Ch. 34 Acute Kidney Injury and Chronic Kidney Disease
A client with a diagnosis of end-stage renal disease received a kidney transplant 2 years ago that was deemed a success. During the most recent follow-up appointment, the nurse should prioritize the client for referral based on which statement?
"I'm feeling a bit under the weather these days and I'm a bit feverish."
With the increased risk of drug toxicity among chronically ill older adults, which statement by the nurse explains why the older adult's kidney is vulnerable to toxic injury?
"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney."
Which conditions have the potential to cause chronic kidney disease? Select all that apply.
- Hypertension - Diabetes - Glomerulonephritis
A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that which statements regarding CKD are correct? Select all that apply.
- Nephron destruction takes place over many months. - Signs and symptoms develop gradually. - Functioning nephrons compensate for those that are damaged. - There is a reduction in glomerular filtration rate (GFR) as nephrons are destroyed
A client is suspected to have chronic kidney disease (CKD). The nurse will use which glomerular filtration rate (GFR) to aid in this diagnosis?
60 mL/min/1.73 m2 or less for 3 months
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.
Which individual likely faces the greatest risk for the development of chronic kidney disease?
A client with a recent diagnosis of type 2 diabetes who does not monitor blood sugars or control diet
The nurse is educating a client with chronic kidney disease (CKD). What is the recommended daily fluid intake for this client?
A daily fluid intake of 500 to 800 mL/day to maintain hydration
Chronic kidney disease impacts many systems in the body. What is the most common hematologic disorder caused by CKD?
Anemia
The nurse is caring for a client who has had acute blood loss from ruptured esophageal varices. What does the nurse recognize is an early sign of prerenal failure?
Baseline urine output of 50 mL/hr that is now 10 mL/hr
A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?
Hypertension
A client is to receive a radiocontrast media as part of a diagnostic scan. Which intervention is intended to reduce the nephrotoxic effects of the radiocontrast media?
Increasing the normal saline intravenous infusion rate prior to the exam
The nurse recognizes that acute renal injury is characterized by which of the following?
Rapid decline in renal function
The nurse is instructing a client with advanced kidney disease (AKD) about a dietary regimen. Which restriction should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD?
Dietary protein
Which dermatologic problem most often accompanies chronic kidney disease (CKD)?
Dry skin and pruritus
The nurse is providing dietary instruction for a client with chronic kidney disease (CKD) who is on hemodialysis. Which food would the nurse encourage the client to restrict?
Lean meats
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
An 86-year-old client is being treated for dehydration and hyponatremia after curtailing fluid intake to prevent urinary incontinence. Given these findings, the nurse recognizes that this client is likely in what phase of acute kidney injury?
Prerenal
A client with chronic kidney disease (CKD) will be managed with peritoneal dialysis. Which description of this type of dialysis is most accurate?
Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time.
The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents:
a loss of over half the client's normal kidney function.
A client diagnosed with CKD has begun to experience periods of epistaxis and has developed bruising of the skin and subcutaneous tissues. The nurse recognizes these manifestations as:
Impaired platelet function
A client with a history of chronic kidney disease (CKD) is experiencing increasing fatigue, lethargy, and activity intolerance. The care team has established that the client's glomerular filtration rate (GFR) remains at a low, but stable, level. Which laboratory assessments will most likely be prescirbed to help determine the cause of these new symptoms?
Blood work for hemoglobin, red blood cells, and hematocrit
A client sustained acute tubular injury approximately 2 hours ago. Which cause of acute kidney injury (AKI) would the nurse suspect the client is experiencing?
Intrarenal
Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct?
Kidneys convert inactive vitamin D to its active form, calcitriol.
The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?
Serum creatinine
An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which early sign of prerenal injury?
Sharp decrease in urine output
A client has undergone a kidney transplant and voices concerns about organ rejection to the nurse. The most appropriate response by the nurse would be:
"You will be given medication to decrease the likelihood of your immune system attacking your new kidney."
A client is suspected to have renal disease. The nurse would suggest which diagnostic determinations to confirm this diagnosis? Select all that apply.
- Urinary sediment of red and white cells - Ultrasonography - Measurement of cystatin C - Imaging studies
Accumulation of nitrogenous wastes such as urea in the circulatory system is an early sigh of chronic kidney disease (CKD). The nurse knows that normal levels of urea in blood are approximately:
20 mg/dL (7.14 mmol/L)
A client has prerenal failure. The nurse knows that this type of failure is characterized by which relationship of blood urea nitrogen (BUN) to serum creatinine levels?
A BUN to creatinine level ratio of 20:1
A client has been diagnosed with chronic kidney disease (CKD). Which drug category is usually administered to treat coexisting conditions that manifest early in CKD?
Antihypertensive medications
Which clinical manifestation is the most common indicator of acute kidney injury?
Azotemia
Acute renal failure occurs at a high rate in seriously ill people who are in intensive care units. What is the most common indicator of acute renal failure?
Azotemia and a decrease in the GFR
The nurse is caring for a client with chronic renal failure who is on hemodialysis three times a week. In order to treat hyperphosphatemia and hypocalcemia, which medication will the nurse administer to decrease absorption of phosphate from the gastrointestinal tract?
Calcium carbonate
The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney failure?
Client with prostatic hyperplasia
An 80-year-old client with diabetes has a GFR of 41 mL/min/1.73 m2. His physical and workup show uremia, azotemia, and elevated BUN. Which action should be done first to slow the decline of his kidney function?
Control blood glucose and blood pressure
A client asks, "Why did my provider order a glomerular filtration rate (GFR) to my usual blood work?" The nurse's best response is based on the fact that GFR can estimate serum levels of which substance?
Creatinine
A new client presents with elevated BUN, systemic edema, a BP of 145/93 mm Hg, recurrent infections, and a GFR of 51 mL/min/1.73 m2. Which treatment should the nurse anticipate?
Dialysis
A client is beginning to recover from acute tubular necrosis. During which phase of acute kidney injury will the nurse assess an increase in urine output?
Diuretic phase
Several urine tests can be useful in establishing a diagnosis of acute renal failure (ARF). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which type of drug?
Diuretics
The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for:
Nephrotoxic acute tubular necrosis
The client with substance use disorder was found unconscious after overdosing on heroin 2 days prior. Because of prolonged pressure on the muscles the client has developed myoglobinuria, causing which complication?
Obstruction of the renal tubules with myoglobin and damaged tubular cells
A client with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which condition does the nurse suspect is common with this stage of kidney disease?
Pericarditis
While assessing a peritoneal dialysis client in the home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as:
Peritonitis
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
A client has experienced severe hemorrhage and is in prerenal failure. The nurse anticipates the client's blood urea nitrogen (BUN) and serum creatinine laboratory results will be in which range?
The BUN-to-creatinine ratio is 20:1.
A 45-year-old female is being treated for ovarian cancer. Her treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of:
nephrotoxic acute tubular necrosis (ATN).
