Ch 54 Kidney Disorders (AKI / ESKD)
What is a hallmark of the diagnosis of nephrotic syndrome? a. Hyponatremia b. Proteinuria c. Hypoalbuminemia d. Hypokalemia
b. Proteinuria Rationale: Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.
The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number.
4,000 ml
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: a. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. b. a decreased serum phosphate level secondary to kidney failure. c. an increased serum calcium level secondary to kidney failure. d. metabolic alkalosis secondary to retention of hydrogen ions.
a. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. Rationale: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a. Diuresis b. Fever c. Absence of pain d. Weight loss
b. Fever Rationale: Fever is an indicator of infection or transplant rejection.
The nurse recognizes which condition as an integumentary manifestation of chronic renal failure? a. Asterixis b. Gray-bronze skin color c. Tremors d. Seizures
b. Gray-bronze skin color Rationale: Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.
What is a characteristic of the intrarenal category of acute renal failure? a. Decreased creatinine b. Increased BUN c. High specific gravity d. Decreased urine sodium
b. Increased BUN Rationale: The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.
A nurse cares for an acutely ill client. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill client is: a. blood pressure. b. weight. c. pulse rate. d. edema.
b. weight. Rationale: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. Blood pressure, pulse rate, and edema are not the most accurate indicator of fluid loss or gain.
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? a. Azotemia b. Proteinuria c. Hematuria d. Bacteremia
a. Azotemia Rationale: The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.
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? a. "The risk of peritonitis is greater with this type of dialysis." b. "This type of dialysis will provide more independence." c. "Peritoneal dialysis will require more work for you." d. "Peritoneal dialysis does not work well for every client."
b. "This type of dialysis will provide more independence." Rationale: Once a treatment choice has been selected by the client, the nurse should support the client in that decision. Continuous cyclic peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients.
Which clinical finding should a nurse look for in a client with chronic renal failure? a. Hypotension b. Uremia c. Metabolic alkalosis d. Polycythemia
b. Uremia Rationale: Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? a. "Be sure to eat meat at every meal." b. "Eat plenty of bananas." c. "Increase your carbohydrate intake." d. "Drink plenty of fluids, and use a salt substitute."
c. "Increase your carbohydrate intake." Rationale: A client with CRF requires extra carbohydrates to prevent protein catabolism. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Salt substitutes are high in potassium and should be avoided.
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? a. "Squamous cell carcinomas do not present with detectable symptoms." b. "You should have sought treatment earlier." c. "Very few symptoms are associated with renal cancer." d. "Painless gross hematuria is the first symptom in renal cancer."
c. "Very few symptoms are associated with renal cancer." Rationale: Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease. Adenocarcinomas are the most common renal cancer (about 80%),whereas squamous cell renal cancers are rare. It is not therapeutic to place doubt or blame for delayed diagnosis.
The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: a. 500 mL of fluid b. 1,000 mL of fluid c. 1,500 mL of fluid d. 2,000 mL of fluid
c. 1,500 mL of fluid Rationale: A 1-kg weight gain is equal to 1,000 mL of retained fluid.
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: a. nausea and vomiting. b. dyspnea and cyanosis. c. fatigue and weakness. d. thrush and circumoral pallor.
c. fatigue and weakness. Rationale: RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.
Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?
6 tablets
A client has been diagnosed with acute glomerulonephritis. This condition causes: a. proteinuria. b. pyuria. c. polyuria. d. No option is correct.
a. proteinuria. Rationale: The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided.
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? a. Diuresis b. Oliguria c. Acute tubular necrosis d. Restored glomerular function
b. Oliguria Rationale: During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? a. Tea-colored urine b. Left upper quadrant pain c. Pyuria d. Low blood pressure
a. Tea-colored urine Rationale: Tea-colored urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis.
Which of the following would a nurse classify as a prerenal cause of acute renal failure? a. Polycystic disease b. Ureteral stricture c. Prostatic hypertrophy d. Septic shock
d. Septic shock Rationale: Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias. Ureteral stricture and prostatic hypertrophy would be classified as postrenal causes. Polycystic disease is classified as an intrarenal cause of acute renal failure.
A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client? a. Anemia b. Acidosis c. Hyperkalemia d. Pericarditis
a. Anemia Rationale: Anemia develops as a result of inadequate erythropoietin production, the shortened lifespan of RBCs, nutritional deficiencies, and the patient's tendency to bleed, particularly from the GI tract. Erythropoietin, a substance normally produced by the kidneys, stimulates bone marrow to produce RBCs (Murphy, Bennett, & Jenkins, 2010). In ESKD, erythropoietin production decreases and profound anemia results, producing fatigue, angina, and shortness of breath.
A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? a. Decrease in the blood flow through the kidneys b. Obstruction of urine flow from the kidneys c. Blood clot formed in the kidneys interfered with the flow d. Structural damage occurred in the nephrons of the kidneys
a. Decrease in the blood flow through the kidneys Rationale: Acute renal failure can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? a. Glomerulonephritis b. Hypovolemia c. Ureteral calculus d. Dysrhythmia
a. Glomerulonephritis Rationale: Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? a. Acute renal failure b. Acute glomerulonephritis c. Chronic renal failure d. Nephrotic syndrome
b. Acute glomerulonephritis Rationale: Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.
The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL? a. 250 mL b. 500 mL c. 750 mL d. 1,000 mL
d. 1,000 mL Rationale: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1-kg weight gain is equal to 1,000 mL of retained fluid.
A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause? a. Acute pyelonephritis b. Osmotic dieresis. c. Dysrhythmias d. Renal calculi
d. Renal calculi Rationale: Postrenal ARF is the result of an obstruction that develops anywhere from the collecting ducts of the kidney to the urethra. This results from ureteral blockage, such as from bilateral renal calculi or benign prostatic hypertrophy (BPH).
Patient education regarding a fistulae or graft includes which of the following? Select all that apply a. Check daily for thrill and bruit. b. Avoid compression of the site. c. No IV or blood pressure taken on extremity with dialysis access. d. No tight clothing. e. Cleanse site b.i.d.
a. Check daily for thrill and bruit. b. Avoid compression of the site. c. No IV or blood pressure taken on extremity with dialysis access. d. No tight clothing.
A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate? a. Donors are selected from compatible living or deceased donors. b. Donors must be relatives. c. Donors with hypertension may qualify. d. The client is placed on a transplant list at the local hospital.
a. Donors are selected from compatible living or deceased donors. Rationale: Donors are selected from compatible living donors. Donors do not have to be relatives as long as they are compatible. Potential donors with a history of hypertension, malignant disease, or diabetes are excluded from donation. Each local hospital does not have its own transplant list, instead the client will be placed on a national computerized transplant waiting list.
The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? a. Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. b. BUN of 18 mg/dL. c. Serum creatinine of 1.2 mg/dL. d. Glomerular filtration rate (GFR) of 100 mL/min.
a. Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. Rationale: The normal BUN:Cr ratio is less than 15. Prerenal azotemia is caused by hypoperfusion of the kidneys due to a nonrenal cause. Over time, higher than normal blood levels of urea or other nitrogen-containing compounds will develop.
A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess? a. Hypertension b. Extremity pain c. Fever d. Periorbital edema
a. Hypertension Rationale: Hypertension is present in approximately 75% of clients with polycystic kidney disease at the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and abdominal pain also may be noted based on the size and effects of the cysts. Fever would suggest an infection. Periorbital edema is noted with acute glomerulonephritis.
Which of the following occurs late in chronic glomerulonephritis? a. Peripheral neuropathy b. Nosebleed c. Stroke d. Seizure
a. Peripheral neuropathy Rationale: Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.
What is used to decrease potassium level seen in acute renal failure? a. Sodium polystyrene sulfonate b. Sorbitol c. IV dextrose 50% d. Calcium supplements
a. Sodium polystyrene sulfonate Rationale: The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? a. Elevated urea levels b. Hyperkalemia c. Hypocalcemia d. Elevated white blood cells
b. Hyperkalemia Rationale: Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? a. Initiation b. Oliguria c. Diuresis d. Recovery
b. Oliguria Rationale: The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys, such as urea and creatinine. The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.
A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? a. Administer isotonic fluid therapy as ordered. b. Keep the drainage catheter below the level of insertion. c. Encourage use of incentive spirometer every 2 hours. d. Monitor temperature every 4 hours.
c. Encourage use of incentive spirometer every 2 hours. Rationale: To address the issue of ineffective breathing pattern, encouraging the use of incentive spirometer would be most appropriate to help increase alveolar ventilation. Administering isotonic fluid therapy would be appropriate for issues involving fluid loss such as bleeding or hemorrhage. Keeping the drainage catheter below the level of insertion would be appropriate to reduce the risk of obstruction leading to acute pain. Monitoring the temperature every 4 hours would be appropriate to reduce the client's risk for infection.
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? a. Increase fat intake and limit carbohydrates. b. Eliminate fat intake and increase protein intake. c. Increase carbohydrates and limit protein intake. d. Increase protein, carbohydrates, and fat intake.
c. Increase carbohydrates and limit protein intake. Rationale: Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan? a. Keep the AV fistula site dry. b. Keep the AV fistula wrapped in gauze. c. Take the client's blood pressure in the left arm. d. Assess the AV fistula for a bruit and thrill.
d. Assess the AV fistula for a bruit and thrill. Rationale: The nurse needs to assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.
The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? a. pH 7.20, PaCO2 36, HCO3 14- b. pH 7.31, PaCO2 48, HCO3 24- c. pH 7.47, PaCO2 45, HCO3 33- d. pH 7.50, PaCO2 29, HCO3 22-
a. pH 7.20, PaCO2 36, HCO3 14- Rationale: Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.
One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: a. restricting sources of potassium usually found in fresh fruits and vegetables. b. allowing liberal use of sodium. c. limiting iron and folic acid intake. d. eating protein liberally.
a. restricting sources of potassium usually found in fresh fruits and vegetables. Rationale: Restrict sources of potassium usually found in fresh fruits and vegetables; hyperkalemia can cause life-threatening changes. Restrict sodium intake as ordered; doing so prevents excess sodium and fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken. Iron and folic acid supplements are needed for RBC production. Epogen stimulates bone marrow to produce RBCs. Restrict protein intake to foods that are complete proteins within prescribed limits. Complete proteins provide positive nitrogen balance for healing and growth.
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: a. hematuria. b. weight loss. c. increased urine output. d. increased blood pressure.
b. weight loss. Rationale: Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? a. Encouraging coughing and deep breathing b. Promoting carbohydrate intake c. Limiting fluid intake d. Providing pain-relief measures
c. Limiting fluid intake Rationale: During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and IV fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.
Glomerulonephritis is an inflammatory response in the glomerular capillary membrane, and causes disruption of the renal filtration system. Although diagnostic urinalysis can reveal glomerulonephritis, many clients with glomerulonephritis exhibit: a. no symptoms. b. fever. c. headache. d. polyuria.
a. no symptoms. Rationale: Many clients with glomerulonephritis have no symptoms. Early symptoms may be so slight that the client does not seek medical attention.
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? a. Increased pH with decreased hydrogen ions b. Increased serum levels of potassium, magnesium, and calcium c. Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL d. Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75%
c. Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL Rationale: The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl. A BUN level of 100 mg/dl and a serum creatinine of 6.5 mg/dl are abnormally elevated results, reflecting CRF and the kidneys' decreased ability to remove nonprotein nitrogen waste from the blood. CRF causes decreased pH and increased hydrogen ions — not vice versa. CRF also increases serum levels of potassium, magnesium, and phosphorous, and decreases serum levels of calcium. A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls within the normal range of 60% to 75%.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a. Impaired urinary elimination b. Toileting self-care deficit c. Risk for infection d. Activity intolerance
c. Risk for infection Rationale: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.
The nurse treats a client with end-stage kidney disease (ESKD). The nurse is concerned that the client is developing renal osteodystrophy. Upon review of the client's laboratory values, it is noted the client has had a calcium level of 11 mg/dL for the past 3 days and the phosphate level is 5.5 mg/dL. The nurse anticipates the administration of which medication? a. Calcium carbonate b. Mylanta c. Calcium acetate d. Sevelamer hydrochloride
d. Sevelamer hydrochloride Rationale: Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the gastrointestinal tract. Binders such as calcium carbonate or calcium acetate are prescribed, but there is a risk of hypercalcemia. If calcium is high or the calcium-phosphorus product exceeds 55 mg/dL, a polymeric phosphate binder such as sevelamer hydrochloride may be prescribed. This medication binds dietary phosphorus in the intestinal tract; one to four tablets should be administered with food to be effective. Magnesium-based antacids are avoided to prevent magnesium toxicity.
The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? a. Wear a mask while handling any dialysate solutions. b. Keep the catheter stabilized to the abdomen, below the belt line. c. Use an aseptic technique during the procedure. d. Clean the catheter insertion site daily with soap.
c. Use an aseptic technique during the procedure. Rationale: The client should be instructed to use an aseptic technique during the procedure. The client should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (clients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? a. Pats skin dry after bathing b. Uses moisturizing creams c. Keeps nails trimmed short d. Brief, hot daily showers
d. Brief, hot daily showers Rationale: Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? a. Previous episode of acute pyelonephritis b. History of hyperparathyroidism c. Recent history of streptococcal infection d. History of osteoporosis
c. Recent history of streptococcal infection Rationale: Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.
The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client? a. Hemodialysis b. Peritoneal dialysis c. Continuous arteriovenous hemofiltration (CAVH) d. Continuous venovenous hemofiltration (CVVH)
a. Hemodialysis Rationale: The client is hemodynamically stable and hemodialysis would be most appropriate. Hemodialysis is used for clients who are acutely ill and require short-term dialysis for days to weeks until kidney function resumes and for clients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) who require long-term or permanent renal replacement therapy. Peritoneal dialysis (PD) may be the treatment of choice for clients with renal failure who are unable or unwilling to undergo hemodialysis or kidney transplantation. CAVH and CVVH are used for client who are hemodynamically unstable.
The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? Select all that apply. a. Red blood cells in the urine b. Polyuria c. Proteinuria d. White cell casts in the urine e. Hemoglobin of 12.8 g/dL
a. Red blood cells in the urine c. Proteinuria d. White cell casts in the urine Rationale: The primary presenting features of an acute glomerular inflammation are hematuria, edema, azotemia (an abnormal concentration of nitrogenous wastes in the blood), and proteinuria (excess protein in the urine) (Porth & Matfin, 2009). The urine may appear cola colored because of red blood cells (RBCs) and protein plugs or casts; RBC casts indicate glomerular injury.
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? a. Blood glucose level of 200 mg/dl b. White blood cell (WBC) count of 20,000/mm3 c. Potassium level of 3.5 mEq/L d. Hematocrit (HCT) of 35%
b. White blood cell (WBC) count of 20,000/mm3 Rationale: An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.
Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? a. Urine output of 35 to 40 mL/hour b. Pain of 3 out of 10, 1 hour after analgesic administration c. SpO2 at 90% with fine crackles in the lung bases d. Blood tinged drainage in Jackson-Pratt drainage tube
c. SpO2 at 90% with fine crackles in the lung bases Rationale: The Risk for Ineffective Breathing Pattern is often a challenge in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output is monitored to maintain a urine output of greater than 30 mL/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.
