NRS233 Exam 1-Chapter 34 PrepU
A geriatric nurse is caring for several clients. Which alterations in health should the nurse attribute to age-related physiologic changes?
A 78-year-old woman's GFR has been steadily declining over several years.
Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct?
Kidneys convert inactive vitamin D to its active form, calcitriol.
A client has a marked decrease in the glomerular filtration rate (GFR); lab values with high blood urea nitrogen (BUN), potassium, and creatinine levels; urine output less than 10 mL/hr; 3+ pitting edema in the lower extremities; and BP 170/95. Which phase of acute tubular necrosis (ATN) does the nurse identify the client is in based on assessment data?
Maintenance phase
A 35-year-old female ultramarathon runner is admitted to hospital following a day-long, 80-km race because her urinary volume is drastically decreased and her urine is dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis. Why is her urine red?
Myoglobinuria
A client with a diagnosis of end-stage renal disease received a kidney transplant 2 years ago that was deemed a success. During the most recent follow-up appointment, the nurse should prioritize the client for referral based on which statement?
"I'm feeling a bit under the weather these days and I'm a bit feverish."
A client states, "I see my provider prescribed an glomerular filtration rate (GFR) to my usual blood work. Do you have to take an additional sample?" How should nurse respond?
"No additional sample is needed. The GFR can be calculated from your blood creatinine level."
With the increased risk of drug toxicity among chronically ill older adults, which statement by the nurse explains why the older adult's kidney is vulnerable to toxic injury?
"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney."
A client has developed chronic kidney disease (CKD). The nurse will advise the client to be alert for the development of which hematologic signs and symptoms associated with this disorder? Select all that apply. -Bruising -Gastrointestinal bleeding -Fatigue -Intravascular clotting -Bradycardia
-Bruising -Gastrointestinal bleeding -Fatigue
A client is diagnosed with decreased glomerular filtration rate but has no renal damage. The nurse recognizes this can occur with which disease process? Select all that apply. -Carbohydrate diet -Cirrhosis -Heart failure -Removal of one kidney -Dehydration
-Cirrhosis -Heart failure -Removal of one kidney -Dehydration
A client with chronic kidney disease (CKD) asks the nurse, "Why do I itch all the time?" The nurse bases there response on which integumentary physiologic factors that causes pruritis? Select all that apply. -Too harsh of soap while bathing -Decrease in perspiration -Limited sodium intake -Enlarged size of sweat glands -Elevated serum phosphate levels
-Decrease in perspiration -Elevated serum phosphate levels
A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that this client will experience which manifestations? Select all that apply. -Decreased renal endocrine function -Decreased tubular reabsorption -Proliferation of nephrons -Hypophosphatemia -Decreased glomerular filtration
-Decreased renal endocrine function -Decreased tubular reabsorption -Decreased glomerular filtration
The nurse is preparing to assess a client who has just been admitted to the hospital with a diagnosis of prerenal failure. Which would the nurse expect the client to manifest? Select all that apply. -Decreased urinary output -Increased BUN -BUN-to-serum creatinine ratio of greater than 20:1 -Increased urinary output -Decreased BUN -BUN to serum creatinine ratio of 10:1
-Decreased urinary output -Increased BUN -BUN-to-serum creatinine ratio of greater than 20:1
The parents of a child who has been diagnosed with chronic kidney disease (CKD) ask the nurse about manifestations of the disease. Which information is the most appropriate information to provide these parents? Select all that apply. -Developmental delay -Delayed cognitive development -Secondary hyperparathyroidism -Growth impairment -Accelerated sexual maturation -Early-onset puberty
-Developmental delay -Delayed cognitive development -Secondary hyperparathyroidism -Growth impairment
The nurse caring for a client with chronic kidney disease (CKD) would monitor for which early manifestations of uremia? Select all that apply. -Elevated blood glucose -Fatigue -Nausea -Apathy -Weakness
-Fatigue -Nausea -Apathy -Weakness
Glomerular filtration rate (GFR) is the best indicator of renal function. The nurse knows that GFR can vary with which factors? Select all that apply. -Gender -Age -Body size -Diet -Ethnicity
-Gender -Age -Body size -Ethnicity
The nurse will monitor the client with chronic kidney disease (CKD) for which possible cardiovascular changes? Select all that apply. -Heart failure -Hypertension -Hypophosphatemia -Impaired platelet function -Pericarditis
-Heart failure -Hypertension -Pericarditis
Which conditions have the potential to cause chronic kidney disease? Select all that apply. -Hypertension -Cardiomyopathy -Diabetes -Glomerulonephritis
-Hypertension -Diabetes -Glomerulonephritis
A child has received a kidney transplant at the age of 3. Knowing he will be on immunosuppressive agents like corticosteroids, the nurse should educate the parents about which long-term side effects? Select all that apply. -Excess weight loss -Hypertension -Frequent hematuria -Growth retardation -Development of cataracts
-Hypertension -Growth retardation -Development of cataracts
A client is diagnosed with acute renal injury. The nurse will evaluate the client for which possible causes of this disorder? Select all that apply. -Ischemic injury -Nonischemic reduced renal blood flow -Obstruction of urinary outflow -Hormonal imbalance -Nephrotoxic substances
-Ischemic injury -Nonischemic reduced renal blood flow -Obstruction of urinary outflow -Nephrotoxic substances
A client with chronic kidney disease who has renal osteodystrophy should be assessed for which complications? Select all that apply. -Muscle weakness -Kidney stones -Bone pain -Stress fractures -Urosepsis
-Muscle weakness -Bone pain -Stress fractures
The nurse knows that a client with chronic kidney disease (CKD) may experience which changes in skin integrity? Select all that apply. -Pale skin -Brittle fingernails -Moist skin and mucous membranes -Increased oil gland secretion -Decreased perspiration
-Pale skin -Brittle fingernails -Decreased perspiration
Many drugs and other nephrotoxic agents can induce nephrotic acute tubular necrosis (ATN). The nurse knows that these agents cause tubular injury by which mechanisms? Select all that apply. -Renal vasoconstriction -Hyponatremia -Intratubular obstruction -Renal vasodilation -Direct tubular damage
-Renal vasoconstriction -Intratubular obstruction -Direct tubular damage
A client is diagnosed with early chronic kidney disease (CKD). The nurse will recommend which actions to slow progression of renal damage? Select all that apply. -Smoking cessation -Blood pressure control -High-protein diet -Angiotensin converting enzyme (ACE) inhibitor administration -Blood glucose control
-Smoking cessation -Blood pressure control -Angiotensin converting enzyme (ACE) inhibitor administration -Blood glucose control
A client who is suspected of having acute kidney injury would first be assessed by which blood test(s)? Select all that apply. -blood urea nitrogen (BUN) -complete blood count (CBC) -creatinine -phosphorus
-blood urea nitrogen (BUN) -creatinine
The nurse is caring for a client with chronic kidney disease (CKD). The nurse suspects the client may have developed uremic pericarditis based on which sign(s) or symptom(s)? Select all that apply. -substernal discomfort -chest pain that is worse on inspiration -abnormal heart sounds -abdominal distension -purpuric rash on the torso
-substernal discomfort -chest pain that is worse on inspiration -abnormal heart sounds
The health care provider is comparing results of a client's recent GFR measurement. Which result would be interpreted as normal?
120 to 130 mL/minute
Accumulation of nitrogenous wastes such as urea in the circulatory system is an early sigh of chronic kidney disease (CKD). The nurse knows that normal levels of urea in blood are approximately:
20 mg/dL (7.14 mmol/L)
The nurse is caring for a client with chronic kidney disease (CKD). The nurse determines the client may consume how much fluid intake per day?
500 to 800 mL/day
A client is suspected to have chronic kidney disease (CKD). The nurse will use which glomerular filtration rate (GFR) to aid in this diagnosis?
60 mL/min/1.73 m2 or less for 3 months
The nurse is caring for a client with heart failure, which in turn is causing a prerenal problem. Which alteration in diagnostic studies does the nurse anticipate?
A BUN-Creatinine ratio of greater than 15:1
The nurse is educating a client with chronic kidney disease (CKD). What is the recommended daily fluid intake for this client?
A daily fluid intake of 500 to 800 mL/day to maintain hydration
The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents:
A loss of over half the client's normal kidney function.
Chronic kidney disease impacts many systems in the body. What is the most common hematologic disorder caused by CKD?
Anemia
A client has been diagnosed with chronic kidney disease (CKD). Which drug category is usually administered to treat coexisting conditions that manifest early in CKD?
Antihypertensive medications
Which clinical manifestation is the most common indicator of acute kidney injury?
Azotemia
A client with a history of chronic kidney disease (CKD) is experiencing increasing fatigue, lethargy, and activity intolerance. The care team has established that the client's glomerular filtration rate (GFR) remains at a low, but stable, level. Which laboratory assessments will most likely be prescribed to help determine the cause of these new symptoms?
Blood work for hemoglobin, red blood cells, and hematocrit
The health care provider is reviewing laboratory results of a client. Select the diagnostic test that is considered the best measurement of overall kidney function.
Glomerular filtration rate (GFR)
The nurse is caring for a client with chronic renal failure who is on hemodialysis three times a week. In order to treat hyperphosphatemia and hypocalcemia, which medication will the nurse administer to decrease absorption of phosphate from the gastrointestinal tract?
Calcium carbonate
The nurse knows that which medication causes cellular mitochondrial injury and deficient activity of ATP to power cellular functions?
Cisplatin
Which medical term describes a manifestation of bleeding disorders in clients with chronic kidney disease (CKD)?
Coagulopathies
An 80-year-old client with diabetes has a GFR of 41 mL/min/1.73 m2. His physical and workup show uremia, azotemia, and elevated BUN. Which action should be done first to slow the decline of his kidney function?
Control blood glucose and blood pressure
As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by:
Decrease in GFR of 60 to 89 mL/minute/1.73 m2
Client and family education regarding peritoneal dialysis should include assessing the client for:
Dehydration that may appear as dry mucous membranes or poor skin turgor.
A client with chronic kidney disease (CKD) is starting hemodialysis. Which diet will the dialysis nurse likely recommend?
Diet low in proteins but including eggs and lean meat
The nurse is instructing a client with advanced kidney disease (AKD) about a dietary regimen. Which restriction should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD?
Dietary protein
A 1-year-old baby boy with renal dysplasia risks end-stage renal disease unless intervention occurs. Which treatment option is his care team most likely to reject?
Dietary restriction plus erythropoietin
A client is beginning to recover from acute tubular necrosis. During which phase of acute kidney injury will the nurse assess an increase in urine output?
Diuretic phase
Several urine tests can be useful in establishing a diagnosis of acute kidney injury (AKI). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which type of drug?
Diuretics
A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is:
Dorsiflexion of hands and feet
Which dermatologic problem most often accompanies chronic kidney disease (CKD)?
Dry skin and pruritus
A client is being treated for chronic kidney disease (CKD). One of the nurse's responsibilities is to explain to the client the need to keep her blood pressure under control. Why is blood pressure control so important in CKD clients?
Elevated blood pressure will exacerbate nephron loss and accelerate renal failure.
Disorders of phosphate and calcium metabolism frequently occur in clients with chronic kidney disease (CKD). The nurse recognizes which statement regarding phosphate and calcium imbalances is correct?
Hypercalcemia can lead to osteodystrophy of CKD, which predisposes clients to cardiovascular disorders.
A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?
Hypertension
A client diagnosed with CKD has begun to experience periods of epistaxis and has developed bruising of the skin and subcutaneous tissues. The nurse recognizes these manifestations as:
Impaired platelet function
According to the Kidney Disease Outcome Quality Initiative (KDOQI) guidelines, in the first stage of kidney disease, the nurse will assess which finding?
Kidney damage with normal glomerular filtration rate (GFR)
In hemodialysis, access to the vascular system is most commonly through:
Internal arteriovenous fistula
A client sustained acute tubular injury approximately 2 hours ago. Which cause of acute kidney injury (AKI) would the nurse suspect the client is experiencing?
Intrarenal
The client with substance use disorder was found unconscious after overdosing on heroin 2 days prior. Because of prolonged pressure on the muscles the client has developed myoglobinuria, causing which complication?
Obstruction of the renal tubules with myoglobin and damaged tubular cells
A client with postrenal acute kidney injury (AKI) exhibits oliguria and edema with laboratory results revealing increased levels of urea, potassium, and creatinine. Based on these data, which phase of AKI is this client most likely experiencing?
Oliguric phase
A client with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which condition does the nurse suspect is common with this stage of kidney disease?
Pericarditis
While assessing a peritoneal dialysis client in the home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as:
Peritonitis
A client has an obstructive urine outflow related to benign prostatic hyperplasia. Due to the inability to excrete adequate amounts of urine, which type of renal failure should the nurse closely monitor for?
Postrenal failure
Phosphate excretion is impaired in chronic kidney disease (CKD), resulting in high serum phosphate levels and the development of phosphate crystals. Which manifestation of hyperphosphatemia should the nurse assess for?
Pruritus
Which symptom occurs in a client with chronic kidney disease (CKD) as a result of elevated serum phosphate levels and the development of phosphate crystals that occur with hyperparathyroidism?
Pruritus
The nurse recognizes that acute renal injury is characterized by which of the following?
Rapid decline in renal function
A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which intervention would be most appropriate for the nurse to provide?
Restrict intake of dietary protein
The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?
Serum creatinine
A client has experienced severe hemorrhage and is in prerenal acute kidney injury. The nurse anticipates the client's blood urea nitrogen (BUN) and serum creatinine laboratory results will be in which range?
The BUN-to-creatinine ratio is 20:1.
A client with significant burns on their lower body has developed sepsis on the third day following the accident. Which manifestation does the nurse anticipate for an ischemic acute tubular necrosis rather than prerenal failure?
The client's glomerular filtration rate does not increase after restoration of renal blood flow.
A 56-year-old woman has been diagnosed with CKD. She first went to the doctor due to complications of hypertension. How are hypertension and CKD related?
The mechanisms that produce hypertension in CKD include an increased vascular volume and increased activity of the renin-angiotensin-aldosterone system.
A client with chronic kidney disease (CKD) will be managed with peritoneal dialysis. Which description of this type of dialysis is most accurate?
Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time.
Acute kidney injury occurs at a high rate in client who are critically ill and in the intensive care unit. What is the most common indicator of acute kidney injury?
azotemia and a decrease in the glomerular filtration rate (GFR)
The nurse is caring for a client who has had acute blood loss from ruptured esophageal varices. What does the nurse recognize is an early sign of prerenal kidney injury?
baseline urine output of 50 ml/hr that is now 10 mlk/hr
A client with chronic kidney disease has been admitted with increased shortness of breath and abnormal breath sounds (rales heard to scapular region of posterior back). The admission hemoglobin level is 7.8 g/dL. Vital signs are as follows: respiratory rate 30; BP 180/98; pulse 110. +3 pitting edema in lower extremities bilaterally. Knowing the correlation of hypertension and associated anemia, the nurse suspects this client has developed:
heart failure.
A client is to receive a radiocontrast media as part of a diagnostic scan. Which intervention is intended to reduce the nephrotoxic effects of the radiocontrast media?
increasing the normal saline intravenous infusion rate prior to the exam
A client is being treated for acute pyelonephritis. The nurse will monitor the client for development of:
intrarenal failure
The health care provider has prescribed an aminoglycoside (gentamicin) for a client. Which complication is the client is at risk for?
nephrotoxic acute tubular necrosis
A 45-year-old client is being treated for ovarian cancer. The treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of which complication?
nephrotoxic acute tubular necrosis (ATN)
Which sign is one of the earliest manifestations of acute kidney injury (AKI)?
polyuria
An 86-year-old client is being treated for dehydration and hyponatremia after curtailing fluid intake to prevent urinary incontinence. Given these findings, the nurse recognizes that this client is likely in what phase of acute kidney injury?
prerenal
A client with chronic kidney disease (CKD) who is treated with hemodialysis reports poor sleep. For which complication common in clients with CKD should the nurse assess?
restless legs syndrome
An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after they curtailed their fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal kidney failure. The nurse should be assessing this client for which early sign of prerenal kidney injury?
sharp decrease in urine output
A client in acute kidney injury has marked decrease in renal blood flow caused by hypovolemia, the result of gastrointestinal bleeding. The nurse is aware that this form of acute kidney injury can be reversed if the bleeding is under control. Which form of acute kidney injury does this client have?
prerenal kidney injury
In addition to progressive permanent loss of nephrons, chronic kidney disease can result in which other consequence?
Loss of endocrine functions
The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney injury?
client with prostatic hyperplasia
