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Practice Questions AKI, CKD patho

Terms in this set (38)

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.
Drink 1500 to 2000 mL of fluids daily.
c.
Take phosphate-binders with each meal.
d.
Choose high-protein foods for most meals.
e.
Have several servings of dairy products daily.
A, C, D
Patients who are receiving peritoneal dialysis should have a high-protein diet. Phosphate binders are taken with meals to help control serum phosphate and calcium levels. Commercial salt substitutes are high in potassium and should be avoided. Fluid intake is limited in patients requiring dialysis. Dairy products are high in phosphate and usually are limited.
After receiving change-of-shift report, which patient should 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 and has a heart rate of 124/min
D
The patient who is tachycardic after hemodialysis may be bleeding or excessively hypovolemic and should be assessed immediately for these complications. The other patients also need assessments or interventions but are not at risk for life-threatening complications.
A 74-year-old who is progressing to stage 5 chronic kidney disease asks the nurse, "Do you think I should go on dialysis? Which initial response by the nurse is best?
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."
B
The nurse should initially clarify the patient's concerns and questions about dialysis. The patient is the one responsible for the decision and many people using dialysis do have good quality of life, but these responses block further assessment of the patient's concerns. Referring to which type of dialysis the patient might use only indirectly responds to the patient's question.
A patient complains of leg cramps during hemodialysis. The nurse should first
a.
massage the patient's legs.
b.
reposition the patient supine.
c.
give acetaminophen (Tylenol).
d.
infuse a bolus of normal saline.
D
Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.
The nurse is titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation. Which parameter will be most important for the nurse to consider?
a.
Heart rate
b.
Urine output
c.
Creatinine clearance
d.
Blood urea nitrogen (BUN) level
B
Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a liter an hour. The other data will be monitored but are not the most important determinants of fluid infusion rate.
During routine hemodialysis, the 68-year-old patient complains of nausea and dizziness. Which action should the nurse take first?
a.
Slow down the rate of dialysis.
b.
Check patient's blood pressure (BP).
c.
Review the hematocrit (Hct) level.
d.
Give prescribed PRN antiemetic drugs.
B
The patient's complaints of nausea and dizziness suggest hypotension, so the initial action should be to check the BP. The other actions may also be appropriate based on the blood pressure obtained.
The nurse is assessing a patient 4 hours after a kidney transplant. Which information is most important to communicate to the health care provider?
a.
The urine output is 900 to 1100 mL/hr.
b.
The patient's central venous pressure (CVP) is decreased.
c.
The patient has a level 7 (0 to 10 point scale) incisional pain.
d.
The blood urea nitrogen (BUN) and creatinine levels are elevated.
B
The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant.
A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2 L inflows. Which information should the nurse report immediately 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 has abdominal pain during the inflow phase.
d.
The patient's abdomen appears bloated after the inflow.
B
Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.
A licensed practical/vocational nurse (LPN/LVN) is caring for a patient with stage 2 chronic kidney disease. Which observation by the RN requires an intervention?
a.
The LPN/LVN administers the erythropoietin subcutaneously.
b.
The LPN/LVN assists the patient to ambulate out in the hallway.
c.
The LPN/LVN administers the iron supplement and phosphate binder with lunch.
d.
The LPN/LVN carries a tray containing low-protein foods into the patient's room.
C
Oral phosphate binders should not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder should be given with a meal and the iron given at a different time. The other actions by the LPN/LVN are appropriate for a patient with renal insufficiency.
A patient has arrived for a scheduled hemodialysis session. Which nursing action is most 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.
B
Dialysis technicians are educated in monitoring for blood pressure. Assessment, adjustment of the appropriate ultrafiltration rate, and patient teaching require the education and scope of practice of an RN.
A 42-year-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed actions should the nurse take first?
a.
Insert a urinary retention catheter.
b.
Place the patient on a cardiac monitor.
c.
Administer epoetin alfa (Epogen, Procrit).
d.
Give sodium polystyrene sulfonate (Kayexalate).
B
Because hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. Kayexalate and Epogen will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output but does not correct the cause of the renal failure.
A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first?
a.
Notify the patient's health care provider.
b.
Document the QRS interval measurement.
c.
Check the medical record for most recent potassium level.
d.
Check the chart for the patient's current creatinine level.
C
The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval is also appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening dysrhythmias.
A 62-year-old female patient has been hospitalized for 8 days with acute kidney injury (AKI) caused by dehydration. Which information will be most important for the nurse to report to the health care provider?
a.
The creatinine level is 3.0 mg/dL.
b.
Urine output over an 8-hour period is 2500 mL.
c.
The blood urea nitrogen (BUN) level is 67 mg/dL.
d.
The glomerular filtration rate is <30 mL/min/1.73m2.
B
The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The other information is typical of AKI and will not require a change in therapy.
A 72-year-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/hour.
A
The patient's elevation in BUN is most likely associated with hydronephrosis caused by the acute urinary retention, so the insertion of a retention catheter is the first action to prevent ongoing postrenal failure for this patient. The other actions also are appropriate, but should be implemented after the retention catheter.
A 25-year-old male 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 2.1 mg/dL
b.
Serum potassium level 6.5 mEq/L
c.
White blood cell count 11,500/µL
d.
Blood urea nitrogen (BUN) 56 mg/dL
B
The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately. The nurse also will report the other laboratory values, but abnormalities in these are not immediately life threatening.
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