Ch 46 Acute Kidney Injury and Chronic Kidney Disease

A nurse is caring for a client with end-stage kidney disease who is about to receive a transplant. When the client returns from the postanesthesia care unit after a kidney transplant, how often should the nurse measure the client's urinary output? A. 1 hr B. 2 hrs C. 15 mins D. 30 mins

A. Hourly output is critical in assessing kidney function; decreasing urinary output is a sign of rejection. Every 2 hrs is too infrequent for monitoring output immediately after a kidney transplant; it is essential to monitor output more frequently to evaluate whether the new kidney is working or being rejected. It is not necessary to monitor every 15 or 30 mins.

A nurse is caring for a client who had a kidney transplant. Which test is most important for the nurse to monitor to determine whether a client's newly transplanted kidney is working effectively? A. Renal scan B. Serum creatinine C. 24-hr urine output D. WBC count

B. Serum creatinine, a test of renal function, measures the kidneys' ability to excrete metabolic wastes; creatinine, a nitrogenous product of protein breakdown, is elevated in renal insufficiency. A renal scan will not provide information about the filtering ability of the transplanted kidney. Although intake and output will be monitored, this will not provide information about the ability of kidney to excrete metabolic wastes. The WBC count will not reflect functioning of a transplanted kidney.

A nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet. What is the rationale for the nurse's instruction? A. a person's body tends to retain fluid when a salt substitute is included in the diet B. Limiting salt substitutes in the diet prevents a buildup of waste products in the blood C. Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats D. A substance in the salt substitute interferes with the transfer of fluid across capillary membranes, resulting in anasarca

C. Salt substitutes usually contain potassium, which can lead to hyperkalemia; dysrhythmias are associated with hyperkalemia. Sodium, not salt substitutes, in the diet causes retention of fluid. Salt substitutes do not contain substances that influence blood urea nitrogen (BUN) and creatinine levels; these are the result of protein metabolism. There is no such substance in salt substitutes that interferes with the transfer of fluid across capillary membranes.

A nurse is caring for a client with end-stage kidney disease after a kidney transplant. Which finding indicates the transplant is successful? A. Increased specific gravity B. Correction of hypotension C. Elevated serum potassium D. Decreasing serum creatinine

D. As the transplanted organ functions, nitrogenous wastes are eliminated, lowering the serum creatinine. As more urine is produced by the transplanted kidney, the specific gravity and concentration of the urine will decrease. With end-stage kidney disease, fluid retention causes hypertension; there should be a correction of hypertension, not hypotension. After the transplant, the serum potassium should correct to within expected limits for an adult.

A client has end-stage kidney disease and is receiving hemodialysis. During dialysis the client reports nausea and a headache and appears confused. Operating on prescribed protocols, which action will the nurse take? A. Give an analgesic B. Administer an antiemetic C. Decrease the rate of exchange D. Discontinue the procedure immediately

C. Headache, nausea, and confusion are signs and symptoms of disequilibrium syndrome, which results from rapid changes in composition of the extracellular fluid; therefore, the rate of exchange should be decreased. Although an analgesic may relieve the headache, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Although administering an antiemetic may relieve the nausea, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Discontinuing the procedure is unnecessary; reducing the rate of exchange should reduce the adaptations of disequilibrium syndrome.

During the postoperative period after surgery for a kidney transplant, the client's creatinine level is 3.1 mg/dL. What should the nurse do first in response to this laboratory result? A. Notify the primary HCP B. Obtain current blood test results C. Assess for decreased urine output D. Check the IV infusion

C. The expected serum creatinine range is 0.7-1.4 mg/dL. The nurse should obtain additional information that may indicate acute rejection; therefore, the nurse must first assess for decreased urine output and changes in vital signs. Once additional data are collected (e.g., urine output, current blood work reports) and the IV infusions are checked, the nurse should contact the primary HCP, explain the situation, and implement further prescriptions. Eventually the nurse should ensure that proper infusion rates, along with IV medications, are being maintained after the client is first assessed for decreased urine output and for changes in vital signs. Current blood work reports should be obtained after the client is assessed for decreased urine output and changes in vital signs.