Kidneys

Normal Serum Creatinine Range

0.5 - 1.5

Normal Calcium Range

4.5 - 5.5 mEq/L OR 9-11 mg/dL

Normal BUN Range

7-20

Normal Phosphate Range

1.7 - 2.6 mEq/L or 2.5 - 4.5 mg/dL

Normal GFR Range

100-125

Normal Sodium Range

135 - 145

Normal Potassium Range

3.5 - 5.3

A child has been admitted to the unit with nephrotic syndrome. In talking with the mother, she reports that her cousin had acute glomerulonephritis last year. The mother asks how these two diseases compare, as they both affect the kidneys. The nurses response would include which piece of information? A. Both disorders produce smoky colored urine B. Both disorders cause greatly reduced urine output C. Both disorders have a genetic basis D. Both disorders require treatment with anabiotic therapy

B. Both AGN and the nephrotic syndrome are characterized by a reduction in urine output. AGN presents with smoky here and while the urine in the Nephrotic syndrome is clear and frothy. AGN is a post infectious disease with no genetic basis. Anabiotic's are not used in nephrotic syndrome

Which laboratory data is the most accurate indicator that a client with acute renal failure or has met the expected outcomes? A. Decreasing blood urea nitrogen levels B. Decreasing serum creatinine C. Decreasing neutrophil count D. Decreasing lymphocyte count

B. Creatinine is the metabolic end product of creatinine phosphate and is excreted via the kidneys in relatively consistent amounts. BUN, a measurement of the nitrogen portion of urea, is also excreted in urine and is a good indicator of renal function. However, conditions that increase protein catabolism also cause a rise in BUN levels. Therefore, the serum creatinine levels are more appropriate to evaluate in determining the return of renal function. Neutrophils and lymphocytes are not used to monitor the return of renal function.

After a client has returned from surgery, the nurse needs to report which urinary output? a. 20 mL per hour b. 40 mL per hour c. 300 mL per 8 hours d. 400 mL per 8 hours

a. 20 mL/hr Urine output of less than 30 mL/hr should be reported, specifically urine output of less than 30 mL/hr on average over a 4-hour period of time.

A nurse is planning care for a client who has stage 4 chronic kidney disease. Which of the following should the nurse include in the plan of care? select all a. assess for jugular vein distention b. provide frequent mouth rinses c. auscultate for a pleural friction rub d. assess using the Glasgow Coma Scale e. monitor for dysrhythmias

a. JVD may indicate fluid overload and CHF b. halitosis caused by urea waste in the blood c. pleural friction rub = respiratory failure and pulmonary edema = adit base imbalance and fluid retention e. dysrhythmias = increased potassium (not being excreted by the kidneys) d. GCS is used for a client with a head injury

When caring for a client with acute renal failure, the nurse would plan which of the following treatment goals for the client? a. Compensate for renal impairment by restoring fluid balance. b. Increase fluids to prevent nephrolithiasis. c. Maintain adequate nutrition by encouraging a high-protein and high-calorie diet. d. Prevent infection by administering antibiotics.

a. The treatment goals for acute renal failure include identifying and correcting underlying cause, preventing kidney damage, restoring urine output and kidney function, and compensating for renal impairment. Antibiotics are administered for a documented infection. Preventing nephrolithiasis is a medical goal. High-protein and high-calorie diets will contribute to kidney failure.

What disease process is marked by these findings: fatigue pallor dizziness, confusion, lethargy tachycardia, tachypnea, hypotension

anemia

What are three common clinical manifestations of acute renal failure?

anemia fluid volume excess hyperkalemia

The nurse is caring for a client with acute renal failure. When providing the dietary instruction, the nurse would evaluate that the client has understood the instructions when the client states: a. "I will avoid meatloaf, green beans, and country biscuits." b. "I will avoid cereal with bananas and orange juice." c. "I will avoid tilapia, baked macaroni and cheese, and stewed tomatoes." d. "I will avoid coffee, eggs, and rye toast."

b. A client with renal failure should avoid foods high in potassium and sodium. Foods high in potassium include nonsalt seasoning mixes, potatoes, bananas, and orange juice. The other foods listed are not typically high in potassium or sodium.

A nurse is caring for a client who has stage 4 chronic kidney disease. Which of the following is an expected laboratory finding? a. BUN 54 mg/dL b. Glomerular filtration rate (GFR) 20 mL/min c. Serum Creatinine 1.2 mg/dL d. Serum Potassium 5.0 mEq/L

b. GFR is severely decreased to 20 mL/dL a. BUN would be 180 - 200 mg/dL c. Createnine would be 15-30 mg/dL d. potassium greater than 5.0 mEq/L

The most important nursing interventions to prevent acute renal failure in the critically ill client include: a. Avoiding all potentially nephrotoxic drugs. b. Maintaining fluid volume and cardiac output. c. Administering antihypertensive drugs. d. Assessing for a history of diabetes or systemic lupus erythematosus.

b. Ischemia is the most common cause of acute renal failure (ARF); therefore, maintaining fluid volume, cardiac output, and renal output are the highest-priority nursing interventions to prevent renal failure. The other options are viable interventions but do not take precedence over maintaining fluid volume and cardiac output.

A nurse is monitoring for postoperative complications in a client who had a kidney biopsy. Which of the following complications causes the most immediate risk to the client? a. infection b. hemorrhage c. hematuria d. kidney failure

b. hemorrhage all others are risks, however not the most immediate risk

A nurse is caring for a client who is receiving hemodialysis and develops disequilibrium syndrome. Which of the following is an appropriate action by the nurse? a. administer an opioid medication b. monitor for hypertension c. assess LOC d. increase the dialysis exchange rate

c. LOC: a change in urea levels can cause increased intracranial pressure, and subsequently, the client's LOC is decreased. b. hypotension d/t rapid change in fluids and electrolytes causing the disequilibrium syndrome d. slow the dialysis exchange rate to slow the rapid changes in fluid and electrolyte status.

A client who has experienced a burn injury over 40 percent of the body is at risk for acute tubular necrosis. In order to prevent renal failure in this client, the nurse should: (Select all that apply.) a. Increase fluids to prevent crystal formation. b. Reduce sodium intake. c. Maintain blood pressure. d. Prevent infection. e. Maintain adequate fluid balance.

c. d. and e Acute tubular necrosis results from burns and hypovolemia sepsis. The nurse should prevent ischemia by maintaining blood flow to the kidney and prevent hypotension and infection. Because sodium and water are lost in equal amounts, there is no need to limit sodium intake. The nurse does not increase fluids without an order; however, fluid resuscitation in a burn client is carefully calculated to prevent kidney failure.

A nurse is planning care for a client who has prerenal acute kidney injury following abdominal aortic aneurysm repair. The client's urinary output is 80 mL in the past 4 hours, and blood pressure is 92/58. Which of the following should be included in the plan of care? a. prepare the client for a CAT scan with contrast dye b. anticipate urine specific gravity to be 1.010 c. plan to administer a fluid challenge d. place client in trendelenburg position

c. hypovolemia is indicated by the low urinary output and blood pressure a. contrast dye is contraindicated with acute kidney injury b. specific gravity of 1.030 (hypovolemia) d. reverse trendelenberg (head down feet up)

A nurse is reviewing a client's laboratory findings for urinalysis. The findings indicate the urine is positive for leukoesterase and nitrates. Which of the following is an appropriate nursing action? a. repeat the test early the next morning b. start a 24-hour urine collection for creatinine clearance c. obtain a clean-catch urine specimen or culture and sensitivity d. Insert a urinary catheter to collect a urine specimen

c. obtaining a clean-catch urine specimen for culture and sensitivity is appropriate because this determines the antibiotic that will be most effective for treatment of the UTI. leukoesterase and nitrates indicate a UTI

Which nursing actions are instituted for the client with kidney trauma? a. Observe urine for oliguria and proteinuria. b. Monitor level of consciousness and urine output. c. Monitor vital signs for hypotension and bradycardia. d. Observe for hypertension and check urine for hematuria.

d. Damage to the kidney resulting in reduced renal perfusion will stimulate the renin-angiotensin system causing hypertension and reducing the ability of the kidney to prevent blood from escaping into the urine. Monitoring level of consciousness is appropriate for the client but not necessarily for kidney trauma. The client is more likely to have hypertension and tachycardia. The client may eventually have oliguria or proteinuria if renal failure results, but initially the nurse is observing for hypertension and hematuria as the best sign that the kidneys have sustained damage.

A nurse is providing teaching to a client who is to have an x-ray of the kidneys, ureters, and bladder (KUB). Which of the following statements should the nurse include in the teaching? a. contrast dye is given during this procedure b. an enema is necessary before the procedure c. you will need to lie in a prone position during the procedure d. the procedure determines if there is a kidney stone present

d. a KUB can identify renal calculi, strictures, calcium deposits, or obstructions. (c. supine not prone)

A nurse is providing teaching to a client who has chronic kidney disease and is to start hemodialysis. Which of the following information should the nurse include in the teaching? a. hemodialysis restores renal function b. hemodialysis replaces hormonal function of the renal system c. hemodialysis allows an unrestricted diet d. hemodialysis returns a balance to serum electrolytes

d. by removing excess sodium, potassium, fluids, and waste products; and restores acid-base balance

What disease process is marked by these findings: dependent pitting edema respiratory crackles dyspnea, pulmonary edema, hypoxemia weight gain tachycardia JVD

fluid volume excess

What type of diet should a person have while on hemodialysis?

high in folate and protein low in sodium, potassium, and phosphorus

What disease process is marked by these findings: ventricular arrhythmias tall peaked t-waves, widened QRS cardiac arrest smooth muscle hyperactivity n/v abdominal cramping diarrhea muscle weakness paresthesias flaccid paralysis

hyperkalemia

Drugs that end in -ide

loop diuretics

What does the hormone aldosterone stimulate?

reabsorption of sodium

What does the hormone ADH stimulate?

reabsorption of water

What does the hormone renin stimulate?

vasoconstriction

Do loop diuretics waste/save potassium?

waste

Which discharge instructions with the nurse give to a client who will receive an aminoglycoside anabiotic at home to address the risk of nephrotoxicity? Select all that apply. A. Increase fluid intake to 2000 to 2500 mL of fluid daily. B. Report sudden weight gain or puffy eyes. C. Don't be concerned with Adema as a normal side effect. D. Elevated blood pressure is an expected drug affect. E. Eat a low-protein diet while taking this anabiotic.

A and B The client should maintain a fluid intake of 2000 to 2500 mL per day to reduce the risk of nephrotoxicity. To detect nephrotoxicity early, the client should report signs of edema. Adema is not a normal side effect of the medication. To reduce the risk of nephrotoxicity, the client should report hypertension. It is a necessary to eat a low-protein diet while taking and aminoglycoside

The nurse caring for a client preparing to undergo hemodialysis will include which of the following in the plan of care? (Select all that apply.) a. Obtain weight and orthostatic vital signs. b. Assess blood pressure of extremity where fistula has been created. c. Determine urine specific gravity and pH. d. Monitor serum creatinine, BUN, and hematocrit levels. e. Restrict fluid and protein intake.

A. and D. Weight and orthostatic vital signs are indicators of fluid volume status and electrolyte balance. Laboratory tests are monitored to evaluate the effects of treatment. Restriction of fluid and food during dialysis is not necessary and may contribute to decreased fluid volume. The client does not produce urine to be tested. Blood pressure is never taken in the arm where the fistula is placed.

A client receiving peritoneal dialysis has outflow less than 100 mL less than the inflow for two consecutive exchanges. Which of the following actions would be the best for the nurse to take first? A. Check clients blood pressure B. Change clients position C. Irrigate dialysis catheter D. Will continue to monitor third exchange

B. Peritoneal dialysis uses osmosis and diffusion and across the peritoneal membrane to clear toxins from the patient. The dialysate fluid, once in skilled, migrates to most dependent areas, which may not be in direct contact with the dialysis catheter. Took the silver tape drainage, the clients position should be changed to move the dialysate solution into contact with the tip of the catheter.

In a child with acute renal failure, the nurse would help to prevent hyperkalemia by limiting which foods in the child's diet? A. Grains, cheese, and citrus fruits B. Potatoes, tomatoes, and oranges C. Cereals, processed sugars, and wheat D. Rice, leafy green vegetables, and carbonated beverages

B. Potatoes, tomatoes, and oranges have a high level of potassium content. The others have less potassium in them.

A client with chronic renal failure or asks the nurse why he is anemic. What response by the nurse is best? A. The increased metabolic waste products in your body depress the bone marrow B. We will need to review your dietary intake of iron rich foods C. There is a decreased production by the kidneys of the hormone erythropoietin D. It is most likely that you have hereditary traits for the development of anemia

C. Anemia is common in clients with renal failure because of decreased production of erythropoietin by the kidneys and shorten red blood cell life. Erythropoietin is involved in the stimulation of the bone marrow to produce red blood cells. Metabolic wastes do not depressed the bone marrow. Anemia is common in clients with renal failure but is not caused by iron deficiency. Heredity does not play a role in Amenia associated with renal failure

A client with chronic renal failure or has fluid volume excess. The laboratory report indicates the sodium level to be 120 mEq per liter. The nurse interprets this as which of the following? A. And elevated sodium level that must be reported immediately to the physician B. An error in the laboratory analysis C. A possible hemodilution affect secondary to excessive water retention D. And expected reduce number of sodium ions in client with chronic renal failure

C. Clients with renal failure retain sodium, and any decrease in the serum level will most likely be caused by hemodilution from the excessive fluid retention. A sodium level of 120 is significantly lower than normal there is no reason to conclude there is a laboratory year. Clients with renal failure retain sodium, and the number of sodium ions would be expected to increase if there was not a corresponding increase in fluid retention.

A client in the intensive care unit develops prerenal failure following surgery. Which of the following causes should the nurse suspect? A. Vascular disease B. Urethral obstruction C. Hypovolemia D. Glomerulonephritis

C. Prerenal failure is caused by factors such as hypovolemia and decreased cardiac output that reduce renal bloodflow and perfusion, vascular disease may be a factor in the development of intrarenal failure. Urethral obstruction can cause post renal failure. Glomerulonephritis may be a factor in the development of

The nurse is explaining the process of peritoneal dialysis to a client who recently developed renal failure. Which statement with the nurse include in a discussion with the client? A. The solutes in the dialysate Will enter the bloodstream through the peritoneum B. The peritoneum is more permeable because of the presence of excess metabolites C. The peritoneum acts as a semi permeable membrane through which wastes move by diffusion and osmosis D. The metabolites will move from the interstitial space to the bloodstream mainly through diffusion and ultra filter ration

C. The peritoneum acts as a semi permeable membrane, allowing substances to move from an area of high concentration which is the blood, to an area of lower concentration which is the dialysate. Metabolic waste products and excess water can be eliminated through osmosis and diffusion and utilizing the peritoneum as the semi permeable membrane

A child is being treated for nephrotic syndrome. The nurse has told the mother that is important to keep the child skin clean and dry. When the mother asks why, what rationale with the nurse include in our response? A. The skin is fragile secondary to electrolyte deficiency B. Frequent urination may leave moisture on the skin that predisposes to breakdown C. Dietary restrictions make fighting infection hard D. The condition causes the reduction of gamma globulin in the body

D. Nephrotic syndrome involves the loss of protein in the urine. Gammaglobulins, which help the body fight infection, are proteins. There is no electrolyte deficiency. The child is only oliguric and therefore does not urinate frequently. The only restrictions on the child's intake or fluid and perhaps sodium.

What type of renal failure with the nurse expect to see you in a client who overdosed accidentally on tobramycin? A. Pre-renal failure B. Post renal failure C. Extra renal failure D. Intra-renal failure

D. Nephrotoxic drugs, such as aminoglycoside anabiotic's like tobramycin, can damage the nephrons and cause intrarenal failure. Pre-renal failure causes include any condition that reduces the blood flow to the kidney, such as heart failure, shock, and other conditions. Post renal failure can be caused by conditions that obstructs you're an outflow in the lower urinary system. There is no condition called extra renal failure.

In conducting client teaching with a client who will undergo peritoneal dialysis at home, the nurse includes discussion of what common and significant complication of peritoneal dialysis? A. Pulmonary embolism B. Hypotension C. Dyspnea D. Peritonitis

D. Peritonitis is a grave complication of peritoneal dialysis, caused by bacteria that may enter through the catheter or dialysate solution. Hypertension is a common complication of hemodialysis but not peritoneal dialysis. Pulmonary embolus and dyspnea are not common complications of peritoneal dialysis.

The nurse caring for a client undergoing a hemodialysis procedure places high-priority on evaluating the client frequently for what common complication during the treatment. A. Hyperglycemia B. Infection and fever C. Dialysis dementia D. Hypotension

D. Hypotension is the most common complication during hemodialysis and is related to several factors, including changes in serum osmolarity and rapid removal of fluid from the intravascular compartment. Hyperglycemia could occur in peritoneal dialysis because of the glucose composition of the dialysate. Infection and fever should be an ongoing assessment, not just when the client is undergoing hemodialysis. Dialysis dementia is a progressive, long-term complication.

Which statement made by a client with chronic renal failure or and who is on hemodialysis indicates the need for further teaching? A. I will report any increase in my weight of 5 pounds in a 2 day period B. I take my prescribed antihypertensive drugs daily C. I am careful to take precautions in the arm with the AV fistula D. I comply with salt restrictions in my diet by using salt substitutes

D. Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in clients with renal failure, and the use of salt substitutes will worsen hyperkalemia. Increases and weight do not need to be reported to healthcare provider as a possible indication of fluid volume excess. The control of hypertension is essential in the management of a client with renal failure. An AV fistula does need to be protected from injury that could be caused by constricting clothing, venipunctures, and other items

A nurse administered captopril to a client during renography (kidney scan). Which of the following is an appropriate action by the nurse? a. assess the client for hypertension b. limit the client's fluid intake c. monitor for orthostatic hypotension d. encourage early ambulation

c. orthostatic hypotension captopril = antihypertensive = orthostatic hypotension a. HYPOtensive effects b. increasing fluids can help with HYPOtension d. hypotensive = risk for falls

The nurse evaluates client teaching as effective when the client recovering from acute renal failure states: a. "I will avoid taking drugs that may be nephrotoxic." b. "I will self-catheterize for residual urine at least once a week." c. "I will consume only vegetable proteins." d. "I will limit my intake to 1500 mL or less per day."

a. Nephrotoxic drugs, including over-the-counter products, can produce further damage to the kidney cells and should be avoided. Depending on urinary output, fluid intake generally is not restricted during the recovery phase of acute renal failure. Vegetable proteins are not complete proteins, and therefore are not recommended if protein intake is restricted. Self-catheterization by the client is performed when the client has urinary retention or nerve damage to the bladder.

A nurse is planning care for a client who has postrenal acute kidney injury due to metastatic cancer. The client has a serum creatinine of 5mg/dL. Which of the following are appropriate actions by the nurse? (select all) a. provide a high-protein diet b. assess the urine for blood c. monitor for intermittent anuria d. administer diuretic medication e. provide NSAIDs for pain

a. acute kidney injury = high rate of protein breakdown b. blood could indicate obstruction c. anuria = bilateral structure obstruction d. diuretic can increase destruction of the remaining nephrons in the kidney e. NSAIDS are nephrotoxic

A nurse is caring for a client who has type 2 DM and is to undergo excretory urography. Which of the following are appropriate nursing actions prior to this procedure? a. identify client allergy to seafood b. hold metformin for 24 hours c. administer an enema d. obtain client's serum coagulation profile e. assess client for history of asthma

a. contrast dye is used in this procedure b. metformin + contrast dye increases risk for lactic acidosis c. removing feces, fluid, and gas provides a more clear visualization e. asthma + contrast dye increased risk for allergic reaction d. serum coagulation profile = kidney biopsy

A nurse is planning post procedure care for a client who received hemodialysis. Which of the following should the nurse include in the plan of care? select all a. check the BUN and serum creatinine b. administer medications held prior to dialysis c. observe for signs of hypovolemia d. assess the access site for bleeding e. evaluate blood pressure on side of AV access

a. determines the presence and degree of uremia or waste products after dialysis b. medications that can be partially dialyzed during the treatment should be withheld. After the treatment, the nurse should administer the medications c. a client who is post-dialysis is at risk for hypovolemia due to a rapid decrease in fluid volume d. heparin is administered during the procedure to prevent clotting of blood with the dialyzing surfaces

A nurse assessing a client who has prerenal acute kidney injury. Which of the following should the nurse include in the assessment? (select all) a. blood pressure b. cardiac enzymes c. urine output d. creatinine e. electrolytes

a. hypotenstion = hypovolemia c. urine output = oliguria d. creatinine would determine the extent of the AKI and the need for intervention e. electrolytes would determine the extent of the AKI and the need for intervention

A nurse is planning care for a client who is having peritoneal dialysis. Which of the following are appropriate nursing actions? (select all) a. monitor serum glucose levels b. report cloudy dialysate return c. warm the dialysate in a microwave d. assess for SHOB e. check the access site dressing for wetness f. maintain medical asepsis when accessing the catheter insertion site

a. the dialysate solution contains glucose b. cloudy indicates infection d. SHOB indicates inability to handle large amounts of dialysate e. wetness indicates tubing is kinked, pulled, clamped, or twisted which increases risk for exit site infections c. microwave = uneven warming of the solution f. surgical asepsis

A nurse is preparing to initiate hemodialysis for a client who has acute kidney injury and has been hospitalized. Which of the following are appropriate nursing actions? select all a. review the client's current medications b. assess the client's arteriovenous fistula for a bruit c. calculate the client's total urine output during the shift d. obtain the client's weight e. check the client's serum electrolytes f. use the client's access site area for venipuncture

a. will determine which meds to hold after dialysis b. determines the potency of the fistula for dialysis d. compare weight before and after dialysis e. determines the need for dialysis c. output may vary according to the remaining kidney function and does not determine the need for dialysis. f. the access site should never be used for venipuncture, can cause loss of vascular site.