Chapter 63: Concepts of Care for Patients with Acute Kidney Injury and Chronic Kidney Disease
A client in the intensive care unit with acute kidney injury (AKI) must maintain a mean arterial pressure (MAP) of 65 mm Hg to promote kidney perfusion. What is the clients MAP if the blood pressure is 98/50 mmHg? (Record your answer using a whole number.) _____ mm Hg
66 mmHg
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
A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would give the nurse the most concern? a. Albumin level of 2.5 g/dL b. Phosphorus level of 5 mg/dL c. Sodium level of 135 mmol/L d. Potassium level of 5.5 mmol/L
A
A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mL/dL. What question should the nurse ask first when taking this clients 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
For which causes will the nurse monitor clients for development of intrarenal (intrinsic) acute kidney injury (AKI)? Select all that apply. A. Glomerulonephritis B. Bladder cancer C. Exposure to nephrotoxins D. Embolism in renal blood vessels E. Severe dehydration F. Kidney stones
ACD
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 clients care? a. Edema and pain b. Electrolyte and fluid imbalance c. Cardiac and respiratory status d. Mental health status
B
The nurse is taking the vital signs of a client after hemodialysis. Blood pressure is 110/58 mm Hg, pulse 66 beats/min, and temperature is 99.8 F (37.6 C). What is the most appropriate action by the nurse? a. Administer fluid to increase blood pressure. b. Check the white blood cell count. c. Monitor the clients temperature. d. Connect the client to an electrocardiographic (ECG) monitor.
C
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.
D
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
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.
A
A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, 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 clients intake and output. d. Ask to have the laboratory redraw the blood specimen.
A
A client in the intensive care unit is started on continuous venovenous hemofiltration (CVVH). Which finding is the cause of immediate action by the nurse? a. Blood pressure of 76/58 mm Hg b. Sodium level of 138 mEq/L c. Potassium level of 5.5 mEq/L d. Pulse rate of 90 beats/min
A
A client is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect the positive 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 clients abdomen. d. Assess the clients diet history.
A
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
A client with chronic kidney disease (CKD) has an elevated serum phosphorus level. What drug would the nurse anticipate to be prescribed for this client? a. Calcium acetate b. Doxycyline c. Magnesium sulfate d. Lisinopril
A
A client with chronic kidney disease (CKD) is experiencing nausea, vomiting, visual changes, and anorexia. Which action by the nurse is best? a. Check the clients digoxin (Lanoxin) level. b. Administer an anti-nausea medication. c. Ask if the client is able to eat crackers. d. Get a referral to a gastrointestinal provider.
A
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
A male 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 him. 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
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 mmHg. 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.
A
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 the priority? a. Give the client a bottle of water immediately. b. Start an intravenous line for fluids. c. Teach the client to drink 2 to 3 liters of water daily. d. Perform an electrocardiogram.
A
Based on the Kidney Disease: Improving Global Outcomes classification (KDIGO), how will the nurse interpret this client data (serum creatinine increases 1.5 times over baseline with urine output of less than 0.5 mL/kg/hr for 6 hours or longer)? A. Stage 1 B. Stage 2 C. Stage 3 D. End-stage kidney disease
A
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 to the dialysate solution C. Transient symptoms in a client new to hemodialysis D. Expected manifestations of end-stage kidney disease
A
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 more teaching is needed? a. I am thrilled that I can continue to eat fast food. b. I will cut out bacon with my eggs every morning. c. My cooking style will change by not adding salt. d. I will probably lose weight by cutting out potato chips.
A
What is the nurse's priority action when the health care provider orders IV fluids at a rate of 1 mL/kg/hr for 12 hours prior to a CT scan with contrast media for a client who weighs 152 lbs? A. Set the IV pump to deliver fluid at 69 mL/hr. B. Set the IV pump to deliver fluid at 152 mL/hr. C. Call the health care provider for clarification of the order. D. Ask the radiologist for clarification of the order.
A
When the nurse reviews the laboratory results and finds that a client with chronic kidney disease (CKD) has a serum potassium level of 8 mEq/L (mmol/L), which assessment will be completed before notifying the health care provider? A. Cardiac rhythm B. Respiratory rate and depth C. Tremors of the hands D. Change in urine appearance
A
The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for post-renal acute kidney injury (AKI)? (Select all that apply.) a. Man with prostate cancer b. Woman with blood clots in the urinary tract c. Client with ureterolithiasis d. Firefighter with severe burns e. Young woman with lupus
ABC
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
ABC
Which nutritional supplements does the nurse expect the health care provider will prescribe for a client with chronic kidney disease? Select all that apply. A. Water-soluble vitamins B. Calcium C. Iron D. Magnesium E. Vitamin D F. Phosphorus
ABCE
For which client conditions does the nurse expect the possibility of emergent hemodialysis (HD)? Select all that apply. A. Severe uncontrollable hypertension B. Pericarditis C. Symptomatic hyperkalemia with ECG changes D. Myocardial infarction E. Pulmonary edema F. Some drug overdoses
ABCEF
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
ABD
A client is undergoing hemodialysis. The clients blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions should the nurse perform to maintain blood pressure? (Select all that apply.) a. Adjust the rate of extracorporeal blood flow. b. Place the client in the Trendelenburg position. c. Stop the hemodialysis treatment. d. Administer a 250-mL bolus of normal saline. e. Contact the health care provider for orders.
ABD
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 accurate 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.
ABD
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."
ABD
What are the criteria used for selection of clients for hemodialysis (HD)? Select all that apply. A. Client values and preferences B. Client's family member or partner who is willing to learn about HD C. Irreversible kidney failure when other therapies are unacceptable or ineffective D. No disorders that would seriously complicate HD E. Expected ability to continue or resume roles at home, work, or school F. Insurance plan will cover costs of procedures
ACDE
Which are the goals of nutritional support for a client with acute kidney injury (AKI) when the nurse collaborates with the registered dietitian nutritionist (RDN)? Select all that apply. A. Maintaining or improving nutritional status B. Creating a program for weight loss C. Preserving lean body mass D. Restoring or maintaining fluid balance E. Preserving kidney function F. Preventing end-state kidney disease
ACDE
A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The nurse is teaching the client's spouse about the renal-specific formulation for the enteral solution compared to standard formulas. What components would be discussed in the teaching plan? (Select all that apply.) a. Lower sodium b. Higher calcium c. Lower potassium d. Higher phosphorus e. Higher calories
ACE
A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The nurse is teaching the clients spouse about the kidney-specific formulation for the enteral solution compared to standard formulas. What components should be discussed in the teaching plan? (Select all that apply.) a. Lower sodium b. Higher calcium c. Lower potassium d. Higher phosphorus e. Higher calories
ACE
A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery. Which findings by the nurse should prompt immediate action to prevent acute kidney injury? (Select all that apply.) a. Urine output of 100 mL in 4 hours b. Urine output of 500 mL in 12 hours c. Large amount of sediment in the urine d. Amber, odorless urine e. Blood pressure of 90/60 mm Hg
ACE
A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery.Which findings by the nurse would prompt immediate action to prevent acute kidney injury? (Select all that apply.) a. Urine output of 100 mL in 4 hours b. Urine output of 500 mL in 12 hours c. Large amount of sediment in the urine d. Amber, odorless urine e. Blood pressure of 90/60 mm Hg
ACE
Which client conditions will the nurse recognize as absolute contraindications to receiving a kidney transplant? Select all that apply. 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
ACE
What urinalysis findings does the nurse expect when a client is in the early stage of chronic kidney disease? Select all that apply. A. Proteinuria B. Increased specific gravity C. Red blood cells (RBCs) D. Increased urine osmolarity E. White blood cells (WBCs) F. Glucosuria
ACEF
When prerenal and postrenal causes of acute kidney injury occur, how does the nurse expect a client's kidneys to compensate? Select all that apply. A. Constricting of blood vessels in the kidneys B. Restricting of secretion of glucocorticoids C. Releasing antidiuretic hormone (ADH) D. Crushing then passing fragments of kidney stones E. Dilating of peripheral arteries throughout the body F. Activating the renin-angiotensin-aldosterone pathway
ACF
6. Which assessment questions are most appropriate for the nurse to ask a client at risk for acute kidney injury (AKI)? Select all that apply. A. "Have you noticed any changes in your urine's 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 any unexpected weight loss?" D. "Do you have a history of diabetes, hypertension, or peripheral vascular disease?" E. "Do you use any nonsteroidal anti-inflammatory drugs regularly?" F. "Have you had and recent surgeries, traumas, or transfusions?"
ADEF
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.
B
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. Take 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.
B
A client is recovering from a kidney transplant. The clients urine output was 1500 mL over the last 12-hour period since transplantation. What is the priority assessment by the nurse? a. Checking skin turgor b. Taking blood pressure c. Assessing lung sounds d. Weighing the client
B
For which emergency procedure does the nurse prepare when a client with chronic kidney disease develops chest pain, tachycardia, low-grade fever, friction rub, and muffled heart tones? A. Hemodialysis B. Removal of pericardial fluid C. Cardioversion D. Endotracheal intubation
B
The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which condition would the nurse expect to find in the clients recent history? a. Pyelonephritis b. Myocardial infarction c. Bladder cancer d. Kidney stones
B
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
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
B
The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess first upon initial rounding? a. Woman with a blood pressure of 158/90 mm Hg b. Client with Kussmaul respirations c. Man with skin itching from head to toe d. Client with halitosis and stomatitis
B
The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse? a. My sodium level changes by movement from the blood into the dialysate. b. Dialysis works by movement of wastes from lower to higher concentration. c. Extra fluid can be pulled from the blood by osmosis. d. The dialysate is similar to blood but without any toxins.
B
What does the nurse expect the nephrology health care provider to prescribe when a post kidney transplant client develops oliguria, elevated temperature of 100° F (37.8° C), increased blood pressure, 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 peritoneal dialysis D. Antibiotic therapy until infection symptoms are resolved
B
What is the nurse's best response when a client asks how often and for how long he or she will have to go for hemodialysis (HD)? A. "It varies and you will need to discuss this with your nephrology health care provider for specific instructions." B. "Most clients require about 12 hours per week, which is usually divided into three 4-hour treatments." C. "If you follow the diet and fluid therapies you will spend less time in dialysis, about 8 hours each week." D. "Many clients prefer to have home treatment dialysis that occurs every night while sleeping."
B
What is the nurse's first action when a client with chronic kidney disease (CKD) 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 intensive care unit 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 minutes D. Administering an IV loop diuretic such as furosemide
B
When a client is in the diuretic phase of acute kidney injury (AKI), what priority action will the nurse take? A. Assessing for hypertension and fluid overload B. Monitoring for hypovolemia and electrolyte loss C. Adjusting the dosage of diuretic medications D. Balancing diuretic therapy with intake and output
B
Which electrolyte imbalance does the nurse expect when a client is in the early phase of chronic kidney disease (CKD)? A. Hyperkalemia B. Hyponatremia C. Hypercalcemia D. Hypokalemia
B
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 and electrolytes. D. The effluent is expected to be cloudy because it has spent time (dwelled) in the abdomen, in close contact with the intestines.
B
Why will the nurse immediately notify the nephrology health care provider if a client develops hypotension and diuresis postoperatively 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 kidney. C. These assessment findings are indicators of a possible serious acute infection. D. Increased work by the kidney for diuresis results in excessive buildup of cellular toxins that damage the new kidney's tubules.
B
A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD). Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.) a. "I can continue to take antacids to relieve heartburn." b. "I need to ask for an antibiotic when scheduling a dental appointment." c. "I'll need to check my blood sugar often to prevent hypoglycemia." d. "The dose of my pain medication may have to be adjusted." e. "I should watch for bleeding when taking my anticoagulants."
BCDE
A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD). Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.) a. I can continue to take antacids to relieve heartburn. b. I need to ask for an antibiotic when scheduling a dental appointment. c. Ill need to check my blood sugar often to prevent hypoglycemia. d. The dose of my pain medication may have to be adjusted. e. I should watch for bleeding when taking my anticoagulants.
BCDE
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
BCDE
Which gastrointestinal changes does the nurse expect to find when assessing a client with uremia? Select all that apply. A. Increased salivation B. Halitosis C. Stomatitis D. Anorexia E. Nausea and vomiting F. Hiccups
BCDEF
The nurse collaborates with the registered dietician nutritionist (RDN) to teach a client about which recommendations for management of chronic kidney disease? Select all that apply. A. Reducing calories B. Controlling protein intake C. Limiting fluid intake D. Restricting potassium E. Increasing sodium F. Restricting phosphorus
BCDF
Which actions will the nurse take to check the peritoneal dialysis system of a client when the dialysate outflow is slow? Select all that apply. A. Ensuring that the drainage bag is elevated above the client's abdomen B. Inspecting the tubing to ensure there is no kinking 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
BCDF
The nurse is teaching a client with diabetes mellitus how to prevent or delay chronic kidney disease (CKD). Which client statements indicate a lack of understanding of the teaching? (Select all that apply.) a. I need to decrease sodium, cholesterol, and protein in my diet. b. My weight should be maintained at a body mass index of 30. c. Smoking should be stopped as soon as I possibly can. d. I can continue to take an aspirin every 4 to 8 hours for my pain. e. I really only need to drink a couple of glasses of water each day.
BDE
1. Which criteria does the nurse understand are included in the current definition of acute kidney injury (AKI)? Select all that apply. A. Signs and symptoms of fluid overload such as peripheral edema and crackles in the lungs B. Urine volume of less than 0.5 mL/kg/hr for 6 hours C. Presence of polyuria, nocturia, and very dilute pale yellow urine D. Increase in serum creatinine by 0.3 mg/dL (26.2 µmol/L) or more within 48 hours E. Hypotension and tachycardia with progressively decreased amounts of urine F. Increase in serum creatinine to 1.5 times or more from baseline in the previous 7 days
BDF
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
C
A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema? a. Maintaining oxygen saturation of 89% b. Minimal crackles and wheezes in lung sounds c. Maintaining a balanced intake and output d. Limited shortness of breath upon exertion
C
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
C
A client is placed on fluid restrictions because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the clients 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
C
A client is started on continuous venovenous hemofiltration (CVVH). Which finding would require immediate action by the nurse? a. Potassium level of 5.5 mEq/L (5.5 mmol/L) b. Sodium level of 138 mEq/L (138 mmol/L) c. Blood pressure of 76/58 mm Hg d. Pulse rate of 88 beats/min
C
A client with diabetes mellitus type 2 has been well controlled with metformin. The client is scheduled for magnetic resonance imaging (MRI) scan with contrast. What priority would the nurse take at this time? a. Teach the client about the purpose of the MRI. b. Assess the client's blood urea nitrogen and creatinine. c. Tell the client to withhold metformin for 24 hours before the MRI. d. Ask the client if he or she is taking antibiotics.
C
A nurse reviews the laboratory values of a client who returned from kidney transplantation 12 hours ago: Sodium 136 mEq/L (135 mmol/L) Potassium 5 mEq/L (5 mmol/L) Blood urea nitrogen (BUN) 44 mg/dL (15.7 mmol/L) Serum creatinine 2.5 mg/dL (221 mcmol/L) 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.
C
For a client diagnosed with acute kidney injury (AKI), the nurse considers questions an order for which diagnostic test? A. Ultrasonography B. Kidney-ureter-bladder x-ray (KUB) C. Computed tomography with contrast D. Kidney biopsy
C
For which condition does the nurse suspect a client with chronic kidney disease (CKD) is attempting to compensate for when respirations increase in rate and depth? A. Hypoxia B. Alkalosis C. Acidosis D. Hypoxemia
C
The charge nurse is orienting a float nurse to 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
C
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
C
The charge nurse of the medical-surgical unit is making staff assignments. Which staff member should be assigned to a client with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub? a. Registered nurse who just floated from the surgical unit b. Registered nurse who just floated from the dialysis unit c. Registered nurse who was assigned the same client yesterday d. Licensed practical nurse with 5 years experience on this floor
C
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."
C
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.
C
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
C
What is the best method for the nurse to monitor the weight of a client who is receiving peritoneal dialysis (PD)? A. Calculating the client's dry weight by comparing daily weights to baseline weights B. Determining dry weight by comparing the client's weight to a standard weight chart C. Checking the weight after a drain and before the next fill to monitor the dry weight D. Weighing the client daily and subtracting dialysate volume to determine dry weight
C
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 health care provider C. Recording the difference as intake on the flow sheet D. Instructing the client to stand and walk then measuring the next outflow
C
Which client will the nurse consider most likely to be a candidate for continuous kidney replacement therapy (CKRT) using venovenous hemofiltration? A. 65-year-old with fluid volume overload B. 55-year-old who needs long-term management C. 45-year-old who is critically ill and unstable D. 35-year-old with a peritoneal infection
C
Which condition will the nurse recognize increases the risk for a client with benign prostatic hyperplasia (BPH) to develop? A. Perfusion reduction (prerenal failure) B. Intrinsic or intrarenal failure C. Urine flow obstruction (postrenal failure) D. End-stage kidney disease
C
Which health promotion teaching will the nurse stress to healthy adults to prevent harm from acute kidney injury (AKI)? A. Check your blood pressure every day. B. Find out if you have a family history of diabetes. C. Avoid dehydration by drinking 2 to 3 liters of water daily. D. Have annual testing for blood urea nitrogen (BUN), creatinine, protein, and glucose.
C
Which outcome statement indicates to the nurse that the goal of giving a client IV therapy after a diagnostic imaging test with contrast media has been met? A. Lung sounds are clear and there are no signs or symptoms of fluid overload. B. The client has no signs or symptoms of contrast-induced immune response. C. Urine output is 150 mL/hr for 6 hours after the use of the contrast agent. D. Urine output is 0.5mL/kg/hr for 6 hours and the client remains euvolemic.
C
Which type of medication does the nurse expect the health care provider to prescribe for a client with acute kidney injury to improve blood flow to the kidneys? A. Loop diuretics B. Phosphate binders C. Calcium channel blockers D. Erythropoietin-stimulating agents
C
nurse reviews these 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.
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
Which laboratory results will the nurse monitor when a client is receiving IV gentamicin? Select all that apply. A. Platelet count B. Hemoglobin and hematocrit C. Blood urea nitrogen (BUN) D. Prothrombin time E. Creatinine F. Gentamicin peak and trough levels
CEF
A client has a long history of hypertension. Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)? a. Antibiotic b. Histamine blocker c. Bronchodilator d. Angiotensin-converting enzyme (ACE) inhibitor
D
A client has just had a central line catheter placed that is specific for hemodialysis. What is the most appropriate action by the nurse? a. Use the catheter for the next laboratory blood draw. b. Monitor the central venous pressure through this line. c. Access the line for the next intravenous medication. d. Place a heparin or heparin/saline dwell after hemodialysis.
D
A client is assessed by the nurse after a hemodialysis session. The nurse notes bleeding from the clients nose and around the intravenous catheter. What action by the nurse is the priority? a. Hold pressure over the clients nose for 10 minutes. b. Take the clients pulse, blood pressure, and temperature. c. Assess for a bruit or thrill over the arteriovenous fistula. d. Prepare protamine sulfate for administration.
D
A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurses priority action? a. Calculate the mean arterial pressure (MAP). b. Ask for insertion of a pulmonary artery catheter. c. Take the clients pulse. d. Slow down the normal saline infusion.
D
A client with chronic kidney disease states, I feel chained to the hemodialysis machine. What is the nurses best response to the clients statement? a. That feeling will gradually go away as you get used to the treatment. b. You probably need to see a psychiatrist to see if you are depressed. c. Do you need help from social services to discuss financial aid? d. Tell me more about your feelings regarding hemodialysis treatment.
D
A nurse is caring for a client who is scheduled for a dose of cefazolin and vitamins at this time. Hemodialysis for this client is also scheduled in 60 minutes. Which action by the nurse is best? a. Administer cefazolin since the level of the antibiotic must be maintained. b. Hold the vitamins but administer the cefazolin. c. Hold the cefazolin but administer the vitamins. d. Hold all medications since both cefazolin and vitamins are dialyzable.
D
For how many hours will the nurse instruct the assistive personnel (AP) to check the hourly urine output of a postoperative client who had a kidney transplant? A. 8 hours B. 12 hours C. 24 hours D. 48 hours
D
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
D
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."
D
To avoid harm and prevent osteodystrophy, which intracollaborative action does the nurse implement? A. Encouraging high-quality protein foods B. Administering iron supplements twice a day C. Encouraging extra milk with meals and snacks D. Administering phosphate binders with each meal
D
What does the nurse expect when comparing a client's posthemodialysis weight and blood pressure with predialysis data? A. Blood pressure is increased and weight is decreased B. Blood pressure and weight are slightly increased C. Blood pressure and weight are the same D. Blood pressure and weight are decreased
D
What instructions will the nurse give to the assistive personnel (AP) regarding care of a client with an arteriovenous fistula? A. Assess for bleeding at the needle insertion sites every 2 hours. B. Monitor the client's distal pulses and capillary refill for circulation. C. Palpate the dialysis site for thrills and auscultate for a bruit every 4 hours. D. Avoid taking blood pressure readings on the client's arm with the arteriovenous fistula.
D
Which client does the nurse understand has the greatest risk of developing acute kidney injury (AKI)? A. 23-year-old female who was recently treated for a urinary tract infection B. 32-year-old female who is pregnant and has gestational diabetes C. 49-year-old male who is obese and has a history of skin cancer D. 73-year-old male who has hypertension and peripheral vascular disease
D
Which drug will the nurse avoid administering to a client with chronic kidney disease (CKD) to prevent harm? A. Opioids B. Antibiotics C. Oral antihyperglycemics D. Magnesium antacids
D
Which instruction will the nurse give an assistive personnel (AP) to prevent harm when providing care to a client who has osteodystrophy? A. Assist the client with feeding for all meals. B. Gently wash the client's skin with a mild soap and rinse well. C. Assist the client with ambulation to the toilet every 2 hours. D. Use a lift sheet when moving or lifting the client.
D
Which laboratory result will the nurse expect when a client with chronic kidney disease reports fatigue, lethargy with weakness, and mild shortness of breath with dizziness when rising to a standing position? A. Low blood glucose B. Low white blood cell count C. Low blood urea nitrogen (BUN) D. Low hemoglobin/hematocrit
D
