test 3
The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client?
hemodialysis
During hemodialysis, toxins and wastes in the blood are removed by which of the following?
Diffusion
The nurse is assessing a client suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem?
Hematuria
A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)?
Hydrating with saline intravenously before the test
A client is brought to the renal unit from the PACU status postresection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this client?
Managing postoperative pain
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?
Recognize this as an expected finding
A child is brought into the clinic with symptoms of edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem?
Sore throat 2 weeks ago
Silver sulfadiazine topically to burn site; bacitracin ointment for superficial partial-thickness burns. Not good on burns that have eschar, due to not being able to penetrate it (T/F)
T
The most accurate indicator of fluid loss or gain in an acutely ill client is:
weight
Precipitating factors in this client may contribute to AKI:
hypovolemia, increased cardiac output, age related changes, chronic systemic diseases.
Expected findings after a kidney transplant:
increase urine output, GFR begins to increase, Crt and BUN begin to decrease. Kidneys should start begin working immediately after surgery. Large quantities of diluted urine
s/s of IV therapy: what can go wrong with IV site
infiltration, air emboli, phlebitis
most common causes of metabolic alkalosis:
vomiting, gastric suction. Anything that causes loss of hydrogen ions
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?
"Increase your carbohydrate intake."
A client is experiencing a decreasing glomerular filtration. What laboratory values should the nurse expect to follow the change? Select all that apply.
-Serum creatinine increases -Blood urea nitrogen (BUN) increases -Creatinine clearance decreases
What is considered the 'hallmark' of ARF?
50% or > increase in serum creatinine (when N baseline is < 1.0 mg/dl)
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis?
Azotemia
A client is being treated for AKI and the client daily weights have been ordered. The nurse notes a weight gain of 3 pounds (1.4 kg) over the past 48 hours. What nursing diagnosis is suggested by this assessment finding?
Excess fluid volume
A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess?
Hypertension
A client with decreased renal function is to receive a low-protein diet. The client asks the nurse why he needs this type of diet. The nurse would incorporate which reason into the response?
Lessen workload on the kidneys
treatment of second degree burns
Soak in cool water for 15 minutes when first occurred. Then put cool, clean, wet cloths on daily for a few minutes. Then apply Silvadene cream (make sure there is not an allergy to silver), and occlusive dressing with a closed dressing technique. Skin graft may be needed if it takes longer than 3 weeks to heal due to propensity for scarring.
Assessment of a patient after renal surgery:
Urine output, pain, inflammation, urine color and characteristics
The nurse cares for a client diagnosed with chronic glomerulonephritis. The nurse will observe the client for the development of
anemia
preparing a client for allergy skin testing:
be prepared for allergic reaction
how to collect a creatinine clearance measurement?
24 hour urine
The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI?
Oliguria
Nursing assessment for the patient receiving peritoneal dialysis would include which of the following to detect the most serious complication of this procedure?
Palpate the abdominal wall for rebound tenderness.
priority in the care of a client who has been burned and suffered smoke inhalation.
Patent airway. Airway management
A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action?
Reposition the client to facilitate drainage.
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?
Smoking cessation
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?
Start IV fluids with a normal saline solution bolus followed by a maintenance dose.
The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse?
Turn the client from side to side.
What are some causes of prerenal ARF?
Volume depletion - hemorrhage, GI loss Decreased cardiac perfusion: MI, HF, cardiogenic shock Vasodilation: sepsis, anaphylaxis
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?
White blood cell (WBC) count of 20,000/mm3
s/s of third spacing:
comes out of cell into interstitial space. Can cause diminished pulses, hypovolemia
Signs of acute kidney injury (AKI)
decreased urinary output, increased creatinine, increased BUN
What is the most common cause of chronic renal failure?
diabetes
Who is at more risk for toxic acute tubular necrosis from contrast dyes?
diabetics esp with accompanying renal failure; also patients that are intravascular volume depleted; prevent by making sure they are hydrated; possibly mucomyst given
__________ degree burn is superficial injury and only involves the outermost layer of the skin. They present with erythema, painful, no blisters. Heals 3-7 days without scarring.
first degree
Rejection of a transplanted kidney within 24 hours after transplant is termed
hyperacute rejection
The most common cause of acute respiratory alkalosis:
hyperventilation
Implications of GFR on other labs:
if GFR is decreased, BUN and crt are increased
Foods high in phosphate:
milk and milk products, organ meats, nuts, fish, poultry and whole grains
What are the sub classifications of distributive shock?
neurogenic, anaphylactic, and septic
third degree burns
or full thickness burns involves total destruction of the epidermis & dermis and in some cases, destruction of underlying tissue. These types of burns are usually related to: flame, prolonged exposure to hot liquids, electrical current, chemical, or contact.
foods high in potassium:
potatoes, strawberries, leafy green veggies, bananas
A client has been diagnosed with acute glomerulonephritis. This condition causes:
proteinuria.
what is renin:
released by kidneys. Part of the renin- angiotensin system that helps increase blood pressure
signs and symptoms of hyperchloremia:
same as those of metabolic acidosis. Hypervolemia, hypernatremia, tachypnea, weakness, lethargy, diminished cognitive ability, FVO
___________ degree or partial thickness burn. It involves the entire epidermis and varying portions of the dermis.
second degree
what dysrhythmia is associated with hypomagnesemia?
torsade's de points
considerations of inserting an IV:
use appropriate size gauges. Look at both arms and hands carefully before choosing a site, prevent placing in area that could cause mobility problems (AC)
CVVHD (what is it, when to use it): Continuous ..... type of dialysis?
used when patients are hemodynamically unstable
A client is undergoing peritoneal dialysis as medical treatment for acute renal failure. Before the next instillation, the nurse observes that the client has marked abdominal distention accompanied by pain. Which of the following nursing actions is likely to offer an immediate solution to this problem?
Delay the next dialysis cycle.
Signs of reduced kidney function:
low urine output, increased BUN and CRT. Decreased GFR
Besides dosage, what else increases the risk of toxic acute tubular necrosis?
volume depletion, advanced age, cardiac surgery
A client with acute renal failure progresses through four phases. Which describes the onset phase?
It is accompanied by reduced blood flow to the nephrons.
type of patients that can have life threating complications of burns:
very old and very young
Expected U/A results in a patient with AKI:
presence of glucose and protein in urine
A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?
Hyperphosphatemia
As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur?
Hyperphosphatemia
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?
Hypovolemic shock caused by hemorrhage
recovery phase ARF
-Lasts several months -Depending on the damage; there may be residual damage so some patients may require ongoing dialysis -rement and the need for follow up care and preventive measures to prevent recurrence
What are the categories of ARF?
-Prerenal - hypo perfusion of kidney; 60- 70 % of cases (AKI) -Intrarenal - actual damage to the kidney -Postrenal - obstruction to urine flow
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
Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure?
Glomerulonephritis
What is a hallmark of the diagnosis of nephrotic syndrome?
Proteinuria
A client with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis?
"Hemodialysis is a treatment option that is usually required three times a week."
A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate?
"Keep your showers brief, patting your skin dry after showering."
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse?
"Very few symptoms are associated with renal cancer."
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.
- Hypertension - Pain from retroperitoneal bleeding - Polyuria
causes of postrenal ARF
-Any obstruction of urine -Distal to kidney -Increased pressure in kidney tubules leads to decreased GFR Causes: -Urinary tract obstruction (calculi, tumors, BPH, stricture, blood clots)
Oliguric phase of renal failure
-Occurs during oliguric phase: fluid overload, azotemia, electrolyte imbalances, (increased K, increased phosphatemia, and decrease in calcium), metabolic acidosis; symptoms of uremia -Major goal in oliguric phase is to keep the patient alive until renal injury heals Major cause of death during the oliguric phase d/t: i-increased K, gi bleed, and infection Oliguric phase lasts approximately 12 days can be shorter or as long as 30 days
The nurse is caring for a client's status after a motor vehicle accident. The client has developed AKI. What are the nurse's roles in caring for this client? Select all that apply.
-Providing emotional support for the family -Monitoring for complications -Participating in emergency treatment of fluid and electrolyte imbalances -Providing nursing care for primary disorder (trauma)
A patient has acute kidney injury (AKI) with a negative nitrogen balance. How much weight does the nurse expect the patient to lose
0.5 kg/day
The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than ___________mL/kg/hr.
0.5 mL/kg/hr
The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL?
1,000 mL
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?
Acute glomerulonephritis
An older adult client diagnosed with cancer is admitted to the oncology unit for surgical treatment. The client has been on chemotherapeutic agents to decrease tumor size prior to the planned surgery. The nurse caring for the client is aware that what precipitating factors in this client may contribute to acute kidney injury (AKI)? Select all that apply.
Age-related physiologic changes Chronic systemic disease Nothing by mouth (NPO) status
When assessing a client with chronic glomerulonephritis, the nurse notes that the client has generalized edema. The nurse documents this as which of the following?
Anasarca
The nurse is caring for a client who has returned to the postsurgical suite after postanesthetic recovery from a nephrectomy. The nurse's most recent assessment reveals increased sedation, shortness of breath, hypotension, and low urine output over the last 2 hours. What is the nurse's best response?
Assess the client for signs of bleeding and inform the primary provider.
The nurse is caring for a patient who has returned to the postsurgical suite after post-anesthetic 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.
The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition?
Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.
A nurse is caring for a client on bedrest with end-stage kidney disease. What major manifestation of uremia should the nurse expect to decrease with an exercise plan?
Bone demineralization
The nurse is caring for a client whose acute kidney injury (AKI) resulted from a prerenal cause. Which condition most likely caused this client's health problem?
Burns
A client requires hemodialysis. Which type of drug should be withheld before this procedure?
Cardiac glycosides
The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find?
Cola-colored urine
A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client's hypervolemia and hyperkalemia. Which of the following therapies will the client's hemodynamic status best tolerate?
Continuous venovenous hemodialysis (CVVHD)
Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure?
Fluid volume excess
complications during diuresis phase of AKI:
Dehydration. Diuresis phase is when the urine output gradually increases. Shows slowly restarting to cover. Too much urine output could lead to dehydration.
Which phase of acute renal failure signals that glomerular filtration has started to recover?
Diuretic
A client admitted with nephrotic syndrome is being cared for on the medical unit. When writing this client's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include?
Excess fluid volume related to generalized edema
polystyrene sulfonate (Kayexalate)
Given PO or enema. Decreases potassium. Treats hyperkalemia. Potassium is excreted through feces
The nurse recognizes which condition as an integumentary manifestation of chronic renal failure?
Gray-bronze skin color
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
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
A client with chronic kidney disease becomes confused and reports abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which lab value?
Hyperkalemia
patient education kidney transplant:
Immunosuppressants, avoid large crowds, infection prevention, inform pt that there is always a risk for rejection. Strict routine of medications. AGE DOESN'T PLAY A PART IN KIDNEY TRANSPLANT SUCCESS RATE.
A client with end-stage renal disease 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 health care provider and assess the client for signs of infection.
A client is administered dialysate solution through an abdominal catheter. The nurse notices that the return flow rate is slow, so the nurse advises the client to move to the other side. However, even after changing the client's position, the nurse does not observe an increase in return flow. Which of the following actions should the nurse perform to help accelerate the return flow rate?
Inform the physician that catheter may need repositioning.
The nurse is creating an education plan for a client who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan?
Inspection and care of the incision
The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output?
Less than 400 mL
The nurse is caring for a client after kidney surgery. When assessing for bleeding, what assessment parameter should the nurse evaluate?
Level of consciousness
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important?
Limiting fluid intake
Descrbe urinary outputs for oliguria, nonoliguria and anuria
Oliguria <500 / day Nonoliguria - > 800 ml / day Anuria < 50 ml/ day
A patient is postoperative day 3 following the successful transplantation of a kidney. The nurse is aware of the importance of assessing the patient for signs and symptoms of rejection. Consequently, the nurse is constantly monitoring the patient for:
Oliguria and edema
what is urine specific gravity and what is it used for?
Osmolality of urine. Looks at hydration status. Whether or not urine is diluted. High fluid intake decreases USG.
The nurse performing the health interview of a client with a new onset of periorbital edema has completed a genogram, noting the health history of the client's siblings, parents, and grandparents. This assessment addresses the client's risk of what kidney disorder?
Polycystic kidney disease (PKD)
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?
Preprocedure hydration and administration of acetylcysteine
The nurse is caring for a client who has just returned to the postsurgical unit following renal surgery. When assessing the client's output from surgical drains, the nurse should physically assess what parameter(s)? Select all that apply.
Quantity of output Color of the output Visible characteristics of the output
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?
Recent history of streptococcal infection
What is used to decrease potassium level seen in acute renal failure?
Sodium polystyrene sulfonate
A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead the nurse to suspect that the client is experiencing rejection?
Tenderness over transplant site
A 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?
The client has a history of diverticulitis.
A client on the medical unit has a documented history of polycystic kidney disease (PKD). What principle should guide the nurse's care of this client?
The client's disease is incurable and the nurse's interventions will be supportive.
The kidney performs two major functions to assist in acid-base balance, what are they?
They filter bicarb and excrete acid in the urine.
What is Nikolsky's sign?
This is when the area that is burned is rubbed the tissue does not separate from the underlying dermis. The patient may have tingling, hypersensitivity, pain that is soothed by cooling, peeling, itching. The skin is reddened, balances with pressure, no edema or minimal
A client is admitted to the hospital with a prerenal disorder, a nonurologic condition that disrupts renal blood flow to the nephrons, affecting their filtering ability. One cause of prerenal acute kidney injury is:
anaphylaxis
A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client?
anemia
What are some characteristics of severe anaphylaxis?
bronchospasms, laryngeal edema, hypotension, urticaria, rapid onset, systemic reaction. Main thing we are looking at is respiratory
the clinical manifestations of fluid and electrolyte disturbances:
dysrhythmias, changes in LOC
s/s of hypomagnesemia:
dysrhythmias, increased deep tendon reflexes
Signs and symptoms of rejection following a kidney transplant:
fever, increase in creatinine, tenderness at transplant site, decreased urinary output
Assessing an a/v fistula or graft:
hear the bruit, feel the thrill once per shift.
Side effects of hydrochlorothiazide:
hypokalemia, hyponatremia, hypovolemia
Fluid replacement after a burn: Parkland formula: To replace fluid in an adult with a burn, use the Parkland formula: 4 mL × patient's weight (kg) × % TBSA burn (lactated Ringer solution). Give one-half of volume in the first 8 hours, and then infuse the remainder over 16 hours.
know this
How do you treat flash pulmonary edema?
lasix and nitro
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)
A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the client's chronic kidney disease is at what stage?
stage 3
Avoid applying silver sulfadiazine to the face to prevent permanent facial discoloration (t/f)
t
treatment for AKI:
treat the underlying cause. Fluid resuscitation. 50-75. If it doesn't start up the kidneys, pt will go into FVO.
Increased phosphate level:
treat with aluminum hydroxide
A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:
weight loss.
Moderate burns
•10% to 20% TBSA burn in adults •5% to 10% TBSA in adults over age 50 •2% to 5% full-thickness burn •High-voltage injury •Suspected inhalation injury •Circumferential burn •Underlying medical problem, such as diabetes
complications of major burns
•Anemia •Flexion contractures of affected area •Scarring and disability due to deformity and destruction of skin, nerves, vessels, and musculoskeletal tissue •Hypovolemic shock •Malnutrition •Multiple organ dysfunction syndrome •Pneumonia •Acute respiratory distress syndrome •Respiratory collapse Sepsis
Major burns
•Greater than 20% TBSA in adults •Greater than 10% TBSA in adult over age 50 •Greater than 5% full thickness burn •High voltage burn •Known inhalation injury •Any significant burn to face, eyes, ears, genitalia or joints •Significant associated injuries
minor burns
•Less than 10% of total body surface area (TBSA) in adults •Less than 5% TBSA in adults over age 50 Less than 2% full-thickness burn
s/s of Hypocalcemia:
tetany (muscle twitching)
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:
"As the disease progresses, you will most likely require renal replacement therapy."
Manifestation of Renal Trauma:
car wreck, punch. Little to no urine output, pain, urine analysis for blood in urine, hematuria
most life-threatening effect of AKI:
potassium imbalances, cardiac issues
Care of an A/V fistula, Graft, Venous Catheter:
-Arm restrictions (no blood draws or blood pressures because it could reduce blood flow to the fistula) , -Listen for bruit and thrill in AV fistula (listen for the bruit and feel for thrill),
The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply.
-Calcium 7.5 mg/dL; hypotension and irritability -Potassium 6.4 mEq/L; dysrhythmias and abdominal distention -Phosphate 5.0 mg/dL; tachycardia and nausea and emesis
priority of care during anaphylaxis:
ABCDE
A client who agreed to become an organ donor is pronounced dead. What is the most important factor in selecting a transplant recipient?
Compatible blood and tissue types
A client 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 client about what priority topic?
Current medication use
A client who suffered hypovolemic shock during a cardiac incident has developed acute kidney injury. Which is the best nursing rationale for this complication?
Decrease in the blood flow through the kidneys
A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client's diet to maximize the therapeutic effect and minimize the risks of complications. The client's diet should include which of the following modifications? Select all that apply.
Decreased protein intake Decreased sodium intake Fluid restriction
During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication?
Dehydration
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?
Dehydration
treatment of third degree burns
Eschar may slough, grafting necessary, scarring & loss of contour & function.
The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take?
Hold the medications until after dialysis.
Based on the pathophysiologic changes that occur as renal failure progresses, the nurse identifies the following indicators associated with the disease. Select all that apply.
Hyperkalemia Anemia Hypocalcemia
The nurse is caring for a patient in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:
Hyperkalemia.
What is a characteristic of the intrarenal category of acute kidney injury (AKI)?
Increased BUN
Complications of peritoneal dialysis:
Infection, peritonitis (s/s: abdominal pain, fever, cloudy urine)
the initial action of an allergic response:
Inflammation. Assess airway first, always.
Diet restriction ESKD:
Low potassium, low sodium, low protein, fluid restrictions
The nurse has identified the nursing diagnosis of "Risk for Infection" in a client who undergoes peritoneal dialysis. What nursing action best addresses this risk?
Maintain aseptic technique when administering dialysate.
How can you prevent someone suffering from toxic acute renal necrosis?
Making sure they are not dehydrated! Or are hydrated prior to tests, etc
A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure?
Nephrotoxic injury secondary to use of contrast media
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys?
Oliguria
A nurse who provides care in a high-acuity medical setting is aware of the high incidence and morbidity of acute renal failure (ARF). To reduce patients' risks of developing ARF during their stay in hospital, it is imperative that:
Patients' medication regimens be monitored closely
A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause?
Renal calculi
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:
cardiac arrhythmia.
Which of the following would a nurse classify as a prerenal cause of acute renal failure?
Septic shock
The nurse treats a client with end-stage kidney disease (ESKD). The nurse is concerned that the client is developing renal osteodystrophy. Upon review of the client's laboratory values, it is noted the client has had a calcium level of 11 mg/dL for the past 3 days and the phosphate level is 5.5 mg/dL. The nurse anticipates the administration of which medication?
Sevelamer hydrochloride
Concerns with an IV infiltrates:
Some medications can cause extravation (damage to tissues, necrosis)
A 15-year-old is admitted to the renal unit with a diagnosis of post-infectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event?
Streptococcal infection
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.
Tall, peaked T waves
What are some causes on intrarenal ARF?
The hypoperfusion and ischemia can be result from burns, crushing injuries, infections, blood transfusion reactions ATN (acute tubular necrosis) - d/t ischemia, toxin (like with drugs) dyes
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute kidney injury. Which statement from the nurse best reflects the ability of the kidneys to recover from acute kidney injury?
The kidneys can improve over a period of months
Where is bicarbonate generated.
The kidneys. (renal tubular cells)
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?
The patient is experiencing a cerebral fluid shift.
Why do we maintain alignment for the joints for second degree burns?
To prevent the complication of contractures, the nurse will establish a goal to maintain position of joints in alignment. Gentle range-of-motion exercises and a consult to PT and OT for exercises and positioning recommendations are also appropriate interventions for the prevention of contractures.
Which clinical finding should a nurse look for in a client with chronic renal failure?
Uremia
nursing actions during peritoneal dialysis:
wash hands, use aseptic technique. Peritonitis and infection precautions.
presentation of second degree burn
Usually red, but can also be white. Painful, blisters, edema, weeping surface. Heals in 7-28 days. May scar. Hair follicles and skin appendages remain intact. These type of burns are usually related scalds, flash flame & contact
The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to take what action?
Wash hands carefully and frequently.
The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time?
With each meal
The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication?
With food
Describe a type I hypersensitivity reaction.
anaphylactic reaction, know what it is. Wheezing.
age-related change affecting the renal or urinary system:
decreased GFR
treatment for prerenal ARF
-Meds that increase systemic BP may help but may also make perfusion of the kidneys worse d/t the vasoconstrictive actions on the renal arteries Need to -replace volume - fluids, blood -Improve cardiac output Correct dysrhythmias
Nonoliguric phase ARF
-Nonoliguric phase is most often seen d/t toxic injury from aminoglycoside antibiotics -Usually don't see fluid problems with nonoliguric phase cause the kidneys retain the ability to concentrate urine to some degree -Increased K remains a major risk with nonoliguric phase - nonoliguric phase lasts 5 to 8 days
A nurse is providing education to the family of a client beginning peritoneal dialysis. The family ask questions concerning catheter placement and stabilization. Which information will the nurse provide about the cuffs? Select all that apply.
-The cuffs are constructed of Dacron polyester material. -The cuffs will help stabilize the catheter. -The cuffs prevent the dialysate from leaking. -The cuffs provide a barrier against microorganisms.
A client's renal failure has become chronic. Which signs and symptoms are associated with chronic renal failure? Select all that apply.
-lethargy -muscle cramps -bleeding of the oral mucous membranes
The nurse is caring for a client with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply.
Assess for the presence of peripheral edema. Assess the client's BP.
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?
Assess the AV fistula for a bruit and thrill.
The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium?
citrus fruits
Factors contributing to dehydration:
decreased GFR, decreased renal blood flow, decreased kidney mass, decreased ability to concentrate urine. Decreased excretion of potassium. Decrease of total body water.
Health education of fluid volume deficit:
drink water.
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:
fatigue and weakness.
S/S of prolonged hypokalemia:
fatigue, anorexia, n/v, muscle weakness, leg cramps, dysrhythmias. If prolonged, can lead to the ability of kidneys to concentrate urine, leading to DILUTED URINE
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?
fever
systemic response to burns (WHY):
fluid shifts
s/s of Chvostek sign and the cause:
his clinical sign refers to a twitch of the facial muscles that occurs when gently tapping an individual's cheek, in front of the ear. Caused by hypocalcemia
The nurse monitors the client for potential complications during dialysis but recognizes NOT to monitor for
hypertension
The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching?
"I should drink as much as possible to keep my kidneys working."
diet for severe burn treatment
-Nothing by mouth until severity of burn is established and then high-protein, high-calorie diet when bowel function returns -Increased hydration with high-calorie, high-protein drinks, not free water -Enteral feedings for patients unable to take food orally -Total parenteral nutrition (TPN) if unable to take food by mouth -Control of blood glucose levels because of hyper metabolic stress response or receiving TPN
Acute dialysis is indicated during which situation?
Impending pulmonary edema
Based on her knowledge of the primary cause of end-stage renal disease, the nurse knows to assess the most important indicator. What is that indicator?
Serum glucose
Prioritization during cardiac/respiratory arrest
maintaining patent airway, maintaining adequate perfusion (ABCs)
The nurse coming on shift on the medical unit is taking a report on four clients. What client does the nurse know is at the greatest risk of developing ESKD?
A client with diabetes mellitus and poorly controlled hypertension
Physical assessment of urinary retention:
distention
diuretic phase ARF
-Diuresis or Diuretic -See a gradual increase in urinary output -Outputs can be really high; depending on state of hydration when enters this phase -Diuretic phase puts the patient at risk for fluid volume deficit and electrolyte disturbances -Goal of diuretic phase is to keep the patient hydrated and electrolytes balanced; and to continue to support renal function
initation/onset stage of renal failure
-s/s of initiation or onset phase: decreased urinary output; increased creatinine -Goal of onset phase is to determine the cause and get treatment started before irreversible damage is done to the tubules
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia?
Increase carbohydrates and limit protein intake.
The client with chronic kidney disease is exhibiting signs of anemia. Which is the best nursing rationale for this symptom?
Diminished erythropoietin production
A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate?
Donors are selected from compatible living or deceased donors.
A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care?
Encourage use of incentive spirometer every 2 hours.
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?
A GFR of 30-59 mL/min/1.73 m2
A client has a decreased secretion of erythropoietin from the kidneys due to end-stage kidney disease. The nurse explains that the decrease in erythropoietin will have what effect?
Anemia from the decrease in maturation of red blood cells
early phase burn care:
prevent further injury (stop burning, remove burnt clothing), fluid resuscitation, ensuring hemodynamic stability.
what is cimetidine (Tagamet) and know the uses:
reduces production of gastric, therefore increasing metabolic alkalosis
Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for:
removal of the transplanted kidney.
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.
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase?
Oliguria
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?
Penicillin
Which of the following occurs late in chronic glomerulonephritis?
Peripheral neuropathy
presentation of third degree burns
The color of the wound ranges from pale white to red, brown or charred. Will they have pain? No because the burned area lacks sensation because nerve fibers are damaged. Due to this the severity is often deceiving to patients. The wound appears leathery, hair follicles & sweat glands are destroyed. The patient may present with shock, why?
The most common causes of hypercalcemia:
hyperparathyroidism, malignancies
Complications of peritoneal dialysis drainage:
slowing of drainage, check tubing, reposition pt, raise head of bed. DO NOT ASPIRATE DIALYSIS CATHETER!!!!!!!!!
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
Phosphate-binding medications:
-Calcium acetate, phoslo, calcium carbonate. -Bind with phosphate to excrete for pts in end stage renal disease. -Given 4x per day. decreased phosphate level. -Given before meals. Should be given with food in order to be effective.
manifestations of intrarenal ARF
-Decreased GFR -Elevated BUN and creatinine -Increased calcium -Increased sodium (urine) -Varied urinary output (often decreased) -Urine specific gravity low normal -Abnormal casts and debris
What can cause ARF?
-Hypovolemia -Hypotension -Decreased cardiac output and heart failure -Obstruction of kidney or lower tract -Tumor, clot, stone -Obstruction of renal arteries or veins -bilaterally
The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder?
pH 7.20, PaCO2 36, HCO3 14-
Risk factors of developing ESRD:
hypertension, diabetes, alcoholism, nephritis, infections, medications, toxic agents, chronic inflammation
indication of renal replacement therapy:
look at GFR, BUN and Creatinine. When 80% of nephrons are not working, renal replacement therapy needs to be considered. Ex. Dialysis
§'dosing' of aminoglycoside antibiotics ?
may be less nephrotoxic to give a larger dose once a day then a smaller dose three times a day
How to reduce the risk of infection in a client with a transplanted kidney:
perform hand hygiene, screen visitors for infection, implement face mask usage, visitors should be limited
Glomerulonephritis is an inflammatory response in the glomerular capillary membrane, and causes disruption of the renal filtration system. Although diagnostic urinalysis can reveal glomerulonephritis, many clients with glomerulonephritis exhibit:
no symptoms.
A client diagnosed with acute kidney injury (AKI) has developed congestive heart failure. The client has received 40 mg of intravenous push (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The client's vital signs are stable. Which health care order should the nurse anticipate?
Lasix 80 mg IVP
hypermagnesemia:
diminished reflexes, monitor VS, noting hypotension and shallow respirations. Observe for decreased D.T.R. and changes in LOC
Compliance to a renal diet is a difficult lifestyle change for a patient on hemodialysis. The nurse should reinforce nutritional information. Which of the following teaching points should be included? Select all that apply
-Eat foods such as milk, fish, and eggs. -Restrict sodium to 2,000 to 3,000 mg daily. -Restrict fluid to daily urinary output plus 500 to 800 mL.
