Chapter 34: Acute Kidney Injury and Chronic Kidney Disease Patho Prep U
A client diagnosed with CKD has begun to experience periods of epistaxis and has developed bruising of the skin and subcutaneous tissues. The nurse recognizes these manifestations as:
Impaired platelet function
The nurse recognizes that acute renal injury is characterized by which of the following?
Rapid decline in renal function
With the increased risk of drug toxicity among chronically ill older adults, which statement by the nurse explains why the older adult's kidney is vulnerable to toxic injury?
"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney."
The nurse caring for clients with chronic kidney disease (CKD) assesses for signs of renal osteodystrophy (skeletal damage). Which manifestations are characteristic of both high-bone-turnover and low-bone-turnover osteodystrophy? Select all that apply.
- Abnormal bone resorption - Defective bone remodeling
Which conditions have the potential to cause chronic kidney disease? Select all that apply.
- Hypertension - Diabetes - Glomerulonephritis
The diagnosis is chronic kidney disease (CKD). While caring for a client with CKD, the nurse will monitor for which neurologic signs and symptoms? Select all that apply.
- Loss of recent memory - Peripheral neuropathy - Restless legs syndrome - Burning sensation in feet
A client is diagnosed with early chronic kidney disease (CKD). The nurse will recommend which actions to slow progression of renal damage? Select all that apply.
- Smoking cessation - Blood pressure control - Angiotensin converting enzyme (ACE) inhibitor administration - Blood glucose control
A client with chronic kidney disease (CKD) is anemic. The nurse will attempt to alleviate the anemia in order to prevent which of the following? Select all that apply.
- Tachycardia - Fatigue - Decreased myocardial oxygen
A client has experienced severe hemorrhage and is in prerenal acute kidney injury. The nurse anticipates the client's blood urea nitrogen (BUN) and serum creatinine laboratory results will be in which range?
10:1
Accumulation of nitrogenous wastes such as urea in the circulatory system is an early sigh of chronic kidney disease (CKD). The nurse knows that normal levels of urea in blood are approximately:
20 mg/dL (7.14 mmol/L)
A client has been diagnosed with chronic kidney disease (CKD). Which drug category is usually administered to treat coexisting conditions that manifest early in CKD?
Antihypertensive medications
The nurse is caring for a client with chronic renal failure who is on hemodialysis three times a week. In order to treat hyperphosphatemia and hypocalcemia, which medication will the nurse administer to decrease absorption of phosphate from the gastrointestinal tract?
Calcium carbonate
The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney failure?
Client with prostatic hyperplasia
Manifestations of childhood renal disease are varied and may differ from adult-onset renal failure. A school-aged child with chronic kidney disease may exhibit which manifestation?
Developmental delays such as uncoordinated gait and minimal fine motor skills
The nurse is instructing a client with advanced kidney disease (AKD) about a dietary regimen. Which restriction should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD?
Dietary protein
A client is beginning to recover from acute tubular necrosis. During which phase of acute kidney injury will the nurse assess an increase in urine output?
Diuretic phase
Several urine tests can be useful in establishing a diagnosis of acute renal failure (ARF). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which type of drug?
Diuretics
A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is:
Dorsiflexion of hands and feet
Which dermatologic problem most often accompanies chronic kidney disease (CKD)?
Dry skin and pruritus
A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?
Hypertension
A client is to receive a radiocontrast media as part of a diagnostic scan. Which intervention is intended to reduce the nephrotoxic effects of the radiocontrast media?
Increasing the normal saline intravenous infusion rate prior to the exam
While assessing a peritoneal dialysis client in the home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as:
Peritonitis
A client with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which condition does the nurse suspect is common with this stage of kidney disease?
Pericarditis
A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which intervention would be most appropriate for the nurse to provide?
Restrict intake of dietary protein
An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which early sign of prerenal injury?
Sharp decrease in urine output
The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents:
a loss of over half the client's normal kidney function.
Chronic kidney disease impacts many systems in the body. What is the most common hematologic disorder caused by CKD?
anemia
A client asks, "Why did my provider order a glomerular filtration rate (GFR) to my usual blood work?" The nurse's best response is based on the fact that GFR can estimate serum levels of which substance?
creatinine
The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?
serum creatinine
A client diagnosed with CKD has begun to experience periods of epistaxis and has developed bruising of the skin and subcutaneous tissues. The nurse recognizes these manifestations as:
impaired platelet function
A client with a history of chronic kidney disease (CKD) is experiencing increasing fatigue, lethargy, and activity intolerance. The care team has established that the client's glomerular filtration rate (GFR) remains at a low, but stable, level. Which laboratory assessments will most likely be prescribed to help determine the cause of these new symptoms?
Blood work for hemoglobin, red blood cells, and hematocrit
A client sustained acute tubular injury approximately 2 hours ago. Which cause of acute kidney injury (AKI) would the nurse suspect the client is experiencing?
Intrarenal
Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct?
Kidneys convert inactive vitamin D to its active form, calcitriol.
An 86-year-old client is being treated for dehydration and hyponatremia after curtailing fluid intake to prevent urinary incontinence. Given these findings, the nurse recognizes that this client is likely in what phase of acute kidney injury?
Prerenal
A client with significant burns on his lower body has developed sepsis on the third day following his accident. Which manifestation would the nurse anticipate for an ischemic acute tubular necrosis rather than prerenal failure?
The client's GFR does not increase after restoration of renal blood flow
A 45-year-old female is being treated for ovarian cancer. Her treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of:
nephrotoxic acute tubular necrosis (ATN).
