressure medications before dialysis should not be routine practice, but rather determined on a client-by-client basis since persistent hypertension is seen in some clients during or after treatment. It is therefore best to confer with the nephrologist before routinely omitting antihypertensive agents prior to dialysis.

The nurse is visiting the home of a client who is receiving at-home peritoneal dialysis therapy. Which finding indicates to the nurse that the client is developing peritonitis? A. Low back pain B. Bloody effluent C. Cloudy dialysate effluent D. Report of pronounced hunger

C. Cloudy dialysate effluent Rationale: Most complications of peritoneal dialysis are minor; however, if left untreated, it can lead to serious consequences. Peritonitis is the most common and serious complication of peritoneal dialysis. The first sign of peritonitis is cloudy dialysate effluent. Low back pain can occur from the weight of the fluid in the abdomen. Bloody effluent can occur in young menstruating female clients. It is also common during the first few exchanges after a new catheter is inserted, which most often clears up after several exchanges. Clients with peritonitis are more likely to report anorexia than pronounced hunger.

A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client's hypervolemia and hyperkalemia. Which of the following therapies will the client's hemodynamic status best tolerate? A. Hemodialysis B. Peritoneal dialysis C. Continuous venovenous hemodialysis (CVVHD) D. Plasmapheresis

C. Continuous venovenous hemodialysis (CVVHD) Rationale: CVVHD facilitates the removal of uremic toxins and fluid. The hemodynamic effects of CVVHD are usually mild in comparison to hemodialysis, so CVVHD is best tolerated by an unstable client. Peritoneal dialysis is not the best choice, as the client may have sustained abdominal injuries during the accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and electrolyte balance.

A nurse is caring for a client who is in the diuresis phase of acute kidney injury. The nurse should closely monitor the client for what complication during this phase? A. Hypokalemia B. Hypocalcemia C. Dehydration D. Acute flank pain

C. Dehydration Rationale: The diuresis period is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover. The client must be observed closely for dehydration during this phase; if dehydration occurs, the uremic symptoms are likely to increase. Excessive losses of potassium and calcium are not typical during this phase, and diuresis does not normally result in pain.

A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? A. Administer isotonic fluid therapy as ordered. B. Keep the drainage catheter below the level of insertion. C. Encourage use of incentive spirometer every 2 hours. D. Monitor temperature every 4 hours.

C. Encourage use of incentive spirometer every 2 hours. Rationale: To address the issue of ineffective breathing pattern, encouraging the use of incentive spirometer would be most appropriate to help increase alveolar ventilation. Administering isotonic fluid therapy would be appropriate for issues involving fluid loss such as bleeding or hemorrhage. Keeping the drainage catheter below the level of insertion would be appropriate to reduce the risk of obstruction leading to acute pain. Monitoring the temperature every 4 hours would be appropriate to reduce the client's risk for infection.

The nurse is caring for a client in acute kidney injury (AKI). Which complication would most clearly warrant the administration of polystyrene sulfonate? A. Hypernatremia B. Hypomagnesemia C. Hyperkalemia D. Hypercalcemia

C. Hyperkalemia Rationale: Hyperkalemia (high potassium) is a common complication of AKI. If the client's potassium is elevated but does not cause ECG (electrocardiography) changes, then polystyrene sulfonate may be administered since it reduces serum potassium levels. It is not recommended for emergency treatment since it takes more than 6 hours to work. Polystyrene sulfonate does not treat low (hypo) magnesium, high sodium (hypernatremia), or high calcium (hypercalcemia).

A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? A. Elevated serum creatinine B. Hyperkalemia C. Hyperphosphatemia D. Elevated urea and nitrogen

C. Hyperphosphatemia Rationale: Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.

A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? A. Increase fat intake and limit carbohydrates. B. Eliminate fat intake and increase protein intake. C. Increase carbohydrates and limit protein intake. D. Increase protein, carbohydrates, and fat intake.

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

The nurse is creating an education plan for a client who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan? A. The importance of increased fluid intake B. Signs and symptoms of rejection C. Inspection and care of the incision D. Techniques for preventing metastasis

C. Inspection and care of the incision Rationale: The nurse teaches the client to inspect and care for the incision and perform other general postoperative care, including activity and lifting restrictions, driving a vehicle, and pain management. There would be no need to teach the signs or symptoms of rejection as there has been no transplant. Increased fluid intake is not normally recommended and the client has minimal control on the future risk for metastasis.

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

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

The nurse is caring for a client after kidney surgery. When assessing for bleeding, what assessment parameter should the nurse evaluate? A. Oral intake B. Pain intensity C. Level of consciousness D. Radiation of pain

C. Level of consciousness Rationale: Bleeding is a major complication of kidney surgery. The nurse's role is to observe for these complications, to report their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision, and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood, and fluid volume and cardiac output. Bleeding is not normally evidenced by changes in pain or oral intake.

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

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

The nurse is providing a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants' risks of renal carcinoma? A. Avoiding heavy alcohol use B. Control of sodium intake C. Smoking cessation D. Adherence to recommended immunization schedules

C. Smoking cessation Rationale: Tobacco use is a significant risk factor for renal cancer, surpassing the significance of high alcohol and sodium intake. Immunizations do not address an individual's risk of renal cancer.

A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the client's chronic kidney disease is at what stage? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

C. Stage 3 Rationale: Stages of chronic kidney disease are based on the GFR. Stage 3 is defined by a GFR in the range of 30 to 59 mL/min/1.73 m2. This is considered a moderate decrease in GFR.

The nurse is caring for a client receiving hemodialysis three times weekly. The client has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this client? A. Using a stethoscope for auscultating the fistula is contraindicated B. The client feels best immediately after the dialysis treatment C. Taking a BP reading on the affected arm can damage the fistula D. The client should not feel pain during initiation of dialysis

C. Taking a BP reading on the affected arm can damage the fistula Rationale: When blood flow is reduced through the access for any reason (hypotension, application of BP cuff/tourniquet), the access site can clot. Auscultation of a bruit in the fistula is one way to determine patency. Typically, clients feel fatigued immediately after hemodialysis because of the rapid change in fluid and electrolyte status. Although the area over the fistula may have some decreased sensation, a needle stick is still painful.

A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD? A. The client is blind in his right eye. B. The client has a history of severe anemia during hemodialysis. C. The client has a history of diverticulitis. D. The client is on the kidney transplant waiting list.

C. The client has a history of diverticulitis. Rationale: A history of diverticulitis contraindicates CAPD because CAPD has been associated with the rupture of diverticulum. A history of severe anemia while on hemodialysis or being on the transplant waiting list doesn't contraindicate CAPD. The client who's blind or partially blind can still learn to perform CAPD.

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: A. nausea and vomiting. B. dyspnea and cyanosis. C. fatigue and weakness. D. thrush and circumoral pallor.

C. fatigue and weakness. Rationale: RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.

A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event? A. Psychosocial stress B. Hypersensitivity to an immunization C. Menarche D. Streptococcal infection

D. Streptococcal infection Rationale: Postinfectious causes of postinfectious glomerular disease are group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks. Menarche, stress, and hypersensitivity are not typical causes.

A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? A. Hypotension B. Weight loss C. Polyuria D. Tenderness over transplant site

D. Tenderness over transplant site Rationale: Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.

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

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

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

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

A client requires hemodialysis. Which type of drug should be withheld before this procedure? A. Phosphate binders B. Insulin C. Antibiotics D. Cardiac glycosides

D. Cardiac glycosides Rationale: Cardiac glycosides such as digoxin (Lanoxin) should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digoxin toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.

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

D. Current medication use Rationale: The kidneys are susceptible to the adverse effects of medications because they are repeatedly exposed to substances in the blood. Nephrotoxic medications are a more likely cause of AKI than diet, allergies, or stress.

A client admitted with nephrotic syndrome is being cared for on the medical unit. When writing this client's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include? A. Constipation related to immobility B. Risk for injury related to altered thought processes C. Hyperthermia related to the inflammatory process D. Excess fluid volume related to generalized edema

D. Excess fluid volume related to generalized edema Rationale: The major clinical manifestation of nephrotic syndrome is edema, so the appropriate nursing diagnosis is "Excess fluid volume related to generalized edema." Edema is usually soft, pitting, and commonly occurs around the eyes, in dependent areas, and in the abdomen.

The nurse performing the health interview of a client with a new onset of periorbital edema has completed a genogram, noting the health history of the client's siblings, parents, and grandparents. This assessment addresses the client's risk of what kidney disorder? A. Nephritic syndrome B. Acute glomerulonephritis C. Nephrotic syndrome D. Polycystic kidney disease (PKD)

D. Polycystic kidney disease (PKD) Rationale: PKD is a genetic disorder characterized by the growth of numerous cysts in the kidneys. Nephritic syndrome, acute glomerulonephritis, and nephrotic syndrome are not genetic disorders.

A client with end stage renal disease (ESKD) is being treated for a right ankle fracture unrelated to a fall. The client's lab values show high phosphate levels, low calcium levels, and low vitamin D levels. What is the most likely reason for this client's fracture? A. Osteoporosis B. Codman triangle C. Hypertrophic osteoarthropathy D. Renal osteodystrophy

D. Renal osteodystrophy Rationale: An abnormality seen in ESKD is called renal osteodystrophy or uremic bone disease. It is a disease that involves complex changes in calcium, phosphate, and parathormone balances. Damage seen in ESKD results in an increase in phosphate and a decrease in calcium (reciprocal relationship), which causes increased production from the parathyroid. Clients with ESKD cannot handle these increases, effectively resulting in bone changes and bone disease. All of the other choices can cause fractures but are not typically suspected in a client with ESRD with the presented lab values. Osteoporosis, where bone becomes brittle and fragile, is usually diagnosed with a bone density scan. Codman triangle is a radiologic sign seen commonly on x-rays. It is usually an indication of bone tumors. Hypertrophic osteoarthropathy (HOA) is characterized by abnormal proliferation (growth) of skin and periosteal tissue involving the extremities. Diagnosis is typically from x-rays and physical findings.

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

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

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

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

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

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

The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time? A. Only when needed B. Daily at bedtime C. First thing in the morning D. With each meal

D. With each meal Rationale: Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding medications must be given with food to be effective.