Med Surg Chapter 46

The nurse is attending to a patient who has received a kidney transplant. What parameters would indicate a successful transplant? Select all that apply. 1 High blood pressure is corrected. 2 Blood sodium levels are decreased. 3 Serum potassium levels are elevated. 4 The specific gravity of urine increases. 5 Serum creatinine levels are decreased.

Correct 1,2,5 The patient with end-stage kidney disease may have hypertension due to fluid retention; the hypertension is corrected after a successful transplant through adequate urine output. The serum creatinine levels decrease as the transplanted kidney starts eliminating the nitrogenous wastes. After the transplant, the sodium levels should be corrected as the fluid balance returns to normal. As more urine is produced by the transplanted kidney, the specific gravity and concentration of the urine will decrease. Following a transplant, the serum potassium levels are corrected as fluid balance is restored.

The nurse is caring for a patient with acute kidney injury. Upon reviewing the laboratory reports of the patient, the nurse learns that the patient has a very high level of potassium. Which therapy does the nurse expect to be the most effective in this patient? 1 Restricting the diet 2 Infusing regular insulin 3 Performing hemodialysis 4 Infusing sodium bicarbonate

Correct 3 Hemodialysis is the most effective therapy for patients with hyperkalemia because it removes potassium ions in a short amount of time. Dietary restrictions are used to prevent recurrent elevations, but they are not used for acute elevations. Infusions of insulin and sodium bicarbonate are also beneficial but require more time to return the potassium levels to normal.

The nurse is caring for a patient with sepsis who was just initiated on continuous renal replacement therapy (CRRT). In which order should the nurse perform the following actions? Place the options in the order in which they should be performed. 1. Obtain weight 2. Document laboratory values 3. Obtain vital signs 4. Assess intake and output

Correct 1. Obtain vital signs 2. Assess intake and output 3. Obtain weight 4. Document laboratory values The patient on CRRT is hemodynamically unstable. Therefore frequent vital signs should be assessed. Intake and output should be next, followed by obtaining a weight with assistance from unlicensed assistive personnel (UAP). Document all laboratory values after the patient has been determined to be stable. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal.

Which statement made by a nursing student indicates effective learning about what should be included on a plan of care for a patient with chronic kidney disease that is taking gluconate and calcium acetate? 1 Administer a stool softener. 2 Give both drugs at the same time. 3 Obtain consent for immediate dialysis. 4 Administer sodium polystyrene sulfonate.

Correct 1 A patient with chronic kidney disease who is taking oral iron salts, such as ferrous gluconate, and phosphate binders, such calcium acetate, may develop constipation and need to take a stool softener. Dialysis does not provide relief from constipation in patients with chronic kidney disease. Oral iron supplements should not be given at the same time as calcium-containing phosphate binders because they prevent iron absorption. Sodium polystyrene sulfonate helps to treat hyperkalemia but does not provide relief from constipation.

A patient complains of pedal edema. The laboratory reports show 0.4 mL/kg/hr of urine output for the past 12 hours. The patient has a history of acute glomerulonephritis. Which method is the best to confirm acute glomerulonephritis as a cause of acute kidney injury in this patient? 1 Kidney biopsy 2 Kidney ultrasound 3 Computed tomographic scan 4 Magnetic resonance imaging

Correct 1 Pedal edema and urine output less than 0.5 mL/kg/hr for 12 hours indicate acute kidney injury. Glomerulonephritis is one of the intrarenal causes of acute kidney injury. A kidney biopsy is the best method to confirm intrarenal causes of kidney injury. A kidney ultrasound is the first diagnostic test used to establish acute kidney injury. A computed tomography scan is used to identify lesions, masses, lesions, and vascular anomalies. Magnetic resonance imaging is not advised in patients with renal failure unless necessary due to the development of nephrogenic systemic fibrosis.

During hemodialysis, the patient reports nausea, headache, and chest pain to the nurse. The patient has a blood pressure of 80/60 mm Hg. Which nursing action would be most beneficial to the patient? 1 Infusing normal saline solution 2 Infusing 5% w/v dextrose solution 3 Administering ondansetron (Zofran) 4 Administering acetaminophen (Paracetamol)

Correct 1 The rapid removal of large amount of body fluids results in hypotension. The decrease in blood pressure is manifested by nausea, vomiting, headache, and chest pain. Infusing normal saline solution will restore the volume of body fluid and help relieve the symptoms. Dextrose solution is infused in patients with hypoglycemia to restore the glucose levels in the body. Ondansetron (Zofran) and acetaminophen (Paracetamol) are antiemetic and analgesic drugs respectively, which can be administered to temporarily relieve negative side effects of hemodialysis.

The nurse knows the patient with acute kidney injury (AKI) has entered the diuretic phase when what assessments occur? Select all that apply. 1 Dehydration 2 Hypokalemia 3 Hypernatremia 4 Serum creatinine increases 5 Blood urea nitrogen (BUN) increases

Correct 1,2 Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes, but not concentrate urine. Therefore the serum BUN and serum creatinine levels also begin to decrease. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response.

A nurse is caring for a patient with chronic renal failure who is on peritoneal dialysis. During the exchange, more than 45 minutes have passed, but the dialysate has not drained completely. Which nursing interventions would be appropriate to facilitate drainage? Select all that apply. 1 Give an abdominal massage. 2 Turn the patient from side to side. 3 Promote deep breathing and coughing. 4 Give the patient a glass of water to drink. 5 Periodically rotate and reposition the catheter.

Correct 1,2 Drainage of the dialysate fluid can be facilitated by abdominal massage and turning the patient from side to side. These activities will change the position of the catheter, thereby freeing the drainage holes, which may be obstructed. Intake of fluids may prevent dehydration; however, this has no effect on the drainage of dialysate from the peritoneal cavity. Deep breathing and coughing are advised to promote pulmonary ventilation; however, these activities do not have any effect on the process of peritoneal dialysis. The position of the catheter should be changed by the health care provider, and only if absolutely necessary.

The nurse is attending to a patient who is undergoing peritoneal dialysis. The nurse assesses the patient is developing symptoms of respiratory distress. What nursing interventions are necessary to prevent further respiratory complications? Select all that apply. 1 Elevate the head of the bed. 2 Frequently reposition the patient. 3 Promote deep-breathing exercises. 4 Place the patient in a low Fowler's position. 5 Increase the rate of infusion of the dialysate.

Correct 1,2,3 Elevating the head of the bed can prevent further complications and ease breathing. Decreased areas of ventilation suggest the presence of atelectasis, whereas adventitious sounds may suggest fluid overload, retained secretions, or infection. Frequent positioning will promote equal ventilation to all parts of the lungs. Deep-breathing exercises could help to promote proper expansion of lungs. Rapid infusion would cause more pressure on the diaphragm. The patient should be placed in the semi-Fowler's position for peritoneal dialysis; this allows inflow of fluid while not impinging on the thoracic cavity.

A patient is in end-stage renal failure. What are the signs and symptoms that the nurse is likely to find while assessing neurologic function? Select all that apply. 1 Asterixis 2 Nocturnal leg cramps 3 Restless leg syndrome 4 Hypertonicity of muscles 5 Hyperexaggerated deep tendon reflexes

Correct 1,2,3 Individuals with advanced stage 5 chronic kidney disease may complain of restless legs syndrome, described as "bugs crawling inside the leg." Muscle twitching, jerking, asterixis (hand-flapping tremor), and nocturnal leg cramps also occur. Eventually, motor involvement may lead to bilateral footdrop, muscular weakness and atrophy, and loss of deep tendon reflexes. There is slowing down of conduction in the peripheral nerves; therefore, hyperexaggerated reflexes and hypertonicity will not be found. Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass.

A patient with chronic kidney disease is advised to undergo peritoneal dialysis (PD). What advantages of PD over hemodialysis should the nurse explain to the patient? Select all that apply. 1 It is home-based. 2 It is a simple procedure. 3 Equipment setup is simple. 4 It requires special water systems. 5 It needs a vascular access device.

Correct 1,2,3 PD has many advantages over hemodialysis. The procedure is simple and home-based, with easy equipment setup. The patient can perform peritoneal dialysis. Because the dialysis is done through the peritoneal membrane, PD does not require a special water system or a vascular access device, as in hemodialysis.

A patient with end-stage kidney disease is to begin continuous ambulatory peritoneal dialysis (CAPD). What are the preparations to be done by the nurse before starting the catheter insertion for this patient? Select all that apply. 1 Note the patient's weight. 2 Obtain a signed consent form. 3 Ask patient to empty the bladder and bowel. 4 Monitor for abnormal cardiac signs and symptoms. 5 Monitor for abnormal respiratory signs and symptoms.

Correct 1,2,3 Preparation of the patient for catheter insertion includes emptying the bladder and bowel, weighing the patient, and obtaining a signed consent form. The bladder should be emptied to prevent accidental puncture of the bladder by the needle. Weighing the patient before and after the procedure is important to determine the effectiveness of dialysis. Because it is an invasive procedure, the nurse should explain about the risks and benefits, and informed consent should be obtained. Other factors are not contraindications for CAPD. Monitoring of cardiac and respiratory signs is essential but does not directly affect the procedure.

The patient with an acute kidney injury is being admitted. Which prescriptions by the primary health care provider should the nurse anticipate? Select all that apply. 1 Sodium restriction 2 Potassium restriction 3 Phosphate binding agents 4 Encourage fluid replacement 5 Intermittent straight catheterization

Correct 1,2,3,4 The patient with acute kidney injury is at risk for kidney failure. Close monitoring of fluid and electrolyte balance is a key nursing assessment, so the nurse will anticipate fluid replacement, potassium restriction, sodium restriction, and phosphate binding agents to be prescribed. There will be no prescription for intermittent straight catheterizations, because this places the patient at risk for a urinary tract infection (UTI).

What are the common causes of acute kidney injury? Select all that apply. 1 Hypovolemia 2 Interstitial nephritis 3 Increased cardiac output 4 Decreased renovascular blood flow 5 Increased peripheral vascular resistance

Correct 1,2,4 Acute kidney injury is defined as rapid loss of kidney function. The common causes of acute renal injury are prerenal, intrarenal, and postrenal. One cause of acute kidney injury is hypovolemia, which is associated with dehydration, diarrhea, burns, and hemorrhage. Interstitial nephritis, which is associated with allergies and infections, is another cause of acute kidney injury. Decreased renovascular blood flow, which is associated with embolism and renal artery thrombosis, is another cause of acute kidney injury. Decreased cardiac output, which is associated with cardiac dysrhythmias and cardiogenic shock, is also a cause of acute kidney injury. Decreased peripheral vascular resistance, which is associated with neurologic injury and septic shock, is another cause of acute kidney injury. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation.

A patient has undergone successful kidney transplantation but develops a sudden rapid decrease in urine output five days after the surgery. What are the factors that the nurse should suspect to have caused this condition? Select all that apply? 1 Leakage of urine 2 Rejection of kidney 3 Overdose of steroids 4 Obstruction in the urinary catheter 5 Inadequate administration of fluids

Correct 1,2,4,5 A sudden decrease in urine output in the early postoperative period is a cause for concern. It may be caused by dehydration, rejection, a urine leak, or obstruction. Inadequate administration of fluids may cause dehydration. Decreased urine output is a sign of organ rejection. A common cause of early obstruction is a blood clot in the urinary catheter. An overdose of steroids does not cause decreased urine output.

Which statements made by the nurse indicate an understanding of patient care during hemodialysis? Select all that apply. 1 "I should auscultate the lungs." 2 "I should record the body temperature." 3 "I should check the mouth for bad breath." 4 "I should monitor the level of consciousness." 5 "I should monitor the access site for discharge."

Correct 1,2,4,5 Patients receiving hemodialysis (HD) are typically volume overloaded, so the nurse should assess respiratory status, including auscultation of the lungs. Microbes from the access site can enter the body, therefore the nurse should monitor both the site and body temperature as a means of assessing for infection. Accumulation of waste in the blood (blood urea nitrogen) affects mental functioning; thus the nurse should monitor the patient's level of consciousness. The mouth is assessed to detect inflammation and dryness, not bad breath.

The registered nurse is teaching a student nurse about physiologic changes in the diuretic phase of a patient with acute kidney disease. Which statement by the student nurse about the diuretic phase indicates effective learning? Select all that apply. 1 "The diuretic phase lasts for one to three weeks." 2 "Urine volume decreases in the diuretic phase." 3 "Hypovolemia occurs during the diuretic phase." 4 "The kidneys will have the ability to concentrate urine." 5 "The creatinine level increases drastically at the end of the diuretic phase."

Correct 1,3 The diuretic phase lasts for one to three weeks and hypovolemia and hypotension occur due to increased urinary output. In the diuretic phase, urine output increases because of the renal tubules' inability to concentrate urine. At the end of the diuretic phase, the creatinine, blood urine nitrogen, and electrolyte levels return to normal.

The nurse is caring for a patient who is a recent recipient of a kidney transplant. Which interventions should the nurse perform in the immediate postoperative period? Select all that apply. 1 Record central venous pressure. 2 Replace urine output with fluids for the first five hours. 3 Monitor the patient for hyponatremia and hypokalemia. 4 Report for urine output more than 500 mL in the initial phase. 5 Notify the health care provider of a sudden decrease in urine output.

Correct 1,3,5 The nurse caring for the kidney transplant recipient should record central venous pressure readings in order to monitor postoperative fluid status. The patient should be monitored for hyponatremia and hypokalemia, which are often associated with rapid diuresis. The health care provider should be notified in case of a sudden decrease in urine output in the early postoperative period; it may be due to dehydration, rejection, a urine leak, or obstruction. Urine output during this phase may be as high as 1 L/hr and may gradually decrease as the blood urea nitrogen (BUN) and serum creatinine levels return toward normal. Urine output is replaced with fluids mL for mL hourly for the first 12 to 24 hours. Dehydration must be avoided to prevent subsequent renal hypoperfusion and renal tubular damage. Test-Taking Tip: When using this program, be sure to note if you guess at an answer. This will permit you to identify areas that need further review. Also it will help you to see how correct your guessing can be.

The patient is in the diuretic phase of acute kidney injury. What education should the nurse provide to the patient regarding this phase? Select all that apply. 1 Urine output is increased. 2 The kidney has become fully functional. 3 The electrolyte imbalance will be normalized. 4 This phase will last no more than three weeks 5 There is a possibility that the fluid volume will be reduced in the body.

Correct 1,4,5 During the diuretic phase of acute kidney injury, daily urine output is usually around 1 to 3 L but may reach 5 L or more. Hypovolemia and hypotension can occur from massive fluid losses. The diuretic phase may last one to three weeks. Near the end of this phase, the patient's acid-base, electrolyte, and waste product (blood urea nitrogen, creatinine) values begin to normalize. Although urine output is increasing, the nephrons are still not fully functional. The high urine volume is caused by osmotic diuresis from the high urea concentration in the glomerular filtrate and the inability of the tubules to concentrate the urine. In this phase the kidneys have recovered their ability to excrete wastes, but not to concentrate the urine. Because of the large losses of fluid and electrolytes, the patient must be monitored for hyponatremia, hypokalemia, and dehydration.

A patient with acute kidney injury has been admitted to the hospital, and the nurse observes the electrocardiogram (ECG) reading shows tall peaked T waves, ST depression, and QRS widening. What nursing interventions should the nurse perform for this patient? Select all that apply. 1 Administer sodium bicarbonate. 2 Administer diuretics as ordered. 3 Ensure potassium intake of 50 mEq/day. 4 Administer regular insulin intravenously. 5 Administer calcium gluconate intravenously.

Correct 1,4,5 ECG readings for this patient are indicative of cardiac changes due to hyperkalemia induced by acute kidney injury. Regular insulin, administered intravenously, helps the potassium to move into the cells. Sodium bicarbonate corrects the acidosis and causes the potassium to shift into the cells. Calcium gluconate raises the threshold for excitation, protecting the heart. The potassium intake should be limited to 40 mEq/day. Diuretics are not effective in hyperkalemia.

The patient's laboratory report reveals the glomerular filtration rate (GFR) is decreased by 75%. What does the nurse suspect from the patient's findings? 1 Kidney injury 2 Kidney failure 3 Risk of kidney injury 4 Loss of kidney function

Correct 2 The Rifle classification for staging of acute kidney injury utilizes percentages of loss of GFR to define stages of kidney injury. Risk of kidney injury is defined by a GFR decrease by 25%. Kidney injury is defined by a GFR decrease by 50%. Kidney failure is defined by a GFR decrease by 75%. Loss of kidney function is defined by loss of kidney function > 4 weeks.

A patient with chronic kidney disease is prescribed regular peritoneal dialysis (PD). What should the nurse inform the patient while teaching about PD? 1 Avoid high-protein diets. 2 Take potassium supplements. 3 Avoid powdered breakfast drinks. 4 Restrict fluid intake, as in hemodialysis.

Correct 2 The patient undergoing regular peritoneal dialysis (PD) does not need to restrict potassium intake; instead, this patient may be prescribed oral potassium supplementation because of hypokalemia caused by dialysis. The patient need not restrict protein or fluid intake. The patient should include enough protein in the diet to compensate for loss of protein in dialysate. The patient may even take liquid or powdered breakfast drinks in case of inadequate protein intake. Patients on hemodialysis have a more restricted fluid intake than patients receiving peritoneal dialysis (PD).

The nurse just received an urgent laboratory value on a patient in renal failure. The potassium level is 6.3. The telemetry monitor is showing peaked T waves. Which prescription from the primary health care provider should be implemented first? 1 Administer kayexalate enema 2 Administer regular insulin intravenously (IV) 3 Restrict dietary potassium intake to 40 meq daily 4 Educate the patient on dietary restriction of potassium

Correct 2 This patient is showing signs of hyperkalemia, which could be fatal and lead to myocardial damage. Regular insulin IV is needed to quickly force potassium into the cells. The kayexalate enema will take too long to excrete the potassium. Restricting oral intake and educating the patient will be needed when the crisis has resolved. Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; however, every rule has its exceptions, so answer with care.

A patient with chronic renal failure complains of severe itching all over the body. What should the nurse suspect as causes of itching? Select all that apply. 1 Edema 2 Improper skin care 3 Excess urea in blood 4 Abnormal liver function 5 Imbalances in electrolyte levels

Correct 2,3 Pruritus could be caused by uremia and dry skin, both of which are features of kidney failure. Edema and electrolyte imbalances are a feature of renal failure but do not cause itching per se. Liver dysfunction may cause pruritus but may not be always associated with renal failure.

Routine urinalysis for a diabetic patient reveals moderate proteinuria. What further tests help to identify decreased kidney function at an early stage? Select all that apply. 1 Serum creatinine 2 Renal ultrasound 3 Glomerular filtration rate (GFR) 4 Evaluation of microalbuminuria 5 Magnetic resonance angiography (MRA)

Correct 2,3,4 If routine urinalysis indicates moderate to severe proteinuria, the preferred way of determining kidney functions is by assessing the GFR. An ultrasound of the kidneys is usually done to detect any obstructions and to determine the size of the kidneys. A patient with diabetes needs to have a further examination of the urine for microalbuminuria. The patient may not have an increase in serum creatinine until there is a decrease of 50% or more in kidney function. MRA study with the contrast media gadolinium is generally not advised unless the ultrasound or computed tomography (CT) does not provide the information needed. Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors.

A patient with chronic kidney disease has developed uremic syndrome. What complications should the nurse anticipate due to an increase in blood urea levels? Select all that apply. 1 Anemia 2 Pericarditis 3 Hypertension 4 Pulmonary edema 5 Hemorrhagic tendencies

Correct 2,5 Uremic pericarditis is one of the cardiac complications of chronic renal failure. Uremia can cause qualitative defects in platelet function, thereby predisposing the patient to hemorrhages. Anemia is caused by decreased production of erythropoietin from the kidneys. Hypertension is caused by sodium retention and increased extracellular fluid volume. Pulmonary edema could be a consequence of both fluid overload and hypertension.

The nursing instructor asks the student nurse about fluid and electrolyte changes that occur in a patient with an acute kidney injury. Which statement by the student nurse indicates effective learning? 1 "The patient will have hypokalemia." 2 "The patient will have hypernatremia." 3 "The patient will have increased serum creatinine levels." 4 "The patient will have decreased levels of blood urea nitrogen."

Correct 3 Creatinine is a waste product of muscle catabolism. Patients with acute kidney injury cannot remove body waste, and it accumulates in the blood, which raises the serum creatinine level. Acute kidney injury is associated with an increased level of potassium (hyperkalemia), a decreased level of sodium (hyponatremia), and an increased level of blood urea nitrogen. Thus the statements that the patient will have hypokalemia, hypernatremia, and decreased levels of blood urea nitrogen are incorrect.

A patient who has been on hemodialysis for several weeks asks the nurse what substances are being removed by the dialysis. What substances should the nurse tell the patient are passing through the membrane during hemodialysis? Select all that apply. 1 Glucose 2 Bacteria 3 Creatinine 4 Phosphate 5 Red blood cells (RBCs)

Correct 3,4 Creatinine, urea, uric acid, and electrolytes such as phosphate and potassium are filtered by the semipermeable membrane during hemodialysis. RBCs do not pass through the semipermeable membrane during hemodialysis because of their molecular weight. Glucose does not pass through the semipermeable membrane during hemodialysis due to the osmotic difference of the dialysate. Bacteria do not pass through the semipermeable membrane during hemodialysis due to their high molecular weight.

A patient with chronic kidney disease is on hemodialysis. What should the nurse teach the patient and his or her caregiver? Select all that apply. 1 Avoid cheese, yogurt, and pudding. 2 Ensure interdialytic weight gain is not more than 5 kg. 3 Include gelatin and ice cream as part of the fluid intake. 4 Space out the amount of fluid intake throughout the day. 5 Avoid frequent use of nonsteroidal antiinflammatories (NSAIDS) such as ibuprofen.

Correct 3,4,5 The patient with chronic kidney disease on hemodialysis should space his or her limited fluid allotment throughout the day. Foods that are liquid at room temperature, such as gelatin and ice cream, should be included in the total fluid intake. The patient should avoid frequent use of NSAIDS because they can cause further damage to the kidneys. If NSAIDS are taken as prescribed for short periods, they are usually considered safe. Patients do not need to avoid cheese, yogurt, or pudding unless their kidney disease progresses into end-stage kidney disease. Patients are advised to limit fluid intake so that interdialytic weight gain is no more than 1 to 3 kg.

The nurse reviews a plan of care for a patient with diagnosis of chronic kidney disease who is undergoing hemodialysis. Which part of the plan should the nurse question? 1 2-g sodium diet 2 Oxygen via nasal cannula at 4 L/min 3 Furosemide (Lasix) 40 mg PO twice a day 4 IV of 0.9% sodium chloride at 125 mL/hour

Correct 4 A patient with chronic kidney disease (CKD) should receive limited fluids because the kidneys are unable to remove excessive water. An IV solution of 0.9% sodium chloride at a rate of 125 mL/hr places this patient at high risk for complications such as fluid overload, electrolyte imbalance, and hypertension. A 2-g sodium diet, oxygen, and furosemide (Lasix) would be appropriate if prescribed for a patient with CKD.

A registered nurse is teaching a trainee nurse about the parameters to be assessed in a patient with acute kidney injury who is undergoing dialysis. Which statement by the trainee nurse indicates a need for further teaching? 1 "I should auscultate patient's lung sounds." 2 "I should record the patient's input and output." 3 "I should assess for any change in the patient's skin color." 4 "I should examine the patient's mouth for a change in color."

Correct 4 Acute kidney injury is associated with dry mouth and inflammation and is caused by increased levels of ammonia in the saliva. The nurse should examine the mouth for inflammation and dryness. Therefore the trainee nurse's statement about examining the mouth for a change in color indicates a need for further teaching. Because of renal impairment, fluid can accumulate in the lungs and result in difficulty breathing. Therefore the nurse should auscultate the patient's lung sounds. Recording the patient's input and output will help to determine the efficacy of the treatment. Acute kidney injury is also associated with hyperpigmentation; thus the nurse should assess for changes in the patient's skin color. Test-Taking Tip: Acute kidney injury is associated with increased amounts of nitrogenous waste in blood and secretions. Use this tip to answer the above question.

A patient has a glomerular filtration rate (GFR) of 50 mL/minute and a serum potassium level of 8 mEq/L. The nurse should monitor the patient for what complication? 1 Hypotension 2 Respiratory failure 3 Metabolic acidosis 4 Cardiac dysrhythmias

Correct 4 The patient's glomerular filtration rate (GFR) of 50 mL/min is indicative of stage 3 chronic kidney disease, and the patient's serum potassium level of 8 mEq/L indicates hyperkalemia, which may lead to cardiac dysrhythmias. Hypotension and respiratory failure may result from hypermagnesemia. Metabolic acidosis occurs when the patient's bicarbonate levels are lower than 20 mEq/L.