MS 1 Final Exam Review - Renal Flashcards
The nurse performs a neurologic assessment on a patient with end-stage renal disease (ESRD) and expects which clinical manifestations? Select all that apply.
1 Asterixis 2 Nocturnal leg cramps 3 Restless leg syndrome 4 Hypertonicity of muscles 5 Hyperexaggerated deep tendon reflexes
1 Asterixis
2 Nocturnal leg cramps
3 Restless leg syndrome
Individuals with advanced stage 5 chronic kidney disease may report restless leg syndrome, described as “bugs crawling inside the leg.” Muscle twitching, jerking, asterixis (hand-flapping tremor), and nocturnal leg cramps also occur. Eventually, motor involvement may lead to bilateral footdrop, muscular weakness and atrophy, and loss of deep tendon reflexes. There is slowing down of conduction in the peripheral nerves; therefore hyperexaggerated reflexes and hypertonicity will not be found.
The nurse is caring for a patient who had a surgery for a left-arm arteriovenous fistula (AVF) in preparation for hemodialysis. Which precautionary step does the nurse take when caring for this patient?
1 Initiate hemodialysis after four weeks.
2 Take BP measurements in the right arm only.
3 Perform venipuncture in either extremity after three months.
4 Allow insertion of IV lines in the right extremity after six months.
2 Take BP measurements in the right arm only.
The nurse should never take BP measurements, insert IV lines, or perform venipunctures in the extremity with vascular access. These special precautions are taken to prevent infection and clotting of the vascular access site. Maturation may take six weeks to months. Arteriovenous fistula (AVF) should be placed at least three months before initiating hemodialysis.
The nurse is attending to a patient who is receiving hemodialysis for chronic kidney disease. The nurse observes for which complications? Select all that apply.
1 Hypotension 2 Renal calculi 3 Muscle cramps 4 Hepatitis B 5 Bladder infection
1 Hypotension
3 Muscle cramps
4 Hepatitis B
The patient on hemodialysis may have decreased BP due to rapid removal of blood. Hepatitis B is a bloodborne infection, and hemodialysis poses a high risk for transmission of hepatitis B. Muscle cramps are a common complication of hemodialysis. Factors associated with the development of muscle cramps in hemodialysis include hypotension, hypovolemia, a high ultrafiltration rate (large interdialytic weight gain), and low-sodium dialysis solution. Hemodialysis does not increase the risk of development of renal calculi; people who are on bed rest or have low urine output may be at risk. Bladder infection is not related to dialysis.
A patient is scheduled to undergo peritoneal dialysis (PD). Which is a high priority action that the nurse performs before starting the procedure?
1 Obtain the patient’s weight.
2 Administer pain medication to the patient.
3 Place the patient in a high-Fowler’s position.
4 Place the patient in the Trendelenburg position.
1 Obtain the patient’s weight.
The nurse must check the patient’s weight before and after PD to determine how much fluid has been removed. The patient should assume a position of comfort, such as a low Fowler’s, unless there is difficulty with removing the effluent, in which case the nurse will position the patient to facilitate drainage. Administering pain medication is not a priority in regard to PD. There is no indication that the patient is experiencing pain. Placing the patient in a high Fowler’s or Trendelenburg position is not recommended for patients during PD.
A patient with chronic kidney disease is advised to undergo peritoneal dialysis (PD). Which advantages of PD over hemodialysis does the nurse explain to the patient? Select all that apply.
1 It requires a rather short training time. 2 It is less complicated. 3 There are fewer dietary restrictions. 4 It allows for rapid fluid removal. 5 There is less cardiovascular stress.
1 It requires a rather short training time.
2 It is less complicated.
3 There are fewer dietary restrictions.
5 There is less cardiovascular stress.
PD has many advantages over hemodialysis. It is less complicated than hemodialysis. There are fewer dietary restrictions. It requires a rather short training time. There is less cardiovascular stress associated with PD. An advantage of hemodialysis is that it allows for rapid fluid removal.
Which event is a cause of prerenal acute kidney injury?
1 Release of nephrotoxins
2 Reduced renal blood flow
3 Urine reflux into renal pelvis
4 Formation of calculi
2 Reduced renal blood flow
Prerenal acute kidney injury can be caused by a reduced flow of blood to the kidneys. A release of nephrotoxins is an intrarenal cause of acute kidney injury. Urine reflux into the renal pelvis and the formation of calculi are postrenal causes of acute kidney injury.
Which is a clinical manifestation of acute kidney injury?
1 Oliguria
2 Uremia
3 Anemia
4 Pruritus
1 Oliguria
Oliguria is a sign of acute kidney injury. Uremia, anemia, and pruritus are signs of chronic kidney injury.
A patient has a glomerular filtration rate (GFR) of 70 mL/minute, a BP of 140/100 mm Hg, and fluid accumulation in the legs. To help prevent heart failure, the nurse provides the patient with which instruction?
1 Limit protein intake.
2 Restrict sodium to 2 g/day.
3 Take vitamin D supplements.
4 Avoid magnesium-containing laxatives.
2 Restrict sodium to 2 g/day.
A patient with a glomerular filtration rate of 70 mL/min has stage 2 chronic kidney disease. A BP of 140/100 mm Hg, along with fluid accumulation in the legs, indicates that the patient has hypertension and edema. Patients with increased blood urea nitrogen levels should limit protein intake to prevent neurologic complications. High sodium retention may lead to heart failure, so the patient should restrict sodium intake to 2 grams per day. Patients with low vitamin D levels or hypocalcemia should take vitamin D supplements. Patients with hypermagnesemia should avoid taking magnesium-containing laxatives.
The nurse provides education about maintenance hemodialysis (HD) for a group of nursing students and states that which is the leading cause of death for these patients?
1 Cardiovascular complications
2 Suicide
3 Infection
4 Respiratory complications
1 Cardiovascular complications
The yearly death rate of patients receiving maintenance HD is around 19% to 24%. Cardiovascular disease (stroke, myocardial infarction [MI]) causes most deaths. Adaptation to maintenance HD varies considerably. At first, many patients feel positive about the dialysis because it makes them feel better and keeps them alive, but there is often great ambivalence about whether it is worthwhile. Dependence on a machine is a reality. In response to their illness, dialysis patients may be nonadherent or depressed and show suicidal tendencies. Infectious complications are the second leading cause of death. Respiratory complications are not the leading cause of death.
The nursing student provides dietary education for a patient with acute kidney injury (AKI). The nurse intervenes when the student encourages the patient to increase the intake of which foods?
1 Foods rich in fiber
2 Foods rich in potassium
3 Foods rich in calcium
4 Foods rich in carbohydrates
2 Foods rich in potassium
Hyperkalemia is a complication associated with acute kidney injury. Foods rich in potassium will further increase the potassium level in the blood; these foods should not be included in the patient’s diet plan. Foods rich in fiber do not cause any harm to the patient’s health and can be included. There are no contraindications for patient with AKI to consume foods high in calcium or foods rich in carbohydrates.
Which statements describe the functions of the kidneys? Select all that apply.
1 Eliminate vitamin D. 2 Purge erythropoietin. 3 Control BP. 4 Excrete waste products. 5 Regulate volume of extracellular fluid.
3 Control BP.
4 Excrete waste products.
5 Regulate volume of extracellular fluid.
The primary functions of the kidneys are to regulate the volume and composition of extracellular fluid (ECF) and to excrete waste products from the body. The kidneys also function to control BP, produce (not purge) erythropoietin, activate (not eliminate) vitamin D, and regulate acid-base balance.
The nurse suspects that which electrolyte abnormality is a cause of cerebral edema in a patient with chronic kidney disease?
1 Hyperkalemia
2 Hyponatremia
3 Hypermagnesemia
4 Hypophosphatemia
2 Hyponatremia
Damaged tubules cannot conserve sodium. Urinary sodium excretion may increase, resulting in normal or below-normal levels of serum sodium. Uncontrolled hyponatremia or water excess can lead to cerebral edema. Hyperkalemia can cause cardiac dysrhythmias. Hypermagnesemia may lead to absence of reflexes, decreased mental status, and hypotension. Hypophosphatemia can lead to bone weakness, fractures, and muscle damage.
