Renal Part 2 (prep u)
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)? A. Blood urea nitrogen (BUN) level of 22 mg/dl B. Urine output of 250 ml/24 hours C. Serum creatinine level of 1.2 mg/dl D. Temperature of 100.2° F (37.8° C)
B
A client has a family history of polycystic kidney disease. As the nurse gathers information and completes an assessment related to a polycystic kidney diagnosis, which findings would the nurse expect to find? Select all that apply. A. Normal urinalysis B. No renal stones C. Pain from retroperitoneal bleeding D. Polyuria E. Hypertension
CE
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? A. Chronic renal failure B. Acute renal failure C. Nephrotic syndrome D. Acute glomerulonephritis
D
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? Gentamicin Penicillin Neomycin Tobramycin
B
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has?
calcium
when not using HD line it is filled with
heparin
sings and sumptoms in intrearenal
high blood urea - often low urine output - high urine sodium (over 40 ) - high creatinine
sings and symptoms of post renal
high blood urea nitrogen - high creatinine - now urine output or sudden anuria -
Which of the following is the most accurate indicator of fluid loss or gain?
weight
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? Diuresis Initiation Recovery Oliguria
Oliguria
phases of ARF
Onset Oliguric Diuretic Recovery
One of the roles of the nurse in caring for clients with chronic kidney disease is to help them learn to minimize and manage potential complications. This would include: eating protein liberally. limiting iron and folic acid intake. allowing liberal use of sodium. restricting sources of potassium.
D
aseptic technique
A procedure performed under sterile conditions.
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? A. History of osteoporosis B. Recent history of streptococcal infection C. History of hyperparathyroidism D. Previous episode of acute pyelonephritis
B
What is a characteristic of the intrarenal category of acute renal failure? A. High specific gravity B. Increased BUN C. Decreased creatinine D. Decreased urine sodium
B
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: A. "Dietary changes can reverse the damage that has occurred in your kidneys." B. "Genetic testing will determine the best treatment for your condition." C. "As the disease progresses, you will most likely require renal replacement therapy." D. "Draining of the cysts and antibiotic therapy will cure your disease."
C
dialysis is a
artificial kidney
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? Dehydration Hypertension Crackles Hyperkalemia
dehydration
Normal BUN levels
8-20
A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering: sodium polystyrene sulfonate (Kayexalate) Sorbitol Calcium supplements IV dextrose 50%
A
diuretic phase most concerned about
FVD
in prerenal stage of ARF what would be some signs and symptoms
low urine out put - low sodium in urine - high osmolarity - high specific gravity - high creatine - high uric in blood
initiating phase of ARF
problem starts and sings and symptoms appear to correct the problem
What is a hallmark of the diagnosis of nephrotic syndrome?
proteinuria
The nurse is able to identify which condition as uremia? An excess of protein in the blood An excess of blood in the urine An excess of protein in the urine An excess of urea in the blood
raised level of urea in the bloo d
A patient is placed on hemodialysis for the first time. The patient complains of a headache with nausea and begins to vomit, and the nurse observes a decreased level of consciousness. What does the nurse determine has happened?
too much fluid was pulled off during dialyisis
recovery phase
up to 12 months - some may never recover
diuretic phase
- kidneys start to recover - they start making dilute urienencreased urine output - watch for fluid loss
first stage oluguric phase
- under 400 ml/ 24 hours of urine - 1-7 days - lasts 7-14 days to months - electolyte imbalances
A client is diagnosed with polycystic kidney disease. Which symptom would the nurse mostlikely assess? Periorbital edema Fever Hypertension Flank pain
A
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? A. Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL B. Increased serum levels of potassium, magnesium, and calcium C. Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75% D. Increased pH with decreased hydrogen ions
A
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? Administration of sodium polystyrene sulfonate [Kayexalate]) Administration of a loop diuretic Administration of an insulin drip Administration of sodium bicarbonate
A
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? Pyuria Left upper quadrant pain Low blood pressure Cola-colored urine
A
A client who suffered hypovolemic shock during a cardiac incident has developed acute kidney injury. Which is the best nursing rationale for this complication? A. Obstruction of urine flow from the kidneys B. Structural damage occurred in the nephrons of the kidneys C. Decrease in the blood flow through the kidneys D. Blood clot formed in the kidneys interfered with the flow
C
The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client? A. Pain of 3 out of 10, 1 hour after analgesic administration B. Urine output of 35 to 40 mL/hour C. SpO2 at 90% with fine crackles in the lung bases D. Blood tinged drainage in Jackson-Pratt drainage tube
C
nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD? A. The client is on the kidney transplant waiting list. B. The client has a history of severe anemia during hemodialysis. C. The client has a history of diverticulitis. D. The client is blind in his right eye.
C
Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure? Fluid volume excess Activity intolerance Disturbed body image Urinary retention
fluid volume excess
care for central venous line for HD
aseptic technique (sterile) - only used for access unless emergency
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis?
azotemia
A client develops acute renal failure (ARF) after receiving IV therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 mL, the nurse suspects that the client is at risk for: A. paresthesia. B. cardiac arrhythmia. C. dehydration. D. pruritus.
cardiac arrhythmia (as urine output decreased the potassium levels rise)
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?
cola-colored urine
characteristics of ARF
electrolytes imblances - volume regualtion - BP control - endocrine functions impacted least - renal size preservided - evidence of acute illness or inuslt exists
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse?
even a perfect match doesnt guarantee success
someone has poor vasculature but needs access for hemodialysis, which kind of assess would they put in
graft
symptoms of acute renal failure
hematuria may be present - low specific gravity (under 1.010) -
