PrepU CH.26

Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which of the following statements regarding vitamin D is correct?

Kidneys convert inactive vitamin D to its active form, calcitriol.

The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for:

Nephrotoxic acute tubular necrosis

A client is diagnosed with renal failure. The nurse must monitor for failure of which of the following functions? Select all that apply.

Maintenance of body water Electrolyte balance Acid-base balance Removal of metabolic waste from blood

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."

A client has acute pyelonephritis. The nurse will monitor the client for development of which of the following?

Intrarenal failure

The nurse is caring for a group of patients in the acute care unit. Which of the following patients are at risk for developing intrarenal failure? Select all that apply.

• One who is taking gentamicin for the treatment of a kidney infection • One with lead poisoning • One with acute glomerulonephritis

The nurse knows that a patient with chronic kidney disease (CKD) may experience which of the following changes in skin integrity? Select all that apply.

• Pale skin • Brittle fingernails • Decreased perspiration

Which of the following patients does the nurse need to monitor for the development of intense intrarenal vasoconstriction that may induce prerenal failure? Select all that apply.

• Patient undergoing cardiac catheterization • Patient taking cyclosporine to prevent rejection for a liver transplant • Patient with an elevated blood urea nitrogen who is taking ibuprofen every 6 hours for back pain

A client with CKD is being treated for hyperphosphatemia and hypocalcemia. Select the most appropriate intervention. Select all that apply.

• Phosphate-binding antacids • Activated vitamin D • Restriction of foods high in phosphate

A patient has developed acute tubular necrosis (ATN). The nurse knows that which of the following groups of drugs can cause this type of renal injury? Select all that apply.

• Radiocontrast dyes • Chemotherapy drugs • Aminoglycoside anti-infectives

Many drugs and other nephrotoxic agents can induce nephrotic acute tubular necrosis (ATN). The nurse knows that these agents cause tubular injury by which of the following mechanisms? Select all that apply.

• Renal vasoconstriction • Intratubular obstruction • Direct tubular damage

A client is diagnosed with early chronic kidney disease (CKD). The nurse will recommend which of the following actions to slow progression of renal damage? Select all that apply.

• Smoking cessation • Blood pressure control • Angiotensin converting enzyme inhibitor (ACEI) administration • Blood glucose control

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

The nurse will monitor clients with which of the following disorders for development of chronic kidney disease (CKD)? Select all that apply.

• Systemic lupus erythematosus • Polycycstic kidney disease • Glomerulonephritis • Diabetes

A 42 year-old male has been diagnosed with renal failure secondary to diabetes mellitus and is scheduled to begin dialysis soon. Which of the following statements by the client reflects an accurate understanding of the process of hemodialysis?

"I won't be able to go about my normal routine during treatment."

A client with a diagnosis of end-stage renal disease received a kidney transplant 2 years ago that was deemed a success. During the most recent follow-up appointment, the nurse should prioritize the client for referral based on which statement?

"I'm feeling a bit under the weather these days and I'm a bit feverish."

A nurse educator is performing client education with a 51 year-old man who has been recently diagnosed with chronic kidney disease. Which of the following statements by the client would the nurse most likely want to correct or clarify?

"My kidney problems increase my chance of developing high blood pressure or diabetes."

The clinical nurse educator on a nephrology unit of a large, urban hospital is orientating recent nursing graduates to the unit. Which of the following teaching points about acute tubular necrosis (ATN) should the educator include in the orientation session?

"Trauma, burns and major surgery are common precursors to ATN."

A client has undergone a kidney transplant and voices concerns about organ rejection to the nurse. The most appropriate response by the nurse would be:

"You will be given medication to decrease your immune systems from attacking your new kidney."

A patient has prerenal failure. The nurse knows that this type of failure is characterized by which relationship of blood urea nitrogen (BUN) to serum creatinine levels?

A BUN to creatinine level ratio of 20:1

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 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 nurse is caring for a patient with chronic renal failure who is on hemodialysis three times a week. In order to treat hyperphosphatemia and hypocalcemia, which of the following medications will the nurse administer to decrease absorption of phosphate from the gastrointestinal tract?

Calcium carbonate

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

Cardiovascular, cerebrovascular systems, skeletal

A patient sustained acute tubular injury approximately 2 hours ago. Which of the following phases of this disorder does the nurse recognize that the patient is in at this time?

Initiating phase

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

A 1-year-old baby boy with renal dysplasia risks end-stage renal disease unless intervention occurs. Which of the following treatment options is his care team most likely to reject?

Dietary restriction plus erythropoietin

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

A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor this client for which gastrointestinal signs and symptoms? Select all that apply.

Early morning nausea Gastrointestinal ulceration Metallic taste Anorexia

Following the diagnosis of acute renal failure, the nurse knows that one of the earliest manifestations of residual tubular damage is which of the following lab/diagnostic results?

Elevated blood urea nitrogen (BUN).

The nurse knows that uremia or "urine in the blood" is often used to describe the clinical manifestations of chronic kidney disease (CKD). Which of the following are early signs and symptoms of uremia? Select all that apply.

Fatigue Nausea Apathy Weakness

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)

A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?

Hypertension

Which of the following have the potential to cause chronic kidney disease? (Select all that apply.)

Hypertension • Diabetes • Glomerulonephritis

A child has received a kidney transplant at the age of 3. Knowing he will be on immunosuppressive agents like corticosteroids, the nurse should educate the parents about which long-term side effects? Select all that apply.

Hypertension • Growth retardation • Development of cataracts

A 35-year-old female ultramarathon runner is admitted to hospital following a day-long, 80-km race because her urinary volume is drastically decreased and her urine is dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis. Why is her urine red?

Myoglobinuria

A 35-year-old female ultramarathon runner is admitted to the hospital following a day-long, 50-mile race because her urinary volume is drastically decreased and her urine is dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis. Why is her urine red?

Myoglobinuria

A 45-year-old client with chronic kidney disease (CKD) voices concern about her dialysis treatment. The client would like to work and spend time with her family. Which type of dialysis will best fit this client's lifestyle?

Nocturnal intermittent peritoneal dialysis (NIPD)

A patient with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which of the following conditions does the nurse suspect is common with this stage of kidney disease?

Pericarditis

A client with chronic kidney disease (CKD) is anemic. The nurse will attempt to alleviate the anemia in order to prevent which of the following? Select all that apply.

Tachycardia • Fatigue • Decreased myocardial oxygen

A client has experienced severe hemorrhage and is in prerenal failure. The nurse anticipates the laboratory results of the client's BUN and serum creatinine to identify:

The BUN-to-creatinine ratio is 20:1.

Bruising of the skin is a manifestation of bleeding disorders in patients with CKD.

True

Which of the following clinical manifestations would lead the nurse to suspect their renal failure patient is developing uremia? Select all that apply.

Weakness and fatigue. Lethargy and confusion. Extreme itching.

A family physician is providing care for a 61 year-old obese male who has a history of diabetes and hypertension. Blood work has indicated that the man has a GFR of 51 mL/min with elevated serum creatinine levels. Which of the following statements will the physician most likely provide to the client in light of these results?

"Your chronic kidney disease has likely been caused by your diabetes and high blood pressure."

The health care provider is comparing results of a client's recent GFR measurement. Which of the following results would be interpreted as normal?

120 to 130 mL/minute

Older adults often have other chronic diseases that influence the early symptoms and signs of renal dysfunction. The nurse knows that which of the following can be the dominant clinical events in older adults with early kidney disease? Select all that apply.

Heart failure Hypertension

A client is suspected to have chronic kidney disease (CKD). The nurse will use which glomerular filtration rate (GFR) to aid in this diagnosis?

60 ml/min/1.73 square meters or less for three months

The nurse knows that a patient with which glomerular filtration rate (GFR) would be classified as "decreased GFR"?

70 mL/min

Which of the following clients would be considered to have a significant risk of developing the prerenal form of acute renal failure? Select all that apply.

79 year-old male with diagnoses of poorly controlled diabetes mellitus and heart failure. 22 year-old male who has lost large amounts of blood following a workplace injury. 80 year-old female who has been admitted for the treatment of dehydration and malnutrition.

A geriatric nurse is caring for several clients. Which alterations in clients' health should the nurse attribute to age-related physiologic changes?

A 78-year-old woman's GFR has been steadily declining over several years.

Which of the following clients' diagnostic bloodwork is most suggestive of chronic kidney disease (CKD)?

A client with low vitamin D levels; low calcitrol levels and elevated parathyroid hormone (PTH) levels

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

A hospital client with a diagnosis of chronic renal failure has orders for measurement of her serum electrolyte levels three times per week. Which of the following statements best captures the relationship between renal failure and sodium regulation?

Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption.

Chronic kidney disease (CKD) can provoke many cardiovascular changes. The nurse will monitor for which of the following in a client with CKD? Select all that apply.

Congestive heart failure • Hypertension • Impaired platelet function • Pericarditis

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

A new client presents with elevated BUN, systemic edema, a BP of 145/93 mm Hg, recurrent infections, and a GFR of 51 mL/min/1.73 m2. What treatment should the nurse anticipate?

Dialysis

A patient with chronic kidney disease (CKD) will begin hemodialysis. The nurse will recommend which of the following diets?

Diet low in proteins but including eggs and lean meat

A client is being treated for chronic kidney disease (CKD. . One of the nurse's responsibilities is to explain to the client the need to keep her blood pressure under control. Why is blood pressure control so important in CKD clients?

Elevated blood pressure will exacerbate nephron loss and accelerate renal failure.

A client has acute tubular necrosis (ATN) caused by myoglobinuria. The nurse knows that myoglobinuria can result from which of the following? Select all that apply.

Hyperthermia • Muscle damage • Alcohol abuse • Prolonged seizures

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

Skeletal disorders frequently accompany chronic kidney disease (CKD). The nurse recognizes which of the following statements regarding bone turnover in CKD are correct? Select all that apply.

In high-bone-turnover, there is both increased bone formation and increased resorption. High-bone-turnover produces porous, coarse-fibered bone. Metabolic acidosis of CKD can affect bone turnover. Both high and low turnover present risk for fracture.

Albuminuria is an important indicator of nephron damage. The nurse recognizes that which of the following statements regarding albuminuria are correct? Select all that apply.

Increased excretion of albumin indicates CKD. • Urine dipstick can detect albuminuria. • Albumin-to-creatinine ratio can confirm albuminuria.

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).

In hemodialysis, access to the vascular system is most commonly through what?

Internal arteriovenous fistula

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.

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

Polyuria

A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor this client for which of the following Select all that apply.

Polyuria • Hyperkalemia • Hypocalcemia • Hyponatremia

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

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?

Prerenal failure

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

Which symptom occurs in a client with chronic kidney disease (CKD) as a result of elevated serum phosphate levels and the development of phosphate crystals that occur with hyperparathyroidism?

Pruritus

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

Rapid decline in renal function

A 72-year-old patient is scheduled for a kidney transplant. The nurse knows that which aspect of advanced age has a positive effect on the success of kidney transplant survival?

Reduction in T-lymphocyte function

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 client is diagnosed with chronic kidney disease (CKD). The nurse knows that which of the following statements regarding CKD are correct? Select all that apply

Renal damage is irreversible. Hypertension is a major cause.

A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which would be the best instruction for the nurse to provide?

Restrict intake of dietary protein

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

Serum creatinine

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

Acute tubular necrosis (ATN) is the most common cause of intrinsic renal failure. One of the causes of ATN is ischemia. What are the most common causes of ischemic ATN? (Select all that apply.)

Severe hypovolemia, Burns, and overwhelming sepsis.

A 56-year-old woman has been diagnosed with CKD. She first went to the doctor due to complications of hypertension. How are hypertension and CKD related?

The mechanisms that produce hypertension in CKD include an increased vascular volume and increased activity of the renin--angiotensin system.

A client with chronic kidney disease has been admitted with increased shortness of breath and abnormal breath sounds (rales heard to scapular region of posterior back). The admission hemoglobin level is 7.8 g/dL. Vital signs are as follows: respiratory rate 30; BP 180/98; pulse 110. +3 pitting edema in lower extremities bilaterally. Knowing the correlation of hypertension and associated anemia, the nurse suspects this client has developed:

heart failure.

A 45-year-old Caucasian woman is being treated for ovarian cancer. Her treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of:

nephrotoxic acute tubular necrosis.

A client with chronic kidney disease has developed cardiac calcification. On admission the priority assessment would be for the nurse to:

place on a heart monitor to watch for arrhythmias.

The nurse recognizes that which of the following individuals have the greatest risk for the development of chronic kidney disease (CKD)? Select all that apply.

• A patient with a recent diagnosis of type 2 diabetes who does not monitor his blood sugar or control his diet • A 42-year-old patient with uncontrolled hypertension

The nurse knows that a patient with chronic kidney disease (CKD) may develop renal osteodystrophy (skeletal damage). Which of the following are characteristic of both high-bone-turnover and low-bone-turnover osteodystrophy? Select all that apply.

• Abnormal bone resorption • Defective bone remodeling

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

A client is diagnosed with decreased gomerular filtration rate but has no renal damage. The nurse recognizes that this can occur with which of the following? Select all that apply.

• Cirrhosis • Heart failure • Removal of one kidney • Dehydration

Anemia frequently occurs in clients with chronic kidney disease (CKD). The nurse will monitor these clients for which of the following contributors to anemia? Select all that apply.

• Decreased erythropoietin production • Anorexia • Bone marrow suppression • Chronic blood loss

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 renal endocrine function • Decreased tubular reabsorption • Decreased glomerular filtration

In a client in the uremic state of chronic kidney failure (CKD), the nurse will monitor for which of the following signs and symptoms? Select all that apply.

• Encephalopathy • Nausea • Anemia • Apathy

Glomerular filtration rate (GFR) is the best indicator of renal function. The nurse knows that GFR can vary with which of the following factors? Select all that apply.

• Gender • Age • Body size • Ethnicity

Chronic kidney disease (CKD) can cause derangement of calcium and phosphate metabolism. The nurse will monitor a client with CKD for which of the following? Select all that apply.

• Impaired phosphate excretion • Decreased blood levels of calcium

A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor for which of the following manifestations of this disorder? Select all that apply.

• Increased nitrogenous waste in blood • Anemia • Osteodystrophy

A client is diagnosed with acute renal injury. The nurse will evaluate the client for which of the following possible causes for this disorder? Select all that apply.

• Ischemic injury • Nonischemic reduced renal blood flow • Obstruction of urinary outflow • Nephrotoxic substances