Mastery Quiz questions Ch.26

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

"Acute kidney injury is abrupt in onset and often reversible if recognized early and treated appropriately." -AKI is the result of a rapid decline in kidney function that increases blood levels of nitrogenous wastes. Once the underlying cause is treated, AKI is potentially reversible if the precipitating factors can be corrected or removed before permanent damage occurs.

The nurse is educating a patient with chronic kidney disease (CKD). What is the recommended daily fluid intake for this patient?

A daily fluid intake of 500 to 800 mL/day to maintain hydration -

The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents:

A loss of over half the client's normal kidney function -In clinical practice, GFR is usually estimated using the serum creatinine concentration. A GFR below 60 mL/minute/1.73 m2 represents a loss of one half or more of the level of normal adult kidney function. The GFR is not diagnostic for concentrated urine or the need to drink more water.

The nurse is caring for a patient who has had acute blood loss from ruptured esophageal varices. Which of the following does the nurse recognize is an early sign of prerenal failure?

Baseline urine output of 50 mL/hr that is now 10 mL/hr -The kidney normally responds to a decrease in the glomerular filtration rate with a decrease in urine output. Thus, an early sign of prerenal failure is a sharp decrease in urine output.

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

Decrease in GFR of 60 to 89 mL/minute/1.73 m^2 -Diminished renal reserve is characteristic of renal insufficiency, when labs remain normal but there is renal insufficiency. Only the second stage, formerly known as renal insufficiency, is characterized by a decrease in GFR of 60 to 89 mL/minute/1.73 m2. The other choices represent stage 3, 4, and 5, respectfully.

The nurse is instructing a patient with advanced kidney disease (AKD) about a dietary regimen. Which of the following restrictions should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD?

Dietary protein -Restriction of dietary proteins may decrease the progress of renal impairment in people with advanced renal disease. Proteins are broken down to form nitrogenous wastes, and reducing the amount of protein in the diet lowers the blood urea nitrogen and reduces symptoms

A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is which of the following?

Dorsiflexion of hands and feet -Asterixis, which is involuntary dorsiflexion of hands and feet, can develop as CKD worsens. Burning sensation in feet, unsteady gait and demyelination of nerves can also accompany CKD, but are not part of asterixis.

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

Glomerular filtration rate (GFR) -GFR is the best overall measure of kidney function. GFR is usually estimated using the serum creatinine concentration. Creatinine, a by-product of muscle metabolism, is produced at a fairly constant rate, is freely filtered in the glomerulus, and is not reabsorbed in the renal tubules. Essentially all of the creatinine filtered by the kidneys is lost in the urine; therefore, serum creatinine is an indirect measure of GFR. Proteinuria serves as a key adjunctive tool for measuring nephron injury and repair. Urine normally contains small amounts of protein. Blood tests for BUN and creatinine provide information regarding the ability to remove nitrogenous wastes from the blood.

A client diagnosed with CKD has begun to experience periods of epistaxis and developed bruising of skin and subcutaneous tissues. The nurse recognizes these manifestations as:

Impaired platelet function -The coagulation disorders of CKD are mainly caused by platelet dysfunction. Platelet counts may be slightly decreased, and the bleeding time is prolonged because of abnormal adhesiveness and aggregation. Clinically, persons with CKD can experience epistaxis (nosebleeds), menorrhagia (excessive menstrual bleeding), gastrointestinal bleeding, and bruising of the skin and subcutaneous tissues

Which of the following data would a clinician consider as most indicative of acute renal failure?

Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR). -The hallmark of acute renal injury is azotemia, an accumulation of nitrogenous wastes such as creatinine, urea nitrogen, and uric acid plus a decrease in the GFR of the kidneys. While pH alterations, edema, electrolyte imbalances and decreased urine output may accompany acute renal failure, they are all potentially attributable to other pathologies. Creatinine, GFR and BUN would be unlikely to rise during renal failure.

A patient has a marked decrease in the glomerular filtration rate (GFR) and has elevations in blood urea nitrogen, potassium, and creatinine levels. The patient's urine output has decreased to 10 mL/hr and has 3+ pitting edema in the lower extremities. In which of the following phases of acute tubular necrosis does the nurse determine the patient is in relating to this assessment data?

Initiating phase -The maintenance phase of acute tubular necrosis is characterized by a marked decrease in the GFR causing sudden retention of endogenous metabolites—such as urea, potassium, sulfate, and creatinine—that normally are cleared by the kidneys. Urine output usually is lowest at this point. Fluid retention gives rise to edema, water intoxication, and pulmonary congestion. If the period of oliguria is prolonged, hypertension frequently develops and with it signs of uremia.

The nurse assessing a renal failure patient for encephalopathy caused by high uremic levels may observe which of the following clinical manifestations?

Loss of recent memory and inattention. -Reductions in alertness and awareness are the earliest and most significant indications of uremic encephalopathy. These often are followed by an inability to fix attention, loss of recent memory, and perceptual errors in identifying people and objects. A=pericarditis; B=arthritis; D=liver involvement.

A drug abuser was found unconscious after shooting up heroin 2 days prior. Because of the pressure placed on the hip and arm, the client has developed rhabdomyolysis. The nurse knows this can:

Obstruct the renal tubules with myoglobin and damage tubular cells -Myoglobin normally is not found in the serum or urine. It has a low molecular weight; if it escapes into the circulation, it is rapidly filtered in the glomerulus. A life-threatening condition known as rhabdomyolysis occurs when increasing myoglobinuria levels cause myoglobin to precipitate in the renal tubules, leading to obstruction and damage to surrounding tubular cells. Myoglobinuria most commonly results from muscle trauma but may result from exertion, hyperthermia, sepsis, prolonged seizures, and alcoholism or drug abuse. Rhabdomyolysis is not cured with anticoagulation administration nor does it cause kidney stones. Compartment syndrome occurs when there is insufficient blood supply to muscles and nerves due to increased pressure within one of the body's compartments.

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

Polyuria -One of the earliest signs of ARF is loss of ability to concentrate urine. The other answer selections are not notable markers of early renal failure; however, they may develop as renal failure progresses.

A patient has an obstructive urine outflow related to benign prostatic hyperplasia. Due to the inability to excrete adequate amounts of urine, which of the following types of renal failure should the nurse closely monitor for?

Postrenal failure -Postrenal failure results from obstruction of urine outflow from the kidneys. The obstruction can occur in the ureter, bladder, or urethra. Due to the increased urine not being able to be excreted due to the obstruction, retrograde pressure occurs throughout the tubules and nephrons, which ultimately damages the nephrons. Prostatic hyperplasia is the most common underlying problem

A patient in renal failure has marked decrease in renal blood flow caused by hypovolemia, caused by gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which of the following forms of acute renal injury does this patient have?

Pre-renal failure -Prerenal failure, the most common form of acute renal failure, is characterized by a marked decrease in renal blood flow. It is reversible if the cause of the decreased renal blood flow can be identified and corrected before kidney damage occurs.

The nurse is reviewing the diagnosis of four male clients. Select the diagnosis that places the clients at risk for developing postrenal kidney failure.

Prostatic hyperplasia -The most common cause of postrenal kidney failure is prostatic hyperplasia. Postrenal failure results from conditions that obstruct urine outflow. The obstruction can occur in the ureter, bladder, or urethra. Intratubular obstruction and acute pyelonephritis are intrarenal causes of kidney failure, and severe hypovolemia is a prerenal cause.

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

Rapid decline in renal function -Acute renal injury is a rapid decline in kidney function. BUN rises as nitrogenous wastes are not removed from the circulation. If the cause can be ameliorated, the injury is usually reversible. Most at risk are seriously ill clients; the mortality rate is between 40% and 90% in these clients.

Which of the following phenomena contributes to the difficulties with absorption, distribution and elimination of drugs that is associated with kidney disease?

Reductions in plasma proteins increase the amount of free drug and decrease the amount of protein-bound drug. -A decrease in plasma proteins, particularly albumin, that occurs in many persons with renal failure results in less protein-bound drug and greater amounts of free drug. Drug elimination problems do not stem as directly from impaired tubular reabsorption, decreased retention or the process of dialysis

An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which of the following early signs of prerenal injury?

Sharp decrease in urine output -Dehydration and its consequent hypovolemia can result in acute renal failure that is prerenal in etiology. The kidney normally responds to a decrease in GFR with a decrease in urine output. Thus, an early sign of prerenal injury is a sharp decrease in urine output. Post-renal failure is obstructive in etiology, and intrinsic (or intrarenal) renal failure is reflective of deficits in the function of the kidneys themselves

Bruising of the skin is a manifestation of bleeding disorders in patients with CKD. T/F?

True -Rationale: Bleeding disorders manifested by persons with CKD include epistaxis, menorrhagia, gastrointestinal bleeding, and bruising of skin and subcutaneous tissues.

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?

serum creatinine

Sexual dysfunction in people with CKD is thought to be multifactorial. What are thought to be causes of sexual dysfunction in people with CKD? (Select all that apply.)

• Antihypertensive drugs • Psychological factors • Uremic toxins -The cause of sexual dysfunction in men and women with CKD is unclear. The cause probably is multifactorial and may result from high levels of uremic toxins, neuropathy, altered endocrine function, psychological factors, and medications (e.g., antihypertensive drugs). The other answers do not apply in this situation.

A patient has developed chronic kidney disease (CKD). The nurse will advise the patient to be alert for the development of which hematologic signs and symptoms of this disorder? Select all that apply.

• Bruising • Gastrointestinal bleeding • Fatigue -In CKD, platelet function is impaired and bruising and gastrointestinal bleeding can occur. Intravascular clotting usually does not happen. Decreased renal production of erythropoietin results in decreased synthesis of red blood cells, resulting in anemia and fatigue. Decrease in red cells also decreases blood viscosity and decreases cerebral oxygen delivery, both of which contribute to tachycardia rather than bradycardia.

Select the body systems most commonly affected by chronic kidney disease in the elderly. Select all that apply.

• Cardiovascular • Cerebrovascular systems • Skeletal -Rationale: CKD in the elderly population affects the cardiovascular, cerebrovascular, and skeletal systems and may contribute to conditions such as congestive heart failure and hypertension

A patient is diagnosed with chronic kidney disease (CKD). The nurse recognizes that this patient will experience which of the following? Select all that apply.

• Decreased glomerular filtration • Decreased renal endocrine function • Decreased tubular reabsorption -Chronic kidney disease results in loss of nephrons, with a decrease in tubular reabsorption, glomerular filtration, and endocrine function. Phosphate accumulates in the blood, as the kidneys lose their ability to excrete this electrolyte.

The nurse is preparing to assess a client who has just been admitted to the hospital with a diagnosis of prerenal failure. Which would the nurse expect the client to manifest? Select all that apply.

• Decreased urinary output • Increased BUN • BUN-to-serum creatinine ratio of greater than 20:1 -Prerenal injury is manifested by a sharp decrease in urine output and a disproportionate elevation of blood urea nitrogen (BUN) in relation to serum creatinine levels. Consequently, there also is a disproportionate elevation in the ratio of BUN to serum creatinine, from a normal value of 10:1 to a ratio greater than 20:1.

The parents of a child who has been diagnosed with CKD ask the nurse about manifestations of the disease. Which is the most appropriate information for the nurse to provide? Select all that apply.

• Developmental delay • Delayed cognitive development • Secondary hyperparathyroidism • Growth impairment -Features of CKD during childhood include severe growth impairment, developmental delay, delay in sexual maturation, bone abnormalities, and development of psychosocial problems. Physical growth and cognitive development occur at a slower rate as consequences of CKD, especially among children with congenital kidney disease. Puberty usually occurs at a later age in children with CKD, partly because of endocrine abnormalities. The most common condition seen in children is high bone turnover osteodystrophy caused by secondary hyperparathyroidism.

The nurse assesses a patient for prerenal failure. Which conditions increase the risk for developing this type of kidney failure? Select all that apply.

• Severe burns • Septic shock • Severe dehydration -Prerenal failure occurs with conditions such as burns, septic shock and dehydration, which decrease renal perfusion. Glomerulonephritis and prolonged renal ischemia will result in intrarenal kidney injury.

The nurse recognizes that renal failure has many underlying causes, including which of the following? Select all that apply

• Systemic disease • Renal disease • Nonrenal urological abnormalities -Underlying causes of renal failure include renal or systemic disease and nonrenal urologic abnormalities. Hepatic disease and malnutrition might gradually influence renal function as they can influence many body functions, but are not considered direct causes of renal failure.