Adaptive Quizzes Chapter 54- Kidney Disorders

When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? - Check for thrill or bruit over the access site. - Inspect the catheter insertion site for infection. - Add the prescribed drug to the dialysate. - Warm the solution to body temperature.

- Check for thrill or bruit over the access site. When preparing a client for hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency.

What is a hallmark of the diagnosis of nephrotic syndrome? - Hyponatremia - Proteinuria - Hypoalbuminemia - Hypokalemia

- Proteinuria

The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: - 500 mL of fluid - 1,000 mL of fluid - 1,500 mL of fluid - 2,000 mL of fluid

- 1,500 mL of fluid A 1-kg weight gain is equal to 1,000 mL of retained fluid.

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? - Hyperalbuminemia - Peripheral neuropathy - Cola-colored urine - Hypotension

- Cola-colored urine Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.

A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? - Elevated urea levels - Hyperkalemia - Hypocalcemia - Elevated white blood cells

- Hyperkalemia Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.

What is a characteristic of the intrarenal category of acute renal failure? - Decreased creatinine - Increased BUN - High specific gravity - Decreased urine sodium

- Increased BUN The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? - Impaired urinary elimination - Toileting self-care deficit - Risk for infection - Activity intolerance

- Risk for infection The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products.

What is used to decrease potassium level seen in acute renal failure? - Sodium polystyrene sulfonate - Sorbitol - IV dextrose 50% - Calcium supplements

- Sodium polystyrene sulfonate The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.

The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse? - Notify the health care provider. - Turn the client from side to side. - Lower the head of the bed. - Push the catheter further into the abdomen.

- Turn the client from side to side. If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the client from side to side or raising the head of the bed.

A client develops acute renal failure (ARF) after receiving IV therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 mL, the nurse suspects that the client is at risk for: - cardiac arrhythmia. - paresthesia. - dehydration. - pruritus.

- cardiac arrhythmia. As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn't cause paresthesia (sensations of numbness and tingling). Dehydration doesn't occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. In the client with ARF, pruritus results from increased phosphates and isn't associated with hyperkalemia.

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: - hematuria. - weight loss. - increased urine output. - increased blood pressure.

- weight loss. Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

A client is admitted to the hospital with a prerenal disorder, a nonurologic condition that disrupts renal blood flow to the nephrons, affecting their filtering ability. One cause of prerenal acute kidney injury is: - anaphylaxis - myoglobinuria secondary to burns - polycystic disease - ureteral stricture

Anaphylaxis

The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client? - Hemodialysis - Peritoneal dialysis - Continuous arteriovenous hemofiltration (CAVH) - Continuous venovenous hemofiltration (CVVH)

Hemodialysis The client is hemodynamically stable and hemodialysis would be most appropriate. Hemodialysis is used for clients who are acutely ill and require short-term dialysis for days to weeks until kidney function resumes and for clients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) who require long-term or permanent renal replacement therapy. Peritoneal dialysis (PD) may be the treatment of choice for clients with renal failure who are unable or unwilling to undergo hemodialysis or kidney transplantation. CAVH and CVVH are used for client who are hemodynamically unstable.

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? - Encouraging coughing and deep breathing - Promoting carbohydrate intake - Limiting fluid intake - Providing pain-relief measures

- Limiting fluid intake During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and IV fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure? - Poor perfusion to the kidneys - Damage to cells in the adrenal cortex - Obstruction of the urinary collecting system - Nephrotoxic injury secondary to use of contrast media

- Nephrotoxic injury secondary to use of contrast media Intrinsic renal failure results from damage to the kidney, such as from nephrotoxic injury caused by contrast media, antibiotics, corticosteroids, or bacterial toxins. Poor perfusion to the kidneys may result in prerenal failure. Damage to the epithelial cells of the renal tubules results from nephrotoxic injury, not damage to the adrenal cortex. Obstruction of the urinary collecting system may cause postrenal failure.

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI? - Initiation - Oliguria - Diuresis - Recovery

- Oliguria The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. - Tall, peaked T waves - Shortened QRS complex - Multiple spiked P waves - Prolonged ST segment

- Tall, peaked T waves Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.

A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD? - The client is blind in his right eye. - The client has a history of severe anemia during hemodialysis. - The client has a history of diverticulitis. - The client is on the kidney transplant waiting list.

- The client has a history of diverticulitis. A history of diverticulitis contraindicates CAPD because CAPD has been associated with the rupture of diverticulum.

A patient is placed on hemodialysis for the first time. The patient complains of a headache with nausea and begins to vomit, and the nurse observes a decreased level of consciousness. What does the nurse determine has happened? - The dialysis was performed too rapidly. - The patient is having an allergic reaction to the dialysate. - The patient is experiencing a cerebral fluid shift. - Too much fluid was pulled off during dialysis.

- The patient is experiencing a cerebral fluid shift. Dialysis disequilibrium results from cerebral fluid shifts. Signs and symptoms include headache, nausea and vomiting, restlessness, decreased level of consciousness, and seizures. It is rare and more likely to occur in AKI or when BUN levels are very high (exceeding 150 mg/dL).

Which of the following is the most accurate indicator of fluid loss or gain? - Weight - Urine output - Caloric intake - Body temperature

- Weight The most accurate indicator of fluid loss or gain in an acutely ill patient is weight, as accurate intake and output and assessment of insensible losses may be difficult. Urine output, caloric intake, and body temperature would not be the most reliable indicator of fluid loss or gain.

As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur? - Hyperphosphatemia - Hypercalcemia - Hypokalemia - Metabolic alkalosis

- Hyperphosphatemia

An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? - "The risk of peritonitis is greater with this type of dialysis." - "This type of dialysis will provide more independence." - "Peritoneal dialysis will require more work for you." - "Peritoneal dialysis does not work well for every client."

- "This type of dialysis will provide more independence." Once a treatment choice has been selected by the client, the nurse should support the client in that decision. Continuous cyclic peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients.

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? - Calcium - Magnesium - Phosphorus - Sodium

- Calcium Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.

The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take? - Administer the medications as ordered. - Hold the medications until after dialysis. - Check with the dialysis nurse about the medications. - Ask if the client wants to take the medications.

- Hold the medications until after dialysis. Antihypertensive therapy, often part of the regimen of clients on dialysis, is one example when communication, education, and evaluation can make a difference in client outcomes. The client must know when—and when not—to take the medication. For example, if an antihypertensive agent is taken on a dialysis day, hypotension may occur during dialysis, causing dangerously low blood pressure. Many medications that are taken once daily can be held until after dialysis treatment.