Prep U Kidneys

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 is in cardiogenic shock following a massive myocardial infarction. The client's family asks the nurse, "Why are the health care providers recommending dialysis since its the heart that is sick?" Which response by the nurse is most appropriate at this time?

"When a person has a large heart attack and goes into shock due to heart failure, there is a decrease in renal perfusion which allows toxins to increase in the blood."

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

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.

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 failure?

Baseline urine output of 50 mL/hr that is now 10 mL/hr

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 mostlikely be prescirbed to help determine the cause of these new symptoms?

Blood work for hemoglobin, red blood cells, and hematocrit

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

The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney failure?

Client with prostatic hyperplasia

Which medical term describes a manifestation of bleeding disorders in clients with chronic kidney disease (CKD)?

Coagulopathies

A client asks, "Why did my provider order a glomerular filtration rate (GFR) to my usual blood work?" The nurse's best response is based on the fact that GFR can estimate serum levels of which substance?

Creatinine

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 Decreased glomerular filtration

A new client presents with elevated BUN, systemic edema, a BP of 145/93 mm Hg, recurrent infections, and a GFR of 51 mL/min/1.73 m2. Which treatment should the nurse anticipate?

Dialysis

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

Several urine tests can be useful in establishing a diagnosis of acute renal failure (ARF). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which type of drug?

Diuretics

A child is diagnosed with chronic kidney disease (CKD). The nurse knows that which statements regarding supportive renal therapy in children are true? Select all that apply.

Early transplantation is the preferred treatment when considering long-term effects. Children older than 12 years will benefit from hemodialysis. Peritoneal dialysis is generally most appropriate for children younger than 6.

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)

A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?

Hypertension

In addition to progressive permanent loss of nephrons, chronic kidney disease can result in which other consequence?

Loss of endocrine functions

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

The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for:

Nephrotoxic acute tubular necrosis

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

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 in renal failure has marked decrease in renal blood flow caused by hypovolemia, the result of gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which form of acute renal injury does this client have?

Prerenal failure

The nurse recognizes that acute renal injury is characterized by which of the following?

Rapid decline in renal function

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?

Serum creatinine

An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which early sign of prerenal injury?

Sharp decrease in urine output

A client has experienced severe hemorrhage and is in prerenal failure. 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 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.

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.