Last Quiz

Hemodialysis

-Arterial venous (AV) fistula aka shunt -Subclavian vein catheter give heparin and capped to maintain patency between dialysis -Aspirate from line before dialysis

Renal Biopsy (fine needle used to remove tissue)

-Aspirin is CONTRAINDICATED -PO- hematuria, flank pain, bleeding at the site

Client experiences leg cramps during hemodialysis What do you do?

-fluids

CKD, interventions

-take daily weight -ADMIN epogen or epoetin alfa -If pt is in ER they need a urine dipstick

PT teaching nephrotic syndrome, which statement indicates further teaching?

" I should increase my sodium intake"

PT new prescription furosemide, what indicates an understanding of teaching?

"Limit sun exposure"

Teaching about a creatinine clearance test

"You will need to avoid vigorous exercise during the test"

CKD what do we limit?

Protein Phosphorus Sodium

A nurse is discussing a kidney transplant with a PT who has ESRD, what's a contraindication?

Alcohol use disorder

PT with CKD CAPD teaching?

CAPD requires less diet restrictions

CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD), advantages?

CAPD will have less fluid and diet restrictions because its ongoing everyday -CAPD can be done at home, not at facility

PT w first hemodialysis, reports headache nausea and restlessness, manifestations of what?

Dialysis disequilibrium

Nurse is caring for a PT with N/V and is receiving IV therapy, BUN 32, create 1.1, hct 50%

Eval urine for specific gravity

If client w AKI has been hospitalized, what information (method/dx test) is useful in evaluating kidney function?

GFR is preferred method for evaluating improvement in kidney function

Lab results of PT with prerenal AKI?

Hyperkalemia

PT receiving PD, manifestation of peritonitis?

N/V

Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI. Which patient is most likely to develop ATN? Patient with diabetes mellitus Patient with hypertensive crisis Patient who tried to overdose on acetaminophen Patient with major surgery who required a blood transfusion

Patient with major surgery who required a blood transfusion

PT with ESRD, expected findings?

Slurred speech Bone pain Pruritus

PT has potassium 6.8, what med?

Sodium polystyrene

A nurse is caring for PT 8 days post op kidney trans what 6 findings?

Urinary output Report of pain Creatinine level Blood pressure Energy level Temp

A nurse is reviewing ABG for a PT with CKD, what's expected?

PH 7.25, HCO-3 19, PCO2 30

CKD, what can they develop?

Metabolic acidosis, hypovolemia, hypocalcemia, hypertension and hypervolemia

Post op kidney biopsy interventions

Monitor for hematuria Check for flank pain

CAPD DISADVANTAGE:

-risk of infections (sterile technique) -prevent catheter insertion site from becoming wet, change dressing

PT getting IV urography, what data is contraindicated?

Allergy to shellfish

Discussing lab values associated with the renal system, what shows an understanding?

Creatinine levels are increased in clients with AKI

Dietary teaching for PT with kidney stones?

Drink 3L of fluid everyday

PT with fluid volume deficit findings?

Increased BUN

PT getting kidney biopsy, included in plan?

Obtain urine specimen Obtain consent Maintain NPO Obtain coagulation studies

Obtain a weight from PT with CKD?

Weigh the PT after void

AKI, Intrarenal (physical organ damage)

-most common = acute tubular necrosis (ATN) -prolonged prerenal ischemia, intrarenal ischemia -Nephrotoxicity- antibiotics, chemo meds, NSAIDS -radioactive contrast dye (can use smaller dose if possible)

A nurse is planning teaching for a PT who is getting IVP, which statement should the nurse include in teaching?

"After the procedure you will be encouraged to drink plenty of fluids"

AKI, s/s

-oliguria, anuria -increased potassium, magnesium, phosphorus -retention of fluid -inability to balance electrolytes

BPH, rx

-FINASTERADE: (blocks) MED THAT REDUCES PROSTATE HYPERPLASIA -FLOMAX / TAMSULOSIN (relaxes): MED THAT INCREASES URINE OUTPUT

PT has left AV graft, how do you check patency?

Auscultate for bruit

PT after hemodialysis, which manifestation do we give a PRN dose of phenytoin?

Headache, restlessness

PT asks what serum creatinine shows, nurse response?

Show how your kidneys are functioning

Teaching a PT with AKI about fluid restrictions?

"I will make a list of my favorite beverages"

Nurse is reviewing PT levels with CKD?

BUN 45/ creatinine 8

PT admin to ED with GI bleed what 3 need follow up?

Heart rate Hct and Hgb Neurological assessment

NGN Kidney rejection SATA

Do not choose lung sounds and sodium bc its WNL Symptoms of kidney rejection include: Fever, weight gain, diminished urine output, HTN, pain over the graft site, peripheral edema

A nurse is caring for a client who will have a blood sampling for serum creatinine level and asks what this test shows. Which of the following responses should the nurse make? this test will tell your doctor how your kidneys are functioning you'll have to ask your doctor this test will tell if you have severe renal impairment or a disease. we'll find out if any medications, such as steroids, are interfering with your kidney function.

"This test will tell your doctor how your kidneys are functioning."

CAPD, dialyzate

- Dialyzate should be warm, cold causes discomfort -pt will go home with warmer, cannot be microwaved bc of uneven distribution of heat

Femoral vein catheter on groin area

- needs meticulous perineal care Should not sit up within 45 degrees or lean forward, sit up Catheter will kink or become occluded

BPH interventions

-2-3L fluids/ day -TURP (transurethral resection of the prostate) -Continuous bladder irrigation?= constant urge to void TURP: IF YOU NOTICE DROP IN BP AND TACHYCARDIA >125, CALL MD STAT

Hemodialysis, DISEQUILIBRIUM SYNDROME

-DISEQUILIBRIUM SYNDROME, air embolus, encephalopathy, electrolyte imbalance, sepsis, shock, hemorrhage, hepatitis -MONITOR VS,HYPOTENSION TOP PRIORITY, NOTIFY MD -MANIFESTATIONS: HEADACHES, RESTLESSNESS & CONFUSION, HEADACHES & SEIZURES & ALTERED LOC -START ANTICONVULSANTS AND BARBITUATES TO PREVENT DEATH

Benign Prostatic Hypertrophy (BPH) SLOW ENLARGEMENT OF THE PROSTATE

-Diminished force of urinary stream * early sign -Dribbling from overflow incontinence * later sign

CAPD, Peritonitis s/s

-NAUSEA, PAIN, RESTLESSNESS, CONFUSION CLOUDY URINE -MONITOR FOR ABDOMINAL PAIN, ANOREXIA, NAUSEA, VOMITTING, RESTLESSNESS, AND CONFUSION -antibiotics can be added to dialyzate if peritonitis is present

CKD, what is it?

-PROGRESSIVE DETERIORATION OF RENAL FUNCTION >3 MONTHS -CAUSED BY IRREVERSIBLE LOSS OF KIDNEY FUNCTION CUZ DAMAGE IS DETECTED LATE (diabetes is most common, hypertension 2nd most common)

CKD, labs

-PT WILL BE IN ANEMIC STATE BECAUSE OF LACK OF ERYTHROPOIETIN -CHECK HEMOGLOBIN LABS BEFORE BLOOD TRANSFUSION • If HgB is >11 DO NOT GIVE, ONLY GIVE <10 AFTER DIALYSIS

AKI, interventions

-VS -Ensure adequate perfusion -MONITOR DAILY WEIGHT (same scale, time, clothes) -if AKI does not improve w/ treatment = dialysis indicated

Acute Kidney Injury (AKI) what is it?

-abrupt deterioration of renal function (hours-days) -Abrupt but REVERSIBLE

AKI, mainfestations

-anemia -fluid overload -METABOLIC ACIDOSIS -altered mental state, drowsiness, disorientation, coma, tingling of extremities

AKI, prerenal (happens outside the kidney)

-intravascular volume depletion (blood loss from trauma and surgery) -lack of blood flow -caused by sepsis, hypovolemia, HF

AKI, what will labs/ ECG show?

-labs will show HYPERKALEMIA -ECG will show LONGER/ WIDER QRS

AKI, what kind of diet?

-low/ moderate protein -restrict sodium/ potassium -HIGH CARBOHYDRATES

AKI phases = oliguric, diuretic, then recovery What happens in Oliguric phase?

-sudden decrease in urine <400ml/day -Metabolic Acidosis = Kussmaul's respiration

NGN- 2 hours post op TURP

Action 1: Medicate client for spasms Action 2: Irrigate urinary catheter Condition: Obstructed urinary catheter Parameter: Urine output Parameter: HCT + HGB

NGN

Action: check a urine and culture sensitivity Action 2: Request a prescription for an antispasmodic agent Condition: Urinary tract infection Parameter 1: Temperature Parameter 2: Fluid intake

When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula? Auscultate for a bruit at the fistula site. Assess the quality of the left radial pulse. Compare blood pressures in the left and right arms. Irrigate the fistula site with saline every 8 to 12 hours.

Auscultate for a bruit at the fistula site.

Which assessment finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider? Complaint of flank pain Blood pressure 90/48 mm Hg Cloudy and foul-smelling urine Temperature 100.1° F (57.8° C)

Blood pressure 90/48 mm Hg

Lab values for hemodialysis?

Expect a decrease in potassium

Glomerulonephritis (inflammatory disorder from immune reaction or autoimmune disease)

Complications: kidney failure, HTN encephalopathy, pulmonary edema, HF Manifestations: Hematuria, smoky/rusty/dark colored urine -EDEMA WILL RESOLVE IF TREATMENT IS EFFECTIVE

Assessing a PT for fluid volume increase, reliable level of fluid retention?

Daily weight

A nurse is caring for a client who has benign prostatic hyperplasia (BPH). Which of the following medications should the nurse plan to administer? Danazol Finasteride Fluoxymesterone Methlytestosterone

Finasteride

Nurse in routine hemodialysis, pt complains of nausea and dizziness

First priority → take blood pressure * suggests hypotension

Client w bph that did TURP, postop emptying urinary bag, which assessment findings requires you to notify HCP

Frank bleeding with hypotension and tachycardia PINK/RED URINE IS CONSIDERED CLEAR URINE AS LONG AS THERES NO CLOTS

A 48-year-old patient with stage 2 chronic kidney disease (CKD) is scheduled for an intravenous pyelogram (IVP). Which order for the patient will the nurse question? NPO for 6 hours before procedure Ibuprofen (Advil) 400 mg PO PRN for pain Dulcolax suppository 4 hours before procedure Normal saline 500 mL IV infused before procedure

Ibuprofen (Advil) 400 mg PO PRN for pain

PT 2 weeks post op kidney transplant, organ rejection manifestation?

Oliguria

PT with AKI blood gas values

PH 7.26, HCO3 14, PACO2 30

A nurse is reviewing charts for four clients who have an acid-base imbalance, who is at risk for metabolic acidosis?

PT with diarrhea

Tacrolimus is prescribed for a client who underwent a kidney transplant. Which instruction should the nurse include when teaching the client about this medication? Eat at frequent intervals to avoid hypoglycemia Take the medication with a full glass of grapefruit juice Change positions carefully due to risk of orthostatic hypotension Take the oral medication every 12 hours at the same times each day

Take the oral medication every 12 hours at the same times each day

Foods high in potassium

Tomatoes Bananas Raisins

Which nursing action is of highest priority for a 68 year old patient with renal calculi who is being admitted to the hospital with gross hematuria and severe colicky left flank pain? a. Administer prescribed analgesics b. Monitor temperature every 4hrs c. Encourage increased oral fluid intake d. Give antiemetics as needed for nausea

a. Administer prescribed analgesics

A 55 year old patient with end stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication? a. Creatinine 1.6mg/dL b. Oxygen saturation 89% c. Hemoglobin level 13 g/dL d. Blood Pressure 98/56 mm Hg

a. Creatinine 1.6mg/dL (M 0.7-1.3, F 0.6-1.1) c. Hemoglobin level 13 g/dL (M 13.8-17.2, F12.1-15.1)

A nurse is providing dietary to a client who has a history of recurring calcium oxalate kidney stones. Which of the following instructions should the nurse include in the teaching? a. Drink 3L of fluid every day b. Take 3,000mg of vitamin C daily c. Restrict calcium intake to one serving per day d. Eat 12oz. of animal protein daily

a. Drink 3L of fluid every day

A client with chronic kidney disease is receiving epoetin alfa (epogen). Which lab result would indicate a therapeutic effect of the medication? a. Hct 32% b. platelet 400,000 c. BUN 15 d. WBC 6000

a. Hct 32% (M 41-50, F 36-44)

A nursing instructor is talking with her clinical group about patients with acute glomerulonephritis. The instructor tells the students that the patient may exhibit which of the following clinical manifestations? a. Hematuria b. Decrease in serum creatinine levels c. Hypotension d. Glucosuria

a. Hematuria

A nurse is caring for a client 4hr postoperative following a kidney biopsy. Which of the following interventions should the nurse take? (SATA) a. Monitor for hematuria b. Check for flank pain c. Monitor for extravasation of tissue surrounding the biopsy site d. Encourage ambulation e. Administer aspirin PRN for pain

a. Monitor for hematuria b. Check for flank pain

During routine hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis b. Check the blood pressure c. Review the hematocrit level d. Give prescribed PRN antiemetic drugs

b. Check the blood pressure

A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following manifestations of peritonitis? a. Hyperactive bowel sounds b. Nausea and vomiting c. Bradycardia d. Increased urinary output

b. Nausea and vomiting diarrhea, abdominal tenderness

A nurse is planning care for a client who is 2hrs postoperative following transurethral resection of the prostate. The client is receiving continuous bladder irrigation. Which of the following interventions should the nurse include? a. Restrict the clients fluid intake b. Remind the client he might feel a constant urge to void c. Monitor the clients urine output every 6hrs d. Weigh the client daily

b. Remind the client he might feel a constant urge to void

A nurse is assessing a client who is 2 weeks postoperative following a living donor kidney transplant. Which of the following manifestations should the nurse identify as possible organ rejection? a. insomnia b. oliguria c. temperature 36.1 C (97F) d. weight loss

b. oliguria

A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which actions should the nurse take first? a. Notify the patient's health care provider b. Document the QRS complex c. Check the medical record for most recent potassium level d. Check the char for the patients current creatinine level

c. Check the medical record for most recent potassium level

A nurse is teaching a client who has chronic kidney disease about the process of continuous ambulatory peritoneal dialysis (CAPD). Which of the following information should the nurse include in the teaching? a. CAPD filers the clients blood through an artificial device called a dialyzer b. CAPD is the dialysis treatment of choice for clients who have a history of abdominal surgery c. CAPD requires the client to follow fewer dietary and fluid restrictions than hemodialysis requires d. CAPD requires a rigid schedule of exchange times

c. CAPD requires the client to follow fewer dietary and fluid restrictions than hemodialysis requires

A 28 year old male patient is diagnosed with polycystic kidney disease. Which information is most appropriate for the nurse to include in teaching at this time? a. Complications of renal transplantation b. Methods for treating severe chronic pain c. Discussion of options for genetic counseling d. Differences between hemodialysis and peritoneal dialysis

c. Discussion of options for genetic counseling

A week after kidney transplantation, a client develops a temperature of 101 F, the BP is elevated, and there is tenderness over the transplanted kidney. The serum creatinine is rising and urine output is decreased. The xray indicates that the transplanted kidney is enlarged. Based on these assessment findings, the nurse anticipates which treatment? a. Antibiotic therapy b. Peritoneal dialysis c. Removal of transplanted kidney d. Increased immunosuppression therapy

d. Increased immunosuppression therapy

Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective? a. The patient denies pain with voiding b. The urine dipstick is negative for nitrites c. The antistreptolysin-O (ASO) titer is decreased d. The periorbital and peripheral edema is resolved

d. The periorbital and peripheral edema is resolved

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess the client for which manifestations of this complication? a. warmth, redness, and pain in the left hand b. aching pain, pallor, and edema of the left arm c. edema and reddish discoloration of the left arm d. pallor, diminished pulse, and pain in the left hand

d. pallor, diminished pulse, and pain in the left hand

The nurse is assessing the potency of a clients left arm arteriovenous fistula prior to initiating hemodialysis. which finding indicates that the fistula is patent? palpation of a thrill over the fistula presence of a radial pulse in the left wrist absence of a bruit on auscultation of the fistula cap refill less than 3 seconds in the nail beds on the left hand

palpation of a thrill over the fistula

POLYCYSTIC KIDNEY DISEASE: autosomal, recessive disease

• Main problem/manifestation is CHRONIC FLANK PAIN (where the kidney is) • PT EDUCATION: GENETIC COUNSELING (if its newly diagnosed)