Kidney disorders chapter 54

Citrus fruits

The nurse is educating a patient who is required to restrict potassium intake. What foods would the nurse suggest the patient eliminate that are rich in potassium?

aseptic technique

The nurse is instructing a patient to perform continuous ambulatory peritoneal dialysis correctly at home. Which of the following educational information should the nurse provide to the patient? Use an_______ during the procedure.

Hold the medications until after dialysis.

The nurse is passing out medications on a medical-surgical unit. A male patient is preparing for hemodialysis. The patient is ordered to receive numerous medications including antihypertensives. Which of the following is the best action for the nurse to take?

Hypertension

Following are complications the nurse should monitor for during dialysis except for which of the following?

acute renal failure

A low-protein diet is required to reduce the production of end products of protein metabolism that the kidneys are unable to excrete. Establishing a diet high in calories and low in protein, sodium, and potassium is essential for patients with__________.

above

A mask is generally worn only while performing exchanges, especially when a patient has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine (Betadine), not with soap. In addition, the catheter should be stabilized to the abdomen______ the belt line, not below the belt line, to avoid constant rubbing.

0.5 kg/day

A patient has AKI with a negative nitrogen balance. How much weight does the nurse expect the patient to lose?

increasing acidosis

Acute or urgent dialysis is indicated when there is a high and increasing level of serum potassium, fluid overload, or impending pulmonary edema,_________, pericarditis, and advanced uremia.

immediate antibody-mediated

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_________ reaction that leads to generalized glomerular capillary thrombosis and necrosis.

6-12 months

After the oliguric phase, Fran will experience a period of recovery. How long was the nurse expect the recovery period to last?

glomerulonephritis

Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic________.

1.0 lb

At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much this loss equal to?

Calcium deficit

Carpopedal spasm and tetany

polystyrene sul- fonate [Kayexalate])

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 priori intervention does the nurse anticipate the physician will order to reduce the potassium

Reduced glomerular filtration, renal ischemia, tubular damage

Fran, a 42-year-old patient, is hospitalized with a diagnosis of AKI resulting from the administration of gentamicin sulfate for a pseudomonal infection. Fran is acutely ill upon admission and experiencing an altered level of consciousness. The nurse is concerned that Fran may experi- ence reduced kidney blood flow. What symp- toms would the nurse assess for?

dehydration

How can the nurse assist the patient with all of the testing required to detect a possible renal tumor? The nurse assessed the patient to prepare physically and psychologically for these procedures and monitors carefully for signs and symptoms of________ and exhaustion.

calcium acetate (PhosLo)

Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the Gl tract. Binders such as calcium carbonate (Os-Cal) or ________are prescribed, but there is a risk of hypercalcemia. If calcium is high or the calcium phosphorus product exceeds 55 mg/dL, a polymeric phosphate binder such as sevelamer hydrochloride (Renagel) may be prescribed. This medication binds dietary phosphorus in the intestinal tract; one to four tablets should be administered with food to be effective. Magnesium-based antacids are avoided to prevent magnesium toxicity

Dehydration

In the diuresis period of AKI, the nurse should observe the patient closely for what complication?

heart failure

List some of the signs that a patient chronic glomerulonephritis may be develop- ing heart failure: cardiomegaly, A gallop rhythm, distended neck veins, and other signs and symptoms of________ may be present. Crackles can be heard in the base of the lungs.

vascular

List the factors that influence mortality rate in patients with acute kidney injury: Factors that influence mortality include increased age, comorbid conditions, and pre-existing kidney and_______ diseases and respiratory failure.

Calcium excess

Muscle hypotonicity and flank pain

hypoalbuminanemia, hyperlipidemia

Name the clinical findings that the nurse would expect to find in a patient who has nephrotic syndrome: clinical findings include a marked increase in protein particularly albumin, in the urine which is called protein urea, a decrease in albumin in the blood which is_________, diffuse Edema, high serum cholesterol, and low density lipoprotein's which is called_______.

Fluid volume deficit

Oliguria and weight loss

0.5 mL/kg/hr.

Oliguria is defined as urine output less than

Magnesium deficit

Positive chvosteks sign

3.5

Proteinuria (predominantly albumin) exceeding_____ g/day is the hallmark of the diagnosis of nephrotic syndrome.

Sodium excess

Rough dry tongue and thirst

Potassium deficit

Soft, flabby muscles

Initiation, oliguria, diuresis, recovery

The four phases of acute kidney injury are:

AKI

The intrarenal category of_____ encompasses an increase BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium, Intrarenal AKI is the result of actual parenchymal damage to the glomeruli or kidney tubules.

Edema

The major manifestation of nephrotic syndrome is

Impending pulmonary edema

The nurse understands acute dialysis is indicated in which of the following situations?

Antihypertensive

_______therapy, often part of the regimen of patients on dialysis, is one example when communication, education, and evaluation can make a difference in patient outcomes. The patient 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.

Creatinine, BUN

blood levels that are significantly increased an acute kidney injury are two things

Autosomal recessive PKD

is a rare inherited form. Symptoms of this begin in the earliest months of life or in utero.

Calcium

A patient admitted with electrolyte imbal- ance has carpopedal spasm, ECG changes, and a positive Chvostek's sign. What deficit does the nurse suspect the patient has?

Kayexalate

A patient diagnosed AKI has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering which of the following?

A GFR of 30-59 mL/min/1.73 m2

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?

Protein deficit

Chronic weight loss and fatiguability

sevelamer hydrochloride (Renagel)

Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the Gl tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. If calcium is high or the calcium phosphorus product exceeds 55 mg/dL, a polymeric phosphate binder such as _________may be prescribed. This medication binds dietary phosphorus in the intestinal tract; one to four tablets should be administered with food to be effective. Magnesium-based antacids are avoided to prevent magnesium toxicity

Potassium excess

Irritability and intestinal colic

bruit, or "thrill,"

The nurse assesses the vascular access for patency. The_______ over the venous access site must be evaluated at least every shift. The nurse takes precautions to ensure that the extremity with the vascular access is not used for measuring blood pressure or for obtaining blood specimens; tight dressings, restraints, or jewelry over the vascular access must be avoided as well

Hypovolemic shock caused by hemorrhage

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?

4 to 5

Using CAPD, how often would Edward need to dialyze himself? Approximately______ times per day with no night exchanges

Recessive is a rare inherited form

What is the difference between autosomal- dominant and autosomal-recessive polycystic kidney disease?

From prolonged hypertension, diabetes

nephrosclerosis is primarily caused by two things

Weight

A nurse is caring for an acutely ill patient. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill patient is which of the following?

cerebral fluid shift

A patient is placed on hemodialysis for the first time. The patient complains of a head ache with nausea and begins to vomit, and the nurse observes a decreased level of sciousness. What does the nurse determine has happened? The patient is experiencing a________

Hydrating with saline intravenously before the test

A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropa- thy (CIN)?

2 to 3 months

A patient with ESKD is scheduled to have an arteriovenous fistula created. The nurse explains that the patient will have a temporary dialysis catheter because the fistula has to "mature." The nurse will explain that the patient will have to wait how long before using the fistula?

excess

Azotemia is the concentration of urea and other nitrogenous wastes in the blood. Uremia is an_______ of urea and other nitrogenous wastes in the blood. Hematuria is blood in the urine. Proteinuria is protein in the urine.

high-protein

Because of protein loss with continuous PD, the patient is instructed to eat a________, nutritious diet. The patient is also encouraged to increase his or her daily fiber intake to help prevent constipation, which can impede the flow of dialysate into or out of the peritoneal cavity.

Fluid volume excess

Crackles and dyspnea

Decresed calcium, increased (P P)

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.

diuresis phase

Dehydration is a complication during the________ related to elevated urine output and continued symptoms of uremia. The concern with 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.

Mannitol

Diuretic agents are often used to control fluid volume in patients with AKI. The patient'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 patient is experiencing fluid overload, thus, a 500-mL bolus of NS would be contraindicated. There is no need to complete a chest x-ray.________ is widely used the management of cerebral edema and increased intracranial pressure (ICP) from multiple causes.

70grams in 24hrs

During the oliguric phase of AKI, what should Fran's protein intake for her 156-lb body weight be?

10-15 minutes

Edward needs to be aware that toxic wastes are exchanged during the equilibration or dwell time. How long is he instructed to allow the fluid to dwell?

With food

The nurse is administering calcium acetate (PhosLo) to a patient with ESKD. When is the best time for the nurse to administer this medication?

Anemia

The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following?

Hemodialysis

The nurse is caring for a patient following extensive abdominal surgery. The patient develops an infection that is treated with IV gentamicin. After 4 days of treatment, the patient develops oliguria, and laboratory results indicate azotemia. The patient is diagnosed with acute tubular necrosis and transferred to the ICU. The patient is hemodynamically stable. Which of the following dialysis methods would be most appropriate for the patient?

Less than 400 mL

The nurse is caring for a patient in the oligu- ric phase of AKI. What does the nurse know would be the daily urine output?

Obtaining a blood pressure reading from the right arm

The nurse is caring for a patient with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which of the following nursing actions is contraindicated?

Dysrhythmias

The nurse should monitor for hypotension, not hypertension, during the treatment related to the removal of fluid. Muscle cramping may occur late in dialysis as fluid and electrolytes rapidly leave the extracellular space._________ may result from electrolyte and pH changes or removal of antiarrhythmic medications.

CAVH and CVVH

The patient is hemodynamically stable hemodialysis would be most appropriate. Hemodialysis is used for patients who are acutely ill and require short-term dialysis for days to weeks until kidney function resumes and for patients 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 patients with renal failure who are unable or unwilling to undergo hemodialysis or kidney transplantation.________ are used for patients who are hemodynamically unstable.

exchange procedure

The patient should be instructed to use an aseptic technique during the procedure. The patient should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (patients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an_______ in case of failure or unavailability of a cycling machine).

Diabetes

The primary cause of chronic kidney disease is

arteriosclerotic heart disease

This is the leading cause of death for patients undergoing chronic hemodialysis.

Abdominal distention, paralytic ileus

Two complications of renal surgery that are believed to be caused by reflex paralysis of intestinal peristalsis and manipulation of the colon or duodenum during surgery are

dysrhythmias

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. Calcium 7.5 mg/dL; hypotension and irritability, a) Potassium 6.4 mEq/L;________ and abdominal distention, c) Phosphate 5.0 mg/dL; tachycardia and nausea and emesis

High in protein

The nurse is educating Edward about the dietary modifications that are necessary to decrease the amount of accumulated waste products. What should the nurse be sure to include in the education?

Turn the patient from side to side.

The nurse is performing acute intermittent peritoneal dialysis (PD) on a patient who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. Which of the following is the nurse's best action?

Red blood cells in the urine Proteinuria Hemoglobin of 12.8 g/dL

The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulone- phritis? (Select all that apply.) Red blood cells in the urine Polyuria. Proteinuria White cell casts in the urine Hemoglobin of 12.8 g/dL

1,000 mL

The nurse notes that a patient who is retain- ing fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many ml?

High-protein diet

A patient diagnosed with chronic renal failure is receiving continuous peritoneal dialysis (PD). The nurse instructs the patient about which of the following diet plans?

Anemia

A patient with chronic kidney failure experi- ences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this patient?

Renagel (sevelamer)

The nurse is treating a patient with ESKD. The nurse is concerned that the patient is developing renal osteodystrophy. Upon review of the patient's laboratory values, it is noted the patient has had a calcium level of 11 mg/dL for the past 3 days and the phosphate level is 5.5 mg/dL. The nurse anticipates the administration of which of the following medications?

Azotemia

Which of the following terms is used to describe the concentration of urea and other nitrogenous wastes in the blood?

Nephrotic syndrome

________ is the type of renal failure characterized by increased glomerular permeability and manifested by massive proteinuria.

Acute tubular necrosis (ATN)

__________, acute kidney injury in which there is damage to the kidney tubules, is the most common type of intrinsic AKI. Characteristics of ATN are intratubular obstruction, tubular back leak (abnormal reabsorption of filtrate and decreased urine flow through the tubule), vasoconstriction, and changes in glomerular permeability. These processes result in a decrease of GFR, progressive azotemia, and fluid and electrolyte imbalances.

1 year

Hypoalbuminemia, hypernatremia, and hyperkalemia may also occur. Proteinuria and microscopic hematuria may persist for many months ; in fact , 20 % of patients have some degree of persistent proteinuria or decreased glomerular filtration rate (GFR)______ after presentation.

CAPD

Edward is a 29, year-old diabetic patient with end stage kidney disease (ESKD). He had had a kidne transplant that was rejected and chose_______ as his ESKD. The nurse has been of managing a way educating Edward about the use of_______ and will have a home health nurse come in to the home and ensure that he will be able to manage the regimen. Why does the nurse believe that Edward chose to manage his ESKD with______? The procedure allows the patient reasonable freedom and control of daily activities but requires a serious commitment to be successful.

calcium replacement

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 Gl tract). If the patient is hemodynamically unstable (low blood pressure, changes in mental status , dysrhythmia ) , IV dextrose 50 % , insulin , and__________ may be administered to shift potassium back into the cells.

Weight

The most accurate indicator of fluid loss or gain in an acutely ill patient is

Peritonitis

The most common and serious complication of continuous ambulatory peritoneal dialysis (CAPD) is

85

The most common type of renal carcinoma arises from the renal epithelium and accounts for more than- % of all kidney tumors .

A high protein diet

When Fran has passed the diuretic phase, what diet should the nurse recommend for her?

Increased BUN

Which of the following is a characteristic of the intrarenal category of AKI?

Gray-bronze skin color

Which of the following is integumentary manifestation of chronic renal failure?

Proteinuria

Which of the following is the hallmark of the diagnosis of nephrotic syndrome?

Autosomal dominant PKD

is the most common inherited form. Symptoms usually develop betweer the ages of 30 and 40, but they can begin earlier even in childhood . About 90 % of all PKD cases are this

Sodium deficit

Fingerprinting on the sternum

Metabolic acidosis

___________occurs in 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.

Lasix (Furosemide) 80 mg IVP

A patient diagnosed with AKI has developed congestive heart failure. The patient 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 patient's vital signs are stable. Which of the following health orders should the nurse anticipate?

patency

If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the patient 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________ of the catheter by inspecting for kinks, closed clamps, or an air lock.

ecchymosis

Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus,______, purpura, thin, brittle nails, and coarse, thinning hair.

Hyperacute rejection

The nurse is caring for a patient who underwent a kidney transplant. The nurse understands that rejection ofa transplanted kidney within 24 hours after transplant is termed which of the following?

pH 7.20 , PaCO2 36 , HCO3 14

The nurse is caring for a patient with ESKD. Which of the following acid-base imbalances is associated with this disorder?