Block 10 Module 8 Renal Iggy Questions

A Protein restriction is necessary with CKD due to the buildup of waste products from protein breakdown. The nurse would be concerned with the low albumin level since this indicates that the protein in the diet is not enough for the client's metabolic needs. The electrolyte values are not related to the protein-restricted diet.

A 70-kg adult client with chronic kidney disease (CKD) is on a 40-g protein diet. The patient has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would be of most concern to the nurse? a. Albumin level of 2.5 g/dL (3.63 mcmol/L) b. Phosphorus level of 5 mg/dL (1.62 mmol/L) c. Sodium level of 135 mEq/L (135 mmol/L) d. Potassium level of 5.5 mEq/L (5.5 mmol/L)

A There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the patient since both the serum creatinine and BUN are elevated, indicating some renal problems. A diet high in protein could be a factor in an increased BUN.

A client comes into the emergency department with a serum creatinine of 2.2 mg/dL (1944 mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What question would the nurse ask first when taking this client's history? a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?" b. "Do you have anyone in your family with renal failure?" c. "Have you had a diet that is low in protein recently?" d. "Has a relative had a kidney transplant lately?"

A The best action by the nurse would be to check the cardiac status with a monitor. High-potassium levels can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but not the best immediate action.

A client has a serum potassium level of 6.5 mEq/L (6.5 mmol/L), a serum creatinine level of 2 mg/dL (176 mcmol/L), and a urine output of 350 mL/day. What is the best action by the nurse? a. Place the client on a cardiac monitor immediately. b. Teach the client to limit high-potassium foods. c. Continue to monitor the client's intake and output. d. Ask to have the laboratory redraw the blood specimen.

C This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance are essential. Edema and pain are not usually a problem with fluid loss. There could be changes in the client's cardiac, respiratory, and mental health status if the electrolyte imbalance is not treated.

A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this patient's care? a. Edema and pain b. Cardiac and respiratory status c. Electrolyte and fluid imbalance d. Mental health status

B An opaque or cloudy effluent is the first sign of peritonitis. A sample of the effluent would need to be sent to the laboratory for culture and sensitivity in order to administer the correct antibiotic. Warming the dialysate in a microwave and flushing the tubing are not safe actions by the nurse. Checking the catheter for obstruction is a viable option but will not treat the peritonitis.

A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What is the priority action by the nurse? a. Warm the dialysate solution in a microwave before instillation. b. Obtain a sample of the effluent and send to the laboratory. c. Flush the tubing with normal saline to maintain patency of the catheter. d. Check the peritoneal catheter for kinking and curling.

C The absence of adventitious sounds upon auscultation of the lungs indicates a lack of fluid overload and fluid balance in the client's body. Decreased calcium levels and increased phosphorus levels are common findings with CKD. Edema would indicate a fluid imbalance.

A client is placed on fluid restriction because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client's fluid balance is stable at this time? a. Decreased calcium levels b. Increased phosphorus levels c. No adventitious sounds in the lungs d. Increased edema in the legs

A Furosemide is a loop diuretic that helps reduce fluid overload and hypertension in patients with early stages of CKD. One kilogram of weight equals about 1 L of fluid retained in the client, so daily weights are necessary to monitor the response of the client to the medication. Heart and breath sounds would be assessed if there is fluid retention, as in heart failure. Palpation of the client's abdomen is not necessary, but the nurse would check for edema. The diet history of the client would be helpful to assess electrolyte replacement since potassium is lost with this diuretic, but this does not assess the effectiveness of the medication.

A client is taking furosemide 40 mg/day for management of early chronic kidney disease (CKD). To assess the therapeutic effect of the medication, what action of the nurse is best? a. Obtain daily weights of the client. b. Auscultate heart and breath sounds. c. Palpate the client's abdomen. d. Assess the client's diet history.

A, B, D Hypotension occurs often during hemodialysis treatments as a result of vasodilation from the warmed dialysate. Modest decreases in blood pressure, as is the case with this client, can be maintained with rate adjustment, Trendelenburg positioning, and a fluid bolus. If the blood pressure drops considerably after two boluses and cooling dialysate, the hemodialysis can be stopped and the primary health care provider contacted.

A client is undergoing hemodialysis. The client's blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions would the nurse perform to maintain blood pressure? (Select all that apply.) a. Adjust the rate of extracorporeal blood flow. b. Place the patient in the Trendelenburg position. c. Stop the hemodialysis treatment. d. Administer a 250-mL bolus of normal saline. e. Contact the primary health care provider.

A, B, D PD is based on exchanges of waste, fluid, and electrolytes in the peritoneal cavity. There is no need for vascular access. Protein is lost in the exchange, which allows for more protein and fluid in the diet. There is flexibility in the time for exchanges, but the treatment takes a longer period of time compared to hemodialysis. There still is risk for infection with PD, especially peritonitis.

A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are correct regarding PD? (Select all that apply.) a. "You will not need vascular access to perform PD." b. "There is less restriction of protein and fluids." c. "You will have no risk for infection with PD." d. "You have flexible scheduling for the exchanges." e. "It takes less time than hemodialysis treatments."

D The nurse would assess that the client could be developing fluid overload and respiratory distress and slow down the normal saline infusion. The calculation of the MAP also reflects perfusion. The insertion of a pulmonary artery catheter would evaluate the client's hemodynamic status, but this would not be the initial or priority action by the nurse. Vital signs are also important after adjusting the intravenous infusion.

A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm Hg. The primary health care provider prescribed 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client starts to develop shortness of breath. What is the nurse's priority action? a. Calculate the mean arterial pressure (MAP). b. Ask for insertion of a pulmonary artery catheter. c. Take the client's pulse. d. Decrease the rate of the IV infusion.

A The initial action for the nurse is to assess anxiety, coping styles, and the client's acceptance of the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling hemodialysis appointments may help, and referral to a mental health practitioner and the possibility of peritoneal dialysis are all viable options, assessment of the client's acceptance of the treatment would come first.

A client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse? a. Discuss what the treatment regimen means to the client. b. Refer the client to a mental health nurse practitioner. c. Reschedule the appointments to another date and time. d. Discuss the option of peritoneal dialysis.

A This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood pressure. The nurse can start hydrating the client with a bottle of water first, followed by teaching the patient to drink 2 to 3 L of water each day. An intravenous line may be needed later, after the patient's degree of dehydration is assessed. An electrocardiogram is not necessary at this time.

A marathon runner comes into the clinic and states "I have not urinated very much in the last few days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is most appropriate? a. Give the client a bottle of water immediately. b. Start an intravenous line for fluids. c. Teach the patient to drink 2 to 3 L of water daily. d. Perform an electrocardiogram.

C The client may need a higher dose of immunosuppressive medication as evidenced by the elevated BUN and serum creatinine levels. This increased dose may reverse the possible acute rejection of the transplanted kidney. The client does not need hemodialysis, peritoneal dialysis, or further surgery at this point.

A nurse reviews the laboratory values of a client who returned from kidney transplantation 12 hours ago: Sodium 136 mEq/L Potassium 5 mEq/L Blood urea nitrogen (BUN) 44 mg/dL Serum creatinine 2.5 mg/dL What initial intervention would the nurse anticipate? a. Start hemodialysis immediately. b. Discuss the need for peritoneal dialysis. c. Increase the dose of immunosuppression. d. Return the client to surgery for exploration.

D A postop client who had a kidney transplant has a urinary catheter in place for accurate measurements of urine output and decompression of the bladder. Decompression prevents stretch on sutures and ureter attachment sites on the bladder. The nurse and AP check urine output at least hourly during the first 48 hours. This includes examining the urine for color.

For how many hours will the nurse instruct the assistive personnel (AP) to check the hourly urine output of a postop client who had a kidney transplant? a. 8 hours b. 12 hours c. 24 hours d. 48 hours

A, C, D Examples of disorders causing intrinsic AKI include allergic disorders, embolism or thrombosis of the renal vessels, and nephrotoxic agents. Severe dehydration would be prerenal. Bladder cancer and kidney stones cause postrenal.

For which causes will the nurse monitor clients for development of intrarenal (intrinsic) acute kidney injury (AKI)? SATA A. Glomerulonephritis B. Bladder cancer C. Exposure to nephrotoxins D. Embolism in renal blood vessels E. Severe dehydration F. Kidney stones

A, B, C, E, F

For which client conditions does the nurse expect the possibility of emergent hemodialysis (HD)? SATA A. Severe uncontrolled hypertension B. Pericarditis C. Symptomatic Hyperkalemia with ECG D. Myocardial infarction E. Pulmonary edema F. Some drug overdoses

C As CKD worsens and acid retention increases, increased respiratory action is needed to keep the blood pH normal. The resp system adjusts or compensates for the increased blood hydrogen ion levels (acidosis or decreased pH levels) by increasing rate and depth of breathing to excrete carbon dioxide through the lungs.

For which condition does the nurse suspect a client with CKD is attempting to compensate for when respirations increase in rate and depth? A. Hypoxia B. Alkalosis C. Acidosis D. Hypoxemia

A Dialysis disequilibrium syndrome may develop during HD or after HD has been completed. It is characterized by mental status changes and can include seizure or coma, although rare to get that severe. A mild form of disequilibrium syndrome includes symptoms of nausea, vomiting, headaches, fatigue, and restlessness. It is thought to be the result of a rapid reduction in electrolytes and other particles.

How does the nurse best interpret a condition when a client is undergoing hemodialysis (HD) and develops symptoms including headache, nausea, vomiting and fatigue? a. Mild dialysis disequilibrium syndrome b. Adverse reaction the dialysate solution c. Transient symptoms in a client new to hemodialysis d. Expected manifestations of end stage kidney disease

C The nurse would not use the arm with the AV fistula for intravenous infusion, blood pressure readings, or venipuncture. Compression and infection can result in the loss of the AV fistula. The AV fistula would be monitored by auscultating or palpating the access site. Checking the distal pulse would be an appropriate assessment.

The charge nurse is orienting a new nurse about care for an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe? a. Palpating the access site for a bruit or thrill b. Using the right arm for a blood pressure reading c. Administering intravenous fluids through the AV fistula d. Checking distal pulses in the left arm

D The purpose of giving epoetin alfa to a client with CKD is to manage anemia by stimulating the bone marrow to produce more red blood cells. Therefore, monitoring the client's hemoglobin, hematocrit, and red blood cell count would indicate if the drug was effective.

The nurse administers epoetin alfa to a client who has chronic kidney disease (CKD). Which laboratory test value would the nurse monitor to determine this drug's effectiveness? a. Potassium b. Sodium c. Renin d. Hemoglobin

B Prerenal causes of AKI are related to a decrease in perfusion, such as in clients who have prolonged dehydration. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney stones are postrenal causes of AKI related to urine flow obstruction.

The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI). Which condition would the nurse expect to find in the patient's recent history? a. Pyelonephritis b. Dehydration c. Bladder cancer d. Kidney stones

B, C, D, E The client who has CKD has fluid overload and electrolyte imbalances, especially hyperkalemia, that can cause hypertension, heart failure, and dysrhythmias. Anemia results because erythropoietin production by the kidneys is decreased.

The nurse is caring for a client with a new diagnosis of chronic kidney disease. Which priority complications would the nurse anticipate? (Select all that apply.) a. Dehydration b. Anemia c. Hypertension d. Dysrhythmias e. Heart failure

A, B, C Urine flow obstruction, such as prostate cancer, blood clots in the urinary tract, and kidney stones (ureterolithiasis), causes postrenal AKI. Severe burns would be a prerenal cause. Lupus would be an intrarenal cause for AKI.

The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for postrenal acute kidney injury (AKI)? (Select all that apply.) a. Client with prostate cancer b. Client with blood clots in the urinary tract c. Client with ureterolithiasis d. Client with severe burns e. Client with lupus

B Kussmaul respirations indicate that the client has metabolic acidosis which is a complication of CKD. The client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs to lower serum pH. Hypertension is common in most patients with CKD, and skin itching increases with calcium-phosphate imbalances and elevations of nitrogenous wastes, another common finding in CKD. Uremia from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis.

The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the nurse assess first upon initial rounding? a. Client with a blood pressure of 158/90 mm Hg b. Client with Kussmaul respirations c. Client with skin itching from head to toe d. Client with halitosis and stomatitis

C Inflow and outflow problems of the dialysate are best controlled by preventing constipation. A daily stool softener is the best option for the client. The drainage bag should be below the level of the abdomen. Flushing the tubing will not help with the flow. A diet high in fiber will also help with a constipation problem.

The nurse is teaching a client how to increase the flow of dialysate into the peritoneal cavity during dialysis. Which statement by the client demonstrates a correct understanding of the teaching? a. "I should leave the drainage bag above the level of my abdomen." b. "I could flush the tubing with normal saline if the flow stops." c. "I should take a stool softener every morning to avoid constipation." d. "My diet should have low fiber in it to prevent any irritation."

D Fast-food restaurants usually serve food that is high in sodium. This statement indicates that more teaching needs to occur. The other statements show a correct understanding of the teaching.

The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates that more teaching is needed? a. "I will probably lose weight by cutting out potato chips." b. "I will cut out bacon with my eggs every morning." c. "My cooking style will change by not adding salt." d. "I am thrilled that I can continue to eat fast food."

C The general principle for fluid restriction for clients is that they may have a daily fluid intake of 500 mL plus the amount of their urinary output. In this case, 120 mL urinary output plus 500 mL equals 620 mL fluid allowance.

The nurse is teaching assistive personnel (AP) about fluid restriction for a client who has acute kidney injury (AKI). The client's 24-hour urinary output is 120 mL. How much fluid would the client be allowed to have over the next 24 hours? a. 380 mL b. 500 mL c. 620 mL d. 750 mL

B

What does the nurse expect the nephrology provider to prescribed when post kidney transplant client develops oliguria, elevated temperature of 100 F(38.7C), increased BP, and signs of fluid retention 9 days after the surgery? a. Immediate removal of the transplanted kidney b. Increased doses of immunosuppressive drugs c. Immediate return to either hemodialysis or PD d. Antibiotic therapy until infection symptoms are resolved

D After hemodialysis, the nurse expects BP and weight to be decreased as a result of fluid removal.

What does the nurse expect when comparing a client's post-hemodialysis weight and BP to pre-dialysis data? a. BP increased and weight is decreased b. BP and weight slightly increase c. BP and weight are the same d. BP and weight are decreased

C When outflow is less than inflow, the difference is retained by the client during dialysis and it is counted as fluid intake

What is the nurse's best action when a client receiving PD has slightly less outflow than inflow? a. Placing the client on an oral fluid intake restriction b. Notifying the nephrology provider c. Recording the difference as intake on the flow sheet d. Instructing the client to stand and walk then measuring the next outflow

B Symptoms of pulmonary edema. High Fowler is the best option for this.

What is the nurse's first action when a client with chronic kidney disease develops restlessness, anxiousness, shortness of breath, a rapid heart rate, frothy sputum, and crackles in the bases of the lungs? A. Facilitating transfer to the ICU for aggressive treatment B. Placing the client's head of bed in the high-fowler position C. Monitoring vital signs and assessing the lungs every 15 min D. Administering an IV loop diuretic such as furosemide

C The kidneys produce the hormone erythropoietin for RBCs synthesis. When kidney function is poor, erythropoietin production decreases and anemia results.

When a client's kidneys hormonal function is not working properly, which condition does the nurse expect to occur? A. Leukemia B. Thrombocytopenia C. Anemia D. Neutropenia

A, B, D, E To assess fluid overload, the nurse looks at skin and tissue which may show edema associated with kidney disease, esp pedal (foot), pretibial (shin), periorbital (eyes), and sacral tissues. A stethoscope is used to listen to the lungs to determine whether fluid is present. The client is weighed and blood pressure measured as a baseline for later comparisons. A client with chronic kidney failure does not make much urine, thus checking for residual urine with a bladder scanner is not necessary. A sterile sample is not needed unless infection is suspected.

When the nurse provides care for a client with Chronic Kidney Failure, what assessments will be made that support a finding of fluid overload? SATA A. Weigh the client and compare to baseline B. Compare current BP to baseline C. Measure for residual urine with a bladder scanner D. Auscultate the lung fields to determine if fluid is present E. Check for pedal and periorbital swelling F. Obtain a sterile urine specimen by catheterization

A

When the nurse reviews lab results and finds that client with CKD has a serum potassium level of 8 mEq/L, which assessment will be completed before notifying the provider? A. Cardiac rhythm B. Respiratory rate and depth C. Tremors of the hands D. Change in urine appearance

B, C, D, F pg 551 #37 iggy study guide book

Which action will the nurse tske to check the peritoneal dialysis system of a client when the dialysate outflow is slow? SATA a. Ensuring that the drainage bag is elevated above the abdomen b. Inspecting the tubing to ensure there is no kiniking or twisting c. Making sure that clamps are open and unclamped d. Repositioning the client to the other side and ensuring good body alignment e. Instructing the client to stand up at the bedside and cough f. Placing the client in a supine low fowler position

A, D, E, F

Which assessment questions are most appropriate for the nurse to ask a client at risk for acute kidney injury (AKI)? SATA A. "Have you noticed any changes in your urines appearance, frequency, or volume?" B. "Have you experienced any leakage of urine when coughing or laughing?" C. "Do you weigh yourself and have you noticed unexpected weight loss?" D. "Do you have a history of diabetes, hypertension or peripheral vascular disease?" E. "Do you use any non steroidal anti inflammatory drugs regularly?" F. "Have you had any recent surgery, traumas, or transfusions?"

A, C, E Absolute contraindications to kidney transplants include active cancer, current infection, active psychiatric illness, active substance abuse and nonadherence with dialysis or medical regimen.

Which client conditons will the nurse recognize as absolute contraindications to receving a kidney transplant? SATA a. Breast cancer and metastasis to the lungs b. Type 2 diabetes controlled with diet and exercise c. Urinary tract infection d. Active treatment for peptic ulcer disease e. Chemical dependency f. Living related donor

B

Which electrolyte imbalance does the nurse expect when a client is in the early phase of CKD? A. Hyperkalemia B. Hyponatremia C. Hypercalcemia D. Hypokalemia

B, C, D, E, F

Which gastrointestinal changes does the nurse expect to find when assessing a client with uremia? a. Increased salivation b. Halitosis c. Stomatitis d. Anorexia e. Nausea and vomiting f. Hiccups

B Cloudy or opaque effluent is an early indication of peritonitis

Which priority teaching will the nurse provide to the client receiving peritoneal dialysis (PD) when the effluent becomes cloudy? a. The change means that more waste products are being removed from the blood b. The presence of cloudiness is an early sign of an infection called peritonitis and is very serious c. Effluent cloudiness is the result of eating foods that contain too much protein electrolytes d. The effluent is expected to be cloudy because it has spent time (dwelled) in the abdomen, in close contact with the intestines

C Uremia is the build of nitrogenous waste in blood from inadequate elimination as a result of kidney failure. Symptoms include anorexia , nausea and vomiting, muscle cramps, Pruritus, fatigue, and lethargy. Anuria is failure to produce urine; oliguria is production of abnormally small amounts of urine and azotemia is the build up of nitrogenous waste products in the blood.

Which problem or complication does the nurse suspect when a client with chronic kidney disease develops anorexia, nausea and vomiting, muscle cramping and pruritus? A. Client has oliguria B. Client has anuria C. Client has uremia D. Client has azotemia

B, C, E Large particles such as blood cells, albumin, and other proteins are too large to filer through the glomerular capillary walls. Therefore, these substances are not normal present in the excreted final urine.

Which substances will the nurse consider an abnormal finding in a clients routine urine sample? SATA A. Electrolytes B. Red blood cells C. Proteins D. Water E. Albumin F. Creatinine

B

Why will the nurse immediately notify the nephrology health care provider if a client develops hypotension and diuresis postop after a kidney transplant? a. These problems place the client at risk for hypervolemia and dehydration b. Dehydration with hypotension reduces perfusion and oxygen to the new kidneys c. These assessment findings are indicators of a possible serious acute infection d. Increased work by the kidney for diuresis results in excessive build up of cellular toxins that damage the new kidney's tubules