Ch 54. Management of Patients with Kidney Disorders

Diet modifications are part of nutritional therapy for the management of Acute renal Failure. Select the high potassium food that should be restricted. Citrus fruits white rice salad oils butter

Citrus fruits. Citrus fruits and bananas are high in potassium and should be reduced in the diet. Along side with coffee.

Which phase of acute renal failure signals that glomerular filtration has started to recover? a) Diuretic b) Recovery c) Initiation d) Oliguric

Diuretic This phase indicates a gradual increase in urine output, signaling the recovery of glomerular filtration.

The nurse recognizes which condition as an integumentary manifestation of chronic renal failure? Asterixis Gray-bronze skin Tremors Seizures

Gray bronze skin This is the only manifestation listed that deals with the integumentary system (skin).

A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess? Fever Hypertension Extremity pain Periorbital edema

Hypertension Hypertension is present in 75% of all clients with polycystic kidney disease.

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 50 mL Less than 400 mL 1.0 L 1.5 L

Less than 400 mL The minimum amount of urine needed to rid the body of normal metabolic waste products is 400 mL.

The nurse cares for a client with acute kidney (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? Initiation Oliguria Diuresis Recovery

Oliguria - this is when there is a buildup of fluids in the body, and therefore the serum concentrations are increased.

The nurse is administering calcium acetate (PhosLo) to a patient with end stage disease. When is the best time for the nurse to administer this medication? With food 2 hours before meals 2 hours after meals At bed time with 8 oz of fluid

With food Phoslo with food increases the effectiveness.

The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous meds including antihypertensives. What is the best action for the nurse to take? Administer the medications as ordered. Hold the medications until after dialysis. Check with the dialysis nurse about the medications. Ask if the client wants to take the medications.

Hold the meds until after dialysis Giving antihypertensive meds with dialysis can cause severe hypotension

A history of infection specifically caused by group A beta hemolytic streptococci is associated with which disorder? Acute renal failure Acute glomerulonephritis Chronic renal failure Nephrotic syndrome

Acute glomerulonephritis

A client has a decreased secretion o erythropoietin from the kidneys due to end stage kidney disease. What outcomes will the decrease in erythropoetin have? Anemia from the decrease in maturation of red blood cells. Decrease in blood sugar due to alteration in insulin levels. Increase in Blood sugar levels due to alteration in insulin levels. Development of male sex characteristics.

Anemia from the decrease in maturation of red blood cells The kidneys secrete erythropoetin, which promotes the maturation of red blood cells from erythrocytes.

The client with polycystic kidney disease ask 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 Dietary changes can reverse the damage that has occurred in your kidneys Draining of the cysts and antibiotic therapy will cure your disease Genetic testing will determine the best treatment for your condition

As the disease progresses, you will most likely require renal replacement therapy. There is no cure for polycystic kidney disease.

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? Increased pH with decreased hydrogen ions Increased serum levels of potassium, magnesium, and calcium Blood urea nitrogen (BUN) 100 mg and serum creatinine 6.5 Uric acid analysis 3.5 mg and PSP excretion 75%

BUN 100 mg and creatinine 6.5 Normal BUN is 8-23 Normal Creatinine is 0.7 to 1.5. The above levels are abnormally high due to the kidneys inability to remove the waste from the blood stream.

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. BUN of 18 mg/dL. Serum creatinine of 1.2 mg/dL. Glomerular filtration rate (GFR) of 100 mL/min.

Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. The normal BUN:Cr ratio is less than 15. Prerenal azotemia is caused by hypoperfusion of the kidneys due to a nonrenal cause. Over time, higher than normal blood levels of urea or other nitrogen-containing compounds will develop.

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 Magnesium Phosphorus Sodium

Calcium - muscle spasms, ECG changes and more happens when calcium is low or has a deficit. Phosphorus would change in these conditions too, But it INCREASES.

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? Hyperalbunemia Peripheral neuropathy Cola colored urine Hypotension

Cola colored urine Clinical manifestations of acute glomerulonephritis includes cola colored urine, hematuria, edema, azotemia, and proteinuria.

A client with chronic renal failure has developed faulty RBC production. The nurse should monitor for: Nausea & Vomiting Dyspnea and cyanosis Fatigue and weakness thrush and circumoral pallor

Fatigue and weakness RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. .

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 fat intake and limit carbohydrates Eliminate fat intake and increase protein intake Increase carbohydrates and limit protein intake Increase protein, carbs, and fat intake

Increase carbohydrates and limit protein intake Carbs would provide calories that would prevent wasting. Protein is restricted due to its breakdown products (urea, uric acid, organic acids) accumulating quickly in the blood.

Which is a characteristic of the intrarenal category of acute renal failure? Decreased creatinine Increased BUN High specific gravity Decreased urine sodium

Increased BUN Increased BUN is indicative of acute renal failure

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? It is important to use strict aseptic technique It is appropriate to warm the dialysate in the microwave The infusion clamp should be open during infusion The efluent should be allowed to drain by gravity.

It is appropriate to warm the dialysate in the microwave

For a client in the oliguric phase of acute renal failure, which nursing intervention is the most important? Encouraging coughing and deep breathing promoting carbohydrate intake Limiting fluid intake Providing pain relief measure

Limiting fluid intake Oliguria means that there is a decrease in urine output. limiting fluid intake would help in preventing fluid volume overload or complicating it even more.

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when which of the following as occurring during the second phase? Diuresis Oliguria Acute tubular necrosis Restored glomerular function

Oliguria Initiation, Oliguria, Diuresis, Recovery - the phases of acute renal failure.

Which of the following would a nurse classify a prerenal cause of acute renal failure? Polycystic disease ureteral stricture prostatic hypertrophy septic shock

Septic shock PRE-renal meaning it happens NORTH of the kidney, meaning ABOVE the kidney. So septic shock is the only option here that is above the kidney, relating to the heart.

What is used to decrease potassium levels seen in acute renal failure? Sodium polystyrene sulfonate Sorbitol IV dextrose 50% Calcium supplements

Sodium polystyrene sulfonate (Kayexalate) Kayexalate exchanges sodium for potassium in the intestinal tract.

Hyperkalemia is a serious side effect of acute renal failure. Identify the ECG tracing that is diagnostic for hyperkalemia. Tall, peaked T waves Shortened QRS complex Multiple spike P waves Prolonged ST segment

Tall Peaked T waves Characteristic sings of hyperkalemia on an ECG are tall, peaked T waves, absent P waves, and a widened QRS complex

Which statement by the client with end stage renal disease indicates teaching by the nurse was effective? "There are few complications with renal replacement therapies." "A family member can help me perform hemodialysis in my home." "Ultrafiltration methods take much longer than hemodialysis." "A special access is created in my vein for peritoneal dialysis."

Ultrafiltration methods take much longer than hemodialysis Ultrafiltration methods are better tolerated by unstable clients as fluid is removed slowly, resulting in mild hemodynamic effects

A nurse assesses a client shortly after living donor kidney transplant surgery. Which post operative finding must the nurse report to the physician immediately? Serum potassium level of 4.9 Serum Sodium of 135 Temp of 99.2 Urine Output of 20 ml/hr

Urine output of 20 ml/hr Urinary function should be monitored closely following a transplant. Normal urine output is 30 ml/hr

A client with a gunshot wound to the abdomen is transferred to the ICU after an exploratory laparotomy. IV fluid is being infused at 150 ml/hr. Which assessment finding suggests that the client is experiencing acute renal failure BUN of 22 Creatinine of 1.2 Temp of 100.2 F Urine output of 250ml/24 hrs

Urine output of 250 ml/24 hrs Acute renal failure causes oliguria, which is characterized by a urine output of 250 ml/ day

A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? Squamous cell carcinomas do not present with detectable symptoms. You should have sought treatment earlier Very few symptoms are associated with renal cancer Painless gross hematuria is the first symptom in renal cancer

Very few symptoms are associated with renal cancer Renal cancers rarely cause symptoms in the early stage.

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- pH 7.31, PaCO2 48, HCO3 24- pH 7.47, PaCO2 45, HCO3 33- pH 7.50, PaCO2 29, HCO3 22-

pH 7.20, PaCO2 36, HCO3 14- ESKD creates metabolic Acidosis. so the PaCO2 will be high and the HCO3 will be lower

The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client? Wear a mask while handling any dialysate solutions Keep the catheter stabilized to the abdomen , below the belt line Keep the dialysis supplies in a clean area, away from children and pets Clean the catheter insertion site daily with soap

keep the dialysis supplies in clean area, away from children and pets Supplies may be dangerous and toxic to them

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? A decrease serum phosphorus level Hyperparathyroidism Bone marrow demineralization Increased secretion of parathyroid hormone

Bone marrow demineralization The client is on bed rest and has end stage kidney disease. Meaning he has low calcium levels and no exercise. This would lead to bone degredation. By being on an exercise plan, the client will be able to strengthen the bone.

Which of the following occurs late in chronic glomerulonephritis? Peripheral neuropathy Nosebleed Stroke Seizure

Peripheral Neuropathy This occurs with diminished deep tendon reflexes and neurosensory changes occur in the late stage

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. Once on dialysis, the need will be permanent. Kidney function will improve with transplant. Acute renal failure tends to turn to end-stage 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.

An investment with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? The risk of peritonitis is greater with this type of dialysis This type of dialysis will provide more independence Peritoneal dialysis will require more work for you Peritoneal dialysis does not work well for every client

This type of dialysis will provide more independence

The nurse is caring for a patient that has developed oliguria. Oliguria is defines as urine output less than ...

0.5 ml