Chapter 46: Acute Kidney Injury and Chronic Kidney Disease elsover

20. Besides being mixed with struvite or oxalate stones, what characteristic is associated with calcium phosphate calculi? a. Associated with alkaline urine b. Genetic autosomal recessive defect c. Three times as common in women as in men d. Defective gastrointestinal (GI) and kidney absorption

✅. a. Calcium phosphate stones are typically mixed with struvite or oxalate stones and related to alkaline urine. Cystine stones are associated with a genetic autosomal recessive defect and defective gastrointestinal (GI) and kidney absorption of cystine. Struvite stones are 3 to 4 times more common in women than in men

A nurse is caring for a client with diabetic nephropathy. The nurse understands that which of the following is the primary indication for hemodialysis in a client with chronic renal failure? A. Ascites B. Alkalosis C. Hypotension D. Serum creatinine > 8 mg/dL

Correct Answer: D. Serum creatinine > 8 mg/dL The failure of the kidneys to maintain the proper balance of potassium is one of the primary indications for dialysis. Hyperkalemia can cause cardiac dysrhythmia leading to cardiac arrest due to ventricular fibrillation and asystole. A glomerular filtration rate <10 or serum creatinine >8 mg/dL are indications for dialysis. Incorrect Answers: A. Ascites occurs in liver disease and is not an indication for dialysis. B. Dialysis is not a treatment for alkalosis. Acidosis would be expected in renal failure. C. Dialysis is not a treatment for hypotension. Hypertension is more likely in renal failure Vital Concept: Clients with diabetic nephropathy often start dialysis earlier than those with other kidney diseases. In normal case, indicator for dialysis is serum creatinine over 8 mg/dL (707mmol/l) or glomerular filtration rate (GFR) less than 10. In diabetic nephropathy, the serum creatinine level may not accurately reflect the client's renal condition. Clients with diabetes should begin dialysis earlier if they develop retinopathy, brain disorder, heart disease. Indications for dialysis include intractable acidosis; electrolyte imbalance (K+, Na+, Ca++); intoxicants (methanol ethylene glycol, Li, ASA); intractable fluid overload; and uremic symptoms (nausea, seizure, pericarditis, bleeding). The goal of early dialysis is to maintain the BUN < 100 mg/dl and creatinine < 10 mg/dl.

17. The mother of an 8-year-old girl has brought her child to the clinic because she is wetting the bed at night. What terminology should the nurse use when documenting this situation? a. Ascites b. Dysuria c. Enuresis d. Urgency

✅. c. Enuresis is involuntary urination at night. Ascites is excess fluid in the intraperitoneal cavity. Dysuria is painful urination. Urgency is the feeling of needing to void immediately.

6. Which characteristic is more likely with acute pyelonephritis than with a lower UTI? a. Fever b. Dysuria c. Urgency d. Frequency

✅a. Systemic manifestations of fever and chills with leukocytosis and nausea and vomiting are more common in pyelonephritis than in a lower UTI. Dysuria, frequency, and urgency can be present with both.

PO? Folic Acid/Folate B12, folvite

Classification:Vitamin/Mineral Supplements Therapeutic uses: Used as a supplement in kidney disease. Replace what is lost through dialysis or diet Side effect/adverse reaction: N/V Nursing Implications: Teach to take with meals to prevent GI upset. Take after dialysis.

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✅ a, b, d. Pruritus is common in patients receiving dialysis. It causes scratching from dry skin, sensory neuropathy, and calcium-phosphate deposition in the skin. Vascular calcifications contribute to cardiovascular disease, not to itching skin. Uremic frost rarely occurs without BUN levels >200 mg/dL, which should not occur in a patient on dialysis; urea crystallizes on the skin and also causes pruritus.

31. Which drugs are used to treat overflow incontinence (select all that apply)? a. Baclofen (Lioresal) b. Anticholinergic drugs c. α-Adrenergic blockers d. 5α-reductase inhibitors e. Bethanechol (Urecholine)

✅c, d, e. α-Adrenergic blockers block the stimulation of the smooth muscle of the bladder, 5α-reductase inhibitors decrease outlet resistance, and bethanechol enhances bladder contractions. Baclofen or diazepam is used to relax the external sphincter for reflex incontinence. Anticholinergics are used to relax bladder tone and increase sphincter tone with urge incontinence.

14. Number in sequence the following ascending pathologic changes that occur in the urinary tract in the presence of a bladder outlet obstruction. a. _______ Hydronephrosis b. _______ Reflux of urine into ureter c. _______ Bladder detrusor muscle hypertrophy d. _______ Ureteral dilation e. _______ Renal atrophy f. _______ Vesicoureteral reflux g. _______ Large residual urine in bladder h. _______ Chronic pyelonephritis

14. a. 6; b. 3; c. 1; d. 4; e. 8; f. 5; g. 2; h. 7

Classification :Loop diuretics oral or IV Furosemide Bumetanide

Therapeutic uses: For volume overload Dose varies with severity of kidney disease, not effective in ESKD. Expected output is greater than input Side effect/adverse reaction: Hypokalemia- desired effect Hypotension ototoxicity Nursing Implications I/O, Lytes, Output > intake Monitor for toxicity due to possible loss of kidney function

24. What impairment in kidney function would cause the following laboratory findings in a patient with kidney disease? List Impaired Kidney Function Laboratory Finding Serum Ca2 +: 7.2 mg/dL (1.8 mmol/L) Hemoglobin (Hgb): 9.6 g/dL (96 g/L) Serum creatinine: 3.2 mg/dL (283 mmol/L)

i. Serum Ca2 +: 7.2 mg/dL (1.8 mmol/L)—>Impaired conversion of inactive vitamin D to active vitamin D results in poor calcium absorption from the bowel, resulting in hypocalcemia. ii. Hemoglobin (Hgb): 9.6 g/dL (96 g/L)Loss of cells that produce erythropoietin results in lack of stimulation of bone marrow to produce RBCs. iii.Serum creatinine: 3.2 mg/dL (283 mmol/L) This serum creatinine level is high, indicating the loss of tubular secretion (passage of substances from the blood into the tubule) by the kidney.

20. Which urine specific gravity value would indicate to the nurse that the patient is receiving excessive IV fluid therapy? a. 1.002 b. 1.010 c. 1.025 d. 1.033

✅ a A urine specific gravity of 1.002 is low, indicating dilute urine and the excretion of excess fluid. Fluid overload, diuretics, or lack of ADH can cause dilute urine. Normal urine specific gravity is 1.003 to 1.030. A high urine specific gravity indicates concentrated urine that would be seen in dehydration.

15. The health care provider documented that the patient has urinary retention. How should the nurse explain this when the nursing student asks what it is? a. Inability to void b. No urine formation c. Large amount of urine output d. Increased incidence of urination

✅ a. Retention is the inability to void even though urine is in the bladder. Anuria is no urine formation. Polyuria is a large amount of urine output over time. Frequency is increased incidence of urination.

A nurse is caring for a client who has chronic pyelonephritis. Which of the following actions should the nurse take? (Select all that apply.) A. Encourage the client to restrict daily fluid intake to 1 L. B. Arrange a consultation with a registered dietician C. Palpate the costovertebral angles of the client. D. Instruct the client to void every two hours. E. Monitor the client's creatinine level.

✔Correct Answers: B. Arrange a consultation with a registered dietician C. Palpate the costovertebral angles of the client. D. Instruct the client to void every two hours. E. Monitor the client's creatinine level. Chronic pyelonephritis is a disorder that results in renal scarring and decreased kidney functioning. In order to delay the development of end stage kidney disease, the client should consume a diet that provides needed nutrients, controls blood pressure, and consists of plenty of fruits and vegetables. The nurse should provide the client with a referral to a registered dietitian who will provide information on meeting nutritional needs while delaying the progression of the disease. Manifestations of chronic pyelonephritis can be vague and include changes in urine color, nocturia, hypertension, and low grade fevers. Inflammation and tenderness of the costovertebral angle can be an indication of inflammation or infection. The nurse should observe the area for redness, edema, or asymmetry and gently palpate the costovertebral angle for flank tenderness as part of the client assessment. Chronic pyelonephritis is caused by repeated urinary tract infections which result in inflammation and scarring of the kidneys. To prevent urinary tract infections, the nurse should provide education to the client including instructions on how to cleanse the perineum and urethral meatus, to avoid fluids that are irritants to the urinary tract, and to void every 2 to 3 hr during the day to prevent overdistention of the bladder. Pharmacological treatment of chronic pyelonephritis includes long term antibiotics to treat and prevent further infections. Impaired kidney function resulting from the chronic pyelonephritis increases the risk for toxicity from the antibiotics due to decreased excretion. The nurse should monitor the client's renal function including BUN and creatinine levels as well as the glomerular filtration rate. Increased levels of BUN or creatinine or a decrease in the glomerular filtration rate are indications of increasing kidney damage and should be reported to the provider. Incorrect Answer: A. Fluid intake is encouraged in the client who has chronic pyelonephritis to prevent dehydration, which will increase the risk for end-stage kidney disease, and to promote urinary output, which increases the excretion of metabolic wastes. The nurse should encourage fluid intake of at least 2 L daily to maintain dilute urine that is pale yellow in color. Vital Concept: Chronic pyelonephritis is a disorder that occurs when a client experiences repeated urinary tract infections, has a structural deformity of the kidney, or urinary reflux, stasis, or obstruction. Repeated or ongoing infection results in changes to the nephrons. This causes a decrease in kidney function with alterations in filtration, reabsorption, and excretion. Care of the client who has chronic pyelonephritis is supportive and involves monitoring for and treating urinary tract infections, managing the manifestations of the disorder such as hypertension, alterations in electrolytes and acid-base balance, fever, anorexia, and weight loss. The nurse should provide education to the client regarding prescribed medications such as antibiotics and urinary antiseptics, increasing fluid intake, preventing urinary tract infections, and manifestations of inflammation or infection that the client should monitor for. The nurse should refer the client to a registered dietitian who can provide the client with information regarding dietary adjustments to maintain kidney function for as long as possible.

A nurse is administering vancomycin to a client with methicillin resistant Staphylococcus aureus. Which of the following is an adverse effect of vancomycin (Vancocin) that should be reported immediately to the healthcare provider? A. Vertigo B. Tinnitus C. Muscle stiffness D. Ataxia

Correct Answer: B. Tinnitus The client should report tinnitus because vancomycin can affect the acoustic branch of the eighth cranial nerve. Vancomycin does not affect the vestibular branch of the acoustic nerve; vertigo and ataxia would occur if the vestibular branch were involved. Incorrect Answers: A. Vertigo is not an adverse outcome associated with vancomycin. C. Muscle stiffness is not an adverse outcome associated with vancomycin. D. Ataxia is not an adverse outcome associated with vancomycin. It is associated with ototoxicity due to aminoglycoside antibiotics, which affect the vestibular apparatus. Vital Concept: Vancomycin is used intravenously for treatment of clients with gram-positive infections, including methicillin-resistant Staphylococcus aureus (MRSA). Adverse effects include ototoxicity, nephrotoxicity, and Red Man Syndrome. If a client develops ototoxicity, the drug should be discontinued. Ototoxicity due to vancomycin is characterized by high frequency hearing loss. Risk is increased with higher doses and when vancomycin is administered with aminoglycoside antibiotics (gentamicin.) It is more common in older clients and those with preexisting renal insufficiency.

A nurse at a hemodialysis center is caring for a client who has a new order for erythropoietin (Epogen) to be administered subcutaneously. Which of the following side effects should the nurse advise the client to report to the healthcare provider? A. Anuria B. Pruritus C. Nausea D. Severe headache

Correct Answer: D. Severe headache Erythropoietin (EPO) is a hormone made in the kidney and is necessary for maturation of red blood cells. It is used to treat anemia associated with chronic renal failure and due to cancer and treatment with toxic chemotherapeutic drugs. Hypertension and related headaches occur in 15% of individuals with the administration of erythropoietin. A headache may progress to seizures or encephalopathy. Increased blood pressure occurs less frequently with subcutaneous administration compared to intravenous administration of EPO. Hypertension can be relieved with dialysis or, in individuals who are not on dialysis, with a diuretic. Incorrect Answers: A. Anuria is a urine output of less than 50 mL/day and is expected in a client on hemodialysis. B. Pruritus is associated with end-stage renal disease. C. Nausea is a side effect that is expected with the initiation of EPO therapy. Vital Concept: Erythropoeitin is a hormone produced in the kidney that promotes maturation of red blood cells. In clients with anemia due to chemotherapy or chronic renal failure, supplementation may be necessary. Significant adverse effects include hypertension with headache, seizure, and even encephalopathy.

23. Following electrohydraulic lithotripsy for treatment of kidney stones, the patient has a nursing diagnosis of risk for infection. What is the most appropriate nursing intervention for this patient? a. Monitor for hematuria. b. Encourage fluid intake of 3 L/day. c. Apply moist heat to the flank area. d. Strain all urine through gauze or a special strainer.

✅ b. A high fluid intake maintains dilute urine, which decreases bacterial concentration in addition to washing stone fragments and expected blood through the urinary system following lithotripsy. High urine output also prevents supersaturation of minerals. Moist heat to the flank may be helpful to relieve muscle spasms during renal colic. All urine should be strained in patients with renal stones to collect and identify stone composition, but these are not related to infection. Interprofessional care usually will include antibiotics to reduce infection risk.

19. : A patient with a history of gout has been diagnosed with renal calculi. Which treatment will be used with this patient (select all that apply)? a. Reduce dietary oxalate b. Administer allopurinol c. Administer α-penicillamine d. Administer thiazide diuretics e. Reduce animal protein intake f. Reduce intake of milk products

✅. b, e. This patient is most likely to have uric acid stones. Gout is a predisposing factor. The treatment will include allopurinol and reducing animal protein intake to reduce purine, as uric acid is a waste product from purine metabolism. Reducing oxalate and using thiazide diuretics help treat calcium oxalate stones. Giving α-penicillamine and tiopronin prevents cystine crystallization for cystine stones. Reducing intake of milk products to decrease calcium intake may be indicated for patients with calcium stones.

27. Which diagnostic study would include assessing for iodine sensitivity, teaching the patient to take a cathartic the night before the procedure, and telling the patient that a warm sensation may occur during the contrast media injection? a. Cystometrogram b. Renal arteriogram c. Kidneys, ureters, bladder (KUB) d. MRI.

✅. b. A cathartic the evening before the procedure and assessing sensitivity to iodine are important for a renal arteriogram as well as a CT scan and an intravenous pyelogram (IVP). The cystometrogram involves filling the bladder with water or saline to measure tone and stability. The kidneys, ureters, and bladder (KUB) is an x-ray that may have bowel preparation.

3. Which important functions of regulation of water balance and acid-base balance occur in the distal convoluted tubules of the nephron (select all that apply)? a. Secretion of H+ into filtrate b. Reabsorption of water without antidiuretic hormone (ADH) c. Reabsorption of Na+ in exchange for K+ d. Reabsorption of glucose and amino acids e. Reabsorption of water under ADH influence f. Reabsorption of Ca+ 2 under parathormone influence

✅a, c, e, f. The distal convoluted tubules regulate water and acid-base balance by reabsorption of water under antidiuretic hormone (ADH) influence, secreting H+ and reabsorbing bicarbonate, reabsorption of Na+ in exchange for K+, and reabsorption of Ca+ 2 with the influence of parathormone. The reabsorption of water without ADH occurs in the proximal convoluted tubule and descending loop of Henle. The reabsorption of glucose and amino acids occurs in the proximal convoluted tubule. Active reabsorption of Cl− and passive reabsorption of Na+ occurs in the ascending loop of Henle.

Iron dextran -IV Iron Sucrose-Parenteral IV

Classification Therapeutic uses: Used along with erythropoietin stimulators Side effect/adverse reaction: Anaphylaxis, hypotension, Tachycardia, Rhabdomyolysis Nursing Implications: Monitor for anaphylaxis. Administer test dose. Allergic reactions are high.

A nurse is assessing a client who has experienced a rapid loss of renal function and is determined to be in the prerenal stage of acute kidney injury (AKI). Which of the following findings should the nurse expect? (Select all that apply.) A. Reduced BUN level B. Elevated cardiac enzymes C. Reduced urine output D. Elevated serum creatinine level E. Increased sodium in the urine

Correct Answers: C. Reduced urine output D. Elevated serum creatinine level A manifestation of the prerenal stage of AKI is reduced urine output caused by fluid volume depletion, resulting from injuries such as burns or hemorrhage, and the resultant hypoperfusion of the kidneys. A manifestation of the prerenal stage of AKI is elevated serum creatinine levels. Incorrect Answers: A. A manifestation of the prerenal stage of AKI is an elevated BUN level caused by the accumulation of nitrogenous wastes in the blood. B. Elevated cardiac enzymes is a manifestation of cardiac tissue injury, not AKI. E. A manifestation of the prerenal stage of AKI is decreased, not increased, sodium in the urine. Vital Concept: Acute kidney injury (AKI) results from an underlying cause leading to hypovolemia, with inadequate perfusion to the kidneys. Unless the precipitating factor can be identified and corrected, damage to the kidneys will be progressive, become permanent, and lead to chronic renal disease. When caring for a client who has AKI, nurses monitor for complications, treat the client's fluid and electrolyte imbalances, and provide emotional support. Daily weights and frequent laboratory tests are monitored for the client, and the dietary orders are checked daily for possible changes. In general a high-carbohydrate, low-potassium, low-phosphorus diet is prescribed for a client who has AKI.

4. The right atrium myocytes secrete atrial natriuretic peptide (ANP) when there is increased plasma volume. What actions does ANP take to produce a large volume of dilute urine (select all that apply)? a. Inhibits renin b. Increases ADH c. Inhibits angiotensin II action d. Decreases sodium excretion e. Increases aldosterone secretion

✅. a, c. Atrial natriuretic peptide (ANP) responds to increased atrial distention by increasing sodium excretion and inhibiting renin, ADH, and angiotensin II action. Aldosterone secretion is also suppressed. ANP also causes afferent arteriole relaxation that increases the glomerular filtration rate (GFR).

5. Which statement accurately describes glomerular filtration rate (GFR)? a. The primary function of GFR is to excrete nitrogenous waste products. b. Decreased permeability in the glomerulus causes loss of proteins into the urine. c. The GFR is primarily dependent on adequate blood flow and adequate hydrostatic pressure. d. The GFR is decreased when prostaglandins cause vasodilation and increased renal blood flow.

✅. c. GFR is primarily dependent on adequate blood flow and hydrostatic pressure. The glomerulus filters the blood. The GFR is the amount of blood filtered each minute by the glomeruli, which determines the concentration of urea in the blood. Increased permeability in the glomerulus from kidney diseases causes loss of proteins in the urine. The prostaglandins increase the GFR with increased renal blood flow. .

12. The nurse plans care for the patient with APSGN based on what knowledge? a. Most patients with APSGN recover completely or rapidly improve with conservative management. b. Chronic glomerulonephritis leading to renal failure is a common sequela to acute glomerulonephritis. c. Pulmonary hemorrhage may occur as a result of antibodies also attacking the alveolar basement membrane. d. A large percentage of patients with APSGN develop rapidly progressive glomerulonephritis, resulting in kidney failure.

✅a. Most patients recover completely from acute poststreptococcal glomerulonephritis (APSGN) with supportive treatment. Chronic glomerulonephritis that progresses insidiously over years and rapidly progressive glomerulonephritis that results in renal failure within weeks or months occur in only a few patients with APSGN. In Goodpasture syndrome, antibodies are present against both the glomerular basement membrane (GBM) and the alveolar basement membrane of the lungs, and dysfunction of kidneys and lungs are present.

A nurse is preparing to initiate peritoneal dialysis for a client who has chronic kidney disease. Which of the following actions should the nurse take? (Select all that apply.) A. Monitor the client's glucose levels. B. Report cloudy dialysate return. C. Warm the dialysate in a microwave oven. D. Assess the client for the presence of shortness of breath. E. Position the drainage bag lower than the client's abdomen. F. Maintain medical asepsis when accessing the catheter insertion site.

✔Correct Answers: A. Monitor the client's glucose levels. B. Report cloudy dialysate return. D. Assess the client for the presence of shortness of breath. E. Position the drainage bag lower than the client's abdomen. Dialysis is the process of filtering the client's blood to remove excess fluid and nitrogenous waste products. It is completed by diffusion of the fluid and waste products across a semi-permeable membrane, such as the peritoneum, which is used in peritoneal dialysis. Because the dialysate solution contains glucose to manage tonicity of the solution, the client can develop hyperglycemia. The nurse should monitor the client's glucose levels to identify and treat hyperglycemic events. The dialysate return should appear clear and light yellow in color. If the effluent, or returned dialysate solution, is different than this, it is an indication of a potential complication. For example, cloudy effluent is an indication of peritonitis. If this occurs, the nurse should collect a specimen of the dialysate fluid for culture and sensitivity. The nurse should also further assess the client for fever, tenderness or pain in the abdomen, nausea, vomiting, or general malaise. Each of these are also manifestations of peritonitis. Peritoneal dialysis is not without complications. The client can develop peritonitis, infections of the exit site, displacement of the catheter, bleeding, perforation of the bowel or bladder, and shortness of breath. Shortness of breath can be caused by infusing a larger amount of dialysate than the client can tolerate. This causes the level of the diaphragm to rise, limiting the ability of the lungs to expand. The nurse should assess for shortness of breath, measure the quantity of effluent and compare that to the amount of dialysate infused, and weigh the client before and after dialysis. Peritoneal dialysis effluent is drained into a bag that is positioned lower than the client's abdomen. This helps in the outflow by using gravity to promote the drainage of the solution. The nurse should ensure that the catheter clamp to the effluent container is opened and that there is no kinking or twisting of the tubing. If effluent drainage is sluggish, the nurse should ensure that the client is in proper body alignment and can reposition the client to promote flow. Peritoneal Dialysis Effluent Characteristics and Indications Effluent Color Possible Causes Clear, light yellow Expected Cloudly, opaque Infection Blood Tinged Can be expected for initial 2-weeks of peritoneal dialysis Brown Bowel perforation Yellow with same glucose level as urine Bladder perforation Incorrect Answers: C. Instilling cold dialysate can cause discomfort for the client. The nurse should warm the dialysate using a warming chamber in the automated cycling machine if the client received automated peritoneal dialysis. Otherwise, the nurse should warm the dialysate by wrapping a heating pad around the dialysate bag. The nurse should avoid warming the dialysate in a microwave oven, which causes uneven heating of the solution and can result in client injury. F. A major complication of peritoneal dialysis is infection at the exit site, which is difficult to treat and can evolve into peritonitis. The nurse should maintain surgical asepsis when accessing the catheter insertion site to prevent infection from contamination. The nurse should wear a mask and sterile gloves when accessing the site. Dressing changes to the catheter site are sterile procedures; therefore, the nurse should ensure all supplies are sterile as well. Vital Concept: Care of the client who is receiving peritoneal dialysis requires nursing assessment and interventions prior to, during, and after the procedure. Before initiating peritoneal dialysis, the nurse should assess the client, paying close attention to the client's respiratory status, and obtain the client's vital signs and weight. The nurse should review the client's laboratory results including electrolyte and glucose levels. When initiating peritoneal dialysis, the nurse should wear a mask and sterile gloves to remove the dressing around the catheter. The nurse should inspect the catheter site, assessing for indications of infections or catheter displacement. When cleansing and accessing the catheter site, the nurse should use sterile technique to decrease the risk for infection. During dialysis, the nurse should monitor the inflow of the dialysis and ensure the tubing is not kinked or clamped, frequently monitor and record the client's vital signs, respiratory and pain status, blood glucose level, and the condition of the catheter dressing. Following the prescribed dwell time of the dialysate, the nurse should initiate outflow. During outflow, the nurse should ensure that the effluent is draining in a continuous stream, and reposition the client or assess for complications if drainage is slow. The nurse should also measure the effluent and compare this to the amount of dialysate infused. Any fluid that has been retained by the client following peritoneal dialysis is considered intake. The nurse should weigh the client following completion of the dialysis.

sodium polystyrene sulfonate (Kayexalate) ATI

Classification: potassium-removing agents Therapeutic uses : Treatment of hyperkalemia Releases sodium ions in exchange for other cations in the intestines. Resin enters the large intestine and exchanges ions and binds K and pulls out through feces, thereby reducing K level. Side effect/adverse reaction: Abdominal cramps, decreased urine output, hypokalemia, hypocalcemia, hypomagnesemia Should have good bowel function. Diarrhea, cardiac arrhythmias. Constipation can be an adverse effect when administered rectally Nursing Implications: Assess bowel function. Use cautiously in patients with heart failure or HTN. Teach patients they may experience cramps. Slow onset of action so not for an acute situation. Assess for hypokalemia and EGG changes. Monitor calcium and magnesium levels. Administer other oral medications 3 hrs before or 3 hrs after administration as drug may interfere with absorption of other drugs. If given rectally retain for 30-60 minutes ( may need foley with balloon.) Monitor skin integrity. Assess bowel function daily and monitor for fecal impaction. Mild laxative may be prescribed.

A nurse is reviewing the laboratory results of a middle-aged adult client who has Stage 4 chronic kidney disease. Which of the following findings should the nurse expect? A. Blood urea nitrogen (BUN) 15 milligrams per deciliter (mg/dL) B. Glomerular filtration rate (GFR) 20 milliliters per minute (mL/min) C. Creatinine 1.1 milligrams per deciliter (mg/dL) D. Potassium 5.0 millequivalents per liter (mEq/L)

Correct Answer: B. Glomerular filtration rate (GFR) 20 milliliters per minute (mL/min) The GFR is a measurement of the amount of blood the nephron is able to filter in 1 min and is an indication of renal function. The expected reference range for the GFR in a middle-aged adult is between 93 and 107 mL/min. A client who has stage 4 chronic kidney disease can have a GFR in the range of 15 to 29 mL/min. Incorrect Answers: A. Urea nitrogen is a byproduct of protein metabolism and is excreted in the urine. The BUN level is directly correlated to renal functioning. The expected reference range for an adult client is 10 to 20 mg/dL. Elevated BUN levels can indicate a variety of conditions such as shock, dehydration, heart failure, gastrointestinal bleeding, and kidney disease. The nurse should expect the BUN level of a client who is in stage 4 chronic kidney disease to be up to 20 times greater than the expected reference range. C. Creatinine is a result of the metabolism of creatine phosphate, an enzyme needed for skeletal muscle contraction. It is excreted in the urine and levels are correlated to the functioning of the kidneys. The expected reference range for creatinine increases with age from a low of 0.1 to 0.4 mg/dL in an infant to 0.5 to 1.3 mg/dL in the older adult client. Elevated creatinine levels can indicate dehydration or a renal disorder such as chronic kidney disease. A client who has stage 4 chronic kidney disease can have a creatinine level greater than 30 mg/dL. D. Due to the decreased ability of the kidneys to excrete fluids and electrolytes, the client who has stage 4 chronic kidney disease is at risk for developing hyperkalemia. This occurs when the urine output is less than 500 mL/day. The expected reference range for potassium is 3.5 to 5 mEq/L. A client in stage 4 chronic kidney disease will have a potassium level greater than 5 mEq/L. Vital Concept: Chronic kidney disease is a progressive and irreversible disorder resulting in decreasing function of the kidneys. There are 5 stages of chronic kidney disease which are based on the ability of the kidney's nephrons to filter blood, referred to as the glomerular filtration rate (GFR). At stage 1, the client can have a GFR of 90 mL/min or more but by the time the client reaches the 5th level, or end stage kidney disease, the GFR is less than 15 mL/min. Other indicators of renal function include the creatinine and the blood urea nitrogen (BUN) levels. The nurse should monitor a variety of laboratory results for a client who has chronic kidney disease including sodium, potassium, calcium, phosphorus, magnesium, hemoglobin, hematocrit, serum osmolality, and arterial blood gases in addition to those mentioned above.

A nurse is caring for a client with acute renal failure who is undergoing hemodialysis. What should the nurse consider when educating the client on healthy food choices? A. Increase dairy products to maintain phosphorus balance. B. Decrease total fat intake to 45% of daily calories. C. Decrease potassium intake to 40 mg/kg per day. D. Limit sodium intake to 4.5 g/day.

Correct Answer: C. Decrease potassium intake to 40 mg/kg per day. A client who is receiving hemodialysis should limit potassium intake to 2 to 4 g/day or 40 mg/kg per day. Clients on hemodialysis should limit intake of potassium, phosphorus, fluids, and sodium. Incorrect Answers: A. intake of milk, yogurt, and cheese should be limited to ½-cup milk or ½-cup yogurt or 1-ounce cheese per day. Most dairy foods are very high in phosphorus. Consumption of phosphorus should be limited in clients on hemodialysis. B. Total fat intake should be limited to 35% of daily calories. D. Sodium intake should be limited to 2 to 4 g/day to prevent weight gain and maintain fluid homeostasis. Vital Concept: One of the nutritional goals of a client who is receiving dialysis is to match dietary intake needs with renal replacement therapy while decreasing deficiencies of nutrients. Clients who are receiving dialysis are at an increased risk for complications related to malnutrition and metabolic issues.

A nurse is caring for a client with diabetic nephropathy who is receiving peritoneal dialysis and experiences abdominal pain and chills. The client has a temperature of 100.3°F (37.9°C) and a glucose level of 180 mg/dL. Which of the following is the priority nursing intervention? A. Assist the client to the high-Fowler's position B. Administer intravenous insulin C. Obtain peritoneal fluid for culture and sensitivity D. Warm the dialysate

Correct Answer: C. Obtain peritoneal fluid for culture and sensitivity Peritoneal dialysis can result in peritonitis from contamination when connecting or disconnecting the infusion. Cloudy peritoneal fluid is usually the first indication of peritonitis. Other signs of peritonitis include a low-grade fever and chills, abdominal pain, and rebound tenderness, which refers to pain on the removal of a hand placing pressure on the abdominal wall. The peritoneal fluid should be collected from the drainage bag for culture and sensitivity, which are used to guide antibiotic therapy. Antibiotics are administered orally, intravenously, or added to the dialysate. Incorrect Answers: A. This can increase abdominal discomfort in clients with peritonitis. The high Fowler's position can decrease dyspnea in clients with volume overload. B. The osmotic agent in dialysate is dextrose, so glucose levels must be closely monitored during dialysis. Insulin can be added to dialysate before instilling the dialysate solution. A glucose level of 180 mg/dL does not require IV insulin. D. The rebound tenderness, chills, and increased temperature indicate infection in this client. Dialysate is usually warmed to body temperature before instillation. This increases urea clearance by dilating blood vessels and can reduce abdominal discomfort. Vital Concept: Dialysis refers to a process to remove fluids and waste products from the body when the kidneys have failed. Peritoneal dialysis removes waste and excess fluid by using the abdominal lining, called the peritoneal membrane, as a filter or membrane across which fluids and dissolved substances (electrolytes, urea, glucose, albumin and other small molecules) are exchanged from the blood. Clients should be monitored carefully for signs of peritonitis, or infection of the fluid. Signs include cloudy fluid, low-grade fever, chills, abdominal pain and rebound pain.

A 10-year-old client with ESRD (end-stage renal disease) is receiving hemodialysis, and experiences chills. Which of the following is the most appropriate nursing intervention? A. Provide blankets or extra clothing B. Increase the temperature of the room C. Notify the physician immediately D. Stop dialysis

Correct Answer: D. Stop dialysis ESRD is a condition in which kidney failure has reached its final stage, and the kidneys are no longer functional. Kidney failure can result from acute kidney injury (AKI) or chronic kidney disease (CKD). Hemodialysis is a common treatment option for clients with ESRD. Kidney transplantation is performed when feasible. The occurrence of chills during dialysis is a sign of bacteremia. It may be associated with fever, malaise, nausea, and vomiting. When this occurs, it is best to stop the transfusion before notifying the physician. Blood cultures are collected to determine the causative agent. Infection occuring during hemodialysis is usually the result of poor aseptic technique when handling equipment. Provision of blankets and increasing room temperature does not resolve chills due to infection. Vital Concept: Hemodialysis is used in renal failure to remove blood from the body and filter it through a dialyzer to clean the blood of toxins, excess water, and electrolytes The dialyzed blood is then returned to the client's circulation. Hemodialysis can be performed using different access devices. The most common access device used is an arteriovenous fistula (AVF), An arteriovenous graft or a temporary hemodialysis catheter are other access devices used to perform dialysis. The nurse should continually assess the client for infection by looking for elevations in temperature and white blood cell count and assessing for warmth and redness at or around the access site. The access site should also be monitored carefully for bleeding. Early detection and treatment of bleeding can prevent life-threatening hemorrhage that may occur as a result of heparin that is used during hemodialysis. References

A nurse is assessing an adolescent female who has chronic renal failure. Which of the following findings should the nurse expect? A. Flushed face B. Hyperactivity C. Weight gain D. Amenorrhea

Correct Answer: D. Amenorrhea Amenorrhea is a common finding for adolescent females who have chronic renal failure. This can be due in part to anemia that develops, along with decreased levels of estrogen, luteinizing hormone, and progesterone. Incorrect Answers: A. The nurse should expect the adolescent to exhibit pallor, not flushing. Pallor can be noticeable only to friends or family members initially, but as renal failure progresses, the adolescent develops anemia and a sallow, or yellow, appearance due to the increased levels of urochrome in the skin. B. The nurse should expect the adolescent to experience fatigue that increases with activity. The nurse should encourage the adolescent to set her own limits with regard to activity levels. C. The nurse should expect the adolescent to experience weight loss from anorexia, nausea, and vomiting. Vital Concept: Chronic renal failure results in systemic manifestations, including fluid and electrolyte imbalances, failure to thrive, increased susceptibility to infection, muscle, bone, and joint pain, alterations in sensation and motor activity, and bruising and dryness of the skin. As the disease progresses, uremia can develop which, if untreated, can result in toxicity. At the toxic level, the adolescent can experience a progressive decrease in the level of consciousness, circulatory overload, acid-base imbalance, and a tendency to bleed.

A client with ulcerative colitis is scheduled for treatment with sulfasalazine (Azulfidine). Which of the following are correct about this drug? (Select all that apply) A. Can cause folate deficiency B. Can cause hyperchloremia C. Can cause megaloblastic anemia D. Can cause anaphylactic reaction E. Can cause blindness F. Can cause thrombocytosis

Correct Answers: A. Can cause folate deficiency C. Can cause megaloblastic anemia D. Can cause anaphylactic reaction Ulcerative colitis is a condition characterized by chronic inflammation of the intestines. It commonly affects the rectum and sigmoid colon. Ulcerative colitis is caused by an autoimmune disorder of the lower GI (gastrointestinal) tract. It is best diagnosed by endoscopy in which the affected part of the colon is visualized and examined. Diarrhea with blood and mucus is the usual symptom associated with UC. Ulcerative colitis is commonly treated with anti-inflammatory drugs such as sulfasalazine (Azulfidine), which inhibits production of prostaglandin that causes inflammatory responses. Azulfidine can have adverse effects such as folate deficiency, megaloblastic anemia, anaphylactic reaction, thrombocytopenia, and kidney damage. These adverse effects are primarily due to the chemical component of the drug that either inhibits metabolic processes or exerts toxic effects. Azulfidine is not reported to cause blindness or hyperchloremia. Vital Concept: Sulfasalazine is a locally acting anti-inflammatory medication that works in the colon, where activity is probably a result of inhibition of prostaglandin synthesis. Adverse effects include headache, pneumonitis, anorexia, diarrhea, nausea, vomiting, drug-induced hepatitis, crystalluria, infertility, oligospermia, orange-yellow discoloration of urine and exfoliative dermatitis, including Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Hematologic side effects can include agranulocytosis, aplastic anemia, and megaloblastic anemia. References:

A nurse is providing discharge instructions to a client who is to begin dialysis. Which of the following instructions about protein intake should the nurse include? (Select all that apply.) A. Consume 1.2 g of protein per kg of body weight B. Take phosphate binders when eating protein‑rich foods. C. Increase intake of complete sources of protein. D. Increase protein intake by 50% of the recommended dietary allowance (RDA). E. Consume daily protein intake in the morning.

Correct Answers: A. Consume 1.2 g of protein per kg of body weight B. Take phosphate binders when eating protein‑rich foods. C. Increase intake of complete sources of protein. D. Increase protein intake by 50% of the recommended dietary allowance (RDA). The recommended protein intake for clients who are receiving hemodialysis is 1.2 g of protein per kg. Protein consumption increases phosphorus intake. The nurse should recommend that the client take phosphate binders with meals. Protein intake should include complete sources of protein such as eggs, milk, meat, fish, and poultry The recommended protein intake for a client on dialysis is 50% greater than the RDA because amino acids are lost in the dialysate. The nurse should instruct the client to select protein sources of high biological value. Incorrect Answers: E. The client should spread protein intake throughout the day to prevent excessive intake of phosphorous and potassium. Vital Concept: Clients who are receiving dialysis are at increased risk for complications related to malnutrition and metabolic issues. Therefore, the primary nutritional goal for a client who is on dialysis is to match dietary intake needs with renal replacement therapy while decreasing deficiencies of nutrients.

A nurse is planning care for a client who has end stage renal disease (ESKD) and is receiving hemodialysis. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Monitor the client's weight daily. B. Encourage the client to comply with fluid restrictions. C. Evaluate intake and output. D. Instruct the client about restricting calories from carbohydrates. E. Monitor the client for elevated potassium levels.

Correct Answers: A. Monitor the client's weight daily. B. Encourage the client to comply with fluid restrictions. C. Evaluate intake and output. E. Monitor the client for elevated potassium levels. The nurse should plan to monitor the client's daily weight to determine fluid retention. Implementing fluid restriction for a client helps to slow fluid retention. Restrictions are based on several factors, including weight gain between dialysis procedures and residual kidney function. Evaluating the client's intake and output allows the nurse to determine if there is an increase in fluid retention. The amount of dietary potassium allowed for daily consumption varies depending upon urinary output. Typically, as the glomerular filtration rate decreases, the excretion of potassium decreases. Incorrect Answer: D. Carbohydrates are not restricted for a client who has ESKD. Vital Concept: Clients who have ESKD and who are receiving hemodialysis will require close monitoring of calories, protein, sodium, potassium, and fluids to determine adequate levels of each

A nurse is preparing to initiate hemodialysis through an Arteriovenous (AV) fistula for a client who has end stage kidney disease. Which of the following actions should the nurse take? (Select all that apply.) A. Review the client's current medications. B. Assess the AV fistula for a bruit. C. Calculate the client's hourly urine output. D. Measure the client's weight. E. Administer heparin subcutaneously. F. Obtain pre-dialysis serum laboratory from a site distal to the fistula.

Correct Answers: A. Review the client's current medications. B. Assess the AV fistula for a bruit. D. Measure the client's weight. Incorrect Answers: C. The client's fluid allowance is based upon the amount of urine the client voids daily added to a volume of 500 to 700 mL. The restriction of fluid intake prevents fluid overload when the kidneys have minimal ability to excrete excess fluids. The client's hourly urine output can vary with the remaining kidney function and does not determine the need for dialysis. E. Dialysis can result in thrombus formation. Anticoagulation is administered to prevent this from occurring. Heparin, or another anticoagulant, is administered using an IV pump and is not administered subcutaneously. The nurse should take measures to ensure client safety following the administration of heparin, which remains in the body for up to 6 hr following dialysis. Because dialysis can also result in orthostatic hypotension, the nurse should carefully monitor the client's vital signs and level of consciousness for several hours after dialysis. F. While the nurse should ensure a recent lab is obtained and reviewed prior to administering dialysis to the client, venipuncture should never be performed on the arm that has the AV fistula. Additionally, blood pressures should never be taken in the arm with the fistula, because compression of the cuff or a tourniquet can compromise the integrity of the fistula and make it unusable. Vital Concept: When caring for a client who has an AV fistula for dialysis, the nurse should perform a preassessment, including the client's weight and vital signs. The nurse should review current laboratory results and medications, and assess the client's overall health with a focus on the integrity of the AV fistula and the vascular status of the client's extremity distal to the AV site. During dialysis, the nurse monitors the AV site for complications such as bleeding or air embolism; regulates the flow of the dialysate; and monitors the client.

A healthcare provider has prescribed intravenous vancomycin (Vancocin) for a client with osteomyelitis. Which of the following measures will the nurse implement during administration of the infusion ? (Select all that apply.) A. Assess the client's skin for facial flushing or redness/rash on upper extremities and torso B. Limit the infusion rate to 1 mg/min C. Monitor blood pressure during the infusion D. Monitor deep tendon reflexes E. Draw a trough level 30 minutes after administration

Correct Answers: A. Assess the client's skin for facial flushing or redness/rash on upper extremities and torso C. Monitor blood pressure during the infusion Hypersensitivity reactions to vancomycin (Vancocin) infusion include anaphylaxis and red man syndrome. Red man syndrome is characterized by rapid onset of flushing and maculopapular rash on the face, neck, torso, and upper extremities. Muscle pain or spasm may occur. Red man syndrome is not a true allergic reaction and may develop in clients without prior exposure to vancomycin. Onset is related to the rate of infusion. The maximum rate recommended for infusion is 10 mg/minute. Vital signs should be monitored during the infusion. If flushing or rash occur, the nurse should reassure the client that the reaction is not life-threatening. The nurse should monitor the client for signs of an anaphylactic reaction, including laryngeal edema, wheezing, pruritus, and syncope. An antihistamine, epinephrine, and resuscitation equipment should be readily available in case of anaphylaxis. The IV site should be monitored every 30 minutes for signs of extravasation or thrombophlebitis. Vancomycin is a vesicant and extravasation can cause tissue necrosis. Incorrect Answers: B. The infusion rate should be no more than 10 mg/min. D. Loss of deep tendon reflexes occurs with magnesium toxicity. E. A trough level should be obtained prior to administration of vancomycin. Therapeutic levels range from 10-20 mg/dL. Toxicity can result in nephrotoxicity and/or ototoxicity, including hearing loss, tinnitus, and vertigo. Vital Concept: Hypersensitivity reactions associated with vancomycin (Vancocin) infusion include red man syndrome and anaphylaxis. Red man syndrome is a common reaction related to rapid infusion of vancomycin. It is not a true allergic reaction and can occur in individuals without prior exposure to vancomycin. Anaphylaxis is a severe type I hypersensitivity allergic reaction. Resuscitation equipment, epinephrine, and an antihistamine should be available during infusion for treatment of anaphylaxis and the client should be monitored for wheezing, pruritus, dizziness, or syncope.

3. A woman with no history of UTI who has urgency, frequency, and dysuria comes to the clinic. A dipstick and microscopic urinalysis indicate bacteriuria. What should the nurse anticipate for this patient? a. Obtaining a clean-catch midstream urine specimen for culture and sensitivity b. No treatment with medication unless she develops fever, chills, and flank pain c. Empirical treatment with trimethoprim-sulfamethoxazole (Bactrim) for 3 days d. Need to have a blood specimen drawn for a complete blood count (CBC) and kidney function tests

c. Unless a patient has a history of recurrent UTIs or a complicated UTI, trimethoprim-sulfamethoxazole or nitrofurantoin is usually used to empirically treat an initial UTI without a culture and sensitivity or other testing. Asymptomatic bacteriuria does not justify treatment, but symptomatic UTIs should always be treated.

21.: After a patient had a renal arteriogram and is back on the clinical unit, what is the most important action by the nurse? a. Observe for gross bleeding in the urine. b. Place the patient in high Fowler's position. c. Monitor the patient for signs of allergy to the contrast medium. d. Assess peripheral pulses in the involved leg every 30 to 60 minutes.

✅ d. During a renal arteriogram, a catheter is inserted, most commonly in the femoral artery. Following the procedure, the patient is positioned with the affected leg extended with a pressure dressing applied. Peripheral pulse monitoring is essential to detect the development of thrombi around the insertion site, which may occlude blood supply to the leg. Gross bleeding in the urine is a complication of a renal biopsy. Allergy to the contrast medium should be established before the procedure.

19. Which urinalysis results of a freshly voided specimen most likely indicate a urinary tract infection (UTI)? a. Cloudy, yellow; red blood cell (RBC) 5/hpf; white blood cell (WBC) 10/hpf; pH 8.2 b. Yellow; protein 6 mg/dL; pH 6.8; 102 CFU/mL bacteria c. Cloudy, brown; ammonia odor; specific gravity 1.030; RBC 18/hpf d. Clear; colorless; glucose: trace; ketones: trace; osmolality 500 mOsm/kg (500 mmol/kg

✅. a. Cloudiness in a fresh urine specimen, RBC above 4 per high- powered field (hpf), WBC count above 5/hpf are all indicative of urinary tract infection (UTI). When the pH is elevated, it is usually because bacteria in urine split the urea into CO2 and alkaline ammonia. Yellow urine, protein 0 to 8 mg/dL, pH 4.0 to 8.0, and bacteria <103 colony-Coping- stress tolerance Withdrawal or ineffective coping with incontinence or urinary problem forming units/mL indicate normal or healthy urine. Cloudy, brown urine usually indicates hematuria or the presence of bile. Colorless urine is usually very dilute, which occurs with increased glucose and ketones.

36. Which urinary diversion is a continent diversion created by formation of an ileal pouch with a stoma for catheterization? a. Kock pouch b. Ileal conduit c. Orthotopic neobladder d. Cutaneous ureterostomy

✅. a. The Kock pouch is a continent diversion created by formation of an ileal pouch with an external stoma requiring catheterization. Ileal conduit is the most common incontinent diversion using a stoma of resected ileum with implanted ureters. Orthotopic neobladder is a new bladder from a reshaped segment of intestine in the anatomic position of the bladder with urine discharged through the urethra. A cutaneous ureterostomy diverts the ureter from the bladder to the abdominal skin, but there is frequent scarring and strictures of the ureters, so ileal conduits are used more often.

25. In providing care for the patient with adult-onset polycystic kidney disease, what should the nurse do? a. Help the patient cope with the rapid progression of the disease. b. Suggest genetic counseling resources for the children of the patient. c. Expect the patient to have polyuria and poor concentration ability of the kidneys. d. Implement measures for the patient's deafness and blindness in addition to the renal problems.

✅. b. Adult-onset polycystic kidney disease is an inherited autosomal dominant disorder that often manifests after the patient has had children. Therefore the children should receive genetic counseling regarding their life choices. The disease progresses slowly, eventually causing progressive renal failure. Hereditary medullary cystic disease causes poor concentration ability of the kidneys, and classic Alport syndrome is a hereditary nephritis that is associated with deafness and deformities of the optic lens.

34. A patient has a right ureteral catheter placed following a lithotripsy for a stone in the ureter. In caring for the patient immediately after the procedure, what is the most appropriate nursing action? a. Milk or strip the catheter every 2 hours. b. Measure ureteral urinary drainage every 1 to 2 hours. c. Encourage ambulation to promote urinary peristaltic action. d. Irrigate the catheter with 30-mL sterile saline every 4 hours.

✅. b. Output from ureteral catheters must be monitored every 1 to 2 hours because an obstruction will cause overdistention of the renal pelvis and renal damage. The renal pelvis has a capacity of only 3 to 5 mL, and if irrigation is ordered, no more than 5 mL of sterile saline is used. The patient with a ureteral catheter is usually kept on bed rest until specific orders for ambulation are given. Suprapubic tubes may be milked to prevent obstruction of the catheter by sediment and clots.

24. With which diagnosis will the patient benefit from being taught to do self-catheterization? a. Renal trauma b. Urethral stricture c. Renal artery stenosis d. Accelerated nephrosclerosis

✅. b. The patient with urethral stricture will benefit from being taught to dilate the urethra by self-catheterization every few days. Renal trauma is treated related to the severity of the injury with bed rest, fluids, and analgesia to surgery. Renal artery stenosis includes control of hypertension with possible surgical revascularization. Accelerated nephrosclerosis is associated with malignant hypertension that must be aggressively treated as well as monitoring kidney function.

33. What is included in nursing care that applies to the management of all urinary catheters in hospitalized patients? a. Measuring urine output every 1 to 2 hours to ensure patency b. Turning the patient frequently from side to side to promote drainage c. Using strict sterile technique during irrigation and obtaining culture specimens d. Daily cleaning of the catheter insertion site with soap and water and application of lotion

✅. c. All urinary catheters in hospitalized patients pose a very high risk for infection, especially antibiotic-resistant, health care-associated infections, and scrupulous aseptic technique is essential in the insertion and maintenance of all catheters. Routine irrigations are not performed. Turning the patient to promote drainage is recommended only for suprapubic catheters. Cleaning the insertion site with soap and water should be performed for urethral and suprapubic catheters, but lotion or powder should be avoided. Site care for other catheters may require special interventions.

16. What can patients at risk for kidney stones do to prevent them in many cases? a. Lead an active lifestyle b. Limit protein and acidic foods in the diet c. Drink enough fluids to produce dilute urine d. Take prophylactic antibiotics to control UTIs

✅. c. Because crystallization of stone constituents can precipitate and unite to form a stone when in supersaturated concentrations, one of the best ways to prevent stones of any type is by drinking adequate fluids to keep the urine dilute and flowing (e.g., an output of about 2 L of urine a day). Sedentary lifestyle is a risk factor for renal stones, but exercise also causes fluid loss and a need for additional fluids. Protein foods high in purine should be restricted only for the small percentage of patients with uric acid stones. Although UTIs contribute to stone formation, prophylactic antibiotics are not indicated.

10. Glomerulonephritis is characterized by glomerular damage caused by? a. growth of microorganisms in the glomeruli. b. release of bacterial substances toxic to the glomeruli. c. accumulation of immune complexes in the glomeruli. d. hemolysis of red blood cells circulating in the glomeruli.

✅. c. Glomerulonephritis is not an infection but rather an antibody-antigen-induced injury of the glomerulus, and complement activation causes inflammation. Prior infection by bacteria or viruses may stimulate the antibody production but is not present or active at the time of glomerular damage.

32. To assist the patient with stress incontinence, what should the nurse teach the patient to do? a. Void every 2 hours to prevent leakage. b. Use absorptive perineal pads to contain urine. c. Perform pelvic floor muscle exercises 40 to 50 times per day. d. Increase intraabdominal pressure during voiding to empty the bladder completely.

✅. c. Pelvic floor exercises (Kegel exercises) increase the tone of the urethral sphincters and should be done in sets of 10 or more contractions 4 to 5 times a day (total of 40 to 50 per day). Frequent bladder emptying is recommended for patients with urge incontinence and an increase in pressure on the bladder is recommended for patients with overflow incontinence. Absorptive perineal pads should be only a temporary measure because long-term use discourages continence and can lead to skin problems.

13. What results in the edema associated with nephrotic syndrome? a. Hypercoagulability b. Hyperalbuminemia c. Decreased plasma oncotic pressure d. Decreased glomerular filtration rate

✅. c. The massive proteinuria that results from increased glomerular membrane permeability in nephrotic syndrome leaves the blood without adequate proteins (hypoalbuminemia) to create an oncotic colloidal pressure to hold fluid in the vessels. Without oncotic pressure, fluid moves into the interstitium, causing severe edema. Hypercoagulability occurs in nephrotic syndrome but is not a factor in edema formation, and glomerular filtration rate (GFR) is not necessarily affected in nephrotic syndrome.

28. Thirty percent of patients with kidney cancer have metastasis at the time of diagnosis. Why does this occur? a. The only treatment modalities for the disease are palliative. b. Diagnostic tests are not available to detect tumors before they metastasize. c. Classic symptoms of hematuria and palpable mass do not occur until the disease is advanced. d. Early metastasis to the brain impairs the patient's ability to recognize the seriousness of symptoms.

✅. c. There are no early characteristic symptoms of cancer of the kidney, and gross hematuria, flank pain, and a palpable mass do not occur until the disease is advanced. The treatment of choice is a partial or radical nephrectomy, which can be successful in early disease. Radiation is palliative. Many kidney cancers are diagnosed as incidental imaging findings. The most common sites of metastases are the lungs, liver, and long bones.

13. What action accurately describes the physical assessment of the urinary system by the nurse? a. Auscultates the lower abdominal quadrants for fluid sounds b. Palpates an empty bladder at the level of the symphysis pubis c. Percusses the kidney with a firm blow at the posterior costovertebral angle d. Positions the patient prone to palpate the kidneys with a posterior approach

✅. c. To assess for kidney tenderness, the nurse strikes the fist of 1 hand over the dorsum of the other hand at the posterior costovertebral angle. The upper abdominal quadrants and costovertebral angles are auscultated for vascular bruits in the renal vessels and aorta, and an empty bladder is not palpable. The kidneys are palpated through the abdomen, with the patient supine.

10. In caring for the patient with AKI, of what should the nurse be aware? a. The most common cause of death in AKI is irreversible metabolic acidosis. b. During the oliguric phase of AKI, daily fluid intake is limited to 1000 mL plus the prior day's measured fluid loss. c. Dietary sodium and potassium during the oliguric phase of AKI are managed according to the patient's urinary output. d. One of the most important nursing measures in managing fluid balance in the patient with AKI is taking accurate daily weights.

✅. d. Measuring daily weights with the same scale at the same time each day allows for the evaluation and detection of excessive body fluid gains or losses. Infection is the leading cause of death in AKI, so meticulous aseptic technique is critical. The fluid limitation in the oliguric phase is 600 mL plus the prior day's measured fluid loss. Dietary sodium and potassium intake are managed according to the plasma levels.

29. Which characteristics are associated with urge incontinence (select all that apply)? a. Treated with Kegel exercises b. Found following prostatectomy c. Common in postmenopausal women d. Involuntary urination preceded by urgency e. Caused by overactivity of the detrusor muscle f. Bladder contracts by reflex, overriding central inhibition

✅d, e, f. Urge incontinence is involuntary urination preceded by urgency caused by overactivity of the detrusor muscle when the bladder contracts by reflex, which overrides central inhibition. Treatment includes treating the underlying cause and retraining the bladder with urge suppression, anticholinergic drugs, or containment devices. The other options are characteristic of stress incontinence. Patients may have a combination of urge and stress incontinence.

A nurse is caring for a client who is undergoing peritoneal dialysis. The nurse understands that which of the following is the most reliable indication of the efficacy of peritoneal dialysis? A. Decreased blood pressure B. Hematemesis C. Weight loss D. Decreased urine output

✔ Correct Answer: C. Weight loss The purpose of peritoneal dialysis is to remove excess fluid and waste that cannot be excreted by the kidneys. The best indicator that the dialysis treatment has been successful is weight loss. Therefore, it is important for the client to be weighed before and after the treatment. Decreased urine output and hematemesis are NOT expected results of dialysis. Although blood pressure MIGHT be decreased, that indicator is not a reliable measure of the success of peritoneal dialysis. Incorrect Answers: A. Blood pressure may decrease during dialysis, but decreased blood pressure is not a reliable indicator of the success of peritoneal dialysis. B. Hematemesis is not an expected outcome of peritoneal dialysis and does not indicate success. D. Decreased urine output is not an expected outcome of peritoneal dialysis and does not indicate success. Vital Concept: Peritoneal dialysis uses the peritoneal membrane, as a filter membrane across which fluids, electrolytes, urea, glucose, albumin and other small molecules are exchanged from the blood. Like hemodialysis, peritoneal dialysis depends upon the passive movement of water and dissolve solutes across a semipermeable membrane by diffusion. Movement of solutes occurs down a concentration gradient from fluid with higher concentration to fluid with lower concentration. With dialysis, the client is at risk of deficient fluid volume. The desired outcome is to achieve the target alteration in fluid volume and weight, with blood pressure and electrolyte levels remaining in an acceptable range without symptoms of dehydration in the client.

A healthcare provider orders a sodium polystyrene sulfonate retention enema for a client. What is the most likely reason for this enema? A. To reduce the number of bacteria in the colon before surgery B. To relieve constipation by drawing fluid into the colon and stimulating evacuation C. To provide contrast for X-rays of the colon D. To remove excess potassium in hyperkalemia

✔Correct Answer: D. To remove excess potassium in hyperkalemia Hyperkalemia, or high serum potassium, can cause life-threatening cardiac arrhythmias. One of the treatments used to reduce serum potassium in individuals with hyperkalemia is Kayexalate, a sodium polystyrene sulfonate retention enema. The resin in the enema replaces potassium ions with sodium ions in the large intestine and promotes elimination to reduce serum potassium. Kayexalate can be administered by enema or orally. Oral administration is more effective. A rare adverse effect is intestinal necrosis. Incorrect Answers: A. A neomycin enema is used to reduce the bacterial load in the colon before colon surgery. B. Sodium phosphate (Fleet) is an example of an enema preparation that is used to draw fluid into the colon and stimulate evacuation, but it should only be used in individuals with good kidney function and normal electrolyte values. It should not be used in clients with heart failure or cirrhosis. C. Barium is a radioactive material administered in an enema to provide contrast and allow visualization of the inside (lumen) of the colon. Vital Concept: Sodium polystyrene sulfonate (Kayexelate) is used for treatment of mild to moderate hyperkalemia. It works by exchange of sodium ions for potassium ions in the intestine. If hyperkalemia is severe, more immediate measures such as sodium bicarbonate IV, calcium, or glucose/insulin infusion should be initiated. Contraindications include hypersensitivity to saccharin or parabens; Ileus; abnormal bowel function; a history of impaction; chronic constipation, inflammatory bowel disease, ischemic colitis, vascular intestinal atherosclerosis, previous bowel resection, or bowel obstruction.

A nurse is assessing a client who has manifestations characteristic of end‑stage kidney disease (ESKD). Which of the following findings should the nurse expect? (Select all that apply.) A. Proteinuria B. Marked azotemia C. Crackles in the lungs D. Decreased potassium level E. Moist, oily skin

✔Correct Answers: A. Proteinuria B. Marked azotemia C. Crackles in the lungs Proteinuria is the excretion of protein in the urine. Protein end products also accumulate in the blood. These are manifestations of ESKD. Marked azotemia is an abnormal concentration of waste products in the blood and is a manifestation of ESKD. Crackles in the lungs can indicate the client has pulmonary edema, caused from hypervolemia due to ESKD. Incorrect Answers: D. Potassium levels are increased due to metabolic acidosis and catabolism as well as decreased excretion when the client has ESKD. Hyperkalemia may lead to ventricular tachycardia and cardiac arrest. E. Dryness, itching, and excoriation of the skin are expected findings for a client who has ESKD. A gray-bronze or brownish change in skin color due to the accumulation of toxins is also a manifestation of ESKD. Vital Concept: End-stage kidney disease (ESKD) is the fifth and final stage of chronic kidney disease. A client who has ESKD requires extensive care planning based on at least five nursing diagnoses and a multitude of interrelated problems. Comfort measures and emotional support are important for the nurse to provide as well as physical and procedural interventions dealing with the client's excess fluid levels, nutritional deficits, and activity intolerance. If the client is receiving dialysis, protection of the client's vascular access is a priority. As the disease progresses, the client develops confusion, tremors, pitting edema, shortness of breath, vomiting, diarrhea, and bleeding from the gastrointestinal tract. If the client is discharged home in the final stages of the illness, the nurse has an important role in educating caregivers about the client's care and in helping them cope with the imminent loss.

30. Number the following in the order of the phases of exchange in PD. Begin with 1 and end with 3. ______ a. Drain ______ b. Dwell ______ c. Inflow

30. a. 3; b. 2; c. 1

30. The patient has a thoracic spinal cord lesion and incontinence that occurs equally during the day and night. What type of incontinence is this patient experiencing?

30. a. Reflex incontinence occurs with no warning, equally during the day and night, and with spinal cord lesions above S2. Overflow incontinence is when the pressure of urine in the overfull bladder overcomes sphincter control and is caused by bladder or urethral outlet obstruction. Functional incontinence is loss of urine resulting from cognitive, functional, or environmental factors. Incontinence after trauma or surgery occurs when fistulas have occurred or after a prostatectomy.

sodium polystyrene sulfonate (Kayexalate)

Classification Treatment of Hyperkalemia Therapeutic uses Oral or Rectal onset 2-12 hrs Dosing oral 15 g 1 to 4 times a day (Oral route preferred) Rectal retention 30-50 g as a retention enema every 6 hrs as needed Side effect/adverse reaction Abdominal cramps, decreased urine output, hypokalemia, hypocalcemia, hypomagnesemia Should have good bowel function. Diarrhea, cardiac arrhythmias. Constipation can be an adverse effect when administered rectally Malignancies Nursing Implications Assess bowel function. Use cautiously in patients with heart failure or HTN. Teach patients they may experience cramps. Slow onset of action so not for an acute situation. Assess for hypokalemia and EGG changes. Monitor calcium and magnesium levels. Administer other oral medications 3 hrs before or 3 hrs after administration as drug may interfere with absorption of other drugs. If given rectally retain for 30-60 minutes ( may need foley with balloon.) Monitor skin integrity. Assess bowel function daily and monitor for fecal impaction. Mild laxative may be prescribed

Sirolimus -PO

Classification: Antiproliferatives Therapeutic uses: Inhibits T lymphocyte activation Side effect/adverse reaction: Leukopenia Thrombocytopenia Elevated triglycerides Elevated cholesterol Creatinine increase, peripheral edema, angioedema. Nursing Implications: Monitor triglycerides levels Monitor cholesterol levels. Don't take with grapefruit juice.

Epoetin alfa - IV or Subcutaneous

Classification: Erythropoietin- Biologic Response Modifier Therapeutic uses: Treat anemia by stimulating red blood production. Can be given IV or subcutaneous Side effect/adverse reaction: Headache, seizures, chest pain, HTN, dizziness, insomnia, fever, hypokalemia, edema and nausea. Monitor for flu-like symptoms. (Malaise, chills, tachycardia, myalgia). Injection site rednessAdverse: angioedema, bronchospasm, HTN, heart failure and encephalopathy Nursing Implications: Monitor hemoglobin levels. If > 10 g/dl can lead to MI, stroke, thromboembolic disease Target is 10 g/dl. Medication can overproduce RBC's. Don't mix with any other medications. Treatment is 3 times/week. IV/Subcut 50-100 units/kg 3 times a week. Inadequate iron stores may interfere with the response to the drug.Given IV or Subcutaneous. Monitor cardiac symptoms as medication can cause MI.

Muromonab-CD3IV Basiliximab IV Daclizumab IV

Classification: Monoclonal antibodies Therapeutic uses: Targets the activation sites of T-lymphocytes- increasing elimination from circulation Side effect/adverse reaction: Aseptic meningitis, fever, N/V, headache, tachycardia, hypotension Steven Johnsen syndrome Opportunistic infections Malignancies Both cause GI disturbances Nursing Implications: Monitor s/s meningitisHand hygiene Annual screenings Should not receive live vaccines. Unsafe during pregnancy. Anaphylaxis risk high with any dose

A nurse is planning care for a client who has pre-renal acute kidney injury (AKI) following an acute myocardial infarction. The client's urinary output is 60 mL in the past 2 hr, and blood pressure is 92/58 mm Hg. Which of the following interventions should the nurse anticipate a prescription for? A. A CT scan with contrast dye. B. Administer nitroprusside 0.3 mcg/kg/min intravenously. C. A fluid challenge with 0.9% sodium chloride solution. D. Addition of 40 mEq/L of potassium to IV fluids.

Correct Answer: C. A fluid challenge with 0.9% sodium chloride solution. Prerenal AKI is the result of poor perfusion to the kidney. Perfusion is often increased through the use of fluid challenges if the client does not have preexisting fluid overload. A fluid challenge in the amount of 500 to 1,000 mL can be infused over 1 hr. During this time, the nurse should closely monitor the client's response and be prepared to slow or stop the infusion if manifestations of fluid overload occur such as neck vein distention, the development of crackles in the lungs, decreasing oxygen saturation, dyspnea, and tachycardia. Therapeutic responses to the fluid challenge include increases in blood pressure and urine output. Incorrect Answers: A. Prerenal AKI occurs as a result of volume depletion, impaired cardiac functioning, and vasodilation. A client who has experienced an acute MI is at an increased risk for the development of prerenal AKI due to the inability of the heart to effectively perfuse the kidneys. Studies to diagnose AKI include urine testing for sodium, osmolality, and specific gravity along with serum studies evaluating BUN, creatinine, glomerular filtration rate (GFR), electrolyte levels, and arterial blood gases. Imaging studies include ultrasonography, X-rays of the kidneys, ureter, and bladder (KUB), MRI or CT scan without contrast. Contrast dye is contraindicated for a client who has possible acute kidney injury because this can cause further injury to the kidney. B. Medical management of prerenal AKI involves treatment of the initial cause and initiating interventions to promote renal perfusion. Diuretics such as mannitol or furosemide can be prescribed to increase urine output and rid the body of retained fluid. However, nitroprusside is a rapid-acting vasodilator used to rapidly reduce blood pressure for clients who have hypertensive crisis. It is contraindicated for clients who have hypotension. D. The breakdown of protein and cellular damage to the cells of the heart resulting from the MI cause an increase in potassium levels. Coupled with the decreased ability of the kidneys to filter out the excess potassium, the client can experience severe hyperkalemia. Manifestations of hyperkalemia include dysrhythmia and cardiac arrest, paresthesia, muscle weakness, flaccid paralysis, hyperactive bowel sounds, and the development of diarrhea. The nurse should monitor and report manifestations of hyperkalemia and plan to initiate continuous cardiac monitoring. If hyperkalemia does occur, the nurse should anticipate a prescription to administer dextrose 50%, insulin, and calcium intravenously to a client who is hemodynamically unstable, such as having a blood pressure of 92/58 mm Hg, to move the potassium back into the cells. If the client is stable, sodium polystyrene sulfonate can be administered orally or via enema to decrease the potassium level. Vital Concept: Prerenal AKI can occur due to volume depletion, vasodilation, or impaired cardiac function. The client who has experienced an acute MI is at increased risk for developing AKI due to the inability of the heart to effectively perfuse the kidneys. The nurse should identify clients at risk for AKI and take measures to prevent the development. These measures include frequent monitoring of the client's renal status, including intake and output and laboratory results, as well as vital signs, especially blood pressure to treat hypotension promptly. The nurse should monitor fluid status and provide adequate fluids for clients at risk for dehydration, prevent and treat infections promptly, and prevent and treat shock with blood and fluids. If AKI does occur, the nurse should manage the client's care by treating the primary disorder (initial cause of the AKI) and monitoring fluid and electrolyte balances, as well as the manifestations which can indicate an imbalance. The nurse should frequently assess the client's intake and output, daily weight, lung and heart sounds, as well as monitor the client for the presence of neck vein distention or edema. The nurse should ensure the client rests to reduce metabolic demand and encourage frequent coughing and deep breathing to decrease the risk of pulmonary complications.

18. A urinalysis of a urine specimen that is not processed within 1 hour may result in erroneous measurement of? a. glucose. b. bacteria. c. specific gravity. d. white blood cells.

b. Bacteria in warm urine specimens multiply rapidly and falsely elevated bacterial counts may occur with urine that has been sitting for periods of time. Glucose, specific gravity, and white blood cells (WBCs) do not change in urine specimens, but pH becomes more alkaline, red blood cells (RBCs) hemolyze, and casts disintegrate.

22. Which test is most specific for renal function? a. Renal scan b. Serum creatinine c. Creatinine clearance d. Blood urea nitrogen (BUN)

c. The rate at which creatinine is cleared from the blood and eliminated in the urine approximates the GFR and is the most specific test of renal function. The renal scan is useful in showing the location, size, and shape of the kidney and general blood perfusion. Serum creatinine is an end product of muscle and protein metabolism and may be elevated with body builders and decreased with older people. Blood urea nitrogen (BUN) can be altered with gastrointestinal (GI) bleeding, starvation, and hyper- or hypovolemia.

8. What are common diagnostic studies done for a patient with severe renal colic (select all that apply)? a. CT scan b. Urinalysis c. Cystoscopy d. Ureteroscopy e. Abdominal ultrasound

✅. a, b, e. Testing would include urinalysis to see crystals and look for red blood cells. Abdominal ultrasound and CT scan may also be done to look for renal calculi.

9. When caring for the patient with IC, what can the nurse teach the patient to do? a. Avoid foods that make the urine more alkaline. b. Use high-potency vitamin therapy to decrease the autoimmune effects of the disorder. c. Always keep a voiding diary to document pain, voiding frequency, and patterns of nocturia. d. Use the dietary supplement calcium glycerophosphate (Prelief) to decrease bladder irritation.

d. Calcium glycerophosphate (Prelief) is an OTC dietary supplement that alkalinizes the urine and can help relieve the irritation from acidic foods. A diet low in acidic foods is recommended. If a multivitamin is used, high-potency vitamins should be avoided because these products may irritate the bladder. A voiding diary is useful in diagnosis but does not have to be kept indefinitely.

25. Which drugs will be used to treat the patient with CKD for mineral and bone disorder (select all that apply)? a. Calcium acetate b. Cinacalcet (Sensipar) c. IV glucose and insulin d. IV 10% calcium gluconate e. Sevelamer carbonate (Renvela)

✅. a, b, e. Cinacalcet (Sensipar), a calcimimetic agent to control secondary hyperparathyroidism; calcium acetate, a calcium-based phosphate binder, and sevelamer carbonate (Renvela), a non-calcium- based phosphate binder, are used to treat mineral and bone disorder in CKD. IV glucose and insulin and IV 10% calcium gluconate along with sodium polystyrene sulfonate (Kayexalate) are used to treat the hyperkalemia of CKD.

18. The patient with CKD is brought to the emergency department with Kussmaul respirations. What does the nurse know about CKD that could cause this patient's Kussmaul respirations? a. Uremic pleuritis is occurring. b. There is decreased pulmonary macrophage activity. c. They are caused by respiratory compensation for metabolic acidosis. d. Pulmonary edema from heart failure and fluid overload is occurring.

✅ c Kussmaul respirations occur with severe metabolic acidosis when the respiratory system is attempting to compensate by removing carbon dioxide with exhalations. Uremic pleuritis would cause a pleural friction rub. Decreased pulmonary macrophage activity increases the risk of pulmonary infection. Dyspnea would occur with pulmonary edema.

19. Which serum laboratory value indicates to the nurse that the patient's CKD is getting worse? a. Decreased BUN b. Decreased sodium c. Decreased creatinine d. Decreased calculated glomerular filtration rate (GFR)

✅ d. As GFR decreases, BUN and serum creatinine levels increase. Although elevated BUN and creatinine indicate that waste products are accumulating, the calculated GFR is considered a more accurate indicator of kidney function than BUN or serum creatinine.

37. A patient rapidly progressing toward ESRD asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that what is a contraindication to kidney transplantation? a. Hepatitis C infection b. Coronary artery disease c. Refractory hypertension d. Extensive vascular disease

✅ d. Extensive vascular disease is a contraindication for renal transplantation, primarily because adequate blood supply is essential for the health of the new kidney. Other contraindications include disseminated malignancies, refractory or untreated cardiac disease, chronic respiratory failure, chronic infection, or unresolved psychosocial disorders. Hepatitis B or C infection is not a contraindication. Coronary artery disease (CAD) may be treated with bypass surgery before transplantation, and transplantation can relieve hypertension. .

9. : While caring for the patient in the oliguric phase of AKI, the nurse monitors the patient for associated collaborative problems. When should the nurse notify the health care provider (HCP)? a. Urine output is 300 mL/day. b. Edema occurs in the feet, legs, and sacral area. c. Cardiac monitor reveals a depressed T wave and elevated ST segment. d. The patient develops increasing muscle weakness and abdominal cramping.

✅ d. Hyperkalemia is a potentially life-threatening complication of AKI in the oliguric phase. Muscle weakness and abdominal cramping are signs of the neuromuscular impairment that occurs with hyperkalemia. In addition, hyperkalemia can cause the cardiac conduction abnormalities of peaked T wave, prolonged PR interval, prolonged QRS interval, and depressed ST segment. Urine output of 300 mL/day is expected during the oliguric phase, as is the development of peripheral edema.

13. A patient on a medical unit has a potassium level of 6.8 mEq/L. What is the priority action that the nurse should take? a. Place the patient on a cardiac monitor. b. Check the patient's BP. c. Teach the patient to avoid high-potassium foods. d. Call the laboratory and request a redraw of the laboratory to verify results.

✅. a. Dysrhythmias may occur with an elevated potassium level and are potentially lethal. Monitor the rhythm while contacting the HCP or calling the rapid response team. Vital signs should be checked. Depending on the patient's history and cause of increased potassium, instruct the patient about dietary sources of potassium; however, this would not help at this point. The nurse may want to recheck the value, but

38.: During the immediate postoperative care of a recipient of a kidney transplant, what is a priority for the nurse to do? a. Regulate fluid intake hourly based on urine output. b. Monitor urine-tinged drainage on abdominal dressing. c. Medicate the patient frequently for incisional flank pain. d. Remove the urinary catheter to evaluate the ureteral implant.

✅. a. Fluid and electrolyte balance is the priority in the transplant recipient patient, especially because diuresis often begins soon after surgery. Fluid replacement is adjusted hourly based on kidney function and urine output. Urine-tinged drainage on the abdominal dressing may indicate leakage from the ureter implanted into the bladder, and the HCP should be notified. The recipient has an abdominal incision where the kidney was placed in the iliac fossa. The urinary catheter is usually used for 2 to 3 days to monitor urine output and kidney function

38. A teaching plan developed by the nurse for the patient with a new ileal conduit includes instructions to do what? a. Clean the skin around the stoma with alcohol every day. b. Use a wick to keep the skin dry during appliance changes. c. Use sterile supplies and technique during care of the stoma. d. Change the appliance every day and wash it with soap and warm water.

✅. b. Because the stoma continuously drains urine, a wick formed of a rolled-up 4 × 4 gauze or a tampon is held against the stoma to absorb the urine while the skin is cleaned and a new appliance is attached. The skin is cleaned with warm water only because soap and other agents cause drying and irritation. Clean, not sterile, technique is used. The appliance should be left in place for as long as possible before it loosens and allows leakage onto the skin, perhaps up to 14 days

24. The patient with CKD asks why she is receiving nifedipine (Procardia) and furosemide (Lasix). The nurse understands that these drugs are being used to treat the patient's a. anemia. b. hypertension. c. hyperkalemia d. mineral and bone disorder.

✅. b. Both are used to treat hypertension. Nifedipine (Procardia) is a calcium channel blocker, and furosemide (Lasix) is a loop diuretic that can help decrease potassium.

32. To prevent the most common serious complication of PD, what is important for the nurse to do? a. Infuse the dialysate slowly. b. Use strict aseptic technique in the dialysis procedures. c. Have the patient empty the bowel before the inflow phase. d. Reposition the patient frequently and promote deep breathing.

✅. b. Exit site infection and peritonitis are common complications of PD and may require catheter removal and termination of dialysis. Infection occurs from contamination of the dialysate or tubing or from progression of exit-site or tunnel infections, and strict sterile technique must be used by health care professionals as well as the patient to prevent contamination. Too-rapid infusion may cause shoulder pain, and pain may be caused if the catheter tip touches the bowel. Difficulty breathing, atelectasis, and pneumonia may occur from pressure of the fluid on the diaphragm, which may be prevented by elevating the head of the bed and promoting repositioning and deep breathing.

4. : A dehydrated patient is in the Injury stage of the RIFLE staging of AKI. What would the nurse first anticipate in the treatment of this patient? a. Assessment of daily weight b. IV administration of fluid and furosemide (Lasix) c. IV administration of insulin and sodium bicarbonate d. Urinalysis to check for sediment, osmolality, sodium, and specific gravity

✅. b. Injury is the stage of RIFLE classification in which urine output is <0.5 mL/kg/hr for 12 hours, the serum creatinine is increased times two, or the glomerular filtration rate (GFR) is decreased by 50%. This stage may be reversible by treating the cause or, in this patient, the dehydration by administering IV fluid and a low dose of a loop diuretic, furosemide (Lasix). Assessing the daily weight will be done to monitor fluid changes, but it is not the first treatment the nurse should anticipate. IV administration of insulin and sodium bicarbonate would be used for hyperkalemia. Checking the urinalysis will help determine if the AKI has a prerenal, intrarenal, or postrenal cause by what is seen in the urine. With this patient's dehydration, it is thought to be prerenal to begin treatment.

36. A patient with AKI is a candidate for continuous renal replacement therapy (CRRT). What is the most common indication for use of CRRT? a. Pericarditis b. Hyperkalemia c. Fluid overload d. Hypernatremia

✅. c. Continuous renal replacement therapy (CRRT) is indicated for the patient with AKI as an alternative or adjunct to HD to slowly remove solutes and fluid in the hemodynamically unstable patient. It is especially useful for treatment of fluid overload, but HD is indicated for treatment of hyperkalemia, pericarditis, or other serious effects of uremia.

17. What causes the gastrointestinal (GI) manifestation of stomatitis in the patient with CKD? a. High serum sodium levels b. Irritation of the GI tract from creatinine c. Increased ammonia from bacterial breakdown of urea d. Iron salts, calcium-containing phosphate binders, and limited fluid intake

✅. c. Increased ammonia in saliva, from bacterial breakdown of urea, leads to stomatitis and mucosal ulcerations. Uremic fetor, or the urine odor of the breath, is caused by high urea content in the blood. Irritation of the gastrointestinal (GI) tract from urea in CKD contributes to anorexia, nausea, and vomiting. Ingestion of iron salts and calcium- containing phosphate binders, limited fluid intake, and limited activity cause constipation.

27. During the nursing assessment of the patient with renal insufficiency, the nurse asks the patient specifically about a history of? a. angina. b. asthma. c. hypertension. d. rheumatoid arthritis.

✅. c. The most common causes of CKD in the United States are diabetes and hypertension. The nurse should obtain information on long-term health problems that are related to kidney disease. The other disorders are not closely associated with renal disease.

22.: What is the most appropriate snack for the nurse to offer a patient with stage 4 CKD? a. Raisins b. Ice cream c. Dill pickles d. Hard candy

✅. d. A patient with CKD may have sugars and starches (unless the patient is diabetic); hard candy is an appropriate snack and may help relieve the metallic and urine taste that is common in the mouth. Raisins are a high-potassium food. Ice cream contains protein and phosphate and counts as fluid. Pickled foods have high sodium content. M

8. What indicates to the nurse that a patient with AKI is in the recovery phase? a. A return to normal weight b. A urine output of 3700 mL/day c. Decreasing sodium and potassium levels d. Decreasing blood urea nitrogen (BUN) and creatinine levels

✅. d. The blood urea nitrogen (BUN) and creatinine levels remain high during the oliguric and diuretic phases of AKI. The recovery phase begins when the glomerular filtration returns to a rate at which BUN and creatinine stabilize and then decrease. Urinary output of 3 to 5 L/day, decreasing sodium and potassium levels, and fluid weight loss are characteristic of the diuretic phase of AKI.

33. A patient on HD develops a thrombus of a subcutaneous arteriovenous graft (AVG), requiring its removal. While waiting for a replacement graft or fistula, the patient is most likely to have what done for treatment? a. PD b. Peripheral vascular access using radial artery c. Long-term cuffed catheter tunneled subcutaneously to the jugular vein d. Peripherally inserted central catheter (PICC) line inserted into subclavian vein

✅33. c. A more permanent, soft, flexible double-lumen catheter is used for long-term access when other forms of vascular access have failed. These catheters are tunneled subcutaneously and have Dacron cuffs that prevent infection from tracking along the catheter. Because the patient has chosen HD, APD would not be started. The peripheral vessels and peripherally inserted central catheter (PICC) lines are not used for HD.

11.: A 68-year-old man with a history of heart failure resulting from hypertension has AKI resulting from the effects of nephrotoxic diuretics. Currently, his serum potassium is 6.2 mEq/L (6.2 mmol/L) with cardiac changes, his BUN is 108 mg/dL (38.6 mmol/L), his serum creatinine is 4.1 mg/dL (362 mmol/L), and his serum bicarbonate (HCO3−) is 14 mEq/L (14 mmol/L). He is somnolent and disoriented. Which treatment should the nurse expect to be used for him? a. Loop diuretics b. Renal replacement therapy c. Insulin and sodium bicarbonate d. Sodium polystyrene sulfonate (Kayexalate)

✅b This patient has at least 3 of the 6 common indications for renal replacement therapy (RRT), including: (1) high potassium level; (2)metabolic acidosis; and (3) changed mental status. The other indications are (4) volume overload, resulting in compromised cardiac status (this patient has a history of hypertension); (5) BUN >120 mg/dL; and (6) pericarditis, pericardial effusion, or cardiac tamponade. Although the other treatments may be used, they will not be as effective as RRT for this older patient. Loop diuretics and increased fluid are used if the patient is dehydrated. Insulin and sodium bicarbonate can be used to temporarily drive the potassium into the cells. Sodium polystyrene sulfonate (Kayexalate) is used to actually decrease the amount of potassium in the body.

28. The patient with CKD is considering whether to use peritoneal dialysis (PD) or hemodialysis (HD). What are advantages of PD when compared to HD (select all that apply)? a. Less protein loss b. Rapid fluid removal c. Less cardiovascular stress d. Decreased hyperlipidemia e. Requires fewer dietary restrictions

✅c, e. Peritoneal dialysis (PD) is less stressful for the cardiovascular system and requires fewer dietary restrictions. PD actually contributes to more protein loss and increased hyperlipidemia. The fluid and creatinine removal are slower with PD than hemodialysis (HD).

3. Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI. Which patient is most likely to develop ATN? a. Patient with diabetes b. Patient with hypertensive crisis c. Patient who tried to overdose on acetaminophen d. Patient with major surgery who required a blood transfusion

✅d. Acute tubular necrosis (ATN) is primarily the result of ischemia, nephrotoxins, or sepsis. Major surgery is most likely to cause severe kidney ischemia in the patient requiring a blood transfusion. A blood transfusion hemolytic reaction produces nephrotoxic injury. Diabetes, hypertension, and acetaminophen overdose will not contribute to ATN.

5. What is the most common cause of acute pyelonephritis resulting from an ascending infection from the lower urinary tract? a. The kidney is scarred and fibrotic. b. The organism is resistant to antibiotics. c. There is a preexisting abnormality of the urinary tract. d. The patient does not take all of the antibiotics for treatment of a UTI.

. c. Ascending infections from the bladder to the kidney are prevented by the normal anatomy and physiology of the urinary tract, unless a preexisting condition, such as vesicoureteral reflux or lower urinary tract dysfunction (bladder tumors, prostatic hyperplasia, strictures, or stones), is present. Scarred and fibrotic kidney is a result of chronic pyelonephritis. Resistance to antibiotics and failure to take a full prescription of antibiotics for a UTI usually result in relapse or reinfection of the lower urinary tract.

Darbepoetin alfa

Classification: Biologic Response Modifier Therapeutic uses: Treat anemia by stimulating red blood production. Can be given IV or subcutaneous. Side effect/adverse reaction: Dizziness, fatigue Nursing Implications: Needle cover for aranesp in prefilled syringes contains latex. Do not administer epogen and aranesp together

1. What are intrarenal causes of acute kidney injury (AKI) (select all that apply)? a. Anaphylaxis b. Renal stones c. Bladder cancer d. Nephrotoxic drugs e. Acute glomerulonephritis f. Tubular obstruction by myoglobin

. ✅d, e, f. Intrarenal causes of acute kidney injury (AKI) include conditions that cause direct damage to the kidney tissue, including nephrotoxic drugs, acute glomerulonephritis, and tubular obstruction by myoglobin, or prolonged ischemia. Anaphylaxis and other prerenal problems are frequently the initial cause of AKI. Renal stones and bladder cancer are among the postrenal causes of AKI.

22. On assessment of the patient with a renal calculus passing down the ureter, what should the nurse expect the patient to report? A. A history of chronic UTIs B. Dull, costovertebral flank pain C. Severe, colicky back pain radiating to the groin D. A feeling of bladder fullness with urgency and frequency

C . A classic sign of the passage of a stone down the ureter is intense, colicky back pain that may radiate into the testicles, labia, or groin and may be accompanied by mild shock with cool, moist skin. Many patients with renal stones do not have a history of chronic UTIs. Stones obstructing a calyx or at the ureteropelvic junction may produce dull costovertebral flank pain, and large bladder stones may cause bladder fullness and lower obstructive symptoms.

Muromonab-CD3 IV Basiliximab IV Daclizumab IV

Classification Monoclonal antibodies Therapeutic uses Targets the activation sites of T-lymphocytes- increasing elimination from circulation Side effect/adverse reaction Aseptic meningitis, fever, N/V, headache, tachycardia, hypotension Steven Johnsen syndrome Opportunistic infections Malignancies Both cause GI disturbances Nursing Implications Monitor s/s meningitis Hand hygiene Annual screenings Should not receive live vaccines. Unsafe during pregnancy. Anaphylaxis risk high with any does

Azathioprine _PO

Classification: Antiproliferatives Therapeutic uses: Inhibits DNA synthesis which prevents cell division in activate lymphocytes. Inhibits metabolism of purines Side effect/adverse reaction: Hepatotoxicity Malignancies Bone marrow suppression Thrombocytopenia Anemia Pancreatitis Nursing Implications: Monitor platelets, CBC, LFT's and annual screenings

Tacrolimus Oral/IV

Classification: Calcineurin Inhibitors Therapeutic uses: prevents the activation of lymphocytes involved in transplant rejection. Doing this by binding to proteins Side effect/adverse reaction: Nephrotoxic, HTN, Hyperkalemia, diarrhea, hypomagnesemia, hyperglycemia, hepatotoxicity, dizziness coughOpportunistic infectionsMalignancies( black box warning) Nursing Implications: Monitor BP, BUN, CR, Mg and blood sugars. Annual screenings and hand washing and avoid large crowds. Should begin within 24 hrs of transplant. Interacts with calcium channel blockers, antacids, anticonvulsants and St John's wort. Avoid grapefruit juice.

Cinacalcet -PO oral

Classification: Parathyroid Hormone Modulator Therapeutic uses: Reduces parathyroid hormone production. Correct calcium/phosphorous levels Side effect/adverse reaction: Diarrhea, seizures, GI bleeding, hypocalcemia, HTN Nursing Implications: Monitor calcium and phosphorus levels. Teach patients to report diarrhea, myalgia. Take with food or shortly after a meal. Don't crush.

Ferrous Sulfate -PO Ferrous fumarate -PO Ferrous gluconate

Classification: iron supplements Therapeutic uses: Used along with erythropoietin stimulators Side effect/adverse reaction: Constipation, stools may be green. N/V May stain skin and teeth. May increase bilirubin and may decrease calcium Nursing Implications: Teach patients to take stool softeners and that stools may turn greenish black. Take with orange juice to enhance absorption. Use straw as it may stain teeth(liquid form)

A nurse is planning care for a client who has intrarenal AKI due to aminoglycoside antibiotic therapy. The client has a serum creatinine level of 5 milligrams per deciliter (mg/dL). Which of the following interventions should the nurse include in the plan? (Select all that apply.) A. Provide proteins from animal sources. B. Bathe the client with cool water. C. Ambulate the client four times daily. D. Weigh the client daily. E. Provide NSAIDs for pain.

Correct Answers: A. Provide proteins from animal sources. B. Bathe the client with cool water. D. Weigh the client daily. Intrarenal AKI can be caused by prolonged renal ischemia, infectious processes, and the use of nephrotoxic agents such as gentamicin, an aminoglycoside antibiotic. Clients who are ill, as well as those who have AKI, have increased protein catabolism. Because protein is required for healing, a registered dietitian is often consulted for the client who develops AKI. The amount of protein recommended for the client will vary depending upon whether or not the client requires dialysis. Regardless of whether or not dialysis is a part of the prescribed treatment for the client, the nurse should ensure that the protein the client consumes has a high-biologic value, consisting of animal sources that provide more protein per calorie than protein alternatives such as legumes. Processed proteins such as bacon, deli meats, and hot dogs should be avoided because of the high amount of sodium and phosphorus they contain. The client who has intrarenal AKI can develop pruritus resulting from the toxins that are deposited in the skin when they cannot be cleared through the kidneys. These toxins can result in itching and excoriation of the skin. The nurse should provide meticulous skincare to the client by keeping the client's skin clean and well-moisturized and using cool water to bathe the skin. The cool water will help decrease the itching and prevent drying of the skin, which can increase the itching the client experiences. A complication of AKI is fluid overload due to an inability of the kidneys to filter and excrete fluids. This can result in manifestations that include distention of the neck veins, a bounding pulse, pulmonary crackles, generalized and dependent edema, dyspnea, tachypnea, and decreased oxygen saturation levels. The nurse should weigh the client daily to monitor for the complication of fluid retention. In addition to daily weights, the nurse should maintain strict intake and output records, monitor laboratory results for indications of fluid and electrolyte imbalances, and should notify the provider of any deterioration in the client's status. Incorrect Answers: C. The client who has intrarenal AKI has an increased metabolic rate and is at risk for protein-energy wasting. To avoid complications of protein catabolism that occurs with AKI, the nurse should promote rest for the client during the acute stage of the illness. The nurse should also encourage the client to change positions frequently, either side-to-side while in bed or get up into a chair at the bedside, along with frequent deep breathing and coughing exercises, to promote pulmonary function and prevent other complications of limited mobility such as skin breakdown and the development of deep vein thrombosis. E. Manifestations of AKI include lethargy, weakness, and discomfort. Other manifestations that can be present are related to electrolyte imbalances or fluid overload. Many NSAIDs are metabolized in the liver and excreted in the kidneys. It is contraindicated in clients who have AKI to receive NSAIDs because these medications can cause further injury to the kidney, resulting in complications of the AKI. Vital Concept: Intrarenal AKI involves damage to the glomeruli or renal tubules and can result from prolonged renal ischemia, infection of the renal system, or nephrotoxic agents that damage the ability of the kidneys to filter and excrete waste and fluids. Examples of nephrotoxic agents include radiopaque contrast agents used in diagnostic imaging, heavy metals such as lead and mercury, solvents and chemicals such as ethylene glycol, carbon tetrachloride, and arsenic. Medications can also be nephrotoxic including aminoglycosides such as gentamicin and tobramycin. ACE inhibitors such as enalapril and captopril and NSAIDs such as ketorolac and ibuprofen can also be nephrotoxic. Nurses should monitor clients who are exposed to or are prescribed these agents for manifestations of AKI by measuring client intake and output, monitoring daily weight, indications of fluid overload, and characteristics of urine. The nurse should report the presence of sediment, hematuria, foul odor, or urine output of less than 0.3 mL/kg/hr for more than 2 hr. For the client who develops intrarenal AKI, the nurse should consult with the registered dietitian regarding dietary needs to prevent the development of protein-energy wasting. The nurse should monitor the client's laboratory results and intake and output for fluid and electrolyte imbalances, and report findings indicating an imbalance to the provider right away. The nurse should also take measures to prevent infection which can further complicate the client's health status by implementing interventions such as the use of strict asepsis when managing catheters and invasive lines, monitoring vital signs for increases in temperature, and avoiding the use of indwelling urinary catheters when possible or removing the indwelling catheter as soon as possible. The nurse should take measures to reduce metabolic demands on the client by encouraging rest and should provide frequent skincare and take measures to alleviate skin-related issues such as pruritus.

A nurse is planning care for a client who has end-stage chronic kidney disease (ESKD). Which of the following interventions should the nurse include in the plan? (Select all that apply.) A. Assess for jugular vein distention. B. Provide frequent mouth rinses. C. Observe for the development of Kussmaul respirations. D. Provide a diet high in potassium. E. Monitor for melena.

Correct Answers: A. Assess for jugular vein distention. B. Provide frequent mouth rinses. C. Observe for the development of Kussmaul respirations. E. Monitor for melena. The client who has ESKD cannot excrete sodium and water effectively, resulting in fluid overload. If fluid overload is not effectively managed, the client can develop complications such as heart failure and pulmonary edema. The nurse should assess the client for manifestations of fluid overload which include edema, crackles in the lungs, an S₃ heart sound, hypertension, shortness of breath either with exertion or at rest, and jugular vein distention. ESKD has systemic manifestations. The kidneys are no longer able to effectively filter and excrete urea and other wastes. Protein metabolism by the body results in 25 to 30 g of urea each day. If the kidneys are unable to excrete urea, it is absorbed into the tissues throughout the body. In the mouth, an enzyme called urease is present that breaks down urea into ammonia, which causes a type of halitosis called uremic fetor. Ammonia also causes stomatitis, ulcerations, and bleeding in the mouth which can result in poor dietary intake. The nurse should provide oral care using a soft toothbrush. Commercial mouthwashes should be avoided because these contain alcohol and can cause further irritation to the oral mucosa. The nurse should also provide frequent oral rinses using 0.9% sodium chloride solution, usually upon awakening, after meals, and at bedtime; although, it can be used as often as every 2 hr to provide added comfort. Because the kidneys can no longer excrete hydrogen ions, a base deficit occurs due to decreased levels of bicarbonate. As a result, the body develops metabolic acidosis. To compensate for the acidosis, the body increases the rate and depth of respirations in an attempt to excrete carbon dioxide and raise the pH level. Initially, the client is tachypneic and hyperpneic, but as the metabolic acidosis continues, the client begins to display Kussmaul respirations. The nurse should monitor the client for alterations in breathing patterns including shortness of breath, frequent yawning or sighing, tachypnea, hyperpnea, and Kussmaul respirations. ESKD results in a decrease in erythropoietin shortened RBC lifespan, and impaired platelet function placing the client at risk for the development of anemia and bleeding disorders. The nurse should monitor the client's hemoglobin, hematocrit, RBC, and platelet levels, and assess the client for the presence of petechiae, bruising, or bleeding. The nurse should monitor the client's stools for the presence of blood (melena). Incorrect Answers: D. Due to the decreased ability of the kidneys to excrete fluids and electrolytes in ESKD, the client is at risk for developing hyperkalemia. This occurs when the urine output is less than 500 mL per day. As a result, the client can develop life-threatening cardiac dysrhythmias. The nurse should provide a low potassium diet and should monitor the client's ECG rhythm and potassium levels. Vital Concept: Chronic kidney disease is progressive and irreversible. The client's glomerular filtration rate gradually decreases from a rate of greater than 90 mL/min at stage 1, when kidney function is normal but risk factors are present for increasing damage to the kidneys, to end-stage kidney disease with a glomerular filtration rate of less than 15 mL/min. When the client reaches ESKD, the kidneys are no longer able to filter wastes from the body or excrete fluid and excess electrolytes. The client develops systemic manifestations including the neurologic, integumentary, cardiovascular, pulmonary, gastrointestinal, hematologic, reproductive, and musculoskeletal systems. The nursing care for the client can become quite intensive and includes close monitoring to prevent the development of complications such as metabolic acidosis, pulmonary edema, heart failure, abnormal bleeding, electrolyte abnormalities, seizures, malnutrition, and fractures. The nurse should assess the client's laboratory results for alterations in electrolytes, hemoglobin, hematocrit, RBCs, platelets, as well as fluid and acid-base balances. Monitoring and implementing a dietary program that supports the client's nutritional needs and helps avoid the development of complications such as hypernatremia and hyperkalemia are also part of the nursing care for the client who has ESKD.

Phosphate Binders oral with calcium Calcium acetate Calcium carbonate Without calcium Lanthanum carbonate Sevelamer

Therapeutic uses: Binds and prevents GI absorption Side effect/adverse reaction: Constipation, N/V Contraindications: hypercalcemia, cautious with patients taking digoxin. Interacts with rhubarb and spinach Nursing Implications: Take medication with meals for effectiveness. Monitor phosphorus and calcium levelsTake these drugs and other drugs 2 hrs. apart. Teach patients to report muscle weakness, slow or irregular pulse or confusion.(hypophosphatemia) May need dosage adjustment

7. Metabolic acidosis occurs in the oliguric phase of AKI as a result of impairment of? a. excretion of sodium. b. excretion of bicarbonate. c. conservation of potassium. d. excretion of hydrogen ions.

✅ d. Metabolic acidosis occurs in AKI because the kidneys cannot synthesize ammonia or excrete hydrogen (H +) ions or the acid products of metabolism, resulting in an increased acid load. Sodium is lost in urine because the kidneys cannot conserve sodium. Bicarbonate is normally generated and reabsorbed by the functioning kidney to maintain acid-base balance. Impaired excretion of potassium results in hyperkalemia.

39.: When working with patients with urologic problems, which nursing interventions could be delegated to unlicensed assistive personnel (UAP) (select all that apply)? a. Assess the need for catheterization. b. Use bladder scanner to estimate residual urine. c. Teach patient pelvic floor muscle (Kegel) exercises. d. Insert indwelling catheter for uncomplicated patient. e. Assist incontinent patient to commode at regular intervals. f. Provide perineal care with soap and water around a urinary catheter

✅. e, f. The UAP may assist the incontinent patient to void at regular intervals and provide perineal care. An RN should perform the assessments and teaching. The LPN/VN will do bladder scanning. In long-term care and rehabilitation facilities, UAP may use bladder scanners after they are trained.

23. Which complication of chronic kidney disease is treated with erythropoietin? a. Anemia b. Hypertension c. Hyperkalemia d. Mineral and bone disorder

✅a. Erythropoietin is used to treat anemia, as it stimulates the bone marrow to produce red blood cells.

35. What is the primary way that a nurse will evaluate the patency of an patent arteriovenous fistula AVF? a. Palpate for pulses distal to the graft site. b. Auscultate for the presence of a bruit at the site. c. Evaluate the color and temperature of the extremity. d. Assess for the presence of numbness and tingling distal to the site.

✅b. A (AVF) creates turbulent blood flow that can be assessed by listening for a bruit or palpated for a thrill as the blood passes through the graft. Assessment of neurovascular status in the extremity distal to the graft site is important to determine that the graft does not impair circulation to the extremity, but the neurovascular status does not indicate whether the graft is open.

6. In a patient with AKI, which laboratory urinalysis result indicates tubular damage? a. Hematuria b. Specific gravity fixed at 1.010 c. Urine sodium of 12 mEq/L (12 mmol/L) d. Osmolality of 1000 mOsm/kg (1000 mmol/kg)

✅b. A urine specific gravity that is consistently 1.010 and a urine osmolality of about 300 mOsm/kg is the same specific gravity and osmolality as plasma. This indicates that tubules are damaged and unable to concentrate urine. Hematuria is more common with postrenal damage. Tubular damage is associated with a high sodium concentration (>40 mEq/L).

31. In which type of dialysis does the patient dialyze during sleep and leave the fluid in the abdomen during the day? a. Long nocturnal HD b. Automated peritoneal dialysis (APD) c. Continuous venovenous hemofiltration (CVVH) d. Continuous ambulatory peritoneal dialysis (CAPD)

✅b. Automated peritoneal dialysis (APD) is the type of dialysis in which the patient dialyzes during sleep and leaves the fluid in the abdomen during the day. Long nocturnal HD occurs while the patient is sleeping and is done up to 6 times per week. Continuous venovenous hemofiltration (CVVH) is a type of continuous RRT used to treat AKI. Continuous ambulatory peritoneal dialysis (CAPD) is dialysis that is done with exchanges of 2 to 3 L of dialysate at least 4 times daily.

14. A patient with AKI has a serum potassium level of 6.7 mEq/L (6.7 mmol/L) and the following arterial blood gas results: pH 7.28, partial pressure of carbon dioxide in arterial blood (PaCO2) 30 mm Hg, partial pressure of oxygen in arterial blood (PaO2) 86 mm Hg, HCO3− 18 mEq/L (18 mmol/L). The nurse recognizes that treatment of theacid-base problem with sodium bicarbonate would cause a decrease in which value? a. pH b. Potassium level c. Bicarbonate level d. Carbon dioxide level

✅b. During acidosis, potassium moves out of the cell in exchange for H+ ions, increasing the serum potassium level. Correction of the acidosis with sodium bicarbonate will help temporarily shift the potassium back into the cells. A decrease in pH and the bicarbonate and partial pressure of carbon dioxide in arterial blood (PaCO2) levels would indicate worsening acidosis.

39.: A patient received a kidney transplant last month. Because of the effects of immunosuppressive drugs and CKD, what complication of transplantation should the nurse be assessing the patient for to decrease the risk of mortality? a. Cancer b. Infection c. Rejection d. Cardiovascular disease

✅b. Infection is a significant cause of morbidity and mortality after transplantation because the surgery, immunosuppressive drugs, and effects of CKD all suppress the body's normal defense mechanisms, thus increasing the risk of bacterial, fungal, and viral infections. The nurse must assess the patient as well as use aseptic technique to prevent infections. Rejection may occur but for other reasons. Malignancy occurrence increases later because of immunosuppressive therapy. Cardiovascular disease is the leading cause of death after renal transplantation as it is with CKD, but this would not be expected to cause death within the first month after transplantation.

2. An 83-year-old female patient was found lying on the bathroom floor. She said she fell 2 days ago and has not been able to take her heart medicine or eat or drink anything since then. What conditions could contribute to prerenal AKI in this patient (select all that apply)? a. Anaphylaxis b. Renal stones c. Hypovolemia d. Nephrotoxic drugs e. Decreased cardiac output

✅c, e. Because the patient has had nothing to eat or drink for 2 days, she is probably dehydrated and hypovolemic. Decreased cardiac output (CO) is most likely because she is older and takes heart medicine, which is probably for heart failure or hypertension. Both hypovolemia and decreased CO cause prerenal AKI. Anaphylaxis is also a cause of prerenal AKI but is not likely in this situation. Nephrotoxic drugs would contribute to intrarenal causes of AKI, and renal stones would be a postrenal cause of AKI.

8. A patient with suprapubic pain and symptoms of urinary frequency and urgency has 2 negative urine cultures. What is 1 assessment finding that would indicate interstitial cystitis (IC)? a. Residual urine greater than 200 mL b. A large, atonic bladder on urodynamic testing c. A voiding pattern that indicates psychogenic urinary retention d. Pain with bladder filling that is transiently relieved by urination

✅d. The symptoms of interstitial cystitis (IC) imitate those of an infection of the bladder, but the urine is free of infectious agents. Unlike a bladder infection, the pain with IC increases as urine collects in the bladder and is temporarily relieved by urination. Acidic urine is very irritating to the bladder in IC and the bladder is small, but urinary retention is not common.

A nurse is reviewing the plan of care for a client who has systemic lupus erythematosus (SLE). Which of the following laboratory findings should the nurse anticipate? (Select all that apply.) A. Positive ANA titer B. Increased WBC count C. 2+ urine protein D. Increased serum C3 and C4 E. Elevated BUN

✔Correct Answers: A. Positive ANA titer C. 2+ urine protein E. Elevated BUN A positive antinuclear antibody (ANA) titer is an expected finding in a client who has SLE. The ANA test identifies the presence of antibodies produced against the client's own DNA. Increased urine protein is an expected finding due to the kidney injury that occurs as a result of SLE. Elevated BUN is an expected finding due to the kidney injury that occurs in a client who has SLE. Incorrect Answers: B. Pancytopenia, not an elevated WBC count, is an expected finding in a client who has SLE. D. A client who has SLE is expected to have a decreased level of serum C3 and C4. Vital Concept: Systemic lupus erythematosus (SLE) is a chronic and progressive systemic inflammatory autoimmune disease of the connective tissue that can affect any body system. The nurse should review laboratory results that are specific to SLE, including positive ANA titer, erythrocyte sedimentation rate (ESR), C3 or C4 complements, CBC with differential, renal function tests, and electrolytes.

18. A female patient has a UTI and kidney stones. The nurse knows that these are most likely which type of stone? a. Cystine b. Struvite c. Uric acid d. Calcium phosphate

✅ b. Struvite stones are most common in women and always occur with UTIs. They are usually large staghorn type

1. Which classification of urinary tract infection (UTI) is described as infection of the renal parenchyma, renal pelvis, and ureters? a. Upper UTI b. Lower UTI c. Complicated UTI d. Uncomplicated UTI

✅a. An upper urinary tract infection (UTI) affects the renal parenchyma, renal pelvis, and ureters. A lower UTI is an infection of the bladder and/or urethra. A complicated UTI exists in the presence of coexisting obstruction, stones, catheters, or preexisting diseases. An uncomplicated UTI occurs in an otherwise normal urinary tract.

Cyclosporine- Oral/IV

Classification: Calcineurin Inhibitors. (RENAL DRUG GUIDE) Therapeutic uses: prevents the activation of lymphocytes involved in transplant rejection. Doing this by binding to proteins Side effect/adverse reaction Nephrotoxic, HTN, CAD, Opportunistic infectionsMalignancies, hepatotoxicity Nursing Implications

Corticosteroids Oral/IV

Classification: Immunosuppressants Therapeutic uses: Inhibits cytokine production in most leukocytes Side effect/adverse reaction: HTN, hyperglycemia hypokalemia, Hyperlipidemia. Osteoporosis, weight gain, cushing appearance, GI ulcers and hyperglycemia.Sodium retention, weight gain, PUD, GI bleeding Nursing Implications: Monitor blood sugars, blood pressure, electrolytes, monitor weight. Have annual eye screenings and take with food. Self checks. Should not receive live vaccines

A nurse is providing post-dialysis care for a client. Which of the following interventions should the nurse take? (Select all that apply.) A. Obtain the client's weight B. Administer medications the nurse withheld prior to dialysis. C. Observe for signs of hypovolemia. D. Assess the access site for bleeding. E. Evaluate blood pressure on the arm with AV access.

Correct Answers: A. Obtain the client's weight B. Administer medications the nurse withheld prior to dialysis. C. Observe for signs of hypovolemia. D. Assess the access site for bleeding. The client's weight in an important factor before and after dialysis. The client is weighed prior to dialysis to determine the amount of fluid that is required to be removed to bring the client as close as possible to the client's dry weight. The dry weight is the weight the client would be without the excess fluid buildup due to the decreased kidney function. Following dialysis, the client is weighed once again to evaluate how close to the dry weight the client is after the fluid has been removed. Dialysis is the process of filtering the client's blood to remove excess fluid and nitrogenous waste products. It is completed by diffusion of the fluid and waste products across a semi-permeable membrane. Many medications can be completely or partially removed during the dialysis process. The nurse should consult with the pharmacist and nephrologist to determine which medications to hold prior to dialysis. After the treatment, the nurse should administer medications indicated by the client's provider and pharmacist. Medications That Are Affected by Dialysis • Antibiotics (aminoglycosides, cephalosporins, penicillins) • Antituberculosis Medications (ethambutol, isoniazid) • Antiviral Medications (acyclovir, ganciclovir) • Antifungal Medications (fluconazole) • Other Medications (cimetidine, allopurinol, enalapril, aspirin) Following dialysis, frequent assessment of the client including vital signs and level of consciousness are completed. The nurse should assess the blood pressure and pulse of the client who is post-dialysis for hypovolemia due to a rapid decease in fluid volume. The nurse should monitor the client's temperature as well. Although the dialysis machine warms the blood and the dialysate is warmed to 37.8° C (100° F), it is possible for the client to become septic. If a fever is present, the client might require having blood cultures drawn. The nurse should assess the access site for bleeding for at least 1 hr following dialysis because the client receives heparin during the procedure to prevent clotting of blood. The heparin remains active for a period of up to 6 hr following dialysis. The nurse should monitor the access site as well as any other vascular access sites or incisions for bleeding. The nurse should also instruct the client to avoid all invasive procedures for up to 6 hr following dialysis. Incorrect Answer: E. The nurse should never measure the client's blood pressure on the arm that has the fistula because compression of the cuff or a tourniquet can compromise the integrity of the AV fistula and can make it unusable. During the dialysis procedure, the machine measures the client's vital signs, arterial and venous pressures, and the flow of blood and dialysate. Prior to and following dialysis, the nurse should obtain the client's blood pressure using the unaffected arm. Vital Concept: Following dialysis, frequent assessment of the client, including vital signs and level of consciousness, is completed. The nurse should monitor the client for complications of dialysis including hypotension, dizziness, cardiac arrhythmias, hypoglycemia, and dialysis disequilibrium syndrome. This syndrome is characterized by nausea, vomiting, fatigue, and restlessness, and can have manifestations such as decreased level of consciousness, seizures, and coma. Infection control and standard precautions should also be observed at all times. Since the dialysis procedure can last several hours, the nurse should ensure that the client repositions frequently to prevent skin breakdown. Occasionally, the client will have meals during the course of dialysis as well.

2. Number the following physiologic occurrences in the order they occur in the formation of urine. Begin with 1 for the first occurrence and number through 6 for the last occurrence in the formation of urine. a. _______ Blood is filtered in the glomerulus. b. _______ Reabsorption of water in the loop of Henle. c. _______ Reabsorption of electrolytes, glucose, amino acids, and small proteins in the proximal convoluted tubules. d. _______ Acid-base regulation with conservation of bicarbonate (HCO3-) and secretion of excess H+ in the distal convoluted tubules. e. _______ Active reabsorption of chloride (Cl-)term-127 ions and passive reabsorption of sodium (Na+) ions in the ascending loop of Henle. f. _______ Ultrafiltrate flows from Bowman's capsule and passes down the tubules without blood cells, platelets, or large plasma proteins.

a, 1; b, 4; c, 3; d, 6; e, 5; f, 2. Blood is filtered in the glomerulus, and the ultrafiltrate flows from the Bowman's capsule to the tubules for reabsorption of essential materials and secretion of nonessential ones. In the proximal convoluted tubule, most electrolytes, glucose, amino acids, and small proteins are reabsorbed. Water is conserved in the loop of Henle with chloride and sodium reabsorbed in the ascending loop. The distal convoluted tubules complete final water balance and acid-base balance.

11. What manifestation in the patient will indicate the need for restriction of dietary protein in management of acute poststreptococcal glomerulonephritis (APSGN)? a. Hematuria b. Proteinuria c. Hypertension d. Elevated blood urea nitrogen (BUN)

d. An elevated blood urea nitrogen (BUN) indicates that the kidneys are not clearing nitrogenous wastes from the blood and protein may be restricted related to the degree of proteinuria until the kidney recovers. Proteinuria indicates loss of protein from the blood and possibly a need for increased protein intake. Hypertension is treated with sodium and fluid restriction, diuretics, and antihypertensive drugs. The hematuria is not specifically treated. .

7. Which test is required for a diagnosis of pyelonephritis? a. Renal biopsy b. Blood culture c. Intravenous pyelogram (IVP) d. Urine for culture and sensitivity

d. A urine specimen specifically obtained for culture and sensitivity is required to diagnose pyelonephritis because it will indicate the bacteria causing the infection and provide information on what drug the bacteria is sensitive to for treatment. The renal biopsy is used to diagnose chronic pyelonephritis or cancer. Blood cultures would be done if bacteremia is suspected. Intravenous pyelogram (IVP) would increase renal irritation, but CT urograms may be used to assess for signs of infection in the kidney and complications of pyelonephritis.

15. Which infection is asymptomatic at first and then progresses to cystitis, frequent urination, burning on voiding, and epididymitis? a. Urosepsis b. Urethral diverticula c. Goodpasture syndrome d. Genitourinary tuberculosis

✅. d. The manifestations of genitourinary tuberculosis are described. Urosepsis is when the UTI has spread systemically. Urethral diverticula are localized outpouching of the urethra and occur more often in women. Goodpasture syndrome manifests with flu-like symptoms with pulmonary symptoms that include cough, shortness of breath, and pulmonary insufficiency and renal manifestations that include hematuria, weakness, pallor, anemia, and renal failure.

14. The patient reports "wetting when she sneezes." How should the nurse document this information? a. Nocturia b. Micturition c. Urge incontinence d. Stress incontinence

✅d. Stress incontinence is involuntary urination with increased pressure when sneezing or coughing and is seen with weakness of sphincter control. Nocturia is frequent urination at night. Micturition is the evacuation of urine. Urge incontinence is involuntary urination preceded by urinary urgency.

Mycophenolate mofetil -oral

Classification: Antiproliferatives Therapeutic uses: Suppresses lymphocyte activation Side effect/adverse reaction: HTN, diarrhea, edema, constipation N/V Serious: Thrombocytopenia Opportunistic infections Malignancies, GI bleeding, AKI and Leukopenia Nursing Implications: Monitor WBC's, annual screening and maintain a well role.Monitor BP. Should not receive live vaccines. When taken with NSAIDs increased risk of GI bleed

26. What nursing responsibilities are done to obtain a clean-catch urine specimen from a patient (select all that apply)? a. Use sterile container. b. Must start the test with full bladder. c. Insert catheter immediately after voiding. d. Have the patient void, stop, and void in container. e. Have the patient clean the meatus before voiding.

✅ a, d, e. A clean-catch urine specimen is obtained in a sterile container after cleaning the meatus. The patient will void a small amount in the toilet, stop, and then void in the container to catch the urine midstream. The first morning specimen is best for a urinalysis. A full bladder is necessary for a urine flow study. A urinary catheter is inserted immediately after voiding to assess residual urine.

9. Which volume of urine in the bladder would cause discomfort and require urinary catheterization? a. 250 mL b. 500 mL c. 1100 mL d. 1500 mL

✅c. When the amount of urine in the bladder has reached 1100 mL, the person would need relief and require catheterization. The bladder capacity ranges from 600 to 1000 mL. When there is 250 mL of urine in the bladder, the person will usually feel the urge to urinate, and at 400 to 600 mL the patient will be uncomfortable.

10. What is a factor that contributes to an increased incidence of urinary tract infections (UTIs) in older women? a. Length of the urethra b. Larger capacity of bladder c. Relaxation of pelvic floor and bladder muscles d. Tight muscular support at the urinary sphincter

✅c. Relaxation of female urethra, bladder, vagina, and pelvic floor muscles may contribute to stress and urge incontinence and urinary tract infections. The short urethra of women allows easier ascension and colonization of bacteria in the bladder than occurs in men and the urethra does not lengthen with age. The bladder capacity of men and women is the same but decreases with aging. With aging, the urinary sphincter weakens.

A nurse is caring for an older client with chronic kidney disease who was admitted with cholangitis. The client has a temperature of 103°F and a blood pressure of 90/60 mmHg. Which of the following orders should the nurse question, based on the information provided WBC 20.000 Potassium 6.0 BUN 50 Creatine 4.2 A. Continue the home dose of lisinopril B. Obtain blood and urine cultures before initiating antibiotics C. Obtain a CT of the abdomen without contrast D. Administer IV antibiotics

✔ Correct Answer: A. Continue the home dose of lisinopril Chronic kidney disease is a significant and irreversible decline in kidney function occurring over a long period of time. It results in water, and electrolyte imbalances in the body and buildup of waste products. The client has hyperkalemia due to chronic renal disease, since potassium excretion is normally modulated by the kidney. Hyperkalemia can be exacerbated by lisinopril, an ACE inhibitor, which suppresses angiotensin II and leads to a decrease in aldosterone levels. Since aldosterone increases the excretion of potassium, use of ACE inhibitors can result in retention of potassium. Antihypertensive medications that work by inhibiting the angiotensin-renin system include ACE inhibitors and angiotensin II receptor blockers. These medications can be used to treat hypertension that results from renal disorders, but they can result in hyperkalemia, particularly in advanced renal disease. ACE inhibitors include enalapril, lisinopril, and ramipril. Candesartan, losartan, valsartan, and irbesartan are angiotensin receptor blockers. Hyperkalemia can cause life-threatening arrhythmias, including ventricular fibrillation. Incorrect Answers: B. Cultures are appropriate. Acute cholangitis refers to a condition characterized by fever, jaundice, and abdominal pain, caused by stasis and infection in the biliary tract. It can be life-threatening. Clients with cholangitis should be monitored for sepsis. Blood and urine cultures should be obtained before initiating antibiotics. C. A CT of the abdomen without contrast is appropriate for a client who has renal failure. A contrasted CT would be contraindicated in a client with chronic renal disease since iodinated contrast is excreted by the kidney and can be nephrotoxic. D. Empiric broad-spectrum antibiotics are appropriate for treatment of cholangitis pending results of cultures. This order would not cause concern. Vital Concept: Chronic kidney disease results in hypervolemia and electrolyte Imbalances, including hyperkalemia, hypocalcemia, hyperphosphatemia, and hypermagnesemia. Hyperkalemia is a potentially life-threatening electrolyte imbalance that causes cardiac and neuromuscular dysfunction. ACE inhibitors, used to treat hypertension, have a protective effect in early renal insufficiency, but can exacerbate hyperkalemia in clients with impaired renal function.

23. What is the most likely reason that the BUN would be increased in a patient? a. Has impaired renal function b. Has not eaten enough protein c. Has decreased urea in the urine d. May have nonrenal tissue hypertrophy

✅. a. BUN is increased in patients with renal problems. It may also be increased when there is rapid or extensive tissue damage from other causes. Very low protein intake may cause a low BUN.

A nurse is providing a meal tray to a client who has just returned from hemodialysis treatment. Which best describes the dietary choices most likely to be included in the client's meal? A. High-calorie, high-protein foods B. Low-calorie, high-sodium foods C. High-calorie saturated fats D. Low-calorie, low-protein foods

Correct Answer: A. High-calorie, high-protein foods A client who receives hemodialysis has many toxicities and nutrients removed from his body; she needs an increase in calories and protein in her diet. Incorrect Answers: B. A client with kidney disease who receives hemodialysis may need to increase caloric consumption, but does not need more sodium. C. A client who receives hemodialysis would need higher caloric intake in her diet. Saturated fats and trans fats are associated with development of atherosclerosis. D. A client who receives hemodialysis would be more likely to need additional calories as a result of poor appetite, not fewer calories. High quality high calorie proteins are an important part of a renal diet. Vital Concept: Clients who are on hemodialysis are unable to eliminate waste or maintain fluid and electrolyte balance between dialysis sessions. Renal dietitians recommend reduced consumption of fluids, sodium, potassium, and phosphorus. Caloric consumption is often low, due to poor appetite. High quality high calorie foods, including vegetable oils and proteins, can supply daily metabolic needs. High quality proteins include fish, eggs, meats, and poultry.

12. List 1 specific finding identified by the nurse during assessment of each of the patient's functional health patterns that indicates a risk factor for urinary problems or a patient response to a urinary disorder. Functional Health Pattern Health perception-health management Nutritional-metabolic Elimination Activity-exercise Sleep-rest Cognitive-perceptual Self-perception-self-concept Role-relationship Sexuality-reproductive Coping-stress tolerance Value-belief

Health perception/management —>Smoking history, occupational history, and history of- exposure to carcinogenic and nephrotoxic chemicals, family health history of kidney disease, geographic residence, confused older person Nutritional-metabolic—>Low fluid intake or loss of fluids, high calcium and purine intake; caffeine, alcohol, carbonated beverage, artificial sweetener, or spicy food intake; weight gain resulting from fluid retention; anorexia, nausea, or vomiting; supplements and herbal therapy Elimination—>Change in appearance and amount of urine, change in urinary patterns, necessary assistance in emptying bladder, bowel function Activity/exercise—>Change in energy level, sedentary lifestyle, urine leakage during activity Sleep/rest—>Sleep deprivation from nocturia Cognitive/perceptual—>Pain in flank, groin, or suprapubic area; dysuria; absence of pain with other urinary symptoms; cognitive impairment affecting continence; mobility, visual acuity, and dexterity Self- perception/self-concept—->Decreased self-esteem and body image because of urinary problem

27. When obtaining a nursing history from a patient with cancer of the urinary system, what does the nurse recognize as a risk factor associated with both kidney cancer and bladder cancer? a. Smoking b. Family history of cancer c. Chronic use of phenacetin d. Chronic, recurrent kidney stones

✅a. Both cancer of the kidney and cancer of the bladder are associated with smoking. A family history of renal cancer is a risk factor for kidney cancer. Cancer of the bladder has been associated with long-term indwelling catheters, recurrent renal calculi (often bladder), and chronic lower UTIs.

16. The male patient is admitted with a diagnosis of benign prostatic hyperplasia (BPH). What urination characteristic would the nurse expect to be present? a. Oliguria b. Hesitancy c. Hematuria d. Pneumaturia

✅b. Hesitancy is difficulty starting the urine stream and is common with benign prostatic hyperplasia (BPH). Oliguria is scanty urine formation and output. Hematuria is blood in the urine. Pneumaturia is urine containing gas, as is caused by a fistula between the bowel and bladder.

A nurse is caring for a client with type 2 diabetes who takes metformin (Glucophage). The client has a cardiac catheterization scheduled. Which of the following should the nurse advise? A. Limit protein in the diet on the day before the procedure. B. Take metformin with water only on the day of the procedure. C. Discontinue the medication prior to the procedure. D. Continue to take the medication as usual.

Correct Answer: C. Discontinue the medication prior to the procedure. Diabetes is associated with increased risk of cardiovascular disease. Cardiac catheterization requires the use of potentially nephrotoxic contrast, and metformin compounds the risk of acute kidney injury, so it is discontinued a day before the procedure and 2 days after. During this time, the client is usually placed on sliding scale insulin in order to avoid hypoglycemia as a result of fasting before the procedure. Incorrect Answers: A. The client will be NPO before the procedure and should resume a normal diet after the procedure. B. Metformin should be stopped a day before the procedure. D. Metformin should be stopped before the procedure, with sliding scale insulin prescribed to avoid renal damage and hypoglycemia associated with fasting. Vital Concept: When a client scheduled for a procedure must be kept NPO, it may be necessary for the prescriber to adjust hypoglycemic medications, including oral hypoglycemics or basal insulin. Metformin is an oral hypoglycemic used in treatment of type 2 diabetes. In addition to the potential for hypoglycemia in a client who is kept NPO, metformin increases the risk of renal injury in clients who are undergoing a diagnostic procedure requiring nephrotoxic contrast.

21. The nurse identifies that a patient with CKD is at risk for fractures because of alterations in calcium and phosphorus metabolism. What is the pathologic process directly related to the increased risk for fractures? Number the processes beginning with 1 and ending with 6. ______ a. Bone remodeling causes weakened bone matrix ______ b. Bone demineralization for calcium and phosphate release ______ c. Decalcification of the bone and replacement of bone tissue with fibrous tissue ______ d. Impaired vitamin D activation resulting in decreased GI absorption of calcium ______ e. Increased release of parathyroid hormone in response to decreased calcium levels ______ f. Hyperphosphatemia decreases serum calcium levels and reduces kidney's vitamin D activation

a. 5, b. 3, c. 6, d. 1, e. 2, f. 4. Less vitamin D is converted to its active form resulting in decreased serum calcium. Hypocalcemia causes the parathyroid to secrete parathyroid hormone (PTH), which stimulates bone demineralization, releasing calcium and phosphate from the bones. Hyperphosphatemia decreases calcium levels and further reduces the kidney's ability to activate vitamin D. Low serum calcium, elevated phosphate, and decreased vitamin D further stimulate PTH secretion. Accelerated bone remodeling occurs, causing weakened bone matrix with replacement of bone tissue with fibrous tissue.

20. What is the most serious electrolyte disorder associated with kidney disease? a. Hypocalcemia b. Hyperkalemia c. Hyponatremia d. Hypermagnesemia

✅b. Hyperkalemia can lead to life-threatening dysrhythmias. Hypocalcemia leads to an accelerated rate of bone remodeling and potentially to tetany. Hyponatremia may lead to confusion. Elevated sodium levels lead to edema, hypertension, and heart failure. Hypermagnesemia may decrease reflexes, mental status, and BP. 21.

29. What does the dialysate for PD routinely contain? a. Calcium in a lower concentration than in the blood b. Sodium in a higher concentration than in the blood c. Dextrose in a higher concentration than in the blood d. Electrolytes in an equal concentration to that of the blood

✅c. Dextrose or icodextrin or amino acid is added to dialysate fluid to create an osmotic gradient across the membrane to remove excess fluid from the blood. Dialysate usually contains higher calcium to promote its movement into the blood. Dialysate sodium is usually less than or equal to that of blood to prevent sodium and fluid retention. The dialysate fluid has no potassium so that potassium will diffuse into the dialysate from the blood.

7. In which clinical situation would the increased release of erythropoietin be expected? a. Hypoxemia b. Hypotension c. Hyperkalemia d. Fluid overload

✅. a. Erythropoietin is released when the oxygen tension of the renal blood supply is low and stimulates production of red blood cells in the bone marrow. Hypotension causes activation of the renin-angiotensin- aldosterone system, as well as release of ADH. Hyperkalemia stimulates the release of aldosterone from the adrenal cortex and fluid overload does not directly stimulate factors affecting the erythropoietin release by the kidney.

Calcitriol -PO Paricalcitol -PO Doxercalciferol- PO

Classification: Vitamin D compounds Therapeutic uses: Supplemental vitamin D. In CKD active form of Vitamin D synthesis is suppressed Side effect/adverse reaction: Rash, urticaria. Nursing Implications: Monitor calcium and vitamin D levels. Lipid soluble. Serum calcium levels should stay below 10mg/dl.

A nurse is caring for a client in the ICU who has acute renal failure. Which of the following ECG findings indicate hyperkalemia? A. Prominent delta waves B. Peaked T wave C. Prominent U waves D. Osbourne J waves

Correct Answer: B. Peaked T wave Hyperkalemia refers to a serum potassium of >5.0-5.5 mEq/L. Normal potassium levels are 3.5-5.0 mEq/L. Impaired excretion of potassium due to medications, acute kidney injury, chronic renal failure, increased movement of potassium out of cells, and increased intake of potassium can all result in hyperkalemia. An intracellular shift occurs in rhabdomyolysis, tumor lysis syndrome, burns, diabetic ketoacidosis, and metabolic acidosis. Increased intake can be dietary or in the form of supplements, blood transfusions, TPN, and medications like Penicillin G that contain potassium. Although neuromuscular symptoms may occur (e.g. muscle weakness, palpitations, nausea, and paresthesias), many individuals are asymptomatic. Severe bradycardia, flaccid paralysis, and decreased deep tendon reflexes occur at levels >7.0 mEq/L. In severe hyperkalemia, respiratory paralysis and/or cardiac arrest may occur. ECG changes progress from tall peaked T waves to a sine wave to ventricular fibrillation or asystole at levels >8.0 mEq/L. Treatment depends on the level and the rate of onset. Calcium can be administered IV to reduce cardiac toxicity immediately. Intravenous saline with a loop diuretic is typically administered to increase excretion of potassium. A cation exchange resin such as Kayexalate (sodium polystyrene sulfonate) can be given orally or as a retention enema to facilitate excretion. IV insulin with glucose is administered in severe hyperkalemia to promote entry of potassium into the cells. Incorrect Answers: A. Delta waves are associated with Wolf Parkinson White syndrome. C. Prominent U waves are associated with hypokalemia. D. Osborne J waves are associated with hypothermia. Vital Concept: Hyperkalemia may occur in clients with renal insufficiency, due to impaired excretion of potassium by the kidney. Normal potassium levels are 3.5-5.0 mEq/L. Flaccid paralysis, diminished reflexes, and bradycardia occur at levels of 7.0 mEq/L and may progress to respiratory paralysis and cardiac arrest if untreated. ECG changes include peaked T waves early with progression to sine waves and asystole.

35. During assessment of the patient who had an open nephrectomy, what should the nurse expect to find? a. Shallow, slow respirations b. Clear breath sounds in all lung fields c. Decreased breath sounds in the lower left lobe d. Decreased breath sounds in the right and left lower lobes

✅b. A nephrectomy incision is usually in the flank, just below the diaphragm or in the abdominal area. Although the patient is reluctant to breathe deeply because of incisional pain, the lungs should be clear. Decreased sounds and shallow respirations are abnormal and would require intervention.

5. What indicates to the nurse that a patient with oliguria has prerenal oliguria? a. Urine testing reveals a low specific gravity. b. Causative factor is malignant hypertension. c. Urine testing reveals a high sodium concentration. d. Reversal of oliguria occurs with fluid replacement.

✅. d. In prerenal oliguria, the oliguria is caused by a decrease in circulating blood volume and there is no damage yet to the renal tissue. It can be reversed by correcting the precipitating factor, such as fluid replacement for hypovolemia. Prerenal oliguria is characterized by urine with a high specific gravity and a low sodium concentration, whereas oliguria of intrarenal failure is characterized by urine with a low specific gravity and a high sodium concentration. Malignant hypertension causes damage to renal tissue and intrarenal oliguria.

34. A man with end-stage renal disease (ESRD) is scheduled for HD following healing of an arteriovenous fistula (AVF). What should the nurse explain to him that will occur during dialysis? a. He will be able to visit, read, sleep, or watch TV while reclining in a chair. b. He will be placed on a cardiac monitor to detect any adverse effects that may occur. c. The dialyzer will remove and hold part of his blood for 20 to 30 minutes to remove the waste products. d. A large catheter with 2 lumens will be inserted into the fistula to send blood to and return it from the dialyzer.

✅34. a. While patients are undergoing HD, they can perform quiet activities that do not require the limb that has the vascular access. BP is monitored frequently, and the dialyzer monitors dialysis function, but cardiac monitoring is not usually indicated. The HD machine continuously circulates both the blood and the dialysate past the semipermeable membrane in the machine. Graft and fistula access involve the insertion of 2 needles into the site: one to remove blood from and the other to return blood to the dialyzer. A double-lumen catheter is used for temporary access

26. Which description accurately describes the care of the patient with CKD? a. Iron is a nutrient that is commonly supplemented for the patient on dialysis because it is dialyzable. b. The syndrome that includes all of the signs and symptoms seen in the various body systems in CKD is azotemia. c. The use of morphine is contraindicated in the patient with CKD because accumulation of its metabolites may cause seizures. d. The use of calcium-based phosphate binders in the patient with CKD is contraindicated when serum calcium levels are increased.

✅d. In the patient with CKD, when serum calcium levels are increased, calcium-based phosphate binders are not used. The dialyzable nutrient supplemented for patients on dialysis is folic acid, although IV iron sucrose injections may be prescribed for anemia if the patient receives erythropoietin. The various body system manifestations occur with uremia, which includes azotemia. Meperidine is contraindicated in patients with CKD related to possible seizures.

Hypertonic Glucose and Insulin (dextrose 50%) Regular insulin 10-20 units

Classification Treatment of Hyperkalemia Therapeutic uses Temporary measure effective for 6 hrs, not always effective when repeated Glucose stimulates insulin production which shifts potassium back into the cell. Quick onset of action- used for unstable patient Side effect/adverse reaction Hypoglycemia Nursing Implications Monitor blood sugars

6. A patient with an obstruction of the renal artery causing renal ischemia has hypertension. What factor may contribute to the hypertension? a. Increased renin release b. Increased ADH secretion c. Decreased aldosterone secretion d. Increased synthesis and release of prostaglandins

✅ a. Renin is released in response to decreased arterial BP, renal ischemia, decreased extracellular fluid (ECF), decreased serum Na+ concentration, and increased urinary Na+ concentration. It is the catalyst of the renin-angiotensin-aldosterone system, which raises BP when stimulated. ADH is secreted by the posterior pituitary in response to serum hyperosmolality and low blood volume. Aldosterone is secreted only after stimulation by angiotensin II. Kidney prostaglandins lower BP by causing vasodilation

2. While caring for a 77-year-old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. What clinical manifestations is the patient likely to experience? a. Cloudy urine and fever b. Urethral burning and bloody urine c. Vague abdominal discomfort and disorientation d. Suprapubic pain and slight decline in body temperature

✅c. The usual classic manifestations of UTI are often absent in older adults, who tend to have nonlocalized abdominal discomfort and cognitive impairment characterized by confusion or decreased level of consciousness rather than dysuria and suprapubic pain.

Patrimer sorbitex calcium

Classification Treatment of Hyperkalemia Therapeutic uses Binds potassium in the GI tract, then excreted in feces Side effect/adverse reaction Abdominal discomfort, constipation, diarrhea, , N/V Hypomagnesemia Nursing implications Clients should have good bowel motility. Mix with one ounce of water then an additional 2 ounces and stir thoroughly. Never administer in dry form. Take with food. Administer 3 hrs before or after other drugs to enhance absorption. Monitor magnesium level and medication binds to magnesium. Teach patients how to mix. Do not add to heated food.

37. A patient with bladder cancer undergoes cystectomy with formation of an ileal conduit. During the patient's first postoperative day, what should the nurse plan to do? a. Measure and fit the stoma for a permanent appliance. b. Encourage high oral intake to flush mucus from the conduit. c. Teach the patient to self-catheterize the stoma every 4 to 6 hours. d. Empty the drainage bag every 2 to 3 hours and measure the urinary output.

✅. d. Urine drains continuously from an ileal conduit and the drainage bag must be emptied every 2 to 3 hours and measured to ensure adequate urinary output. Fitting for a permanent appliance is not done until the stoma shrinks to its normal size in a few weeks. With an ileal conduit, mucus is present in the urine because it is secreted by the ileal segment as a result of the irritating effect of the urine, but the surgery causes paralytic ileus and the patient will be NPO for several days postoperatively. Self- catheterization is performed when patients have formation of a continent Kock pouch.

12. Prevention of AKI is important because of the high mortality rate. Which patients are at increased risk for AKI (select all that apply)? a. An 86-year-old woman scheduled for a cardiac catheterization b. A 48-year-old man with multiple injuries from a motor vehicle accident c. A 32-year-old woman following a C-section delivery for abruptio placentae d. A 64-year-old woman with chronic heart failure admitted with bloody stools e. A 58-year-old man with prostate cancer undergoing preoperative workup for prostatectomy

✅a, b, c, d, e. High-risk patients include those exposed to nephrotoxic agents and advanced age: (a), massive trauma (b), prolonged hypovolemia or hypotension (possibly b, c, and d), obstetric complications (c), cardiac failure (d), preexisting chronic kidney disease (CKD), extensive burns, or sepsis. Patients with prostate cancer may have obstruction of the outflow tract, which increases risk of postrenal AKI (e). until then the heart rhythm must be monitored.

4. What should the nurse include in the teaching plan for a female patient with a UTI? a. Empty the bladder at least 4 times a day. b. Drink at least 2 quarts of water every day. c. Wait to urinate until the urge is very intense. d. Clean the urinary meatus with an antiinfective agent after voiding.

✅ b. Fluid intake should be increased to about 2000 mL/day without caffeine, alcohol, citrus juices, and chocolate drinks, because they are potential bladder irritants. The bladder should be emptied at least every 3 to 4 hours, not waiting until an intense urge. Cleaning the urinary meatus with an antiinfective agent after voiding will irritate the meatus, but the perineal area should be wiped from front to back after urination and defecation to prevent fecal contamination of the meatus.

17. Which type of urinary tract stones are the most common and often obstruct the ureter? a. Cystine b. Uric acid c. Calcium oxalate d. Calcium phosphate

✅ c. Calcium oxalate stones are most common (35% to 40%) and small enough to get trapped in the ureter. Cystine stones incidence is 1% to 2%; uric acid incidence is 5% to 8%; calcium phosphate incidence is 8% to 10%. .

25. : Following a renal biopsy, what is the nurse's priority? a. Offer warm sitz baths to relieve discomfort. b. Test urine for microscopic bleeding with a dipstick. c. Expect the patient to experience burning on urination. d. Monitor the patient for symptoms of a urinary infection.

✅b. Bleeding from the kidney following a biopsy is the most serious complication of the procedure and urine must be examined for both gross and microscopic blood, in addition to vital signs and hematocrit levels being monitored. Following a cystoscopy, the patient may have burning with urination, and warm sitz baths may be used. Urinary infections are a complication of any procedure requiring instrumentation of the bladder.

26. Which disease causes connective tissue changes that cause glomerulonephritis? a. Gout b. Amyloidosis c. Diabetes mellitus d. Systemic lupus erythematosus

✅. d. Systemic lupus erythematosus causes connective tissue damage that affects the glomerulus. Gout deposits uric acid crystals in the kidney. Amyloidosis deposits hyaline bodies in the kidney. Diabetes causes microvascular damage affecting the kidney