MOC 3 Renal ATI

A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity?

Vancomycin. (The nurse should identify that vancomycin, an antibiotic, to be associated with nephrotoxic adverse effects.)

A nurse is caring for a client who has acute kidney injury (AKI). Which of the following arterial blood gas values would the nurse expect this client to have?

AKI causes metabolic acidosis because the kidneys cannot adequately process and excrete the acidic substances the usual bodily functions produce every day. With metabolic acidosis, the pH is low, the bicarbonate is low, and the PaCO2 is low or in the expected range, as in these results.

A nurse is caring for a client immediately following hemodialysis treatment. For which of the following manifestations will the nurse administer a PRN dose of phenytoin?

Headache and restlessness. (Headache and restlessness are manifestations of disequilibrium syndrome, which occurs during or after hemodialysis due to the rapid shift of fluids, pH, and osmolarity between fluid and blood that occurs.. This condition can cause cerebral edema leading to seizures and coma, and a PRN dose of the anticonvulsant phenytoin should be administered.)

A nurse is reviewing the laboratory test results from a client who has prerenal acute kidney injury (AKI). Which of the following electrolyte imbalances should the nurse expect?

Hyperkalemia. (AKI is a loss of renal function that results in a failure to maintain homeostasis. Fluid and electrolyte balance, as well as acid-base balance, are disrupted. The nurse should expect the client to have hyperkalemia due to protein breakdown and the subsequent release of intracellular potassium in to the circulation. The kidneys' inability to filter and excrete potassium results in hyperkalemia.)

A nurse is assessing a client who has fluid overload. Which of the following findings should the nurse expect?

Increased heart rate is correct. (The nurse should expect the client who has fluid volume excess to have tachycardia and increased cardiac contractility in response to the excess fluid.) Increased blood pressure is correct. (The nurse should expect the client who has fluid volume excess to have increased blood pressure and bounding pulse in response to the excess fluid.) Increased respiratory rate is correct. (The nurse should expect the client who has fluid volume excess to have increase in respiratory rate and moist crackles heard in lungs.)

A nurse is reviewing laboratory findings for four client. Which of the following clients has manifestations of acute kidney injury?

Serum creatinine 6 mg/dL. (This finding is above the expected reference range. The expected reference range for creatinine is 0.5 mg/dL to 1.3 mg/dL depending on the client's gender and age. An elevated serum creatinine is a manifestation of impaired kidney function, such as with acute kidney injury.)

A nurse is reviewing the laboratory data of a client following a hemodialysis treatment. The nurse should expect to find a decrease in which of the following laboratory values?

Potassium. Potassium levels are reduced by the process of diffusion during dialysis.

A nurse is reviewing the BUN and creatinine levels of an older adult client who has chronic kidney disease. The nurse should expect which of the following findings?

An elevation of both BUN and creatinine is an expected finding of chronic kidney disease.

A nurse is monitoring a client who has acute kidney injury. Which of the following laboratory findings should the nurse expect?

Elevated BUN. (Client who are in acute kidney injury will have an elevated BUN as damage to the kidneys leads to a build-up of nitrogenous wastes in the blood.)

A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following manifestations of peritonitis?

Nausea and vomiting. (Peritonitis is an inflammation of the peritoneum and is a potential complication of peritoneal dialysis. The nurse should monitor the client for manifestations such as abdominal tenderness or pain, anorexia, nausea, vomiting, restlessness, and confusion.)

A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect?

The nurse should expect a client who has renal failure to have metabolic acidosis, which is characterized by a low HCO3-, a low pH, and a low or normal PaCO2. Expected reference ranges for these laboratory values are as follows: pH 7.35 to 7.45, HCO3- 21 to 28 mEq/L, and PaCO2 35 to 45 mm Hg.

A nurse is teaching a client who has chronic kidney failure about planning a low-protein diet. The client states, "Why do I have to be concerned about protein?" Which of the following responses should the nurse make?

"A low-protein diet reduces the risk for uremia." (Urea is a waste product of protein breakdown and can accumulate in clients who have kidney failure, causing uremia.)

A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication?

The Hematocrit (Hct). (Epoetin alfa is an antianemic medication that is indicated in the treatment of clients who have anemia due to reduced production of endogenous erythropoietin, which may occur in clients who have end-stage renal disease or myelosuppression from chemotherapy. The therapeutic effect of epoetin alfa is enhanced red blood cell production, which is reflected in an increased RBC, Hgb, and Hct.)

A nurse is teaching a client who has chronic kidney disease about limiting foods that are high in potassium. Which of the following foods should the nurse instruct the client to avoid?

tomatoes, bananas, raisins

A nurse is caring for a client who has end-stage renal disease (ESRD). Which of the following are expected findings?

slurred speech, bone pain, tachypnea, pruritus, hypertension

A nurse is teaching a client who has chronic kidney disease about the process of continuous ambulatory peritoneal dialysis (CAPD). Which of the following information should the nurse include in the teaching?

CAPD's advantages include fewer dietary and fluid restrictions as compared to hemodialysis.

A nurse is assessing a client who has chronic kidney disease for fluid volume increase. Which of the following provides a reliable measure of fluid retention?

Daily weight. (Obtaining a client's daily weight and comparing it to previous weights is a reliable method for measuring a client's fluid volume over time.)

A nurse is caring for a client whose serum potassium level is 5.3 mEq/L. Which of the following scheduled medications should the nurse plan to administer?

Furosemide. (Furosemide results in loss of potassium from the nephron as part of its diuretic effect. This medication can be given when a client has an elevated potassium level and can lower the potassium level. For this client, the depletion of potassium is a beneficial effect. For a client who has a therapeutic potassium level, there would be a risk for hypokalemia due to the excretion of potassium.)

A nurse is assessing a client in the oliguric phase of acute kidney injury. Which of the following findings should the nurse expect?

Hyperkalemia. (The nurse should expect the client to have an increase in the serum concentration of potassium during the oliguric phase. Potassium can rise to a life-threatening level during this phase and should be monitored closely.)

A nurse is monitoring an older adult female client who had a myocardial infarction (MI) for the development of an acute kidney injury. Which of the following findings should the nurse identify as indicating an increased risk of acute kidney injury?

The nurse should identify the client who has had an MI is at increased risk for the development of AKI due to decreased perfusion of the kidneys. An indication that the client is at risk for developing AKI is a creatinine level that is 1.5 times greater than the expected reference range. In an older female client, the expected reference range for creatinine is 0.5 - 1.2 mg/dL.

A nurse is providing dietary teaching to a client who has chronic kidney disease (CKD). The nurse should instruct the client to limit which of the following nutrients?

Protein is correct. (A client who has CKD should restrict protein intake to prevent uremia that can develop as a result of the kidneys' inability to remove the waste products of protein.) Phosphorous is correct. (A client who has CKD is at risk for hyperphosphatemia due to a reduction in excretion of phosphorous by the kidneys.) Sodium is correct. (A client who has CKD is at risk for hypernatremia, edema, and hypertension due to sodium retention.)

A nurse is caring for a client who has chronic kidney disease (CKD) and states she has heartburn. The provider prescribes aluminum hydroxide. The client asks, "Why can't I just take the antacid magaldrate my husband has a home?" The nurse explain to the client that aluminum hydroxide is the preferred antacid because it lowers which of the following?

Serum phosphorus levels. (Aluminum-based formulas are also a phosphate binder, helping to lower serum phosphorus levels in clients who have CKD.)

A nurse is assessing a client who has end-stage kidney disease and is receiving hemodialysis. Which of the following findings should the nurse identify as an indiction that the client is experiencing fluid overload?

The client has a 5 lb weight gain since yesterday. (The nurse should identify that a gain of 2 lb per day is stable. A gain of more than 2 lb per day or 5 lb per week is an indication of fluid overload.)