Chapter 26: Acute Kidney Injury and Chronic Kidney Disease

Which symptom occurs in a client with chronic kidney disease (CKD) as a result of elevated serum phosphate levels and the development of phosphate crystals that occur with hyperparathyroidism?

Pruritus

The nurse recognizes that acute renal injury is characterized by which of the following?

Rapid decline in renal function

A 72-year-old client is scheduled for a kidney transplant. The nurse knows that which aspect of advanced age has a positive effect on the success of kidney transplant survival?

Reduction in T-lymphocyte function

Which phenomenon contributes to the difficulties with absorption, distribution, and elimination of drugs that are associated with kidney disease?

Reductions in plasma proteins increase the amount of free drug and decrease the amount of protein-bound drug.

Neuromuscular disorders can be triggered by CKD. For those clients on dialysis, approximately two-thirds suffer from what peripheral neuropathy?

Restless legs syndrome

A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which intervention would be most appropriate for the nurse to provide?

Restrict intake of dietary protein

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

Client and family education regarding peritoneal dialysis should include assessing the client for:

dehydration that may appear as dry mucous membranes or poor skin turgor.

A client with chronic kidney disease has been admitted with increased shortness of breath and abnormal breath sounds (rales heard to scapular region of posterior back). The admission hemoglobin level is 7.8 g/dL. Vital signs are as follows: respiratory rate 30; BP 180/98; pulse 110. +3 pitting edema in lower extremities bilaterally. Knowing the correlation of hypertension and associated anemia, the nurse suspects this client has developed:

heart failure.

A client with CKD has a GFR of 28 mL/min/1.73 m2. When teaching the client about dietary modifications, the nurse should recommend:

identifying and limiting phosphorus intake.

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).

A client with chronic kidney disease has developed cardiac calcification. On admission the priority assessment would be for the nurse to:

place on a heart monitor to watch for arrhythmias.

In addition to progressive permanent loss of nephrons, chronic kidney disease can result in which other consequence?

Loss of endocrine functions

The nurse assesses a client with renal failure for encephalopathy caused by uremia. Which clinical manifestation will the nurse likely find?

Loss of recent memory and inattention.

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 35-year-old client is diagnosed with acute kidney injury (AKI) and is started on hemodialysis. The client is concerned with the diagnosis and wants to know what to expect in the progression of this disorder. Which statement best addresses the client's concern?

"Acute kidney injury is abrupt in onset and often reversible if recognized early and treated appropriately."

An adult diagnosed with renal failure secondary to diabetes mellitus is scheduled to begin dialysis soon. Which statement by the client reflects an accurate understanding of the process of hemodialysis?

"I will not be able to go about my normal routine during treatment."

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."

A client with a recent diagnosis of renal failure who will require hemodialysis is being educated in the dietary management of the disease. Which of the client's following statements shows an accurate understanding of this component of treatment?

"I've made a list of high-phosphate foods, so that I can try to avoid them."

A nurse is performing client education with an adult recently diagnosed with chronic kidney disease. Which statement by the client would the nurse most likely want to correct or clarify?

"My kidney problems increase my chance of developing high blood pressure or diabetes."

Which teaching points about acute tubular necrosis (ATN) should the renal nurse educator include in the orientation session of new nurses?

"Trauma, burns, and major surgery are common precursors to ATN."

A nurse is collecting a urine specimen prior to measuring the albumin level in a client's urine. A colleague states, "I thought albumin was related to liver function, not the kidney." How can the nurse best respond to this statement?

"Urine albumin levels are useful for diagnosing diabetic kidney disease."

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 health care provider for an obese male who has a history of diabetes and hypertension reports that the client's glomerular filtration rate (GFR) is 51 mL/min with elevated serum creatinine levels. Which statement by the health care provider will likely answer the client's question about the result?

"Your chronic kidney disease has likely been caused by your diabetes and high blood pressure."

A client with a recent diagnosis of renal failure requiring hemodialysis is being educated in the dietary management of the disease. Which statement by the client shows an accurate understanding of this component of treatment? Select all that apply. -"I'll increase the carbohydrates in my diet to provide sufficient energy." -"I've made a list of high-phosphate foods so that I can try to avoid them." -"I'm making a point of trying to eat lots of bananas and other food rich in potassium." -"I don't think I've been drinking enough, so I want to include 8 to 10 glasses of water each day." -"I'm going to try a high-protein, low-carbohydrate diet."

-"I'll increase the carbohydrates in my diet to provide sufficient energy." -"I've made a list of high-phosphate foods so that I can try to avoid them."

The nurse recognizes that which individuals have the greatest risk for the development of chronic kidney disease (CKD)? Select all that apply. -A client with a recent diagnosis of type 2 diabetes who does not monitor blood sugar -A client whose diagnosis of thyroid cancer necessitated a thyroidectomy -A 42-year-old client with uncontrolled hypertension averaging 170/94 mm Hg -A client who experienced a hemorrhagic stroke and now has sensory and motor deficits -A first-time mother who recently lost 1.5 L of blood during a postpartum hemorrhage

-A client with a recent diagnosis of type 2 diabetes who does not monitor blood sugar -A 42-year-old client with uncontrolled hypertension averaging 170/94 mm Hg

A diabetic client with a history of hypertension may receive a prescription for which medication to provide a renal protective effect by reducing intraglomerular pressure? Select all that apply. -Loop diuretics -ACE inhibitors -Angiotensin receptor blockers -Calcium channel blockers -A digitalis preparation

-ACE inhibitors -Angiotensin receptor blockers

The nurse caring for clients with chronic kidney disease (CKD) assesses for signs of renal osteodystrophy (skeletal damage). Which manifestations are characteristic of both high-bone-turnover and low-bone-turnover osteodystrophy? Select all that apply. -Abnormal bone resorption -Defective bone remodeling -Bone marrow fibrosis -Normal osteoblast and osteoclast numbers -Decreased osteoblast and elevated osteoclast proliferation

-Abnormal bone resorption -Defective bone remodeling

Sexual dysfunction in people with CKD is thought to be multifactorial. What are thought to be possible causes of sexual dysfunction in people with CKD? Select all that apply. -Antihypertensive drugs -Psychological factors -Uremic toxins -Inability to vasodilate veins -Sexually transmitted infections

-Antihypertensive drugs -Psychological factors -Uremic toxins

A client has developed chronic kidney disease (CKD). The nurse will advise the client to be alert for the development of which hematologic signs and symptoms associated with this disorder? Select all that apply. -Bruising -Gastrointestinal bleeding -Fatigue -Intravascular clotting -Bradycardia

-Bruising -Gastrointestinal bleeding -Fatigue

Select the body systems most commonly affected by chronic kidney disease in older adults. Select all that apply. -Cardiovascular system -Cerebrovascular system -Skeletal system -Gastrointestinal system -Immune system

-Cardiovascular system -Cerebrovascular system -Skeletal system

A client is to begin peritoneal dialysis. The nurse knows that peritoneal dialysis may result in which complications? Select all that apply. -Catheter-related infection -Hyperglycemia -Dehydration -Pain -Edema

-Catheter-related infection -Hyperglycemia -Dehydration

A client is diagnosed with decreased glomerular filtration rate but has no renal damage. The nurse recognizes this can occur with which disease process? Select all that apply. -Carbohydrate diet -Cirrhosis -Heart failure -Removal of one kidney -Dehydration

-Cirrhosis -Heart failure -Removal of one kidney -Dehydration

Which client does the nurse need to monitor for the development of intense intrarenal vasoconstriction that may induce prerenal failure? Select all that apply. -Client undergoing cardiac catheterization -Client taking acetaminophen for fever -Client taking cyclosporine to prevent rejection for a liver transplant -Client who is HIV positive -Client with an elevated blood urea nitrogen who is taking ibuprofen every 6 hours for back pain

-Client undergoing cardiac catheterization -Client taking cyclosporine to prevent rejection for a liver transplant -Client with an elevated blood urea nitrogen who is taking ibuprofen every 6 hours for back pain

Which clients would have a significant risk of developing the prerenal form of acute kidney injury (AKI)? Select all that apply. -Client who has lost large amounts of blood following a workplace injury -Adult who is admitted for intravenous antibiotic treatment of pyelonephritis -Older adult client with diagnoses of poorly controlled diabetes mellitus and heart failure -Adolescent who is admitted for treatment of an overdose of a nephrotoxic drug -Middle-aged client with a diagnosis of benign prostatic hyperplasia (BPH) -Older adult client who has been admitted for the treatment of dehydration and malnutrition

-Client who has lost large amounts of blood following a workplace injury -Older adult client with diagnoses of poorly controlled diabetes mellitus and heart failure -Older adult client who has been admitted for the treatment of dehydration and malnutrition

A client with chronic kidney disease (CKD) asks the nurse, "Why do I itch all the time?" The nurse bases there response on which integumentary physiologic factors that causes pruritis? Select all that apply. -Too harsh of soap while bathing -Decrease in perspiration -Limited sodium intake -Enlarged size of sweat glands -Elevated serum phosphate levels

-Decrease in perspiration -Elevated serum phosphate levels

If a client with CKD is developing uremic encephalopathy, the nurse will recognize which manifestations as one of the earliest? Select all that apply. -Decreased alertness -Delirium and hallucinations -New-onset seizures -Diminished awareness

-Decreased alertness -Diminished awareness

Anemia frequently occurs in clients with chronic kidney disease (CKD). The nurse will monitor these clients for which contributors to anemia? Select all that apply. -Decreased erythropoietin production -Iron overload -Anorexia -Bone marrow suppression -Chronic blood loss

-Decreased erythropoietin production -Anorexia -Bone marrow suppression -Chronic blood loss

A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that this client will experience which manifestations? Select all that apply. -Decreased renal endocrine function -Decreased tubular reabsorption -Proliferation of nephrons -Hypophospatemia -Decreased glomerular filtration

-Decreased renal endocrine function -Decreased tubular reabsorption -Decreased glomerular filtration

The nurse is preparing to assess a client who has just been admitted to the hospital with a diagnosis of prerenal failure. Which would the nurse expect the client to manifest? Select all that apply. -Decreased urinary output -Increased BUN -BUN-to-serum creatinine ratio of greater than 20:1 -Increased urinary output -Decreased BUN -BUN to serum creatinine ratio of 10:1

-Decreased urinary output -Increased BUN -BUN-to-serum creatinine ratio of greater than 20:1

The parents of a child who has been diagnosed with chronic kidney disease (CKD) ask the nurse about manifestations of the disease. Which information is the most appropriate information to provide these parents? Select all that apply. -Developmental delay -Delayed cognitive development -Secondary hyperparathyroidism -Growth impairment -Accelerated sexual maturation -Early-onset puberty

-Developmental delay -Delayed cognitive development -Secondary hyperparathyroidism -Growth impairment

A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor this client for which gastrointestinal signs and symptoms? Select all that apply. -Early morning nausea -Gastrointestinal ulceration -Decreased gastric secretion -Metallic taste -Anorexia

-Early morning nausea -Gastrointestinal ulceration -Metallic taste -Anorexia

A child is diagnosed with chronic kidney disease (CKD). The nurse knows that which statements regarding supportive renal therapy in children are true? Select all that apply. -Early transplantation is the preferred treatment when considering long-term effects. -Children older than 12 years will benefit from hemodialysis. -Less immune system suppression is needed in children than in adults. -Corticosteroid therapy reduces the risk of growth retardation in children. -Peritoneal dialysis is generally most appropriate for children younger than 6.

-Early transplantation is the preferred treatment when considering long-term effects. -Children older than 12 years will benefit from hemodialysis. -Peritoneal dialysis is generally most appropriate for children younger than 6.

In a client in the uremic state of chronic kidney failure (CKD), the nurse will monitor for which signs and symptoms correlated with uremia? Select all that apply. -Encephalopathy -Nausea -Increased vitamin D synthesis -Anemia -Apathy

-Encephalopathy -Nausea -Anemia -Apathy

The nurse caring for a client with chronic kidney disease (CKD) would monitor for which early manifestations of uremia? Select all that apply. -Elevated blood glucose -Fatigue -Nausea -Apathy -Weakness

-Fatigue -Nausea -Apathy -Weakness

Glomerular filtration rate (GFR) is the best indicator of renal function. The nurse knows that GFR can vary with which factors? Select all that apply. -Gender -Age -Body size -Diet -Ethnicity

-Gender -Age -Body size -Ethnicity

Older adults often have other chronic diseases that influence the early symptoms and signs of renal dysfunction. The nurse knows that which finding can be the dominant clinical events in older adults with early kidney disease? Select all that apply. -Heart failure -Hypertension -Oliguria -Discolored urine -Pruritus

-Heart failure -Hypertension

The nurse will monitor the client with chronic kidney disease (CKD) for which possible cardiovascular changes? Select all that apply. -Heart failure -Hypertension -Hypophospatemia -Impaired platelet function -Pericarditis

-Heart failure -Hypertension -Pericarditis

Which conditions have the potential to cause chronic kidney disease? Select all that apply. -Hypertension -Cardiomyopathy -Diabetes -Glomerulonephritis

-Hypertension -Diabetes -Glomerulonephritis

A child has received a kidney transplant at the age of 3. Knowing he will be on immunosuppressive agents like corticosteroids, the nurse should educate the parents about which long-term side effects? Select all that apply. -Excess weight loss -Hypertension -Frequent hematuria -Growth retardation -Development of cataracts

-Hypertension -Growth retardation -Development of cataracts

Chronic kidney disease (CKD) can cause derangement of calcium and phosphate metabolism. The nurse will monitor a client with CKD for which lab abnormality? Select all that apply. -Impaired phosphate excretion -Excess calcium deposits in bone -Decreased blood levels of calcium -Decreased release of parathyroid hormone (PTH) -Decreased blood levels of phosphate

-Impaired phosphate excretion -Decreased blood levels of calcium

Albuminuria is an important indicator of nephron damage. The nurse recognizes that which statements regarding albuminuria are correct? Select all that apply. -Increased excretion of low-molecular-weight globulins indicates chronic kidney disease (CKD). -Increased excretion of albumin indicates CKD. -Urine dipstick can detect albuminuria. -Albumin-to-creatinine ratio can confirm albuminuria. -Urine normally contains no protein.

-Increased excretion of albumin indicates CKD. -Urine dipstick can detect albuminuria. -Albumin-to-creatinine ratio can confirm albuminuria.

A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor for which manifestations of this disorder? Select all that apply. -Increased nitrogenous waste in blood -Anemia -Right ventricular dysfunction -Osteodystrophy -Hypercalcemia

-Increased nitrogenous waste in blood -Anemia -Osteodystrophy

A client is diagnosed with acute renal injury. The nurse will evaluate the client for which possible causes of this disorder? Select all that apply. -Ischemic injury -Nonischemic reduced renal blood flow -Obstruction of urinary outflow -Hormonal imbalance -Nephrotoxic substances

-Ischemic injury -Nonischemic reduced renal blood flow -Obstruction of urinary outflow -Nephrotoxic substances

The diagnosis is chronic kidney disease (CKD). While caring for a client with CKD, the nurse will monitor for which neurologic signs and symptoms? Select all that apply. -Loss of recent memory -Peripheral neuropathy -Restless legs syndrome -Burning sensation in feet -Increased alertness

-Loss of recent memory -Peripheral neuropathy -Restless legs syndrome -Burning sensation in feet

A client is diagnosed with renal failure. The nurse must monitor for failure of which functions? Select all that apply. -Maintenance of body water -Electrolyte balance -Adrenal secretion -Acid-base balance -Removal of metabolic waste from blood

-Maintenance of body water -Electrolyte balance -Acid-base balance -Removal of metabolic waste from blood

A nurse caring for a client with acute tubular necrosis (ATN) caused by myoglobinuria knows this may be caused by which finding in the client's medical history? Select all that apply. -Muscle damage -Hyperthermia -Hyperkalemia -Alcohol abuse -Prolonged seizures

-Muscle damage -Hyperthermia -Alcohol abuse -Prolonged seizures

A client with chronic kidney disease who has renal osteodystrophy should be assessed for which complications? Select all that apply. -Muscle weakness -Kidney stones -Bone pain -Stress fractures -Urosepsis

-Muscle weakness -Bone pain -Stress fractures

As nitrogenous wastes increase in the blood, the client with CKD may exhibit which clinical manifestations? Select all that apply. -Numbness in lower extremities -Photophobia -Extremely low platelet counts -Restless legs syndrome -Pruritis

-Numbness in lower extremities -Restless legs syndrome -Pruritis

The nurse knows that a client with chronic kidney disease (CKD) may experience which changes in skin integrity? Select all that apply. -Pale skin -Brittle fingernails -Moist skin and mucous membranes -Increased oil gland secretion -Decreased perspiration

-Pale skin -Brittle fingernails -Decreased perspiration

A client with CKD is being treated for hyperphosphatemia and hypocalcemia. Select the most appropriate interventions. Select all that apply. -Phosphate-binding antacids -Activated vitamin D -Restriction of foods high in phosphate -Increased daily consumption of milk -Oral phosphate supplements

-Phosphate-binding antacids -Activated vitamin D -Restriction of foods high in phosphate

A client diagnosed with chronic kidney disease (CKD) with GFR < 5 mL/min/1.73 m2 should be monitored for which fluid and electrolye imbalance? Select all that apply. -Polyuria -Hyperkalemia -Metabolic alkalosis -Hypocalcemia -Hyponatremia

-Polyuria -Hyperkalemia -Hypocalcemia -Hyponatremia

When acute tubular necrosis (ATN) is suspected, the nurse will likely see which laboratory findings on the urinalysis report? Select all that apply. -Protein -Glucose -Red blood cells -Sodium excess -Cast cells

-Protein -Red blood cells -Cast cells

A client is diagnosed with chronic kidney disease (CKD). The nurse knows that which statements regarding CKD are correct? Select all that apply -Onset is abrupt. -Symptoms appear with 50% of nephrons lost. -Renal damage is irreversible. -Less than 1% of population is affected. -Hypertension is a major cause.

-Renal damage is irreversible. -Hypertension is a major cause.

Many drugs and other nephrotoxic agents can induce nephrotic acute tubular necrosis (ATN). The nurse knows that these agents cause tubular injury by which mechanisms? Select all that apply. -Renal vasoconstriction -Hyponatremia -Intratubular obstruction -Renal vasodilation -Direct tubular damage

-Renal vasoconstriction -Intratubular obstruction -Direct tubular damage

Hypertension frequently accompanies chronic kidney disease (CKD). The nurse knows that which mechanisms can contribute to this hypertension? Select all that apply. -Renin-angiotensin-aldosterone (RAAS) activation -Increased vasodilator prostaglandins -Sodium retention -Increased vasoconstriction -Increased blood volume

-Renin-angiotensin-aldosterone (RAAS) activation -Sodium retention -Increased vasoconstriction -Increased blood volume

A nurse is assessing a client diagnosed with CKD for neuromuscular manifestation. Select the manifestations the nurse may expect to find. Select all that apply. -Restless leg syndrome -Loss of recent memory -Peripheral neuropathy -Perceptual errors -Increased muscle strength -Increased alertness

-Restless leg syndrome -Loss of recent memory -Peripheral neuropathy -Perceptual errors

The nurse knows that a child with chronic kidney disease (CKD) may experience which manifestations? Select all that apply. -Bladder incontinence -Early sexual maturity -Intellectual disability -Severe growth deficit -High bone turnover

-Severe growth deficit -High bone turnover

Acute tubular necrosis (ATN) is the most common cause of intrinsic renal failure. What are the most common causes of ischemic ATN? Select all that apply. -Severe hypovolemia -Severe hypertension -Burns -Overwhelming sepsis -Severe hypervolemia

-Severe hypovolemia -Burns -Overwhelming sepsis

A client is diagnosed with early chronic kidney disease (CKD). The nurse will recommend which actions to slow progression of renal damage? Select all that apply. -Smoking cessation -Blood pressure control -High-protein diet -Angiotensin converting enzyme (ACE) inhibitor administration -Blood glucose control

-Smoking cessation -Blood pressure control -Angiotensin converting enzyme (ACE) inhibitor administration -Blood glucose control

The nurse recognizes that renal failure may result from which underlying causes? Select all that apply -Malnutrition -Systemic disease -Hepatic disease -Renal disease -Nonrenal urological abnormalities

-Systemic disease -Renal disease -Nonrenal urological abnormalities

The nurse will monitor which clients at risk for the development of chronic kidney disease (CKD)? Select all that apply. -Systemic lupus erythematosus -Polycycstic kidney disease -Glomerulonephritis -Hyperlipidemia -Diabetes

-Systemic lupus erythematosus -Polycycstic kidney disease -Glomerulonephritis -Diabetes

A client with chronic kidney disease (CKD) is anemic. The nurse will attempt to alleviate the anemia in order to prevent which of the following? Select all that apply. -Tachycardia -Fatigue -Increased blood viscosity -Hypersomnia -Decreased myocardial oxygen

-Tachycardia -Fatigue -Decreased myocardial oxygen

Which clinical manifestations would lead the nurse to suspect that a client with renal failure is developing uremia? Select all that apply. -Weakness and fatigue. -Lethargy and confusion. -Extreme itching. -Blood in urine. -Urine smell in the stool.

-Weakness and fatigue. -Lethargy and confusion. -Extreme itching.

Which clients scheduled for an interventional radiology procedure requiring administration of radiocontrast dye would be considered high risk for nephrotoxicity? Select all that apply. -Adolescent with severe abdominal pain -Young adult with a history of glomerular nephritis who is reporting severe flank pain -Middle-aged adult with diabetes undergoing diagnostic testing for new-onset proteinuria -Adult with elevated liver enzymes possibly due to fatty liver cirrhosis -Middle-aged adult undergoing biopsy for a suspicious "spot" on a chest x-ray

-Young adult with a history of glomerular nephritis who is reporting severe flank pain -Middle-aged adult with diabetes undergoing diagnostic testing for new-onset proteinuria

The health care provider is comparing results of a client's recent GFR measurement. Which result would be interpreted as normal?

120 to 130 mL/minute

The nurse is caring for a client with chronic kidney disease (CKD). The nurse determines the client may consume how much fluid intake per day?

500 to 800 mL/day

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

The nurse knows that a client with which glomerular filtration rate (GFR) would be classified as "decreased GFR"?

70 mL/min

Which clinical finding among older adults is most likely to be viewed as a normal part of age-related changes?

78-year-old client whose glomerular filtration rate (GFR) has been steadily declining over several years

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.

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

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

Which diagnostic bloodwork is most suggestive of chronic kidney disease (CKD)?

A client with low vitamin D levels, low calcitrol levels, and elevated parathyroid hormone (PTH) levels

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

A client had excessive blood loss and prolonged hypotension during an extensive surgery. The client's postoperative urine output is sharply decreased and the blood urea nitrogen (BUN) is elevated. Which cause is most likely responsible for these abnormal findings?

Acute tubular necrosis

A client has developed renal failure with associated high serum phosphate levels. To avoid the development of osteodystrophy, the health care provider will try to avoid phosphate-binding agents that contain which compound?

Aluminum salts

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

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 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

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

Which medication would the nurse anticipate being prescribed for the client with renal failure who has hyperphosphatemia?

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

A hospital client with a diagnosis of chronic renal failure has a prescription for measurement of serum electrolyte levels three times per week. Which statement best captures the relationship between renal failure and sodium regulation?

Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption.

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

As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by:

Decrease in GFR of 60 to 89 mL/minute/1.73 m2

Manifestations of childhood renal disease are varied and may differ from adult-onset renal failure. A school-aged child with chronic kidney disease may exhibit which manifestation?

Developmental delays such as uncoordinated gait and minimal fine motor skills

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 with chronic kidney disease (CKD) is starting hemodialysis. Which diet will the dialysis nurse likely recommend?

Diet low in proteins but including eggs and lean meat

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

A 1-year-old baby boy with renal dysplasia risks end-stage renal disease unless intervention occurs. Which treatment option is his care team most likely to reject?

Dietary restriction plus erythropoietin

A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is:

Dorsiflexion of hands and feet

Which dermatologic problem most often accompanies chronic kidney disease (CKD)?

Dry skin and pruritus

A client is being treated for chronic kidney disease (CKD). One of the nurse's responsibilities is to explain to the client the need to keep her blood pressure under control. Why is blood pressure control so important in CKD clients?

Elevated blood pressure will exacerbate nephron loss and accelerate renal failure.

People with chronic kidney disease (CKD) have impaired immune responses due to high levels of urea and metabolic wastes in the blood. What is one thing missing in the immune response when a person with CKD is exposed to sick people?

Failure to mount a fever with infection

The health care provider is reviewing laboratory results of a client. Select the diagnostic test that is considered the best measurement of overall kidney function.

Glomerular filtration rate (GFR)

A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?

Hypertension

The nurse is providing care for a client who has a diagnosis of kidney failure. Which of the following laboratory findings is consistent with this client's diagnosis?

Hypocalcemia

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

Subcutaneous bruising is often present as a result of which imbalance in the client with chronic kidney disease?

Impaired platelet function

Following the diagnosis of acute renal failure, the nurse knows that one of the earliest manifestations of tubular damage is which laboratory/diagnostic result?

Inability to concentrate urine

Which assessment findings would the health care provider consider as most indicative of acute renal failure?

Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR)

In hemodialysis, access to the vascular system is most commonly through:

Internal arteriovenous fistula

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

A client has acute pyelonephritis. The nurse will monitor the client for development of:

Intrarenal failure

According to the Kidney Disease Outcome Quality Initiative (KDOQI) guidelines, in the first stage of kidney disease, the nurse will assess which finding?

Kidney damage with normal glomerular filtration rate (GFR)

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.

A client has a marked decrease in the glomerular filtration rate (GFR); lab values with high blood urea nitrogen (BUN), potassium, and creatinine levels; urine output less than 10 mL/hr; 3+ pitting edema in the lower extremities; and BP 170/95. Which phase of acute tubular necrosis (ATN) does the nurse identify the client is in based on assessment data?

Maintenance phase

Reduced glomerular filtration rate (GFR), with a serum creatinine level that remains in the normal range, is associated with which factor of normal age-related change?

Muscle mass

A 35-year-old female ultramarathon runner is admitted to hospital following a day-long, 80-km race because her urinary volume is drastically decreased and her urine is dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis. Why is her urine red?

Myoglobinuria

An ultramarathon runner is admitted following a day-long, 50-mile (80-kilometer) race because urinary volume is drastically decreased and the urine is dark red. What is the likely cause of the red urine?

Myoglobinuria

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

A 45-year-old client with chronic kidney disease (CKD) voices concern about her dialysis treatment. The client would like to work and spend time with her family. Which type of dialysis will best fit this client's lifestyle?

Nocturnal intermittent peritoneal dialysis (NIPD)

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 postrenal acute kidney injury (AKI) exhibits oliguria and edema with laboratory results revealing increased levels of urea, potassium, and creatinine. Based on these data, which phase of AKI is this client most likely experiencing?

Oliguric phase

Which skeletal complication can occur as a result of high-turnover renal osteodystrophy?

Osteitis fibrosa

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

The nurse knows that which sign is one of the earliest manifestations of acute renal failure (ARF)?

Polyuria

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

A client is diagnosed with a tumor in the urinary bladder. The nurse will monitor the client 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 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

Phosphate excretion is impaired in chronic kidney disease (CKD), resulting in high serum phosphate levels and the development of phosphate crystals. Which manifestation of hyperphosphatemia should the nurse assess for?

Pruritus

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 client with significant burns on his lower body has developed sepsis on the third day following his accident. Which manifestation would the nurse anticipate for an ischemic acute tubular necrosis rather than prerenal failure?

The client's GFR does not increase after restoration of renal blood flow

A 56-year-old woman has been diagnosed with CKD. She first went to the doctor due to complications of hypertension. How are hypertension and CKD related?

The mechanisms that produce hypertension in CKD include an increased vascular volume and increased activity of the renin-angiotensin-aldosterone system.

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.