Med Surg Ch 62 Coordinating Care for Patients with Renal Disorders, Brunner and Suddarth's Textbook of Medical Surgical Nursing- Chapter 54: Management of Patients with Kidney Disorders, Chapter 26 Kidney Disorders and Therapeutic Management, NCLEX 6...
A client with chronic kidney disease (CKD) takes aluminum hydroxide gel (ALternaGEL) as a phosphate binder. On the basis of this information, the nurse determines that the client is most at risk for which problem? A. Constipation B. Dehydration C. Inability to tolerate activity D. Impaired physical mobility
A. Constipation The client with CKD is almost certain to have a problem with constipation as a result of factors such as fluid restriction, fatigue that limits exercise, and dietary restrictions. In addition, phosphate-binding antacids such as aluminum hydroxide gel cause constipation as a side effect. The other problems listed are unrelated to the information in the question.
A 45yearold man with diabetic nephropathy has ESKD and is starting dialysis. "What should the nurse teach the patient about hemodialysis? "Hemodialysis is a treatment option that is usually required three times a week." "Hemodialysis is a program that will require you to commit to daily treatment." "This will require you to have surgery and a catheter will need to be inserted into your abdomen." "Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again."
"Hemodialysis is a treatment option that is usually required three times a week."**** "Hemodialysis is a program that will require you to commit to daily treatment." "This will require you to have surgery and a catheter will need to be inserted into your abdomen." "Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again." Feedback: Hemodialysis is the most commonly used method of dialysis. Patients receiving hemodialysis must undergo treatment for the rest of their lives or until they undergo successful kidney transplantation. Treatments usually occur three times a week for at least 3 to 4 hours per treatment.
A 71yearold patient with ESKD has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The patient tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to make? "The decision is certainly yours to make, but be sure not to make a mistake." "Kidney transplants in patients your age are as successful as they are in younger patients." "I understand your hesitancy to commit to a transplant surgery. Success is comparatively rare." "Have you talked this over with your family?"
"The decision is certainly yours to make, but be sure not to make a mistake." "Kidney transplants in patients your age are as successful as they are in younger patients."******* "I understand your hesitancy to commit to a transplant surgery. Success is comparatively rare." "Have you talked this over with your family?" Feedback: Although there is no specific age limitation for renal transplantation, concomitant disorders (e.g., coronary artery disease, peripheral vascular disease) have made it a less common treatment for the elderly. However, the outcome is comparable to that of younger patients. The other listed options either belittle the patient or give the patient misinformation.
The nurse instructs a client about continuous ambulatory peritoneal dialysis (CAPD). Which statement, if made by the client, indicates an accurate understanding of CAPD? A. "No machinery is involved, and I can pursue my usual activities." B. "A cycling machine is used, so the risk for infection is minimized." C. "The drainage system can be used once during the day and a cycling machine for three cycles at night." D. "A portable hemodialysis machine is used so that I will be able to ambulate during the treatment."
A. "No machinery is involved, and I can pursue my usual activities." CAPD closely approximates normal renal function, and the client will need to infuse and drain the dialysis solution several times a day. No machinery is used, and CAPD is a manual procedure.
The nurse coming on shift on the medical unit is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing ESKD? A patient with a history of polycystic kidney disease A patient with diabetes mellitus and poorly controlled hypertension A patient who is morbidly obese with a history of vascular disorders A patient with severe chronic obstructive pulmonary disease
A patient with a history of polycystic kidney disease A patient with diabetes mellitus and poorly controlled hypertension***** A patient who is morbidly obese with a history of vascular disorders A patient with severe chronic obstructive pulmonary disease Feedback: Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may cause ESKD. A patient with more than one of these risk factors is at the greatest risk for developing ESKD. Therefore, the patient with diabetes and hypertension is likely at highest risk for ESKD.
The nurse is planning patient teaching for a patient with ESKD who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula? A vein and an artery in your arm will be attached surgically. The arm should be immobilized for 4 to 6 days. One needle will be inserted into the fistula for each dialysis treatment. The fistula can be used 2 days after the surgery for dialysis treatment.
A vein and an artery in your arm will be attached surgically.***** The arm should be immobilized for 4 to 6 days. One needle will be inserted into the fistula for each dialysis treatment. The fistula can be used 2 days after the surgery for dialysis treatment. Feedback: The fistula joins an artery and a vein, either sidetoside or endtoend. This access will need time, usually 2 to 3 months, to "mature" before it can be used. The patient is encouraged to perform exercises to increase the size of the affected vessels (e.g., squeezing a rubber ball for forearm fistulas). Two needles will be inserted into the fistula for each dialysis treatment.
To remove fluid during hemodialysis, a positive hydrostatic pressure is applied to the blood and a negative hydrostatic pressure is applied to the dialysate bath. What is this process called? a. Ultrafiltration b. Hemodialysis c. Reverse osmosis d. Colloid extraction
a. Ultrafiltration
A patient with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the patient's abdomen is increasing in girth. What is the nurse's most appropriate action? Advance the catheter 2 to 4 cm further into the peritoneal cavity. Reposition the patient to facilitate drainage. Aspirate from the catheter using a 60mL syringe. Infuse 50 mL of additional dialysate.
Advance the catheter 2 to 4 cm further into the peritoneal cavity. Reposition the patient to facilitate drainage.***** Aspirate from the catheter using a 60mL syringe. Infuse 50 mL of additional dialysate. Feedback: 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. It would be unsafe to aspirate or to infuse more dialysate.
The patient with clinical manifestations of oliguria and elevated creatinine clearance would be most consistent with: A. Tubular necrosis B. Tubular secretion C. Glomerular filtration D. Capillary permeability
Answer: A
The nurse should inform the physician if, when assessing the patient with an AV fistula, they note which of the following? A. A loud, turbulent bruit B. A quiet swooshing bruit C. A low-pitched thrill D. A continuous thrill
Answer: A Rationale: A normal functioning graft will have a low-pitched bruit. A turbulent bruit is indicative of an increased force, mostly due to stenosis.
Which laboratory value provides the best indication of renal function? A. GFR B. Serum potassium level C. Ionized calcium level D. Serum creatinine
Answer: A Renal failure is the partial or complete inability of the kidneys to filter waste products and water from the blood through glomerular and tubular filtration. Renal failure is not just the absence of urine or the reduction of urinary output, even though both oliguria (reduction of urine output to 400 mL per day) and renal failure generally coexist. Ultimately, renal failure is the inability of the kidneys to excrete waste products and water from the bloodstream through filtration. The function of the kidneys is essential to the entire body. If the kidneys fail to function properly, the remainder of the organ systems will be affected, and multisystem organ failure will occur. Acute kidney injury (AKI) is a rapid, acute disease process but in most cases is reversible if addressed in a responsive and timely manner. However, if AKI is not addressed immediately, chronic kidney disease (CKD) is inevitable. The ischemia to the basement membrane and tubular epithelium seen in acute tubular necrosis (ATN is one cause of AKI) results in a decreased glomerular filtration rate (GFR).
The nurse providing care for the patient post motor vehicle accident with a suspected injury to the renal system anticipates which of the following orders? A. Perform an electrocardiogram (ECG). B. Send a urinalysis to the laboratory. C. Administer diuretics. D. Administer antihypertensives.
Answer: B Rationale: Blood in the urine (hematuria) is the best indicator of blunt kidney injury. Microscopic hematuria is easily detected by a simple urinalysis.
The nurse understands CRRT is indicated for which of the following patients? A. A hospitalized but hemodynamically stable patient B. A hospitalized, hemodynamically unstable patient C. A hospitalized ESRD patient being discharged home soon D. A hospitalized ESRD patient who is stable but in an intensive care setting
Answer: B Rationale: CRRT is indicated for the unstable patient who may not tolerate the rapid fluid shifts of HD.
The nurse understands that CKD is characterized by which of the following? A. Rapid decrease in urine output with a CKD-elevated BUN B. Progressive irreversible destruction to the kidneys C. Abrupt increasing creatinine clearance with a decrease in urinary output D. Confusion and somnolence leading to coma and death
Answer: B Rationale: Chronic kidney disease (CKD) is progres- sive, irreversible loss of kidney function. CKD is defined as the presence of kidney damage or a glomerular filtration rate less than 60 ml/min for 3 months or longer.
The nurse should intervene immediately if the patient post renal transplantation is noted to have which of the following symptoms? A. Weight loss, hypotension, reduced urine output B. Fever, reduced urine output, elevated blood pressure C. Weight gain, hypotension, increased urine output D. Increased urine output, hypertension, fever
Answer: B Rationale: Fever, reduced urine output, and elevated BP may be indicative of the presence of AKI related to transplant rejection.
Which laboratory value below would be associated with the patient experiencing dehydration? A. Presence of casts B. WBCs C. Specific gravity 1.035 D. Presence of nitrates
Answer: C
The nurse includes which information in the teaching plan about management of PKD? A. "Your blood pressure will normalize when we successfully manage your PKD." B. "Your UTI will not recur if you finish your antibiotic prescription." C. "Staying on your antihypertensive medication is necessary to control your blood pressure." D. "This disease is reversible if you closely follow your provider's orders."
Answer: C Rationale: BP and UTI are chronic problems with PKD. Continued BP medication will be necessary. PKD is not reversible.
The nurse caring for Ms. Flood incorporates which priority nursing diagnosis into the plan of care related to her diagnosis of PKD? A. Pain related to irritation on urination secondary to UTI B. Imbalanced nutrition related to excessive loss of protein in the urine C. Decreased cardiac output related to dysrhythmias secondary to electrolyte imbalance D. Impaired perfusion related to decreased circulating volume secondary to diuresis
Answer: C Rationale: Decreased cardiac output is a risk due to the potential risk electrolyte imbalances that occur with renal failure.
The nurse includes which dietary information in the teaching plan about the management of chronic kidney disease? A. Decrease fluid intake and protein intake, decrease carbohydrate intake B. Increase fluid intake, decrease carbohydrate intake and protein intake C. Decrease fluid intake and protein intake, increase carbohydrate intake D. Increase fluid intake, increase carbohydrate intake and protein intake
Answer: C Rationale: It is important to decrease fluid intake because people with CKD may have a reduction in urine output, causing fluid to build up in the body; this puts the patient at further risk for volume overload. Decreasing protein intake will limit the buildup of waste products in the body, and increasing carbohydrates will provide patients with a good source of energy that is lost with the low-protein diet.
Prior to the patient's CT scan, which information should be obtained from the patient or family member? A. Family history of CT scans B. Time of patient's last meal C. List of patient's allergies D. Time of last pain medication
Answer: C Rationale: It is not uncommon for patients to be allergic to the IV contrast used for CAT scans. It is important to rule out the presence of this allergy to avoid serious allergic reactions such as anaphylaxis.
The nurse monitors for which clinical manifestation in Ms. Flood, who is newly diagnosed with PKD? A. Hypotension related to fluid shifts B. Bradycardia related to fluid overload C. Hypertension related to decreased renal perfusion D. Tachycardia related to fluid loss
Answer: C Rationale: Newly diagnosed PKD typically presents with hypertension. Fluid overload and fluid shifts occur later in the disease if renal failure occurs.
The nurse recognizes that genetic counseling is appropriate for which patient? A. Child with frequent urinary tract infections B. Adult with frequent urinary tract infection C. Adult with autosomal dominant polycystic kidney disease D. Adult with metastatic renal cancer
Answer: C Rationale: PKD is a genetic disorder. Individuals with PKD who are concerned about passing the disease to their children may want to consult a genetic counselor to help them identify risks for a child developing PKD as well.
The nurses recognizes that the elderly patient may have a reduced ability to concentrate urine which is attributed to which of the following? A. A reduction in bladder receptors B. Thickening of the basement membrane of the Bowman's capsule C. A decrease in the number of functioning nephrons D. A thickening of the efferent arteriole
Answer: C Rationale: The elderly have a reduced space of functioning nephrons which impairs the ability to concentrate urine.
When the patient is in the diuretic phase of AKI, the nurse must monitor which serum electrolyte imbalance? A. Hypokalemia and hyponatremia B. Hypokalemia and hypernatremia C. Hyperkalemia and hyponatremia D. Hyperkalemia and hypernatremia
Answer: C Rationale: There is a decreased excretion of potassium and an increase in sodium losses.
The nurse is screening patient for their risk of developing renal cell cancer. The nurse should consider which patient at greatest risk? A. 76-year-old African American female B. 50-year-old Caucasian male C. 24-year-old male Caucasian male D. 50-year-old African American male
Answer: D Rationale: African Americans and American Indians and Alaskan natives have slightly higher rates of RCC than whites; the exact reasons are unclear. RCC is twice as common in men than women. This is attributed to men more likely to be smokers and have increased exposure chemicals and occupational hazards.
The nurse understands which diagnostic study is most specific in identifying PKD? A. Abdominal x-ray B. Serum creatinine level C. Urinalysis D. Computed tomography scan
Answer: D Rationale: All of the test may indicate renal disease but a CT scan will provide more precise results.
Which statement by Ms. Flood who is diagnosed with PKD indicates that teaching has been effective? A. "I'm glad we can control this disease with medications." B. "I'm glad we caught this early so I won't need dialysis forever." C. "Getting a new kidney will help even if I develop the cysts again." D. "Do I have a choice between hemodialysis or peritoneal dialysis."
Answer: D Rationale: Chronic dialysis is a part of treatment for the renal failure that accompanies PKD.
The nurse providing care for Ms. Flood, who is diagnosed with PKD, should include which activity into the plan of care? A. Providing cranberry juice at meals to reduce the risk of UTIs B. Frequent range-of-motion exercises to reduce stiffness due to inactivity C. Encourage fluids to maintain adequate volume and perfusion to the kidneys D. Restrict fluids to reduce the risk of fluid overload
Answer: D Rationale: Fluid overload is a chronic problem due to renal failure requiring a fluid restriction.
Which is a prerenal cause of AKI? A. Acute glomerulonephritis and neoplasms B. Septic shock and nephrotoxic injury from medications C. Pyelonephritis and calculi formation D. Hypovolemia and myocardial infarction
Answer: D Rationale: Severe blood loss or hypovolemia related to cardiac events are major causes of prerenal acute kidney injury.
A patient on the critical care unit is postoperative day 1 following kidney transplantation from a living donor. The nurse's most recent assessments indicate that the patient is producing copious quantities of dilute urine. What is the nurse's most appropriate response? Assess the patient for further signs or symptoms of rejection. Recognize this as an expected finding. Inform the primary care provider of this finding. Administer exogenous antidiuretic hormone as ordered.
Assess the patient for further signs or symptoms of rejection. Recognize this as an expected finding.***** Inform the primary care provider of this finding. Administer exogenous antidiuretic hormone as ordered. Feedback: A kidney from a living donor related to the patient usually begins to function immediately after surgery and may produce large quantities of dilute urine. This is not suggestive of rejection and treatment is not warranted. There is no obvious need to report this finding.
The nurse is caring for a patient who has returned to the postsurgical suite after postanesthetic recovery from a nephrectomy. The nurse's most recent hourly assessment reveals a significant drop in level of consciousness and BP as well as scant urine output over the past hour. What is the nurse's best response? Assess the patient for signs of bleeding and inform the physician. Monitor the patient's vital signs every 15 minutes for the next hour. Reposition the patient and reassess vital signs. Palpate the patient's flanks for pain and inform the physician.
Assess the patient for signs of bleeding and inform the physician.***** Monitor the patient's vital signs every 15 minutes for the next hour. Reposition the patient and reassess vital signs. Palpate the patient's flanks for pain and inform the physician. Feedback: Bleeding may be suspected when the patient experiences fatigue and when urine output is less than 30 mL/h. The physician must be made aware of this finding promptly. Palpating the patient's flanks would cause intense pain that is of no benefit to assessment.
The nurse is caring for a patient postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize? Assessment of the quantity of the patient's urine output Assessment of the patient's incision Assessment of the patient's abdominal girth Assessment for flank or abdominal pain
Assessment of the quantity of the patient's urine output**** Assessment of the patient's incision Assessment of the patient's abdominal girth Assessment for flank or abdominal pain Feedback: After kidney transplantation, the nurse should perform all of the listed assessments. However, oliguria is considered to be more suggestive of rejection than changes to the patient's abdomen or incision.
The nurse is providing a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants' risks of renal carcinoma? Avoiding heavy alcohol use Control of sodium intake Smoking cessation Adherence to recommended immunization schedules
Avoiding heavy alcohol use Control of sodium intake Smoking cessation****** Adherence to recommended immunization schedules Feedback: Tobacco use is a significant risk factor for renal cancer, surpassing the significance of high alcohol and sodium intake. Immunizations do not address an individual's risk of renal cancer.
A patient was admitted with liver failure and acute kidney injury (AKI). Which intravenous solution should the nurse question if it were ordered for this patient? a. D5W b. 0.9% NaCl c. Lactated Ringer solution d. 0.45% NaCl
c. Lactated Ringer solution
The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, would the nurse identify as a risk factor for this disorder? A. Hypoglycemia B. Diabetes mellitus C. Coronary artery disease D. Orthostatic hypotension
B. Diabetes mellitus Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and presence of an indwelling urinary catheter or frequent catheterization. The conditions noted in options 1, 3, and 4 are not associated risk factors.
A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. The nurse should assess the client for which expected manifestation of AKI? A. Bradycardia B. Hypertension C. Decreased cardiac output D. Decreased central venous pressure
B. Hypertension AKI caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of AKI commonly manifests with hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for any form of renal failure.
The nurse is caring for a client with acute kidney injury (AKI). When performing an assessment, the nurse would expect to note which breathing pattern? A. Apnea B. Kussmaul's respirations C. Decreased respirations D. Cheyne-Stokes respirations
B. Kussmaul's respirations Clinical manifestations associated with AKI occur as a result of metabolic acidosis. The nurse would expect to note Kussmaul's respirations as a result of the metabolic acidosis because the bodily response is to exhale excess carbon dioxide. The breathing patterns noted in options 1, 3, and 4 are not characteristic of AKI.
The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, would indicate an adequate understanding of the treatment plan for this client? A. Prevent fluid overload. B. Prevent loss of electrolytes. C. Promote the excretion of wastes. D. Reduce the urine specific gravity.
B. Prevent loss of electrolytes. In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring. Options 1, 3, and 4 are not the primary concerns in this phase of acute kidney injury.
A cystectomy is performed for a client with a diagnosis of bladder cancer, and a Kock pouch is created for urinary diversion. In preparing a discharge teaching plan for the client, the nurse should include which instruction in the plan? A. Dietary restrictions B. Technique of catheterization C. External pouch and application care D. Proper administration of prophylactic antibiotics
B. Technique of catheterization Kock's pouch is a continent internal ileal reservoir. The nurse instructs the client about the technique of catheterization. Dietary restrictions are not required. There is no external pouch. Antibiotics are not required unless an infection is present; also, antibiotics are prescribed by the health care provider.
A client with chronic kidney disease (CKD) is about to begin hemodialysis therapy. The client asks the nurse about the frequency and scheduling of hemodialysis treatments. The nurse's response is based on an understanding that which represents the typical schedule? A. 5 hours of treatment 2 days per week B. 2 hours of treatment 6 days per week C. 3 to 4 hours of treatment 3 days per week D. 2 to 3 hours of treatment 5 days per week
C. 3 to 4 hours of treatment 3 days per week The typical schedule for hemodialysis is 3 to 4 hours of treatment 3 days per week. Individual adjustments are made according to variables such as the size of the client, type of dialyzer, rate of blood flow, personal client preferences, and other factors.
Which client is most at risk for developing a Candida urinary tract infection (UTI)? A. An obese woman B. A man with diabetes insipidus C. A young woman on antibiotic therapy D. A male paraplegic on intermittent catheterization
C. A young woman on antibiotic therapy Candida infections, which are fungal infections, develop in persons who are on long-term antibiotic therapy because an alteration of normal flora occurs. These infections also are commonly seen in clients with blood dyscrasias, diabetes mellitus, cancer, or immunosuppression and in those with a drug addiction.
The nurse tests the urine of a client with acute kidney injury (AKI) with a multitest reagent strip. The strip tests highly positive for proteinuria. The nurse plans care, knowing that this result is consistent with which type of AKI? A. Prerenal B. Postrenal C. Intrinsic D. Atypical
C. Intrinsic With intrinsic failure, there is a fixed specific gravity and the urine tests positive for proteinuria. In prerenal failure, the specific gravity is high and there is very little or no proteinuria. In postrenal failure, there is a fixed specific gravity and little or no proteinuria. There is no disorder known as atypical renal failure.
A client with end-stage renal disease (ESRD) has the problem of ineffective coping. Which nursing intervention would be potentially unsafe in working with this client? A. Assess the client and family's coping patterns. B. Explore the meaning of the illness with the client. C. Set limits on mood swings and expressions of hostility. D. Give the client information when the client is ready to listen.
C. Set limits on mood swings and expressions of hostility. Clients with ESRD are likely to experience mood swings or express hostility, anger, and depression, among other responses. The nurse should acknowledge the client's feelings, allow the client to express those feelings, and be supportive. Options 1, 2, and 4 are helpful and appropriate interventions for the client.
A client is scheduled for surgical creation of an internal arteriovenous (AV) fistula on the following day. The client says to the nurse, "I'll be so happy when the fistula is made tomorrow. This means I can have that other hemodialysis catheter pulled right out." Which interpretation should the nurse make based on the client's statement? A. The client has an accurate understanding of the procedure and aftercare. B. The client does not realize how painful removal of the dialysis catheter will be. C. The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use. D. The client is not aware that the alternative access site is left in place prophylactically for 2 months.
C. The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use. An AV fistula is the internal creation of an arterial-to-venous anastomosis. This causes engorgement of the vein, allowing both the artery and the vein to be easily cannulated for hemodialysis. Fistulas take 1 to 2 weeks to mature (engorgement) or develop before they can be used for dialysis, so the current method of access must remain in place to be used during that time period.
A patient admitted with nephrotic syndrome is being cared for on the medical unit. When writing this patient's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include? Constipation related to immobility Risk for injury related to altered thought processes Hyperthermia related to the inflammatory process Excess fluid volume related to generalized edema
Constipation related to immobility Risk for injury related to altered thought processes Hyperthermia related to the inflammatory process Excess fluid volume related to generalized edema*** Feedback: The major clinical manifestation of nephrotic syndrome is edema, so the appropriate nursing diagnosis is "Excess fluid volume related to generalized edema." Edema is usually soft, pitting, and commonly occurs around the eyes, in dependent areas, and in the abdomen.
A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the patient's chronic kidney disease is at what stage? Stage 1 Stage 2 Stage 3 Stage 4
Stage 1 Stage 2 Stage 3***** Stage 4 Feedback: Stages of chronic renal failure are based on the GFR. Stage 3 is defined by a GFR in the range of 30 to 59 mL/min/1.73 m2. This is considered a moderate decrease in GFR.
A patient who receives peritoneal dialysis is admitted after a 3-day history of flulike symptoms. The patient reports muscle cramps and is noted to have a low blood pressure and tachycardia. The nurse suspects the patient may be experiencing what condition? a. Dehydration b. Peritonitis c. Fluid obstruction d. Hernias
a. Dehydration
The nurse is giving general instructions to a client receiving hemodialysis. Which statement would be most appropriate for the nurse to include? A. "It is acceptable to eat whatever you want on the day before hemodialysis." B. "It is acceptable to exceed the fluid restriction on the day before hemodialysis." C. "Medications should be double-dosed on the morning of hemodialysis because of potential loss." D. "Several types of medications should be withheld on the day of dialysis until after the procedure."
D. "Several types of medications should be withheld on the day of dialysis until after the procedure." Many medications are dialyzable, which means that they are extracted from the bloodstream during dialysis. Therefore many medications may be withheld on the day of dialysis until after the procedure. It is not typical for medications to be double-dosed, because there is no way to be certain how much of each medication is cleared by dialysis. Clients receiving hemodialysis are not routinely taught that it is acceptable to disregard dietary and fluid restrictions.
A client with chronic kidney disease (CKD) has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now presents with mental cloudiness, dementia, and complaints of bone pain. The nurse determines that these assessment data are compatible with which condition? A. Advancing uremia B. Phosphate overdose C. Folic acid deficiency D. Aluminum intoxication
D. Aluminum intoxication Aluminum intoxication can occur when there is accumulation of aluminum, an ingredient in many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. It can be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body. It can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum. The data in the question are not specifically associated with the other conditions noted in the options.
The nurse is reviewing the medication record of a client diagnosed with chronic kidney disease (CKD). The nurse notes that the client is receiving aluminum hydroxide (ALternaGEL). The nurse plans care, knowing that which is the purpose of this medication? A. Prevents ulcers. B. Prevents constipation. C. Promotes the elimination of potassium from the body. D. Combines with phosphorus and helps eliminate phosphates from the body.
D. Combines with phosphorus and helps eliminate phosphates from the body. Aluminum hydroxide binds with phosphate in the intestines for excretion in the feces, thus lowering phosphorus levels. It can cause constipation, and it does not promote the elimination of potassium. It may be used in the treatment of hyperacidity associated with gastric ulcers, but this is not the purpose of its use in the client with renal failure.
The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? A. Hypertension, tachycardia, and fever B. Hypotension, bradycardia, and hypothermia C. Restlessness, irritability, and generalized weakness D. Headache, deteriorating level of consciousness, and twitching
D. Headache, deteriorating level of consciousness, and twitching Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.
The nurse is monitoring the fluid balance of an assigned client. The nurse determines that the client has proper fluid balance if which 24-hour intake and output totals are noted? A. Intake 1500 mL, output 800 mL B. Intake 3000 mL, output 2000 mL C. Intake 2400 mL, output 2900 mL D. Intake 1800 mL, output 1750 mL
D. Intake 1800 mL, output 1750 mL For the client taking a normal diet, the normal fluid intake is approximately 1200 to 1800 mL of measurable fluids per day. The client's output in the same period should be about the same and does not include insensible losses, which are extra. Insensible losses are offset by the fluid in solid foods, which also is not measured.
A client being discharged home after renal transplantation has a risk for infection related to immunosuppressive medication therapy. The nurse determines that the client needs further instruction on measures to prevent and control infection if the client states that it is necessary to take which action? A. Take an oral temperature daily. B. Use good hand washing technique. C. Take all scheduled medications exactly as prescribed. D. Monitor urine character and output at least 1 day each week.
D. Monitor urine character and output at least 1 day each week. The client receiving immunosuppressive medication therapy must learn and use infection-control methods for use at home. The client self-monitors urine output and its characteristics on a daily basis. The client must learn proper hand washing technique and should take the temperature daily to detect early infection. This is especially important because the client also takes corticosteroids, which mask signs and symptoms of infection. All medications should be taken exactly as prescribed.
A client undergoing hemodialysis is at risk for bleeding from the heparin used during the hemodialysis treatment. The nurse assesses for this occurrence by periodically checking the results of which laboratory test? A. Bleeding time B. Thrombin time C. Prothrombin time (PT) D. Partial thromboplastin time (PTT)
D. Partial thromboplastin time (PTT) Heparin is the anticoagulant used most often during hemodialysis. The hemodialysis nurse monitors the extent of anticoagulation by checking the PTT, which is the appropriate measure of heparin effect. Thrombin and bleeding times are not used to measure the effect of heparin therapy, although they are useful in the diagnosis of other clotting abnormalities. The PT is one test used to monitor the effect of warfarin (Coumadin) therapy
The nurse is analyzing the post-hemodialysis laboratory test results for a client with chronic kidney disease. The nurse interprets that the dialysis is having an expected but nontherapeutic effect if which value is decreased? A. Potassium B. Creatinine C. Phosphorus D. Red blood cell (RBC) count
D. Red blood cell (RBC) count Hemodialysis typically lowers the amounts of fluid, sodium, potassium, urea nitrogen, creatinine, uric acid, magnesium, and phosphate levels in the blood. Hemodialysis also worsens anemia because RBCs are lost during dialysis from blood sampling and anticoagulation and from residual blood left in the dialyzer. Although all of these results are expected, only the lowered RBC count is nontherapeutic and worsens the anemia already caused by the disease process.
A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD). The nurse knows the hemodialyzer filter used in this type of therapy is permeable to what substance? a. Electrolytes b. Red blood cells c. Protein d. Lipids
a. Electrolytes
A client with an arteriovenous fistula in the left arm and who is undergoing hemodialysis is at risk for infection. Which should the nurse formulate as the best outcome goal for this client problem? A. The client washes hands at least once per day. B. The client's temperature remains lower than 101° F. C. The client avoids blood pressure (BP) measurement in the left arm. D. The client's white blood cell (WBC) count remains within normal limits.
D. The client's white blood cell (WBC) count remains within normal limits. General indicators that the client is not experiencing infection include a temperature and WBC count within normal limits. The client also should use proper hand washing technique as a general preventive measure. Hand washing once per day is insufficient. It is true that the client should avoid BP measurement in the affected arm; however, this would relate more closely to the problem of risk for injury.
A patient with chronic kidney disease has been hospitalized and is receiving hemodialysis on a scheduled basis. The nurse should include which of the following actions in the plan of care? Ensure that the patient moves the extremity with the vascular access site as little as possible. Change the dressing over the vascular access site at least every 12 hours. Utilize the vascular access site for infusion of IV fluids. Assess for a thrill or bruit over the vascular access site each shift.
Ensure that the patient moves the extremity with the vascular access site as little as possible. Change the dressing over the vascular access site at least every 12 hours. Utilize the vascular access site for infusion of IV fluids. Assess for a thrill or bruit over the vascular access site each shift.**** Feedback: The bruit, or "thrill," over the venous access site must be evaluated at least every shift. Frequent dressing changes are unnecessary and the patient does not normally need to immobilize the site. The site must not be used for purposes other than dialysis.
Renal failure can have prerenal, renal, or postrenal causes. A patient with acute kidney injury is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it? Heart failure Glomerulonephritis Ureterolithiasis Aminoglycoside toxicity
Heart failure***** Glomerulonephritis Ureterolithiasis Aminoglycoside toxicity Feedback: By causing inadequate renal perfusion, heart failure can lead to prerenal failure. Glomerulonephritis and aminoglycoside toxicity are renal causes, and ureterolithiasis is a postrenal cause.
A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason? Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential. Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this patient. A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary. There is great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations.
Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.***** Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this patient. A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary. There is great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations. Feedback: Hematuria is the most common manifestation of renal trauma; its presence after trauma suggests renal injury. Hematuria may not occur, or it may be detectable only on microscopic examination. All urine should be saved and sent to the laboratory for analysis to detect RBCs and to evaluate the course of bleeding. Measuring intake and output is not a function of the laboratory. The laboratory does not save urine to test creatinine clearance at a later time. The laboratory does not monitor the urine for sodium or potassium concentrations.
The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? Hematuria Precipitous decrease in serum creatinine levels Hypotension unresolved by fluid administration Glucosuria
Hematuria**** Precipitous decrease in serum creatinine levels Hypotension unresolved by fluid administration Glucosuria Feedback: The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Some degree of edema and hypertension is noted in most patients.
A patient is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the patient develops acute kidney injury. The patient is hemodynamically unstable, but renal replacement therapy is needed to manage the patient's hypervolemia and hyperkalemia. Which of the following therapies will the patient's hemodynamic status best tolerate? Hemodialysis Peritoneal dialysis Continuous venovenous hemodialysis (CVVHD) Plasmapheresis
Hemodialysis Peritoneal dialysis Continuous venovenous hemodialysis (CVVHD)***** Plasmapheresis Feedback: CVVHD facilitates the removal of uremic toxins and fluid. The hemodynamic effects of CVVHD are usually mild in comparison to hemodialysis, so CVVHD is best tolerated by an unstable patient. Peritoneal dialysis is not the best choice, as the patient may have sustained abdominal injuries during the accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and electrolyte balance.
The nurse is caring for a patient in acute kidney injury. Which of the following complications would most clearly warrant the administration of polystyrene sulfonate (Kayexalate)? Hypernatremia Hypomagnesemia Hyperkalemia Hypercalcemia
Hypernatremia Hypomagnesemia Hyperkalemia***** Hypercalcemia Feedback: Hyperkalemia, a common complication of acute kidney injury, is lifethreatening if immediate action is not taken to reverse it. The administration of polystyrene sulfonate reduces serum potassium levels.
A nurse is caring for a patient who is in the diuresis phase of AKI. The nurse should closely monitor the patient for what complication during this phase? Hypokalemia Hypocalcemia Dehydration Acute flank pain
Hypokalemia Hypocalcemia Dehydration***** Acute flank pain Feedback: The diuresis period is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover. The patient must be observed closely for dehydration during this phase; if dehydration occurs, the uremic symptoms are likely to increase. Excessive losses of potassium and calcium are not typical during this phase, and diuresis does not normally result in pain.
A patient is being treated for AKI and the patient daily weights have been ordered. The nurse notes a weight gain of 3 pounds over the past 48 hours. What nursing diagnosis is suggested by this assessment finding? Imbalanced nutrition: More than body requirements Excess fluid volume Sedentary lifestyle Adult failure to thrive
Imbalanced nutrition: More than body requirements Excess fluid volume*** Sedentary lifestyle Adult failure to thrive Feedback: If the patient with AKI gains or does not lose weight, fluid retention should be suspected. Shortterm weight gain is not associated with excessive caloric intake or a sedentary lifestyle. Failure to thrive is not associated with weight gain.
The critical care nurse is monitoring the patient's urine output and drains following renal surgery. What should the nurse promptly report to the physician? Increased pain on movement Absence of drain output Increased urine output Bloodtinged serosanguineous drain output
Increased pain on movement Absence of drain output**** Increased urine output Bloodtinged serosanguineous drain output Feedback: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Decreased or absent drainage is promptly reported to the physician because it may indicate obstruction that could cause pain, infection, and disruption of the suture lines. Reporting increased pain on movement has nothing to do with the scenario described. Increased urine output and serosanguineous drainage are expected.
A patient is brought to the renal unit from the PACU status post resection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this patient? Increasing oral intake Managing postoperative pain Managing dialysis Increasing mobility
Increasing oral intake Managing postoperative pain****** Managing dialysis Increasing mobility Feedback: The patient requires frequent analgesia during the postoperative period and assistance with turning, coughing, use of incentive spirometry, and deep breathing to prevent atelectasis and other pulmonary complications. Increasing oral intake and mobility are not priority nursing actions in the immediate postoperative care of this patient. Dialysis is not necessary following kidney surgery.
A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action? Inform the physician and assess the patient for signs of infection. Flush the peritoneal catheter with normal saline. Remove the catheter promptly and have the catheter tip cultured. Administer a bolus of IV normal saline as ordered.
Inform the physician and assess the patient for signs of infection.***** Flush the peritoneal catheter with normal saline. Remove the catheter promptly and have the catheter tip cultured. Administer a bolus of IV normal saline as ordered. Feedback: Peritonitis is the most common and serious complication of peritoneal dialysis. The first sign of peritonitis is cloudy dialysate drainage fluid, so prompt reporting to the primary care provider and rapid assessment for other signs of infection are warranted. Administration of an IV bolus is not necessary or appropriate and the physician would determine whether removal of the catheter is required. Flushing the catheter does not address the risk for infection.
The nurse has identified the nursing diagnosis of "risk for infection" in a patient who undergoes peritoneal dialysis. What nursing action best addresses this risk? Maintain aseptic technique when administering dialysate. Wash the skin surrounding the catheter site with soap and water prior to each exchange. Add antibiotics to the dialysate as ordered. Administer prophylactic antibiotics by mouth or IV as ordered.
Maintain aseptic technique when administering dialysate.**** Wash the skin surrounding the catheter site with soap and water prior to each exchange. Add antibiotics to the dialysate as ordered. Administer prophylactic antibiotics by mouth or IV as ordered. Feedback: Aseptic technique is used to prevent peritonitis and other infectious complications of peritoneal dialysis. It is not necessary to cleanse the skin with soap and water prior to each exchange. Antibiotics may be added to dialysate to treat infection, but they are not used to prevent infection.
A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine level of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders? Monitor the patient's electrolyte values every hour before the procedure . Preprocedure hydration and administration of acetylcysteine Hemodialysis immediately prior to the CT scan Obtain a creatinine clearance by collecting a 24hour urine specimen.
Monitor the patient's electrolyte values every hour before the procedure. Preprocedure hydration and administration of acetylcysteine***** Hemodialysis immediately prior to the CT scan Obtain a creatinine clearance by collecting a 24hour urine specimen. Feedback: Radiocontrastinduced nephropathy is a major cause of hospitalacquired acute kidney injury. Baseline levels of creatinine greater than 2 mg/dL identify the patient as being high risk. Preprocedure hydration and prescription of acetylcysteine (Mucomyst) the day prior to the test is effective in prevention. The nurse would not monitor the patient's electrolytes every hour preprocedure. Nothing in the scenario indicates the need for hemodialysis. A creatinine clearance is not necessary prior to a CT scan with contrast.
The nurse performing the health interview of a patient with a new onset of periorbital edema has completed a genogram, noting the health history of the patient's siblings, parents, and grandparents. This assessment addresses the patient's risk of what kidney disorder? Nephritic syndrome Acute glomerulonephritis Nephrotic syndrome Polycystic kidney disease (PKD)
Nephritic syndrome Acute glomerulonephritis Nephrotic syndrome Polycystic kidney disease (PKD)***** Feedback: PKD is a genetic disorder characterized by the growth of numerous cysts in the kidneys. Nephritic syndrome, acute glomerulonephritis, and nephrotic syndrome are not genetic disorders.
The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently diagnosed with endstage kidney disease (ESKD). The patient has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the patient to take the prescribed phosphorusbinding medication at what time? Only when needed Daily at bedtime First thing in the morning With each meal
Only when needed Daily at bedtime First thing in the morning With each meal*** Feedback: Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphatebinding medications must be administered with food to be effective.
The nurse is caring for a patient after kidney surgery. The nurse is aware that bleeding is a major complication of kidney surgery and that if it goes undetected and untreated can result in hypovolemia and hemorrhagic shock in the patient. When assessing for bleeding, what assessment parameter should the nurse evaluate? Oral intake Pain intensity Level of consciousness Radiation of pain
Oral intake Pain intensity Level of consciousness*** Radiation of pain Feedback: Bleeding is a major complication of kidney surgery. If undetected and untreated, this can result in hypovolemia and hemorrhagic shock. The nurse's role is to observe for these complications, to report their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision, and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood, and fluid volume and cardiac output. Bleeding is not normally evidenced by changes in pain or oral intake.
A 15yearold is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event? Psychosocial stress Hypersensitivity to an immunization Menarche Streptococcal infection
Psychosocial stress Hypersensitivity to an immunization Menarche Streptococcal infection*** Feedback: Postinfectious causes of postinfectious glomerular disease are group A betahemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks. Menarche, stress, and hypersensitivity are not typical causes.
A patient on the medical unit has a documented history of polycystic kidney disease (PKD). What principle should guide the nurse's care of this patient? The disease is selflimiting and cysts usually resolve spontaneously in the fifth or sixth decade of life. The patient's disease is incurable and the nurse's interventions will be supportive. The patient will eventually require surgical removal of his or her renal cysts. The patient is likely to respond favorably to lithotripsy treatment of the cysts.
The disease is selflimiting and cysts usually resolve spontaneously in the fifth or sixth decade of life. The patient's disease is incurable and the nurse's interventions will be supportive.***** The patient will eventually require surgical removal of his or her renal cysts. The patient is likely to respond favorably to lithotripsy treatment of the cysts. Feedback: PKD is incurable and care focuses on support and symptom control. It is not selflimiting and is not treated surgically or with lithotripsy.
A patient is admitted with acute kidney injury (AKI). Which event from the patient's history was the most probable cause of the patient's AKI? a. Recent computed tomography of the brain with and without contrast b. Recent bout of acute heart failure after an acute myocardial infarction c. Twice-daily prescription of Lasix 40 mg by mouth d. Recent bout of benign prostatic hypertrophy and transurethral resection of the prostate
a. Recent computed tomography of the brain with and without contrast
The nurse is caring for acutely ill patient. What assessment finding should prompt the nurse to inform the physician that the patient may be exhibiting signs of acute kidney injury (AKI)? The patient is complains of an inability to initiate voiding. The patient's urine is cloudy with a foul odor. The patient's average urine output has been 10 mL/hr for several hours. The patient complains of acute flank pain.
The patient is complains of an inability to initiate voiding. The patient's urine is cloudy with a foul odor. The patient's average urine output has been 10 mL/hr for several hours.***** The patient complains of acute flank pain. Feedback: Oliguria (<500 mL/d of urine) is the most common clinical situation seen in AKI. Flank pain and inability to initiate voiding are not characteristic of AKI. Cloudy, foulsmelling urine is suggestive of a urinary tract infection.
A patient with acute kidney injury has a potassium level of 6.9 mg/dL. The patient has had no urine output in the past 4 hours despite administration of Lasix 40 mg intravenous push. To correct the hyperkalemia the patient is given 50 mL of 50% dextrose in water and 10 U of regular insulin intravenous push. A repeat potassium level 2 hours later shows a potassium level of 4.5 mg/dL. What order would the nurse expect now? a. Sodium Kayexalate 15 g PO b. Nothing; this represents a normal potassium level c. Lasix 40 mg IVP d. 0.9% normal saline at 125 mL/h
a. Sodium Kayexalate 15 g PO
A patient has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the patient about what topic? Typical diet Allergy status Psychosocial stressors Current medication use
Typical diet Allergy status Psychosocial stressors Current medication use*** Feedback: The kidneys are susceptible to the adverse effects of medications because they are repeatedly exposed to substances in the blood. Nephrotoxic medications are a more likely cause of AKI than diet, allergies, or stress.
The nurse is caring for a patient receiving hemodialysis three times weekly. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient? Using a stethoscope for auscultating the fistula is contraindicated. The patient feels best immediately after the dialysis treatment. Taking a BP reading on the affected arm can damage the fistula. The patient should not feel pain during initiation of dialysis.
Using a stethoscope for auscultating the fistula is contraindicated. The patient feels best immediately after the dialysis treatment. Taking a BP reading on the affected arm can damage the fistula.***** The patient should not feel pain during initiation of dialysis. Feedback: When blood flow is reduced through the access for any reason (hypotension, application of BP cuff/tourniquet), the access site can clot. Auscultation of a bruit in the fistula is one way to determine patency. Typically, patients feel fatigued immediately after hemodialysis because of the rapid change in fluid and electrolyte status. Although the area over the fistula may have some decreased sensation, a needle stick is still painful.
The nurse is working on the renal transplant unit. To reduce the risk of infection in a patient with a transplanted kidney, it is imperative for the nurse to do what? Wash hands carefully and frequently. Ensure immediate function of the donated kidney. Instruct the patient to wear a face mask. Bar visitors from the patient's room.
Wash hands carefully and frequently.***** Ensure immediate function of the donated kidney. Instruct the patient to wear a face mask. Bar visitors from the patient's room. Feedback: The nurse ensures that the patient is protected from exposure to infection by hospital staff, visitors, and other patients with active infections. Careful handwashing is imperative; face masks may be worn by hospital staff and visitors to reduce the risk for transmitting infectious agents while the patient is receiving high doses of immunosuppressants. Visitors may be limited, but are not normally barred outright. Ensuring kidney function is vital, but does not prevent infection.
An alert and oriented patient presents with a pulmonary artery occlusion pressure (PAOP) of 4 mm Hg, blood pressure of 88/50 mm Hg, cardiac index of 1.8, and urine output of 15 mL/h. The patient's blood urea nitrogen (BUN) is 44 mg/dL and creatinine is 3.2 mg/dL. Lungs are clear to auscultation with no peripheral edema noted. Which treatment would the nurse expect the practitioner to order? a. Lasix 40 mg intravenous push b. 0.9% normal saline at 125 mL/h c. Dopamine 15 mcg/kg/min d. Transfuse 1 U of packed red blood cells
b. 0.9% normal saline at 125 mL/h
What is the recommended nutritional intake of protein to control azotemia in the patient with acute kidney injury? a. 0.5 to 1.0 g/kg/day b. 1.2 to 1.5 g/kg/day c. 1.7 to 2.5 g/kg/day d. 2.5 to 3.5 g/kg/day
b. 1.2 to 1.5 g/kg/day
The practitioner has ordered continuous renal replacement therapy (CRRT) for a patient with acute kidney injury. The patient needs both the removal of fluids and a moderate amount of solutes. Which type of CRRT would the nurse anticipate being started on this patient? a. Slow continuous ultrafiltration (SCUF) b. Continuous venovenous hemofiltration (CVVH) c. Continuous venovenous hemodialysis (CVVHD) d. Continuous venovenous hemodiafiltration (CVVHDF)
b. Continuous venovenous hemofiltration (CVVH)
A patient was admitted with an infection that had to be treated with an aminoglycoside antibiotic. After a few days the patient developed oliguria and elevated blood urea nitrogen and creatinine levels. The patient's vital signs are stable. The nurse would anticipate the practitioner ordering which dialysis method for this patient? a. Peritoneal dialysis b. Hemodialysis c. Continuous renal replacement therapy d. Intermittent ultrafiltration
b. Hemodialysis
A patient with chronic kidney disease was admitted with severe electrolyte disturbances. The patient had been ill and missed several hemodialysis sessions. The patient is disoriented, dizzy, cold, clammy, and complains of severe abdominal cramping. The patient's electrocardiogram appears normal. Which electrolyte disturbance would the nurse suspect the patient may be experiencing? a. Hyponatremia b. Hypokalemia c. Hypercalcemia d. Hypochloremia
b. Hypokalemia
A patient was admitted with an infection that had to be treated with gentamicin, an aminoglycoside antibiotic. After 3 days of administration, the patient developed oliguria, and an elevated blood urea nitrogen and creatinine levels. The nurse suspects the patient has developed what type of kidney injury? a. Prerenal b. Intrarenal c. Anuric d. Postrenal
b. Intrarenal
A patient has developed acute kidney injury (AKI) secondary to hemorrhage shock. Which intravenous solution would the nurse expect to be ordered for this patient? a. Dextrose in water b. Normal saline c. Albumin d. Lactated Ringer solution
b. Normal saline
A patient has developed acute kidney injury (AKI) secondary to cardiogenic shock. Which laboratory value would the nurse find helpful in evaluating patient's renal status? a. Serum sodium b. Serum creatinine c. Serum potassium d. Urine potassium
b. Serum creatinine
What is the most common site for short-term vascular access for immediate hemodialysis? a. Subclavian artery b. Subclavian vein c. Femoral artery d. Radial vein
b. Subclavian vein
A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodiafiltration (CVVHDF). The nurse understands the patient should be closely monitored for what circuit-related complications of the therapy? a. Hypervolemia, hypothermia, and hyperkalemia b. Access dislodgment, decreased outflow pressures, and bleeding c. Filter clotting, access failure, and air embolism d. Increased overflow pressure, dehydration, and calcium loss
c. Filter clotting, access failure, and air embolism
A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD). The nurse understands the patient should be closely monitored for what patient-related complications of the therapy? a. Air embolism, access failure, and blood leaks b. Decreased inflow pressure, air bubbles, and power surge c. Infection, hypotension, and electrolyte imbalances d. Catheter dislodgement, decreased outflow pressure, and acid-base imbalances
c. Infection, hypotension, and electrolyte imbalances
A patient with chronic kidney disease receives hemodialysis treatments 3 days a week. Every 2 weeks, the patient requires a transfusion of 1 or 2 U of packed red blood cells. What is the probable reason for this patient's frequent transfusion needs? a. Too much blood phlebotomized for tests b. Increased destruction of red blood cells because of the increased toxin levels c. Lack of production of erythropoietin to stimulate red blood cell formation d. Hemodilution secondary to fluid retention
c. Lack of production of erythropoietin to stimulate red blood cell formation
To assess whether or not an arteriovenous fistula is functioning, what must the nurse do and why? a. Palpate the quality of the pulse distal to the site to determine whether a thrill is present; auscultate with a stethoscope to appreciate a bruit to assess the quality of the blood flow. b. Palpate the quality of the pulse proximal to the site to determine whether a thrill is present; auscultate with a stethoscope to appreciate a bruit to assess the quality of the blood flow. c. Palpate gently over the site of the fistula to determine whether a thrill is present; listen with a stethoscope over this site to appreciate a bruit to assess the quality of the blood flow. d. Palpate over the site of the fistula to determine whether a thrill is present; check whether the extremity is pink and warm.
c. Palpate gently over the site of the fistula to determine whether a thrill is present; listen with a stethoscope over this site to appreciate a bruit to assess the quality of the blood flow.
An elderly patient is in a motor vehicle accident and sustains a significant internal hemorrhage. The nurse knows the patient is at risk for developing what type of acute kidney injury (AKI)? a. Intrinsic b. Postrenal c. Prerenal d. Intrarenal
c. Prerenal
The practitioner has ordered dialysis for a patient with acute heart failure who is unresponsive to diuretics. Which type of dialysis would the nurse anticipate being started on this patient? a. Intermittent ultrafiltration b. Continuous venovenous hemofiltration (CVVH) c. Continuous venovenous hemodialysis (CVVHD) d. Continuous venovenous hemodiafiltration (CVVHDF)
d. Continuous venovenous hemodiafiltration (CVVHDF)
One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin. Which statement regarding how this treatment works is accurate? a. Glucose and insulin force potassium out of the cells, lowering it on a cellular level. b. Glucose and insulin promote higher excretion of potassium in the urine. c. Glucose and insulin bind with potassium, lowering available amounts. d. Glucose and insulin force potassium into the cells, lowering it on a serum level.
d. Glucose and insulin force potassium into the cells, lowering it on a serum level.
Laboratory results come back on a newly admitted patient: Serum blood urea nitrogen, 64 mg/dL; serum creatinine, 2.4 mg/dL; urine osmolality, 210 mOsm/kg; specific gravity, 1.002; and urine sodium, 96 mEq/L. The patient's urine output has been 120 mL since admission 2 hours ago. These values are most consistent with which diagnosis? a. Prerenal acute kidney injury b. Postrenal acute kidney injury c. Oliguric acute kidney injury d. Intrarenal acute kidney injury
d. Intrarenal acute kidney injury
A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD). The nurse understands that this type of continuous renal replacement therapy (CRRT) is indicated for the patient who needs what type of treatment? a. Fluid removal only b. Fluid removal and moderate solute removal c. Fluid removal and maximum solute removal d. Maximum fluid and solute removal
d. Maximum fluid and solute removal
A patient is admitted with sepsis and acute kidney injury (AKI). The patient is started on continuous renal replacement therapy (CRRT). The nurse knows that fluid that is removed each hour is charted as what on the CRRT flowsheet? a. Convection b. Diffusion c. Replacement fluid d. Ultrafiltrate
d. Ultrafiltrate
