Chapter 51: Focused Review on CKD, Dialysis

Question 1

progressive, irreversible loss of kidney function

Answer 1

chronic kidney disease

Question 2

What are the two leading causes of CKD?

Answer 2

diabetes and hypertension

Question 3

T/F

As kidney function deteriorates, all body systems become affected.

Answer 3

true

Question 4

a syndrome in which kidney function declines to the point that all symptoms may develop in multiple body systems

Answer 4

uremia

Question 5

urinary s/s for CKD

Answer 5

• decreased urinary output
• proteinuria
• hematuria

Question 6

neurocognitive s/s for CKD

Answer 6

• lethargy
• altered LOC
• seizures

Question 7

cardiac s/s for CKD

Answer 7

• hypertension
• fluid volume excess
• heart failure

Question 8

GI s/s for CKD

Answer 8

• anorexia
• nausea/vomiting
• ammonia breath
• metallic taste

Question 9

immunologic s/s for CKD

Answer 9

impaired immune and inflammatory response

Question 10

blood s/s for CKD

Answer 10

• anemia
• increased risk for bleeding
• prolonged bleeding time

Question 11

reproductive s/s for CKD

Answer 11

• amenorrhea
• erectile dysfunction
• decreased libido

Question 12

integumentary s/s for CKD

Answer 12

• uremic frost
• pruritus

Question 13

The nurse assesses the patient with chronic kidney disease with the understanding that this condition is characterized by

a. progressive irreversible destruction of the kidneys.
b. a rapid decrease in urine output with an elevated BUN.
c. an increasing creatinine clearance with a decrease in urine output.
d. prostration, somnolence, and confusion with coma and imminent death.

Answer 13

a. progressive irreversible destruction of the kidneys.

Question 14

Nurses can screen patients at risk for developing chronic kidney disease. Those considered to be at increased risk include (select all that apply):

a. older Black patients.
b. patients more than 60 years old.
c. those with a history of pancreatitis.
d. those with a history of hypertension.
e. those with a history of type 2 diabetes.

Answer 14

a. older Black patients.
b. patients more than 60 years old.
d. those with a history of hypertension.
e. those with a history of type 2 diabetes.

Question 15

Which points must the nurse consider when planning nutrition support for patients with chronic kidney disease? (select all that apply)

a. Sodium may be restricted in someone with advanced CKD.

b. Fluid is not usually restricted for patients on peritoneal dialysis.

c. Decreased fluid intake and a low-potassium diet are needed for a patient on hemodialysis.

d. Decreased fluid intake and a low-potassium diet are needed for a patient on peritoneal dialysis.

e. Decreased fluid intake and a diet in protein-rich foods are part of a diet for a patient on hemodialysis.

Answer 15

a. Sodium may be restricted in someone with advanced CKD.
b. Fluid is not usually restricted for patients on peritoneal dialysis.
c. Decreased fluid intake and a low-potassium diet are needed for a patient on hemodialysis.

Question 16

Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse‘s teaching about management of CKD has been effective?

a. “I need to get most of my protein from low-fat dairy products.”

b. “I will increase my intake of fruits and vegetables to 5 per day.”

c. “I will measure my output each day to help calculate the amount I can drink.”

d. “I need erythropoietin injections to boost my immunity and prevent infection.”

Answer 16

c. “I will measure my output each day to help calculate the amount I can drink.”

Question 17

Which information will the nurse monitor to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?

a. Blood pressure

b. Phosphate level

c. Neurologic status

d. Creatinine clearance

Answer 17

b. Phosphate level

Question 18

Which lab values are elevated in CKD?

Answer 18

• BUN
• Creatinine
• Potassium
• Magnesium
• Phosphate

Question 19

Which lab values are decreased in CKD?

Answer 19

calcium

Question 20

Which laboratory result would the nurse check before administering calcium carbonate to a patient with chronic kidney disease?

a. Serum potassium

b. Serum phosphate

c. Serum creatinine

d. Serum cholesterol

Answer 20

b. Serum phosphate

Question 21

The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication being taken by the patient indicates a need for patient teaching?

a. Acetaminophen

b. Calcium phosphate

c. Magnesium hydroxide

d. Multivitamin with iron

Answer 21

c. Magnesium hydroxide

Question 22

What laboratory value would the nurse check before administering captopril to a patient with stage 2 chronic kidney disease?

a. Glucose

b. Potassium

c. Creatinine

d. Phosphate

Answer 22

b. Potassium

Question 23

A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin.

Which laboratory value would the nurse monitor for adverse effects of the medication?

a. Blood glucose

b. Urine osmolality

c. Serum creatinine

d. Serum potassium

Answer 23

c. Serum creatinine

Question 24

A patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information would the nurse discuss with the health care provider before giving the medication?

a. Creatinine 1.6 mg/dL

b. Oxygen saturation 89%

c. Hemoglobin level 13 g/dL

d. Blood pressure 98/56 mm Hg

Answer 24

c. Hemoglobin level 13 g/dL

Question 25

the movement of fluid and molecules across a semipermeable membrane from one compartment to another

Answer 25

dialysis

Question 26

involves instillation of dialysate solution into the peritoneal cavity followed by a prescribed dwell time

Answer 26

peritoneal dialysis

Question 27

T/F Peritoneal dialysis is more common than hemodilaysis.

Answer 27

false; hemodialysis is more common

Question 28

T/F An AV fistula is needed for peritoneal dialysis.

Answer 28

false; hemodialysis

Question 29

An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for a transplant. In helping the patient decide about treatment, the nurse informs the patient that a. successful transplant usually provides better quality of life than that offered by dialysis. b. if rejection of the transplanted kidney occurs, no further treatment for the renal failure is available. c. hemodialysis replaces normal kidney functions, and they do not have to live with the continual fear of rejection. d. immunosuppressive therapy after a transplant makes the person ineligible to receive other treatments if the kidney fails.

Answer 29

a. successful transplant usually provides better quality of life than that offered by dialysis.

Question 30

To assess the patency of a newly placed arteriovenous graft, the nurse should (select all that apply) a. monitor the BP in the affected arm. b. irrigate the graft daily with low-dose heparin. c. palpate the area of the graft to feel a normal thrill. d. listen with a stethoscope over the graft to detect a bruit. e. assess the pulses and neurovascular status distal to the graft.

Answer 30

c. palpate the area of the graft to feel a normal thrill. d. listen with a stethoscope over the graft to detect a bruit. e. assess the pulses and neurovascular status distal to the graft.

Question 31

After an arteriovenous graft is inserted in a patient‘s right forearm, the patient reports pain and coldness in the right fingers. Which action would the nurse take? a. Remind the patient to take a daily low-dose aspirin tablet. b. Report the patient‘s symptoms to the health care provider. c. Elevate the patient‘s arm on pillows above the heart level. d. Teach the patient about normal arteriovenous graft function.

Answer 31

b. Report the patient‘s symptoms to the health care provider.

Question 32

Which menu choice by the patient who is receiving hemodialysis indicates that the nurse‘s teaching has been successful? a. Split-pea soup, English muffin, and nonfat milk b. Poached eggs, whole-wheat toast, and apple juice c. Oatmeal with cream, half a banana, and herbal tea d. Cheese sandwich, tomato soup, and cranberry juice

Answer 32

b. Poached eggs, whole-wheat toast, and apple juice

Question 33

A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft? a. A fistula is much less likely to clot. b. A fistula increases patient mobility. c. A fistula can be used sooner after surgery. d. A fistula can accommodate larger needles.

Answer 33

a. A fistula is much less likely to clot.

Question 34

Which action will the nurse include in the plan of care to maintain the patency of a patient‘s left arm arteriovenous fistula? a. Auscultate for a bruit at the fistula site. b. Assess the quality of the left radial pulse. c. Irrigate the fistula with saline every 8 to 12 hours. d. Compare blood pressures in the left and right arms.

Answer 34

a. Auscultate for a bruit at the fistula site.

Question 35

A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. More protein is allowed because urea and creatinine are removed by dialysis. c. Dietary potassium is not restricted because the level is normalized by dialysis. d. Unlimited fluids are allowed because retained fluid is removed during dialysis.

Answer 35

b. More protein is allowed because urea and creatinine are removed by dialysis.

Question 36

Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a. The patient leaves the catheter exit site without a dressing. b. The patient plans 30 to 60 minutes for a dialysate exchange. c. The patient cleans the catheter while in the bathtub each day. d. The patient slows the inflow rate when experiencing abdominal pain.

Answer 36

c. The patient cleans the catheter while in the bathtub each day.

Question 37

A patient has arrived for a scheduled hemodialysis session. Which nursing action is appropriate for the registered nurse (RN) to delegate to a dialysis technician? a. Teach the patient about fluid restrictions. b. Check blood pressure before starting dialysis. c. Assess for causes of an increase in predialysis weight. d. Determine the ultrafiltration rate for the hemodialysis.

Answer 37

b. Check blood pressure before starting dialysis.

Question 38

A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L inflows. Which information would the nurse report promptly to the health care provider? a. The patient has an outflow volume of 1800 mL. b. The patient‘s peritoneal effluent appears cloudy. c. The patient‘s abdomen appears bloated after the inflow. d. The patient has abdominal pain during the inflow phase.

Answer 38

b. The patient‘s peritoneal effluent appears cloudy.

Question 39

During routine hemodialysis, a patient reports nausea and dizziness. Which action would the nurse take first? a. Slow down the rate of dialysis. b. Check the blood pressure (BP). c. Review the hematocrit (Hct) level. d. Give prescribed PRN antiemetic drugs.

Answer 39

b. Check the blood pressure (BP).

Question 40

A patient reports leg cramps during hemodialysis. Which action would the nurse take? a. Massage the patient‘s legs. b. Reposition the patient supine. c. Give acetaminophen (Tylenol). d. Infuse a bolus of normal saline.

Answer 40

d. Infuse a bolus of normal saline.

Question 41

A 74-yr-old patient who is progressing to stage 5 chronic kidney disease asks the nurse, “Do you think I would go on dialysis?” Which initial response would the nurse provide? a. “It depends on which type of dialysis you are considering.” b. “Tell me more about what you are thinking regarding dialysis.” c. “You are the only one who can make the decision about dialysis.” d. “Many people your age use dialysis and have a good quality of life.”

Answer 41

b. “Tell me more about what you are thinking regarding dialysis.”

Question 42

After receiving change-of-shift report, which patient would the nurse assess first? a. Patient who is scheduled for the drain phase of a peritoneal dialysis exchange b. Patient with stage 4 chronic kidney disease who has an elevated phosphate level c. Patient with stage 5 chronic kidney disease who has a potassium level of 3.4 mEq/L d. Patient who has just returned from having hemodialysis with a heart rate of 110/min

Answer 42

d. Patient who has just returned from having hemodialysis with a heart rate of 110/min

Question 43

Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis? (Select all that apply.) a. Avoid commercial salt substitutes. b. Restrict fluid intake to 1000 mL daily. c. Take phosphate binders with each meal. d. Choose high-protein foods for most meals. e. Have several servings of dairy products daily.

Answer 43

a. Avoid commercial salt substitutes. c. Take phosphate binders with each meal. d. Choose high-protein foods for most meals.