Pre Class Adult GI/AKI/CKD/Dialysis

A nurse is providing teaching for a client who has gastroesophageal reflux disease (GERD) about ways to manage his condition. Which of the following instructions should the nurse include? -"Sleep on your left side." -"Drink milk to soothe your stomach." -"Eat four small meals each day." -"Wait to go to bed for 1 hr after eating."

"Eat four small meals each day." The client should avoid eating large meals because of the pressure it places on the stomach. Instead, he should eat four to six small meals per day.

A nurse is providing discharge teaching to a client who has gastroesophageal reflux disease. Which of the following statements by the client indicates an understanding of the teaching? -"The type of foods I eat does not affect this condition." -"I will sleep on my left side." -"I will eat a snack just before going to bed." -"I will sleep with the head of my bed elevated."

-"I will sleep with the head of my bed elevated."

A nurse is teaching a client who has pre-dialysis end-stage kidney disease about diet. Which of the following instructions should the nurse include? -"Increase intake of dietary phosphorous." -"Eliminate foods high in protein from your diet." -"Reduce intake of foods high in potassium." -"Increase intake of sodium-containing food."

-"Reduce intake of foods high in potassium." The client should reduce foods high in potassium because potassium clearance is impaired in the client who has end-stage kidney disease.

A nurse is admitting a client who reports anorexia and is experiencing malnutrition. Which of the following laboratory findings should the nurse expect to be altered? -Creatine kinase -Troponin -Total bilirubin -Albumin

-Albumin

A nurse is caring for a client who has end-stage renal disease (ESRD). Which of the following are expected findings? (Select all that apply). -Slurred speech -Bone pain -Bradypnea -Pruritus -Hypotension

-Slurred speech -Bone pain -Pruritus Tachypnea, rather than bradypnea, is an expected finding of ESKD. Hypertension, rather than hypotension, is an expected finding of EKRD.

A nurse is teaching a client who has acute kidney injury about the oliguric phase. Which of the following information should the nurse include in the teaching? -Renal function is reestablished. -BUN and creatinine levels decrease. -Urine output is less than 400 mL per 24 hr. -The glomerular filtration rate (GFR) recovers.

-Urine output is less than 400 mL per 24 hr. Inadequate urinary output is associated with the oliguric phase of acute kidney injury. The minimum amount of urine needed to rid the body of metabolic waste products is 400 mL. Therefore, a client who is producing less than 400 mL of output in 24 hr is manifesting acute kidney injury.

A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity? -Omeprazole -Vancomycin -Ondansetron -Diphenhydramine

-Vancomycin The nurse should identify that vancomycin, an antibiotic, to be associated with nephrotoxic adverse effects.

A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect? -pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg -pH 7.30, HCO3- 26 mEq/L, PaCO2 50 mm Hg -pH 7.50, HCO3- 20 mEq/L, PaCO2 32 mm Hg -pH 7.55, HCO3- 30 mEq/L, PaCO2 31 mm Hg

-pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg The nurse should expect a client who has renal failure to have metabolic acidosis, which is characterized by a low HCO3-, a low pH, and a low or normal PaCO2. Expected reference ranges for these laboratory values are as follows: pH 7.35 to 7.45, HCO3- 21 to 28 mEq/L, and PaCO2 35 to 45 mm Hg.

A nurse is caring for a client who has a new arteriovenous (AV) graft in his left forearm. Which of the following techniques should the nurse use to assess the patency of this graft? -Measure the client's blood pressure to ensure it is higher in the left arm than the right. -Check the brachial and radial pulses of the left arm simultaneously. -Auscultate the site for a bruit. -Auscultate the antecubital fossa using a Doppler stethoscope.

Auscultate the site for a bruit. The nurse should auscultate the AV graft site for the presence of a bruit or palpate the site for a thrill every 4 hr to assess for blood flow.

A nurse is providing discharge teaching to a client who has a new arteriovenous fistula in the right forearm. Which of the following manifestations should the nurse include in the teaching as a possible indication of venous insufficiency? -A raised red rash around the fistula site -Pain in the right arm proximal to the fistula site -Cold and numb numbness distal to the fistula site -Foul-smelling drainage from the fistula site

Cold and numb numbness distal to the fistula site Pallor and numbness distal to the fistula site are possible indicators of venous insufficiency and should be immediately reported to the provider.

A nurse is assessing a client in the oliguric phase of acute kidney injury. Which of the following findings should the nurse expect? -Decreased creatinine level -Hyperkalemia -Hypomagnesaemia -Increased glomerular filtration rate (GFR)

Hyperkalemia The nurse should expect the client to have an increase in the serum concentration of potassium during the oliguric phase. Potassium can rise to a life-threatening level during this phase and should be monitored closely.

A nurse is teaching a client who has chronic kidney disease and a new prescription for epoetin alfa. The nurse should instruct the client to increase dietary intake of which of the following substances? -Iron -Protein -Potassium -Sodium

Iron Epoetin alfa is a synthetic form of erythropoietin, a substance produced by the kidneys that stimulates the bone marrow to produce red blood cells. Increased iron is needed for the production of hemoglobin and red blood cells by the bone marrow.

A nurse is providing dietary teaching to a client who has chronic kidney disease (CKD).The nurse should instruct the client to limit which of the following nutrients? (Select all that apply.) -Protein -Calcium -Phosphorous -Sodium -Calories

Protein is correct. A client who has CKD should restrict protein intake to prevent uremia that can develop as a result of the kidneys' inability to remove the waste products of protein. Phosphorous is correct. A client who has CKD is at risk for hyperphosphatemia due to a reduction in excretion of phosphorous by the kidneys. Sodium is correct. A client who has CKD is at risk for hypernatremia, edema, and hypertension due to sodium retention Calcium is incorrect. A client who has CKD is at risk for hypocalcemia due to an alteration in the conversion of vitamin D by the kidneys. Calories is incorrect. A client who has CKD requires adequate calories to meet metabolic needs.

A nurse is teaching a client who has cholecystitis about required dietary modifications. The nurse should include which of the following foods as appropriate for the client's diet? -Creamed chicken -Roast turkey -Ice cream -Macaroni and cheese

Roast turkey Roast turkey is a low-fat protein that is an appropriate choice for inclusion in the client's diet. Low-fat food decreases stimulation of the gallbladder, thereby reducing associated symptoms.

A nurse is reviewing laboratory findings for four clients. Which of the following clients has manifestations of acute kidney injury? -BUN 15 mg/dL -Serum creatinine 6 mg/dL -Hemoglobin 16 g/dL -Serum potassium 4.5 mEq/L

Serum creatinine 6 mg/dL This finding is above the expected reference range. The expected reference range for creatinine is 0.5 mg/dL to 1.3 mg/dL depending on the client's gender and age. An elevated serum creatinine is a manifestation of impaired kidney function, such as with acute kidney injury.

A nurse is caring for a client who has impaired renal function. For which of the following findings should the nurse notify the provider? -Urine output of 175 mL in the past 8 hr -Urine output of 2,200 mL in the past 24 hr -First-voided urine in the morning has a strong odor -Urine is cloudy after sitting in the urinal for 6 hr

Urine output of 175 mL in the past 8 hr The nurse should notify the provider if the client's urinary output is less than 30 mL/hr. This finding indicates a fluid imbalance, decreased circulating fluid volume, and possibly inadequate renal perfusion.

A nurse is caring for a client who has acute kidney injury (AKI). Which of the following arterial blood gas values would the nurse expect this client to have? -pH 7.49, HCO3 24, PaCO2 30 -pH 7.49, HCO3 30, PaCO2 40 -pH 7.26, HCO3 24, PaCO2 46 -pH 7.26, HCO3 14, PaCO2 30

pH 7.26, HCO3 14, PaCO2 30 AKI causes metabolic acidosis because the kidneys cannot adequately process and excrete the acidic substances the usual bodily functions produce every day. With metabolic acidosis, the pH is low, the bicarbonate is low, and the PaCO2 is low or in the expected range, as in these results.

-Use any available scale to weigh the client. -Balance the scale at minus two before weighing the client. -Obtain the weight each day at a time most convenient for the client. -Weigh the client after he has voided.

-Weigh the client after he has voided.

A nurse is assessing a client who is on long term omeprazole therapy. Which of the following findings should indicate to the nurse the medication is effective? -Increased appetite -Regular bowel movements -Absence of headache -Reduced dyspepsia

Reduced dyspepsia Omeprazole, a proton pump inhibitor, reduces gastric acid secretion and treats duodenal and gastric ulcers, prolonged dyspepsia, gastrointestinal reflux disease, and erosive esophagitis.

A nurse is teaching a client who has chronic kidney failure about planning a low-protein diet. The client states, "Why do I have to be concerned about protein?" Which of the following responses should the nurse make? -"A low-protein diet reduces the risk for uremia." -"A low-protein diet reduces the risk for edema." -"A low -protein diet will reduce the risk for hyperkalemia." -"A low-protein diet will increase the nitrogenous wastes in the blood."

"A low-protein diet reduces the risk for uremia." Urea is a waste product of protein breakdown and can accumulate in clients who have kidney failure, causing uremia.

A nurse is providing teaching to a client with gastroesophageal reflux. Which of the following statements by the client indicates a need for further teaching? -"I should elevate the head of my bed while sleeping." -"I drink no more than 4 cups of coffee a day." -"I take my time when I am eating." -"I avoid foods and drinks made with chocolate."

"I drink no more than 4 cups of coffee a day." The client should not consume regular or decaffeinated beverages; therefore, this statement by the client indicates a need for further teaching.

A nurse is teaching a client who has acute kidney disease about fluid restrictions. Which of the following statements by the client should the nurse identify as understanding of the teaching? -"I should consume most of the fluid during the evening." -"I will make a list of my favorite beverages." -"I will put beverages in large containers to give the appearance of drinking a lot." -"I will not add ice cream to the amount of fluid intake."

"I will make a list of my favorite beverages." The nurse should work with the client to develop a schedule for fluid restrictions, and should attempt to include the client's favorite beverages when possible to promote satisfaction.

A nurse is discussing kidney transplant with a client who has end-stage renal disease (ESRD). Which of the following should the nurse identify as a contraindication for this treatment? -Breast cancer survivor for 8 years -Pacemaker -65-years of age -Alcohol use disorder

Alcohol use disorder The nurse should identify that a substance use disorder is a contraindication for kidney transplant.

A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis. Which of the following instructions should the nurse include in the teaching plan? -Include foods high in starch and proteins. -Include foods high in fiber. -Avoid foods high in fat. -Avoid foods high in sodium.

Avoid foods high in fat. The nurse should instruct the client to follow a low-fat diet to decrease episodes of biliary colic. A client who has chronic cholecystitis has intolerance to fatty foods.

A nurse is reviewing the BUN and creatinine levels of an older adult client who has chronic kidney disease. The nurse should expect which of the following findings? -BUN 10 mg/dL and creatinine 0.3 mg/dL -BUN 23 mg/dL and creatinine 1.0 mg/dL

BUN 45 mg/dL and creatinine 8 mg/dL An elevation of both BUN and creatinine is an expected finding of chronic kidney disease.

A nurse is assessing a client who has chronic kidney disease for fluid volume increase. Which of the following provides a reliable measure of fluid retention? -Daily weight -Sodium leve -Tissue turgor -Intake and output

Daily weight Obtaining a client's daily weight and comparing it to previous weights is a reliable method for measuring a client's fluid volume over time.

A nurse is caring for a client who has chronic kidney disease (CKD) and states she has heartburn. The provider prescribes aluminum hydroxide. The client asks, "Why can't I just take the antacid magaldrate my husband has at home?" The nurse explains to the client that aluminum hydroxide is the preferred antacid because it lowers which of the following? -Serum phosphorus levels -Serum potassium levels -Serum magnesium levels -Serum calcium levels

Serum phosphorus levels Aluminum-based formulas are also a phosphate binder, helping to lower serum phosphorus levels in clients who have CKD.

A nurse is teaching a client who has chronic kidney disease about limiting foods that are high in potassium. Which of the following foods should the nurse instruct the client to avoid? (Select all that apply.) -Green Beans -Tomatoes -Bananas -Asparagus -Raisins

Tomatoes, Bananas, and Raisins