Kidney Disorders PrepU Ch. 54
The most accurate indicator of fluid loss or gain in an acutely ill patient is a) blood pressure. b) edema. c) pulse rate. d) weight.
weight. Correct Explanation: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. Blood pressure, pulse rate, and edema are not the most accurate indicator of fluid loss or gain.
A patient diagnosed with chronic renal failure is receiving continuous peritoneal dialysis (PD). The nurse instructs the patient about which of the following diet plans? a) High-protein diet b) High-calorie diet c) Low-protein diet d) Low-sodium diet
High-protein diet Correct Explanation: Because of protein loss with continuous PD, the patient is instructed to eat a high-protein, nutritious diet. The patient is also encouraged to increase his or her daily fiber intake to help prevent constipation, which can impede the flow of dialysate into or out of the peritoneal cavity. A low-protein diet is required to reduce the production of end products of protein metabolism that the kidneys are unable to excrete. Establishing a diet high in calories and low in protein, sodium, and potassium is essential for patients with acute renal failure.
Kidney Disorders PrepU Chapter 54
Kidney Disorders PrepU Chapter 54
The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than ___________mL/kg/hr.
0.5 mL/kg/hr Correct Explanation: Oliguria is defined as urine output less than 0.5 mL/kg/hr.
The nurse is caring for a patient with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which of the following nursing actions is contraindicated? a) Obtaining blood samples from the left arm b) Obtaining a blood pressure reading from the right arm c) Palpating the fistula for a "thrill" d) Placing the patient's watch on the left wrist
Obtaining a blood pressure reading from the right arm Correct Explanation: The nurse assesses the vascular access for patency. The bruit, or "thrill," over the venous access site must be evaluated at least every shift. The nurse takes precautions to ensure that the extremity with the vascular access is not used for measuring blood pressure or for obtaining blood specimens; tight dressings, restraints, or jewelry over the vascular access must be avoided as well.
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? a) Hypertension b) Dehydration c) Hyperkalemia d) Crackles
Dehydration Correct Explanation: The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.
During hemodialysis, toxins and wastes in the blood are removed by which of the following? a) Filtration b) Diffusion c) Ultrafiltration d) Osmosis
Diffusion Explanation: The toxins and wastes in the blood are removed by diffusion, in which particles move from an area of higher concentration in the blood to an area of lower concentration into the dialysate.
As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur? a) Hypokalemia b) Hyperphosphatemia c) Hypercalcemia d) Metabolic alkalosis
Hyperphosphatemia Correct Explanation: Changes include hyperphosphatemia due to its decreased renal excretion, hypocalcemia and decreased vitamin D activation, hyperkalemia due to decreased potassium excretion, and metabolic acidosis from decreased acid secretion by the kidney and inability to regenerate bicarbonate.
Acute dialysis is indicated in which situation? a) Impending pulmonary edema b) Metabolic alkalosis c) Hypokalemia d) Dehydration
Impending pulmonary edema Correct Explanation: Acute dialysis is indicated when there is a high and increasing level of serum potassium, fluid overload, or impending pulmonary edema, or increasing acidosis.
Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective? a) "A special access is created in my vein for peritoneal dialysis." b) "Ultrafiltration methods take much longer than hemodialysis." c) "There are few complications with renal replacement therapies." d) "A family member can help me perform hemodialysis in my home."
"Ultrafiltration methods take much longer than hemodialysis." Explanation: Ultrafiltration methods (CVVH, CVVHD) are better tolerated by unstable clients as fluid is removed slowly, resulting in mild hemodynamic effects.
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: a) "As the disease progresses, you will most likely require renal replacement therapy." b) "Dietary changes can reverse the damage that has occurred in your kidneys." c) "Genetic testing will determine the best treatment for your condition." d) "Draining of the cysts and antibiotic therapy will cure your disease."
"As the disease progresses, you will most likely require renal replacement therapy." Correct Explanation: There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.
The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching? a) "I should limit foods high in potassium in my diet, such as bananas." b) "I should drink as much as possible to keep my kidneys working." c) "My intake of high sodium foods should be limited." d) "I should limit the amount of protein in my diet."
"I should drink as much as possible to keep my kidneys working." Correct Explanation: Dietary management of acute post-streptococcal glomerulonephritis includes restrictions of protein, sodium, potassium, and fluids.
The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? a) Hypotension b) Cola-colored urine c) Hyperalbuminemia d) Peripheral neuropathy
Cola-colored urine Correct Explanation: Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a) Fever b) Diuresis c) Weight loss d) Absence of pain
Fever Correct Explanation: Fever is an indicator of infection or transplant rejection.
Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure? a) Urinary retention b) Activity intolerance c) Disturbed body image d) Fluid volume excess
Fluid volume excess Correct Explanation: The oliguric phase is characterized by fluid retention.
Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure? a) Dysrhythmia b) Ureteral calculus c) Glomerulonephritis d) Hypovolemia
Glomerulonephritis Correct Explanation: Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? a) Pyuria b) Low blood pressure c) Left upper quadrant pain d) Tea-colored urine
Tea-colored urine Correct Explanation: Tea-colored urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis.
Which nursing intervention should the nurse caring for the client with pyelonephritis implement? a) Administer acetaminophen (Tylenol). b) Restrict fluid intake to 1 liter per day. c) Straight catheterize the client every 4 to 6 hours. d) Teach client to increase fluid intake up to 3 liters per day.
Teach client to increase fluid intake up to 3 liters per day. Correct Explanation: The nurse teaches the client to increase fluid intake to promote renal blood flow and flush bacteria from the urinary tract.
An expected outcome for the hemodialysis client is: a) The client demonstrates how to administer the dialysate by gravity. b) The client verbalizes the dwell time for the dialysate. c) The client identifies signs and symptoms of rejection. d) The client explains how to assess the venous access site.
The client explains how to assess the venous access site. Correct Explanation: Hemodialysis requires the creation of an arterio-venous access site. The absence of a palpable thrill suggests the AV site is blocked or clotted.
A client with chronic renal failure is experiencing metabolic acidosis. The client most likely requires: a) no treatment b) sodium bicarbonate supplements c) peritoneal dialysis d) hemodialysis
no treatment Explanation: The metabolic acidosis of chronic renal failure usually produces no symptoms and requires no treatment.
The nurse is caring for a client with end-stage kidney disease. What arterial blood gas results are most closely associated with this disorder? a) pH 7.47, PaCO2 45, HCO3 33- b) pH 7.31, PaCO2 48, HCO3 24- c) pH 7.20, PaCO2 36, HCO3 14- d) pH 7.50, PaCO2 29, HCO3 22-
pH 7.20, PaCO2 36, HCO3 14- Correct Explanation: Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.
Mr. Billings is being seen as a client in the urology practice. He has a family history of polycystic kidney disease. Of the following assessment findings, which would you expect to find as you gather information and complete an assessment related to a polycystic kidney diagnosis? Select all that apply. a) Hypertension b) No renal stones c) Normal urinalysis d) Pain from retroperitoneal bleeding
• Hypertension • Pain from retroperitoneal bleeding Explanation: Hypertension is present in approximately 75% of affected clients at the time of diagnosis. Pain from retroperitoneal bleeding is caused by the size and effects of the cysts. Urinalysis shows mild proteinuria, hematuria, and pyuria. Renal stones are common.
Which of the following is a characteristic of the intrarenal category of AKI? a) Decreased urine sodium b) Increased BUN c) High specific gravity d) Decreased creatinine
Increased BUN Correct Explanation: The intrarenal category of AKI encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium. Intrarenal AKI is the result of actual parenchymal damage to the glomeruli or kidney tubules. Acute tubular necrosis (ATN), acute kidney injury in which there is damage to the kidney tubules, is the most common type of intrinsic AKI. Characteristics of ATN are intratubular obstruction, tubular back leak (abnormal reabsorption of filtrate and decreased urine flow through the tubule), vasoconstriction, and changes in glomerular permeability. These processes result in a decrease of GFR, progressive azotemia, and fluid and electrolyte imbalances.
The client with acute renal failure progresses through four phases. Which of the following describes the initiation phase? a) Normal glomerular filtration and tubular function are restored. b) The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. c) It is accompanied by reduced blood flow to the nephrons. d) Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications.
It is accompanied by reduced blood flow to the nephrons. Correct Explanation: The initiation phase is accompanied by reduced blood flow to the nephrons. In the oliguric phase, fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. During the diuretic phase, excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. During the recovery phase, normal glomerular filtration and tubular function are restored.
A client is being treated for renal calculi and suspected hydronephrosis. Therefore, the nurse should maintain a record of the kidney's function. Which of the following measures can the nurse take to help achieve the objective? a) Monitor the client's intake and output. b) Palpate for a thrill over the vascular access. c) Inspect the skin over the fistula or graft for signs of infection. d) Note the nailbeds and mobility of the fingers.
Monitor the client's intake and output. Correct Explanation: Monitoring and recording the client's intake and output provides information about the kidneys' function. It also helps identify any arising complications such as hydronephrosis. This would be care for a hemodialysis patient.
The nurse is treating a patient with ESKD. The nurse is concerned that the patient is developing renal osteodystrophy. Upon review of the patient's laboratory values, it is noted the patient has had a calcium level of 11 mg/dL for the past 3 days and the phosphate level is 5.5 mg/dL. The nurse anticipates the administration of which of the following medications? a) Os-Cal (calcium carbonate) b) Renagel (sevelamer) c) Mylanta d) Phos-Lo (calcium carbonate)
Renagel (sevelamer) Correct Explanation: Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. If calcium is high or the calcium-phosphorus product exceeds 55 mg/dL, a polymeric phosphate binder such as sevelamer hydrochloride (Renagel) may be prescribed. This medication binds dietary phosphorus in the intestinal tract; one to four tablets should be administered with food to be effective. Magnesium-based antacids are avoided to prevent magnesium toxicity.
Which of the following is the most sensitive indicator of renal function? a) Potassium b) Blood urea nitrogen (BUN) c) Creatinine clearance d) Serum creatinine
Serum creatinine Correct Explanation: Serum creatinine is the more sensitive indicator of renal function because of its constant production in the body.
The nurse is performing acute intermittent peritoneal dialysis (PD) on a patient who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. Which of the following is the nurse's best action? a) Notify the health care provider. b) Turn the patient from side to side. c) Push the catheter further into the abdomen. d) Lower the head of the bed.
Turn the patient from side to side. Correct Explanation: If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the patient from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. Other measures to promote drainage include checking the patency of the catheter by inspecting for kinks, closed clamps, or an air lock.
The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following? a) Metabolic alkalosis b) Hypophosphatemia c) Anemia d) Hypokalemia
Anemia Correct Explanation: Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic glomerulonephritis
Which of the following is a change that occurs in chronic glomerulonephritis? a) Metabolic alkalosis b) Hypokalemia c) Anemia d) Hypophosphatemia
Anemia Correct Explanation: Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic glomerulonephritis.
Mr. Jarvis's renal failure has become chronic. You are seeing him in clinic and he discusses the various signs and symptoms he is experiencing. Select all of the following which you know to be associated with chronic renal failure. a) Bleeding of the oral mucous membranes b) Enhanced cognition c) Lethargy d) Muscle cramps
Correct response: • Lethargy • Muscle cramps • Bleeding of the oral mucous membranes Explanation: Lethargy, muscle cramps, and bleeding of the oral mucous membranes are some of the signs and symptoms of chronic renal failure. With chronic renal failure, mental processes progressively slow as electrolyte imbalances become marked and nitrogenous wastes accumulate.
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? a) Increase protein, carbohydrates, and fat intake. b) Increase carbohydrates and limit protein intake. c) Eliminate fat intake and increase protein intake. d) Increase fat intake and limit carbohydrates.
Increase carbohydrates and limit protein intake. Correct Explanation: Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.
The nurse is caring for a patient with CKD. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? __________________ a) 4,000
4,000 Correct Explanation: A 1-kg weight gain is equal to 1,000 mL of retained fluid. 4 kg × 1,000 = 4,000. The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded.
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? a) Acute glomerulonephritis b) Chronic renal failure c) Acute renal failure d) Nephrotic syndrome
Acute glomerulonephritis Correct Explanation: Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.
Which of the following is the leading cause of death among patients undergoing maintenance hemodialysis? a) Coronary heart disease b) Stroke c) Heart failure d) Atherosclerotic cardiovascular disease
Atherosclerotic cardiovascular disease Correct Explanation: A leading cause of death among patients undergoing maintenance hemodialysis is atherosclerotic cardiovascular disease. Heart failure, coronary heart disease and angina pain, stroke, and peripheral vascular insufficiency may occur and may incapacitate the patient.
Which of the following is a term used to describe excessive nitrogenous waster in the blood, as seen in acute glomerulonephritis? a) Azotemia b) Hematuria c) Bacteremia d) Proteinuria
Azotemia Correct Explanation: The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.
Which of the following terms is used to describe the concentration of urea and other nitrogenous wastes in the blood? a) Azotemia b) Uremia c) Hematuria d) Proteinuria
Azotemia Explanation: Azotemia is the concentration of urea and other nitrogenous wastes in the blood. Uremia is an excess of urea and other nitrogenous wastes in the blood. Hematuria is blood in the urine. Proteinuria is protein in the urine.
The nurse is caring for a patient who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed which of the following? a) Chronic rejection b) Simple rejection c) Acute rejection d) Hyperacute rejection
Correct response: Hyperacute rejection Explanation: After a kidney transplant, rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years. A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized glomerular capillary thrombosis and necrosis. The term "simple" is not used in the categorization of types of rejection of kidney transplants.
Ms. Linden is in end-stage chronic renal failure and is being added to the transplant list. You are explaining to her how donors are found for clients needing kidneys. You would be accurate in telling her which of the following? a) The client is placed on a transplant list at the local hospital. b) Donors with hypertension may qualify. c) Donors must be relatives. d) Donors are selected from compatible living donors.
Donors are selected from compatible living donors. Correct Explanation: Donors are selected from compatible living donors. Donors do not have to be relatives as long as they are compatible. Potential donors with a history of hypertension, malignant disease, or diabetes are excluded from donation. The client is placed on a national computerized transplant waiting list.
Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure? a) Ureteral calculus b) Dysrhythmia c) Glomerulonephritis d) Hypovolemia
Glomerulonephritis Correct Explanation: Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
Which of the following is an integumentary manifestation of chronic renal failure? a) Tremors b) Gray-bronze skin color c) Asterixis d) Seizures
Gray-bronze skin color Correct Explanation: Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.
A patient diagnosed with chronic renal failure is receiving continuous peritoneal dialysis (PD). The nurse instructs the patient about which of the following diet plans? a) Low-sodium diet b) High-protein diet c) High-calorie diet d) Low-protein diet
High-protein diet Correct Explanation: Because of protein loss with continuous PD, the patient is instructed to eat a high-protein, nutritious diet. The patient is also encouraged to increase his or her daily fiber intake to help prevent constipation, which can impede the flow of dialysate into or out of the peritoneal cavity. A low-protein diet is required to reduce the production of end products of protein metabolism that the kidneys are unable to excrete. Establishing a diet high in calories and low in protein, sodium, and potassium is essential for patients with acute renal failure.
As an inflammatory response in the glomerular capillary membrane, the renal filtration system is disrupted. Although diagnostic urinalysis can reveal glomerulonephritis, many of those suffering with glomerulonephritis exhibit what symptoms? a) Fever b) No symptoms c) Headache d) Polyuria
No symptoms Explanation: Many clients with glomerulonephritis have no symptoms. Early symptoms may be so slight that the client does not seek medical attention.
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? a) Recovery b) Initiation c) Oliguria d) Diuresis
Oliguria Correct Explanation: The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys, such as urea and creatinine. The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.
Which of the following is the hallmark of the diagnosis of nephrotic syndrome? a) Hyponatremia b) Hyperalbuminemia c) Hypokalemia d) Proteinuria
Proteinuria Correct Explanation: Proteinuria (predominantly albumin) exceeding 3.5 g/day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may also occur. Proteinuria and microscopic hematuria may persist for many months; in fact, 20% of patients have some degree of persistent proteinuria or decreased glomerular filtration rate (GFR) 1 year after presentation.
A 44-year-old client is in the hospital unit where you practice nursing. From the results of a series of diagnostic tests, she has been diagnosed with acute glomerulonephritis. What would you expect to find as a result of this condition? a) Polyuria b) Proteinuria c) Pyuria d) No option is correct.
Proteinuria Correct Explanation: The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided. The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. This answer is incorrect.
The nurse caring for the client with acute renal failure would question which of the following for the treatment of hyperkalemia? a) albuterol sulfate (Ventolin HFA) b) sodium polysterene sulfonate (Kayexalate) c) hypertonic glucose and insulin infusions d) lanthanum carbonate (Fosrenol)
You selected: lanthanum carbonate (Fosrenol) Correct Explanation: Hyperkalemia associated with acute renal failure may be treated wtih sodium polysterene sulfonate (Kayexalate), hypertonic glucose and insulin infusion, or albuterol sulfate (Ventolin HFA). Albuterol sulfate (Ventolin HFA) is used to treat hyperphosphatemia.
As glomerular filtration decreases, which of the following occurs? Select all that apply. a) Creatinine clearance decreases b) BUN decreases c) Serum creatinine decreases d) Blood urea nitrogen (BUN) increases e) Serum creatinine increases
• Creatinine clearance decreases • Blood urea nitrogen (BUN) increases • Serum creatinine increases Correct Explanation: As glomerular filtration decreases, the serum creatinine and BUN levels increase; the creatinine clearance decreases.
Select all of the following which are true about extracorporeal shock wave lithotripsy (ESWL). a) ESWL is administered with the client in a water bath or surrounded by a soft cushion while under light anesthesia or sedation. b) ESWL is done while the patient is undergoing a percutaneous nephrolithotomy. c) Stones are shattered into smaller particles that are passed from the urinary tract. d) ESWL is a ureteroscopic approach.
• ESWL is administered with the client in a water bath or surrounded by a soft cushion while under light anesthesia or sedation. • Stones are shattered into smaller particles that are passed from the urinary tract. Correct Explanation: Stones are shattered into smaller particles that are passed from the urinary tract. ESWL is administered with the client in a water bath or surrounded by a soft cushion while under light anesthesia or sedation. ESWL is not a ureteroscopic approach. ESWL is not done while the patient is undergoing a percutaneous nephrolithotomy.
Patient education regarding a fistulae or graft includes which of the following? Select all that apply. a) Cleanse site b.i.d. b) No tight clothing. c) Avoid compression of the site. d) Check daily for thrill and bruit. e) No IV or blood pressure taken on extremity with dialysis access.
• No tight clothing. • Avoid compression of the site. • Check daily for thrill and bruit. • No IV or blood pressure taken on extremity with dialysis access. Correct Explanation: The nurse teaches the patient with fistulae or grafts to check daily for a thrill and bruit. Further teaching includes avoiding compression of the site; not permitting blood to be drawn, an IV to be inserted, or blood pressure to be taken on the extremity with the dialysis access; not to wear tight clothing, carry bags or pocketbooks on that side, and not lie on or sleep on the area. The site is not cleansed unless it is being accessed for hemodialysis.
The nurse is helping a patient to correctly perform peritoneal dialysis at home. The nurse must educate the patient about the procedure. Which educational information should the nurse provide to the patient? a) Keep the catheter stabilized to the abdomen, below the belt line b) Clean the catheter insertion site daily with soap c) Keep the dialysis supplies in a clean area, away from children and pets d) Wear a mask while handling any dialysate solutions
Correct response: Keep the dialysis supplies in a clean area, away from children and pets Explanation: It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a patient has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine (Betadine), not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.
Following are complications the nurse should monitor for during dialysis except for which of the following? a) Air embolism b) Hypertension c) Dysrhythmias d) Muscle cramping
Hypertension Correct Explanation: The nurse should monitor for hypotension, not hypertension, during the treatment related to the removal of fluid. Muscle cramping may occur late in dialysis as fluid and electrolytes rapidly leave the extracellular space. Dysrhythmias may result from electrolyte and pH changes or removal of antiarrhythmic medications. Air embolism is rare, but could occur if air enters the vascular system.
The nurse is passing out medications on a medical-surgical unit. A male patient is preparing for hemodialysis. The patient is ordered to receive numerous medications including antihypertensives. Which of the following is the best action for the nurse to take? a) Administer the medications as ordered. b) Check with the dialysis nurse about the medications. c) Hold the medications until after dialysis. d) Ask the patient if he wants to take his medications.
Hold the medications until after dialysis. Correct Explanation: Antihypertensive therapy, often part of the regimen of patients on dialysis, is one example when communication, education, and evaluation can make a difference in patient outcomes. The patient must know when—and when not—to take the medication. For example, if an antihypertensive agent is taken on a dialysis day, hypotension may occur during dialysis, causing dangerously low blood pressure. Many medications that are taken once daily can be held until after dialysis treatment.
The client with acute renal failure progresses through four phases. Which of the following describes the initiation phase? a) The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. b) It is accompanied by reduced blood flow to the nephrons. c) Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. d) Normal glomerular filtration and tubular function are restored.
It is accompanied by reduced blood flow to the nephrons. Correct Explanation: The initiation phase is accompanied by reduced blood flow to the nephrons. In the oliguric phase, fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. During the diuretic phase, excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. During the recovery phase, normal glomerular filtration and tubular function are restored.
A patient diagnosed AKI has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering which of the following? a) Calcium supplements b) Kayexalate c) Sorbitol d) IV dextrose 50%
Kayexalate Correct Explanation: The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract. Sorbitol may be administered in combination with Kayexalate to induce a diarrhea-type effect (it induces water loss in the GI tract). If the patient is hemodynamically unstable (low blood pressure, changes in mental status, dysrhythmia), IV dextrose 50%, insulin, and calcium replacement may be administered to shift potassium back into the cells.
Mr. Williams, age 56 years, is admitted to the hospital with a prerenal disorder, a nonurologic condition that disrupts renal blood flow to the nephrons, affecting their filtering ability. Of the following possible causes of types of acute renal failure, which of these is a cause of prerenal acute renal failure? a) Myoglobinuria secondary to burns b) Ureteral stricture c) Anaphylaxis d) Polycystic disease
Myoglobinuria secondary to burns Incorrect Correct response: Anaphylaxis Explanation: Anaphylaxis is a cause of prerenal acute renal failure. Myoglobinuria secondary to burns is a cause of intrarenal acute renal failure. Polycystic disease is a cause of intrarenal acute renal failure. Ureteral stricture is a cause of postrenal acute renal failure.
One of the roles of the nurse in caring for the clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include teaching which of the following? a) Limiting iron and folic acid intake b) Allowing liberal use of sodium c) Eating protein liberally d) Restricting sources of potassium usually found in fresh fruits and vegetables
Restricting sources of potassium usually found in fresh fruits and vegetables Correct Explanation: Restrict sources of potassium usually found in fresh fruits and vegetables. Hyperkalemia can cause life-threatening changes. Restrict sodium intake as ordered. Doing so prevents excess sodium and fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken. Iron and folic acid supplements are needed for RBC production. Epogen stimulates bone marrow to produce RBCs. Restrict protein intake to foods that are complete proteins within prescribed limits. Complete proteins provide positive nitrogen balance for healing and growth.
The nurse is helping a patient to correctly perform peritoneal dialysis at home. The nurse must educate the patient about the procedure. Which educational information should the nurse provide to the patient? a) Wear a mask while handling any dialysate solutions b) Clean the catheter insertion site daily with soap c) Keep the dialysis supplies in a clean area, away from children and pets d) Keep the catheter stabilized to the abdomen, below the belt line
Keep the dialysis supplies in a clean area, away from children and pets Correct Explanation: It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a patient has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine (Betadine), not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.
The nurse is instructing a patient to perform continuous ambulatory peritoneal dialysis correctly at home. Which of the following educational information should the nurse provide to the patient? a) Clean the catheter insertion site daily with soap. b) Use an aseptic technique during the procedure. c) Keep the catheter stabilized to the abdomen, below the belt line. d) Wear a mask while handling any dialysate solutions.
Use an aseptic technique during the procedure. Correct Explanation: The patient should be instructed to use an aseptic technique during the procedure. The patient should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (patients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a patient has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine (Betadine), not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.
Which of the following nursing actions is most important in caring for the client following lithotripsy? a) Monitor the continuous bladder irrigation. b) Administer allopurinol (Zyloprim). c) Notify the physician of hematuria. d) Strain the urine carefully for stone fragments.
Correct response: Strain the urine carefully for stone fragments. Explanation: The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical anaysis.
Which nursing intervention should the nurse caring for the client with pyelonephritis implement? a) Straight catheterize the client every 4 to 6 hours. b) Restrict fluid intake to 1 liter per day. c) Teach client to increase fluid intake up to 3 liters per day. d) Administer acetaminophen (Tylenol).
Correct response: Teach client to increase fluid intake up to 3 liters per day. Explanation: The nurse teaches the client to increase fluid intake to promote renal blood flow and flush bacteria from the urinary tract.
A patient diagnosed with AKI has developed congestive heart failure. The patient has received 40 mg of intravenous pyelogram (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The patient's vital signs are stable. Which of the following health care orders should the nurse anticipate? a) Normal saline (NS) bolus of 500 mL b) Chest x-ray c) Mannitol (Osmitrol) 12.5 g IVP d) Lasix (Furosemide) 80 mg IVP
Lasix (Furosemide) 80 mg IVP Correct Explanation: Diuretic agents are often used to control fluid volume in patients with AKI. The patient's urine output indicates an inadequate response to the initial dosage of Lasix and the nurse should anticipate administering Lasix 80 mg IVP. Often in this situation, the initial dosage of Lasix is doubled. The patient is experiencing fluid overload, thus, a 500-mL bolus of NS would be contraindicated. There is no need to complete a chest x-ray. Mannitol is widely used in the management of cerebral edema and increased intracranial pressure (ICP) from multiple causes.
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? a) Oliguria b) Recovery c) Diuresis d) Initiation
(see full question) Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? You selected: Oliguria Correct Explanation: The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys, such as urea and creatinine. The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.
Which phase of acute renal failure signals that glomerular filtration has started to recover? a) Oliguric b) Recovery c) Diuretic d) Initiation
Diuretic Correct Explanation: The oliguric period is accompanied by an increase in the serum concentration of wastes such as urea, creatinine, organic acids, and the electrolytes potassium, phosphorous, and magnesium. The initiation period begins with the initial insult and ends when cellular injury and oliguria develops. The diuretic phase is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover. The recovery period signals the improvement of renal function and energy level and may take 6 to 12 months.
The nurse is caring for a female patient who underwent a kidney transplant. The patient appears anxious and tearful and states "My body is going to reject the new kidney; I know I'm going to die." Which of the following is the best response by the nurse? a) "If your body rejects the kidney, you can go back on dialysis; you are not going to die." b) "I understand your concerns, let's talk about them." c) "Don't think like that; I'm certain you will be fine." d) "You've waited years for this transplant, you need to think positively."
"I understand your concerns, let's talk about them." Correct Explanation: The nurse must address the patient's concerns and encourage the patient to express her thoughts and concerns. The rejection of a transplanted kidney is of great concern to the patient, the family, and the health care team for many months. An important nursing function is the assessment of the patient's stress and coping. The nurse uses each visit with the patient to determine if the patient and family are coping effectively and the patient is adhering to the prescribed medication regimen. If indicated or requested, the nurse refers the patient for counseling. The other responses are nontherapeutic.
The nurse is caring for a patient following extensive abdominal surgery. The patient develops an infection that is treated with IV gentamicin. After 4 days of treatment, the patient develops oliguria, and laboratory results indicate azotemia. The patient is diagnosed with acute tubular necrosis and transferred to the ICU. The patient is hemodynamically stable. Which of the following dialysis methods would be most appropriate for the patient? a) Hemodialysis b) Peritoneal dialysis c) Continuous arteriovenous hemofiltration (CAVH) d) Continuous venovenous hemofiltration (CVVH)
Hemodialysis Correct Explanation: The patient is hemodynamically stable and hemodialysis would be most appropriate. Hemodialysis is used for patients who are acutely ill and require short-term dialysis for days to weeks until kidney function resumes and for patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) who require long-term or permanent renal replacement therapy. Peritoneal dialysis (PD) may be the treatment of choice for patients with renal failure who are unable or unwilling to undergo hemodialysis or kidney transplantation. CAVH and CVVH are used for patients who are hemodynamically unstable.