NUR 115 RENAL AND KIDNEY
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 urine output of 50 mL/hr that is now 10 mL/hr Explanation: The kidney normally responds to a decrease in the glomerular filtration rate with a decrease in urine output. Thus, an early sign of prerenal failure is a sharp decrease in urine output.
A client comes to the clinic with back pain that has been unrelieved by continuous ibuprofen use over the past several days. Current prescription medications include captopril and hydrochlorothiazide. Which laboratory value should the nurse address?
blood urea nitrogen (BUN) of 26 mg/dL and serum creatinine of 2.35 mg/dL Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) can decrease the antihypertensive effect of ACE inhibitors and predispose clients to the development of acute renal failure. Common lab tests used to evaluate how well the kidneys are working are BUN, creatinine, and creatinine clearance. Labs such as sodium, potassium, CPK, and WBC levels will not provide information on renal function.
The nurse is caring for a patient in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:
Hyperkalemia. Explanation: Hyperkalemia is a common complication of acute renal failure. It is life-threatening if immediate action isn't taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.
A client has developed acute tubular necrosis (ATN). The nurse knows that which classification of drugs can cause this type of renal injury? Select all that apply. Nonsteroidal anti-inflammatory drugs (NSAID) Radiocontrast dyes Angiotensin converting enzyme (ACE) inhibitors Chemotherapy drugs Aminoglycoside anti-infectives
Nonsteroidal anti-inflammatory drugs (NSAID) Radiocontrast dyes Chemotherapy drugs Aminoglycoside anti-infectives Explanation: Aminoglycosides, radiocontrast agents, and chemotherapy drugs such as cisplatin all are directly toxic to the nephron and ATN will occur. NSAIDs inhibit the synthesis of prostaglandins needed to maintain renal blood flow, thus renal perfusion declines and prerenal failure can develop. ACE inhibitors are generally not nephrotoxic and are often used to manage hypertension in persons with renal disease.
A client has experienced severe hemorrhage and is in prerenal failure. 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. Explanation: Prerenal injury is manifested by a sharp decrease in urine output and a disproportionate elevation of blood urea nitrogen (BUN) in relation to serum creatinine levels. The kidney normally responds to a decrease in the glomerular filtration rate (GFR) with a decrease in urine output. An early sign of prerenal injury is a sharp decrease in urine output. A low GFR allows more time for small particles such as urea to be reabsorbed into the blood. Creatinine, which is larger and non-diffusible, remains in the tubular fluid, and the total amount of creatinine that is filtered, although small, is excreted in the urine. Consequently, there also is a disproportionate elevation in the ratio of BUN to serum creatinine, from a normal value of 10:1 to a ratio greater than 20:1.
The nurse recognizes that acute renal injury is characterized by which of the following?
Rapid decline in renal function Explanation: Acute renal injury is a rapid decline in kidney function. BUN rises as nitrogenous wastes are not removed from the circulation. If the cause can be ameliorated, the injury is usually reversible. Most at risk are seriously ill clients; the mortality rate is between 40% and 90% in these clients.
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 Explanation: Early morning nausea is common in CKD. Nausea and vomiting often improve with the restriction of dietary protein and after initiation of dialysis and disappears after kidney transplant. The other actions will not improve the symptoms.
A client receiving continuous ambulatory peritoneal dialysis (CAPD) treatments has excessive weight gain in the past 24 hours and tells the nurse excessive amounts of fluids were consumed while out with family. What change in the client's dialysis order will the nurse anticipate once relaying these findings to the health care provider?
Switching the client from 2.5% to a 4.25% dextrose dialysate Explanation: Given the client is in a state of fluid volume excess, the goal will be to remove additional fluid with the dialysis treatment. Glucose in the dialysis solution accounts for water removal and a solution of 4.25% dextrose concentration will remove more fluid than one of lower concentration. The volume of dialysate would not be decreased; dwell times would not exceed 6 hours. There would be no need for the client to get a hemodialysis treatment.
The nurse is reviewing the laboratory data for a young client in acute kidney failure and notes an elevated serum potassium level. What is the priority assessment action for the nurse based on the laboratory data?
Institute telemetry monitoring. Explanation: Slow, weak, irregular pulse; lethal arrhythmias; and sudden cardiac collapse are serious complications of an elevated potassium level. The elevated value will have less impact on renal, respiratory, and neurologic function.
A client with acute renal failure progresses through four phases. Which describes the onset phase?
It is accompanied by reduced blood flow to the nephrons. Explanation: The onset phase is accompanied by reduced blood flow to the nephrons. In the oliguric phase, fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. During the diuretic phase, excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. During the recovery phase, normal glomerular filtration and tubular function are restored.
The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney failure?
Client with prostatic hyperplasia Explanation: The most common cause of postrenal kidney failure is prostatic hyperplasia. Postrenal failure results from conditions that obstruct urine outflow. The obstruction can occur in the ureter, bladder, or urethra. Intratubular obstruction and acute pyelonephritis are intrarenal causes of kidney failure, and severe hypovolemia is a prerenal cause.
The nurse is caring for a client with acute renal failure and edema. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? Select all that apply.
Make sure the urinal is within the client's reach. Remind the client that all urine is to be saved for intake and output measurement. Weigh the client every morning using the standing scale. Measure and record vital signs. Explanation: Administration of oral medications can be performed by a licensed nurse, and assessment of breath sounds requires additional education and skill development, such as in the scope of practice of the RN. All other actions are within the scope of practice for UAPs.
A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that which statements regarding CKD are correct? Select all that apply.
Nephron destruction takes place over many months. Signs and symptoms develop gradually. Functioning nephrons compensate for those that are damaged. There is a reduction in glomerular filtration rate (GFR) as nephrons are destroyed. Explanation: In CKD, the rate of nephron destruction occurs over many months and is different among clients. Signs and symptoms develop gradually as nephrons are destroyed and functioning nephrons gradually lose the ability to compensate for this. As nephrons are destroyed, GFR declines.
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?
Postrenal failure Explanation: Postrenal failure results from obstruction of urine outflow from the kidneys. The obstruction can occur in the ureter, bladder, or urethra. Due to the increased urine not being able to be excreted due to the obstruction, retrograde pressure occurs throughout the tubules and nephrons, which ultimately damages the nephrons. Prostatic hyperplasia is the most common underlying problem.
Which of the following would a nurse classify as a prerenal cause of acute renal failure?
Septic shock Explanation: Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias. Ureteral stricture and prostatic hypertrophy would be classified as postrenal causes. Polycystic disease is classified as an intrarenal cause of acute renal failure.
