PrepU Chronic Kidney disease

The nurse is planning client teaching for a client with end-stage kidney disease who is scheduled for the creation of a fistula. The nurse should teach the client what information about the fistula? "A vein and an artery in your arm will be attached surgically." "The arm should be immobilized for 4 to 6 days." "One needle will be inserted into the fistula for each dialysis treatment." "The fistula can be used 5 to 7 days after the surgery for dialysis treatment."

"A vein and an artery in your arm will be attached surgically."

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: hematuria. weight loss. increased urine output. increased blood pressure.

weight loss

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.

A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action? Advance the catheter 2 to 4 cm further into the peritoneal cavity. Reposition the client to facilitate drainage. Aspirate from the catheter using a 60-mL syringe. Infuse 50 mL of additional dialysate.

Reposition the client to facilitate drainage.

A client with elevated BUN and creatinine values has been referred by her primary physician for further evaluation. The nurse should anticipate the use of what initial diagnostic test? Ultrasound X-ray Computed tomography (CT) Nuclear scan

Ultrasound

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? A GFR of 90 mL/min/1.73 m2 A GFR of 30-59 mL/min/1.73 m2 A GFR of 120 mL/min/1.73 m2 A GFR of 85 mL/min/1.73 m2

A GFR of 30-59 mL/min/1.73 m2

The nurse on a nephrology unit is caring for a diverse group of clients. For which client would a kidney biopsy most likely be contraindicated? A 64-year-old client with chronic glomerulonephritis A 57-year-old client with proteinuria A 42-year-old client with morbid obesity A 16-year-old client with signs of kidney transplant rejection

A 42-year-old client with morbid obesity

The nurse has identified the nursing diagnosis of "Risk for Infection" in a client who undergoes peritoneal dialysis. What nursing action best addresses this risk? Maintain aseptic technique when administering dialysate. Wash the skin surrounding the catheter site with soap and water prior to each exchange. Add antibiotics to the dialysate as prescribed. Administer prophylactic antibiotics by mouth or IV as prescribed.

Maintain aseptic technique when administering dialysate.

The nurse assess a healthy middle age client with a blood pressure of 158/90mmHg . In which classification of hypertension is the client according to the JNC 8(Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood pressure) recommendation? Stage 1 Stage 2 Stage 1 with compelling indications Stage 2 with compelling indications

Stage 1

A kidney biopsy has been scheduled for a client with a history of acute kidney injury. The client asks the nurse why this test has been scheduled. What is the nurse's best response? "A biopsy is routinely ordered for all clients with renal disorders." "A biopsy is generally ordered following abnormal x-ray findings of the renal pelvis." "A biopsy is often ordered for clients before they have a kidney transplant." "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."

"A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: "As the disease progresses, you will most likely require renal replacement therapy." "Dietary changes can reverse the damage that has occurred in your kidneys." "Draining of the cysts and antibiotic therapy will cure your disease." "Genetic testing will determine the best treatment for your condition."

"As the disease progresses, you will most likely require renal replacement therapy."

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? "Even a perfect match does not guarantee organ success." "Immunosuppressive drugs guarantee organ success." "The doctor may decide to delay the use of immunosuppressant drugs." "Let's wait until after the surgery to discuss your treatment plan."

"Even a perfect match does not guarantee organ success."

A 45-year-old man with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis? "Hemodialysis is a treatment option that is usually required three times a week." "Hemodialysis is a program that will require you to commit to daily treatment." "This will require you to have surgery and a catheter will need to be inserted into your abdomen." "Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again."

"Hemodialysis is a treatment option that is usually required three times a week."

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? "It is important to use strict aseptic technique." "It is appropriate to warm the dialysate in a microwave." "The infusion clamp should be open during infusion." "The effluent should be allowed to drain by gravity."

"It is appropriate to warm the dialysate in a microwave."

A 76-year-old client with ESKD has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The client tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to make? "The decision is certainly yours to make, but be sure not to make a mistake." "Kidney transplants in patients your age are as successful as they are in younger patients." "I understand your hesitancy to commit to a transplant surgery. Success is comparatively rare." "Have you talked this over with your family?"

"Kidney transplants in patients your age are as successful as they are in younger patients."

An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? "The risk of peritonitis is greater with this type of dialysis." "This type of dialysis will provide more independence." "Peritoneal dialysis will require more work for you." "Peritoneal dialysis does not work well for every client."

"This type of dialysis will provide more independence."

The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take? Administer the medications as ordered. Hold the medications until after dialysis. Check with the dialysis nurse about the medications. Ask if the client wants to take the medications.

Hold the medications until after dialysis.

A client with end-stage renal disease receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action? Inform the health care provider and assess the client for signs of infection. Flush the peritoneal catheter with normal saline. Remove the catheter promptly and have the catheter tip cultured. Administer a bolus of IV normal saline as prescribed.

Inform the health care provider and assess the client for signs of infection.

A client with a magnesium concentration of 2.6 mEq/L (1.3 mmol/L) is being treated on a medical-surgical unit. Which treatment should the nurse anticipate will be used? Intravenous furosemide Fluid restriction Oral magnesium oxide Dialysis

Intravenous furosemide

A client will be undergoing abdominal computed tomography (CT) with contrast. The nurse has administered IV sodium bicarbonate and oral acetylcysteine (Mucomyst) before the study, as prescribed. What would indicate that these medications have had the desired therapeutic effect? The client's BUN and creatinine levels are within reference range following the CT. The CT yields high-quality images. The client's electrolytes are stable in the 48 hours following the CT. The client's intake and output are in balance on the day after the CT.

The client's BUN and creatinine levels are within reference range following the CT.

The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse? Notify the health care provider. Turn the client from side to side. Lower the head of the bed. Push the catheter further into the abdomen.

Turn the client from side to side.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? Serum potassium level of 4.9 mEq/L Serum sodium level of 135 mEq/L Temperature of 99.2° F (37.3° C) Urine output of 20 ml/hour

Urine output of 20 ml/hour

The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply. Specific gravity of the client's urine Testing for the presence of glucose in the client's urine Microscopic examination of urine sediment for RBCs Microscopic examination of urine sediment for casts Testing for BUN and creatinine in the client's urine

Specific gravity of the client's urine Testing for the presence of glucose in the client's urine Microscopic examination of urine sediment for RBCs Microscopic examination of urine sediment for casts

An expected outcome for the hemodialysis client is: The client identifies signs and symptoms of rejection. The client verbalizes the dwell time for the dialysate. The client demonstrates how to administer the dialysate by gravity. The client explains how to assess the venous access site.

The client explains how to assess the venous access site.