Renal Quiz
the nurse is caring for the kidney transplant patient in the immediate postoperative period. during this initial period, the nurse will assess the urine output at least every hour for how many hours?
first 48 hours
the home health nurse is visiting a patient who independently performs peritoneal dialysis. which question does the nurse ask the patient to assess for the major complication associated with PD?
have you noticed any signs or symptoms of infection?
a patient and family are trying to plan a schedule that coordinates with the patient's hemodialysis regimen. the patient asks, how often will i have to go and how long does it take? what is the nurse's best response
most patients require about 12 hours per week; this is usually divided into three 4-hour treatments
the home health nurse is evaluating the home setting for a patient who wishes to have in-home hemodialysis. what is important to have in the home setting to support this therapy?
specialized water treatment system to provide a safe, purified water supple
the nurse is providing postdialysis care for a patient. in comparing vital signs and weight measurements to the predialysis data, what does the nurse expect to find?
blood pressure and weight are reduced
a patient with chronic kidney disease has hypertension and the health care provider has tried different medications, combinations, and adjustment of dosages. which outcome statement indicates that the goal of drug therapy is being met?
blood pressure readings are consistently below 135/85
a patient with acute kidney injury has a high rate of catabolism with an increase in blood levels of catecholamines, cortisol, and glucagon. how will this pathophysiology manifest?
blood urea nitrogen will reflect buildup of nitrogenous wastes in the blood
the nurse is caring for a patient with acute kidney injury and notes a trend of increasingly elevated blood urea nitrogen levels. how does the nurse interpret this information?
breakdown of muscle for protein which leads to an increase in azotemia
a patient has acute kidney injury related to nephrotoxins. to improve glomerular filtration rate and improve blood flow to the kidneys, which type of medication does the nurse anticipate the health care provider prescribe?
calcium channel blockers
a patient with chronic kidney disease has a potassium level of 8mEq/L. the nurse notifies the health care provider after assessing for which s/s?
cardiac dysrhythmias
the nurse is teaching a patient about performing peritoneal dialysis at home. in order to identify the earliest manifestation of peritonitis, what does the nurse instruct the patient to do?
check the effluent for clouiness
the nurse is caring for a patient requiring peritoneal dialysis. in order to monitor the patient's weight, what does the nurse do?
check the weight after a drain and before the next fill to monitor the patient's dry weight
for a patient with acute kidney injury, the nurse would consider questioning the order for which diagnostic test?
computed tomography with contrast dye
in collaboration with the registered dietitian, the nurse teaches the patient about which dietary recommendations for management of chronic kidney diseasE?
controlling protein intake limiting fluid intake restricting potassium restricting phosphorus
a patient sustained extensive burns and depletion of vascular volume. the nurse expects which changes in vital signs and urinary function
decreased urine output, hypotension, tachycardia
the community health nurse is designing programs to reduce kidney problems and kidney injury among the general public. in order to do so, the nurse targets health promotion and compliance with therapy for people with which conditions?
diabetes mellitus and hypertension
a patient's laboratory results show an elevated creatinine level. the patient's history reveals no risk factors for kidney disease. which question does the nurse ask the patient to shed further light on the laboratory result?
did you take any type of antibiotics before taking the test?
the nurse is caring for a patient with end-stage kidney disease and dialysis has been initiated. which drug order does the nurse question?
diuretic
the nurse notes an abnormal laboratory test finding for a patient with chronic kidney disease and alerts the health care provider. the nurse also consults with the registered dietitian because an excessive dietary intake is directly related to which factor?
elevated blood urea nitrogen level
the nurse is reviewing urinalysis results for a patient who is in the early stages of chronic kidney disease. what results might the nurse expect to see?
excessive protein, glucose, red blood cells, and white blood cells
if a patient with end-stage kidney disease experiences isosthenuria, what must the nurse be alert for?
fluid volume overload
the nurse is assessing a patient with uremia. which gastrointestinal changes does the nurse expect to find?
halitosis hiccups anorexia nausea vomiting
a patient is diagnosed with renal osteodystrophy. what does the nurse instruct unlicensed assistive personnel to do in relation to this patient's diagnosis?
handle the patient gently because of the risk for fractures
which disorder could be a complication from acute kidney injury?
heart failure
the nurse is assessing a patient who has just returned from hemodialysis. which assessment finding is cause for greatest concern?
bleeding at the access site
which combination of drugs is the most nephrotoxic?
aminoglycoside antibiotics and nonsteroidal anti-inflammatory drugs
a patient with prerenal azotemia receives a fluid challenge. in evaluating response to the therapy, which outcome indicates that the goal was met?
patient produces urine soon after the initial bolus
the nurse is caring for several patients at a walk-in clinic. none of the patients currently have any acute or chronic kidney problems. which patient has the greatest risk for develop acute kidney injury?
73 year old male who has hypertension and peripheral vascular disease
the nurse is caring for a patient with an arteriovenous fistula. what is included in the nursing care for this patient?
-assess the patient's distal pulse and circulation in the arm with the access -encourage routine range-of-motion exercises -avoid venipuncture or IV administration on the arm with the access device -assess for manifestations of infection of the fistula
the nurse is caring for a patient receiving gentamicin. which laboratory results does the nurse monitor?
-blood urea nitrogen -creatinine -drug peak and trough levels
when shock or other problems cause an acute reduction in blood flow to the kidneys, how do the kidneys compensate? SATA
-constrict blood vessels in the kidneys -activate the renin-angiotensin-aldosterone pathway -release antidiuretic hormones
the nurse is taking a history of a patient at risk for kidney failure. what does the nurse ask the patient about during the interview?
-exposure to nephrotoxic chemicals -history of diabetes mellitus, hypertension, systemic lupus erythematosus -recent surgery, trauma, or transfusions -recent or prolonged use of NSAIDS
what might the nurse notice if the patient is experiencing reduced perfusion and altered urinary elimination related to acute kidney injury?
-hemodynamic instability, especially persistent hypotension and tachycardia -urine output of less than 0.5mL/kg/hr for 6 or more hours -abnormal urine sodium values
What criteria are included in the current definition of acute kidney injury?
-increase in serum creatinine by 0.3mg/dL or more within 48hrs -increase in serum creatinine to 1.5 times or more from baseline in the previous 7 days -urine volume of less than 0.5mL/kg/hr for 6 hours
during peritoneal dialysis, the nurse notes slowed dialysate outflow. what does the nurse do to troubleshoot the system?
-inspect the tubing for kinking or twisting -ensure that clamps are open -turn the patient to the other side -make sure the patient has good body alignment
which patients are likely to be excluded from receiving a transplant?
-patient with breast cancer that has metastasized to lungs -patient with advanced and uncorrectable heart disease -patient with a chemical dependency
which patients with chronic kidney disease are candidates for intermittent hemodialysis>
-patient with fluid overload who does not respond to diuretics -patient with symptomatic toxin ingestion -patient with uremic manifestations, such as decreased cognition -patient with symptomatic hyperkalemia and calciphylaxis
a patient can develop intrarenal kidney injury from which causes?
-vasculitis -pyelonephritis -exposure to nephrotoxins -systemic infection
the nurse is teaching the patient to perform continuous ambulatory peritoneal dialysis. place the steps in the correct order.
1. warm the dialysate bags before instillation by using a heating pad to wrap the bag 2. 1-2L of dialysate is infused by gravity over a 10-20 minute period 3. fluid stays in the cavity for a specified time prescribed by the health care provider 4. fluid flows out of the body by gravity into a drainage bag
the patient with chronic kidney disease has consistently weighed 63 kilograms at each clinic visit. patient reports eating "a lot of good, salty food" and drinking too many beers during the weekend. today the patient weighs 65 kilograms. how much fluid has the patient retained?
2 liters
the nurse and the dietitian are planning dietary intake for a patient with acute kidney injury who is currently not on dialysis therapy. the dietitian informs the nurse that 0.6g/kg of body weight of protein are needed. the patient weighs 130 pounds. how many grams of protein should the patient receive?
35 grams
the nurse is assessing a patient's extremity with an arteriovenous graft. the nurse notes a thrill and a bruit, and the patient reports numbness and a cool feeling in the fingers. how does the nurse interpret this information with regards to the graft?
the patient has "steal syndrome" and may need surgical intervention
a patient has returned to the medical-surgical unit after having a dialysis treatment. the nurse notes that the patient is also scheduled for an invasive procedure on the same day. what is the primary rationale for delaying the procedure for 4 to 6 hours?
the patient was heparinized during dialysis
the nurse is assessing the skin of a patient with end-stage kidney disease. which clinical manifestation is considered a sign of very late, premorbid, advanced uremic syndrome?
uremic frost
the nurse is caring for a patient who has hypovolemic shock secondary to trauma. based on the pathophysiology of hypovolemia and prerenal azotemia, what does the nurse assess at least every hour?
urinary output
patients with diabetes or hypertension should be encouraged to have which tests annually?
urine albumin-to creatinine ratio, serum creatinine, and blood urea nitrogen
the emergency department (ED) nurse is assessing a healthy young marathon runner who was brought to the hospital for transient syncope and dizziness that occurred after the race. the nurse notes that the patient has low urine output, decreased systolic blood pressure, decreased pulse pressure, orthostatic hypotension, and thirst. before obtaining orders from the ED provider, which additional assessment is the most important?
assess gag reflex and ability to swallow
the night shift nurse sees a patient with kidney failure sitting up in bed. the patient states, " I feel a little short of breath at night or when I get up to walk to the bathroom." what assessment should the nurse do?
auscultate the lungs for crackles which indicate fluid overload
the nurse is talking to a group of healthy young athletes about maintaining good kidney health and preventing acute kidney injury. which health promotion point is the nurse most likely to emphasize with this group?
avoid dehydration by drinking at least 2-3L of water daily
the nurse is caring for a patient with an arteriovenous fistula. what instructions are given to unlicensed assistive personnel regarding the care of this patient?
avoid taking the blood pressure readings in the arm wth the fistula
the nursing student is explaining principles of hemodialysis to the nursing instructor. which statement by the student indicates a need for additional study and research for the topic?
bacteria and other organisms can also pass through the membrane, so the dialysate must be kept sterile
a patient is undergoing a dialysis treatment and exhibits a progression of symptoms which include headache, nausea and vomiting, and fatigue. how does the nurse interpret these symptoms?
mild dialysis disequilibrium syndrome
what should the nurse do in order to monitor kidney function in the patient with chronic kidney disease?
monitor intake and output check urine specific gravity review blood urea nitrogen and serum creatinine levels monitor serum potassium and sodium levels observe albumin-creatinine ratio
when a patient is in the diuretic phase of acute kidney injury, the nurse is mainly concerned about implementing which intervention?
monitoring for hypovolemia and electrolyte loss
the patient had a diagnostic imaging test with contrast media. IV fluids were ordered before and after the procedure to prevent contrast-induced nephropathy. which outcome statement indicates that the goal of giving IV therapy has been met?
urine output is 150mL/hr for the first 6 hours after use of contrast agent
the nurse monitors the daily weights for a patient with chronic kidney disease because of the risk for fluid retention. what instructions does the nurse give to unlicensed assistive personnel?
weigh the patient daily at the same time each day, same scale, with the same amount of clothing
the nurse is caring for a patient with chronic kidney disease. the family asks about when renal replacement therapy will being. what is the nurse's best response?
when the kidneys are unable to maintain a balance in body functions
the intensive care nurse is caring for the kidney transplant patient who was just transferred from the recovery unit. which finding is the most serious within the first 12hours after surgery and warrants immediate notification fo the transplant surgeon?
abrupt decrease in urine
the nurse is assessing a patient with kidney injury and notes that the patient is having Kussmal respirations. what condition is the body attempting to compensate for?
acidosis
in order to assist a patient in the prevention of osteodystrophy, which intervention does the nurse perform?
administer phosphate binders with meals
the nurse is caring for a patient with acute kidney injury who does not have signs or symptoms of fluid overload. which intervention would be most effective as a fluid challenge to promote kidney perfusion?
administering normal saline 500 to 1000mL infused over 1 hr
a patient is instructed by the dietitian to restrict protein to 0.6g/kg of body weight. the patient weighs 121 pounds and reports consuming milk and eggs or meat for every meal. What should the nurse do?
advise the patient that protein intake is excessive and consult the dietitian for reeducation
the nurse is talking to a patient with end-stage kidney disease. the patient frequently displays weight gain and increased blood pressure beyond the baseline measurements. which question is the nurse most likely to ask to determine if the patient is doing something that is contributing to these assessment findings?
are you controlling your salt intake?
the nurse is evaluating a patient's treatment response to erythropoietin. which hemoglobin reading indicates that the goal is being met?
around 10g/dL
which abnormal electrolyte imbalance is most likely to develop in the early phase of chronic kidney disease?
hyponatremia
the nurse is caring for a patient in the intensive care unit who sustained blood loss during a traumatic accident. to detect signs and symptoms that suggest the development of kidney dysfunction, the nurse observes for which data?
hypotension decreased urine output decreased cardiac output
a patient has been receiving erythropoietin. which statement by the patient indicates that the therapy is producing the desired effect?
i can do my housework with less fatigue
the health care provider has ordered sodium restriction to 3g daily for a patient receiving dialysis therapy. what does the nurse teach the patient?
identify foods that are high in sodium (e.g., bacon, potato chips, fast foods)
as a result of kidney failure, excessive hydrogen ions cannot be excreted. with acid retention, the nurse is most likely to observe what type of respiratory compensation?
increased depth of breathing
the nurse is taking a history on a patient with diabetes and hypertension. because of the patient's high risk for developing kidney problems, which early sign of chronic kidney disease does the nurse assess for?
increased output of very dilute urine
the health care provider has ordered intraperitoneal heparin for a patient with a new peritoneal dialysis catheter to prevent clotting of the catheter by blood and fibrin formation. what advice does the nurse give the patient?
intraperitoneal heparin does not affect clotting times.
the home health nurse is reviewing the medication list of a patient with chronic kidney disease. the nurse calls the health care provider as a reminder that the patient might need which nutritional supplements?
iron calcium vitamin d water-soluble vitamins
a patient has been diagnosed with acute kidney injury, but the cause is uncertain. the nurse prepares patient educational material about which diagnostic test
kidney biopsy
the patient with chronic kidney disease reports chronic fatigue, lethargy with weakness, and mild shortness of breath with dizziness when rising to a standing position. in addition, the nurse notes pale mucous membranes. based on the patient's illness and presenting symptoms, which laboratory result does the nurse expect to see?
low hemoglobin and hematocrit
the nurse is reviewing the medication list and appropriate dose adjustments made for a patient with chronic kidney disease. the nurse would question the use and/or dosage adjustment of which type of medication?
magnesium antacids
the nurse is caring for a patient with acute kidney injury that developed after a severe anaphylactic reaction. what is a primary treatment goal of the initial phase that will help to prevent permanent kidney damage for this patient?
maintain a minimal mean arterial pressure of 65mmHg
a patient with acute kidney injury has a poor appetite. what would the healthcare team try first?
oral supplements designed for kidney patients
which behavior is the strongest indicator that a patient with end stage kidney disease is not coping well with the illness and may need a referral for psychological counseling
repeatedly misses dialysis appointments
the health care provider order IV fluids at a rate of 1mL/kg/hr for 12 hours prior to an imaging test. the patient weighs 152 pounds. what should the nurse do?
set the IV pump to deliver 69mL/hr (nice)
which patient is the most likely candidate for continuous venovenous hemofiltration?
patient who is critically ill
which patient with kidney problems is the best candidate for peritoneal dialysis?
patient with a history of difficulty with anticoagulants
the nurse is caring for a postoperative patient and is evaluating the patient's intake and output as a measure to prevent acute kidney injury. the patient weighs 60kg and has an intake of 120mL and 180mL of urine in the past 4hrs. what should the nurse do?
perform other assessments related to fluid status and record the output
the intensive care nurse is caring for a patient who just received a kidney transplant from a related donor. the nurse notices hypotension and excessive diuresis, 1000mL greater than intake over the past 12 hours. at this point, what is the primary concept that affects graft survival?
perfusion
the nurse is caring for a patient who developed acute prerenal kidney injury secondary to severe and extensive burn injuries. what is the primary concept that underlies the etiology of the acute kidney injury?
perfusion
the nurse is caring for a patient who had kidney transplant surgery 3 days ago. the nurse notes a sudden and abrupt decrease in urine. the nurse alerts the health care provider for suspected thrombosis. what is the priority concept that underlies this complication?
perfusion
a patient with chroni kidney disease develops severe chest pain, an increased pulse, low-grade fever, and a pericardial friction rub with a cardiac dysrhythmia and muffled heart tones. the nurse immediately alerts the health care provider and prepares for which emergency procedure
pericardiocentesis
a patient with chronic kidney disease is restless, anxious, and short of breath. the nurse hears crackles that begin at the base of the lungs. the pulse rate is increased and the patient has frothy, blood-tinged sputum. what does the nurse do first?
place the patient in a high-fowler's position
the nurse is talking to an older adult male patient who is reasonably health for his age, but has benign prostatic hyperplasia (BPH). which condition does the BPH potentially place him at risk for?
postrenal acute kidney injry
the nurse is caring for patients who have cancers of the bladder, certvis, colon, and prostate. these patients have a risk for developing which type of acute kidney injury?
postrenal injury
a patient with acute kidney injury is receiving total parenteral nutrition. what is the therapeutic goal of using TPN?
preserve lean body mass
the nurse requests a dietary consult to address the patient's high rate of catabolism. which nutritional element is directly related to this metabolic process?
proteins
a patient has recently started peritoneal dialysis therapy and reports some mild pain when the dialysate is flowing in. what does the nurse do next?
reassure that pain should subside after the first week or two
the nurse is monitoring a patient's peritoneal dialysis treatment. the total outflow is slightly less than the inflow. what does the nurse do next?
record the difference as intake
what type of breath odor is most likely to be noted in a patient with chronic kidney disease?
smells like urine
according to the KDIGO classification ( Kidney Disease: Improving Global Outcomes), how would the nurse interpret the following data? Serum creatinine increased x 1.5 over baseline with urine output of <0.5mL/kg/hr for >=6hours.
stage 1
