LP 2: Renal

A client is admitted with a 4 day history of diarrhea. BP 88/48,apical heart rate 100 and resp rate 22 with shallow respirations. Lab results Na 148 mEq/L; K 5.9 mEq/L, Hct 52%; Hgb 14 g/dL.The client is receiving an IV of 5% dextrose in 0.45%NS w/20mEq KCL at 120 ml/hr. Prior to calling the MD the nurse should: a. Change the IV fluids to 5% dextrose in 0.45NS b. Increase the current IV rate to 150 ml/hour c. Check the hourly urine output d. Check the client for muscle weakness

a. Change the IV fluids to 5% dextrose in 0.45NS

A client is scheduled to receive vancomycin. Before administering the medication the nurse should analyze the following labs. Select all that apply: a. Hemoglobin and hematocrit b. BUN c. Creatinine d. WBC e. Vancomycin trough level

b. BUN c. Creatinine d. WBC e. Vancomycin trough level

A nurse is caring for a client who has AKI. Which of the following serum laboratory findings should the nurse report to the HCP? a. Potassium 5.0 b. Calcium 9.0 c. Creatinine 4.0 d. Amylase 84

c. Creatinine 4.0 A serum creat above the expected reference range indicates impaired kidney function; therefore the nurse should report this finding to the provider. The nurse should expect the creatinine to decrease to within the expected reference range with successful treatment of AKI

The client with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level? a. Erythropoietin b. Calcium gluconate c. Regular insulin d. Osmotic Diuretic

c. Regular insulin

Which juice is best to offer the client w/ chronic renal failure with potassium and sodium restrictions? a. Tomato juice b. Grapefruit juice c. Orange juice d. Apple juice

d. Apple juice

A nurse is planning care for a client who is postoperative following a nephrectomy. Which of the following assessments is the nurse's priority? a. bowel sounds b. wbc count c. pain level d. blood pressure

d. blood pressure

The client with ARF has a potassium level of 6.8mEq/L. Which collaborative treatment should the nurse anticipate for the client? a. Administer a phosphate binder b. Assess the client for leg cramps c. Type and cross match for whole blood d. Prepare the client for dialysis

d. Prepare the client for dialysis

The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air embolism. What are the priority nursing actions? (select all that apply) 1. Administer oxygen to the client 2. Continue dialysis at a slower rate after checking the lines for air 3. Notify the HCP and RRT 4. Stop dialysis, and turn the client on the left side with head lower than feet 5. Bolus the client with 500mL of normal saline to break up the air embolus

1. Administer oxygen to the client 3. Notify the HCP and RRT 4. Stop dialysis, and turn the client on the left side with head lower than feet If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, position the client so the air embolus is in the right side of the heart, notify the HCP and rapid response team, and administer oxygen as needed. Slowing the dialysis treatment or giving an IV bolus will not correct the air embolism or prevent complications.

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? 1. Peritonitis 2. Hyperglycemia 3. Hyperphosphatemia 4. Disequilibrium syndrome

2. Hyperglycemia An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis. Peritonitis is a risk associated with breaks in aseptic technique. Hyperphosphatemia is an electrolyte imbalance that occurs with renal dysfunction. Disequilibrium syndrome is a complication associated with hemodialysis.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? (select all that apply) 1. Check the level of the drainage bag 2. Reposition the client to his or her side 3. Contact the HCP 4. Place the client in good body alignment 5. Check the peritoneal dialysis system for kinks 6. Increase the flow rate of the peritoneal dialysis solution

1. Check the level of the drainage bag 2. Reposition the client to his or her side 4. Place the client in good body alignment 5. Check the peritoneal dialysis system for kinks If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing and peritoneal dialysis system are also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. There is no reason to contact the HCP. Increasing the flow rate should not be done and also is not associated with the amount of outflow solution.

The nurse is reviewing a client's record and notes that the HCP has documented that the client has chronic renal disease. On review of the laboratory results, the nurse most likely would expect to note which finding? 1. Elevated creatinine levels 2. Decreased hgb levels 3. Decreased RBC count 4. Increased number of WBC in the urine

1. Elevated creatinine levels The creatinine level is the most specific laboratory test to determine renal function. The creatinine level increases when at least 50% of renal function is lost. A decreased hgb level and RBC count are associated with anemia or blood loss and not specifically with decreased renal function. Increased WBC in the urine are noted with UTIs.

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1. Hct of 33% 2. Platelet count of 400,000 3. WBC of 6000 4. BUN of 15 mg/dL

1. Hct of 33% Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate RBC production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hct level is male: 42-52% female: 37-47% Therapeutic effect is seen when the hct reaches between 30% and 33% Platelet production, WBC production and BUN do not respond to erythropoietin

The nurse discusses plans for future treatment options with a client with symptomatic polycystic kidney disease. Which treatment should be included in this discussion? (select all that apply) 1. Hemodialysis 2. Peritoneal dialysis 3. Kidney transplant 4. Bilateral nephrectomy 5. Intense immunosuppression therapy

1. Hemodialysis 3. Kidney transplant 4. Bilateral nephrectomy Polycystic kidney disease is a genetic familial disease in which the kidneys enlarge with cysts that rupture and scar the kidney, eventually resulting in end-stage renal disease. Treatment options include hemodialysis or kidney transplant. Clients usually undergo bilateral nephrectomy to remove the large, painful, cyst-filled kidneys. Peritoneal dialysis is not a treatment option due to the infected cysts. The condition does not respond to immunosuppressants

The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. Palpation of a thrill over the fistula 2. Presence of a radial pulse in the left wrist 3. Visualization of enlarged blood vessels at the fistula site 4. Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand

1. Palpation of a thrill over the fistula The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Enlarged visible blood vessels at the fistula site are a normal observation but are not indicative of fistula patency. Although the presence of a radial pulse in the left write and cap refill less than 3 seconds in the nail beds of the fingers on the left hand indicate adequate circulation to the hand, they do not assess fistula patency

A client with acute kidney injury has a serum K+ level of 7.0 mEq/L. The nurse should plan which actions as a priority? (select all that apply) 1. Place the client on cardiac monitor 2. Notify the HCP 3. Put the client on NPO status except for ice chips 4. Review the client's medications to determine if any contain or retain K+ 5. Allow an extra 500mL of IV fluid intake to dilute the electrolyte concentration

1. Place the client on cardiac monitor 2. Notify the HCP 4. Review the client's medications to determine if any contain or retain K+ The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. The nurse should notify the HCP and also review medications to determine if any contain potassium or are potassium retaining. The client does not need to be put on NPO status. Fluid intake is not increased because it contributes to FVO and would not affect the serum potassium level significantly.

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 101.2. Which nursing action is most appropriate? 1. Encourage fluid intake 2. Notify the HCP 3. Continue to monitor vital signs 4. Monitor the site of the shunt for infection

2. Notify the HCP A temperature of 101.2 is significantly elevated and may indicate infection. The nurse should notify the HCP. Dialysis clients cannot have fluid intake encouraged. Vital signs and the shunt site should be monitored, but the HCP should be notified first.

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestation? 1. Hypertension, tachycardia, fever 2. Hypotension, bradycardia, hypothermia 3. Restlessness, irritability, generalized weakness 4. Headache, deteriorating LOC and twitching

4. Headache, deteriorating LOC and twitching Disequilibrium syndrome is characterized by headache, mental confusion, decreasing LOC, n/v, twitching and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of symptoms. The syndrome most often occurs in client who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates. Tachycardia and fever are associated with infection. Generalized weakness is associated with low blood pressure and anemia. Restlessness and irritability are not associated with disequilibrium syndrome.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action? 1. Monitor the client 2. Elevate the HOB 3. Assess the fistula site and dressing 4. Notify the HCP

4. Notify the HCP Disequilibrium syndrome may be caused by rapid removal of solutes from the body during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs and symptoms of disequilibrium syndrome and appropriate treatments with anti-convulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The HCP must be notified. Monitoring the client, elevating the HOB and assessing the fistula site are correct actions, but the priority action is to notify the HCP.

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication? 1. Warmth, redness, and pain in the left hand 2. Ecchymosis and audible bruit over the fistula 3. Edema and reddish discoloration of the left arm 4. Pallor, diminished pulse, and pain in the left hand

4. Pallor, diminished pulse, and pain in the left hand Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, caused by tissue ischemia. Warmth and redness probably would characterize a problem with infection. Ecchymosis and a bruit are normal findings for a fistula.

A nurse is reviewing the laboratory report of a client who has AKI. Which of the following findings should the nurse expect? (select all that apply) a. BUN 30 b. UO 40mL in the past 3 hours c. potassium 3.6 d. calcium 9.8 e. hct 30%

a. BUN 30 b. UO 40mL in the past 3 hours e. hct 30%

Nutritional support and management are essential across the entire continuum of CKD. Which statements would be considered true related to nutritional therapy (select all that apply): a. Fluid is not usually restricted for patients receiving peritoneal dialysis b. sodium and potassium may be restricted in someone with advanced CKD c. Decreased fluid intake and a low potassium diet are hallmarks of the diet for a patient receiving hemodialysis d. decreased fluid intake and a low potassium diet are hallmarks of the diet for a patient receiving peritoneal dialysis e. increased fluid intake and a diet with potassium-rich foods are hallmarks of a diet for a patient receiving hemodialysis

a. Fluid is not usually restricted for patients receiving peritoneal dialysis b. sodium and potassium may be restricted in someone with advanced CKD c. Decreased fluid intake and a low potassium diet are hallmarks of the diet for a patient receiving hemodialysis

Patients with CKD experience an increased incidence of cardiovascular disease r/t (select all that apply): a. HTN b. vascular calcifications c. a genetic predisposition d. hyperinsulinemia causing dyslipidemia e. increased high-density lipoprotein levels

a. HTN b. vascular calcifications d. hyperinsulinemia causing dyslipidemia

The client receiving dialysis is complaining of being dizzy and light-headed. What action should the nurse take first? a. Place the client in the Trendelenberg position b. Turn off the dialysis machine immediately c. Bolus the client with 500 ml of normal saline d. Notify the health care provider as soon as possible

a. Place the client in the Trendelenberg position

A nurse is planning care for a group of clients. Which of the following clients should the nurse plan to monitor for signs of nephrotoxicity? a. a client who is receiving gentamicin for the treatment of a wound infection b. a client who is receiving digoxin for the treatment of heart failure c. a client who is receiving methylprednisolone for the treatment of severe asthma d. a client who is receiving propranolol for the treatment of hypertension

a. a client who is receiving gentamicin for the treatment of a wound infection

A kidney transplant recipient complains of having fever, chills, and dysuria over the past 2 days. What is the first action that the nurse should take? a. assess temperature and initiate workup to rule out infection b. reassure the patient that this is common after transplantation c. provide warm cover for the patient and give 1g acetaminophen d. notify the nephrologist that the patient has developed symptoms of acute rejection

a. assess temperature and initiate workup to rule out infection

A nurse is reviewing the medical history of a client who has end-stage kidney disease. The nurse should identify which of the following factors in the client's history is a contraindication for receiving hemodialysis? a. history of hemophilia b. difficulty with ambulation c. decreased WBC d. idoine allergy

a. history of hemophilia

Nurses need to teach patients at risk for developing chronic kidney disease. Individuals considered to be at increased risk include (select all that apply): a. older african americans b. patients >60 years old c. those with a history of pancreatitis d. those with a history of HTN e. those with a history of type 2 DM

a. older african americans b. patients >60 years old d. those with a history of HTN e. those with a history of type 2 DM

Which descriptions characterize acute kidney injury? (select all that apply) a. primary cause of death is infection b. it almost always affects older people c. disease course is potentially reversible d. most common cause is diabetic neuropathy e. cardiovascular disease is most common cause of death

a. primary cause of death is infection c. disease course is potentially reversible

A patient is admitted to the hospital with chronic kidney disease. The nurse understands that this condition is characterized by: a. progressive irreversible destruction of the kidneys b. a rapid decrease in urine output with an elevated BUN c. an increasing creatintine clearance with a decrease in urine output d. prostration, somnolence, and confusion with coma and imminent death

a. progressive irreversible destruction of the kidneys

An ESKD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, the nurse informs the patient that a. successful transplantation usually provides better quality of life than that offered by dialysis. b. if rejection of the transplanted kidney occurs, no further treatment for the renal failure is available. c. hemodialysis replaces the normal functions of the kidneys, and patients do not have to live with the continual fear of rejection. d. the immunosuppressive therapy following transplantation makes the person ineligible to receive other forms of treatment if the kidney fails.

a. successful transplantation usually provides better quality of life than that offered by dialysis.

A nurse is performing an admission assessment of a client who has severe CKD. Which of the following findings should the nurse expect? a. tachypnea b. hypotension c. exophthalmos d. insomnia

a. tachypnea The nurse should expect a client who has severe CKD to have tachypnea due to metabolic acidosis client with severe CKD would have HTN

a major advantage to peritoneal dialysis is: a. the diet is less restricted and dialysis can be performed at home b. the dialysate is biocompatible and causes no long-term consequences c. high glucose concentration of the dialysate cause a reduction in appetite, promoting weight loss d. no medications are required because of the enhanced efficiency of the peritoneal membrane in removing toxins

a. the diet is less restricted and dialysis can be performed at home

A nurse is providing discharge teaching for a client who has CKD. Which of the following statements should the nurse identify as an indication that the client understands the teaching? a. "I will consume foods that are high in protein" b. "I will decrease my intake of foods that are high in phosphorus" c. "I will limit my intake of foods that are high in iron" d. "I will add salt to the foods I consume"

b. "I will decrease my intake of foods that are high in phosphorus"

The client is admitted to the ER after a gunshot wound to the abdomen. Which nursing intervention should the nurse implement first to prevent ARF? a. Assess the abdominal dressing b. Administer normal saline IV c. Take vital signs d. Place the client on telemetry

b. Administer normal saline IV

The nurse is caring for a client with chronic renal failure who has an AV fistula in the left arm. What should be included in the plan of care? SELECT ALL THAT APPLY a. Check the blood pressure in both arms and compare b. Auscultate for the whoosh sound over the fistula c. Palpate for warmth and tenderness over the area of the fistula d. Instruct the client to avoid getting the fistula wet e. Instruct the client to avoid carrying heavy objects with the left arm

b. Auscultate for the whoosh sound over the fistula c. Palpate for warmth and tenderness over the area of the fistula e. Instruct the client to avoid carrying heavy objects with the left arm

During the oliguric phase of AKI, the nurse monitors the patient for (select all that apply): a. hypotension b. ECG changes c. hypernatremia d. pulmonary edema e. urine with high specific gravity

b. ECG changes d. pulmonary edema

A client w/ renal failure develops hyperkalemia. Which high potassium food should the client avoid? a. Grapes b. Honeydew melon c. Strawberries d. Rhubarb

b. Honeydew melon

A nurse is providing teaching to a client who has CKD. Which of the following statements by the client indicates an understanding of the teaching? a. "I will check my blood pressure once per week" b. "I will take a magnesium antacid if I get constipated" c. "I will weigh myself every morning" d. "I will use a salt substitute in my diet"

c. "I will weigh myself every morning" A client who has CKD should weigh himself every morning at the same time to monitor fluid balance. The client should void prior to weighing if able, wear similar clothing when obtaining weight, and use the same set of scales each time. patient with CKD should check BP once DAILY

A diagnostic study that indicates renal blood flow, glomerular filtration, tubular function and excretion is a(n): a. IVP b. VCUG c. Renal scan d. loopogram

c. Renal scan

A nurse is monitoring a client following hemodialysis. The nurse should recognize that which of the following factso places the client at risk for seizures? a. hypokalemia b. a rapid increase of catecholamines c. a rapid decrease in fluids d. hypercalcemia

c. a rapid decrease in fluids

The nurse is caring for a client with rule out acute renal failure. What condition predisposes the client to developing pre-renal failure? a. Aminoglycosides b. Benign prostatic hypertrophy c. Diabetes d. Hypotension

d. Hypotension

A nurse is caring for a postoperative client following arteriovenous (AV) fistula creation in her left arm. Which of the following actions should the nurse take? a. measure BP in the client's left arm every 4 hours b. keep the clients left arm in a dependent position c. auscultate for bruits in the clients fistula every 4 hours d. instruct the client to sleep on the affected side

c. auscultate for bruits in the clients fistula every 4 hours

A nurse is assessing a client who has CKD and has completed her third peritoneal dialysis treatment. Which of the following findings should the nurse report to the provider? a. Greater outflow of dialysate than inflow b. weight loss c. cloudy dialysate effluent d. report of pain during inflow

c. cloudy dialysate effluent

If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances? a. hyperkalemia and hyponatremia b. hyperkalemia and hypernatremia c. hypokalemia and hyponatremia d. hypokalemia and hypernatremia

c. hypokalemia and hyponatremia decreased K+ and Na+

A nurse is planning care for a client who has CKD and a potassium level of 7.3. which of the following interventions should the nurse plan to take? a. initiate an IV infusion of LR solution b. give spironolactone 50mg PO BID c. infuse regular insulin in dextrose 10% water d. administer supplemental phosphorus

c. infuse regular insulin in dextrose 10% water

To assess the patency of a newly placed ateriovenous graft for dialysis, the nurse should (select all that apply): a. monitor the BP in affected arm b. irrigate the graft daily with low-dose heparin c. palpate the area of the graft to feel a normal thrill d. listen with a stethoscope over the graft to detect a bruit e. frequently monitor the pulses and neurovascular status distal to the graft

c. palpate the area of the graft to feel a normal thrill d. listen with a stethoscope over the graft to detect a bruit e. frequently monitor the pulses and neurovascular status distal to the graft

The client with chronic renal failure is receiving peritoneal dialysis. Which assessment data would require immediate intervention by the nurse? a. Unable to auscultate a bruit over the fistula b. The client's abdomen is soft, non-tender with bowel sounds c. The dialysate being removed from the client's abdomen is clear d. The dialysate instilled was 1500mL and removed was 1500mL

d. The dialysate instilled was 1500mL and removed was 1500mL

a nurse is providing instructions for reducing the dietary intake of potassium to a client who has CKD. Which of the following food selections should the nurse recommend? a. 1 cup cubed cantaloupe b. 1 cup boiled spinach c. one medium baked potato d. one large raw apple

d. one large raw apple

RIFLE defines three stages of AKI based on changes in: a. blood pressure and urine osmolality b. fractional excretion of urinary sodium c. estimation of GFR with the MDRD equation d. serum creatinine or urine output from baseline

d. serum creatinine or urine output from baseline

On reading the urinalysis results of a dehydrated patient, the nurse would expect to find: a. a pH of 8.4 b. RBCs of 4/hpf c. color: yellow, cloudy d. specific gravity of 1.035

d. specific gravity of 1.035

A nurse is preparing to assess a client who received hemodialysis 1 hour ago. Which of the following assessments should the nurse perform first? a. potassium level b. body weight c. creatinine level d. vital signs

d. vital signs