NCLEX PN studies Renal
A client with chronic kidney disease has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now has mental cloudiness, dementia, and complaints of bone pain. Which does this data indicate?
Aluminum intoxication may occur when there is accumulation of aluminum, an ingredient in many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. This condition was formerly known as dialysis dementia. It may be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body. It can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum.
The nurse is evaluating the data results of a client with sepsis and acute kidney injury with related azotemia and oliguria. Which are the primary features of azotemia and oliguria? Select all that apply.
Azotemia and oliguria refers to an increase in serum creatinine and BUN and oliguria is defined as a urine output less than 0.5 mL/kg/hour. Acute kidney injury with a decrease in GFR is often due to sepsis with related sepsis features.
The nurse is speaking with a client who underwent a minimally invasive procedure treatment for recurrent urolithiasis. Which instructions are appropriate to reinforce in the teaching plan? Select all that apply.
Kidney stones or urolithiasis is often treated with minimally invasive surgical procedures that may include placement of a stent. The stent allows passage of the stone without further irritation of the ureter. Clients should drink at least 3 L of fluid to promote passage of the stone and prevent future stone formation. Filtering the urine and retrieving the stone allows stone analysis. Further preventive treatment is prescribed based on the type of stone. It is important that clients complete the course of prescribed antibiotics to prevent infection after the procedure. Clients should contact the urologic health care provider if hematuria or fever occur and not self-treat.
The nurse is caring for a client who received a recent kidney transplant. Besides actual rejection of the transplant, which are some of the most important complications this client is at risk for? Select all that apply.
Rejection is one of the major problems of kidney transplant recipients. Besides recurrence of renal disease, kidney transplant clients are also at risk for malignancies, cardiovascular disease caused by atherosclerotic vascular disease, infection, and corticosteroid-related complications. Incidences of infection usually occur within the first month of transplant.
The nurse is caring for a hemodialysis client who has been receiving treatment for several years and is not a candidate for kidney transplant. The nurse knows that the majority of deaths of hemodialysis clients are related to which causes? Select all that apply.
The majority of deaths of hemodialysis clients are related to cardiovascular events such as stroke and myocardial infarction and infectious complications.
A client tells the nurse she completed an educational program to manage her stress incontinence but is now discouraged. Which information from the client indicates the need for further teaching? Select all that apply.
With stress incontinence, the client loses a small amount of urine involuntarily during activities that increase abdominal pressure, such as coughing, jogging, or lifting weights. This is due to weakened pelvic muscles and the inability to tighten the urethra enough to counteract bladder contraction. Kegel exercises, in which the woman contracts and relaxes the pelvic muscles to regain muscle tone should be done on a daily basis and may take up to 3 months before yielding positive results. Clients should avoid caffeine and alcoholthat stimulate bladder contraction. Diet cola likely contains caffeine. The exercise program involving weight lifting also increases abdominal pressure, leading to incontinence. The client is correct to lose weight (source for increased abdominal pressure) and maintaining adequate fluid intake.
A client contacts the health care provider's office to report she is not feeling well, has burning with urination, and suspects she may have a urinary tract infection. The nurse instructs the client to collect a urine specimen for testing. Which urinalysis findings indicate the presence of a urinary tract infection? Select all that apply.
A urinalysis reveals the appearance of the urine specimen, presence of abnormal substances, and microscopic examination findings. The urinalysis results that indicate a urinary tract infection include the presence of nitrites and leukoesterase and the microscopic finding of 10 white blood cells. If bacteria are present in the urine, nitrates are converted to nitrites. Leukoesterase is an enzyme found in neutrophil white blood cells and its presence in urine indicates infection. The normal number of white blood cells in the urine is 0 to 5 in females. One would expect the turbidity with a urinary tract infection to be cloudy. The moderate amount of ketones indicates that fat was used to supply energy instead of glucose. This would occur if the client had not eaten for an extended period or was experiencing diabetic ketoacidosis. Specific gravity (normal: 1.010 to 1.030) is the density of the urine compared with water.
A client has an arteriovenous (AV) shunt in place for hemodialysis. The nurse should take which priority precaution, knowing that bleeding is a potential complication?
An AV shunt is a cannula with two ends that are tunneled subcutaneously into an artery and a vein. An AV shunt is a less common form of access site but carries a risk for bleeding when it is used. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also should be observed at least every 4 hours. Once per shift is insufficient. Checking for blood results, bruit, and thrill all apply to the care of this client but do not focus on bleeding.
A client with acute glomerulonephritis is admitted to the nursing unit. The nurse should plan to do which action immediately on admission?
The client with acute glomerulonephritis commonly experiences fluid volume excess and fatigue. Interventions include fluid restriction and ongoing monitoring of weight, intake, and output. It is unnecessary to monitor the temperature as frequently as every 2 hours. The client is placed on bed rest or at least encouraged to rest because increased activity levels are correlated directly with proteinuria and hematuria. The diet is high in calories but low in protein.
The nurse is evaluating the assessment of a client's arteriovenous fistula being used for hemodialysis. Which findings would prompt the nurse to notify the health care provider immediately? Select all that apply.
The health care provider must be notified immediately when there is no thrill or bruit assessed at the fistula site or if there is no pulse noted distal to the site. This indicates a clot. Hemodialysis treatments usually last about 3 to 4 hours. Dressings to the site are changed every 7 days, but it is not necessary to immediately notify the health care provider if it hasn't been changed in 8 days.
Which observations by the nurse caring for clients on a hospital medical-surgical unit should be immediately reported to the health care provider? Select all that apply.
The nurse should report the new confusion and slightly tachycardic condition of the older client because these data suggest symptoms of a urinary tract infection requiring antibiotic therapy. The nurse should report the low urinary output in the postoperative client, so interventions can be prescribed to diagnose and/or avoid acute kidney injury (AKI). Slight hematuria is an expected finding in a client with urolithiasis (renal stones). Urine with mucous shreds is an expected finding in a client with an ileal conduit because the portionof ileum that functions as the "bladder" is bowel mucosa. Some clients who receive routine hemodialysis produce small amounts of urine but others do not urinate because the kidney function is now done through hemodialysis.
A client, who had experienced significant blood loss in an automobile crash, was admitted to the hospital 2 days earlier. The nurse observes the client for which signs/symptoms that indicate acute kidney injury (AKI)? Select all that apply.
Any condition that interrupts blood flow to the kidneys may cause AKI due to a prerenal etiology. Correcting fluid and blood deficits improves blood flow to the kidneys and prevents or treats AKI. Signs associated with AKI include low urinary output of concentrated urine (elevated specific gravity). The BUN and creatinine rise to levels above normal because the kidneys are not effective in clearing the waste products from the body. Hematuria and spasmodic pain are associated with urolithiasis. Hematuria occurs with multiple renal conditions including cancerous tumors in the urinary system and renal trauma
The nurse is caring for a 58-year-old client with renal failure who is on peritoneal dialysis. Which finding is considered most important by the nurse, requiring health care provider notification? Refer to chart.
Peritonitis is the most common complication of peritoneal dialysis and is often caused by a contamination in the system. This infection can initially be determined by an increased WBC count. It can also include abdominal pain, cloudy peritoneal fluid, fever and chills, nausea and vomiting.
A client with new-onset renal failure is having a first hemodialysis treatment. The nurse is especially careful to monitor the client for which signs/symptoms after the dialysis treatment?
Disequilibrium syndrome occurs most often in clients who are new to dialysis. It is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. It results from rapid removal of solutes from the body during hemodialysis, with a higher residual concentration gradient in the brain because of the blood-brain barrier. Water goes into cerebral cells because of the osmotic gradient, causing brain swelling and the onset of symptoms. It is prevented by dialyzing for shorter times or at reduced blood flow rates.
A client with end stage kidney disease (ESKD) begins peritoneal dialysis. The nurse observes for which signs/symptoms indicating peritonitis? Select all that apply.
Peritoneal dialysis is a treatment used in clients with ESKD as an alternative to hemodialysis. The procedure involves the instillation of dialysate fluid into the peritoneal cavity where excess body wastes, fluid, and electrolytes are removed through diffusion and osmosis across the semipermeable peritoneal membrane and peritoneal capillaries. A peritoneal catheter is surgically placed into the abdominal cavity and is used to instill and drain the dialysate fluid, known as effluent. Peritonitis, or infection of the peritoneal cavity, is a possible complication of peritoneal dialysis. The effluent becomes cloudy instead of the normal clear straw color, and the client has symptoms of abdominal tenderness and pain, nausea, vomiting, and fever. Thirty-eight degrees Celsius is an elevated temperature indicating fever, a sign of infection. Poor dialysate outflow is usually caused by constipation. Leakage of clear fluid at the exit site of the peritoneal catheter is more likely to occur in obese or diabetic clients. It occurs as the client physiologically adjusts to the instillation of 2 L of dialysate fluid into the abdominal cavity.
A client who underwent a kidney transplant 6 months earlier is seen in the clinic for a routine monthly appointment. The nurse reviews how the client has been doing and observes for signs/symptoms of acute rejection. Which signs/symptoms suggest acute rejection of the transplanted kidney? Select all that apply.
Acute rejection occurs 1 week to 2 years after a kidney transplant. Antibodies and white blood cells cause inflammation and vasculitis within the transplanted organ. Diagnosis is made by laboratory tests demonstrating impaired function of the organ and by changes in the donated organs found upon biopsy. Acute rejection is treated with increased immunosuppressant medication. Signs/symptoms of acute rejection of a transplanted kidney include abdominal tenderness over the transplanted kidney and decrease in organ function. Signs of decreased kidney function include oliguria (urine output between 100 and 400 mL in 24 hours), elevation in blood pressure, and elevation in the BUN and creatinine levels. Swelling of the lips is a sign of angioedema that occurs with an acute hypersensitivity reaction or anaphylaxis. Tachypnea (rapid breathing) with wheezing, the sound resulting from airway inflammation, occurs with many types of respiratory distress. It is not specific to acute rejection in a transplanted kidney.
A client with end stage kidney disease (ESKD) undergoes a surgical procedure to create an arteriovenous fistula for hemodialysis in the upper extremity. The nurse should take which actions when the client returns from surgery? Select all that apply.
Postoperatively, the nurse should observe the site for bleeding and swelling. The nurse determines that circulation is adequate in the fistula by feeling for a palpable thrill with the fingers and hearing an audible bruit with a stethoscope. The nurse asks the client to rate the pain in the surgical area and administers prescribed analgesics. Blood pressure is not assessed in the limb where the fistula was created because that procedure blocks the blood flow and may lead to thrombosis or clotting off of the fistula. Circulation should be assessed distal to the fistula. A "steal syndrome" is a possible complication of the arteriovenous fistula in which blood flow to the area distal to the fistula is inadequate. The nurse observes for signs of ischemia, such as coldness, cyanosis, and numbness, below the fistula and notifies the surgeon of ischemic changes if observed.
A client, on the waiting list for a renal transplant, receives a hemodialysis treatment. Which findings indicate to the nurse that the treatment has been effective? Select all that apply.
The purpose of hemodialysis is to replace the client's kidney function. Hemodialysis removes waste products and excess fluid from the body and attains electrolyte balance. An effective hemodialysis treatment removes fluid resulting in a loss of weight. Body waste products are removed as reflected in a lower serum BUN and creatinine levels. Potassium is excreted by healthy kidneys, so a normal serum potassium level signifies that dialysis treatment is effective. Fatigue and a functioning arteriovenous fistula are normal findings but do not demonstrate that the dialysis treatment was effective in achieving kidney functions. In some clients, the hemodialysis procedure leads to fatigue, and clients prefer to rest after the treatment. A palpable thrill in the arteriovenous fistula signifies that the fistula has not clotted.
