IMPORTANT* 34Qw/exp Chronic Kidney Disease-critical care-IV semester

The nurse is preparing to discharge a client with chronic kidney disease. The nurse is teaching the client and family about administering calcium acetate tablets by mouth with each meal at home. Which explanation about this medication is the most appropriate? A) "The calcium acetate will lower your serum phosphate levels." B) "The calcium acetate helps to neutralize your gastric acids." C) "The calcium acetate will help to stimulate your appetite." D) "The calcium acetate will decrease your serum creatinine levels."

Answer: A Explanation: The client with chronic kidney disease has elevated phosphate levels due to the inability of the damaged kidney to excrete this electrolyte. Calcium acetate, when given with meals, will bind serum phosphorus and therefore lower the serum level. Calcium acetate has no effect on serum creatinine. Although calcium acetate can act as an antacid and neutralize gastric acid when given between meals, this is not the reason it is given to a client with chronic kidney disease. This medication has no effect on appetite stimulation.

During a home visit, the nurse is concerned that an older adult client is developing renal failure. The client has no history of cardiovascular disease. Which data in the client's assessment caused the nurse to have this concern? Select all that apply. A) Progressive edema B) Complaints of hip joint pain C) New onset of hypertension D) Recent increase in hunger and thirst E) Warm moist skin

Answer: A, C Explanation: The manifestations of renal failure often are missed in aging clients because edema may be attributed to heart failure or high blood pressure to preexisting hypertension. Hip joint pain is not a manifestation of renal failure in the older client. An increase in hunger and thirst could be an indication of diabetes mellitus and not renal failure in the older client. A client with renal failure will have pale dry skin with poor turgor.

The nurse is preparing to administer a hemodialysis treatment for a client with chronic kidney disease. Which laboratory values does the nurse anticipate prior to the client's treatment? Select all that apply. A) Increased blood urea nitrogen (BUN) B) Decreased potassium C) Decreased phosphorus D) Increased urine osmolality E) Increased creatinine

Answer: A, E Explanation:The damaged kidney is unable to excrete waste products, including creatinine, so it will be increased. The client will also have an increased blood urea nitrogen (BUN) level due to the damaged kidneys. The damaged kidney is unable to excrete solutes; therefore, the serum osmolality will be increased and the urine osmolality will be decreased. Both phosphorus and potassium increase during renal failure due to the inability of the kidney to excrete them.

While caring for a client with end-stage renal disease, the nurse tracks the client's serum albumin level. For which nursing diagnosis is the action most indicated? A) Excess Fluid Volume B) Imbalanced Nutrition: Less Than Body Requirements C) Risk for Ineffective Perfusion D) Risk for Infection

Answer: B Explanation: Interventions appropriate for the diagnosis of Imbalanced Nutrition: Less Than Body Requirements include monitoring laboratory values such as such as serum albumin. Assessing for edema and monitoring heart rate and blood pressure would be interventions for the diagnosis of Excess Fluid Volume. Monitoring for orthostatic blood pressure changes would be appropriate for the diagnosis of Risk for Ineffective Perfusion. Monitoring the white blood cell count would be an intervention appropriate for the diagnosis of Risk for Infection.

The nurse is planning a seminar to instruct community members on ways to reduce the development of chronic kidney disease. Which topics should the nurse include in the seminar? Select all that apply. A) Avoid eating red meat. B) Control blood glucose levels in diabetes mellitus. C) Adhere to medication regimen to control hypertension. D) Participate in regular exercise. E) Avoid smoking.

Answer: B, C, D, E Explanation: Prevention of end-stage renal disease should focus on aggressive management of chronic disease states, especially diabetes and hypertension. In addition, clients should consume diets low in sodium, exercise regularly, keep healthcare provider appointments, avoid smoking, and limit alcohol intake. Eating red meat does not need to be avoided to prevent the development of end-stage renal disease.

The nurse is caring for a client with chronic renal disease who is pale and experiencing fatigue. The nurse attributes these symptoms to anemia secondary to chronic renal disease. The client's spouse asks why the client is anemic. Which response by the nurse is the most appropriate? A) "Your spouse has a genetic tendency for the development of anemia." B) "The increased metabolic waste products in the body depress the bone marrow and cause anemia." C) "There is a decreased production by the kidneys of the hormone erythropoietin which is the cause of anemia." D) "The client is not eating enough iron-rich foods which is causing anemia."

Answer: C Explanation: Anemia is common in clients with renal disease. Among the factors causing the anemia are decreased production of erythropoietin by the kidneys and shortened red blood cell (RBC) life. Erythropoietin is involved in the stimulation of the bone marrow to produce RBCs. Metabolic wastes do not suppress the bone marrow. Diet and heredity do not factor into the production of erythropoietin.

The nurse is providing care for a child diagnosed with renal failure who is experiencing hyperkalemia. When planning meals for this child, which choice would be most appropriate for this client? A) Hamburger on a bun, banana B) Cold cuts with bun with fresh pears C) Spaghetti and meat sauce, breadsticks D) Carrots and green, leafy vegetables

Answer: C Explanation: Carrots; green, leafy vegetables; pears; and bananas are high in potassium. Spaghetti and meat sauce with breadsticks would be the most appropriate meal from the choices provided.

A client with a history of hypertension, is diagnosed with chronic renal disease. When the client asks the nurse how this occurred, which response by the nurse is the most appropriate? A) "Thickening of the kidney structures and gradual death of nephrons has caused this diagnosis." B) "Cysts compress renal tissue that destroys the kidneys causing this diagnosis." C) "High blood pressure reduces renal blood flow and harms the kidney tissue causing this diagnosis." D) "Immune complexes form in the kidney tissue that causes inflammation causing this diagnosis."

Answer: C Explanation: Longstanding hypertension leads to sclerosis and narrowing of renal arterioles and small arteries with subsequent reduction of blood flow. This leads to ischemia, glomerular destruction, and tubular atrophy. Diabetic nephropathy causes renal failure by thickening and sclerosis of the glomerular basement membrane and the glomerulus with a gradual destruction of nephrons. Polycystic kidney disease causes renal failure by multiple bilateral cysts gradually compressing renal tissue, impairing renal perfusion and leading to ischemia, which damages and destroys normal kidney tissue. Systemic lupus erythematosus causes renal failure by the formation of immune complexes in the capillary basement membrane, which lead to inflammation and sclerosis.

The nurse is planning care for a client with chronic kidney disease and osteoporosis. After reviewing the client's medical record, which is the priority nursing diagnosis for this client? A) Anxiety B) Disturbed Body Image C) Risk for Injury D) Risk for Bleeding

Answer: C Explanation: The client with chronic kidney disease with osteoporosis is at high risk for fractures; therefore, preventing injury is the priority nursing diagnosis. The client is at risk for anemia, but not bleeding. The client on hemodialysis may have a disturbed body image, but in this case, it is specified that the client has significant osteoporosis. Anxiety is not related to osteoporosis.

The nurse is caring for an older adult client diagnosed with chronic kidney disease. The client reports no bowel movement in the past 2 days. Based on this data, which condition is the client at an increased risk for developing? A) Metabolic acidosis B) Hypercalcemia C) Increased serum creatinine levels D) Hyperkalemia

Answer: D Explanation: Constipation exacerbates hyperkalemia, and it is important to monitor CRF clients who already have impairment of potassium. Hypokalemia is not affected by constipation. Metabolic acidosis and serum creatinine levels may not directly correlate with a decrease in the glomerular filtration rate in the elderly and are not directly affected by constipation.

A client with chronic renal disease is experiencing manifestations of anemia. Based on this data, which treatment does the nurse anticipate for this client? A) Begin a fluid restriction. B) Administer intravenous glucose and insulin. C) Begin a low-sodium diet. D) Epoetin injections

Answer: D Explanation: Epoetin injections are used in the treatment of anemia caused by chronic kidney disease. This medication supplies a hormone typically created in the kidneys that signals the bone marrow to produce more red blood cells. In chronic kidney disease, this hormone production will be reduced. A fluid restriction would be indicated for uremia caused by chronic kidney disease. Intravenous glucose and insulin may be used to reduce excessive potassium that is caused by chronic kidney disease. A low-sodium diet is used to help reduce fluid volume excess that is caused by chronic kidney disease.

The nurse instructs a client with chronic renal disease on the prescribed medication furosemide (Lasix). Which client statement indicates that teaching has been effective? A) "I will take this medication to keep my calcium balance normal." B) "This medication will make sure I have enough red blood cells in my body." C) "I will take this pill to keep my protein level in my body stable." D) "This pill will reduce the swelling in my body and get rid of the extra potassium."

Answer: D Explanation: Furosemide (Lasix) is a loop diuretic that may be prescribed to reduce extracellular fluid volume and edema. Diuretic therapy also can reduce hypertension and cause potassium wasting, lowering serum potassium levels. Oral phosphorus-binding agents, such as calcium carbonate or calcium acetate, are given to lower serum phosphate levels and normalize serum calcium levels. Folic acid and iron supplements are given to combat anemia associated with chronic kidney disease. There is no medication provided to a client with chronic kidney disease that is used to stabilize protein levels in the body.

The nurse is caring for a client from another country who was admitted with hypertension and chronic renal failure. The client is receiving hemodialysis three times a week. The nurse is assessing the client's diet and the client reports the use of salt substitutes. When teaching the client to avoid salt substitute, which rationale supports this teaching point? A) They will increase the risk of AV fistula infection. B) They will cause the client to retain fluid. C) They will interact with the client's antihypertensive medications. D) They can potentiate hyperkalemia.

Answer: D Explanation: Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in clients with renal failure, and the use of salt substitutes will worsen hyperkalemia. Increases in weight do need to be reported to the healthcare provider as a possible indication of fluid volume excess, but this is not the reason why salt substitute is to be avoided. The control of hypertension is essential in the management of a client with kidney disease, but salt substitute is not known to interact with antihypertensive medications. An AV fistula does need to be protected from injury and infection could be caused by constricting clothing, venipunctures, and other items.

A nurse evaluating the therapeutic effect of the drug sodium polystyrene sulfonate (Kayexalate) for a client diagnosed with chronic renal failure. Which therapeutic effect from the medication does the nurse anticipate? A) Increased serum sodium B) Increased stool excretion C) Decreased urine specific gravity D) Decreased serum potassium

Answer: D Explanation:The client with chronic kidney disease is unable to excrete potassium, and therefore the drug sodium polystyrene sulfonate (Kayexalate) is utilized in order to exchange sodium for potassium in the large intestine, resulting in decreased serum potassium levels. Although the client might have increased stools, the therapeutic effectiveness of the drug is measured by monitoring the serum potassium. This drug does not affect either the sodium level or the specific gravity.

A patient is admitted with signs of chronic kidney disease. What finding should the nurse use to determine whether this patient is developing metabolic acidosis? 1. Kussmaul respirations 2. low urine output 3. muscle cramps 4. diarrhea

Correct Answer: 1 Rationale 1: As kidney disease progresses, hydrogen-ion excretion and buffer production are impaired, leading to metabolic acidosis. Respiratory rate and depth increase, as with Kussmaul respirations, to compensate for metabolic acidosis. Rationale 2: Low urine output is often associated with chronic kidney disease and does not indicate metabolic acidosis. Rationale 3: Muscle cramps are often associated with chronic kidney disease and do not indicate metabolic acidosis. Rationale 4: Diarrhea is often associated with chronic kidney disease and does not indicate metabolic acidosis. Global Rationale: As kidney disease progresses, hydrogen-ion excretion and buffer production are impaired, leading to metabolic acidosis. Respiratory rate and depth increase, as with Kussmaul respirations, to compensate for metabolic acidosis. Low urine output, muscle cramps, and diarrhea are often associated with chronic kidney disease and do not indicate metabolic acidosis.

A patient with polycystic kidney disease is planning to be married and asks the nurse if his children could inherit this disorder. What is the nurse's best response? 1. "Yes, this condition can be inherited." 2. "Yes, but this condition is so rare that you shouldn't worry about it." 3. "No, polycystic kidney disease occurs because of spontaneous mutations." 4. "You should ask your fiancée to come with you to your next office visit so we can discuss this."

Correct Answer: 1 Rationale 1: Autosomal dominant polycystic kidney disease is relatively common, affecting 1 in every 400 to 1000 people and accounts for 4% of ESRD in the U. S. Approximately 90% of cases are inherited as an autosomal dominant trait and the remaining 10% are due to spontaneous mutations. Rationale 2: This response gives the patient potentially false information. Rationale 3: Approximately 90% of cases are inherited as an autosomal dominant trait and the remaining 10% are due to spontaneous mutations. Rationale 4: This does not answer the patient's question. Global Rationale: Autosomal dominant polycystic kidney disease is relatively common, affecting 1 in every 400 to 1000 people and accounts for 4% of ESRD in the U. S. Approximately 90% of cases are inherited as an autosomal dominant trait and the remaining 10% are due to spontaneous mutations. The nurse needs to provide correct information and answer the patient's question.

A patient is diagnosed with chronic pyelonephritis. The nurse recognizes that this patient is prone to developing which health problem? 1. chronic kidney disease 2. cystitis 3. acute renal failure 4. renal calculi

Correct Answer: 1 Rationale 1: Chronic pyelonephritis involves chronic inflammation and scarring of the tubules and interstitial tissues of the kidney. It is a common cause of chronic kidney disease. Rationale 2: Cystitis may cause acute pyelonephritis. Rationale 3: Cystitis may cause acute renal failure. Rationale 4: Renal calculi are generally caused by dietary intake, not by chronic pyelonephritis. Global Rationale: Chronic pyelonephritis involves chronic inflammation and scarring of the tubules and interstitial tissues of the kidney. It is a common cause of chronic kidney disease. Cystitis may cause acute pyelonephritis and acute renal failure. Renal calculi are generally caused by dietary intake, not by chronic pyelonephritis.

A patient who received a kidney transplant seven years ago is seen for increasing blood pressure and proteinuria. The nurse realizes that this patient is demonstrating signs of what health problem? 1. chronic rejection 2. acute rejection 3. renal artery stenosis 4. pyelonephritis

Correct Answer: 1 Rationale 1: Chronic rejection may develop months to years following transplant. The manifestations of azotemia, proteinuria, and hypertension are those of progressive kidney disease. Rationale 2: Acute rejection most commonly occurs in the weeks that immediately follow transplant. Rationale 3: Renal artery stenosis manifests with a bruit over the surgical anastomosis site. Rationale 4: Pyelonephritis manifests with abdominal discomfort and low-grade fever. Global Rationale: Chronic rejection may develop months to years following transplant. The manifestations of azotemia, proteinuria and hypertension are those of progressive kidney disease. Acute rejection most commonly occurs in the weeks that immediately follow transplant. Renal artery stenosis manifests with a bruit over the surgical anastomosis site. Pyelonephritis manifests with abdominal discomfort and low-grade fever.

An older patient is scheduled for a CT scan with and without contrast dye. What should be done prior to this CT scan? 1. Monitor renal function. 2. Assess for level of responsiveness. 3. Assess vital signs. 4. Keep the patient NPO.

Correct Answer: 1 Rationale 1: Common nephrotoxins associated with acute tubular necrosis include radiologic contrast media. The risk for acute tubular necrosis is higher when nephrotoxic drugs are given to older patients. Rationale 2: Monitoring responsiveness is important, but does not address the specific risks of this examination. Rationale 3: Monitoring vital signs is important, but does not address the specific risks of this examination. Rationale 4: The specific location of the body for the CT scan is not indicated, therefore, it is not known if the patient would need to be kept NPO prior to the test. Global Rationale: Common nephrotoxins associated with acute tubular necrosis include radiologic contrast media. The risk for acute tubular necrosis is higher when nephrotoxic drugs are given to older patients. Monitoring responsiveness and vital signs are important, but do not address the specific risks of this examination. The specific location of the body for the CT scan is not indicated, therefore, it is not known if the patient would need to be kept NPO prior to the test.

The nurse is caring for a patient receiving peritoneal dialysis. After completing the exchange and draining the dialysate, the nurse notices that the dialysate is cloudy. How should the nurse interpret this finding? 1. a sign of infection 2. a sign of vascular access occlusion 3. the normal appearance of dialysate 4. a sign of possible bowel perforation

Correct Answer: 1 Rationale 1: Dialysate is typically clear; cloudy or malodorous dialysate may indicate infection. Rationale 2: Peritoneal dialysis does not use vascular access. Rationale 3: Dialysate is typically clear. Rationale 4: Blood or feces in the dialysate may indicate organ or bowel perforation. Global Rationale: Dialysate is typically clear. Cloudy or malodorous dialysate may indicate infection. Blood or feces in the dialysate may indicate organ or bowel perforation. Peritoneal dialysis does not use vascular access.

A patient with diabetes and heart disease is diagnosed with chronic kidney disease. Which medication order should the nurse question for this patient? 1. oral antihyperglycemic agent 2. beta-blocker 3. calcium channel blocker 4. analgesic

Correct Answer: 1 Rationale 1: Drugs such as metformin (Glucophage) and other oral antihyperglycemic agents eliminated by the kidney are to be avoided. Rationale 2: Beta-blockers may be used with dosage adjustment. Rationale 3: Calcium channel blockers may be used with dosage adjustment. Rationale 4: Analgesics may be used with dosage adjustment. Global Rationale: Drugs such as metformin (Glucophage), and other oral antihyperglycemic agents eliminated by the kidney are to be avoided. Beta-blockers, calcium channel blockers, and analgesics may be used with dosage adjustment.

The nurse is teaching a patient about hemodialysis. How should the nurse explain this process? 1. It moves blood through a semipermeable membrane into a dialyzer that is used to remove waste products as well as correct fluid and electrolyte imbalances. 2. It allows a choice of either diffusion osmosis or ultrafiltration to remove excess water from the body. 3. It adds potassium to the blood when passing through the dialyzer and works on the principle of diffusion. 4. It will add electrolytes and water to the blood when passing through a semipermeable membrane to correct electrolyte imbalances.

Correct Answer: 1 Rationale 1: Hemodialysis uses the principles of diffusion and ultrafiltration to remove electrolytes, waste products, and excess water from the body. Blood is taken from the patient and pumped into the dialyzer, where a semipermeable membrane allows small molecules to pass through. Rationale 2: Hemodialysis uses both principles of diffusion and ultrafiltration to remove electrolytes. Rationale 3: Hemodialysis removes electrolytes from the body and works on the principles of diffusion and ultrafiltration. Rationale 4: Hemodialysis removes electrolytes and excess water from the body. Global Rationale: Hemodialysis uses the principles of diffusion and ultrafiltration to remove electrolytes, waste products, and excess water from the body. Blood is taken from the patient and pumped into the dialyzer, where a semipermeable membrane allows small molecules to pass through. Hemodialysis removes electrolytes and excess water from the body and works on the principles of diffusion and ultrafiltration.

The nurse administers epoetin alfa (Epogen) to a patient on dialysis. What should the nurse expect the therapeutic effect of this medication to be? 1. It treats the anemia seen in chronic kidney disease patients on dialysis. 2. It combats the effects of dialysis on bone marrow. 3. It promotes elimination of nephrotoxic drugs from the body. 4. It enhances absorption of iron and folate in the intestinal tract.

Correct Answer: 1 Rationale 1: In chronic kidney disease, erythropoietin production in the kidney declines, which suppresses RBC production leading to anemia. Erythropoeisis-stimulating agents such as epoetin alfa increase RBC production. Rationale 2: Epoetin alfa has no action on bone marrow. Rationale 3: Epoetin alfa does not promote elimination of nephrotoxic drugs from the body. Rationale 4: Epoetin alfa does not affect absorption of iron or folate. Global Rationale: In chronic kidney disease, erythropoietin production in the kidney declines, which suppresses RBC production leading to anemia. Erythropoiesis-stimulating agents such as epoetin alfa increase RBC production. Iron and folate deficiencies are also seen in the patient on dialysis but these are related to inadequate nutrition. Epoetin alfa has no action on bone marrow, does not promote elimination of nephrotoxic drugs from the body, and does not affect absorption of iron or folate.

The nurse is planning the care of a patient with chronic glomerulonephritis. What should the nurse identify as being the goal of treatment for this patient? 1. maintaining renal function 2. achieving maximum independence 3. returning to work as soon as possible 4. lifestyle changes

Correct Answer: 1 Rationale 1: Management of all types of glomerulonephritis—acute and chronic, primary and secondary—focuses on identifying the underlying disease process and preserving kidney function. In most glomerular disorders, there is no specific treatment to achieve a cure. Treatment goals are to maintain renal function, prevent complications and support the healing process. Rationale 2: Although maintenance of independence may be included in the plan of care, it is not a priority. Rationale 3: Although returning to work may be included in the plan of care, it is not a priority. Rationale 4: Although lifestyle adaptation may be included in the plan of care, it is not a priority. Global Rationale: Management of all types of glomerulonephritis—acute and chronic, primary and secondary—focuses on identifying the underlying disease process and preserving kidney function. In most glomerular disorders, there is no specific treatment to achieve a cure. Treatment goals are to maintain renal function, prevent complications and support the healing process. Although maintenance of independence, returning to work and lifestyle adaptation may be included in the plan of care, they are not priorities.

A patient with chronic kidney disease is diagnosed with hypertension. The nurse realizes that this patient's blood pressure needs to be controlled because 1. not doing so increases the risk of adverse effects on the kidneys. 2. it is the easiest diagnosis to treat. 3. medications are available to treat this disorder. 4. everyone should have low-normal blood pressure.

Correct Answer: 1 Rationale 1: Management of hypertension to maintain blood pressure within normal limits the risk of adverse effects on the kidneys. Rationale 2: Hypertension is not always easily diagnosed. Rationale 3: Just because medications are available to treat the disorder is not a rationale for why blood pressure should be controlled. Rationale 4: The idea of everyone having low-normal blood pressure does not apply to this patient because of the new diagnosis and history of chronic kidney disease. Global Rationale: Management of hypertension to maintain blood pressure within normal limits the risk of adverse effects on the kidneys. Hypertension is not always easily diagnosed. The goal of having this patient's blood pressure under control is directly related to his chronic kidney disease. Just because medications are available to treat the disorder is not a rationale for why blood pressure should be controlled. The idea of everyone having low-normal blood pressure does not apply to this patient because of the new diagnosis and history of chronic kidney disease.

The nurse is planning care for a patient with kidney disease who is having difficulty maintaining adequate nutrition. Which intervention should the nurse include in this patient's plan of care? 1. Provide mouth care before meals. 2. Schedule meals for three times each day. 3. Provide antiemetics after meals. 4. Weigh once per week.

Correct Answer: 1 Rationale 1: Mouth care improves taste, stimulates the appetite, and maintains the integrity of oral mucous membranes. Rationale 2: The patient would benefit from small meals and between-meal snacks. Rationale 3: Antiemetics should be administered 30 to 60 minutes before meals. Rationale 4: The patient should be weighed daily before breakfast. Global Rationale: Mouth care improves taste, stimulates the appetite, and maintains the integrity of oral mucous membranes. The patient would benefit from small meals and between meal snacks. Antiemetics should be administered 30 to 60 minutes before meals. The patient should be weighed daily before breakfast.

The nurse is evaluating the effectiveness of dietary teaching provided to a patient with chronic kidney disease. Which menu choices indicate that the patient understands the dietary regimen? 1. apple and oatmeal for breakfast; peanut butter sandwich for lunch; pasta with fish for dinner 2. bacon and eggs for breakfast; hot dog with sauerkraut for lunch; baked canned ham with green peas for dinner 3. two bananas for breakfast; rice and beans for lunch; fruit salad, green beans, and an 8-ounce steak for dinner 4. half a cantaloupe and three eggs for breakfast; a baked potato with processed cheese spread and broccoli for lunch; chicken, pinto beans, squash, and pecan pie for dinner

Correct Answer: 1 Rationale 1: The patient with chronic kidney disease needs to adhere to a low-protein, sodium- and potassium-restricted diet. These menu choices adhere to the dietary regimen. Rationale 2: Processed foods (canned ham, sauerkraut, cheese spread) contain high levels of sodium, which is restricted. Rationale 3: These menu choices include excessive amounts of potassium (bananas) and protein, which are restricted. Rationale 4: These menu choices include processed foods (canned ham, sauerkraut, cheese spread) that contain high levels of sodium, which is restricted. Global Rationale: The patient with chronic kidney disease needs to adhere to a low-protein, sodium- and potassium-restricted diet. Menu choices that include large amounts of protein, potassium, and sodium in processed foods indicate that dietary teaching was not effective.

The nurse is caring for a patient with chronic glomerulonephritis. Which intervention should the nurse add to this patient's plan of care to address excess body fluid? 1. Weigh daily on the same scale. 2. Document energy level. 3. Schedule activities to conserve energy. 4. Assess for signs of infection.

Correct Answer: 1 Rationale 1: To address excess body fluid, the nurse should add daily weights with a consistent technique to the patient's plan of care. Accurate daily weights are the best indicator of approximate fluid balance. Rationale 2: Energy level does not address the issue of excess body fluid. Rationale 3: Energy level does not address the issue of excess body fluid. Rationale 4: Signs of infection do not address the issue of excess body fluid. Global Rationale: To address excess body fluid, the nurse should add daily weights with a consistent technique to the patient's plan of care. Accurate daily weights are the best indicator of approximate fluid balance. Energy level and signs of infection do not address the issue of excess body fluid.

The nurse is completing the instructions to a patient who underwent a cadaver kidney transplant and is ready for discharge from the hospital. What patient statement indicates that further teaching is needed? 1. "I'm glad I won't have to take immunosuppressants any longer." 2. "I know to check my weight on a regular basis." 3. "I'll call my doctor if I notice any decrease in my urine output." 4. "I'll tell my friends to stay away from me if they have colds or the flu."

Correct Answer: 1 Rationale 1: Unless the donor and recipient are identical twins, immunosuppressants are taken to minimize the immune response to reject the transplanted organ. Rationale 2: The patient will need to check weight on a regular basis. Rationale 3: The patient should contact the physician with any decreases in urine output. Rationale 4: The patient should also avoid individuals who have colds or the flu. Global Rationale: Unless the donor and recipient are identical twins, immunosuppressants are taken to minimize the immune response to reject the transplanted organ. The patient will need to check weight on a regular basis. The patient should contact the physician with any decreases in urine output. The patient should also avoid individuals who have colds or the flu.

The nurse is preparing to assess an older patient with age-related renal dysfunction. What should the nurse include in this assessment? 1. evidence of medication or drug toxicity 2. recreational activities 3. activity status 4. daily meal pattern

Correct Answer: 1 Rationale 1: With age-related changes in kidney function, there is a decrease in glomerular filtration rate (GFR). This can lead to a decrease in the clearance of drugs, primarily through the kidneys. The nurse should assess this patient for drug toxicity. Rationale 2: Recreational activities may or may not be affected. Rationale 3: Activity status may or may not be affected. Rationale 4: Meal patterns may or may not be affected. Global Rationale: With age-related changes in kidney function, there is a decrease in glomerular filtration rate (GFR). This can lead to a decrease in the clearance of drugs, primarily through the kidneys. The nurse should assess this patient for drug toxicity. Recreational activities, activity status, and meal patterns may or may not be affected.

A patient is scheduled to have an arteriovenous (AV) fistula created for hemodialysis. What should the nurse include when teaching the patient about this fistula? Standard Text: Select all that apply. 1. Avoid using the arm with the fistula for blood pressure readings. 2. A functioning fistula has a palpable pulse and bruit. 3. Ensure the use of the dominant hand and arm for placement. 4. The fistula can be used immediately after its creation. 5. Venipunctures should be performed on the arm with the fistula.

Correct Answer: 1, 2 Rationale 1: The arm in which is fistula is placed should not be used for blood pressure, and that arm should be marked as not available for these purposes. Rationale 2: A functional arteriovenous (AV) fistula has a palpable pulse and a bruit on auscultation. Rationale 3: The nondominant arm is preferred for fistula placement. Rationale 4: It takes about a month for the fistula to mature. Rationale 5: The arm in which is fistula is placed should not be used for venipuncture and that arm should be marked as not available for these purposes. Global Rationale: Avoid using the arm with the fistula for blood pressure readings. A functional arteriovenous (AV) fistula has a palpable pulse and a bruit on auscultation. The arm in which a fistula is placed should not be used for venipuncture, and that arm should be marked as not available for these purposes. It takes about a month for the fistula to mature.

A patient with chronic kidney disease is trying to decide between hemodialysis and peritoneal dialysis. What should the nurse encourage the patient to consider as advantages of peritoneal dialysis? Standard Text: Select all that apply. 1. minimal vascular complications 2. liberal intake of fluids 3. better self-management 4. better metabolite elimination 5. lower risk of infection

Correct Answer: 1, 2, 3 Rationale 1: Peritoneal dialysis has several advantages over hemodialysis. Heparinization and vascular complications associated with an arteriovenous (AV) fistula are avoided. Rationale 2: More liberal intake of fluid and nutrients is often allowed for the patient on continuous ambulatory peritoneal dialysis (CAPD). Rationale 3: The patient on peritoneal dialysis is better able to self-manage the treatment regimen, which reduces feelings of helplessness. Rationale 4: The major disadvantages of peritoneal dialysis include less effective metabolite elimination. Rationale 5: The major disadvantages of peritoneal dialysis include risk for infection (peritonitis). Global Rationale: Peritoneal dialysis has several advantages over hemodialysis. Heparinization and vascular complications associated with an arteriovenous (AV) fistula are avoided. The clearance of metabolic wastes is slower but more continuous. More liberal intake of fluid and nutrients is often allowed for the patient on continuous ambulatory peritoneal dialysis (CAPD). The patient on peritoneal dialysis is better able to self-manage the treatment regimen, which reduces feelings of helplessness. The major disadvantages of peritoneal dialysis include less effective metabolite elimination and risk for infection (peritonitis), serum triglyceride levels may increase, and the presence of an indwelling catheter may cause a body image disturbance.

At the conclusion of a health history the nurse determines that a patient is at risk for kidney cancer. What did the nurse assess to make this clinical decision? Standard Text: Select all that apply. 1. obesity 2. over 55 years of age 3. genetic predisposition 4. female 5. bladder calculi

Correct Answer: 1, 2, 3 Rationale 1: Risk factors for the development of kidney cancer include obesity. Rationale 2: Risk factors for the development of kidney cancer include age greater than 55. Rationale 3: Risk factors for the development of kidney cancer include having a genetic predisposition to the disease. Rationale 4: Males are affected more than females by a 2:1 ratio. Rationale 5: Bladder calculi are not identified as increasing the risk of kidney cancer. Global Rationale: Risk factors for the development of kidney cancer include obesity, age greater than 55, and having a genetic predisposition to the disease. Males are affected more than females by a 2:1 ratio. Bladder calculi are not identified as increasing the risk of kidney cancer.

A patient with chronic kidney disease is prescribed a diet containing 0.75 grams of protein per kg of body weight per day. The patient weighs 231 lbs. How many grams of protein should the nurse instruct the patient to ingest each day? Standard Text: Calculate to the nearest whole number.

Correct Answer: 79 grams Global Rationale: To calculate this patient's weight in kg, divide the weight in lbs. by 2.2 or 231/2.2 = 105 kg. Then multiply the prescribed amount of protein by the weight in kg or 0.75 grams × 105 = 78.75 grams. When rounded, the patient should be instructed to ingest 79 grams of protein each day.