Med Surg Test 3

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. Which strategy is used to achieve ultrafiltration in peritoneal dialysis? Increasing the pressure gradient Increasing osmolality of the dialysate Decreasing the glucose in the dialysate Decreasing the concentration of the dialysate

Increasing osmolality of the dialysate

During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first? Administer hypertonic saline. Administer a blood transfusion. Decrease the rate of fluid removal. Administer antiemetic medications.

Decrease the rate of fluid removal. Correct

Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury (AKI) (select all that apply.)? Dehydration Correct Hypokalemia Correct Hypernatremia BUN increases Urine output increases Correct Serum creatinine increases

Dehydration Correct Hypokalemia Correct Urine output increases Correct

A 56-yr-old woman with type 2 diabetes mellitus and chronic kidney disease has a serum potassium level of 6.8 mEq/L. Which finding will the nurse monitor for? Fatigue Hypoglycemia Cardiac dysrhythmias Elevated triglycerides

Cardiac dysrhythmias

Which patient has the most significant risk factors for CKD? A 50-yr-old white woman with hypertension A 61-yr-old Native American man with diabetes A 40-yr-old Hispanic woman with cardiovascular disease A 28-yr-old African American woman with a urinary tract infection

A 61-yr-old Native American man with diabetes

The patient has rapidly progressing glomerular inflammation. Weight has increased and urine output is steadily declining. What is the priority nursing intervention? A. Monitor the patient's cardiac status. B. Teach the patient about hand washing. C. Obtain a serum specimen for electrolytes. D. Increase direct observation of the patient.

A. Monitor the patient's cardiac status.

A 52-yr-old man with stage 2 chronic kidney disease is scheduled for an outpatient diagnostic procedure using contrast media. Which priority action should the nurse perform? A.Assess skin turgor to determine hydration status. B. Insert a urinary catheter for the expected diuresis. C. Evaluate the patient's lower extremities for edema. D. Check the patient's urine for the presence of ketones.

A.Assess skin turgor to determine hydration status.

A frail 72-yr-old woman with stage 3 chronic kidney disease is cared for at home by her family. The patient has a history of taking many over-the-counter medications. Which over-the-counter medications should the nurse teach the patient to avoid? Aspirin Acetaminophen Diphenhydramine Aluminum hydroxide

Aluminum hydroxide

Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD) (select all that apply.)? Anemia Dehydration Hypertension Hypercalcemia Increased risk for fractures Elevated white blood cells

Anemia Correct Hypertension Correct Increased risk for fractures Correct

A 78-yr-old patient has stage 3 CKD and is being taught about a low-potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat? Apple, green beans, and a roast beef sandwich Granola made with dried fruits, nuts, and seeds Watermelon and ice cream with chocolate sauce Bran cereal with ½ banana and milk and orange juice

Apple, green beans, and a roast beef sandwich Correct

Which statement regarding continuous ambulatory peritoneal dialysis (CAPD) would be most important when teaching a patient new to the treatment? A. "Maintain a daily written record of blood pressure and weight." B. "It is essential that you maintain aseptic technique to prevent peritonitis." C. "You will be allowed a more liberal protein diet once you complete CAPD." D. "Continue regular medical and nursing follow-up visits while performing CAPD."

B. "It is essential that you maintain aseptic technique to prevent peritonitis."

The home care nurse visits a 34-yr-old woman receiving peritoneal dialysis. Which statement indicates a need for immediate follow-up by the nurse? A. "Drain time is faster if I rub my abdomen." B. "The fluid draining from the catheter is cloudy." C. "The drainage is bloody when I have my period." D. "I wash around the catheter with soap and water."

B. "The fluid draining from the catheter is cloudy."

A patient with end-stage renal disease (ESRD) secondary to diabetes mellitus has arrived at the outpatient dialysis unit for hemodialysis. Which assessments should the nurse perform as a priority before, during, and after the treatment? A. Level of consciousness B. Blood pressure and fluid balance C.Temperature, heart rate, and blood pressure D. Assessment for signs and symptoms of infection

B. Blood pressure and fluid balance

A 24-yr-old woman donated a kidney via a laparoscopic donor nephrectomy to a nonrelated recipient. The patient is experiencing significant pain and refuses to get up to walk. How should the nurse respond? A. Have the transplant psychologist convince her to walk. B. Encourage even a short walk to avoid complications of surgery. C. Tell the patient that no other patients have ever refused to walk. D. Tell the patient she is lucky she did not have an open nephrectomy.

B. Encourage even a short walk to avoid complications of surgery.

The nurse is caring for a 68-yr-old man who had coronary artery bypass surgery 3 weeks ago. During the oliguric phase of acute kidney disease, which action would be appropriate to include in the plan of care? A. Provide foods high in potassium. B. Restrict fluids based on urine output. C. Monitor output from peritoneal dialysis. D. Offer high-protein snacks between meals.

B. Restrict fluids based on urine output.

A patient is recovering in the intensive care unit (ICU) 24 hours after receiving a kidney transplant. What is an expected assessment finding during the earliest stage of recovery? A. Hypokalemia B. Hyponatremia C. Large urine output D. Leukocytosis with cloudy urine output

C. Large urine output Patients frequently experience diuresis in the hours and days immediately following a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.

A patient with a 25-year history of type 1 diabetes mellitus is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse notes newly developed hypertension and uncontrolled blood sugars. Which diagnostic study is most indicative of chronic kidney disease (CKD)? Serum creatinine Serum potassium Microalbuminuria Calculated glomerular filtration rate (GFR)

Calculated glomerular filtration rate (GFR)

The physician has decided to use renal replacement therapy to remove large volumes of fluid from a patient who is hemodynamically unstable in the intensive care unit. The nurse should expect which treatment to be used for this patient? Hemodialysis (HD) three times per week Automated peritoneal dialysis (APD) Continuous venovenous hemofiltration (CVVH) Continuous ambulatory peritoneal dialysis (CAPD)

Continuous venovenous hemofiltration (CVVH)

Which patient diagnosis or treatment is most consistent with prerenal acute kidney injury (AKI)? A. IV tobramycin B. Incompatible blood transfusion C. Poststreptococcal glomerulonephritis D. Dissecting abdominal aortic aneurysm

D. Dissecting abdominal aortic aneurysm A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can decrease renal artery perfusion and therefore the glomerular filtrate rate. Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction, and post-streptococcal glomerulonephritis are intrarenal causes of AKI.

The nurse preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD). Which laboratory result will the nurse monitor to determine if the desired effect was achieved? Sodium Potassium Magnesium Phosphorus

Phosphorus Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore, administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with CKD. Calcium acetate will not have an effect on sodium, potassium, or magnesium levels.

When caring for a patient during the oliguric phase of acute kidney injury (AKI), which nursing action is appropriate? A.Weigh patient three times weekly. B. Increase dietary sodium and potassium. C. Provide a low-protein, high-carbohydrate diet. D. Restrict fluids according to previous daily loss.

Restrict fluids according to previous daily loss.

A kidney transplant recipient complains of having fever, chills, and dysuria over the past 2 days. What is the first action that the nurse should take? a. Assess temperature and initiate workup to rule out infection b. Reassure the patient that this is common after transplantation c. Provide warm cover for the patient and give 1 g acetaminophen orally d. Notify the nephrologist that the patient has developed symptoms of acute rejection

a. Assess temperature and initiate workup to rule out infection Rationale: The nurse must be astute in the observation and assessment of kidney transplant recipients because prompt diagnosis and treatment of infections can improve patient outcomes. Fever, chills, and dysuria indicate an infection. The temperature should be assessed, and the patient should undergo diagnostic testing to rule out an infection.

Nutritional support and management are essential across the entire continuum of chronic kidney disease. Which statements would be considered true related to nutritional therapy (select all that apply)? a. Fluid is not usually restricted for patients receiving peritoneal dialysis b. Sodium and potassium may be restricted in someone with advanced CKD c. Decreased fluid intake and a low-potassium diet are hallmarks of the diet for a patient receiving hemodialysis d. Decreased fluid intake and a low-potassium diet are hallmarks of the diet for a patient receiving peritoneal dialysis e. Decreased fluid intake and a diet with phosphate-rich foods are hallmarks of a diet for a patient receiving hemodialysis

a. Fluid is not usually restricted for patients receiving peritoneal dialysis b. Sodium and potassium may be restricted in someone with advanced CKD c. Decreased fluid intake and a low-potassium diet are hallmarks of the diet for a patient receiving hemodialysis Rationale: Water and any other fluids are not routinely restricted before Stage 5 end-stage renal disease (ESRD). Patients receiving hemodialysis have a more restricted diet than do patients receiving peritoneal dialysis. Patients receiving hemodialysis are frequently educated about the need for a dietary restriction of potassium- and phosphate-rich foods. However, patients receiving peritoneal dialysis may actually require replacement of potassium because of the higher losses of potassium with peritoneal dialysis. Sodium and salt restriction is common for all patients with CKD. For those receiving hemodialysis, as their urinary output diminishes, fluid restrictions are enhanced. Intake depends on the daily urine output. In general, 600 mL (from insensible loss) plus an amount equal to the previous day's urine output is allowed for a patient receiving hemodialysis. Patients are advised to limit fluid intake so that weight gains between dialysis sessions (i.e., interdialytic weight gain) are no more than 1 to 2 kg. For the patient who is undergoing dialysis, protein is not routinely restricted. The beneficial role of protein restriction in CKD stages 1 through 4 as a means to reduce the decline in kidney function is controversial. Historically, dietary counseling often encouraged restriction of protein for individuals with CKD. Although there is some evidence that protein restriction has benefits, many patients find these diets difficult to adhere to. For CKD stages 1 through 4, many clinicians encourage a diet with normal protein intake. However, patients must be taught to avoid high-protein diets and supplements because they may overstress the diseased kidneys.

Which descriptions characterize acute kidney injury (select all that apply)? a. Primary cause of death is infection b. It almost always affects older people c. Disease course is potentially reversible d. Most common cause is diabetic nephropathy e. Cardiovascular disease is most common cause of death

a. Primary cause of death is infection c. Disease course is potentially reversible Rationale: Acute kidney injury (AKI) is potentially reversible. AKI has a high mortality rate, and the primary cause of death in patients with AKI is infection. The primary cause of death in patients with chronic kidney failure is cardiovascular disease. Most commonly, AKI follows severe, prolonged hypotension or hypovolemia or exposure to a nephrotoxic agent. Older adults are more susceptible to AKI because the number of functioning nephrons decrease with age, but AKI can occur at any age.

Patients with chronic kidney disease experience an increased incidence of cardiovascular disease related to (select all that apply) a. hypertension b. vascular calcifications c. a genetic predisposition d. hyperinsulinemia causing dyslipidemia e. increased high-density lipoprotein levels

a. hypertension b. vascular calcifications d. hyperinsulinemia causing dyslipidemia Rationale: CKD patients have traditional cardiovascular (CV) risk factors, such as hypertension and elevated lipids. Hyperinsulinemia stimulates hepatic production of triglycerides. Most patients with uremia develop dyslipidemia. CV disease may be related to nontraditional CV risk factors, such as vascular calcification and arterial stiffness, which are major contributors to CV disease in CKD. Calcium deposits in the vascular medial layer are associated with stiffening of the blood vessels. The mechanisms involved are multifactorial and incompletely understood, but they include (1) change of vascular smooth muscle cells into chondrocytes or osteoblast-like cells, (2) high total-body amounts of calcium and phosphate as a result of abnormal bone metabolism, (3) impaired renal excretion, and (4) drug therapies to treat the bone disease (e.g., calcium phosphate binders).

Nurses must teach patients at risk for developing chronic kidney disease. Individuals considered to be at increased risk include (select all that apply) a. older African Americans b. patients more than 60 years old c. those with a history of pancreatitis d. those with a history of hypertension e. those with a history of type 2 diabetes

a. older African Americans b. patients more than 60 years old d. those with a history of hypertension e. those with a history of type 2 diabetes Rationale: Risk factors for CKD include diabetes mellitus, hypertension, age older than 60 years, cardiovascular disease, family history of CKD, exposure to nephrotoxic drugs, and ethnic minority (e.g., African American, Native American).

A patient is admitted to the hospital with chronic kidney disease. The nurse understands that this condition is characterized by a. progressive irreversible destruction of the kidneys b. a rapid decrease in urine output with an elevated BUN c. an increasing creatinine clearance with a decrease in urine output d. prostration, somnolence, and confusion with coma and imminent death

a. progressive irreversible destruction of the kidneys Rationale: Chronic kidney disease (CKD) involves progressive, irreversible loss of kidney function.

An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, the nurse informs the patient that a. successful transplantation usually provides better quality of life than that offered by dialysis b. if rejection of the transplanted kidney occurs, no further treatment for the renal failure is available c. hemodialysis replaces the normal functions of the kidneys, and patients do not have to live with the continual fear of rejection d. the immunosuppressive therapy following transplantation makes the person ineligible to receive other forms of treatment if the kidney fails

a. successful transplantation usually provides better quality of life than that offered by dialysis Rationale: Kidney transplantation is extremely successful, with 1-year graft survival rates of about 90% for deceased donor organs and 95% for live donor organs. An advantage of kidney transplantation over dialysis is that it reverses many of the pathophysiologic changes associated with renal failure when normal kidney function is restored. It also eliminates the dependence on dialysis and the need for the accompanying dietary and lifestyle restrictions. Transplantation is less expensive than dialysis after the first year.

A major advantage of peritoneal dialysis is a. the diet is less restricted and dialysis can be performed at home b. the dialysate is biocompatible and causes no long-term consequences c. high glucose concentrations of the dialysate cause a reduction in appetite, promoting weight loss d. no medications are required because of the enhanced efficiency of the peritoneal membrane in removing toxins

a. the diet is less restricted and dialysis can be performed at home Rationale: Advantages of peritoneal dialysis include fewer dietary restrictions and the possibility of home dialysis.

During the oliguric phase of AKI, the nurse monitors the patient for (select all that apply) a. hypotension b. ECG changes c. hypernatremia d. pulmonary edema e. urine with high specific gravity

b. ECG changes d. pulmonary edema Rationale: The nurse monitors the patient in the oliguric phase of acute renal injury for the following: -Hypertension and pulmonary edema: When urinary output decreases, fluid retention occurs. The severity of the symptoms depends on the extent of the fluid overload. In the case of reduced urine output (i.e., anuria, oliguria), the neck veins may become distended with a bounding pulse. Edema and hypertension may develop. Fluid overload can eventually lead to heart failure (HF), pulmonary edema, and pericardial and pleural effusions. -Hyponatremia: Damaged tubules cannot conserve sodium. Consequently, the urinary excretion of sodium may increase, which results in normal or below-normal serum levels of sodium. -Electrocardiographic changes and hyperkalemia: Initially, clinical signs of hyperkalemia are apparent on electrocardiogram (ECG) demonstrating peaked T waves, widening of the QRS complex, and ST-segment depression. -Urinary specific gravity: Urinary specific gravity is fixed at about 1.010.

If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances? a. Hyperkalemia and hyponatremia b. Hyperkalemia and hypernatremia c. Hypokalemia and hyponatremia d. Hypokalemia and hypernatremia

c. Hypokalemia and hyponatremia Rationale: In the diuretic phase of AKI, the kidneys have recovered the ability to excrete wastes but not the ability to concentrate urine. Hypovolemia and hypotension can result from massive fluid losses. Because of the large losses of fluid and electrolytes, the patient must be monitored for hyponatremia, hypokalemia, and dehydration.

To assess the potency of a newly placed arteriovenous graft for dialysis, the nurse should (select all that apply) a. monitor the BP in the affected arm b. irrigate the graft daily with low-dose heparin c. palpate the area of the graft to feel a normal thrill d. listen with a stethoscope over the graft to detect a bruit e. frequently monitor the pulses and neurovascular status distal to the graft

c. palpate the area of the graft to feel a normal thrill d. listen with a stethoscope over the graft to detect a bruit e. frequently monitor the pulses and neurovascular status distal to the graft Rationale: A thrill can be felt on palpation of the area of anastomosis of the arteriovenous graft, and a bruit can be heard with a stethoscope. The bruit and thrill are created by arterial blood rushing into the vein. The BP should not be taken in the arm with the AV graft.

RIFLE defines three stages of AKI based on changes in a. blood pressure and urine osmolality b. fractional excretion of urinary sodium c. estimation of GFR with the MDRD equation d. serum creatinine or urine output from baseline

d. serum creatinine or urine output from baseline Rationale: The RIFLE classification is used to describe the stages of AKI. RIFLE standardizes the diagnosis of AKI. Risk (R) is the first stage of AKI, followed by injury (I), which is the second stage, and then increasing in severity to the final or third stage of failure (F). The two outcome variables are loss (L) and end-stage renal disease (E). The first three stages are characterized by the serum creatinine level and urine output.