Ch. 26 Prep U
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).
A 42 year-old male has been diagnosed with renal failure secondary to diabetes mellitus and is scheduled to begin dialysis soon. Which statement 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 chronic kidney disease (CKD) is starting hemodialysis. Which diet will the dialysis nurse likely recommend?
Diet low in proteins but including eggs and lean meat
Which of the following have the potential to cause chronic kidney disease? (Select all that apply.)
Hypertension Diabetes Glomerulonephritis
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 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."
Which clients would be considered to have a significant risk of developing the prerenal form of acute renal failure? Select all that apply.
22 year-old male who has lost large amounts of blood following a workplace injury. 79 year-old male with diagnoses of poorly controlled diabetes mellitus and heart failure. 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.
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
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 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
Which of the following medications would the nurse anticipate being prescribed for the renal failure patient who has hyperphosphatemia?
Calcium carbonate.
A client is diagnosed with decreased gomerular filtration rate but has no renal damage. The nurse recognizes this can occur with which disease process? Select all that apply.
Cirrhosis Heart failure Removal of one kidney Dehydration
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
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 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
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
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)
The nurse will monitor the client with chronic kidney disease (CKD) for which possible cardiovascular changes? Select all that apply.
Heart failure Hypertension Pericarditis
A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?
Hypertension
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
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 nurse is providing dietary instruction for a client with chronic kidney disease who is on hemodialysis. Which would the nurse encourage the client to restrict?
Lean meats
The nurse assessing a renal failure patient for encephalopathy caused by uremia may observe which of the following clinical manifestations?
Loss of recent memory and inattention.
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)
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
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 is diagnosed with a tumor in the urinary bladder. The nurse will monitor the client for which of the following?
Postrenal failure
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
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
Neuromuscular disorders can be triggered by CKD. For those clients on dialysis, approximately two thirds suffer from what peripheral neuropathy?
Restless legs syndrome
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
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
Bruising of the skin is a manifestation of bleeding disorders in patients with CKD.
True
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.
