Nurs 4 - Mod 14 - Renal EAQ's

The nurse teaches safety measures to a patient with chronic kidney disease (CKD) who is experiencing constipation. The patient's blood pressure is 145/95 mm Hg. Which statement made by the patient indicates effective learning? 1 "I should eat three bananas after every meal." 2 "I should monitor my blood pressure regularly at home." 3 "I should rest in a prone position while recording my blood pressure." 4 "I should take magnesium-containing laxatives if I am experiencing constipation."

2 - "I should monitor my blood pressure regularly at home." A patient with chronic kidney disease (CKD) and hypertension has to monitor blood pressure at home regularly. Controlling blood pressure helps to slow the incidence of atherosclerosis that further impairs kidney function. The patient with CKD has an elevated level of serum potassium and ingestion of bananas may aggravate the condition and lead to fatal dysrhythmias. The patient should be in supine position while measuring blood pressure, not in prone position. The patient may develop hypermagnesemia from taking magnesium-containing laxatives.

The student nurse is preparing a dietary chart for a patient with acute kidney injury. Which foods included by the nurse in the diet chart need correction? 1 Foods rich in fiber 2 Foods rich in potassium 3 Foods rich in fatty acids 4 Foods rich in carbohydrates

2 - Foods rich in potassium Hyperkalemia is a complication associated with acute kidney injury. Foods rich in potassium will further increase the potassium level in the blood; these foods should not be included in the patient's diet plan. Foods rich in fiber do not cause any harm to the patient's health and can be included. Fats and carbohydrates provide adequate energy; foods rich in fatty acids and carbohydrates can be included in the patient's diet.

The nurse performs an admission assessment of a patient with acute renal failure. For which common complication does the nurse assess the patient? 1 Polyphagia 2 Hypernatremia 3 Hypotensive shock 4 Cardiac dysrhythmias

4 - Cardiac dysrhythmias Because the kidneys are not effectively removing waste products, including electrolytes, an increased potassium level (hyperkalemia) of more than 5.0 mEq/L is common in acute renal failure and places the patient at risk for cardiac arrhythmias. Patients usually experience anorexia, not an increase in hunger (polyphagia). Acute renal failure will likely manifest as hyponatremia. Hypotensive shock may be the result of a severe cardiac arrhythmia that is not treated.

The patient was diagnosed with prerenal acute kidney injury (AKI). The nurse should know that what is most likely the cause of the patient's diagnosis? 1 Intravenous (IV) tobramycin 2 Incompatible blood transfusion 3 Poststreptococcal glomerulonephritis 4 Dissecting abdominal aortic aneurysm

4 - 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 poststreptococcal glomerulonephritis are intrarenal causes of AKI.

Which is a clinical manifestation of acute kidney injury? 1 Oliguria 2 Uremia 3 Anemia 4 Pruritus

1 - Oliguria Oliguria is a sign of acute kidney injury. Uremia, anemia, and pruritus are signs of chronic kidney injury.

The nursing instructor is teaching a student nurse about continuous renal replacement therapy (CRRT). Which statement by the student nurse indicates effective learning? 1 "CRRT is provided over approximately 24 hours." 2 "CRRT has a faster blood flow rate than hemodialysis." 3 "CRRT does not require the addition of an anticoagulant." 4 "CRRT cannot be used in conjunction with hemodialysis."

1 - "CRRT is provided over approximately 24 hours." Continuous renal replacement therapy (CRRT) is a physiologic therapy that simulates kidney function day and night. CRRT is done either by cannulating an artery and a vein or by cannulating two veins. CRRT is provided continuously for approximately 24 hours. CRRT involves the flow of blood from the body through a filter and carries an increased risk of clotting; thus an anticoagulant must be added. CRRT can be performed along with hemodialysis. CRRT has a slower blood flow rate than intermittent hemodialysis.

What are the postrenal causes of acute kidney injury? Select all that apply. 1 Renal calculi 2 Renal trauma 3 Prostate cancer 4 Kidney ischemia 5 Myoglobin release

1 - Renal calculi 2 - Renal trauma 3 - Prostate cancer Renal calculi, trauma, and prostate cancer are postrenal causes of acute kidney injury. Intrarenal causes of acute kidney injury include kidney ischemia and myoglobin released from muscle cells.

The nurse instructs a patient with hyperphosphatemia to avoid what food item? 1 Yogurt 2 Soy sauce 3 Canned soup 4 Salad dressing

1 - Yogurt Yogurt is rich is phosphate and should be avoided by patients with hyperphosphatemia. The patient with hypernatremia and hypertension should avoid soy sauce, canned soups, and salad dressings because they are high in sodium.

The nurse teaches a new graduate nurse about the plan of care for a patient with chronic kidney disease (CKD) and anemia. The nurse notes that the anemia was caused by acute blood loss and that the patient is scheduled to receive a blood transfusion. Which statement made by the new graduate indicates effective learning? 1 "The patient should take iron orally and also phosphate binders." 2 "Multiple blood transfusions may lead to iron overload in the patient." 3 "Erythropoietin treatment helps patients with iron deficiency anemia." 4 "Blood transfusions should be avoided in patients with symptomatic anemia."

2 - "Multiple blood transfusions may lead to iron overload in the patient." A patient with anemia from acute blood loss can be given blood transfusions. The patient may develop iron overload after multiple transfusions because one unit of blood contains 250 mg of iron. Oral administration of iron and phosphate binders prevents absorption of iron because calcium binds with iron. Blood transfusion is avoided in the patient with anemia unless the patient experiences acute blood loss or dyspnea, excess fatigue, tachycardia, palpitations, and chest pain that present with symptomatic anemia. Erythropoietin therapy may lead to iron deficiency because it increases demand for iron in the body to support erythropoiesis.

The nursing instructor is teaching a student nurse about sodium polystyrene sulfonate. Which statement by the student nurse indicates the need for further teaching? 1 "It can be administered as an enema." 2 "The drug is effective in treating a paralytic ileus." 3 "The drug helps exchange potassium for sodium." 4 "It is mixed in water with sorbitol and then administered."

2 - "The drug is effective in treating a paralytic ileus." Sodium polystyrene sulfonate is used to correct hyperkalemia and is contraindicated in patients with a paralytic ileus because it causes bowel necrosis. Sodium polystyrene sulfonate can be administered in the form of an enema, which acts by exchanging potassium for sodium ions. It can also be administered after mixing it in water with sorbitol to facilitate the removal of potassium from the body.

A 70-year-old female patient weighs 50 kg and has a serum creatinine level of 1.4 mg/dL. Using the Cockcroft-Gault rule, what should the nurse document as the patient's glomerular filtration rate (GFR)? Record the answer using one decimal place. ____________ mL/min

29.5 The Cockcroft-Gault formula estimates glomerular filtration rate (GFR): [(140 - Age) x (weight in kilograms) x (0.85 if female)]/(72 x Creatinine (Cr) mg/dL) = GFR. Using this formula, a female patient of 70 years weighing 50 kg with serum creatinine level of 1.4 mg/dL has a GFR of 29.5 mL/min as shown by ((140 - 70) x (50 kg) x 0.85 if female))/(72 x (1.4 mg/dL) = 29.5.

The nurse is caring for a patient with acute kidney injury. Upon reviewing the laboratory reports of the patient, the nurse learns that the patient has a very high level of potassium. Which therapy does the nurse expect to be the most effective in this patient? 1 Restricting the diet 2 Infusing regular insulin 3 Performing hemodialysis 4 Infusing sodium bicarbonate

3 - Performing hemodialysis Hemodialysis is the most effective therapy for patients with hyperkalemia because it removes potassium ions in a short amount of time. Dietary restrictions are used to prevent recurrent elevations, but they are not used for acute elevations. Infusions of insulin and sodium bicarbonate are also beneficial but require more time to return the potassium levels to normal.

Which nursing intervention should the nurse implement while preparing a high-risk patient with contrast-induced nephropathy for magnetic resonance imaging? 1 Give low-fat foods 2 Give low-calorie foods 3 Provide plenty of fluids 4 Provide a high-protein diet

3 - Provide plenty of fluids Contrast agents accumulate in the nephrons, causing their death and resulting in renal failure. Therefore patients who have a high risk of contrast-induced nephropathy should be well hydrated. Fatty foods are rich in calories and should be given to provide energy. High-calorie foods should be included in a patient's diet. A high-protein diet causes increased levels of nitrogenous waste in the blood. Therefore a low-protein diet should be given to this patient.

A patient with end-stage chronic kidney disease is scheduled for hemodialysis. What recommendation should the nurse give to the patient? 1 Drink more fluids 2 Eat protein-rich foods 3 Take folic acid supplementation 4 Take phosphate supplementation

3 - Take folic acid supplementation The patient with chronic kidney disease (CKD) who has a very low glomerular filtration rate (GFR), such as 10 mL/min, requires dialysis. Folic acid, which is required for red blood corpuscles maturation, is water soluble and depleted during dialysis. A supplement can prevent anemia. A patient with CKD has low urine output and fluid retention, so fluid intake should be restricted. Protein-rich foods should be restricted in a patient with CKD to prevent neurologic complications. A patient with CKD has a low rate of phosphate excretion and may develop hyperphosphatemia, so additional phosphate is not recommended.

The patient with end-stage renal disease (ESRD) has decided to terminate dialysis treatments. Which is the best response by the nurse? 1 "You cannot stop now; you have so much to live for." 2 "Are you sure this is the right decision? How about if I ask a psychiatrist to come speak with you?" 3 "I respect your decision. Would you like me to ask the health care provider for a palliative care consult?" 4 "I respect your decision, but believe you need to discuss options with your health care provider. Would you like me to page the health care provider to come speak with you?"

4 - "I respect your decision, but believe you need to discuss options with your health care provider. Would you like me to page the health care provider to come speak with you?" The patient has the right to end treatment. This decision must be made with the health care provider. Telling the patient he or she has too much to live for may be giving false reassurance. The nurse has no right questioning the decision or calling a psychiatrist at this point.

A registered nurse is teaching a trainee nurse about the parameters to be assessed in a patient with acute kidney injury who is undergoing dialysis. Which statement by the trainee nurse indicates a need for further teaching? 1 "I should auscultate patient's lung sounds." 2 "I should record the patient's input and output." 3 "I should assess for any change in the patient's skin color." 4 "I should examine the patient's mouth for a change in color."

4 - "I should examine the patient's mouth for a change in color." Acute kidney injury is associated with dry mouth and inflammation and is caused by increased levels of ammonia in the saliva. The nurse should examine the mouth for inflammation and dryness. Therefore the trainee nurse's statement about examining the mouth for a change in color indicates a need for further teaching. Because of renal impairment, fluid can accumulate in the lungs and result in difficulty breathing. Therefore the nurse should auscultate the patient's lung sounds. Recording the patient's input and output will help to determine the efficacy of the treatment. Acute kidney injury is also associated with hyperpigmentation; thus the nurse should assess for changes in the patient's skin color.

The nurse identifies that which drug should be used with caution in a patient with renal failure? 1 Cinacalcet 2 Paricalcitol 3 Gemfibrozil 4 Vancomycin

4 - Vancomycin A patient with renal failure has a reduced ability to eliminate metabolites and drugs. Therefore, drugs like vancomycin, which are mainly excreted by the kidney, need to be used with caution and monitoring for accumulation and potential drug toxicity is necessary. Cinacalcet is a calcimimetic agent that helps to control secondary hyperparathyroidism. Paricalcitol is an active vitamin D supplement that helps to control elevated levels of parathyroid hormone and is used for treating secondary hyperparathyroidism in patients with end stage chronic kidney disease. Gemfibrozil helps to reduce triglyceride levels and increases high-density cholesterol in patients with chronic kidney disease.

The nurse is teaching a patient with chronic kidney disease to avoid foods high in potassium. Which high-potassium foods should the patient avoid? Select all that apply. 1 Bananas 2 Apples 3 Oranges 4 Potatoes 5 White rice

1 - Bananas 3 - Oranges 4 - Potatoes Bananas, oranges, and potatoes are foods high in potassium and should be avoided on a renal-restricted diet. Foods lower in potassium include apples and white rice.

The nurse is teaching a patient with acute kidney injury about lifestyle modifications. Which actions by the patient indicate effective teaching? 1 Consuming less salt 2 Eating foods rich in protein 3 Increase intake of fluids 4 Consuming potassium-rich foods

1 - Consuming less salt Sodium causes fluid and water retention and thereby increases blood volume; thus, the patient should consume less salt. Patients with renal impairment should decrease protein intake because proteins break down into urea, which is dangerous if it accumulates in the brain. Increasing the intake of fluid will increase the volume of fluid in the body. Because the kidney function is impaired, excess fluid cannot be eliminated and it accumulates in the body, leading to edema and congestive cardiac failure. Kidney disease is associated with hyperkalemia; thus eating potassium-rich food will worsen the condition and may lead to cardiac arrhythmia.

While caring for a patient with acute kidney injury, the nurse observes that the patient has hand tremors while extending the wrist. The patient's laboratory report shows a blood urea nitrogen (BUN) level of 123 mg/dL. Which action by the patient does the nurse suspect as the cause of this symptom? 1 Eating protein-rich food 2 Eating sodium-rich food 3 Eating potassium-rich food 4 Eating carbohydrate-rich food

1 - Eating protein-rich food Patients with acute kidney injury have impaired renal excretion cannot eliminate nitrogenous wastes; this will result in increased blood urea nitrogen (BUN) levels. Eating protein-rich food will increase the level of BUN and cause neurologic changes such as asterixis, which is characterized by flapping tremor upon extension of the wrist. A normal level of BUN is 120 mg/dL. Because the patient has asterixis and a BUN level of 125 mg/dL, the nurse suspects the consumption of protein-rich food to be the cause of this symptom, not the consumption of sodium-rich, potassium-rich, or carbohydrate-rich food.

A 72-year-old African American male with a history of chronic hypertension, coronary artery disease, and type II diabetes presents to the emergency room with complaints of shortness of breath and difficulty urinating. Upon review of test results, what is the best indicator of acute renal failure? 1 Elevated serum creatinine levels 2 Elevated serum blood urea nitrogen (BUN) 3 Elevated serum pH on the arterial blood gases (ABGs) 4 Hydronephrosis on the computed tomography (CT) scan

1 - Elevated serum creatinine levels The best indicator of level of renal functioning is the serum creatinine level. Elevated creatinine levels indicate renal failure. Hydronephrosis, or swelling of the kidney, may occur with obstructive processes such as renal calculi, but this is not an exclusive indicator of renal function. Elevated serum BUN levels may result from a variety of problems, including dehydration, severe injury, catabolic states, gastrointestinal (GI) bleeding, or renal failure. An elevated pH indicates acid-base imbalance, not necessarily renal failure.

The nurse identifies that if a patient with chronic kidney disease (CKD) consumes baked beans, sweet potatoes, canned mushrooms, and chocolates, the patient is at risk for what condition? 1 Hyperkalemia 2 Hypernatremia 3 Hypermagnesemia 4 Hyperphosphatemia

1 - Hyperkalemia Baked beans, sweet potatoes, canned mushrooms, and chocolates are rich in potassium. Hyperkalemia, or an abnormally high potassium level, is observed in patients with chronic kidney disease (CKD) with consumption of these foods. Hypernatremia occurs due to retention of sodium, aggravated by sodium-rich foods such as pickles. Hypermagnesemia, an increase in serum magnesium levels, is an electrolyte disturbance seen in the patients with CKD aggravated by intake of milk of magnesia and magnesium-containing laxatives. Hyperphosphatemia is aggravated by consumption of meat and dairy products in patients with CKD.

While caring for a patient with an acute kidney injury, the patient complains of severe weakness and palpitations. The electrocardiogram reveals widening of the QRS complex and an elevated T wave. What complication does the nurse suspect in this patient? 1 Hyperkalemia 2 Hypercalcemia 3 Hypernatremia 4 Hyperchloremia

1 - Hyperkalemia Hyperkalemia is associated with electrocardiographic changes like T-wave elevation, widening of the QRS complex, and ST-segment depression. A short QT interval and a small ST segment indicate hypercalcemia. Hypernatremia is characterized by a flat T wave. A depressed T wave is a characteristic of hyperchloremia.

The nurse provides discharge instructions to a patient with chronic kidney disease (CKD). Which action by the patient indicates effective learning? 1 Maintains a pillbox organizer at home 2 Takes over-the-counter medications for pain 3 Takes aluminum-based laxatives for constipation 4 Includes sweet potatoes and chocolates in the diet

1 - Maintains a pillbox organizer at home A patient with chronic kidney disease has to take many medications, and maintaining a pillbox organizer at home helps the patient in medication compliance. The nurse should instruct the patient to avoid over-the-counter drugs because most of these drugs are nephrotoxic, which leads to further deterioration of kidney function. The patient must avoid aluminum-based laxatives because aluminum is accumulated in the body, leading to bone disease such as osteomalacia. Sweet potatoes and chocolates are rich in potassium and, therefore, they must be avoided to prevent hyperkalemia and fatal dysrhythmias.

Assessment findings of a patient with chronic kidney failure include a glomerular filtration rate (GFR) of 10 mL/min, numbness and burning sensation in the legs, and a blood urea nitrogen level (BUN) of 26 mg/dL. The nurse anticipates that which intervention will be included on the patient's plan of care? 1 Make a referral for dialysis. 2 Restrict sodium bicarbonate. 3 Administer sodium polystyrene sulfonate. 4 Provide a magnesium-containing antacid.

1 - Make a referral for dialysis. Numbness and burning sensation in the legs are manifestations of peripheral neuropathy caused by nitrogenous waste accumulation in the brain. A patient with a chronic kidney disease (CKD), increased blood urea nitrogen (BUN) levels, and a very low glomerular filtration rate of 10 mL/min should undergo dialysis to remove nitrogenous wastes and prevent fluid accumulation due to impaired excretion. Sodium polystyrene sulfonate treats hyperkalemia. Sodium bicarbonate treats metabolic acidosis. A patient with CKD must not take antacids containing magnesium or aluminum because they are excreted by the kidneys.

The nurse is teaching a patient with chronic kidney disease about restricting phosphorous in the diet. The nurse determines the teaching was effective when the patient correctly identifies which examples of foods as high in phosphorous? Select all that apply. 1 Milk 2 Steak 3 Cheese 4 Pudding 5 White bread

1 - Milk 2 - Steak 3 - Cheese 4 - Pudding In general, foods that contain more than 160 mg of phosphorous per serving are considered high in phosphorous and should be avoided. Pudding is high in phosphorous. Meats such as beef or chicken are considered high in phosphorous. Milk and dairy products like cheese are also high in phosphorous and should be avoided. White bread is not considered high in phosphorous.

The nurse recognizes that which intervention would help a patient with stage 5 chronic kidney disease who experiences restless leg syndrome, altered mental ability, seizures, coma, and a blood urea nitrogen (BUN) level of 35 mg/dL? 1 Refer the patient for dialysis. 2 Administer calcium phosphate binders. 3 Administer 10% calcium gluconate intravenously. 4 Recommend that the patient receive a blood transfusion.

1 - Refer the patient for dialysis. The patient's symptoms of restless leg syndrome, altered mental ability, and irritability are manifestations of neurologic complications due to accumulation of nitrogenous wastes in the brain and nervous system. The patient has seizures and coma due to the high blood urea nitrogen (BUN) level of 35 mg/dL. Therefore dialysis would improve central nervous system functions and slow the neuropathies. Calcium phosphate binders are administered in a patient with hyperphosphatemia. A blood transfusion is not preferred to treat anemia unless the patient experiences an acute blood loss or symptomatic anemia. Intravenous administration of 10% calcium gluconate helps to reduce hyperkalemia in a patient.

A patient with acute kidney injury is prescribed intravenous (IV) insulin and IV dextrose (glucose). What is the purpose of administering insulin and dextrose? 1 Treat hyperkalemia with insulin and prevent hypoglycemia with glucose. 2 Manage hyperglycemia with insulin and prevent hypoglycemia with glucose. 3 Prevent metabolic acidosis with insulin and restore metabolic activity with glucose. 4 Promote renal absorption of sodium with glucose and to prevent hyponatremia with insulin.

1 - Treat hyperkalemia with insulin and prevent hypoglycemia with glucose. The purpose of administering insulin and dextrose is to lower the serum potassium level. Insulin works by pushing the potassium back into the cells, and glucose prevents hypoglycemia. Hyperglycemia may be managed with insulin but not dextrose simultaneously. Insulin does not prevent metabolic acidosis nor does glucose restore metabolic activity. Glucose does not promote renal absorption of sodium, and insulin does not prevent hyponatremia.

Which condition does the nurse suspect in a patient with a glomerular filtration rate (GFR) of 10 mL/minute, a blood urea nitrogen (BUN) level of 23 mg/dL, a potassium level of 4 mEq/L, and a serum bicarbonate level of 20 mEq/L? 1 Uremia 2 Hypertension 3 Dysrhythmias 4 Metabolic acidosis

1 - Uremia A patient with glomerular filtration rate (GFR) of 10 mL/minute has chronic kidney disease (CKD), causing the BUN to rise above the normal BUN level of 6 to 20 mg/dL, which may be a result of uremia. Hypertension may result from hypernatremia in the patient with CKD; there is no sodium level information given. Dysrhythmias may occur in the patient with CKD due to hyperkalemia due to decreased excretion of potassium by the kidneys; however, this patient's potassium level of 4 mEq/L is a normal finding. An inability of the kidneys to excrete ammonia and generate bicarbonates leads to metabolic acidosis, indicated by a serum bicarbonate level lower than 15 mEq/L.; the patient's level is greater than 15 mEq/L.

The patient is in the diuretic phase of acute kidney injury. What education should the nurse provide to the patient regarding this phase? Select all that apply. 1 Urine output is increased. 2 The kidney has become fully functional. 3 The electrolyte imbalance will be normalized. 4 This phase will last no more than three weeks 5 There is a possibility that the fluid volume will be reduced in the body.

1 - Urine output is increased. 4 - This phase will last no more than three weeks 5 - There is a possibility that the fluid volume will be reduced in the body. During the diuretic phase of acute kidney injury, daily urine output is usually around 1 to 3 L but may reach 5 L or more. Hypovolemia and hypotension can occur from massive fluid losses. The diuretic phase may last one to three weeks. Near the end of this phase, the patient's acid-base, electrolyte, and waste product (blood urea nitrogen, creatinine) values begin to normalize. Although urine output is increasing, the nephrons are still not fully functional. The high urine volume is caused by osmotic diuresis from the high urea concentration in the glomerular filtrate and the inability of the tubules to concentrate the urine. In this phase the kidneys have recovered their ability to excrete wastes, but not to concentrate the urine. Because of the large losses of fluid and electrolytes, the patient must be monitored for hyponatremia, hypokalemia, and dehydration.

A patient with chronic kidney disease is at risk for anemia. Arrange the events in the order in which they lead to anemia caused by chronic kidney disease. 1. Bone marrow fibrosis 2. Elevated levels of parathyroid hormone (PTH) 3. Inhibition of erythropoiesis 4. Shortened survival of red blood cells (RBCs)

1. - Elevated levels of parathyroid hormone (PTH) 2. - Inhibition of erythropoiesis 3. - Shortened survival of red blood cells (RBCs) 4. - Bone marrow fibrosis Elevated levels of PTH, produced to compensate for low serum calcium levels, can inhibit erythropoiesis, shorten the survival of RBCs, and cause bone marrow fibrosis, which can result in a decrease in hematopoietic cells.

Which patient is most likely to develop chronic kidney disease (CKD) and should be taught preventive measures by the nurse? 1 A 50-year-old white female with hypertension 2 A 61-year-old Native American male with diabetes 3 A 40-year-old Hispanic female with cardiovascular disease 4 A 28-year-old African American female with a urinary tract infection

2 - A 61-year-old Native American male with diabetes It is especially important that the nurse should teach CKD prevention to the 61-year-old Native American with diabetes. This patient is at highest risk because diabetes causes about 50% of CKD. This patient is the oldest, and Native Americans with diabetes develop CKD six times more frequently than other ethnic groups. Hypertension causes about 25% of CKD. Hispanics have CKD about 1.5 times more than non-Hispanics. African Americans have the highest rate of CKD because hypertension is increased significantly in African Americans. A urinary tract infection (UTI) will not cause CKD unless it is not treated or occurs recurrently.

The nurse recognizes that which intervention will likely be included in a treatment plan for a patient with chronic kidney disease (CKD) who is undergoing peritoneal dialysis? 1 Restricting potassium intake 2 Encouraging consumption of 25 to 35 kcal/kg/day 3 Calculating fluid restrictions based on urine output 4 Avoiding iron supplements when taking erythropoietin

2 - Encouraging consumption of 25 to 35 kcal/kg/day A patient with chronic kidney disease (CKD) must maintain good nutrition and should be referred to a dietitian for nutritional education and guidance. To avoid calorie-protein malnutrition, the patient should consume 25 to 35 kcal/kg/day, which includes calories from dialysate glucose absorption. Potassium is usually not restricted for a patient undergoing peritoneal dialysis. The patient needs to take iron supplements when on erythropoietin to prevent iron deficiency. Fluid intake in the patient who is undergoing peritoneal dialysis should be unrestricted if weight and blood pressure are in control. Therefore it is not dependent upon urine output.

A nurse planning care for a patient with acute renal failure recognizes that the interventions of highest priority are directly related to what? 1 Ineffective coping 2 Excess fluid volume 3 Impaired gas exchange 4 Imbalanced nutrition: less than body requirements

2 - Excess fluid volume The issue of excess fluid volume is the primary problem of acute renal failure and the highest priority for the nurse in this situation. The major problem with acute renal failure is altered fluid and electrolytes, which, if not managed, can lead to permanent renal damage, cardiac complications, and death. The nursing diagnosis of ineffective coping is due to the acute severity of the illness. The nursing diagnosis of impaired gas exchange is related to excess fluid volume, such as in the development of pulmonary edema. The nursing diagnosis of imbalanced nutrition, less than body requirements, is due to a decrease in appetite as a result of the acute renal failure.

The nurse should monitor for which adverse effect of erythropoietin in patients with kidney failure? 1 Paralytic ileus 2 Iron deficiency 3 Hyperparathyroidism 4 Systemic lupus erythematosus

2 - Iron deficiency Erythropoietin (EPO) helps replenish EPO stores in the body and promotes erythropoiesis in a patient with kidney failure. A side effect of EPO is iron deficiency anemia from increased demand for iron to support erythropoiesis. Paralytic ileus is a side effect of sodium polystyrene sulfonate administered for the treatment of hyperkalemia. Hyperparathyroidism occurs in the patient with end stage renal failure. Systemic lupus erythematosus leads to chronic renal failure.

Routine urinalysis for a diabetic patient reveals moderate proteinuria. What further tests help to identify decreased kidney function at an early stage? Select all that apply. 1 Serum creatinine 2 Renal ultrasound 3 Glomerular filtration rate (GFR) 4 Evaluation of microalbuminuria 5 Magnetic resonance angiography (MRA)

2 - Renal ultrasound 3 - Glomerular filtration rate (GFR) 4 - Evaluation of microalbuminuria If routine urinalysis indicates moderate to severe proteinuria, the preferred way of determining kidney functions is by assessing the GFR. An ultrasound of the kidneys is usually done to detect any obstructions and to determine the size of the kidneys. A patient with diabetes needs to have a further examination of the urine for microalbuminuria. The patient may not have an increase in serum creatinine until there is a decrease of 50% or more in kidney function. MRA study with the contrast media gadolinium is generally not advised unless the ultrasound or computed tomography (CT) does not provide the information needed.

A patient has a glomerular filtration rate (GFR) of 70 mL/minute, a blood pressure of 140/100 mm Hg, and fluid accumulation in the legs. To help prevent heart failure, the nurse should provide the patient with which instruction? 1 Limit protein intake. 2 Restrict sodium to 2 g/day. 3 Take vitamin D supplements. 4 Avoid magnesium-containing laxatives.

2 - Restrict sodium to 2 g/day. A patient with a glomerular filtration rate of 70 mL/min has stage 2 chronic kidney disease. A blood pressure of 140/100 mm Hg along with fluid accumulation in the legs indicates that the patient has hypertension and edema. Patients with increased blood urea nitrogen levels should limit protein intake to prevent neurologic complications. High sodium retention may lead to heart failure, so the patient should restrict sodium intake to 2 grams per day. Patients with low vitamin D levels or hypocalcemia should take vitamin D supplements. Patients with hypermagnesemia should avoid taking magnesium-containing laxatives.

Which medication does the nurse suspect to be the cause of myopathy in a patient with chronic kidney disease (CKD) who has a very-low-density cholesterol level of 50 mg/dL? 1 Cinacalcet 2 Simvastatin 3 Gemfibrozil 4 Atorvastatin

2 - Simvastatin Simvastatin is an antilipidemic drug that may cause myopathy. Cinacalcet is a calcimimetic agent that helps control secondary hyperparathyroidism. Fibrates such as gemfibrozil help lower triglyceride levels and increase high-density cholesterol levels. Atorvastatin is used as an antilipidemic drug in patients who develop myopathy with simvastatin.

The nurse provides information to a nursing student about the administration of erythropoietin (EPO) therapy to a patient with chronic kidney disease (CKD). Which statement made by the nursing student indicates effective learning? 1 "EPO benefits a patient with plasma ferritin concentrations less than 100 mg/mL." 2 "EPO should be administered in higher doses to a patient with low hemoglobin levels." 3 "EPO, iron, sucrose, and folic acid of 1 mg/day should be administered to patients undergoing hemodialysis." 4 "EPO can be safely given to a patient that takes an antihypertensive and maintains a blood pressure of 150/90 mm Hg."

3 - "EPO, iron, sucrose, and folic acid of 1 mg/day should be administered to patients undergoing hemodialysis." A patient with chronic kidney disease (CKD) develops anemia due to decreased production of erythropoietin (EPO). Exogenous erythropoietin helps replenish the erythropoietin demand. Iron supplements for a patient with low plasma ferritin levels prevent the patient from developing an iron deficiency from the increased demand for iron to support erythropoiesis. A folic acid supplement is given to patients on hemodialysis because it is required for red blood cell (RBC) formation, and is removed by dialysis. A high dosage of EPO should be avoided for a patient with anemia because of increased risk of thromboembolic events and death from cardiovascular effects. The recommendation is to use the lowest possible dose of EPO to treat anemia. EPO should be avoided for a patient with uncontrolled hypertension because it exacerbates hypertension by increasing blood viscosity.

The nursing instructor asks the student nurse about fluid and electrolyte changes that occur in a patient with an acute kidney injury. Which statement by the student nurse indicates effective learning? 1 "The patient will have hypokalemia." 2 "The patient will have hypernatremia." 3 "The patient will have increased serum creatinine levels." 4 "The patient will have decreased levels of blood urea nitrogen."

3 - "The patient will have increased serum creatinine levels." Creatinine is a waste product of muscle catabolism. Patients with acute kidney injury cannot remove body waste, and it accumulates in the blood, which raises the serum creatinine level. Acute kidney injury is associated with an increased level of potassium (hyperkalemia), a decreased level of sodium (hyponatremia), and an increased level of blood urea nitrogen. Thus the statements that the patient will have hypokalemia, hypernatremia, and decreased levels of blood urea nitrogen are incorrect.

The patient admitted with sepsis is at risk of developing what renal pathology? 1 Nephritis 2 Glomerular nephritis 3 Acute tubular necrosis 4 Chronic kidney disease

3 - Acute tubular necrosis Acute tubular necrosis is a result of an acute shock on the renal system and is recoverable, but the patient is likely to develop acute kidney impairment (AKI). Nephritis is an acute infection of the nephrons. Glomerular nephritis develops into chronic kidney disease and is not a result of sepsis.

The nurse is planning an educational course on risk factors for chronic kidney disease. Which factors should the nurse identify as nonmodifiable risk factors? Select all that apply. 1 Hypertension 2 Type II diabetes 3 Age greater than 60 4 Exposure to nephrotoxic drugs 5 Family history of chronic kidney disease (CKD)

3 - Age greater than 60 5 - Family history of chronic kidney disease (CKD) Family history of chronic kidney disease and age greater than 60 are risk factors out of the patient's control. The patient can make lifestyle changes to reduce high blood pressure and decrease blood glucose. The patient has a choice to take drugs that are considered to be nephrotoxic.

The nurse is teaching a student nurse about the development of anemia in patients with chronic kidney disease (CKD). The student nurse correctly identifies which pathologic alteration as the cause of anemia in a patient with CKD? 1 Poor absorption of calcium 2 Elevated serum creatinine levels 3 Decreased production of erythropoietin 4 Accumulation of circulating phosphorous

3 - Decreased production of erythropoietin Erythropoietin is a hormone secreted by the kidney that stimulates the production of red blood cells. Decreased levels of erythropoietin results in anemia in the patient with CKD. Elevated serum creatinine levels indicate impaired renal function. Calcium is poorly absorbed due to decreased vitamin D conversion; however, this does not result in anemia. Accumulation of circulating serum phosphorous is problematic for the CKD patient, but it does not result in anemia.

A patient with acute kidney injury has hypovolemia. After an intravenous infusion of fluids, the nurse observes that the patient has no urine output and a blood pressure of 140/90 mm Hg. Which risk does the nurse anticipate in this patient? 1 Gall stones 2 Lung failure 3 Heart failure 4 Liver damage

3 - Heart failure Heart failure is caused by an increase in the circulatory volume. An observation of a lack of urine output and increased blood pressure indicates a buildup of fluid in the body, and the patient is at risk of heart failure. Gallstones are caused by increased levels of cholesterol in the bile or an inability of the gallbladder to empty properly. Conditions such as pneumonia and chronic obstructive pulmonary disease decrease the amounts of air and blood that enter and exit the lungs, causing lung failure. Increased levels of liver enzymes are signs of liver damage.

The nurse receives an order to administer polystyrene sulfate to a patient with significant hyperkalemia. Which assessment finding is a priority concern regarding safe administration of polystyrene sulfate? 1 Complaints of nausea 2 Apical pulse of 55 bpm 3 Hypoactive bowel sounds 4 Complaints of palpitations

3 - Hypoactive bowel sounds The priority concern in this situation is hypoactive bowel sounds. Before administering polystyrene sulfate, the nurse should auscultate bowel sounds. If the findings indicate hypoactivity, the medication should help, and the healthcare provider should be notified as fluid shifts caused by the medication may result in bowel necrosis. Nausea, palpitations, and bradycardia are signs and symptoms of hyperkalemia, and so the polystyrene should be administered promptly.

The nurse reviews the medical record of a patient with chronic kidney disease (CKD) and notes a history of taking cholecalciferal, a vitamin D level of 20 mg/mL, a calcium level of 13 mg/dL, and a phosphorous level of 5 mg/dL. Based on the laboratory results, the nurse anticipates that what medication will be prescribed? 1 Calcitriol 2 Calcium acetate 3 Sevelamer carbonate 4 Polystyrene sulfonate

3 - Sevelamer carbonate A patient with chronic kidney disease (CKD) may have low vitamin D levels. Vitamin D supplementation using cholecalciferol is recommended for patients who have vitamin D levels less than 30 mg/dL, but it can cause hypercalcemia. The laboratory reports of the patient show a calcium level of 13 mg/dL and a phosphorous level of 5 mg/dL, which are higher than normal values (calcium 8.6 to 10.2 mg/dL and phosphorous 2.4 to 4.4 mg/dL). Therefore the patient should be given non-calcium-based phosphate binders such as sevelamer carbonate to lower the phosphate levels. Calcitriol is an activated form of vitamin D, which is indicated for severe hypocalcemia in CKD. It may further aggravate hypercalcemia and hyperphosphatemia on administration. Calcium acetate is a calcium-based phosphate binder, which may further increase calcium levels, leading to hypercalcemia. Polystyrene sulfonate is a potassium-binding agent used in patients with severe hyperkalemia.

The nurse recognizes that which medication is the most appropriate for a patient with chronic kidney disease (CKD) who has a glycosylated hemoglobin of 5%, blood pressure of 140/95 mm Hg, and whose urinalysis reveals the presence of protein? 1 A diuretic 2 A calcimimetic agent 3 A calcium channel blocker 4 An angiotensin receptor blocker

4 - An angiotensin receptor blocker A patient with glycosylated hemoglobin of 5%, blood pressure of 140/95 mm Hg, and protein in the urine has hypertension with nondiabetic proteinuria. The patient can take angiotensin receptor blockers and angiotensin-converting enzyme (ACE) inhibitors. These medications help to decrease proteinuria and delay the progression of chronic kidney disease (CKD). Diuretics help control elevated blood pressure in patients with CKD but do not have an effect on proteinuria. Calcimimetic agents help to control secondary hyperparathyroidism by increasing the sensitivity of the calcium receptors in the parathyroid glands. They are not used for treatment of hypertension, diabetes, or proteinuria. Calcium channel blockers also do not have an effect on proteinuria.

The patient has had type 1 diabetes mellitus for 25 years and now is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse finds that the patient has newly developed hypertension and difficulty with blood glucose control. The nurse should know that which diagnostic study will be most indicative of chronic kidney disease (CKD) in this patient? 1 Serum creatinine 2 Serum potassium 3 Microalbuminuria 4 Calculated glomerular filtration rate (GFR)

4 - Calculated glomerular filtration rate (GFR) The best study to determine kidney function or CKD that would be expected in the patient with diabetes is the calculated GFR that is obtained from the patient's age, gender, race, and serum creatinine. It would need to be abnormal for three months to establish a diagnosis of CKD. A creatinine clearance test done with a blood sample, and a 24-hour urine collection is also important. Serum creatinine is not the best test for CKD because the level varies with different patients. Serum potassium levels could explain why the patient has an irregular heartbeat. The finding of microalbuminuria can alert the patient with diabetes about potential renal involvement and potentially failing kidneys. However, urine albumin levels are not used for diagnosis of CKD.

A patient with chronic kidney disease has an arteriovenous (AV) graft in the right forearm. What is the nurse's priority in determining the patency of the graft? 1 Determine the range of motion of the right arm and shoulder 2 Observe for clubbing of the fingers on the right hand of the AV graft site 3 Compare radial pulses by checking the right and left pulses simultaneously 4 Check for a bruit by listening over the right arm AV graft site with a stethoscope

4 - Check for a bruit by listening over the right arm AV graft site with a stethoscope The arteriovenous (AV) graft is an artificial connection between an artery and vein to provide access for hemodialysis. Thrombosis may occur; therefore the need to determine patency is an essential assessment. Palpation of the site should indicate a thrill, which also indicates that the graft is patent. Listening over the AV graft should reveal a bruit sound, indicating patency. A bruit sounds similar to the impulse beat heard when measuring blood pressure. The arm that has the AV graft site should not be put through range-of-motion movements or exercises. Clubbing is not a complication observed in the fingers of a patient with an AV graft. Comparing the left radial pulse with the pulse on the AV graft site is not an accurate patency assessment procedure.

The nurse caring for a patient with heart failure notes the patient has decreased urine output of 200 mL/day. Which laboratory finding aids in the diagnosis of prerenal azotemia in this patient? 1 Normal creatinine level 2 Decreased sodium level 3 Decreased potassium level 4 Elevated blood urea nitrogen (BUN)

4 - Elevated blood urea nitrogen (BUN) The patient with heart failure has a decreased circulating blood volume. This causes autoregulatory mechanisms to preserve blood flow to essential organs. Laboratory data for this patient will likely demonstrate an elevation in BUN, creatinine, and potassium. Prerenal azotemia results in a reduction in the excretion of sodium, increased sodium and water retention, and decreased urine output.

Which clinical action plan is most appropriate for a patient in stage 3 of chronic kidney disease? 1 Diagnosis and treatment 2 Estimation of progression 3 Renal replacement therapy 4 Evaluation and treatment of complications

4 - Evaluation and treatment of complications A patient in stage 3 of chronic kidney disease has a moderate decrease in the glomerular filtration rate (GFR). The most appropriate clinical action plan for this patient is evaluation and treatment of complications. Diagnosis and treatment is the clinical action plan for patients in stage 1 of chronic kidney disease. Estimation of progression is the clinical action plan for patients in stage 2 of chronic kidney disease because this stage is associated with kidney damage with mild decrease in GFR. Renal replacement therapy is the clinical action plan for patients in stage 5, which is associated with kidney failure.

The nurse recalls that the reason that patients with chronic kidney disease experience arterial stiffness is what? 1 Excessive sodium retention 2 Increase in nitrogenous waste products 3 Decrease in the sodium bicarbonate level 4 Excessive calcium deposition in vascular smooth layer

4 - Excessive calcium deposition in vascular smooth layer A patient with chronic kidney disease (CKD) may have arterial stiffness due to calcium deposition in the vascular smooth layer of the blood vessels. Excessive sodium retention causes extracellular fluid accumulation that leads to hypertension and edema. Decrease in the sodium bicarbonate level in the body leads to metabolic acidosis. Accumulation of the nitrogenous waste products leads to neurologic complications.

What is an intrarenal cause of acute kidney injury? 1 Renal artery thrombosis 2 Neuromuscular disorders 3 Benign prostatic hyperplasia 4 Hemolytic blood transfusion reaction

4 - Hemolytic blood transfusion reaction Hemolytic blood transfusion reaction is an intrarenal cause of acute kidney injury. Renal artery thrombosis is a prerenal cause of acute kidney injury. Neuromuscular disorders and benign prostatic hyperplasia are postrenal causes of acute kidney injury.

A patient with chronic kidney failure (CKD) has a paralytic ileus and laboratory findings of a serum potassium level of 7 mEq/L and a phosphate level of 3.5 mg/dL. The nurse anticipates that what medication will be prescribed? 1 Calcium carbonate 2 Lanthanum carbonate 3 Sodium polystyrene sulfonate 4 Intravenous 10% calcium gluconate

4 - Intravenous 10% calcium gluconate Serum potassium levels of 7 mEq/L indicate hyperkalemia in a patient with chronic kidney disease. The patient should be given 10% calcium gluconate intravenously to control the elevated levels of serum potassium. A serum phosphate level of 3.5 mg/dL is a normal finding. Administration of calcium-based phosphate binders, such as calcium carbonate, and non-calcium-based phosphate binders, such as lanthanum carbonate, are only beneficial for chronic kidney failure patients with elevated serum phosphate levels. Sodium polystyrene sulfonate should not be given to patients with paralytic ileus because it can cause bowel necrosis in a hypoactive bowel.

The nurse is caring for a patient with chronic kidney disease. Which electrolyte, if abnormal, can result in decreased mental status, absence of reflexes, and respiratory failure for this patient? 1 Sodium 2 Calcium 3 Potassium 4 Magnesium

4 - Magnesium A patient with hypermagnesemia, or an increase in the level of magnesium in the body, may have absence of reflexes, decreased mental status, cardiac dysrhythmias, hypotension, and respiratory failure. Sodium retention contributes to edema, hypertension, and heart failure in a patient with chronic kidney disease. Patients with hypocalcaemia are at an increased risk for fractures. Hyperkalemia, or abnormally high potassium levels, is a serious electrolyte disorder in a patient with chronic renal failure that can lead to fatal dysrhythmias.

Which condition should the nurse suspect in a patient with chronic kidney disease (CKD) who develops osteomalacia? 1 Asterixis 2 Uremic frost 3 Gastroparesis 4 Uremic red eye

4 - Uremic red eye Chronic kidney disease mineral and bone disorder (CKD-MBD) is a common complication of CKD and results in both skeletal and extraskeletal complications. Osteomalacia is a skeletal complication. Calcium deposition in the eye may create irritation leading to uremic red eye, an extraskeletal complication. Asterixis (hand-flapping tremor) occurs due to motor neuropathy. Uremic frost is the crystallization of urea on the skin when blood urea nitrogen levels are elevated to 200 mg/dL. Gastroparesis (delayed gastric emptying) compounds the effect of malnutrition for patients with diabetes.