Renal Critical Care Exam

The client arrives at the ED with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assess the client to determine a history of which condition? 1. Pyelonephritis 2. Glomerulonephritis 3. Trauma to the bladder or abdomen 4. Renal cancer in the clients family

3 Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever and are thus not applicable to the client described in the question. Renal cancer would not cause pain that is felt in the low abdomen; rather, the pain would be in the flank area.

The nurse is reviewing a client's record and notes that the health care provider 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 level 2. Decreased hemoglobin level 3. Decreased RBC count 4. Increased number of white blood cells in the urine

1 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 hemoglobin level and RBC count are associated with anemia or blood loss and not specifically with decreased renal function. Increased WBCs in the urine are noted with UTI.

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 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 a not indicative of fistula patency. Although the presence of a radial pulse in the left wrist and capillary 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 is admitted to the ED following a fall from a horse and the HCP prescribes insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? 1. Notify the HCP before performing the catheterization. 2. Use a small-sized catheter and an anesthetic gel as a lubricant. 3. Administer parenteral pain medication before inserting the catheter. 4. Clean the meatus with soap and water before opening the catheterization kit.

1 The presence of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse notifies the HCP, knowing that the client should not be catheterized until the caues of the bleeding is determined by diagnostic testing. The other options include performing the catheterization procedure and therefore are incorrect.

A client with AKI has a serum potassium level of 7.0 mEq/L. The nurse should plan which actions as a priority. Select all that apply. 1. Place the client on a 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 potassium 5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration

1, 2, 4 The potassium level is elevarted. The client is at risk for 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 fluid overload and would not affect the serum potassium level significantly.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse should take which actions? 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, 2, 4, 5 If outflow drainage is inadequate, the nurse attemps 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 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. The priority action for the nurse is to: (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 Rapid Response team. 4. Stop dialysis and turn the client on the left side with head lower than feet. 5. Bolus the client with 500 mL of normal saline to break up the air embolus.

1, 3, 4 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 embolus or prevent complications.

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, 3, 4 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 trasnplant. Clients usually undergo bilateral nephrectomy to remove the large, painful, cyst-filled kidneys. Peritoneal dialysis is not an option due to the infected cysts. The condition does not respond to immunosuppression.

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 38.5C (101.2F). 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 A temperature of 101.2F 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 nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination? 1. Fever, diarrhea, groin pain, and ecchymosis 2. Nausea, painful scrotal edema, and ecchymosis 3. Fever, nausea, vomiting, and painful scrotal edema 4. Diarrhea, groin pain, testicular torsion, and scrotal edema

3 Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are accompanied by fever, nausea and vomiting, and chills. Epididymitis most often is caused by infection, although sometimes it can be caused by trauma. The remaining options do not present all of the accurate manifestations.

A week after kidney transplantation, a client develops a temperature of 101F, the blood pressure is elevated, and there is tenderness over the transplanted kidney. The serum creatinine is rising and urine output is decreased. The x-ray indicates that the transplanted kidney is enlarged. Based on these assessment findings, the nrse anticipates which treatment. 1. Antibiotic therapy 2. Peritoneal dialysis 3. Removal of the transplanted kidney 4. Increased immunosuppression therapy

4 Acute rejection often occurs within one week after transplantation but can occur anytime posttransplantation. Clinical manifestations include fever, malaise, elevated WBC count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Treatment consists of increasing immunosuppresive therapy. Antibiotics are used to treat infection. Peritoneal dialysis cannot be used with a newly transplanted kidney due to the recent surgery. Removal of the transplanted kidney is indicated with acute rejection, which occurs within 48 hours of the transplant surgery.

The nurse is collecting data from a client. Which symptom described by the client is a characteristic of an early symptom of benign prostatic hyperplasia? 1. Nocturia 2. Scrotal edema 3. Occasional constipation 4. Decreasead force in the stream of urine

4 Decreased force in the stream of urine is an early symptom of benign prostatic hyperplasia. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, compelte obstruction and urinary retention can occur. Constipation or scrotal edema is not associated with benign prostatic hyperplasia.

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 manifestations? 1. Hypertension, tachycardia, and fever 2. Hypotension, bradycardia, and hypothermia 3. Restlessness, irritability, and generalized weakness 4. Headache, deteriorating LOC, and twitching

4 Disequilibrium syndrome is characterized by headache, mental confusion, decreasing LOC, nausea, vomiting, 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 ICP and onset of symptoms. The syndrome most often occurs in clients 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 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 head of the bed. 3. Assess the fistula site and dressing. 4. Notify the HCP.

4 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 anticonvulusive medications and barbiturates may be necessary to prevent a life-threatening situation. The HCP must be notified. Monitoring the client, elevating the head of the bed, and assessing the fistula site are correct actions, but the priority action is to notify the HCP.

A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the HCP? 1. Red, bloody urine 2. Pain rates as a 2 on a 0-10 scale 3. Urinary output of 200 mL higher than intake 4. Blood pressure 100/50 mmHg, pulse 130 bpm

4 Frank bleeding (arterial or venous) may occur during the first day after surgery. Some hematuria is usual for several days after surgery. A urinary output of 200 mL more than intake is adequate. A client pain rating of 2 on a 0-10 scale inidcates adequate pain control. A paid pulse with a low blood pressure is a potential sign of excessive blood loss. The HCP should be notified.

A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the prostatic examination for which characteristic of this disorder? 1. Soft and swollen prostate gland 2. Swollen and boggy prostate gland 3. Tender and edematous prostate gland 4. Tender, indurated prostate gland that is warm to the touch

4 The client with bacterial prostatitis has a swollen and tender prostate gland that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection, which often accompany the disorder.

A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder? 1. Hematuria and pyuria 2. Dysuria and proteinuria 3. Hematuria and urgency 4. Dysuria and penile discharge

4 Urethritis in the male client often results from chalmydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays. Hematuria is not associated with urethritis. Proteinuria is associated with kidney dysfunction.

A client with severe back pain and hematuria is found to have hydronephrosis due to urolithiasis. The nurse anticipates which treatment will be done to relieve the obstruction. Select all that apply. 1. Peritoneal dialysis 2. Analysis of the urinary stone 3. Intravenous opioid analgesics 4. Insertion of a nephrectomy tube 5. Placement of a ureteral stent with ureteroscopy

4, 5 Urolithiasis is the condition that occurs when a stone forms in the urinary system. Hydronephrosis develops when the stone has blocked the ureter and urine backs up and dilates and damages the kidney. Priority treatment is to allow the urine to drain and relieve the obstruction in the ureter. This is accomplished by placement of a percutaneous nephrostomy tube to drain urine from the kidney and placement of a ureteral stent to keep the ureter open. Peritoneal dialysis is not needed since the kidney is functioning. Stone analysis will be done later when the stone has been retrieved and analyzed. Opioid analgesics are necessary for pain relief but do not treat the obstruction.

The enterostomal therapist is consulting with the surgeon regarding placement of a urinary stoma. Which of the following locations should be suggested? A. Lower abdominal quadrants B. Pubic area C. Rib margins D. Umbilical area

A

The nurse is providing instructions to a client about continuous ambulatory peritoneal dialysis (CAPD). Which of the following information would be included in discussions with this client? A. There are four daily cycles with an 8 hour dwell for one cycle during the night. B. A small, lightweight pump must be carried in a pocket or on a belt. C. This eliminates the need for strict aseptic technique when handling the catheter. D. The procedure involves instilling 250-500 mL of fluid into the abdomen at a time.

A

The nurse would monitor which of the following laboratory values to monitory the effect of epoetin alpha being given to a client with chronic renal failure? A. Hematocrit B. BUN C. Leukocyte count D. Serum creatinine

A

A patient on a medical unit has a potassium level of 6.8 mEq/L. What is the priority action that the nurse should take? A. Place the patient on a cardiac monitor. B. Check the patient's blood pressure. C. Instruct the patient to avoid high-potassium foods. D. Call the lab and request a redraw of the lab to verify results.

A Dysrhythmias may occur with an elevated potassium level and are potentially lethal. Monitor the rhythm while contacting the HCP or calling the rapid response team. Vital signs should be checked. Depending on the patien'ts history and cause of increased potassium, instruct the patient about dietary sources of potassium; however, this would not help at this point. The nurse may want to recheck the value, but until then the heart rhythm must be monitored.

Which complication of chronic kidney disease is treated with erythropoietin (EPO)? A. Anemia B. Hypertension C. Hyperkalemia D. Mineral and bone disorder

A Erythropoietin is used to treat anemia, as it stimulates the bone marrow to produce RBCs.

During the immediate postoperative care of a recipient of a kidney transplant, what is a priority for the nurse to do? A. Regulate fluid intake hourly based on urine output. B. Monitor urine-tinged drainage on abdominal dressing. C. Medicate the patient frequently for incisional flank pain. D. Remove the urinary catheter to evaluate the ureteral implant.

A Fluid and electrolyte balance is the priority in the transplant recipient patient, especially because diuresis often begins soon after surgery. Fluid replacement is adjusted hourly based on kidney function and urine output. Urine-tinged drainage on the abdominal dressing may indicate leakage from the ureter implanted into the bladder, and the HCP should be notified. The recipient has an abdominal incision where the kidney was placed int he iliac fossa. The urinary catheter is usually used for 2 to 3 days to monitor urine output and kidney function.

A patient received a kidney transplant last month. Because of the effects of immunosuppressive drugs and CKD, what complication of transplantation should the nurse be assessing the patient for to decrease the risk of mortality? A. Infection B. Rejection C. Malignancy D. Cardiovascular disease

A Infection is a significant cause of morbidity and mortality after transplantation becaues the surgery, immunosuppresive drugs, and effects of CKD all suppress the body's normal defense mechanisms, thus increasing the risk of bacterial, fungal, and viral infections. The nurse must assess the patient as well as use aseptic technique to prevent infections. Rejection may occur but for other reasons. Malignancy occurrence increases later due to immunosuppressive therapy. Cardiovascular disease is the leading cause of death after renal transplantation as it is with CKD, but this would not be expected to cause death within the first month after transplantation.

A man with end-stage renal disease (ESRD) is scheduled for HD following healing of an arteriovenous fistula (AVF). What should the nurse explain to him that will occur during dialysis? A. He will be able to visit, read, sleep, or watch TV while reclining in a chair. B. He will be placed on a cardiac monitor to detect any adverse effects that may occur. C. The dialyzer will remove and hold part of his blood for 20 to 30 minutes to remove the waste products. D. A large catheter with two lumens will be inserted into the fistula to send blood to and return it from the dialyzer.

A While patients are undergoing HD, they can perform quiet activities that do not require the limb that has the vascular access. Blood pressure is monitored frequently and the dialyzer monitors dialysis function, but cardiac monitoring is not usually indicated. The HD machine continuously circulates both the blood and the dialysate past the semipermeable membrane in the machine. Graft and fistula access involve the insertion of two needles into the site: one to remove blood from and the other to return blood to the dialyzer. A double lumen catheter is used for temporary access.

A nurse is planning care for a client who has postrenal AKI due to metastatic cancer. The client has a serum creatinine of 5mg/dL. Which of the following interventions should the nurse include in the plan? (Select all that apply.) A. Provide a high-protein diet. B. Assess the urine for blood. C. Monitor for intermittent anuria. D. Weigh the client once per week. E. Provide NSAIDs for pain.

A, B, C A high protein diet should be provided due to the high rate of protein breakdown that occurs with AKI. The nurse should assess urine for blood, stones, and particles indicating an obstruction of the urinary structures that leave the kidney. The nurse should assess for intermittent anuria due to obstruction or damage to the kidneys or urinary structures. The client should be weighted daily to monitor for fluid retention. NSAIDs are nephrotoxic.

A nurse is planning postprocedure care for a client who received hemodialysis. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Check BUN and serum creatinine. B. Administer medications the nurse withheld prior to dialysis. C. Observe for signs of hypovolemia. D. Assess the access site for bleeding. E. Evaluate blood pressure on the arm with AV access.

A, B, C, D The nurse should check the BUN and creatinine to determine the presence and degree of uremia or waste products that remain following dialysis. Withheld medications should be administered after dialysis. A client who is post dialysis is at risk for hypovolemia due to a rapid decrease in fluid volume. The nurse should assess the access site for bleeding because the client receives heparin during the procedure to prevent clotting of blood. The nurse should never measure blood pressure on the extremity that has the AV access site because it can cause collapse of the AV fistula or graft.

Prevention of AKI is important because of the high mortality rate. Which patients are at increased risk for AKI (select all that apply)? A. An 86-year-old woman scheduled for a cardiac catheterization B. A 48-year-old man with multiple injuries from a motor vehicle accident C. A 32-year-old woman following a C-section delivery for abruptio placentae D. A 64-year-old woman with chronic heart failure admitted with bloody stools E. A 58-year-old man with prostate cancer undergoing preoperative workup for prostatectomy

A, B, C, D, E High-risk patients include those exposed to nephrotoxic agents and advanced age (A), massive trauma (B), prolonged hypovolemia or hypotension (possibly B, C, and D), obstetric complications (C), cardiac failure (D), preexisting chronic kidney disease (CKD), extensive burns, or sepsis. Patients with prostate cancer may have obstruction of the outflow tract, which increases risk of postrenal AKI (E).

A nurse is caring for a client who has type 2 diabetes mellitus and will have excretory urography. Prior to the procedure, which of the following actions should the nurse take? (Select all that apply.) A. Identify an allergy to seafood. B. Withhold metformin for 24 hr. C. Administer an enema. D. Obtain a serum coagulation profile. E. Assess for asthma.

A, B, C, E Clients who have an allergy to seafood are at higher risk for an allergic reaction to the contrast dye they will receive during the procedure (A). Clients who take metformin are at risk for lactic acidosis from the contrast dye with iodine they will receive during the procedure (B). Clients should receive an enema to remove fecal contents, fluid, and gas from the colon for a more clear visualization (C). Clients who have asthma have a higher risk of an exacerbation as an allergic response to the contrast dye they will receive during the procedure (D). A serum coagulation profile is essential for a client prior to a kidney biopsy because of the risk of hemorrhage from the procedure (D).

A nurse is planning care for a client who has Stage 4 CKD. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Assess for jugular vein distension. B. Provide frequent mouth rinses. C. Auscultate for a pleural friction rub. D. Provide a high-sodium diet. E. Monitor for dysrhythmias.

A, B, C, E Jugular vein distention can indicate fluid overload and heart failure. Frequent mouth rinses should be provided due to uremic halitosis caused by urea waste in the blood. The nurse should auscultate for a pleural friction rub related to respiratory failure and pulmonary edema caused by acid base imbalances and fluid retention. Dysrhythmias can be related to increased serum potassium caused by Stage 4 CKD.

The patient with CKD is receiving dialysis, and the nurse observes excoriations on the patient's skin. What pathophysiologic changes in CKD most likely occur that can contribute to this finding (select all that apply)? A. Dry skin B. Sensory neuropathy C. Vascular calcifications D. Calcium-phosphate skin deposits E. Uremic crystallization from high BUN

A, B, D Pruritis is common in patients receiving dialysis. It causes scratching from dry skin, sensory neuropathy, and calcium-phosphate deposition in the skin. Vascular calcifications contribute to cardiovascular disease, not to itching skin. Uremic frost rarely occurs without BUN levels greater than 200 mg/dL, which should not occur in a patient on dialysis; urea crystallizes on the skin and also causes pruritis.

A nurse is preparing to initiate hemodialysis for a client who has acute kidney injury. Which of the following actions should the nurse take? (Select all that apply.) A. Review the medications the client currently takes. B. Assess the AV fistula for a bruit. C. Calculate the client's hourly urine output. D. Measure the client's weight. E. Check serum electrolytes. F. Use the access site area for venipuncture.

A, B, D, E By reviewing the medications the client currently takes, the nurse can determine which meds to withhold until after dialysis (A). Assessing the AV fistula for a bruit determines the patency of the fistula for dialysis (B). Measuring the client's weight before dialysis is essential for comparing it with the client's weight after dialysis (D). Checking the serum electrolytes determines the need for dialysis (E). The clients hourly urine output can vary with the remaining kidney function and does not determine the need for dialysis (C). The nurse should never use the access site area for venipuncture because compression from the tourniquet can cause loss of the vascular access.

A nurse is planning care for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse take? (Select all that apply.) A. Monitor serum glucose levels. B. Report cloudy dialysate return. C. Warm the dialysate in a microwave oven. D. Assess for SOB. E. Check the access site dressing for wetness. F. Maintain medical asepsis when accessing the catheter insertion site.

A, B, D, E Monitor serum glucose levels because the dialysate solution contains glucose. Cloudy dialysate return indicates infection. Clear, light-yellow solution is typical during the outflow process. SOB indicates inability to tolerate a large volume of dialysis. Wetness at the access site, along with kinking, pulling, clamping, or twisting of the tubing, can increase the risk for exit-site infections.

Which drugs will be used to treat the patient with CKD for mineral and bone disorder (select all that apply)? A. Cinacalcet (Sensipar) B. IV glucose and insulin C. Calcium acetate (Eliphos) D. IV 10% calcium gluconate E. Sevelamer carbonate (Renvela)

A, C, E Cinacalcet (Sensipar), a calcimimetic agent to control secondary hyperparathyroidism; calcium acetate, a calcium-based phosphate binder, and sevelamer carbonate (Renvela), a non-calcium-based phosphate binder, are used to treat mineral and bone disorder in CKD. IV glucose and insulin and IV 10% calcium gluconate along with sodium polystyrene sulfonate (Kayexalate) are used to treat the hyperkalemia of CKD.

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

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.

A client, newly diagnosed with chronic renal failure, has recently begun hemodialysis. The nurse, establishing the client's plan of care, includes monitoring the client for disequilibrium syndrome. Which of the following symptoms will the nurse assess the client for? A. Headache, nausea, vomiting, altered level of consciousness, and hypotension B. Headache, nausea, vomiting, altered level of consciousness, and hypertension C. Muscle cramps, seizure activity D. Chills, fever, shortness of breath, and discolored urine

B

A nurse is evaluating a client's demonstration of peritoneal dialysis. Which of the following actions by the client demonstrates a need for further teaching? A. Primes the tubing with solution and connects it to the peritoneal catheter, taping connections. B. Instills the dialysate into the abdominal cavity quickly and clamps the tubing. C. Checks the tubing and catheter for kinks. D. Opens clamps and allows the dialysate to drain by gravity after the prescribed dwell time.

B

The nurse is conducting peritoneal dialysis for a client with renal failure. The drainage tubing had no outflow. Which of the following actions should the nurse take first? A. Notify the physician B. Check the tubing for kinks or obstruction C. Try a more concentrated dialysate solution. D. Apply a 5 pound sandbag to the abdomen

B

What dietary regime would the nurse encourage clients who are receiving peritoneal dialysis to engage in? A. High carbohydrate diet B. High protein intake C. Low fat, low sodium diet D. High fat, high carbohydrate diet

B

What is the filter called that functions as an artificial kidney in hemodialysis? A. Hemolyzer B. Dialyzer C. Nephrolyzer D. Kidneyzer

B

What is the most common complication of peritoneal dialysis? A. Urinary retention B. Peritonitis C. Abdominal pain D. Infiltration

B

Mrs. V is a client with oliguric acute renal failure. Which of the following clinical manifestations would be consistent with that diagnosis? A. Urine specific gravity of 1.001 B. Bun:creatinine ration of 30:1 C. Proteinuria D. Hematuria

B (normal is between 10:1 and 20:1)

What is the primary way that a nurse will evaluate the patency of an AVF? A. Palpate for pulses distal to the graft site. B. Auscultate for the presence of a bruit at the site. C. Evaluate the color and temperature of the extremity. D. Assess for the presence of numbness and tingling distal to the site.

B A patent arteriovenous fistula (AVF) creates turbulent blood flow that can be assessed by listening for a bruit or palpated for a thrill as the blood passes through the graft. Assessment of neurovascular status in the extremity distal to the graft site is important to determine that the graft does not impair circulation to the extremity, but the neurovascular status does not indicate whether the graft is open.

In a patient with AKI, which laboratory urinalysis result indicates tubular damage? A. Hematuria B. Specific gravity fixed at 1.010 C. Urine sodium of 12 mEq/L (12mmol/L) D. Osmolality of 1000 mOsm/kg (1000 mmol/kg)

B A urine specific gravity that is consistently 1.010 and a urine osmolality of about 300 mOsm/kg is the same specific gravity and osmolality as plasma. This indicates that tubules are damages and unable to concentrate urine. Hematuria is more common with postrenal damage. Tubular damage is associated with a high sodium concentration (greater than 40 mEq/L).

In which type of dialysis does the patient dialyze during sleep and leave the fluid in the abdomen during the day? A. Long nocturnal hemodialysis B. Automated peritoneal dialysis (APD) C. Continuous venovenous hemofiltration (CVVH) D. Continuous ambulatory peritoneal dialysis (CAPD)

B Automated peritoneal dialysis (APD) is the type of dialysis in which the patient dialyzes during sleep and leaves the fluid in the abdomen during the day. Long nocturnal HD occurs while the patient is sleeping and is done up to six times per week. Continuous venovenous hemofiltration (CVVH) is a type of continuous RRT used to treat AKI. Continuous ambulatory peritoneal dialysis (CAPD) is dialysis that is done with exchanges of 2 to 3 L of dialysate at least four times daily.

The patient with CKD asks why she is receiving nifedipine (Procardia) and furosemide (Lasix). The nurse understands that these drugs are being used to treat the patient's A. anemia. B. hypertension. C. hyperkalemia. D. mineral and bone disorder.

B Both are used to treat hypertension. Nifedipine (Procardia) is a calcium channel blocker, and furosemide (Lasix) is a loop diuretic that can help decrease potassium.

To prevent the most common serious complication of PD, what is important for the nurse to do? A. Infuse the dialysate slowly B. Use strict aseptic technique in the dialysis procedures. C. Have the patient empty the bowel before the inflow phase. D. Reposition the patient frequently and promote deep breathing.

B Exit site infection and peritonitis are common complications of peritoneal dialysis (PD) and may rquire catheter removal and termination of dialysis. Infection occurs from contamination of the dialysate or tubing or from progression of exit-site or tunnel infections, and strict sterile technique must be used by health care professionals as well as the patient to prevent contamination. Too-rapid infusion may cause shoulder pain, and pain may be caused if the catheter tip touches the bowel. Difficulty breathing, atelectasis, and pneumonia may occur from pressure of the fluid on the diaphragm, which may be prevented by elevating the head of the bed and promoting repositioning and deep breathing.

What is the most serious electrolyte disorder associated with kidney disease? A. Hypocalcemia B. Hyperkalemia C. Hyponatremia D. Hypermagnesemia

B Hyperkalemia can lead to life-threatening dysrhythmias. Hypocalcemia leads to an accelerated rate of bone remodeling and potentially to tetany. Hyponatremia may lead to confusion. Elevated sodium levels lead to edema, hypertension, and heart failure. Hypermagnesemia may decrease reflexes, mental status, and blood pressure.

Priority Decision: A dehydrated patient is in the injury stage of the RIFLE staging of AKI. What would the nurse first anticipate in the treatment of this patient? A. Assessment of daily weight B. IV administration of fluid and furosemide (Lasix) C. IV administration of insulin and sodium bicarbonate D. Urinalysis to check for sediment, osmolality, sodium, and specific gravity

B Injury is the stage of RIFLE classification in which urine output is less than 0.5 mL/kg/hr for 12 hours, the serum creatinine is increased times two, or the glomerular filtration rate (GFR) is decreased by 50%. This stage may be reversible by treating the cause or, in this patient, the dehydration by administering IV fluid and a low dose of a loop diuretic., furosemide (Lasix). Asswssing the daily weight will be done to monitor fluid changes, but it is not the first treatment the nurse should anticipate. IV administration of insulin and sodium bicarbonate would be used for hyperkalemia. Checking the urinalysis will help to determine if the AKI has a prerenal, intrarenal, or postrenal cause by what is seen in the urine. With this patient's dehydration, it is thought to be prernal to begin treatment.

In replying to a patient's questions about the seriousness of her chronic kidney disease (CKD), the nurse knows that the stage of CKD is based on what? A. Total daily urine output B. Glomerular filtration rate (GFR) C. Degree of altered mental status D. Serum creatinine and urea levels

B Stages of chronic kidney disease are based on the GFR. No specific markers of urinary output, mental status, or azotemia classify the seriousness of chronic kidney disease (CKD).

A nurse is review client laboratory data. The nurse should recognize that which of the following findings is expected for a client who has Stage 4 CKD? A. BUN 15 mg/dL B. GFR 20 mL/min C. Serum creatinine 1.1 mg/dL D. Serum potassium 5.0 mEq/L

B The GFR is severely decreased to approximately 20 mL/min, which is indicative of stage 4 CKD.

A nurse is monitoring a client who had a kidney biopsy for postoperative complications. Which of the following complications should the nurse identify as causing the greatest risk to the client? A. Infection B. Hemorrhage C. Hematuria D. Pain

B The greatest risk to a client following a kidney biopsy is hemorrhage due to a lack of clotting at the puncture site. The nurse should report this finding to the provider immediately. All other options are risks, however they are not the priority.

A 68-year-old man with a history of heart failure resulting from hypertension has AKI as a result of the effects of nephrotoxic diuretics. Currently his serum potassium is 6.2 mEq/L (6.2 mmol/L) with cardiac changes, his BUN is 108 mg/dL (38.6 mmol/L), his serum creatinine is 4.1 mg/dL (362 mmol/L), and his serum HCO3 is 14 mEq/L (14 mmol/L). He is somnolent and disoriented. Which treatment should the nurse expect to be used for him? A. Loop diuretics B. Renal replacement therapy C. Insulin and sodium bicarbonate D. Sodium polystyrene sulfonate (Kayexalate)

B This patient has at least three of the six common indications for renal replacement therapy (RTT), including (1) high potassium level, (2) metabolic acidosis, and (3) changed mental status. The other indications are (4) volume overload, resulting in compromised cardiac status (this patient has a history of hypertension), (5) BUN greater than 120 mg/dL, and (6) pericarditis, pericardial effusion, or cardiac tamponade. Although the other treatments may be used, they will not be as effective as RRT for this older patient. Loop diuretics and increased fluid are used if the patient is dehydrated. Insulin and sodium bicarbonate can be used to temporarily drive the potassium into the cells. Sodium polystyrene sulfonate (Kayexalate) is used to actually decrease the amount of potassium in the body.

A client is admitted for emergency dialysis for newly diagnosed chronic renal failure. The nurse recognizes that which of the following laboratory values poses the greatest risk to the client? A. BUN 40 mg/mL B. Serum creatinine 5.8 C. Potassium 7.0 mEq/L D. pH 7.30

C

How often must hemodialysis be performed in order to be effective? A. Every day B. Twice a week C. Three times a week D. Four times a week and prn

C

In peritoneal dialysis, which anatomic area acts as the filter for this method of dialysis? A. The lining of the stomach B. The lining of the small intestine C. The lining of the peritoneum D. The lining of the abdomen

C

The nurse determines that which of the following types of antibiotics being prescribed for one or more of a group of clients is least likely to cause nephrotoxicity? A. A cephalosporin B. An aminoglycoside C. A penicillin D. A sulfonamide

C

The nurse is caring for Mr. P, a chronic dialysis patient who has an arteriovenous fistula. Nursing care of the fistula should include: A. Irrigating the fistula with heparin to prevent clotting. B. Frequent dressing changes to prevent infection C. Washing the fistula site with soap and water D. Checking blood pressure in the arm with the fistula to see if circulation is adequate

C

The nurse notes in the first few exchanges during peritoneal dialysis of Mrs. H that the effluent is pink-tinged. Which of the following is the most appropriate action? A. Stop the dialysis immediately. B. Notify the physician. C. Continue the dialysis and observe. D. Send a specimen of the effluent for culture.

C

The nurse performing intermittent peritoneal dialysis notes that the client's medical record shows that the client has not had a bowel movement for 3 days. The nurse would be careful to assess the client for which of the following manifestations related to this information? A. Fluid leakage B. Cloudy dialysate output C. Reduced catheter outflow D. Increased thirst

C

Which of the following is the most common overall sign of acute renal failure? A. Hypokalemia B. Hypercalcemia C. Hyponatremia D. Hypocalcemia

C

A patient on HD develops a thrombus of subcutaneous arteriovenous graft (AVG), requiring its removal. While waiting for a replacement graft or fistula, the patient is most likely to have what done for treatment? A. Peritoneal dialysis B. Peripheral vascular access using radial artery C. Long-term cuffed catheter tunneled subcutaneously to the jugular vein D. Peripherally inserted central catheter (PICC) line inserted into subclavian vein

C A more permanent, soft, flexible double-lumen catheter is used for long-term access when other forms of vascular access have failed. These catheters are tunneled subcutaneously and have Dacron cuffs that prevent infection from tracking along the catheter. Because the patient has chosen HD, APD would not be started. The peripheral vessels and PICC lines are not used for HD.

A nurse administered captopril to a client during a renal scan. Which of the following actions should the nurse take? A. Assess for hypertension. B. Limit the client's fluid intake. C. Monitor for orthostatic hypotension. D. Encourage early ambulation.

C Captopril is an antihypertensive medication, so the nurse should monitor for hypotensive effects. The nurse should monitor for orthostatic hypotension because this is an adverse effect of captopril. This results in a change in blood flow to the kidneys after the initial dose. Increasing the client's fluid intake can help resolve hypotensive effects following the administration of captopril. The client is at risk for falls wen ambulating due to the hypotensive effects of captopril so the nurse should encourage the client to stay in bed.

A patient with AKI is a candidate for continuous renal replacement therapy (CRRT). What is the most common indication for use of CRRT? A. Pericarditis B. Hyperkalemia C. Fluid overload D. Hypernatremia

C Continous renal replacement therapy (CRRT) is indicated for the patient with AKI as an alternative or adjunct to HD to slowly remove solutes and fluid in the hemodynamically unstable patient. It is especially useful for treatment of fluid overload, but HD is indicated for treatment of hyperkalemia, pericarditis, or other serious effects of uremia.

What does the dialysate for PD routinely contain? A. Calcium in a lower concentration than in the blood B. Sodium in a higher concentration than in the blood C. Dextrose in a higher concentration than in the blood D. Electrolytes in an equal concentration to that of the blood

C Dextrose or icodextrin or amino acid is added to dialysate fluid to create an osmotic gradient across the membrane to remove excess fluid from the blood. Dialysate usually contains higher calcium to promote its movement into the blood. DIalysate sodium is usually less than or equal to that of blood to prevent sodium and fluid retention. The dialysate fluid has no potassium so that potassium will diffuse into the dialysate from the blood.

What causes the gastrointestinal (GI) manifestation of stomatitis in the patient with CKD? A. High serum sodium levels B. Irritation of the GI tract from creatinine C. Increased ammonia from bacterial breakdown of urea D. Iron salts, calcium-containing phosphate binders, and limited fluid intake

C Increased ammonia in saliva, from bacterial breakdown of urea leads to stomatitis and mucosal ulcerations. Uremic fetor, or the urine odor of the breath, is caused by high urea content in the blood. Irritation of the GI tract from urea in CKD contributes to anorexia, nausea, and vomiting. Ingestion of iron salts and calcium-containing phosphate binders, limited fluid intake, and limited activity cause constipation.

The patient with CKD is brought to the emergency department with Kussmaul respirations. What does the nurse know about CKD that could cause this patient's Kussmaul respirations? A. Uremic pleuritis is occurring. B. There is decreased pulmonary macrophage activity. C. They are caused by respiratory compensation for metabolic acidosis. D. Pulmonary edema from heart failure and fluid overload is occurring.

C Kussmaul respirations occur with severe metabolic acidosis when the respiratory system is attempting to compensate by removing carbon dioxide with exhalations. Uremic pleuritis would cause a pleural friction rub. Decreased pulmonary macrophage activity increases the risk of pulmonary infection. Dyspnea would occur with pulmonary edema.

During the nursing assessment of the patient with renal insufficiency, the nurse asks the patient specifically about a history of A. Angina B. Asthma C. Hypertension D. Rheumatoid arthritis

C The most common causes of CKD in the United States are diabetes mellitus and hypertension. The nurse should obtain information on long-term health problems that are related to kidney disease. The other disorders are not clearly associated with renal disease.

A nurse is caring for a client who develops equilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take? A. Administer an opiod medication. B. Monitor for hypertension. C. Assess LOC. D. Increase the dialysis exchange rate.

C The nurse should assess the client's LOC. A change in urea levels can cause increase ICP. Subsequently, the client's LOC decreases.

A nurse is reviewing the results of a client's urinalysis. The findings indicate the urine is positive for leukocyte esterase and nitrites. Which of the following actions should the nurse take? A. Repeat the test early the next morning. B. Start a 24 hour urine collection for creatinine clearance. C. Obtain a clean-catch urine specimen for culture and sensitivity. D. Insert an indwelling urinary catheter to collect a urine specimen.

C The nurse should obtain a clean-catch urine specimen for culture and sensitivity. This test will identify which antibiotic will be most effective for treating the client's UTI. Repeating the test will not change the urinalysis results. A 24-hr urine collection for creatinine helps to determine kidney function. The nurse should insert a urinary catheter to collect urine when a client cannot empty his bladder.

A nurse is planning care for a client who has prerenal AKI following abdominal aortic aneurysm repair. Urinary output is 60 mL in the past 2 hr, and blood pressure is 92/58 mmHg. The nurse should anticipate which of the following interventions? A. Prepare the client for a CT scan with contrast dye. B. Plan to administer nitroprusside. C. Prepare to administer a fluid challenge. D. Plan to position the client in Trendelenburg.

C The nurse should plan to administer a fluid challenge for hypovolemia, which is indicated by the client's low urinary output and blood pressure.

A nurse is assessing a client who has prerenal AKI. Which of the following findings should the nurse expect? (Select all that apply.) A. Reduced BUN B. Elevated cardiac enzymes C. Reduced urine output D. Elevated serum creatinine E. Elevated serum calcium

C, D, E Manifestations of prerenal AKI include reduced urine output, elevated serum creatinine and elevated serum calcium. BUN will be elevated, not reduced. Cardiac enzymes are indicative of a cardiac tissue injury, not AKI.

An 83-year-old female patient was found lying on the bathroom floor. She said she fell 2 days ago and has not been able to take her heart medicine or eat or drink anything since then. What conditions could be causing prerenal AKI in this patient (select all that apply)? a. Anaphylaxis b. Renal calculi c. Hypovolemia d. Nephrotoxic drugs e. Decreased cardiac output

C, E Because the patient has had nothing to eat or drink for 2 days, she is probably dehydrated and hypovolemic. Decreased cardiac output (CO) is most likely because she is older and takes heart medicine, which is probably for heart failure or hypertension. Both hypovolemia and decreased CO cause prerenal AKI but is not likely in this situation. Nephrotoxic drugs would contribute to intrarenal causes of AKI, and renal calculi would be a postrenal cause of AKI.

The patient with chronic kidney disease is considering whether to use peritoneal dialysis (PD) or hemodialysis (HD). What are advantages of PD when compared to HD (select all that apply)? A. Less protein loss B. Rapid fluid removal C. Less cardiovascular stress D. Decreased hyperlipidemia E. Requires fewer dietary restrictions

C, E Peritoneal dialysis (PD) is less stressful for the cardiovascular system and requires fewer dietary restrictions. PD actually contributes to more protein loss and increased hyperlipidemia. The fluid and creatinine removal are slower with PD than hemodialysis (HD).

During peritoneal dialysis, Mrs. H's dialysate white blood cell count is 150/mm and neutrophils are 60%. This would indicate that the client has developed A. Anemia B. Pyelonephritis C. Bowel perforation D. Peritonitis

D

Hemodialysis rids the body of harmful waste. What else does hemodialysis remove? A. Extra protein and fat B. Extra sodium and potassium C. Extra insulin D. Extra water and sodium

D

Mr. U is a client recently receiving hemodialysis treatments. Following a treatment, the client complains of a severe headache and he appears somewhat confused. Which of the following initial actions by the nurse is most appropriate? A. Check the client's blood pressure. B. Administer oxygen. C. Encourage the client to drink fluids. D. Notify the physician immediately.

D

Mrs. K is in the diuretic phase of acute renal failure. During this phase, the client is asses for signs of: A. Hyperkalemia B. Metabolic acidosis C. Hypertension D. Hypovolemia

D

Select the most correct statement related to peritoneal dialysis treatments. A. Procedures require a venous access site. B. Dialysate is infused slowly over 20-30 minutes. C. Dialysate solution is allowed to dwell for 1 hour. D. Dialysate needs to be prewarmed before infusion.

D

The nurse would anticipate that a client with rhabdomyolysis would exhibit which of the following manifestations? A. Gross hematuria B. Clear yellow urine C. Dark amber urine D. Brown-tinged urine

D

The nurse would encourage the client receiving peritoneal dialysis to do which of the following to manage low back pain associated with increased weight in the abdomen? A. Lying down as much as possible B. Walking on surfaces with gradual inclines C. Reducing voluntary fluid intake D. Performing specified exercises

D

What is a common side effect for hemodialysis? A. Muscle cramps B. Dizziness and weakness, hypotension C. Nausea and vomiting D. All of the above

D

Which dietary mineral must be limited for a person on hemodialysis? A. Iron B. Zinc C. Sodium D. Potassium

D

Which of the following clients with chronic renal failure would not be a candidate for peritoneal dialysis? A. A 50 year old man with cardiovascular disease B. A 45 year old woman with diabetes mellitus C. A 10 year old child with congenital urethral strictures D. A 70 year old woman with tuberculosis

D

What is the most appropriate snack for the nurse to offer a patient with stage 4 CKD? A. Raisins B. Ice cream C. Dill Pickles D. Hard candy

D A patient with CKD may have sugars and starches (unless the patient is diabetic); hard candy is an appropriate snack and may help to relieve the metallic and urine taste that is common in the mouth. Raisins are a high-potassium food. Ice cream contains protein and phosphate and counts as a fluid. Pickled foods have high sodium content.

Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI. Which patient is most likely to develop ATN? A. Patient with diabetes mellitus B. Patient with hypertensive crisis C. Patient who tried to overdose on acetaminophen D. Patient with major surgery who required a blood transfusion

D Acute tubular necrosis (ATN) is primarily the result of ischemia, nephrotoxins, or sepsis. Major surgery is most likely to cause severe kidney ischemia in the patient requiring a blood transfusion. A blood transfusion hemolytic reaction produces nephrotoxic injury. Diabetes mellitus, hypertension, and acetaminophen overdose will not contribute to ATN.

Which serum laboratory value indicates to the nurse that the patient's CKD is getting worse? A. Decreased BUN B. Decreased sodium C. Decreased creatinine D. Decreased calculated GFR

D As GFR decreases, BUN and serum creatinine levels increase. Although elevated BUN and creatinine indicate that waste products are accumulating, the calculated GFR is considered a more accurate indicator of kidney function than BUN and creatinine.

A patient with AKI has a serum potassium level of 6.7 mEq/L (6.7 mmol/L) and the following arterial blood gas results: pH 7.28 PaCO2 30 mm Hg PaO2 86 mm Hg, HCO3 18 mEq/L (18 mmol/L). The nurse recognizes that treatment of the acid-base problem with sodium bicarbonate would cause a decrease in which value? A. pH B. Potassium level C. Bicarbonate level D. Carbon dioxide level

D During acidosis, potassium moves out of the cell in exchange for H+ ions, increasing the serum potassium level. Correction of the acidosis with sodium bicarbonate will help to temporarily shift the potassium back into the cells. A decrease in pH and the bicarbonate and PaCO2 levels would indicate worsening acidosis.

A patient rapidly progressing toward ESRD asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that what is a contraindication to kidney transplantation? A. Hepatitis C infection B. Coronary artery disease C. Refractory hypertension D. Extensive vascular disease

D Extensive vascular disease is a contraindication for renal transplantation, primarily because adequate blood supply is essential for the health of the new kidney. Other contraindications include disseminated malignancies, refractory or untreated cardiac disease, chronic respiratory failure, chronic infection or unresolved psychosocial disorders. Hepatitis B or C infection is not a contraindication. Coronary artery disease (CAD) may be treated with bypass surgery before transplantation, and transplantation can relieve hypertension.

While caring for the patient in the oliguric phase of AKI, the nurse monitors the patient for associated collaborative problems. When should the nurse notify the health care provider? A. Urine output is 300 mL/day. B. Edema occurs in the feet, legs, and sacral area. C. Cardiac monitor reveals a depressed T wave and elevated ST segment. D. The patient experiences increasing muscle weakness and abdominal cramping.

D Hyperkalemia is a potentially life-threatening complication of AKI in the oliguric pase. Muscle weakness and abdominal cramping are signs of the neuromuscular impairment that occurs with hyperkalemia. In addition, hyperkalemia can cause the cardiac conduction abnormalities of peaked T wave, prolonged PR interval, prolonged QRS interval, and depressed ST segment. Urine output of 300 mL/day is expected during the oliguric phase, as is the development of peripheral edema.

What indicates to the nurse that a patient with oliguria has prerenal oliguria? A. Urine testing reveals a low specific gravity. B. Causative factor is malignant hypertension. C. Urine testing reveals a high sodium concentration. D. Reversal of oliguria occurs with fluid replacement.

D In prerenal oliguria, the oliguria is caused by a decrease in circulating blood volume and there is no damage yet to the renal tissue. It can be reversed by correcting the precipitating factor, such as fluid replacement for hypovolemia. Prerenal oliguria is characterized by urine with a high specific gravity and a high sodium concentration. Malignant hypertension causes damage to renal tissue and intrarenal oliguria.

Which description accurately describes the care of the patient with CKD? A. Iron is a nutrient that is commonly supplemented for the patient on dialysis because it is dialyzable. B. The syndrome that includes all of the signs and symptoms seen in the various body systems in CKD is azotemia. C. The use of morphine is contraindicated in the patient with CKD because accumulation of its metabolites may cause seizures. D. The use of calcium-based phosphate binders in the patient with CKD is contraindicated when serum calcium levels are increased.

D In the patient with CKD, when serum calcium levels are increased, calcium-based phosphate binders are not used. The dialyzable nutrient supplemented for patients on dialysis is folic acid, although IV iron sucrose injections may be prescribed for anemia if the patient receives erythropoietin. The various body system manifestations occur with uremia, which includes azotemia. Meperidine is contraindicated in patients with CKD related to possible seizures.

In caring for the patient with AKI, of what should the nurse be aware? A. The most common cause of death in AKI is irreversible metabolic acidosis. B. During the oliguric phase of AKI, daily fluid intake is limited to 1000 mL plus the prior day's measured fluid loss. C. Dietary sodium and potassium during the oliguric phase of AKI are managed according to the patient's urinary output. D. One of the most important nursing measures in managing fluid balance in the patient with AKI is taking accurate daily weights.

D Measuring daily weights with the same scale at the same time each day allows for the evaluation and detection of excessive body fluid gains or losses. Infection is the leading cause of death in AKI, so meticulous aseptic technique is critical. The fluid limitation in the oliguric phase is 600 mL plus the prior day's measured fluid loss. Dietary sodium and potassium intake are managed according to plasma levels.

Metabolic acidosis occurs in the oliguric phase of AKI as a result of impairment of ________. A. Excretion of sodium B. Excretion of bicarbonate C. Conservation of potassium D. Excretion of hydrogen ions

D Metabolic acidosis occurs in AKI because the kidneys cannot synthesize ammonia or excrete hydrogen (H+) ions or the acid products of metabolism, resulting in an increased acid load. Sodium is lost in urine because the kidneys cannot conserve sodium. Bicarbonate is normally generated and reabsorbed by the functioning kidney to maintain acid-base balance. Impaired excretion of potassium results in hyperkalemia.

What indicates to the nurse that a patient with AKI is in the recovery phase? A. A return to normal weight B. A urine output of 3700 mL/day C. Decreasing sodium and potassium levels D. Decreasing blood urea nitrogen (BUN) and creatinine levels

D The BUN and creatinine levels remain high during the oliguric and diuretic phases of AKI. The recovery phase begins when the glomerular filtration returns to a rate at which BUN and creatinine stabilize and then decrease. Urinary output of 3-5 L/day, decreasing sodium and potassium levels, and fluid weight loss are characteristic of the diuretic phase of AKI.

A nurse is teaching a client who will have an x-ray of the kidneys, ureters, and bladder. Which of the following statements should the nurse include in the teaching? A. "You will receive contrast dye during the procedure." B. "An enema is necessary before the procedure." C. "You will need to lie in a prone position during the procedure." D. "The procedure determines whether you have a kidney stone."

D The nurse should explain to the client that a KUB can identify renal calculi, strictures, calcium deposits, and obstructions of the urinary system. Clients do not receive any contrast dye for this procedure as they would for excretory urography. Clients do not receive an enema before this procedure because it does not affect the GI system. The client will lie supine, not prone.

A nurse is teaching a client who has chronic kidney disease and is to begin hemodialysis. Which of he following information should the nurse include in the teaching? A. Hemodialysis restores kidney function. B. Hemodialysis replaces hormonal function of the renal system. C. Hemodialysis allows an unrestricted diet. D. Hemodialysis returns a balance to serum electrolytes.

D The nurse should explain to the client that hemodialysis restores electrolyte balance by removing excess sodium, potassium, fluids, and waste products, and also restores acid-base balance.

What are intrarenal causes of acute kidney injury (AKI) (select all that apply)? A. Anaphylaxis B. Renal stones C. Bladder cancer D. Nephrotoxic drugs E. Acute glomerulonephritis F. Tubular obstruction by myoglobin

D, E, F Intrarenal causes of acute kidney injury (AKI) include conditions that cause direct damage to the kidney tissue, including nephrotoxic drugs, acute glomerulonephritis, and tubular obstruction by myoglobin, or prolonged ischemia. Anaphylaxis and other prerenal problems are frequently the initial cause of AKI. Renal stones and bladder cancer are among the postrenal causes of AKI.

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse monitors this client for which manifestation 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

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.