Lewis Chapter 49: Nursing Management: Acute Kidney Injury and Chronic Kidney Disease Flashcards
The nurse is caring for a patient with chronic kidney disease who is prescribed calcium acetate. Which of the following laboratory values should the nurse assess to determine if this medication has had a beneficial effect?
A. Sodium
B. Potassium
C. Magnesium
D. Phosphorus
D. Phosphorus and calcium have an inverse or reciprocal relationship, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore, administration of calcium should help to reduce the patient’s abnormally high phosphorus level, as seen with chronic kidney disease.
The nurse is caring for a patient during the oliguric phase of acute kidney injury. Which of the following actions should the nurse implement?
A. Weigh patient three times weekly.
B. Increase dietary sodium and potassium.
C. Provide a low-protein, high-carbohydrate diet.
D. Restrict fluids according to previous daily loss.
D. Patients in the oliguric phase of acute kidney injury will have fluid volume excess with potassium and sodium retention; hence, they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times a week.
Which of the following statements by the nurse regarding continuous ambulatory peritoneal dialysis (CAPD) would be of highest priority when teaching a patient who is new to this procedure?
A. “It is essential that you maintain aseptic technique to prevent peritonitis.”
B. “You will be allowed a more liberal protein diet once you complete CAPD.”
C. “It is important for you to maintain a daily written record of blood pressure and weight.”
D. “You will need to continue regular medical and nursing follow-up visits while performing CAPD.”
A. Peritonitis is a potentially fatal complication of peritoneal dialysis, and therefore it is imperative to teach the patient methods of preventing peritonitis from occurring. Although the other teaching statements are accurate, they do not have the same potential for mortality as does the peritonitis, thus making that nursing action of highest priority.
A patient with a history of end-stage renal disease secondary to diabetes mellitus has presented to the outpatient dialysis unit for scheduled hemodialysis. Which of the following assessments should the nurse prioritize before, during, and after their treatment?
A. Level of consciousness
B. Blood pressure and fluid balance
C. Temperature, heart rate, and blood pressure
D. Assessment for signs and symptoms of infection
B. Although all of the assessments are relevant to the care of a patient receiving hemodialysis, the nature of the procedure indicates a particular need to monitor patients’ blood pressure and fluid balance.
The nurse is caring for a patient who is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. Which of the following findings is expected for the patient during this early stage of recovery?
A. Hypokalemia
B. Hyponatremia
C. Large urine output
D. Leukocytosis with cloudy urine output
C. Patients frequently experience diuresis in the hours and days immediately following a kidney transplant. This is due to the new kidney’s ability to filter BUN, the abundance of fluids administered during the operation, and initial renal tubular dysfunction. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.
Which of the following assessment findings is a consequence of the oliguric phase of acute kidney injury (AKI)?
A. Hypovolemia
B. Hyperkalemia
C. Hypernatremia
D. Thrombocytopenia
B. In acute kidney injury (AKI), the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased because of decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.
The RIFLE criteria define three stages of AKI based on changes in which of the following?
a. Blood pressure (BP) and urine osmolality
b. Urine output and urinary creatinine
c. Fractional excretion of urinary sodium and glomerular filtration rate (GFR)
d. Baseline serum creatinine and urine output
D.
In the oliguric phase of acute kidney injury (AKI), for which symptoms does the nurse monitor the client?
a. Hypotension
b. Pulmonary edema
c. Hypernatremia
d. Hypokalemia
B.
Which systemic effect best characterizes chronic kidney disease (CKD)?
a. Progressive irreversible damage of the kidneys
b. Rapid decrease in urinary output with an elevated blood urea nitrogen (BUN)
c. Progressive increase in creatinine clearance
d. Rapid rise in serum creatinine from baseline
A.
Clients with CKD stages 3–4 require an interprofessional approach to care that focuses on delaying the progression of CKD by which of the following?
a. Educating clients and caregivers about BP control
b. Instructing clients to significantly restrict protein in their diet
c. Instructing clients that radiocontrast agents are not harmful at this stage of CKD
d. Educating clients to restrict their sodium intake to 3.5 g/day
A.
Which of the following interventions should the nurse undertake to assess the patency of a newly placed arteriovenous graft for dialysis?
a. Irrigate the graft daily with low-dose heparin.
b. Monitor for any increase in blood pressure in the affected arm.
c. Listen with a stethoscope over the graft for the presence of a bruit.
d. Frequently monitor the pulses and the neurovascular status distal to the graft.
C.
Following a kidney transplantation, which signs of rejection would the nurse include in the client education?
a. Fever, weight loss, increased urinary output, increased blood pressure (BP)
b. Fever, weight gain, increased urinary output, increased BP
c. Fever, weight loss, decreased urinary output, decreased BP
d. Fever, weight gain, decreased urinary output, increased BP
D.
The nurse monitors the client in the diuretic phase of AKI for which serum electrolyte imbalances?
a. Hyperkalemia and hyponatremia
b. Hyperkalemia and hypernatremia
c. Hypokalemia and hyponatremia
d. Hypokalemia and hypernatremia
C.
Which factor causes direct damage to the parenchyma resulting in intrarenal acute kidney injury (AKI)?
A. Decrease in circulating blood volume
B. Bladder cancer
C. Acute tubular necrosis (ATN)
D. Obstruction of urinary flow
C. Acute tubular necrosis (ATN)
ATN is the most common intrarenal cause of AKI. Intrarenal causes include conditions that cause direct damage to the renal tissue (parenchyma), resulting in impaired nephron function.
A patient presents with a urine output of 250 mL/day for the past number of months, as well as elevated BUN and creatinine levels. Which outcome would the nurse expect for a patient experiencing acute kidney injury (AKI)?
A. Onset of chronic kidney disease
B. Kidney failure resulting in death
C. Complete recovery in 1 to 2 months
D. Development of acute tubular necrosis
A. Onset of chronic kidney disease
When a patient still has oliguria and elevated blood urea nitrogen (BUN) and creatinine levels for several months after the AKI; the patient will likely progress to chronic kidney disease.
