Ch 48: Management of Patients with Kidney Disorders

c) Fever Pg. 1599 Fever is an indicator of infection or transplant rejection.

20. Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a) Weight loss b) Absence of pain c) Fever d) Diuresis

d) Dehydration Pg. 1566 Dehydration is a complication during the diuresis phase related to elevated urine output and continued symptoms of uremia. The concern with acute kidney injury (AKI) is hyperkalemia. The diuresis phase of AKI is marked by normal or elevated urine output. Oliguria is urine output less than 400 mL in 24 hours and is seen in the oliguria phase. Renal calculi are a possible cause but not a complication of AKI.

35. During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication? a) Renal calculi b) Oliguria c) Hypokalemia d) Dehydration

a) Penicillin Pg. The three nephrotoxic drugs are aminoglycerides.

80. When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic? a) Penicillin b) Neomycin c) Gentamicin d) Tobramycin

c) 0.5 kg/day Pg. 1555 AKI causes severe nutritional imbalances (because nausea and vomiting contribute to inadequate dietary intake), impaired glucose use and protein synthesis, and increased tissue catabolism. The patient is weighed daily and loses 0.2 to 0.5 kg (0.5 to 1 lb) daily if the nitrogen balance is negative (i.e., caloric intake falls below caloric requirements).

82. A patient has acute kidney injury (AKI) with a negative nitrogen balance. How much weight does the nurse expect the patient to lose? a) 2.0 kg/day b) 1.5 kg/day c) 0.5 kg/day d) 1.0 kg/day

4,000 mL Pg. 1555 A 1-kg weight gain is equal to 1,000 mL of retained fluid. 4 kg × 1,000 = 4,000. The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded.

23. The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number.

b) Cola-colored urine

22. When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? a) Left upper quadrant pain b) Cola-colored urine c) Low blood pressure d) Pyuria

d) Gray-bronze skin color Pg. 1571 Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.

1. The nurse recognizes which condition as an integumentary manifestation of chronic renal failure? a) Seizures b) Asterixis c) Tremors d) Gray-bronze skin color

c) Hypovolemic shock caused by hemorrhage Pg. 1595 If bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack.

10. The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? a) Pneumonia caused by shallow breathing because of severe incisional pain b) Abdominal distention owing to reflex cessation of intestinal peristalsis c) Hypovolemic shock caused by hemorrhage d) Paralytic ileus caused by manipulation of the colon during surgery

c) Azotemia Pg. 1559 The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.

24. Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? a) Hematuria b) Proteinuria c) Azotemia d) Bacteremia

b) Dehydration Pg. 1567 The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.

34. The nurse expects which of the following assessment findings in the client is the diuretic phase of acute renal failure? a) Hypertension b) Dehydration c) Hyperkalemia d) Crackles

c) Increased serum creatinine level Pg. 1564 In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.

41. Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? a) Increased serum calcium level b) Decreased serum potassium level c) Increased serum creatinine level d) Increased red blood cell count

b) Fluid volume excess Pg. 1565 The oliguric phase is characterized by fluid retention.

79. Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure? a) Urinary retention b) Fluid volume excess c) Activity intolerance d) Disturbed body image

a) Increase carbohydrates and limit protein intake Pg. 1569 Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.

11. A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? a) Increase carbohydrates and limit protein intake b) Increase protein, carbohydrates, and fat intake c) Increase fat intake and limit carbohydrates d) Eliminate fat intake and increase protein intake

114 g/day Pg. 1572 To calculate the amount of protein the client is to ingest per day, first determine the client's weight in kg by dividing the weight in lbs by 2.2 or 209/2.2 = 95 kg. Then multiply the client's weight in kg by 1.2 or 95 x 1.2 = 114 grams. The client is to ingest 114 grams of protein per day.

12. A client with chronic kidney disease weighs 209 lbs (95 kg) and is prescribed 1.2 grams of protein per kg per day. Which amount of protein will the client ingest per day?

c) Glomerulonephritis Pg. 1566 Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.

13. Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? a) Hypovolemia b) Dysrhythmia c) Glomerulonephritis d) Ureteral calculus

b) Cardiac glycosides Pg. 1580 Cardiac glycosides such as digoxin (Lanoxin) should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digoxin toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.

14. A client requires hemodialysis. Which type of drug should be withheld before this procedure? a) Phosphate binders b) Cardiac glycosides c) Antibiotics d) Insulin

a) Risk for infection Pg. 1590 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. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

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

a) Absence of pallor Pg. 1573-1574 Erythropoietin stimulates the bone marrow to produce more red blood cells. The absence of pallor indicates that this treatment has been effective. Lack of a paradoxical pulse indicates the absence of a pericardial effusion. Blood pressure within normal limits indicates treatment for hypertension has been effective. Formed and solid bowel movements indicate the potassium level is within normal limits.

16. A client with chronic kidney disease (CKD) has been receiving erythropoietin injections as prescribed. Which outcome would indicate to the nurse that this medication has been effective? a) Absence of pallor b) Absence of a paradoxical pulse c) Blood pressure within normal limits d) Bowel movements solid and formed

d) Start IV fluids with a normal saline solution bolus followed by a maintenance dose Pg. 1566 The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.

17. A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? a) Start hemodialysis after a temporary access is obtained b) Encourage oral fluids c) Administer furosemide (Lasix) 20 mg IV d) Start IV fluids with a normal saline solution bolus followed by a maintenance dose

6 tablets Pg. 1572 The nurse will administer 2 tablets per dose (800 mg/400 mg per tablet). The client receives a total of 3 doses per day or 6 tablets (2 tablets per dose x 3 doses).

18. Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?

d) Anemia Pg. 1557 Anemia develops as a result of inadequate erythropoietin production, the shortened lifespan of RBCs, nutritional deficiencies, and the patient's tendency to bleed, particularly from the GI tract. Erythropoietin, a substance normally produced by the kidneys, stimulates bone marrow to produce RBCs (Murphy, Bennett, & Jenkins, 2010). In ESKD, erythropoietin production decreases and profound anemia results, producing fatigue, angina, and shortness of breath.

2. A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client? a) Pericarditis b) Acidosis c) Hyperkalemia d) Anemia

b) Restricting sources of potassium Pg. 1572 The nurse will teach the client to restrict sources of potassium, such as fresh fruits and vegetables, because hyperkalemia can cause life-threatening changes. The client will restrict sodium intake as ordered; doing so prevents fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken; iron and folic acid supplements are needed for red blood cell (RBC) production, and Epogen stimulates the bone marrow to produce RBCs. The client will restrict protein intake to foods that are complete proteins within prescribed limits; complete proteins provide positive nitrogen balance for healing and growth.

20. One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: a) Eating protein liberally b) Restricting sources of potassium c) Allowing liberal use of sodium d) Limiting iron and folic acid intake

a) Impending pulmonary edema Pg.

21. Acute dialysis is indicated during which situation? a) Impending pulmonary edema b) Hypokalemia c) Metabolic alkalosis d) Dehydration

a) Increased BUN Pg. 1565 The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.

21. What is a characteristic of the intrarenal category of acute renal failure? a) Increased BUN b) Decreased urine sodium c) High specific gravity d) Decreased creatinine

c) Administration of sodium polystyrene sulfonate [Kayexalate] Pg. 1568 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.

22. The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? a) Administration of a loop diuretic b) Administration of sodium bicarbonate c) Administration of sodium polystyrene sulfonate [Kayexalate] d) Administration of an insulin drip

d) Wear a mask when performing exchanges Pg. 1587 The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.

25. A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? a) Perform deep-breathing exercises vigorously b) Avoid carrying heavy items c) Auscultate the lungs frequently d) Wear a mask when performing exchanges

d) Tenderness over transplant site Pg. 1596-1597 Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.

26. A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead the nurse to suspect that the client is experiencing rejection? a) Polyuria b) Weight loss c) Hypotension d) Tenderness over transplant site

b) The patient is experiencing a cerebral fluid shift Pg. 1580 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).

27. 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? a) Too much fluid was pulled off during dialysis b) The patient is experiencing a cerebral fluid shift c) The patient is having an allergic reaction to the dialysate d) The dialysis was performed too rapidly

b) White blood cell (WBC) count of 20,000/mm3 Pg. 1587 An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

28. Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? a) Hematocrit (HCT) of 35% b) White blood cell (WBC) count of 20,000/mm3 c) Blood glucose level of 200 mg/dl d) Potassium level of 3.5 mEq/L

d) SpO2 at 90% with fine crackles in the lung bases Pg. 1590 Altered Breathing Pattern and Ineffective Airway Clearance Risk are often challenges in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output is monitored to maintain a urine output of greater than 30 mL/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.

29. The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client? a) Urine output of 35 to 40 mL/hour b) Pain of 3 out of 10, 1 hour after analgesic administration c) Blood tinged drainage in Jackson-Pratt drainage tube d) SpO2 at 90% with fine crackles in the lung bases

c) "Very few symptoms are associated with renal cancer" Pg. 1563 Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease. Adenocarcinomas are the most common renal cancer (about 80%),whereas squamous cell renal cancers are rare. It is not therapeutic to place doubt or blame for delayed diagnosis.

3. A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? a) "Painless gross hematuria is the first symptom in renal cancer" b) "Squamous cell carcinomas do not present with detectable symptoms" c) "Very few symptoms are associated with renal cancer" d) "You should have sought treatment earlier"

c) Keep the dialysis supplies in a clean area, away from children and pets Pg. 1585 It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

30. The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client? a) Keep the catheter stabilized to the abdomen, below the belt line b) Clean the catheter insertion site daily with soap c) Keep the dialysis supplies in a clean area, away from children and pets d) Wear a mask while handling any dialysate solutions

c) Hemodialysis Pg. 1577 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.

31. 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? a) Peritoneal dialysis b) Continuous arteriovenous hemofiltration (CAVH) c) Hemodialysis d) Continuous venovenous hemofiltration (CVVH)

b) Oliguria Pg. 1565 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.

32. 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? a) Initiation b) Oliguria c) Recovery d) Diuresis

d) "This type of dialysis will provide more independence" Pg. 1588 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.

33. 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? a) "The risk of peritonitis is greater with this type of dialysis" b) "Peritoneal dialysis will require more work for you" c) "Peritoneal dialysis does not work well for every client" d) "This type of dialysis will provide more independence"

a) Use an aseptic technique during the procedure Pg. 1585 The client should be instructed to use an aseptic technique during the procedure. The client should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (clients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

36. The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? a) Use an aseptic technique during the procedure b) Clean the catheter insertion site daily with soap c) Wear a mask while handling any dialysate solutions d) Keep the catheter stabilized to the abdomen, below the belt line

c) Septic shock Pg. 1566 Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias. Ureteral stricture and prostatic hypertrophy would be classified as postrenal causes. Polycystic disease is classified as an intrarenal cause of acute renal failure.

37. Which of the following would a nurse classify as a prerenal cause of acute renal failure? a) Polycystic disease b) Ureteral stricture c) Septic shock d) Prostatic hypertrophy

b) The client has a history of diverticulitis Pg. 1588 A history of diverticulitis contraindicates CAPD because CAPD has been associated with the rupture of diverticulum. A history of severe anemia while on hemodialysis or being on the transplant waiting list doesn't contraindicate CAPD. The client who's blind or partially blind can still learn to perform CAPD.

38. 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? a) The client is blind in his right eye b) The client has a history of diverticulitis c) The client is on the kidney transplant waiting list d) The client has a history of severe anemia during hemodialysis

d) Hyperkalemia Pg. 1568 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.

39. A client with chronic kidney disease becomes confused and reports abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which lab value? a) Hypocalcemia b) Elevated white blood cells c) Elevated urea levels d) Hyperkalemia

d) A GFR of 30-59 mL/min/1.73 m2 Pg. 1557 Stage 3 of chronic kidney disease is defined as having a GFR of 30-59 mL/min/1.73 m2

4. A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? a) A GFR of 90 mL/min/1.73 m2 b) A GFR of 120 mL/min/1.73 m2 c) A GFR of 85 mL/min/1.73 m2 d) A GFR of 30-59 mL/min/1.73 m2

c) Donors are selected from compatible living or deceased donors Pg. 1596 Donors are selected from compatible living donors. Donors do not have to be relatives as long as they are compatible. Potential donors with a history of hypertension, malignant disease, or diabetes are excluded from donation. Each local hospital does not have its own transplant list, instead the client will be placed on a national computerized transplant waiting list.

40. A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate? a) The client is placed on a transplant list at the local hospital b) Donors must be relatives c) Donors are selected from compatible living or deceased donors d) Donors with hypertension may qualify

c) With food Pg. 1572 Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. The nurse administers phosphate binders with food for them to be effective.

42. The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication? a) 2 hours after meals b) 2 hours before meals c) With food d) At bedtime with 8 ounces of fluid

b) Gentamycin d) Tobramycin e) Neomycin Pg. 1567 The kidneys are sensitive to the metabolic byproducts from aminoglycosides such as gentamycin, tobramycin, and neomycin. Penicillin and ceftriaxone are not known to be nephrotoxic.

43. A nurse is assessing a client with acute renal failure. What medications should the nurse identify as a nephrotoxic drug? Select all that apply. a) Ceftriaxone b) Gentamycin c) Penicillin d) Tobramycin e) Neomycin

c) Renal calculi Pg. 1565 Postrenal ARF is the result of an obstruction that develops anywhere from the collecting ducts of the kidney to the urethra. This results from ureteral blockage, such as from bilateral renal calculi or benign prostatic hypertrophy (BPH).

44. A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause? a) Dysrhythmias b) Acute pyelonephritis c) Renal calculi d) Osmotic diuresis

c) Peripheral neuropathy Pg. 1560 Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.

45. Which of the following occurs late in chronic glomerulonephritis? a) Nosebleed b) Seizure c) Peripheral neuropathy d) Stroke

b) Headache c) Nausea d) Confusion e) Vomiting Pg. 1580 There are complications that can occur when receiving hemodialysis. One complication is dialysis disequilibrium, which results from cerebral fluid shifts. Signs and symptoms of dialysis disequilibrium include nausea, vomiting, headache, and decreased level of consciousness. Bleeding is not associated with dialysis disequilibrium.

46. A client is receiving hemodialysis for acute kidney failure. Which assessment finding(s) indicates to the nurse that the client is experiencing dialysis disequilibrium? Select all that apply. a) Bleeding b) Headache c) Nausea d) Confusion e) Vomiting

a) Less than 400 mL Pg. 1569 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 minimum amount of urine needed to rid the body of normal metabolic waste products is 400 mL. In this phase, uremic symptoms first appear and life-threatening conditions such as hyperkalemia develop.

47. The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output? a) Less than 400 mL b) 1.0 L c) 1.5 L d) Less than 50 mL

c) pH 7.20, PaCO2 36, HCO3 14- Pg. 1570 Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.

48. The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? a) pH 7.31, PaCO2 48, HCO3 24- b) pH 7.50, PaCO2 29, HCO3 22- c) pH 7.20, PaCO2 36, HCO3 14- d) pH 7.47, PaCO2 45, HCO3 33-

b) Hemodialysis Pg. 1577 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.

49. 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? a) Continuous arteriovenous hemofiltration (CAVH) b) Hemodialysis c) Continuous venovenous hemofiltration (CVVH) d) Peritoneal dialysis

a) Recent history of streptococcal infection Pg. 1558 Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.

5. A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? a) Recent history of streptococcal infection b) History of osteoporosis c) Previous episode of acute pyelonephritis d) History of hyperparathyroidism

d) Lasix 80 mg IVP Pg. 1565 Diuretic agents are often used to control fluid volume in clients with acute kidney injury (AKI). The client's urine output indicates an inadequate response to the initial dosage of Lasix and the nurse should anticipate administering Lasix 80 mg IVP. Often in this situation, the initial dosage of Lasix is doubled. The client is experiencing fluid overload, thus, a 500-mL bolus of normal saline bolus would be contraindicated. There is no need to complete a chest x-ray. Mannitol is widely used in the management of cerebral edema and increased intracranial pressure from multiple causes.

50. A client diagnosed with acute kidney injury (AKI) has developed congestive heart failure. The client has received 40 mg of intravenous push (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The client's vital signs are stable. Which health care order should the nurse anticipate? a) Normal saline bolus of 500 mL b) Mannitol 12.5 g IVP c) Chest x-ray d) Lasix 80 mg IVP

a) Hypertension Pg. 1562 Hypertension is present in approximately 75% of clients with polycystic kidney disease at the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and abdominal pain also may be noted based on the size and effects of the cysts. Fever would suggest an infection. Periorbital edema is noted with acute glomerulonephritis.

51. A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess? a) Hypertension b) Fever c) Extremity pain d) Periorbital edema

c) Cloudy dialysate effluent Pg. 1587 Most complications of peritoneal dialysis are minor; however, if left untreated, it can lead to serious consequences. Peritonitis is the most common and serious complication of peritoneal dialysis. The first sign of peritonitis is cloudy dialysate effluent. Low back pain can occur from the weight of the fluid in the abdomen. Bloody effluent can occur in young menstruating female clients. It is also common during the first few exchanges after a new catheter is inserted, which most often clears up after several exchanges. Clients with peritonitis are more likely to report anorexia than pronounced hunger.

52. The nurse is visiting the home of a client who is receiving at-home peritoneal dialysis therapy. Which finding indicates to the nurse that the client is developing peritonitis? a) Bloody effluent b) Low back pain c) Cloudy dialysate effluent d) Report of pronounced hunger

c) It is accompanied by reduced blood flow to the nephrons Pg. 1562 The onset phase is accompanied by reduced blood flow to the nephrons. In the oliguric phase, fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. During the diuretic phase, excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. During the recovery phase, normal glomerular filtration and tubular function are restored.

53. A client with acute renal failure progresses through four phases. Which describes the onset phase? a) The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine b) Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications c) It is accompanied by reduced blood flow to the nephrons d) Normal glomerular filtration and tubular function are restored

a) Hyperacute rejection Pg. 1598 After a kidney transplant, rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years. A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized glomerular capillary thrombosis and necrosis. The term "simple" is not used in the categorization of types of rejection of kidney transplants.

54. The nurse cares for a client who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed: a) Hyperacute rejection b) Acute rejection c) Chronic rejection d) Simple rejection

d) Weight loss Pg. 1577 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.

55. 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: a) Increased blood pressure b) Hematuria c) Increased urine output d) Weight loss

b) Decrease in the blood flow through the kidneys Pg. 1564 Acute kidney injury can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.

58. A client who suffered hypovolemic shock during a cardiac incident has developed acute kidney injury. Which is the best nursing rationale for this complication? a) Blood clot formed in the kidneys interfered with the flow b) Decrease in the blood flow through the kidneys c) Structural damage occurred in the nephrons of the kidneys d) Obstruction of urine flow from the kidneys

d) Acute glomerulonephritis Pg. 1558 Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

59. A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? a) Nephrotic syndrome b) Acute renal failure c) Chronic renal failure d) Acute glomerulonephritis

a) Proteinuria Pg. 1558 The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided.

6. A client has been diagnosed with acute glomerulonephritis. This condition causes: a) Proteinuria b) Polyuria c) No option is correct d) Pyuria

b) Phosphate 5.0 mg/dL; tachycardia and nausea and emesis c) Calcium 7.5 mg/dL; hypotension and irritability d) Potassium 6.4 mEq/L; dysrhythmias and abdominal distention Pg. 1570 Decreased calcium, increased potassium, and increased phosphate levels are associated with ESKD, along with the signs and symptoms associated with these serum values. Decreased magnesium and chloride levels are not associated with ESKD.

60. The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply. a) Chloride 90 mEq/L; irritability and seizures b) Phosphate 5.0 mg/dL; tachycardia and nausea and emesis c) Calcium 7.5 mg/dL; hypotension and irritability d) Potassium 6.4 mEq/L; dysrhythmias and abdominal distention d) Magnesium 1.5 mg/dL; mood changes and insomnia

c) Sodium polystyrene sulfonate (Kayexalate) Pg. 1568 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. Sorbitol may be administered in combination with Kayexalate to induce a diarrhea-type effect (it induces water loss in the GI tract). If the client is hemodynamically unstable (low blood pressure, changes in mental status, dysrhythmia), IV dextrose 50%, insulin, and calcium replacement may be administered to shift potassium back into the cells.

61. A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering: a) Calcium supplements b) IV dextrose 50% c) Sodium polystyrene sulfonate (Kayexalate) d) Sorbitol

b) Sodium polystyrene sulfonate Pg. 1568 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.

62. What is used to decrease potassium level seen in acute renal failure? a) Calcium supplements b) Sodium polystyrene sulfonate c) Sorbitol d) IV dextrose 50%

a) Anemia b) Hypocalcemia d) Hyperkalemia Pg. 1576 Hyperkalemia is due to decreased potassium excretion and excessive potassium intake. Metabolic acidosis results from decreased acid secretion by the kidney. A damaged glomerular membrane causes excess protein loss.

72. Based on the pathophysiologic changes that occur as renal failure progresses, the nurse identifies the following indicators associated with the disease. Select all that apply. a) Anemia b) Hypocalcemia c) Hyperalbuminemia d) Hyperkalemia e) Metabolic alkalosis

b) Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL Pg. 1565 The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl. A BUN level of 100 mg/dl and a serum creatinine of 6.5 mg/dl are abnormally elevated results, reflecting CRF and the kidneys' decreased ability to remove nonprotein nitrogen waste from the blood. CRF causes decreased pH and increased hydrogen ions — not vice versa. CRF also increases serum levels of potassium, magnesium, and phosphorous, and decreases serum levels of calcium. A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls within the normal range of 60% to 75%.

63. A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? a) Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75% b) Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL c) Increased serum levels of potassium, magnesium, and calcium d) Increased pH with decreased hydrogen ions

d) Anemia Pg. 1560 Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur during chronic glomerulonephritis.

64. A change that occurs during chronic glomerulonephritis is termed a) Hypophosphatemia b) Hypokalemia c) Metabolic alkalosis d) Anemia

a) Urine output of 20 ml/hour Pg. 1600 Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.

65. A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a) Urine output of 20 ml/hour b) Temperature of 99.2° F (37.3° C) c) Serum sodium level of 135 mEq/L d) Serum potassium level of 4.9 mEq/L

a) Calcium Pg. 1556 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.

66. 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? a) Calcium b) Magnesium c) Phosphorus d) Sodium

c) Uremia Pg. 1570 Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.

67. Which clinical finding should a nurse look for in a client with chronic renal failure? a) Polycythemia b) Metabolic alkalosis c) Uremia d) Hypotension

b) Cola-colored urine Pg. 1559 Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.

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

c) Oliguria Pg. 1565 During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.

69. A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? a) Restored glomerular function b) Diuresis c) Oliguria d) Acute tubular necrosis

c) Encourage use of incentive spirometer every 2 hours Pg. 1593 To address the issue of ineffective breathing pattern, encouraging the use of incentive spirometer would be most appropriate to help increase alveolar ventilation. Administering isotonic fluid therapy would be appropriate for issues involving fluid loss such as bleeding or hemorrhage. Keeping the drainage catheter below the level of insertion would be appropriate to reduce the risk of obstruction leading to acute pain. Monitoring the temperature every 4 hours would be appropriate to reduce the client's risk for infection.

7. A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? a) Administer isotonic fluid therapy as ordered b) Keep the drainage catheter below the level of insertion c) Encourage use of incentive spirometer every 2 hours d) Monitor temperature every 4 hours

a) Fatigue and weakness Pg. 1570 RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.

70. A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: a) Fatigue and weakness b) Dyspnea and cyanosis c) Thrush and circumoral pallor d) Nausea and vomiting

c) Hold the medications until after dialysis Pg. 1581 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.

71. 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? a) Administer the medications as ordered b) Check with the dialysis nurse about the medications c) Hold the medications until after dialysis d) Ask if the client wants to take the medications

c) Tenderness over transplant site Pg. 1599 Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.

73. A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? a) Polyuria b) Hypotension c) Tenderness over transplant site d) Weight loss

a) "I should drink as much as possible to keep my kidneys working" Pg. 1559 Dietary management of acute post-streptococcal glomerulonephritis includes restrictions of protein, sodium, potassium, and fluids.

74. The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching? a) "I should drink as much as possible to keep my kidneys working" b) "I should limit foods high in potassium in my diet, such as bananas" c) "My intake of high sodium foods should be limited" d) "I should limit the amount of protein in my diet"

b) Turn the client from side to side Pg. 1588 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. The catheter should never be pushed further into the peritoneal cavity. Other measures to promote drainage include checking the patency of the catheter by inspecting for kinks, closed clamps, or an air lock.

75. 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? a) Notify the health care provider b) Turn the client from side to side c) Push the catheter further into the abdomen d) Lower the head of the bed

c) Removal of the transplanted kidney Pg. 1597 Hyperacute rejection isn't treatable; the only way to stop this reaction is to remove the transplanted organ or tissue. Although cyclosporine is used to treat acute transplant rejection, it doesn't halt hyperacute rejection. Bone marrow transplant isn't effective against hyperacute rejection of a kidney transplant. Methylprednisolone sodium succinate may be given IV to treat acute organ rejection, but it's ineffective against hyperacute rejection.

76. Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for: a) Intra-abdominal instillation of methylprednisolone sodium succinate (Solu-Medrol) b) Bone marrow transplant c) Removal of the transplanted kidney d) High-dose IV cyclosporine (Sandimmune) therapy

c) Oliguria Pg. 1565 The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys, such as urea and creatinine. 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.

77. Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? a) Diuresis b) Initiation c) Oliguria d) Recovery

a) No tight clothing c) Check daily for thrill and bruit d) Avoid compression of the site e) No IV or blood pressure taken on extremity with dialysis access Pg. 1579 The nurse teaches the patient with fistulae or grafts to check daily for a thrill and bruit. Further teaching includes avoiding compression of the site; not permitting blood to be drawn, an IV to be inserted, or blood pressure to be taken on the extremity with the dialysis access; not to wear tight clothing, carry bags or pocketbooks on that side, and not lie on or sleep on the area. The site is not cleansed unless it is being accessed for hemodialysis.

78. Patient education regarding a fistulae or graft includes which of the following? Select all that apply. a) No tight clothing b) Cleanse site b.i.d. c) Check daily for thrill and bruit d) Avoid compression of the site e) No IV or blood pressure taken on extremity with dialysis access

d) 1,000 mL Pg. 1555 The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1-kg weight gain is equal to 1,000 mL of retained fluid.

8. The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL? a) 250 mL b) 500 mL c) 750 mL d) 1,000 mL

b) Anemia Pg. 1560 Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur during chronic glomerulonephritis.

81. The nurse cares for a client diagnosed with chronic glomerulonephritis. The nurse will observe the client for the development of a) Hypokalemia b) Anemia c) Hypophosphatemia d) Metabolic alkalosis

a) The kidneys can improve over a period of months Pg. 1565-1566 The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute kidney injury can progress to chronic renal failure.

9. The nurse is providing supportive care to a client receiving hemodialysis in the management of acute kidney injury. Which statement from the nurse best reflects the ability of the kidneys to recover from acute kidney injury? a) The kidneys can improve over a period of months b) Acute kidney injury tends to turn to end-stage failure c) Kidney function will improve with transplant d) Once on dialysis, the need will be permanent