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Ch. 47 Lewis; Acute Kidney Injury and Chronic Kidney Disease

Terms in this set (39)

After the insertion of an arteriovenous graft (AVG) in the right forearm, a 54-year-old patient complains of pain and coldness of the right fingers. Which action should the nurse take?
a.
Teach the patient about normal AVG function.
b.
Remind the patient to take a daily low-dose aspirin tablet.
c.
Report the patient's symptoms to the health care provider.
d.
Elevate the patient's arm on pillows to above the heart level.
c. report the patient's symptoms to the healthcare provider

The patient's complaints suggest the development of distal ischemia (steal syndrome) and may require revision of the AVG. Elevation of 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.
When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of
a.
persistent skin tenting
b.
rapid, deep respirations.
c.
bounding peripheral pulses.
d.
hot, flushed face and neck.
b. rapid, deep respirations

Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the lungs try to regulate 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 elevated blood urea nitrogen (BUN) and creatinine levels. The primary collaborative treatment goal in the plan will be
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 would 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
A 48-year-old patient with stage 2 chronic kidney disease (CKD) is scheduled for an intravenous pyelogram (IVP). Which order for the patient will the nurse question?
a.
NPO for 6 hours before procedure
b.
Ibuprofen (Advil) 400 mg PO PRN for pain
c.
Dulcolax suppository 4 hours before procedure
d.
Normal saline 500 mL IV infused before procedure
b. ibuprofen 400 mg PO PRN for pain

The contrast dye used in IVPs is potentially nephrotoxic, and concurrent use of other nephrotoxic medications such as the nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided. The suppository and NPO status are necessary to ensure adequate visualization during the IVP. IV fluids are used to ensure adequate hydration, which helps reduce the risk for contrast-induced renal failure.
Which statement by a 62-year-old 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 urinary output each day to help calculate the amount I can drink."
d.
"I need to take erythropoietin to boost my immune system and help prevent infection."
c. i will measure my urinary output each day to help calculate the amount I can drink

The patient with end-stage kidney 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 in order 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. Before administering the medication, the nurse should assess the
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.
9. 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.
Oatmeal with cream, half a banana, and herbal tea
c.
Poached eggs, whole-wheat toast, and apple juice
d.
Cheese sandwich, tomato soup, and cranberry juice
c. 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 would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.
Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney disease (CKD), the nurse should check laboratory results for
a.
potassium level.
b.
total cholesterol.
c.
serum phosphate.
d.
serum creatinine.
c. serum phosphate

If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The 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 37-year-old female 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 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 accommodate larger needles.
d.
A fistula can be used sooner after surgery.
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.
When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the 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 64-year-old male 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.
Unlimited fluids are allowed because retained fluid is removed during dialysis.
c.
More protein is allowed because urea and creatinine are removed by dialysis.
d.
Dietary potassium is not restricted because the level is normalized by dialysis.
c. more protein is allowed because urea and creatinine are removed by dialysis

Once the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.
Which action by a 70-year-old 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 taking a bath each day.
d.
The patient slows the inflow rate when experiencing abdominal pain.
c. the patient cleans the catheter while taking a bath 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.
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