Med Surg: Renal & Urinary

A geriatric nurse is caring for several clients. Which alterations in health should the nurse attribute to age-related physiologic changes?

A 78-year-old woman's GFR has been steadily declining over several years. A gradual decrease in GFR is considered a normal age-related change.

The nurse is reviewing the laboratory data for a young client in acute kidney failure and notes an elevated serum potassium level. What is the priority assessment action for the nurse based on the laboratory data?

Institute telemetry monitoring. Slow, weak, irregular pulse; lethal arrhythmias; and sudden cardiac collapse are serious complications of an elevated potassium level.

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?

Serum creatinine In clinical practice, GFR is usually estimated using the serum creatinine concentration.

A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication?

Decrease in the blood flow through the kidneys Acute renal failure can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock.

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?

Dehydration The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.

The health care provider is reviewing laboratory results of a client. Select the diagnostic test that is considered the best measurement of overall kidney function.

Glomerular filtration rate (GFR) GFR is the best overall measure of kidney function. GFR is usually estimated using the serum creatinine concentration. Creatinine, a by-product of muscle metabolism, is produced at a fairly constant rate, is freely filtered in the glomerulus, and is not reabsorbed in the renal tubules. Essentially all of the creatinine filtered by the kidneys is lost in the urine; therefore, serum creatinine is an indirect measure of GFR.

Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure?

Glomerulonephritis Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect?

Infection Frequency, urgency, and dysuria are commonly associated with urinary tract infection.

A client has a marked decrease in the glomerular filtration rate (GFR); lab values with high blood urea nitrogen (BUN), potassium, and creatinine levels; urine output less than 10 mL/hr; 3+ pitting edema in the lower extremities; and BP 170/95. Which phase of acute tubular necrosis (ATN) does the nurse identify the client is in based on assessment data?

Maintenance phase The maintenance phase of acute tubular necrosis is characterized by a marked decrease in the GFR, causing sudden retention of endogenous metabolites—such as urea, potassium, sulfate, and creatinine—that normally are cleared by the kidneys. Urine output usually is lowest at this point. Fluid retention gives rise to edema, water intoxication, and pulmonary congestion. If the period of oliguria is prolonged, hypertension frequently develops and with it signs of uremia.

A client has an obstructive urine outflow related to benign prostatic hyperplasia. Due to the inability to excrete adequate amounts of urine, which type of renal failure should the nurse closely monitor for?

Postrenal failure Postrenal failure results from obstruction of urine outflow from the kidneys. The obstruction can occur in the ureter, bladder, or urethra. Due to the increased urine not being able to be excreted due to the obstruction, retrograde pressure occurs throughout the tubules and nephrons, which ultimately damages the nephrons. Prostatic hyperplasia is the most common underlying problem.

A client in renal failure has marked decrease in renal blood flow caused by hypovolemia, the result of gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which form of acute renal injury does this client have?

Prerenal failure Prerenal failure, the most common form of acute renal failure, is characterized by a marked decrease in renal blood flow. It is reversible if the cause of the decreased renal blood flow can be identified and corrected before kidney damage occurs.

Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant?

Risk for infection related to immunocompromised state Children are administered immunosuppressants following a transplant. These drugs lower the immune system response and help prevent rejection following the transplant. As a result, this leaves them susceptible to infection.

What is used to decrease potassium level seen in acute renal failure?

Sodium polystyrene sulfonate The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.

Tall, peaked T waves Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure?

The kidneys can improve over a period of months. The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute renal failure can progress to chronic renal failure.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours.

A primary health care provider prescribes regular insulin 10 units intravenously (I.V.) along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing?

hyperkalemia Administering regular insulin I.V. concomitantly with 50 ml of dextrose 50% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia.

When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic? gentamycin, tobramycin, neomycin, penicillin

penicillin The three nephrotoxic drugs are aminoglycerides.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours.