Chapter 34: AKI/CKD

A client is diagnosed with early chronic kidney disease (CKD). The nurse will recommend which actions to slow progression of renal damage? Select all that apply.

Smoking cessation Blood pressure control Angiotensin converting enzyme (ACE) inhibitor administration Blood glucose control

With the increased risk of drug toxicity among chronically ill older adults, which statement by the nurse explains why the older adult's kidney is vulnerable to toxic injury?

"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney."

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?

"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."

A geriatric nurse is caring for several clients. Which alterations in health should the nurse attribute to age-related physiologic changes?

A 78-year-old woman's GFR has been steadily declining over several years. Explanation: A gradual decrease in GFR is considered a normal age-related change. Increased creatinine or BUN would warrant follow up, as would the presence of protein in a client's urine.

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 Explanation: Hypertension is a common result of CKD, and the mechanisms that produce hypertension in CKD include increased vascular volume, elevation of peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins, and increased activity of the renin-angiotensin-aldosterone system.

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 hemoglobin, red blood cells, and hematocrit Explanation: Anemia is a frequent and debilitating consequence of CKD. The anemia may be due to chronic blood loss, hemolysis, bone marrow suppression due to retained uremic factors, and decrease in red cell production due to impaired production of erythropoietin and iron deficiency

The parents of a child who has been diagnosed with chronic kidney disease (CKD) ask the nurse about manifestations of the disease. Which information is the most appropriate information to provide these parents? Select all that apply.

Developmental delay Delayed cognitive development Secondary hyperparathyroidism Growth impairment

Which dermatologic problem most often accompanies chronic kidney disease (CKD)?

Dry skin and pruritus

A client in the intensive care unit is receiving a blood transfusion. The client immediately developed a reddish-color urine flowing into the Foley bag. What is likely the cause of this red urine and what priority intervention should the nurse implement?

Hemoglobinuria indicating an acute hemolytic reaction; the transfusion must be stopped immediately. Explanation: The onset of red urine during or shortly after a blood transfusion may represent hemoglobinuria indicating an acute hemolytic reaction. The priority of the nurse is to stop the transfusion, then call the laboratory and the health care provider

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

According to the Kidney Disease Outcome Quality Initiative (KDOQI) guidelines, in the first stage of kidney disease, the nurse will assess which finding?

Kidney damage with normal glomerular filtration rate (GFR)

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.

Dietary restrictions placed on clients with chronic kidney disease (CKD) include limiting protein in their diet. The recommended sources of protein for clients with CKD include what source of protein?

MILK At least 50% of the protein intake should consist of proteins of high biologic value, such as those in eggs, lean meat, and milk, which are rich in essential amino acids.

The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for:

Nephrotoxic acute tubular necrosis Explanation: Pharmacologic agents that are directly toxic to the renal tubule include aminoglycosides (e.g., gentamicin), chemotherapeutic agents such as cisplatin and ifosfamide, and radiocontrast agents.

The client with substance use disorder was found unconscious after overdosing on heroin 2 days prior. Because of prolonged pressure on the muscles the client has developed myoglobinuria, causing which complication?

Obstruction of the renal tubules with myoglobin and damaged tubular cells

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 Decreased perspiration

Many drugs and other nephrotoxic agents can induce nephrotic acute tubular necrosis (ATN). The nurse knows that these agents cause tubular injury by which mechanisms? Select all that apply.

Renal vasoconstriction Intratubular obstruction Direct tubular damage

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?

Serum creatinine

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.

The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents:

a loss of over half the client's normal kidney function. Normal GFR 120-130

A 45-year-old female 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 (ATN).