patho chapter 26
A 42 year-old male has been diagnosed with renal failure secondary to diabetes mellitus and is scheduled to begin dialysis soon. Which of the following statements by the client reflects an accurate understanding of the process of hemodialysis?
"I won't be able to go about my normal routine during treatment."
A nurse educator is performing client education with a 51 year-old man who has been recently diagnosed with chronic kidney disease. Which of the following statements by the client would the nurse most likely want to correct or clarify?
"My kidney problems increase my chance of developing high blood pressure or diabetes."
A family physician is providing care for a 61 year-old obese male who has a history of diabetes and hypertension. Blood work has indicated that the man has a GFR of 51 mL/min with elevated serum creatinine levels. Which of the following statements will the physician most likely provide to the client in light of these results?
"Your chronic kidney disease has likely been caused by your diabetes and high blood pressure."
The health care provider is comparing results of a client's recent GFR measurement. Which of the following results would be interpreted as normal?
120 to 130 mL/minute
The nurse knows that a patient with which glomerular filtration rate (GFR) would be classified as "decreased GFR"?
70 mL/min
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
A client who has developed stage 3 renal failure has been diagnosed with high phosphate levels. To avoid the development of osteodystrophy, the physician may prescribe a phosphate-binding agent that does not contain:
Aluminum
The nurse is caring for a patient who has had acute blood loss from ruptured esophageal varices. Which of the following does the nurse recognize is an early sign of prerenal failure?
Baseline urine output of 50 mL/hr that is now 10 mL/hr
The nurse is caring for a patient with chronic renal failure who is on hemodialysis three times a week. In order to treat hyperphosphatemia and hypocalcemia, which of the following medications will the nurse administer to decrease absorption of phosphate from the gastrointestinal tract?
Calcium carbonate
As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by:
Decrease in GFR of 60 to 89 mL/minute/1.73 m2
Client and family education regarding peritoneal dialysis should include assessing the client for:
Dehydration that may appear as dry mucous membranes or poor skin turgor
The nurse is instructing a patient with advanced kidney disease (AKD) about a dietary regimen. Which of the following restrictions should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD?
Dietary protein
A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is which of the following?
Dorsiflexion of hands and feet
Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which of the following statements regarding vitamin D is correct?
Kidneys convert inactive vitamin D to its active form, calcitriol.
The nurse assessing a renal failure patient for encephalopathy caused by high uremic levels may observe which of the following clinical manifestations?
Loss of recent memory and inattention.
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
While assessing a peritoneal dialysis client in his or her home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as:
Peritonitis
A client is diagnosed with a tumor in the urinary bladder. The nurse will monitor the client for which of the following?
Postrenal failure
A patient has an obstructive urine outflow related to benign prostatic hyperplasia. Due to the inability to excrete adequate amounts of urine, which of the following types of renal failure should the nurse closely monitor for?
Postrenal failure
A patient in renal failure has marked decrease in renal blood flow caused by hypovolemia, caused by gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which of the following forms of acute renal injury does this patient have?
Prerenal failure
The nurse recognizes that acute renal injury is characterized by which of the following?
Rapid decline in renal function
The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?
Serum creatinine
Bruising of the skin is a manifestation of bleeding disorders in patients with CKD.
True
The nurse recognizes that which of the following individuals have the greatest risk for the development of chronic kidney disease (CKD)? Select all that apply.
• A patient with a recent diagnosis of type 2 diabetes who does not monitor his blood sugar or control his diet • A 42-year-old patient with uncontrolled hypertension
A diabetic client with a history of hypertension may receive a prescription for which medication to provide a renal protective effect by reducing intraglomerular pressure? Select all that apply.
• ACE inhibitors • Angiotensin receptor blockers
Sexual dysfunction in people with CKD is thought to be multifactorial. What are thought to be causes of sexual dysfunction in people with CKD? (Select all that apply.)
• Antihypertensive drugs • Psychological factors • Uremic toxins
A client is diagnosed with decreased gomerular filtration rate but has no renal damage. The nurse recognizes that this can occur with which of the following? Select all that apply.
• Cirrhosis • Heart failure • Removal of one kidney • Dehydration
Chronic kidney disease (CKD) can provoke many cardiovascular changes. The nurse will monitor for which of the following in a client with CKD? Select all that apply.
• Congestive heart failure • Hypertension • Impaired platelet function • Pericarditis
If a CKD client is developing uremic encephalopathy, the earliest manifestations may include: Select all that apply.
• Decreased alertness • Diminished awareness
A patient is diagnosed with chronic kidney disease (CKD). The nurse recognizes that this patient will experience which of the following? Select all that apply.
• Decreased renal endocrine function • Decreased tubular reabsorption • Decreased glomerular filtration
The nurse is preparing to assess a client who has just been admitted to the hospital with a diagnosis of prerenal failure. Which would the nurse expect the client to manifest? Select all that apply.
• Decreased urinary output • Increased BUN • BUN-to-serum creatinine ratio of greater than 20:1
A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor this client for which gastrointestinal signs and symptoms? Select all that apply.
• Early morning nausea • Gastrointestinal ulceration • Metallic taste • Anorexia
In a client in the uremic state of chronic kidney failure (CKD), the nurse will monitor for which of the following signs and symptoms? Select all that apply.
• Encephalopathy • Nausea • Anemia • Apathy
Older adults often have other chronic diseases that influence the early symptoms and signs of renal dysfunction. The nurse knows that which of the following can be the dominant clinical events in older adults with early kidney disease? Select all that apply.
• Heart failure • Hypertension
Chronic kidney disease (CKD) can cause derangement of calcium and phosphate metabolism. The nurse will monitor a client with CKD for which of the following? Select all that apply.
• Impaired phosphate excretion • Decreased blood levels of calcium
A chronic kidney disease client who has renal osteodystrophy should be assessed for which of the following complications? Select all that apply.
• Muscle weakness • Bone pain • Stress fractures
A 35-year-old client is diagnosed with acute kidney injury (AKI) and is started on hemodialysis. The client is concerned with the diagnosis and wants to know what to expect in the progression of this disorder. Which statement best addresses the client's concern?
"Acute kidney injury is abrupt in onset and often reversible if recognized early and treated appropriately."
A nurse is collecting a urine specimen prior to measuring the albumin level in a client's urine. A colleague questions the rationale for the test, stating, "I thought albumin was related to liver function, not kidney function." How can the nurse best respond to this statement?
"Urine albumin levels are useful for diagnosing diabetic kidney disease."
A client has undergone a kidney transplant and voices concerns about organ rejection to the nurse. The most appropriate response by the nurse would be:
"You will be given medication to decrease your immune systems from attacking your new kidney."
Which of the following clinical findings among older adults is most unlikely to warrant further investigation and possible treatment?
78 year-old female GFR has been steadily declining over several years.
The nurse is planning care for a client with chronic kidney disease (CKD). The nurse determines that an allowable fluid intake would be:
500 to 800 mL/day
A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?
Hypertension
A client diagnosed with CKD has begun to experience periods of epistaxis and developed bruising of skin and subcutaneous tissues. The nurse recognizes these manifestations as:
Impaired platelet function
A 45-year-old client with chronic kidney disease (CKD) voices concern about her dialysis treatment. The client would like to work and spend time with her family. Which type of dialysis will best fit this client's lifestyle?
Nocturnal intermittent peritoneal dialysis (NIPD)
Which symptom occurs in a client with chronic kidney disease (CKD) as a result of elevated serum phosphate levels and the development of phosphate crystals that occur with hyperparathyroidism?
Pruritus
A client has experienced severe hemorrhage and is in prerenal failure. The nurse anticipates the laboratory results of the client's BUN and serum creatinine to identify:
The BUN-to-creatinine ratio is 20:1.
The nurse recognizes that renal failure has many underlying causes, including which of the following? Select all that apply
• Systemic disease • Renal disease • Nonrenal urological abnormalities
A client with chronic kidney disease (CKD) is anemic. The nurse will attempt to alleviate the anemia in order to prevent which of the following? Select all that apply.
• Tachycardia • Fatigue • Decreased myocardial oxygen
A 35-year-old female ultramarathon runner is admitted to the hospital following a day-long, 50-mile race because her urinary volume is drastically decreased and her urine is dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis. Why is her urine red?
Myoglobinuria
An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which of the following early signs of prerenal injury?
Sharp decrease in urine output
In hemodialysis, access to the vascular system is most commonly through what?
Internal arteriovenous fistula
The nurse is reviewing the diagnosis of four male clients. Select the diagnosis that places the clients at risk for developing postrenal kidney failure.
Prostatic hyperplasia
Neuromuscular disorders can be triggered by CKD. For those clients on dialysis, approximately two thirds suffer from what peripheral neuropathy?
Restless legs syndrome
Which of the following phenomena contributes to the difficulties with absorption, distribution and elimination of drugs that is associated with kidney disease?
Reductions in plasma proteins increase the amount of free drug and decrease the amount of protein-bound drug.
A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which would be the best instruction for the nurse to provide?
Restrict intake of dietary protein
A client with chronic kidney disease has developed cardiac calcification. On admission the priority assessment would be for the nurse to:
place on a heart monitor to watch for arrhythmias.
A patient has developed chronic kidney disease (CKD). The nurse will advise the patient to be alert for the development of which hematologic signs and symptoms of this disorder? Select all that apply.
• Bruising • Gastrointestinal bleeding • Fatigue
A patient is to begin peritoneal dialysis. The nurse knows that complications of peritoneal dialysis include which of the following? Select all that apply.
• Catheter-related infection • Hyperglycemia • Dehydration
Which of the following clients' diagnostic bloodwork is most suggestive of chronic kidney disease (CKD)?
A client with low vitamin D levels; low calcitrol levels and elevated parathyroid hormone (PTH) levels
A patient sustained acute tubular injury approximately 2 hours ago. Which of the following phases of this disorder does the nurse recognize that the patient is in at this time?
Initiating phase
A child is diagnosed with chronic kidney disease (CKD). The nurse knows that which of the following statements regarding supportive renal therapy in children are true? Select all that apply
• Early transplantation is the preferred treatment when considering long-term effects. • Children older than 12 years will benefit from hemodialysis. • Peritoneal dialysis is generally most appropriate for children younger than 6
Glomerular filtration rate (GFR) is the best indicator of renal function. The nurse knows that GFR can vary with which of the following factors? Select all that apply.
• Gender • Age • Body size • Ethnicity
Which of the following have the potential to cause chronic kidney disease? (Select all that apply.)
• Hypertension • Diabetes • Glomerulonephritis
The nurse knows that a child with chronic kidney disease (CKD) may experience which of these manifestations? Select all that apply.
• Severe growth deficit • High bone turnover
A hospital client with a diagnosis of chronic renal failure has orders for measurement of her serum electrolyte levels three times per week. Which of the following statements best captures the relationship between renal failure and sodium regulation?
Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption.
A 1-year-old baby boy with renal dysplasia risks end-stage renal disease unless intervention occurs. Which of the following treatment options is his care team most likely to reject?
Dietary restriction plus erythropoietin
Following the diagnosis of acute renal failure, the nurse knows that one of the earliest manifestations of residual tubular damage is which of the following lab/diagnostic results?
Elevated blood urea nitrogen (BUN).
A patient has a marked decrease in the glomerular filtration rate (GFR) and has elevations in blood urea nitrogen, potassium, and creatinine levels. The patient's urine output has decreased to 10 mL/hr and has 3+ pitting edema in the lower extremities. In which of the following phases of acute tubular necrosis does the nurse determine the patient is in relating to this assessment data?
Initiating phase
The nurse is providing dietary instruction for a client with chronic kidney disease who is on hemodialysis. Which would the nurse encourage the client to restrict?
Lean meats
A chronic kidney disease (CKD) client asks the nurse, "Why do I itch all the time?" The nurse bases her response on which of the following integumentary physiologic factors that causes pruritis? Select all that apply.
• Decrease in perspiration • Elevated serum phosphate levels
The parents of a child who has been diagnosed with CKD ask the nurse about manifestations of the disease. Which is the most appropriate information for the nurse to provide? Select all that apply.
• Developmental delay • Delayed cognitive development • Secondary hyperparathyroidism • Growth impairment
A child has received a kidney transplant at the age of 3. Knowing he will be on immunosuppressive agents like corticosteroids, the nurse should educate the parents about which long-term side effects? Select all that apply.
• Hypertension • Growth retardation • Development of cataracts
Albuminuria is an important indicator of nephron damage. The nurse recognizes that which of the following statements regarding albuminuria are correct? Select all that apply.
• Increased excretion of albumin indicates CKD. • Urine dipstick can detect albuminuria. • Albumin-to-creatinine ratio can confirm albuminuria.
A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor for which of the following manifestations of this disorder? Select all that apply.
• Increased nitrogenous waste in blood • Anemia • Osteodystrophy
A client is diagnosed with acute renal injury. The nurse will evaluate the client for which of the following possible causes for this disorder? Select all that apply.
• Ischemic injury • Nonischemic reduced renal blood flow • Obstruction of urinary outflow • Nephrotoxic substances
The diagnosis is chronic kidney disease (CKD). The nurse will monitor the client for which of the following neurological signs and symptoms? Select all that apply.
• Loss of recent memory • Peripheral neuropathy • Restless legs syndrome • Burning sensation in feet
A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that which of the following 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.
Many drugs and other nephrotoxic agents can induce nephrotic acute tubular necrosis (ATN). The nurse knows that these agents cause tubular injury by which of the following mechanisms? Select all that apply.
• Renal vasoconstriction • Intratubular obstruction • Direct tubular damage
Hypertension frequently accompanies chronic kidney disease (CKD). The nurse knows that which of the following mechanisms can contribute to this hypertension? Select all that apply.
• Renin-angiotensin aldosterone (RAAS) activation • Sodium retention • Increased vasoconstriction • Increased blood volume
A nurse is assessing a client diagnosed with CKD for neuromuscular manifestation. Select the manifestations the nurse may expect to find. Select all that apply.
• Restless leg syndrome • Loss of recent memory • Peripheral neuropathy • Perceptual errors • Increased muscle strength
The nurse assesses a patient for prerenal failure. Which conditions increase the risk for developing this type of kidney failure? Select all that apply.
• Severe burns • Septic shock • Severe dehydration
Acute tubular necrosis (ATN) is the most common cause of intrinsic renal failure. One of the causes of ATN is ischemia. What are the most common causes of ischemic ATN? (Select all that apply.)
• Severe hypovolemia • Burns • Overwhelming sepsis
A client is diagnosed with early chronic kidney disease (CKD). The nurse will recommend which of the following actions to slow progression of renal damage? Select all that apply.
• Smoking cessation • Blood pressure control • Angiotensin converting enzyme inhibitor (ACEI) administration • Blood glucose control
The health care provider is reviewing lab results of a client. Select the test that is the best measurement of overall kidney function?
Glomerular filtration rate (GFR)
A drug abuser was found unconscious after shooting up heroin 2 days prior. Because of the pressure placed on the hip and arm, the client has developed rhabdomyolysis. The nurse knows this can:
Obstruct the renal tubules with myoglobin and damage tubular cells
A patient with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which of the following conditions does the nurse suspect is common with this stage of kidney disease?
Pericarditis
A 72-year-old patient is scheduled for a kidney transplant. The nurse knows that which aspect of advanced age has a positive effect on the success of kidney transplant survival?
Reduction in T-lymphocyte function
A client with chronic kidney disease has been admitted with increased shortness of breath and abnormal breath sounds (rales heard to scapular region of posterior back). The admission hemoglobin level is 7.8 g/dL. Vital signs are as follows: respiratory rate 30; BP 180/98; pulse 110. +3 pitting edema in lower extremities bilaterally. Knowing the correlation of hypertension and associated anemia, the nurse suspects this client has developed:
heart failure.
As nitrogenous wastes increase in the blood, the CKD client may exhibit which of the following clinical manifestations? Select all that apply.
• Numbness in lower extremities • Restless leg syndrome • Pruritis
The nurse is caring for a group of patients in the acute care unit. Which of the following patients are at risk for developing intrarenal failure? Select all that apply.
• One who is taking gentamicin for the treatment of a kidney infection • One with lead poisoning • One with acute glomerulonephritis
A client with CKD is being treated for hyperphosphatemia and hypocalcemia. Select the most appropriate intervention. Select all that apply.
• Phosphate-binding antacids • Activated vitamin D • Restriction of foods high in phosphate
