Prep U renal Questions
The nurse is explaining to a client the difference between hemodialysis and continuous renal replacement therapy (CRRT). What statement by the client leads the nurse to determine that additional education is needed? -"CRRT is faster than hemodialysis." -"CRRT is used to treat acute kidney injury." -"CRRT is used for hemodynamically unstable clients." -"CRRT causes less electrolyte changes."
"CRRT is faster than hemodialysis." Explanation: The nurse determines that additional education is needed when the client states that CRRT is faster than hemodialysis because CRRT is administered around the clock. It causes less electrolyte and hemodynamic changes and therefore is used in hemodynamically unstable clients. It is used to treat acute kidney injury.
The nurse is planning the care for a client with acute kidney injury (AKI). What should the nurse prioritize in the client's plan of care? Select all that apply. -Assessing fluid balance -Monitoring electrolyte levels -Promoting infection control -Optimizing pain control -Protecting from falls
Assessing fluid balance Monitoring electrolyte levels Promoting infection control Explanation: The nurse will need to monitor fluid balance carefully as the client can experience both fluid volume excess and deficit in AKI. There are also serious consequences due to electrolyte imbalances, such as cardiac dysrhythmias related to hyperkalemia. Secondary infections are a major cause of death in people with AKI, making infection control another priority. Having AKI on its own does not increase the risk for falls or cause pain in the client.
The nurse caring for a group of clients should monitor which clients for the development of intrarenal failure? Select all that apply. -Client taking gentamicin for the treatment of a kidney infection -Client with lead poisoning -Client with acute glomerulonephritis -Client with septic shock from pneumonia -Client with a gastrointestinal hemorrhage
Client taking gentamicin for the treatment of a kidney infection Client with lead poisoning Client with acute glomerulonephritis Client with septic shock from pneumonia Explanation: Causes of intrarenal kidney injury are acute tubular necrosis/acute renal injury; prolonged renal ischemia; exposure to nephrotoxic drugs such as gentamicin, heavy metals, and organic solvents; intratubular obstruction resulting from hemoglobinuria, myoglobinuria, myeloma light chains, uric acid casts, and acute renal disease (e.g., acute glomerulonephritis, pyelonephritis)
A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client's hypervolemia and hyperkalemia. Which of the following therapies will the client's hemodynamic status best tolerate? -Hemodialysis -Peritoneal dialysis -Continuous venovenous hemodialysis (CVVHD) -Plasmapheresis
Continuous venovenous hemodialysis (CVVHD) Explanation: CVVHD facilitates the removal of uremic toxins and fluid. The hemodynamic effects of CVVHD are usually mild in comparison to hemodialysis, so CVVHD is best tolerated by an unstable client. Peritoneal dialysis is not the best choice, as the client may have sustained abdominal injuries during the accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and electrolyte balance
During hemodialysis, toxins and wastes in the blood are removed by which of the following? -Diffusion -Osmosis -Ultrafiltration -Filtration
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.
Which phase of acute renal failure signals that glomerular filtration has started to recover? -Diuretic -Oliguric -Initiation -Recovery
Diuretic 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.
Compliance to a renal diet is a difficult lifestyle change for a patient on hemodialysis. The nurse should reinforce nutritional information. Which of the following teaching points should be included? Select all that apply. -Limit protein to 1.6 g/kg/day. -Eat foods such as milk, fish, and eggs. -Restrict sodium to 2,000 to 3,000 mg daily. -Increase potassium to prevent cardiac problems. -Restrict fluid to daily urinary output plus 500 to 800 mL.
Eat foods such as milk, fish, and eggs. Restrict sodium to 2,000 to 3,000 mg daily. Restrict fluid to daily urinary output plus 500 to 800 mL. Explanation: With hemodialysis, protein should be limited to 1.2 to 1.3 g/kg/24 hr. Potassium, along with sodium and phosphorus should be restricted.
A health care provider has completed an assessment on a client diagnosed with cirrhosis. The client asks, "What, if any, serious complications are associated with cirrhosis?" Which response is the most accurate for the provider to relay to the client? -Esophageal varices -Duodenal ulcers -Biliary colic -Dehydration
Esophageal varices. Most deaths from alcoholic cirrhosis are attributable to liver failure, bleeding esophageal varices, or kidney failure. Esophageal varices are a life-threatening complication of cirrhosis related to the risk of rupturing and producing a massive amount of hemorrhage. The remaining options may be irritating but are not life-threatening.
A client receiving continuous ambulatory peritoneal dialysis (CAPD) treatments has excessive weight gain in the past 24 hours and tells the nurse excessive amounts of fluids were consumed while out with family. What change in the client's dialysis order will the nurse anticipate once relaying these findings to the health care provider? -Switching the client from 2.5% to a 4.25% dextrose dialysate -Reducing the volume of dialysate from 3 L to 1 L -Increasing the dialysate dwell time from 6 hours to 8 hours -Preparing the client for a hemodialysis treatment
Switching the client from 2.5% to a 4.25% dextrose dialysate Explanation: Given the client is in a state of fluid volume excess, the goal will be to remove additional fluid with the dialysis treatment. Glucose in the dialysis solution accounts for water removal and a solution of 4.25% dextrose concentration will remove more fluid than one of lower concentration. The volume of dialysate would not be decreased; dwell times would not exceed 6 hours. There would be no need for the client to get a hemodialysis treatment.
A client has developed acute tubular necrosis (ATN). The nurse knows that which classification of drugs can cause this type of renal injury? Select all that apply. -Nonsteroidal anti-inflammatory drugs (NSAID) -Radiocontrast dyes -Angiotensin converting enzyme (ACE) inhibitors -Chemotherapy drugs -Aminoglycoside anti-infectives
Nonsteroidal anti-inflammatory drugs (NSAID) Radiocontrast dyes Chemotherapy drugs Aminoglycoside anti-infectives Explanation: Aminoglycosides, radiocontrast agents, and chemotherapy drugs such as cisplatin all are directly toxic to the nephron and ATN will occur. NSAIDs inhibit the synthesis of prostaglandins needed to maintain renal blood flow, thus renal perfusion declines and prerenal failure can develop. ACE inhibitors are generally not nephrotoxic and are often used to manage hypertension in persons with renal disease.
A patient is postoperative day 3 following the successful transplantation of a kidney. The nurse is aware of the importance of assessing the patient for signs and symptoms of rejection. Consequently, the nurse is constantly monitoring the patient for: -Decreased level of consciousness and pruritus -Oliguria and edema -Pain and hematuria -Weight loss and lethargy
Oliguria and edema Explanation: After kidney transplantation, the nurse assesses the patient for signs and symptoms of transplant rejection: oliguria, edema, fever, increasing blood pressure, weight gain, and swelling or tenderness over the transplanted kidney or graft. The other given assessment findings are not directly suggestive or organ rejection
Nursing assessment for the patient receiving peritoneal dialysis would include which of the following to detect the most serious complication of this procedure? -Palpate the abdominal wall for rebound tenderness. -Inspect the catheter site for leakage of dialysate. -Observe for evidence of bleeding. -Measure fluid drainage to estimate incomplete recovery of fluid.
Palpate the abdominal wall for rebound tenderness.Peritonitis is the most serious complication of peritoneal dialysis. To detect rebound tenderness, the nurse presses one hand firmly into the abdominal wall and quickly withdraws the hand. Rebound tenderness exists when pain occurs upon removal; this pain is associated with inflammation of the peritoneal cavity.
A nurse is teaching a client about the newly prescribed furosemide and how it affects fluid and electrolyte balance. In addition to water, the nurse would explain that the drug also affects which electrolyte(s)? Select all that apply. -Sodium -Chloride -Potassium -Magnesium -Calcium -Phosphate
Sodium Chloride Potassium Magnesium Explanation: Diuretics are prescribed to increase the excretion of sodium, chloride, and water in clients with high blood pressure or with chronic heart, renal, or liver problems. At times, the medications may remove too much ECF from the body, resulting in a deficit. Diuretics, except for the potassium-sparing diuretics, also promote the excretion of potassium and magnesium from the body, increasing the risk of electrolyte deficits as well. Imbalances of calcium and phosphate are usually not associated with diuretic therapy.
The nurse is caring for a client on hemodialysis who has an arteriovenous (AV) fistula in the right arm. When managing a client's plan of care, which instructions would the nurse determine as a priority for being completed? Select all that apply. -maintaining the right arm above the heart -utilizing a splint to maintain the right arm in an extended position -avoiding all blood pressure readings and trauma to the right arm -assessing the shunt by auscultating a bruit -completing arm and finger exercises -wearing snug-fitted shirts
avoiding all blood pressure readings and trauma to the right arm assessing the shunt by auscultating a bruit completing arm and finger exercises Explanation: An AV fistula is a connection between an artery and a vein creating a ready source with a rapid flow of blood. The fistula is located under the skin and is used during dialysis to access the bloodstream. When managing the care of the client, instruction is needed to ensure the patency of the fistula. The client would not have any blood pressure readings, lab work drawn, or trauma to the right arm. To check the fistula for adequate blood flow, the client would feel the thrill of the blood moving through the vessels and auscultate a bruit hearing the swish in the vessels. Arm and finger exercises are encouraged for blood flow. The client would not elevate the right arm above the heart as would be done to decrease swelling or inflammation or split the arm. Snug-fitting clothes are to be avoided.
A client is scheduled for hemodialysis three times a week. The nurse is explaining complications to the client. Which complications are related to hemodialysis treatments? Select all that apply. -bleeding -nausea and vomiting -leg cramps -hypertension -hypotension
bleeding leg cramps hypotension Explanation: Bleeding, leg cramps, and hypotension are hemodialysis complications. Nausea/vomiting and hypertension are related to the kidney failure.
The nurse is caring for a 6-year-old client diagnosed with acute renal failure. During assessment, the nurse notes: temperature 99.0°F (37.2°C), urine output less than 0.4 mL/kg/hr, blood pressure 130/88 mm Hg, periorbital edema, and respirations 28 breaths/minute. Which prescriptions will the nurse anticipate from the primary health care provider? Select all that apply. -furosemide -dialysis -serum electrolyte levels -urinalysis -labetalol
furosemide dialysis serum electrolyte levels urinalysis labetalol Explanation: The child is experiencing complications of the acute renal failure including oliguria, interstitial fluid shifting, and hypertension. Oliguria is defined as a urine output that is less than 0.5 mL/kg/h in children. The nurse would prepare to administer furosemide to assist with the edema and labetalol to lower the blood pressure. Dialysis may be needed due to the severe oliguria. The client is at risk for electrolyte disturbances and should be monitored closely. A urinalysis may reveal proteinuria or hematuria, which could indicate additional complications.
A client receiving peritoneal dialysis in the home is suspected of having peritonitis. Which finding should the nurse expect to assess in this client? Select all that apply. -weight loss -hypotension -extreme thirst -abdominal pain -rebound tenderness
hypotension abdominal pain rebound tenderness Explanation: A client receiving peritoneal dialysis is at risk for developing peritonitis. Manifestations of peritonitis include diffuse abdominal pain and rebound tenderness. Hypotension can occur if the infection continues. Weight loss and extreme thirst are not signs of peritonitis.
