Chapter 68

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?

Dialysis works by movement of wastes from lower to higher concentration

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?

Discuss what treatment regimen means to him

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 client's care?

Electrolyte and fluid imbalance

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?

Give the client a bottle of water immediately

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 client's history?

Have you been taking any aspirin, ibuprofen, or naproxen recently?

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 scheduled in 60 minutes. What action by the nurse is best?

Hold all medications since both cefazolin and vitamins are dialyzable

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?

I am thrilled that I can continue at eat fast food

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)

I need to ask for an antibiotic when scheduling a dental appointment. I'll need to check my blood sugar often to prevent hypoglycemia. The dose of my pain medication may have to be adjusted. I should watch for bleeding when taking my anticoagulants.

The nurse is teaching a client how to increase flow of dialysate into the peritoneal cavity during dialysis. Which statement by the client demonstrates a correct understanding of the teaching?

I should take a stool softener every morning to avoid constipation

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 kidney-specific formulation for the enteral solution compared to standard formulas. What components should be discussed in the teaching plan? (Select all that apply)

Lower sodium. Lower potassium. Higher calories.

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?

Maintaining a balanced intake and output

The nurse is caring for five client 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)

Man with prostate cancer. Woman with blood clots in the urinary tract. Client with ureterolithiasis.

The nurse is take 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. What is the most appropriate action by the nurse?

Monitor the client's temperature

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)

My weight should be maintained at a body mass index of 30. I can continue to take an aspirin every 4 to 8 hours for my pain. I really only need to drink a couple of glasses of water each day.

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 client's recent history?

Myocardial infarction

A client is placed on fluid restrictions because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client's fluid balance is stable at this time?

No adventitious sounds in the lungs

A client is take furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect positive effect of the medication, what action of the nurse is best?

Obtain daily weights of the client

A client just had a central line catheter placed that is specific for hemodialysis. What is the most appropriate action by the nurse?

Place a heparin or heparin/saline dwell after hemodialysis

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?

Place the client on a cardiac monitor immediately

A client is assessed by the nurse after a hemodialysis session. The nurse notes bleeding from the client's nose and around the intravenous catheter. What action by the nurse is priority?

Prepare protamine sulfate for administration

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 low-grade fever and a pericardial friction rub?

Registered nurse who was assigned the same client yesterday

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 nurse's priority action?

Slow down the normal saline infusion

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?

Take a sample of the effluent and send to the laboratory

A client is recovering from a kidney transplant. The client's urine output was 1500 mL over the last 12 hour period since transplantation. What is the priority assessment by the nurse?

Taking blood pressure

A client with chronic kidney disease states, I feel chained to the hemodialysis machine. What is the nurse's best response to the client's statement?

Tell me more about your feelings regarding hemodialysis treatment

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)

Urine output of 100 mL in 4 hours. Large amount of sediment in the urine. Blood pressure of 90/60 mm Hg.

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)

You will not need vascular access to perform PD. There is less restriction for protein and fluids. You have flexible scheduling for the exchanges.

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 should the nurse perform to maintain blood pressure? (Select all that apply)

Adjust the rate of extracorporeal blood flow. Place the client in the Trendelenburg position. Administer a 250-mL bolus of normal saline.

The charge nurse is orienting a float nurse to an assigned client with arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe?

Administering intravenous fluids through the AV fistula

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?

Albumin level of 2.5 g/dL

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)?

Angiotensin-converting enzyme (ACE) inhibitor

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?

Blood pressure of 76/58 mm Hg

A client with chronic kidney disease (CKD) is experiencing nausea, vomiting, visual changes, and anorexia. What action by the nurse is best?

Check the client's digoxin (Lanoxin) level

A nurse is caring for four client with chronic kidney disease. Which client should the nurse assess first upon initial rounding?

Client with Kussmaul respirations