HESI Chronic Kidney Disease

The nurse documents the assessment of the arteriovenous (AV) graft. Which documentation best describes a properly functioning AV graft? +4 bounding pulse palpated. Bruit intact with palpation. Thrill present and palpated. Healthcare provider notified of graft occlusion.

Thrill present and palpated. R: This buzzing sensation indicates that the graft is patent. In addition to palpating for a thrill, the nurse should auscultate for a bruit, the sound heard at a client's graft site, as well as for intact pulses distal to the graft site.

Which is the priority nursing assessment during the first 24-hour postoperative period? Vital signs. Bowel sounds. Urine output. Pedal pulses.

Vital signs. R: Vital signs should be monitored frequently to assess for postoperative bleeding, infection, or organ rejection. Assessment for hypotension is essential as it threatens allograft survival.

What is the best initial response by the nurse? "Going home often causes anxiety, which can increase your pain." "You may have developed a tolerance to your pain medication." "Describe the location and type of pain you are having." "The healthcare provider (HCP) will need to call you back later if you need more pain medication." Submit

"Describe the location and type of pain you are having." R: The nurse must always assess first as complete data is needed to determine the nature of the problem and then to intervene appropriately.

What is the best response by the nurse? "Don't blame the HCPs. They're doing everything possible." "Why do you think the healthcare providers (HCPs) are at fault?" "This is a very difficult time for you and your family." "Your obvious anger will not help the client now."

"This is a very difficult time for you and your family." R: Acknowledgment of the stress being experienced will encourage the family member to continue to express their feelings.

The nurse is preparing to give the client's medications. The anti-thymocyte globulin (ATG) comes in a vial with 25mg/10mL. the client weighs 132 lbs (60 kg). The Thymoglobulin will be infused over 6 hours. What rate should the nurse program on the infusion pump? (Enter the numerical value only. If rounding is necessary, round to the whole number.)

18 D/H x V = X60 kg x 4.5 mg = 270mg270mg/25mg x 10 mL = 108 mL108mL/6hours = 18 mL per hour

What complication would the client be most concerned about if choosing peritoneal dialysis? Abdominal infection/Peritonitis. Osteoarthritis. Hepatitis B and C. Hypertension.

Abdominal infection/Peritonitis. R: Peritoneal dialysis places the client at high risk for peritonitis since the catheter and fluid enter the peritoneal cavity. The client must be heparinized during hemodialysis. Therefore, bleeding is a more likely potential complication than thrombosis.

Which action should the nurse implement first? Change the surgical dressing. Administer an analgesic. Convert the IV to a saline lock. Remove the indwelling catheter.

Administer an analgesic. R: This intervention will reduce the client's pain and anxiety. It will also reduce discomfort when other procedures such as a dressing change are performed. This is a priority using Maslow's hierarchy.

Which instructions should the nurse give the client? Instruct client to take prescribed diuretic and analgesic. When the client voids, the time and amount of urine should be recorded. Advise the client to increase fluid intake and report any increase in weight. Ask the client to monitor temperature and report a fever over 101° F (38.3° C). Advise the client to come to the clinic right away for further evaluation.

Advise the client to come to the clinic right away for further evaluation. R: The client is exhibiting symptoms consistent with organ rejection. The client needs immediate assessment and evaluation for this potentially fatal complication. The nurse should assess for kidney pain, oliguria or anuria, hypertension, lethargy, fever, and fluid retention, as well as increased serum BUN, creatinine, and potassium.

After the nurse completes the assessment, what findings are most important to report to the healthcare provider (HCP) ? (Select all that apply. One, some, or all options may be correct.) Blood pressure of 178/92 mmHg. Respiratory rate of 28 breaths per minute. Bibasilar crackles. Edema Clear, pale urine.

Blood pressure of 178/92 mmHg. Respiratory rate of 28 breaths per minute. Bibasilar crackles. Edema R: Blood pressure is elevated. Client may require additional diuretic or antihypertensive therapy to get blood pressure to normal range. Normal respiratory rate is 12-20 breaths per minute. Client has tachypnea and should be reported to the healthcare provider for further evaluation. Client is experiencing fluid volume overload. Bibasilar crackles are a manifestation of the fluid volume overload. Edema is an abnormal finding and should be reported to the physician.

What assessment data supports the diagnosis of acute organ rejection? (Select all that apply. One, some, or all options may be correct.) Blood pressure of 178/96 mmHg. Nausea and vomiting. Sub therapeutic immunosuppression levels. Acute pain rated 6/10. BUN of 56 mg/dL (19.99 mmol/L) and creatinine of 1.9 mg/dL (167.96 mcmol/L). Temperature of 100.6° F (38.1° C).

Blood pressure of 178/96 mmHg. Sub therapeutic immunosuppression levels. Acute pain rated 6/10. BUN of 56 mg/dL (19.99 mmol/L) and creatinine of 1.9 mg/dL (167.96 mcmol/L). Temperature of 100.6° F (38.1° C). R: Correct, blood pressure is elevated with organ rejection. May indicate the client has not taken the immunosuppressive medications. Correct, pain over the allograft is associated with acute rejection. Correct, even slight elevations of BUN and creatinine post transplant can indicate organ failure. Correct, clients experiencing acute organ rejection may have an elevated temperature.

Which assessment should the nurse perform to determine if the desired outcome of the losartan has been achieved? Apical pulse. Blood pressure. Intake and output. Fingerstick glucose.

Blood pressure. R: Losartan is an angiotensin receptor blocker (ARB) used as an antihypertensive agent.

Which intervention should the nurse implement? Administer the prescribed tablet. Request a faxed copy of the prescription. Obtain the name of the office nurse. Call and speak directly with the healthcare provider (HCP).

Call and speak directly with the healthcare provider (HCP). R: The medication prescription is unsafe and requires direct communication with the prescribing healthcare provider (HCP).

Which expected outcome should be included in the nurse's teaching plan? Client will adhere to a low-protein diet. Client will avoid canned and processed foods. Client will identify the need to avoid fresh fruits and vegetables. Client will identify the need to increase their fluid intake.

Client will avoid canned and processed foods. R: Clients on ESRD should restrict sodium to 2-4 grams per day. Canned and processed foods are high in sodium.

Which assessment data indicates to the nurse that the desired outcome of the epoetin alfa has been achieved? Conjunctival sac returns to a reddish-pink color. Consumed 100% of diet. No evidence of edema. Normoactive bowel sounds.

Conjunctival sac returns to a reddish-pink color. R: This assessment finding reflects an improvement in the client's anemia. Epoetin stimulates the production of RBCs, resulting in an increase in hematocrit. It is used to treat the anemia common in clients with CKD.

What action should the nurse take based on the response from the healthcare provider (HCP) phone call? (Select all that apply. One, some, or all options may be correct.) Document both phone calls and the HCP's prescriptions. Give the potassium chloride and document disagreement with carrying out prescription. Notify the charge nurse and activate the chain of command. Hold the potassium chloride. Order another potassium level to confirm level is correct. Instruct the client that the HCP has ordered medication even though potassium is high and ask if they want to refuse the medication.

Document both phone calls and the HCP's prescriptions. Notify the charge nurse and activate the chain of command. Hold the potassium chloride. R: The nurse should document the facts of the phone call, including the prescriptions. Unsafe orders must be escalated up the chain of command which starts with the charge nurse. It is not safe to give the medication due to the elevated potassium level.

Based on these problems, which nursing intervention should be included in the client's plan of care? Avoid any subcutaneous and intramuscular injections. Encourage the client to ask questions and discuss fears about diagnosis. Offer frequent high-protein snacks. Encourage oral fluid intake.

Encourage the client to ask questions and discuss fears about diagnosis. R: An open atmosphere that allows for discussion can decrease anxiety. Facilitate discussions with family members about the prognosis and the impact on lifestyle.

What is the best nursing intervention for the family member's anger? Educate the family member that this is a known complication of the procedure. Encourage the family member to share frustration regarding the loss of the kidney Share a story of another client who went through a similar experience. Offer to call pastoral care for the family member.

Encourage the family member to share frustration regarding the loss of the kidney R: Allowing the family member the opportunity to verbalize anger will help to work through the anger.

Which lab value would the nurse be most concerned about? Glomerular filtration rate (GFR) of 9 mL/min/1.73m2. Blood urea nitrogen (BUN) of 100 mg/dL (35.7 mmol/L). Parathyroid hormone (PTH) of 182 pg/mL (182 ng/L). Phosphorous of 5.5 mg/dL (1.78 mmol/L)

Glomerular filtration rate (GFR) of 9 mL/min/1.73m2. R: Estimated glomerular filtration rate (GFR) is the best test to measure level of kidney function and determine stage of kidney disease.

The nurse prepares and instructs the client for hemodialysis. Which statements by the client indicate the need for further education? (Select all that apply. One, some, or all options may be correct.) Hemodialysis or peritoneal dialysis can be done at home. Hemodialysis will help restore kidney function back to a normal level. Bowel or bladder perforation may occur with hemodialysis catheter placement. Hemodialysis requires a fistula or graft in the arm. A dialyzer filters blood and removes waste products from the body.

Hemodialysis will help restore kidney function back to a normal level. Bowel or bladder perforation may occur with hemodialysis catheter placement. R: Hemodialysis removes waste accumulation in the blood. It replaces a function of the kidney, it does not cure the kidney. This is a serious complication associated with peritoneal dialysis (PD).

Which intervention is most important for the nurse to implement? Ask the pharmacist to supply a tablet rather than an elixir since the client is on fluid restriction. Hold the dose of potassium chloride and contact the HCP to report the serum potassium level. Administer the dose of potassium chloride and document the serum potassium level in the medical record. Calculate the milliliters of medication needed and record the amount on the fluid intake record.

Hold the dose of potassium chloride and contact the HCP to report the serum potassium level. R: The serum potassium level is elevated, and administering additional potassium in any form is potentially dangerous to the client.

The nurse reviews the client's medical history. What part of the medical history should the nurse consider relevant to the client's current history? (Select all that apply. One, some, or all options may be correct.) Gender. Hypertension. Long term use of furosemide Polycystic kidney disease. Diabetes Mellitus.

Hypertension. Polycystic kidney disease. Diabetes Mellitus. R:Hypertension is one of the primary causes of CKD. The vast majority of clients with CKD have hypertension, which may be either the cause or the result of CKD. PKD gene mutation will develop kidney cysts by age 30. Half of these people develop chronic kidney disease (CKD) by age 50 years. Uncontrolled diabetes is a leading causative factor in renal disease.

Which interventions are important to include in the client's plan of care while receiving multiple immunosuppressants? (Select all that apply. One, some, or all options may be correct.) Instruct client to wear a mask when walking in the halls. Instruct visitors that fresh flowers should not be taken into the room. Change the IV site daily. Reinforce, but do not routinely change any dressings. Monitor immunosuppression drug levels regularly.

Instruct client to wear a mask when walking in the halls. Instruct visitors that fresh flowers should not be taken into the room. Monitor immunosuppression drug levels regularly. R: Since the client is at high risk for infection, activity and mobility should be encouraged to prevent the complications of immobility, such as atelectasis and pneumonia. The client should be assisted with mobility as needed since the client is also at risk for injury. Fresh flowers, plants, and fruits are a source of bacteria and should be restricted from the client's room. In addition, visitors should be restricted to healthy adults, and extra precautions should be taken to avoid sharing hospital equipment and to ensure a clean room environment. Too much immunosuppresive medication can result in liver or kidney insufficiency and increased risk for infection. Too little immunosuppressive medication can lead to kidney rejection

The nurse is teaching the patient about fluid management between dialysis treatments. Which instruction by the nurse is the most accurate? Limit fluids in between treatments to minimize the amount of fluid that needs to be removed during dialysis. Increase fluid intake between treatments to stay hydrated in between treatments. Substitute ice chips for fluids to maintain hydration. As long as you are still urinating, there is no need to restrict fluids.

Limit fluids in between treatments to minimize the amount of fluid that needs to be removed during dialysis. R: The goal for hemodialysis clients is to keep their interdialytic (between dialysis treatments) weight gain under 1.5 kg.

Which action can be assigned to the unlicensed assistive personnel (UAP)? Change the surgical dressing. Administer an analgesic. Convert the IV to a saline lock. Measure the client's urinary output.

Measure the client's urinary output. R: This task may be assigned to the UAP.

What is the correct interpretation of these ABGs? Respiratory acidosis (compensated). Respiratory alkalosis (compensated). Metabolic acidosis (compensated). Metabolic alkalosis (compensated).

Metabolic acidosis (compensated). R: As excessive bicarbonate is excreted, the HCO3 level decreases, causing metabolic acidosis (decreased pH). Compensation occurs when an increased rate and depth of respirations reduce the CO2 levels, returning the pH to low normal.

Which intervention should the nurse ensure is included in the plan of care during the immediate postoperative period? Monitor the client's urinary output hourly using an urimeter. Assess the client's surgical incision every shift. Monitor the client's nasogastric tube every 4 hours. Encourage the client to use the incentive spirometer daily.

Monitor the client's urinary output hourly using an urimeter. R: A kidney from a living donor related to the client usually begins to function immediately after surgery and may produce large amounts of dilute urine. Therefore, the output should be closely monitored.

Which additional symptoms should the nurse ask about? (Select all that apply. One, some, or all options may be correct.) Nausea Clay-colored stool. Decreased attention span. Stridor. Itching

Nausea Decreased attention span. Itching R: Ammonia is a breakdown product of urea. When ammonia accumulates in the gastrointestinal tract, it causes irritation, nausea, vomiting, a metallic taste in the mouth, and bleeding. Problems ranging from lethargy to seizures or coma, which may indicate uremic encephalopathy. Calcium phosphate crystals and urea accumulate in the skin, causing itching.

The client's hemoglobin level is 7.8 g/dL (78 g/L). What action should the nurse take? Obtain a urine specimen to assess for hematuria. Obtain an order to start an erythropoietin stimulating agent (ESA). Continue to observe the client. Send the client to the hospital for a blood transfusion. Submit

Obtain an order to start an erythropoietin stimulating agent (ESA). R: Hemoglobin is decreased as the kidneys become less able to produce erythropoietin necessary for the formation of red blood cells. ESA's will replace the erythropoietin levels.

Based on the nurse's assessment, which assessment data supports the decision to administer pain medication as the first intervention? (Select all that apply. One, some, or all options may be correct.) Pain rating of 6/10. Temperature of 100.5° F (38.1° C). Heart rate of 102 beats/minute. Respiratory rate of 20 breaths/minute. Blood pressure of 132/76 mmHg.

Pain rating of 6/10. Heart rate of 102 beats/minute. Blood pressure of 132/76 mmHg. R: Pain was 2/10 prior to transport and is now 6/10. Client is experiencing an increase in intensity of the pain. Heart rate may elevate when acute pain is present. Blood pressure increased from baseline prior to transfer. May be attributed to acute pain.

The client asks the nurse to clarify what palliative care involves. Which explanation provides the client the best education regarding palliative care? (Select all that apply. One, some, or all options may be correct.) Palliative care provides relief from symptoms including pain. Palliative care is the same thing as hospice. Palliative care is aggressive treatment of end stage renal disease. Palliative care supports holistic care and improves quality of life. Palliative care minimizes the financial burden of end stage renal disease.

Palliative care provides relief from symptoms including pain. Palliative care supports holistic care and improves quality of life. R: One of the goals of palliative care is to help clients manage the symptoms of their chronic illness. One of the goals of palliative care is to support holistic care and improve quality of life.

Which intervention should the nurse ensure has been include in the client's plan of care? (Select all that apply. One, some, or all options may be correct.) Instruct lab personnel to obtain blood specimens from the dual-lumen catheter. Perform sterile dressing changes at the dual-lumen catheter site. Empty and record the drainage from the graft tubing regularly. Regularly rotate IV insertion sites above and below the graft site. Assess the client's distal pulses and circulation in the arm with the access.

Perform sterile dressing changes at the dual-lumen catheter site. Assess the client's distal pulses and circulation in the arm with the access. R: Central vein insertion sites are major sources of nosocomial infection, and they should be cleaned weekly using a strict aseptic technique. Ischemia occurs in a few clients with vascular access when the fistula decreases arterial blood flow to areas below the fistula (steal syndrome). Manifestations vary from cold or numb fingers to gangrene. If the collateral circulation is poor, the fistula may need to be surgically tied off and a new one created in another area to preserve extremity circulation.

Which assessment finding indicates to the nurse that the desired outcome of the calcium acetate has been achieved? Serum glucose of 90 mg/dL (5.0 mmol/L). Serum phosphorous of 4.0 mg/dL (1.29 mmol/L). Serum calcium level of 10.2 mg/dL (2.55 mmol/L). Serum hemoglobin of 12 g/dL (120 g/L).

Serum phosphorous of 4.0 mg/dL (1.29 mmol/L). R: Calcium acetate acts as a phosphate binder, reducing the high serum phosphorous levels commonly found in the client with CKD.

The nurse is teaching the client about progression of chronic kidney disease (CKD). Which evaluation statement documented by the nurse indicates the client's understanding of the disease process? The client verbalizes understanding that their chronic kidney disease can be cured if diabetes and hypertension are controlled better. The client understands that they will require a kidney transplant in order to live and they have a brother who will donate a kidney to them. The client acknowledges that renal replacement therapy will need to be initiated immediately to rid the body of waste and maintain fluid balance. The client understands that they are having a relapse of chronic kidney disease and requires dialysis until their kidneys have recovered.

The client acknowledges that renal replacement therapy will need to be initiated immediately to rid the body of waste and maintain fluid balance. R: CKD is fatal unless some form of renal replacement therapy such as dialysis or organ transplantation is done.

Based on the client's symptoms, what should the nurse suspect? The client has anemia and may need to get a blood transfusion. The client has a urinary tract infection and may need an antibiotic. The client has a pneumonia and may need an inhaler. The client has uremia and may need to start dialysis.

The client has uremia and may need to start dialysis. R: Classic signs of uremia are nausea, vomiting, fatigue, weight loss, anorexia, muscle cramps, pruritis, and a change in mental status.

The nurse assesses the dialysis graft. Which assessment should be reported to the healthcare provider (HCP) immediately? (Select all that apply. One, some, or all options may be correct.) Swelling in the arm where the graft is placed. Yellow, purulent drainage from graft incision site. Absence of a thrill over the graft site. Capillary refill >10 seconds in the hand where the graft is placed. Bruit ausculatated over the graft area.

Yellow, purulent drainage from graft incision site. Absence of a thrill over the graft site. Capillary refill >10 seconds in the hand where the graft is placed. R: May indicate infection. Hemodialysis grafts are prone to infection. May indicate the graft is clotted. May indicate circulatory compromise or STEAL syndrome.