Lewis Ch 46: Acute Kidney Injury and Chronic Kidney Disease Flashcards
(37 cards)
After the insertion of an arteriovenous graft in the right forearm, a patient reports pain and coldness of the right fingers. Which action should 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
b. Report the patient’s symptoms to the health care provider.
The patient’s problems suggest the development of distal ischemia (steal syndrome) and may require revision of the AVG. Elevating the arm above the heart will further decrease perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts.
Which assessment finding should the nurse expect when a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30?
a. Persistent skin tenting
b. Rapid, deep respirations
c. Hot, flushed face and neck
d. Bounding peripheral pulses
b. Rapid, deep respirations
Patients with metabolic acidosis caused by AKI may have Kussmaul respirations to eliminate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI.
The nurse is planning care for a patient with severe heart failure who has developed increased blood urea nitrogen (BUN) and creatinine levels. What will be the primary treatment goal in the plan?
a. Augmenting fluid volume
b. Maintaining cardiac output
c. Diluting nephrotoxic substances
d. Preventing systemic hypertension
b. Maintaining cardiac output
The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient’s heart failure is causing AKI, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses could be correct.
A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV?
a. Urine volume
b. Calcium level
c. Cardiac rhythm
d. Neurologic status
c. Cardiac rhythm
The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate.
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.”
c. “I will measure my output each day to help calculate the amount I can drink.”
The patient with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.
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
b. Phosphate level
Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in patients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium carbonate.
Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. What should the nurse assess before administering the medication?
a. Bowel sounds
b. Blood glucose
c. Blood urea nitrogen (BUN)
d. Level of consciousness (LOC)
a. Bowel sounds
Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not affect the nurse’s decision to give the medication.
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
b. Poached eggs, whole-wheat toast, and apple juice
Poached eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup is high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and cream is high in phosphate.
Which laboratory result should 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
b. Serum phosphate
If serum phosphate is increased, the calcium and phosphate can cause soft tissue calcification. Calcium carbonate should not be given until the phosphate level is lowered. Total cholesterol, creatinine, and potassium values do not affect whether calcium carbonate should be administered.
A patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function?
a. Urine volume
b. Creatinine level
c. Glomerular filtration rate (GFR)
d. Blood urea nitrogen (BUN) level
c. Glomerular filtration rate (GFR)
GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status and protein intake. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.
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.
a. A fistula is much less likely to clot.
Arteriovenous (AV) fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or patient mobility.
Which action will the nurse include in the plan of care to maintain the patency of a patient’s eft arm arteriovenous fistula?
a. Auscultate for a bruit at the fistula site.
b. Assess the quality of the left radial pulse.
c. Compare blood pressures in the left and right arms.
d. Irrigate the fistula site with saline every 8 to 12 hours.
a. Auscultate for a bruit at the fistula site.
The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.
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.
b. More protein is allowed because urea and creatinine are removed by dialysis.
When the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Glucose is not lost during hemodialysis. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.
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.
c. The patient cleans the catheter while in the bathtub each day.
Patients are encouraged to take showers rather than baths to avoid infections at the catheter insertion side. The other patient actions indicate good understanding of peritoneal dialysis.
Which information in a patient’s history indicates to the nurse that the patient is not an appropriate candidate for kidney transplantation?
a. The patient has type 1 diabetes.
b. The patient has metastatic lung cancer.
c. The patient has a history of chronic hepatitis C infection
d. The patient is infected with human immunodeficiency virus.
b. The patient has metastatic lung cancer.
Disseminated malignancies are a contraindication to transplantation. The conditions of the other patients are not contraindications for kidney transplant.
Which assessment finding may indicate that a patient is experiencing adverse effects to a corticosteroid taken for four years after kidney transplantation?
a. Postural hypotension
b. Recurrent tachycardia
c. Knee and hip joint pain
d. Increased serum creatinine
c. Knee and hip joint pain
Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not associated with corticosteroid use.
A patient who had a kidney transplant eight years ago is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone. Which assessment data will be of most concern to the nurse?
a. Skin is thin and fragile.
b. Blood pressure is 150/92.
c. A nontender axillary lump.
d. Blood glucose is 144 mg/dL.
c. A nontender axillary lump.
A nontender lump suggests a secondary cancer, such as a lymphoma, which could occur as a result of chronic immunosuppressive therapy. The increased glucose, skin change, and hypertension are possible side effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of cancer
The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required?
a. Acetaminophen
b. Calcium phosphate
c. Magnesium hydroxide
d. Multivitamin with iron
c. Magnesium hydroxide
Since magnesium is excreted by the kidneys, patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD.
What laboratory value should the nurse check before administering captopril to a patient with stage 2 chronic kidney disease?
a. Glucose
b. Potassium
c. Creatinine
d. Phosphate
b. Potassium
Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not affect whether the captopril was given or not.
A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin. What should the nurse monitor for adverse effects of the medication?
a. Blood glucose
b. Urine osmolality
c. Serum creatinine
d. Serum potassium
c. Serum creatinine
When a patient with diabetes, which increases risk for chronic kidney disease (CKD), receives a potentially nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in assessing for the adverse effects of the gentamicin.
A 55-yr-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to 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
c. Hemoglobin level 13 g/dL
High hemoglobin levels are associated with a higher rate of thromboembolic events and
increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke)
when erythropoietin (EPO) is administered to a target hemoglobin of greater than 12 g/dL indicate a need for a decrease in epoetin alfa dose. The other information also will be reported to the health care provider but will not affect whether the medication is administered.
Which intervention will be included in the plan of care for a patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein?
a. Start continuous pulse oximetry.
b. Restrict the patient’s protein intake.
c. Restrict physical activity to bed rest.
d. Discontinue the urethral retention catheter.
c. Restrict physical activity to bed rest.
The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.
A 25-yr-old patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider?
a. Serum creatinine level of 2.1 mg/dL
b. Serum potassium level of 6.5 mEq/L
c. White blood cell count of 11,500/μL
d. Blood urea nitrogen (BUN) of 56 mg/dL
b. Serum potassium level of 6.5 mEq/L
The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately. The nurse will report the other laboratory values, but abnormalities in these are not immediately life threatening.
A 72-yr-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first?
a. Insert urethral catheter.
b. Obtain renal ultrasound.
c. Draw a complete blood count.
d. Infuse normal saline at 50 mL/hr.
a. Insert urethral catheter.
The patient’s elevation in BUN is most likely associated with hydronephrosis caused by the
acute urinary retention, so the insertion of an indwelling catheter is the first action to prevent
ongoing postrenal failure for this patient. The other actions are appropriate but should be implemented after the catheter
