Chapter 54: Management of Patients with Kidney Disorders.

The nurse is planning patient teaching for a patient with ESKD who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula? A- A vein and an artery in your arm will be attached surgically. B- The arm should be immobilized for 4 to 6 days. C- One needle will be inserted into the fistula for each dialysis treatment. D- The fistula can be used 2 days after the surgery for dialysis treatment.

A- A vein and an artery in your arm will be attached surgically. Rationale: Fistula joins a vein and artery, either side-to-side or end-to-end. Access will need time 2-3 months to mature before using. Patient is encouraged to perform exercises to increase size of affected vessels. Two needles will be inserted into the fistula.

The nurse is caring for a patient who has returned to the post surgical suite after post-anesthetic recovery from a nephrectomy. The nurses most recent hourly assessment reveals a significant drop in level of consciousness and BP as well as scant urine output over the past hour. What is the nurses best response? A- Assess the patient for signs of bleeding and inform the physician. B- Monitor the patients vital signs every 15 minutes for the next hour. C- Reposition the patient and reassess vital signs. D- Palpate the patients flanks for pain and inform the physician.

A- Assess the patients for signs of bleeding and inform the physician. Rationale: Bleeding may be suspected when the patient experiences fatigue and when urine output is less than 30 mL/hr.

The nurse is caring for a patient postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize? A- Assessment of the quantity of the patients urine output. B- Assessment of patients incisions. C- Assessment of the patients abdominal girth. D- Assessment for flank or abdominal pain.

A- Assessment of the quantity of the patients urine output. Rationale: After kidney transplantation, the nurse should perform all of the listed assessment. However, oliguria is considered to be more suggestive of rejection then changes to the patients abdomen or incision.

A patient with ESKD is scheduled to begin hemodialysis. The nurse is working with the patient to adapt the patients diet to maximize the therapeutic effect and minimize the risks of complication. The patients diet should include which of the following modifications? Select all that apply. A- Decreased protein intake. B- Decreased sodium intake. C- Increased potassium intake. D- Fluid restriction. E- Vitamin D supplementation.

A- Decreased protein intake. B- Decreased sodium intake. D- Fluid restriction. Rationale: Restricting dietary protein decreases the accumulation of nitrogenous wastes, reduces uremic symptoms, and may even postpone the initiation of dialysis for a few months. Restriction of fluid is also part of the dietary prescription because fluid accumulation may occur.

Renal failure can have prerenal, renal, or post renal causes. A patient with acute kidney injury is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it? A- Heart failure B- Glomerulonephritis C- Ureterolithiasis D- Aminoglycoside toxicity

A- Heart failure Rationale: By causing inadequate renal perfusion, heart failure can lead to prerenal failure.

The nurse is assessing a patient suspect of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? A- Hematuria B- precipitous decrease of serum creatinine level C- Hypotension unresolved by fluid administration D- Glucosuria

A- Hematuria Rationale: The primary presenting feature of acute glomerulonephritis is hematuria. Proteinuria, primarily albumin, which is present is due to increased permeability of the glomerular membrane.

A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason? A- Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential. B- Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this patient. C- A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary. D- There is a great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations.

A- Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential. Rationale: Most common renal trauma is hematuria.

A 45-year-old man with diabetic nephropathy has ESKD and is starting dialysis. What should the nurse teach the patient about hemodialysis? A- Hemodialysis is a treatment option that is usually required three times a week. B- Hemodialysis is a program that will require you to commit to daily treatment. C- This will require you to have surgery and a catheter will need to be inserted into your abdomen. D- Hemodialysis is a treatment that is used for a few months until your kidney heals and start to produce urine again.

A- Hemodialysis is a treatment option that is usually required three times a week. Rationale: Hemodialysis is most commonly used method of dialysis. Treatment is for the rest of the patients life or until they undergo kidney transplant. Treatment is usually three times a week for 3 to 4 hours long.

A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurses most appropriate action? A- Inform the physician and assess the patient for signs of infection. B- Flush the peritoneal catheter with normal saline. C- Remove the catheter promptly and have the catheter tip cultured. D- Administer a bolus of IV normal saline as ordered.

A- Inform the physician and assess for signs of infection. Rationale: Peritonitis is the most common and serious complication of peritoneal dialysis. First sign of peritonitis is cloudy dialysate drainage fluid.

The nurse has identified the nursing diagnosis of risk for infection in a patient who undergoes peritoneal dialysis. What nursing action best addresses this risk? A- Maintain septic technique when administering dialysate. B- Wash the skin surrounding the catheter site with soap and water prior to each exchange. C- Add antibiotics to the dialysate as ordered. D- Administer prophylactic antibiotics by mouth or IV as ordered.

A- Maintain septic technique when administering dialysate. Rationale: Aseptic technique is used to prevent peritonitis and other infectious complications of PD.

The nurse is caring for a patient status after a MVA. The patient has developed AKI. What is the nurses role in caring for this patient? Select all that apply. A- Providing emotional support for the family. B- Monitoring for complications. C- Participating in emergency treatment of fluid and electrolyte imbalances. D- Providing nursing care for primary disorder (Trauma). E- Directing nutritional interventions.

A- Providing emotional support for the family. B- Monitoring for complication. C- Participating in emergency treatment of fluid and electrolyte imbalances. D- Providing nursing care for primary disorder (Trauma). Rationale: The nurse has an important role in caring for the patient with AKI. The nurse monitors for complications, participates in emergency treatment of fluid and electrolyte imbalances, assesses the patients progress and response to treatment, and provides physical and emotional support.

The nurse is caring for a patient who has just returned to the post-surgical unit following renal surgery. When assessing the patients output from surgical drains, the nurse should assess what parameters? Select all that apply. A- Quantity of output B- Color of the output C- Visible characteristics of the output D- Odor of the output E- pH of the output

A- Quantity of output B- Color of the output C- Visible characteristics of the output Rationale: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Odor and pH are not normally assessed.

A nurse on the renal unit is caring for a patient who will soon begin PD. The family of the patient asks for education about the PD catheter that has been placed in the patients peritoneum. The nurse explains the three sections of the catheter and talks about the two cuffs on the dialysis catheter. What would the nurse explain about the cuffs? Select all that apply. A- The cuffs are made of Dacron polyester B- The cuffs stabilize the catheter C- The cuffs prevent the dialysate from leaking D- The cuffs provide a barrier against microorganisms E- The cuffs absorb dialysate

A- The cuffs are made of Dacron polyester B- The cuffs stabilize the catheter C- The cuffs prevent the dialysate from leaking D- The cuffs provide a barrier against microorganisms Rationale: Most of these catheters have two cuffs, which are made of Dacron polyester. The cuffs stabilize the catheter, limit movement, prevent leaks, and provide a barrier against microorganisms.

The nurse is working on the renal transplant unit. To reduce the risk of infection in a patient with a transplanted kidney, it is imperative for the nurse to do what? A- Wash hands carefully and frequently B- Ensure medication function of the donated kidney C- Instruct the patient to wear a face mask D- Bar visitors from the patients room

A- Wash hands carefully and frequently Rationale: Hand washing is the biggest way to prevent spread of germs/bacteria.

The nurse coming on shift on the medical unit is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing ESKD? A- A patient with a history of polycystic kidney disease. B- A patient with diabetes mellitus with poorly controlled hypertension. C- A patient who is morbidly obese with a history of vascular disorder. D- A patient with severe chronic obstructive pulmonary disease.

B- A patient with diabetes mellitus with poorly controlled hypertension. Rationale: Patient has two factors that contribute to ESKD. Diabetes and hypertension with make this patient the most at risk.

The critical care nurse is monitoring the patients urine output and drains following renal surgery. What should the nurse promptly report to the physician? A- Increased pain on movement. B- Absence of drain output. C- Increased urine output. D- Blood-tinged serosanguineous drain output.

B- Absence of drain output. Rationale: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type of characteristics. Decreased or absence drainage is promptly reported to the physician because it can indicate an obstruction.

The nurse is caring for a patient with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessment? Select all that apply. A- Percuss for pain in the right lower abdominal quadrant. B- Assess for the presence of peripheral edema. C- Auscultate the patients apical heart rate for dysrhythmias. D- Assess the patients BP. E- Assess the patients orientation and judgement.

B- Assess for the presence of peripheral edema. D- Assess the patients BP. Rationale: Most patients with acute glomerular inflammation have some degree of edema and hypertension.

A patient is being treated for AKI and the patient daily weights have been ordered. The nurse notes a weight gain of 3 pounds over the past 48 hours. What nursing diagnosis is suggested by this assessment finding? A- Imbalanced nutrition: More than body requirements B- Excess fluid volume C- Sedentary lifestyle D- Adult failure to thrive

B- Excess fluid volume Rationale: Patient with AKI gains or does not lose weight, fluid retention should be suspected.

A 71-year-old patient with ESKD has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The patient tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to take? A- The decision is certainly yours to make, but be sure not to make a mistake. B- Kidney transplants in patients your age are as successful as they are in younger patients. C- I understand your hesitancy to commit to a transplant surgery. Success is comparatively rare. D- Have you talked this over with your family?

B- Kidney transplant in patients your age are successful as they are in younger patients. Rationale: Although there is no specific age limitation for renal transplantation, concomitant disorders have made it a less common treatment for the elderly.

A patient is brought to the renal unit from the PACU status post resection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this patient? A- Increasing oral intake. B- Managing postoperative pain C- Managing dialysis D- Increasing mobility

B- Managing postoperative pain Rationale: The patient requires frequent analgesia during the postoperative period and assistance with turning.

A patient on the critical care unit is postoperative day 1 following kidney transplantation from a living donor. The nurses most recent assessment indicate the the patient is producing copious quantities of dilute urine. What is the nurses most appropriate response? A- Assess the patient for further signs or symptoms of rejection. B- Recognize this is an expected finding. C- Inform the primary care provider of this finding. D- Administer exogenous antidiuretic hormone as ordered.

B- Recognize this is an expected finding. Rationale: A kidney from a living donor related to the patient usually begins to function immediately after surgery and may produce large quantities of dilute urine.

A patient with chronic kidney disease is completing an exchange during PD. The nurse observes that the peritoneal fluid is draining slowly and that the patients abdomen is increasing in girth. What is the nurses most appropriate action? A- Advance the catheter 2 to 4 cm further into the peritoneal cavity. B- Reposition the patient to facilitate drainage. C- Aspirate from the catheter using a 60 mL syringe. D- Infuse 50 mL of additional dialysate

B- Reposition the patient to facilitate drainage. Rationale: Position patient side to side or raise the HOB to facilitate drainage.

A patient on the medical unit has a documented history of polycystic kidney disease (PKD). What principle should guide the nurses care of this patient? A- The disease is self-limiting and cysts usually resolve spontaneously in the fifth or sixth decade of life. B- The patients disease is incurable and the nurses interventions will be supportive. C- The patient will eventually require surgical removal of his or her renal cysts. D- The patient is likely to respond favorably to lithotripsy treatment of the cysts.

B- The patients disease is incurable and the nurse interventions will be supportive. Rationale: PKD is incurable and care focuses on support and symptom control.

A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine level 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders? A- Monitor the patients electrolyte values every hour before the procedure. B- Preprocedure hydration and administer of acetylcysteine. C- Hemodialysis immediately prior to the CT scan. D- Obtain a creatinine clearance by collecting 24-hour urine specimen.

B-Preprocedure hydration and administer of acetylcysteine. Rationale: Radiocontrast-induced nephropathy is a major cause of hospital acquired acute kidney injury. Baseline levels of creatinine greater than 2mg/dL. Hydration and acetylcysteine the day prior to the test is effective in prevention.

The nurse is caring for acutely ill patient. What assessment finding should prompt the nurse to inform the physician that the patient may be exhibiting signs of acute kidney injury (AKI)? A- The patient is complains of an inability to initiate voiding. B- The patients urine is cloudy with a foul odor. C- The patients average urine output has been 10 mL / hr for several hours. D- The patient complains of acute flank pain.

C- The patients average urine output has been 10 mL/hr for several hours. Rationale: Oliguria ( less than 500 mL of urine) is the most common clinical situation seen in AKI.

A nurse is caring for a patient who is in the diuresis phase of AKI. The nurse should closely monitor the patient for what complication during this phase? A- Hypokalemia B- Hypocalcemia C- Dehydration D- Acute flank pain

C- Acute flank pain Rationale: The diuresis period is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover.

An 84-year-old woman diagnosed with cancer is admitted to the oncology unit for surgical treatment. The patient has been on chemotherapeutic agents to decrease the tumor size prior to the planned surgery. The nurse caring for the patient is aware that what precipitating factors in this patients may contribute to AKI? Select all that apply. A- Anxiety B- Low BMI C- Age-related physiologic changes D- Chronic systemic disease E- NPO status

C- Age-related physiologic changes D- Chronic systemic disease Rationale: Changes in kidney function with normal aging increase the susceptibility of elderly patients to kidney dysfunction and renal failure.

A patient is admitted to the ICU after a MVA. On the second day of the hospital admission, the patient is develops acute kidney injury. The patient is hemodynamically unstable, but renal replacement therapy is needed to manage the patients hypervolemia and hyperkalemia. Which of the following therapies will the patients hemodynamic status best tolerate? A- Hemodialysis B- Peritoneal dialysis C- Continuous venovenous hemodialysis (CVVHD) D- Plasmapheresis

C- Continuous venovenous hemodialysis (CVVHD) Rationale: CVVHD facilitates the removal of uremic toxins and fluid. CVVHD effects are usually mild in comparison to HD, so CVVHD is best tolerated by an unstable patient.

The nurse is caring for a patient in acute kidney injury. Which of the following complications would most clearly warrant the administration of polystyrene sulfonate (kayexalate)? A- Hypernatremia B- Hypomagnesemia C- Hyperkalemia D- Hypercalcemia

C- Hyperkalemia Rationale: Hyperkalemia, a common complication of acute kidney injury, is life-threatening

The nurse is creating an education plan for a patient who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan? A- The importance of increased fluid intake. B- Signs and symptoms of rejection C- Inspection and care of the incision. D- Techniques for preventing metastasis.

C- Inspection and care of the incision. Rationale: The nurse teaches the patient to inspect and care for the incision and perform other general postoperative care.

The nurse is caring for a patient after kidney surgery. The nurse is aware that bleeding is a major complication of kidney surgery and that if it goes undetected and untreated can result in hypovolemia and hemorrhagic shock in the patients. When assessing for bleeding, What assessment parameter should the nurse evaluate? A- Oral intake B- Pain intensity C- Level of consciousness D- Radiation of pain

C- Level of consciousness Rationale: Bleeding is a major complication of kidney surgery.

The nurse is providing a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants risks of renal carcinoma? A- Avoiding heavy alcohol use. B- Control sodium intake C- Smoking cessation D- Adherence to recommend immunization schedules

C- Smoking cessation Rationale: Tobacco use is a significant risk factor for renal cancer.

A patient has a glomerular filtration (GFR) of 43 mL/min/1.73m^2. Based on this GFR, the nurse interprets that the patients chronic kidney disease is at what stage? A- Stage 1 B- Stage 2 C- Stage 3 D- Stage 4

C- Stage 3 Rationale: Stages of chronic renal failure are based on the GFR.

The nurse is caring for a patient receiving hemodialysis three times weekly. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient? A- Using a stethoscope for auscultating the fistula is contraindicated. B- The patient feels best immediately after the dialysis treatment. C- Taking a BP reading on the affected arm can damage the fistula. D- The patient should not feel pain during initiation of dia

C- Taking a BP reading on the affected arm can damage the fistula. Rationale: When blood flow is reduced through the access site, the access site can clot.

A patient with chronic kidney disease has been hospitalized and is receiving HD on a scheduled basis. The nurse should include which of the following actions in the plan of care? A- Ensure that the patient moves the extremity with the vascular access site as little as possible. B- Change the dressing over the vascular access site at least every 12 hours. C- Utilize the vascular access site for infusion of IV fluids. D- Assess for a thrill or bruit over the vascular access site each shift.

D- Assess for a thrill or a bruit over the vascular access site each shift. Rationale: The bruit or thrill over the venous access site must be evaluated at least every shift.

A patient has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to intervene the patients about what topic? A- Typical diet B- Allergy status C- Psychosocial stressors D- Current medications use

D- Current medication use Rationale: Kidneys are susceptible to the adverse effects of medications because they are repeatedly exposed to substances in the blood.

A patient is admitted with nephrotic syndrome is being cared for on the medical unit. When writing this patients care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include? A- Constipation related to immobility B- Risk for injury related to altered thought processes C- Hyperthermia related to the inflammatory process D- Excess fluid volume related to generalized edema

D- Excess fluid volume related to generalized edema Rationale: The major clinical manifestation of nephrotic syndrome is edema.

The nurse performing the health interview of a patient with a new onset of periorbital edema has completed a genogram, noting the health history of the patients siblings, parents, and grandparents. This assessment addresses the patients risk of what kidney disorder? A- Nephritic syndrome B- Acute glomerulonephritis C- Nephrotic syndrome D- Polycystic kidney disease (PKD)

D- Polycystic kidney disease (PKD) Rationale: PKD is a genetic disorder characterized by the growth of numerous cysts in the kidneys.

A 15 year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize this form of kidney disease may have been precipitated by what event? A- Psychosocial stress B- Hypersensitivity to an immunization C- Menarche D- Streptococcal infection

D- Streptococcal infection Rationale: Postinfectious causes of postinfectious glomerular disease are group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks.

The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage-kidney disease (ESKD). The patient has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the patient to take the prescribed phosphorus-binding medication at what time? A- Only when needed B- Daily at bedtime C- First thing in the morning D- With each meal

D- With each meal Rationale: Phosphate-binding medications must be administered with food to be effective.