Module 2

A client who has renal failure asks the nurse why anemia keeps recurring. Which reason would the nurse explain to the client? Increase in blood pressure Decrease in erythropoietin Increase in serum phosphate levels Decrease in sodium concentration

Decrease in erythropoietin Rationale: The hormone erythropoietin, produced by the kidneys, stimulates the bone marrow to produce red blood cells. In renal failure, there is a deficiency of erythropoietin that often results in the client developing anemia. The nurse is instructed to administer blood. In renal failure, increased blood pressure is due to impairment of renal vasodilator factors and is not treated by administration of blood. Phosphate is retained in the body during renal failure, causing binding of calcium leading to bone demineralization, not anemia. Increase in urinary sodium concentration and decrease in serum sodium concentration trigger the release of renin from the juxtaglomerular cells.

A child with a diagnosis of acute renal failure has additional blood drawn for laboratory testing. Which serum level requires immediate intervention? Sodium 126 mEq/L (126 mmol/L) Bilirubin 0.3 mg/dL (5.1 µmol/L) Creatinine 1.3 mg/dL (114.4 µmol/L) Potassium 6.1 mEq/L (6.1 mmol/L

Potassium 6.1 mEq/L (6.1 mmol/L) Rationale: A high potassium level can cause cardiac dysrhythmias; the expected range for serum potassium in a child is 3.4 to 4.7 mEq/L (3.4-4.7 mmol/L). The expected range for serum sodium is 136 to 146 mEq/L (136-146 mmol/L). Hyponatremia is expected with acute renal failure. In a child the expected range for both total and direct bilirubin is 0.2 to 0.8 mg/dL (3.4-12.0 µmol/L); indirect bilirubin is expected to be 0.1 to 1.0 mg/dL (1.7-17 µmol/L). The bilirubin level is not related to renal failure. The expected range for serum creatinine is 0.3 to 0.7 mg/dL (26-62 µmol/L). An increase is expected with acute renal failure.

Which element would the nurse teach the client with chronic kidney disease to limit as an intervention to control uremia associated with end-stage renal disease? Fluid Protein Sodium Potassium

Protein Rationale: The waste products of protein metabolism are the main cause of uremia. The severity of the chronic kidney disease determines the degree of protein restriction. Fluid restriction may be necessary to prevent edema, heart failure, or hypertension; fluid intake does not directly influence uremia. Sodium restrictions control fluid retention, not uremia. Potassium restrictions prevent hyperkalemia, not uremia.

Which client statement indicates to the nurse that further teaching about epoetin for the treatment of anemia associated with chronic renal failure is necessary? "I realize it is important to take this medication because it will cure my anemia." "Because I am at risk for seizures, I need to avoid hazardous activities." "I recognize that I may still need blood transfusions if my hemoglobin is very low." "I understand that I will still have to take supplemental iron therapy with this medication."

"I realize it is important to take this medication because it will cure my anemia." Rationale: Epoetin will increase a sense of well-being, but it will not cure the underlying medical problem; this misconception needs to be corrected. Seizures are a risk during the first 90 days of therapy, especially if the hematocrit increases more than 4 points in a 2- week period. A dose adjustment may be necessary. Blood transfusions may still be necessary when the client is severely anemic. Supplemental iron therapy is still necessary when receiving epoetin because the increased red blood cell production still requires iron.

The nurse is caring for a pediatric client diagnosed with chronic renal failure that is exhibiting alterations in growth patterns. Which education would the nurse provide the client' s parent about their child's growth? "Your child's poor growth is most likely caused by sustained alkalosis." "The hypotension associated with your child's diagnosis is causing poor growth." "Your child's poor growth is most likely caused by carbohydrate restriction." "Resistance to growth hormone associated with your child's diagnosis is causing poor growth."

"Resistance to growth hormone associated with your child's diagnosis is causing poor growth." Rationale:Poor growth that occurs in children who are diagnosed with chronic renal failure is often due to tissue resistance to growth hormone. Other reasons for poor growth include sustained acidosis, hypertension, and protein restrictions

Which intervention would be in the plan of care of a client with kidney dysfunction who is about to undergo renal testing using a contrast medium? Select all that apply. One, some, or all responses may be correct Assessing the client for a history of cirrhosis Asking the client about known shellfish allergies Assessing for a history of lactic acidosis Evaluating the client's hydration status by checking blood pressure and respiratory rate Discontinuing metformin for 24 hours from the time of the contrast medium administration

Assessing the client for a history of cirrhosis Asking the client about known shellfish allergies Evaluating the client's hydration status by checking blood pressure and respiratory rate Rationale: While interviewing a client who is about to undergo kidney procedure using a contrast medium, the nurse should assess for a history of cirrhosis. Clients with cirrhosis have an increased chance of developing kidney failure after the procedure. The nurse should confirm any known shellfish allergies because contrast dye administered during the study may cause nephrotoxicity. The nurse should also assess the client's hydration status by checking blood pressure and respiratory rate. It is not necessary to check the client for a history of lactic acidosis when ensuring the client's safety for renal testing. If the client had lactic acidosis currently, then this would be a significant factor when ensuring the client's safety for renal testing. Accumulation of metformin can induce lactic acidosis when contrast medium-induced renal failure happens in the 48 hours after the injection. Metformin should be discontinued for 48 hours after the procedure. The therapy is resumed once the renal function has been checked.

Which situations are common negligent acts of nurses found in the hospital setting? Select all that apply. One, some, or all responses may be correct. Failure to notify the health care provider of problems Failure to follow the six rights of medication administration Failure to ensure the safety of a client with disequilibrium problems Failure to notify a family member about the client's current status Failure to administer medication during an emergency without consulting with the nursing manager

Failure to notify the health care provider of problems Failure to follow the six rights of medication administration Failure to ensure the safety of a client with disequilibrium problems Rationale: Common negligent acts of nurses include failure to notify the health care provider of problems, failure to follow the six rights of medication administration, and failure to ensure the safety of a client with disequilibrium problems. Failure to notify the family member about the client's current status is not a common negligent act. The nurse does not have the authority to administer medications without a primary health care provider's order. Failure to administer medication during an emergency without consulting with the nursing manager is also not a common negligent act.

An older adult who has an endocrine disorder is scheduled for a diagnostic study with contrast medium. The nurse identifies that it is essential for which laboratory test to be performed before the procedure? Urine pH Serum creatinine Serum albumin Creatinine clearance

Serum creatinine Rationale: If a contrast medium is used in older adults with an elevated serum creatinine, it may cause renal failure. Thus the nurse would assess the client's renal function before the diagnostic by checking the serum creatinine to assess for renal failure. Urinary pH may not help the nurse assess the client's risk of renal failure. A serum albumin test is performed if symptoms of liver disease or other liver problems are present; it is not routinely done before contrast medium tests. Creatinine clearance helps assess the glomerular filtration rate.