MEDSURG TEST #3: Ch 46: AKI & CKD

A client with Acute Kidney Injury is being assessed to determine if the cause is prerenal, or post renal. If the cause is pre-renal, which condition is most likely the cause? A. Heart failure B. Glomerular Nephritis C. Kidney stone D. Aminoglycoside toxicity

A. Heart failure

What nursing measure would be included in the plan of care for a client with acute kidney injury? A. Observe for signs of a secondary infection. B. Provide a high-protein, low-carbohydrate diet. C. n and out catheterization for residual urine D. Encourage fluids to 2000 mL in 24 hours

A. Observe for signs of a secondary infection.

A client in kidney failure is to have a serum blood urea nitrogen level determined. What will this diagnostic test measure? A. Concentration of the urine osmolarity and electrolytes B.Serum level of the end products of protein metabolism C.Ability of the kidneys to concentrate urine D.Levels of C-reactive protein to determine inflammation

B.Serum level of the end products of protein metabolism

The nurse teaches a patient with chronic kidney disease about prevention of complications. What should the nurse include in the teaching plan? A. Monitor for proteinuria daily with a urine dipstick. B. Perform self-catheterization every 4 hours to measure urine. C. Take calcium-based phosphate binders on an empty stomach. D. Check weight daily and report a gain of greater than 4 pounds

D. Check weight daily and report a gain of greater than 4 pounds

A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft? a. A fistula is much less likely to clot. b. A fistula increases patient mobility. c. A fistula can accommodate larger needles. d. A fistula can be used sooner after surgery.

a. A fistula is much less likely to clot.

A 78-yr-old patient has stage 3 CKD and is being taught about a low-potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat? a. Apple, green beans, and a roast beef sandwich b. Granola made with dried fruits, nuts, and seeds c. Watermelon and ice cream with chocolate sauce d. Bran cereal with ½ banana and milk and orange juice

a. Apple, green beans, and a roast beef sandwich

When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula? a. Auscultate for a bruit at the fistula site. b. Assess the quality of the left radial pulse. c. Compare blood pressures in the left and right arms. d. Irrigate the fistula site with saline every 8 to 12 hours.

a. Auscultate for a bruit at the fistula site. The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.

Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis (select all that apply)? a. Avoid commercial salt substitutes. b. Restrict fluid intake to 1000 mL daily. c. Take phosphate binders with each meal. d. Choose high-protein foods for most meals. e. Have several servings of dairy products daily.

a. Avoid commercial salt substitutes. c. Take phosphate binders with each meal. d. Choose high-protein foods for most meals. Patients who are receiving peritoneal dialysis should have a high-protein diet. Phosphate binders are taken with meals to help control serum phosphate and calcium levels. Commercial salt substitutes are high in potassium and should be avoided. Fluid intake is not limited unless weight and blood pressure are notmcontrolled. Dairy products are high in phosphate and usually are limited.

A 72-yr-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first? a. Insert urethral catheter. b. Obtain renal ultrasound. c. Draw a complete blood count. d. Infuse normal saline at 50 mL/hour

a. Insert urethral catheter.

a week after kidney transplant, a client develops a temperature of 101F, the blood pressure is elevated, and the kidney is tender. The x-ray indicates that the transplanted kidney is enlarged. Based on those assessment findings, the nurse suspects which complication? a. acute rejection b. kidney infection c. chronic rejection d. kidney obstruction

a. acute rejection

Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD) (select all that apply.)? a. anemia b. dehydration c. hypertension d. hypercalcemia e. increased risk for fractures f. elevated WBCs

a. anemia c. hypertension e. increased risk for fractures When the kidney fails, erythropoietin in not excreted, so anemia is expected. Hypocalcemia from chronic renal disease stimulates the parathyroid to release parathyroid hormone, causing calcium liberation from bones increasing the risk of pathological fracture. Dehydration and hypercalcemia are not expected in chronic renal disease. Fluid volume overload and hypocalcemia are expected. Although impaired immune function should be expected, elevated white blood cells would indicate inflammation or infection not associated with chronic renal failure itself but a complication.

A 52-yr-old man with stage 2 chronic kidney disease is scheduled for an outpatient diagnostic procedure using contrast media. Which priority action should the nurse perform? a. assess skin turgor to determine hydration status b. insert a urinary catheter for the expected diuresis c. evaluate the patient's lower extremities for edema d. check the patient's urine for the presence of ketones

a. assess skin turgor to determine hydration status Preexisting kidney disease is the most important risk factor for the development of contrast-associated nephropathy and nephrotoxic injury. If contrast media must be administered to a high-risk patient, the patient needs to have optimal hydration. The nurse should assess the hydration status of the patient before the procedure is performed. Indwelling catheter use should be avoided whenever possible to decrease the risk of 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 transplant c. provider warm cover for the patient and give 1 g tylenol orally d. notify the nephrologist that the patient has developed symptoms of acute rejection

a. assess temperature and initiate workup to rule out infection

Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before administering the medication, the nurse should assess the a. bowel sounds. b. blood glucose. c. blood urea nitrogen (BUN). d. level of consciousness (LOC).

a. bowel sounds. Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not affect the nurse's decision to give the medication.

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? (SATA) a. check the level of the drainage bag b. reposition the client to his or her side c. contact the HCP d. place the client in good body alignment e. check the peritoneal dialysis system for kinks f. increase the flow rate of the peritoneal dialysis solution

a. check the level of the drainage bag b. reposition the client to his or her side d. place the client in good body alignment e. check the peritoneal dialysis system for kinks

Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury (AKI) (select all that apply.)? a. dehydration b. hypokalemia c. hypernatremia d. BUN increases e. urine output increases f. serum creatinine increases

a. dehydration b. hypokalemia e. urine output increases The hallmark of entering the diuretic phase is the production of copious amounts of urine. Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes but not concentrate urine. Serum BUN and serum creatinine levels begin to decrease.

Nutritional support and management are essential across the entire continuum of CKD. Which statements would be considered true related to nutritional therapy (SATA)? 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. decreased fluid intake and a diet with phosphate-rich foods are hallmarks of the 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 related to (SATA) a. hypertension b. vascular calcification c. a genetic predisposition d. hyperinsulinemia causing dyslipidemia e. increased HDLs

a. hypertension b. vascular calcification d. hyperinsulinemia causing dyslipidemia

The patient has rapidly progressing glomerular inflammation. Weight has increased and urine output is steadily declining. What is the priority nursing intervention? a. monitor the patient's cardiac status b. teach the patient about hand washing c. obtain a serum specimen for electrolytes d. increase direct observation of the patient

a. monitor the patient's cardiac status

nurses must teach patients at risk for developing chronic kidney disease. individuals considered to be at increased risk include (SATA) a. older AA b. patients > 60 years old c. those with a history of pancreatitis d. those with a history of hypertension e. those with a history of type 2 diabetes

a. older AA b. patients > 60 years old d. those with a history of hypertension e. those with a history of type 2 diabetes

which descriptions characterize acute kidney injury (SATA)? 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 nephropathy 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 creatinine 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 ESRD 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 transplant 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 continual fear of rejection d. the immunosuppressive therapy following transplant makes teh 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 major advantage of 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 concentrations of the dialysate cause a reduction in appetite, promoting weight loss d. no medications are requires because of the enhanced efficacy of the peritoneal membrane in removing toxins

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

During routine hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis. b. Check the blood pressure (BP). c. Review the hematocrit (Hct) level. d. Give prescribed PRN antiemetic drugs.

b. Check the blood pressure (BP).

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

b. ECG changes d. pulmonary edema

The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required? a. Acetaminophen b. Magnesium hydroxide c. Calcium phosphate d. Multivitamin w/ iron

b. Magnesium hydroxide

A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. More protein is allowed because urea and creatinine are removed by dialysis. c. Dietary potassium is not restricted because the level is normalized by dialysis. d. Unlimited fluids are allowed because retained fluid is removed during dialysis.

b. More protein is allowed because urea and creatinine are removed by dialysis. When the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.

A 42-yr-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first? a. Insert a urinary retention catheter. b. Place the patient on a cardiac monitor. c. Administer epoetin alfa (Epogen, Procrit). d. Give sodium polystyrene sulfonate (Kayexalate).

b. Place the patient on a cardiac monitor.

The nurse is caring for a 68-yr-old man who had coronary artery bypass surgery 3 weeks ago. During the oliguric phase of acute kidney disease, which action would be appropriate to include in the plan of care? a. Provide foods high in potassium. b. Restrict fluids based on urine output. c. Monitor output from peritoneal dialysis. d. Offer high-protein snacks between meals.

b. Restrict fluids based on urine output. Fluid intake is monitored during the oliguric phase. Fluid intake is determined by adding all losses for the previous 24 hours plus 600 mL. Potassium and protein intake may be limited in the oliguric phase to avoid hyperkalemia and elevated urea nitrogen. Hemodialysis, not peritoneal dialysis, is indicated in acute kidney injury if dialysis is needed.

Which intervention will be included in the plan of care for a patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein? a. Start continuous pulse oximetry. b. Restrict physical activity to bed rest. c. Restrict the patient's oral protein intake. d. Discontinue the urethral retention catheter.

b. Restrict physical activity to bed rest.

Which information in a patient's history indicates to the nurse that the patient is not an appropriate candidate for kidney transplantation? a. The patient has type 1 diabetes. b. The patient has metastatic lung cancer. c. The patient has a history of chronic hepatitis C infection. d. The patient is infected with human immunodeficiency virus.

b. The patient has metastatic lung cancer.

The nurse is assessing a patient 4 hours after a kidney transplant. Which information is most important to communicate to the health care provider? a. The urine output is 900 to 1100 mL/hr. b. The patient's central venous pressure (CVP) is decreased. c. The patient has a level 7 (0- to 10-point scale) incisional pain. d. The blood urea nitrogen (BUN) and creatinine levels are elevated.

b. The patient's central venous pressure (CVP) is decreased.

A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L inflows. Which information should the nurse report promptly to the health care provider? a. The patient has an outflow volume of 1800 mL. b. The patient's peritoneal effluent appears cloudy. c. The patient's abdomen appears bloated after the inflow. d. The patient has abdominal pain during the inflow phase.

b. The patient's peritoneal effluent appears cloudy. Cloudy-appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.

The nurse is titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation. Which parameter will be most important for the nurse to consider? a. Heart rate b. Urine output c. Creatinine clearance d. Blood urea nitrogen (BUN) level

b. Urine output

A 62-yr-old female patient has been hospitalized for 4 days with acute kidney injury(AKI) caused by dehydration. Which information will be most important for the nurse to report to the health care provider? a. The creatinine level is 3.0 mg/dL. b. Urine output over an 8-hour period is 2500 mL. c. The blood urea nitrogen (BUN) level is 67 mg/dL. d. The glomerular filtration rate is less than 30 mL/min/1.73 m2

b. Urine output over an 8-hour period is 2500 mL.

Which patient has the most significant risk factors for CKD? a. a 50-yr-old white woman with hypertension b. a 61-yr-old Native American man with diabetes c. a 40-yr-old Hispanic woman with cardiovascular disease d. a 28-yr-old African American woman with a urinary tract infection

b. a 61-yr-old Native American man with diabetes The nurse identifies the 61-yr-old Native American with diabetes as the most at risk. Diabetes causes about 50% of CKD. This patient is the oldest, and Native Americans with diabetes develop CKD six times more frequently than other ethnic groups. Hypertension causes about 25% of CKD. Hispanics have CKD about 1.5 times more than non-Hispanics. African Americans have the highest rate of CKD because hypertension is significantly increased in African Americans. A UTI will not cause CKD unless it is not treated or UTIs occur recurrently.

A patient with end-stage renal disease (ESRD) secondary to diabetes mellitus has arrived at the outpatient dialysis unit for hemodialysis. Which assessments should the nurse perform as a priority before, during, and after the treatment? a. level of consciousness b. blood pressure and fluid balance c. temperature, heart rate, and blood pressure d. assessment for signs and symptoms of infection

b. blood pressure and fluid balance Although all of the assessments are relevant to the care of a patient receiving hemodialysis, fluid removal during the procedure will require monitoring blood pressure and fluid balance prior, during, and after.

a client being hemodialyzed suddenly becomes short of breath and complains of chest pain. the client is tachycardic, pale, and anxious, and the nurse suspects air embolism. what is the priority nursing action? a. monitor VS every 15 minutes for the next hour b. discontinue dialysis and notify the HCP c. continue dialysis at a slower rate after checking the lines for air d. bolus the client with 500 mL of normal saline to break up the air embolism

b. discontinue dialysis and notify the HCP

the nurse is instructing a client with DM 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 for which complication? a. infection b. hyperglycemia c. hypophosphatemia d. disequilibrium syndrome

b. hyperglycemia

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. Which strategy is used to achieve ultrafiltration in peritoneal dialysis? a. increasing the pressure gradient b. increasing osmolality of the dialysate c. decreasing the glucose in the dialysate d. decreasing the concentration of the dialysate

b. increasing osmolality of the dialysate Ultrafiltration in peritoneal dialysis is achieved by increasing the osmolality of the dialysate with additional glucose. In hemodialysis, the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration. Decreasing the concentration of the dialysate in either peritoneal or hemodialysis will decrease the amount of fluid removed from the blood stream.

Which statement regarding continuous ambulatory peritoneal dialysis (CAPD) would be most important when teaching a patient new to the treatment? a. maintain a daily written record of blood pressure and weight b. it is essential that you maintain aseptic technique to prevent peritonitis c. you will be allowed a more liberal protein diet once you complete CAPD d. continue regular medical and nursing follow-up visits while performing CAPD

b. it is essential that you maintain aseptic technique to prevent peritonitis

The nurse is planning care for a patient with severe heart failure who has developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary treatment goal in the plan will be a. augmenting fluid volume. b. maintaining cardiac output. c. diluting nephrotoxic substances. d. preventing systemic hypertension.

b. maintaining cardiac output.

a client with AKI has a serum potassium level of 6. the nurse should plan which action as a priority? a. check the sodium level b. place the client on a cardiac monitor c. encourage increased vegetables in the diet d. allow an extra 500 mL of fluid intake to dilute the electrolyte concentration

b. place the client on a cardiac monitor

When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of a. persistent skin tenting b. rapid, deep respirations. c. hot, flushed face and neck. d. bounding peripheral pulses.

b. rapid, deep respirations. Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI.

The home care nurse visits a 34-yr-old woman receiving peritoneal dialysis. Which statement indicates a need for immediate follow-up by the nurse? a. drain time is faster if i rub my abdomen b. the fluid draining from the catheter is cloudy c. the drainage is bloody when i have my period d. i was around the catheter with soap and water

b. the fluid draining from the catheter is cloudy The primary clinical manifestation of peritonitis is a cloudy peritoneal effluent. Blood may be present in the effluent of women who are menstruating, and no intervention is indicated. Daily catheter care may include washing around the catheter with soap and water. Drain time may be facilitated by gently massaging the abdomen.

Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective? a. "I need to get most of my protein from low-fat dairy products." b. "I will increase my intake of fruits and vegetables to 5 per day." c. "I will measure my urinary output each day to help calculate the amount I can drink." d. "I need to take erythropoietin to boost my immune system and help prevent infection."

c. "I will measure my urinary output each day to help calculate the amount I can drink." The patient with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.

The physician has decided to use renal replacement therapy to remove large volumes of fluid from a patient who is hemodynamically unstable in the intensive care unit. The nurse should expect which treatment to be used for this patient? a. Hemodialysis (HD) three times per week b. Automated peritoneal dialysis (APD) c. Continuous venovenous hemofiltration (CVVH) d. Continuous ambulatory peritoneal dialysis (CAPD)

c. Continuous venovenous hemofiltration (CVVH)

During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first? a. Administer hypertonic saline. b. Administer a blood transfusion. c. Decrease the rate of fluid removal. d. Administer antiemetic medications.

c. Decrease the rate of fluid removal. The patient is experiencing hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased, and 0.9% saline solution may be infused. Hypertonic saline is not used because of the high sodium load. A blood transfusion is not indicated. Antiemetic medications may help the nausea but would not help the hypovolemia.

A 55-yr-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication? a. Creatinine 1.6 mg/dL b. Oxygen saturation 89% c. Hemoglobin level 13 g/dL d. Blood pressure 98/56 mm Hg

c. Hemoglobin level 13 g/dL High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when erythropoietin (EPO) is administered to a target hemoglobin of greater than 12 g/dL. Hemoglobin levels higher than 12 g/dL indicate a need for a decrease in epoetin alfa dose. The other information also will be reported to the health care provider but will not affect whether the medication is administered.

Which assessment finding may indicate that a patient is experiencing adverse effects to a corticosteroid prescribed after kidney transplantation? a. Postural hypotension b. Recurrent tachycardia c. Knee and hip joint pain d. Increased serum creatinine

c. Knee and hip joint pain Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not caused by corticosteroid use.

After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take? a. Teach the patient about normal AVG function. b. Remind the patient to take a daily low-dose aspirin tablet. c. Report the patient's symptoms to the health care provider. d. Elevate the patient's arm on pillows to above the heart level.

c. Report the patient's symptoms to the health care provider.

Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a. The patient leaves the catheter exit site without a dressing. b. The patient plans 30 to 60 minutes for a dialysate exchange. c. The patient cleans the catheter while taking a bath each day. d. The patient slows the inflow rate when experiencing abdominal pain.

c. The patient cleans the catheter while taking a bath each day. Patients are encouraged to take showers rather than baths to avoid infections at the catheter insertion side. The other patient actions indicate good understanding of peritoneal dialysis.

a client with CKD returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes tht the client's temperature is 100.2. which nursing action is most appropriate? a. encourage fluids b. notify the HCP c. continue to monitor VS d. monitor the site of the shunt for infection

c. continue to monitor VS

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

c. hypokalemia and hyponatremia

A patient is recovering in the intensive care unit (ICU) 24 hours after receiving a kidney transplant. What is an expected assessment finding during the earliest stage of recovery? a. hypokalemia b. hyponatremia c. large urine output d. leukocytosis with cloudy urine output

c. large urine output Patients frequently experience diuresis in the hours and days immediately following a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.

to assess the patency of a newly place AV graft for dialysis, the nurse should (SATA) a. monitor the BP in the 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

Before administration of captopril to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patient's a. glucose. b. creatinine. c. potassium. d. phosphate.

c. potassium. Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not affect whether the captopril was given or not.

A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first? a. Notify the patient's health care provider. b. Document the QRS interval measurement. c. Review the chart for the patient's current creatinine level. d. Check the medical record for the most recent potassium level.

d. Check the medical record for the most recent potassium level.

After receiving change-of-shift report, which patient should the nurse assess first? a. Patient who is scheduled for the drain phase of a peritoneal dialysis exchange b. Patient with stage 4 chronic kidney disease who has an elevated phosphate level c. Patient with stage 5 chronic kidney disease who has a potassium level of 3.4 mEq/L d. Patient who has just returned from having hemodialysis and has a heart rate of 124/min

d. Patient who has just returned from having hemodialysis and has a heart rate of 124/min The patient who has tachycardia after hemodialysis may be bleeding or excessively hypovolemic and should be assessed immediately for these complications. The other patients also need assessments or interventions but are not at risk for life-threatening complications.

When caring for a patient during the oliguric phase of acute kidney injury (AKI), which nursing action is appropriate? a. Weigh patient three times weekly. b. Increase dietary sodium and potassium. c. Provide a low-protein, high-carbohydrate diet. d. Restrict fluids according to previous daily loss.

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

A frail 72-yr-old woman with stage 3 chronic kidney disease is cared for at home by her family. The patient has a history of taking many over-the-counter medications. Which over-the-counter medications should the nurse teach the patient to avoid? a. aspirin b. acetaminophen c. diphenhydramine d. aluminum hydroxide

d. aluminum hydroxide Antacids (that contain magnesium and aluminum) should be avoided because patients with kidney disease are unable to excrete these substances. Also, some antacids contain high levels of sodium that further increase blood pressure. Acetaminophen and aspirin (if taken for a short period of time) are usually safe for patients with kidney disease. Antihistamines may be used, but combination drugs that contain pseudoephedrine may increase blood pressure and should be avoided.

A patient with a 25-year history of type 1 diabetes mellitus is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse notes newly developed hypertension and uncontrolled blood sugars. Which diagnostic study is most indicative of chronic kidney disease (CKD)? a. serum creatinine b. serum potassium c. microalbuminuria d. calculated GFR

d. calculated GFR The best study to determine kidney function or CKD that would be expected in the patient with diabetes is the calculated GFR that is obtained from the patient's age, gender, race, and serum creatinine. It would need to be abnormal for 3 months to establish a diagnosis of CKD. A creatinine clearance test done with a blood sample and a 24-hour urine collection is also important. Serum creatinine is not the best test for CKD because the level varies with different patients. Serum potassium levels could explain why the patient has an irregular heartbeat. The finding of microalbuminuria can alert the patient with diabetes about potential renal involvement and potentially failing kidneys. However, urine albumin levels are not used for diagnosis of CKD.

Which patient diagnosis or treatment is most consistent with prerenal acute kidney injury (AKI)? a. IV tobramycin b. incompatible blood transfusion c. poststreptococcal glomerulonephritis d. dissecting abdominal aortic aneurysm

d. dissecting abdominal aortic aneurysm A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can decrease renal artery perfusion and therefore the glomerular filtrate rate. Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction, and post-streptococcal glomerulonephritis are intrarenal causes of AKI.

a client newly diagnosed with CKD has just been started on peritoneal dialysis. During the infusion of the dialysat, the client complains of abdominal pain. Which action by the nurse is most appropriate? a. stop the dialysis b. slow the infusion c. decrease the amount to be infused d. explain that the pain will subside after the first few exchanges

d. explain that the pain will subside after the first few exchanges

the client newly diagnosed with CKD recently has begun hemodialysis. knowing that the client is at risk for disequilibrium syndome, the nurse should assess the client during dialysis for which associated manifestations? a. hypertension, tachycardia, and fever b. hypotension, bradycardia, and hypothermia c. restlessness, irritability, and generalized weakness d. headache, deteriorating level of consciousness, and twitching

d. headache, deteriorating level of consciousness, and twitching

A patient complains of leg cramps during hemodialysis. The nurse should a. massage the patient's legs. b. reposition the patient supine. c. give acetaminophen (Tylenol). d. infuse a bolus of normal saline.

d. infuse a bolus of normal saline. Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client complaining of headache and nausea is extremely restless. Which is the most appropriate nursing action? a. monitor the clinet b. elevate teh head of the bed c. medicate the client for nausea d. notify the HCP

d. notify the HCP

a hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. the nurse should assess the client for which manifestations of this complication? a. warmth, redness, and pain in the left hand b. aching pain, pallor, and edema of the left arm c. edema and reddish discoloration of the left arm d. pallor, diminished pulse, and pain in the left hand

d. pallor, diminished pulse, and pain in the left hand

The nurse preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD). Which laboratory result will the nurse monitor to determine if the desired effect was achieved? a. sodium b. potassium c. magnesium d. phosphorus

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

RIFLE defines three stages of AKI based on changes in a. BP 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