Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
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 result in greater amounts of urine formation and will over-tax renal function. Elevated blood pressure will exacerbate nephron loss and accelerate renal failure. Elevated blood pressure will slow the excretion of protein (proteinuria) and lead to a hypertrophic kidney. Elevated blood pressure will decrease pressure on the nephron with a corresponding decrease in GFR, leading to renal failure.
Elevated blood pressure will exacerbate nephron loss and accelerate renal failure.
A nurse is performing client education with an adult recently diagnosed with chronic kidney disease. Which statement by the client would the nurse most likely want to correct or clarify? "I will be prone to anemia, since I am not producing as much of the hormone that causes my bones to produce red blood cells." "My heart rate might go up because of my kidney disease and my blood might be a lot thinner than it should be." "My kidney problems increase my chance of developing high blood pressure or diabetes." "I will have a risk of either bleeding too easily or possibly clotting too quickly, though dialysis can help minimize these effects."
"My kidney problems increase my chance of developing high blood pressure or diabetes."
A client is in cardiogenic shock following a massive myocardial infarction. The client's family asks the nurse, "Why are the health care providers recommending dialysis since its the heart that is sick?" Which response by the nurse is most appropriate at this time? "It looks like your loved one has been exposed to nephrotoxic drugs like a nonsteroidal anti-inflammatory drug (NSAID) prior to the heart attack." "When a person has such a large heart attack, the kidneys suffer by developing clots which interfere with urine production." "When a person has a large heart attack and goes into shock due to heart failure, there is a decrease in renal perfusion which allows toxins to increase in the blood." "It looks like your family member has had a blockage in the ureters for quite some time and the heart attack has made it more difficult for the blood to be filtered by the kidney."
"When a person has a large heart attack and goes into shock due to heart failure, there is a decrease in renal perfusion which allows toxins to increase in the blood."
Which dermatologic problem most often accompanies chronic kidney disease (CKD)? Dry skin and pruritus Petechiae and purpura Hirsutism and psoriasis Alopecia and fungal rashes
Dry skin and pruritus
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 Decreased gastric secretion Metallic taste Anorexia
Early morning nausea Gastrointestinal ulceration Metallic taste Anorexia
A client 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 10:1 A BUN to creatinine level ratio of 20:1 An elevated BUN level and decreased creatinine level An elevated creatinine level and decreased BUN level
A BUN to creatinine level ratio of 20:1
Which individual likely faces the greatest risk for the development of chronic kidney disease? A first-time mother who recently lost 1.5 L of blood during a postpartum hemorrhage A client whose diagnosis of thyroid cancer necessitated a thyroidectomy A client who experienced a hemorrhagic stroke and now has sensory and motor deficits A client with a recent diagnosis of type 2 diabetes who does not monitor blood sugars or control diet
A client with a recent diagnosis of type 2 diabetes who does not monitor blood sugars or control diet
Which diagnostic bloodwork is suggestive of chronic kidney disease (CKD)? A client with high pH, low levels of calcium, and low levels of phosphate A client with low vitamin D levels, low calcitriol levels, and elevated parathyroid hormone (PTH) levels A client with low bone density, low levels of calcium, and low levels of phosphate A client with low potassium levels, low calcitriol levels, and increased parathyroid hormone (PTH) levels
A client with low vitamin D levels, low calcitriol levels, and elevated parathyroid hormone (PTH) levels
The nurse is educating a client with chronic kidney disease (CKD). What is the recommended daily fluid intake for this client? No oral intake of fluids Intake equal to daily urine output to maintain hydration A daily fluid intake of 500 to 800 mL/day to maintain hydration A minimum of 2000 mL/day to flush out the kidneys
A daily fluid intake of 500 to 800 mL/day to maintain hydration
The nurse is caring for a client who has had acute blood loss from ruptured esophageal varices. What does the nurse recognize is an early sign of prerenal failure? Baseline blood pressure of 150/90 mm Hg that is now 130/80 mm Hg Baseline heart rate of 100 bpm that has increased to 120 bpm Baseline urine output of 50 mL/hr that is now 10 mL/hr Foul smelling, cloudy urine
Baseline urine output of 50 mL/hr that is now 10 mL/hr
Chronic kidney disease impacts many systems in the body. What is the most common hematologic disorder caused by CKD? Polycythemia Erythrocythemia Anemia Leukocytosis
Anemia
A client has been diagnosed with chronic kidney disease (CKD). Which drug category is usually administered to treat coexisting conditions that manifest early in CKD? Antihypertensive medications Antiarrhythmic medications Opioid analgesics Nonsteroidal anti-inflammatory drugs (NSAIDs)
Antihypertensive medications
Acute renal failure occurs at a high rate in seriously ill people who are in intensive care units. What is the most common indicator of acute renal failure? Azotemia and a decrease in the GFR Proteinuria and a decrease in the GFR Azotemia and an increase in the GFR Proteinuria and an increase in the GFR
Azotemia and a decrease in the GFR
Several urine tests can be useful in establishing a diagnosis of acute renal failure (ARF). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which type of drug? Sulfonylureas Calcium channel blockers Diuretics Beta-adrenergic blockers (beta-blockers)
Diuretics
A client with a history of chronic kidney disease (CKD) is experiencing increasing fatigue, lethargy, and activity intolerance. The care team has established that the client's glomerular filtration rate (GFR) remains at a low, but stable, level. Which laboratory assessments will most likely be prescribed to help determine the cause of these new symptoms? Blood work for white cells and differential Cystoscopy and ureteroscopy Assessment of pancreatic exocrine and endocrine function Blood work for hemoglobin, red blood cells, and hematocrit
Blood work for hemoglobin, red blood cells, and hematocrit
The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney failure? Client with prostatic hyperplasia Client with intratubular obstruction Client with severe hypovolemia Client with acute pyelonephritis
Client with prostatic hyperplasia
A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that this client will experience which manifestations? Select all that apply. Decreased renal endocrine function Decreased tubular reabsorption Proliferation of nephrons Hypophosphatemia Decreased glomerular filtration
Decreased renal endocrine function Decreased tubular reabsorption Decreased glomerular filtration
The nurse is instructing a client with advanced kidney disease (AKD) about a dietary regimen. Which restriction should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD? Fats Dietary protein Carbohydrates Foods high in calcium
Dietary protein
A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display? Hypertension Impotence Terry nails Asterixis
Hypertension
Chronic kidney disease (CKD) can cause derangement of calcium and phosphate metabolism. The nurse will monitor a client with CKD for which lab abnormality? Select all that apply. Impaired phosphate excretion Excess calcium deposits in bone Decreased blood levels of calcium Decreased release of parathyroid hormone (PTH) Decreased blood levels of phosphate
Impaired phosphate excretion Decreased blood levels of calcium
A client diagnosed with CKD has begun to experience periods of epistaxis and has developed bruising of the skin and subcutaneous tissues. The nurse recognizes these manifestations as: Impaired platelet function Increased platelet production Increased erythropoietin Decreased erythropoietin
Impaired platelet function
A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor for which manifestations of this disorder? Select all that apply. Increased nitrogenous waste in blood Anemia Right ventricular dysfunction Osteodystrophy Hypercalcemia
Increased nitrogenous waste in blood Anemia Osteodystrophy
Which assessment findings would the health care provider consider as most indicative of acute renal failure? Alterations in blood pH; peripheral edema Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR) Decreased serum creatinine and blood urea nitrogen (BUN); decreased potassium and calcium levels Decreased urine output; hematuria; increased glomerular filtration rate (GFR)
Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR)
A client sustained acute tubular injury approximately 2 hours ago. Which cause of acute kidney injury (AKI) would the nurse suspect the client is experiencing? Prerenal Intrarenal Postrenal Systemic
Intrarenal
Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct? Kidneys convert inactive vitamin D to its active form, calcitriol. Calcitriol stimulates release of parathyroid hormone (PTH). Suppression of parathyroid hormone release is characteristic of CKD. Calcitriol blocks gastrointestinal absorption of calcium.
Kidneys convert inactive vitamin D to its active form, calcitriol.
A client with postrenal acute kidney injury (AKI) exhibits oliguria and edema with laboratory results revealing increased levels of urea, potassium, and creatinine. Based on these data, which phase of AKI is this client most likely experiencing? Oliguric phase Onset phase Recovery phase Diuretic phase
Oliguric phase
The nurse knows that a client with chronic kidney disease (CKD) may experience which changes in skin integrity? Select all that apply. Pale skin Brittle fingernails Moist skin and mucous membranes Increased oil gland secretion Decreased perspiration
Pale skin Brittle fingernails Decreased perspiration
The nurse knows that a client with chronic kidney disease (CKD) may experience which changes in skin integrity? Select all that apply. Pale skin Brittle fingernails Moist skin and mucous membranes Increased oil gland secretion Decreased perspiration
Pale skin Brittle fingernails Decreased perspiration
A client 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 condition does the nurse suspect is common with this stage of kidney disease? Myocardial infarction Pulmonary embolism Pulmonary edema Pericarditis
Pericarditis
A client has an obstructive urine outflow related to benign prostatic hyperplasia. Due to the inability to excrete adequate amounts of urine, which type of renal failure should the nurse closely monitor for? Prerenal failure Intrarenal failure Postrenal failure Chronic renal failure
Postrenal failure
A client is diagnosed with a tumor in the urinary bladder. The nurse will monitor the client for: Prerenal failure Intrarenal failure Postrenal failure Chronic kidney disease
Postrenal failure
An 86-year-old client is being treated for dehydration and hyponatremia after curtailing fluid intake to prevent urinary incontinence. Given these findings, the nurse recognizes that this client is likely in what phase of acute kidney injury? Prerenal Postrenal Intrinsic Intrarenal
Prerenal
The nurse recognizes that acute renal injury is characterized by which of the following? Rapid decline in renal function Irreversible damage to nephrons Decreased blood urea nitrogen (BUN) Low incidence of mortality
Rapid decline in renal function
A client is diagnosed with chronic kidney disease (CKD). The nurse knows that which statements regarding CKD are correct? Select all that apply Onset is abrupt. Symptoms appear with 50% of nephrons lost. Renal damage is irreversible. Less than 1% of population is affected. Hypertension is a major cause.
Renal damage is irreversible. Hypertension is a major cause.
A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which intervention would be most appropriate for the nurse to provide? Restrict intake of dietary protein Increase intake of carbohydrates Restrict intake of dietary fat Increase intake of fruit juice
Restrict intake of dietary protein
An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which early sign of prerenal injury? Sharp decrease in urine output Excessive voiding of clear urine Acute hypertensive crisis Intermittent periods of confusion
Sharp decrease in urine output
A client has experienced severe hemorrhage and is in prerenal acute kidney injury. The nurse anticipates the client's blood urea nitrogen (BUN) and serum creatinine laboratory results will be in which range? The BUN-to-creatinine ratio is 20:1. Creatinine level increase to 5 mg/dl (442 µmol/l) and BUN decreases to 4 mg/dl (1.4 mmol/l). BUN elevates above 60 mg/dl (21.4 mmol/l) and creatinine decreases to less than 0.3 mg/dl (less than 27 µmol/l). The BUN-to-creatinine ratio is 10:1.
The BUN-to-creatinine ratio is 10:1.
The nurse is caring for a group of four male clients with chronic kidney disease (CKD) and coronary artery disease. The nurse will prioritize which client as being at greatest risk for angina? The client with electrocardiogram results indicating sinus bradycardia The client with a hemoglobin level of 8.0 g/dL (80 g/L) The client with a calcium level of 8 mg/dL (2.0 mmol/L) The client with a blood pressure of 160/90 mm Hg
The client with a hemoglobin level of 8.0 g/dL (80 g/L)
A client with chronic kidney disease (CKD) will be managed with peritoneal dialysis. Which description of this type of dialysis is most accurate? Vascular access is achieved through an internal arteriovenous fistula or an external arteriovenous shunt. Treatments typically occur three times each week for 3 to 4 hours. The dialyzer is usually a hollow cylinder composed of bundles of capillary tubes. Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time.
Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time.
Client and family education regarding peritoneal dialysis should include assessing the client for: bleeding around the arteriovenous fistula or an external arteriovenous shunt. signs and symptoms of hypoglycemia such as weakness, irritability, and shakiness. dehydration that may appear as dry mucous membranes or poor skin turgor. muscle cramps associated with hypoparathyroidism.
dehydration that may appear as dry mucous membranes or poor skin turgor.
A client with chronic kidney disease has developed cardiac calcification. On admission the priority assessment would be for the nurse to: check the BP in both arms and compare. place on a heart monitor to watch for arrhythmias. assess for pulses in the feet bilaterally. listen to the heart for extra clicking sounds.
place on a heart monitor to watch for arrhythmias.