Question 1

What is the most common site for short-term vascular access for immediate hemodialysis?

Accepted Answer

Subclavian and femoral veins are catheterized when short-term access is required or when a graft or fistula vascular access is nonfunctional in a patient requiring immediate hemodialysis.Subclavian and femoral catheters are routinely inserted at the bedside.Most temporary catheters are venous lines only.Blood flows out toward the dialyzer and flows back to the patient through the same catheterized vein.A dual-lumen venous catheter is most commonly used.

Question 2

A patient who receives peritoneal dialysis is admitted after a 3-day history of flulike symptoms.The patient reports muscle cramps and is noted to have a low blood pressure and tachycardia.The nurse suspects the patient may be experiencing what condition?

Accepted Answer

This patient has dehydration.This patient is showing signs and symptoms of muscle cramps and low blood pressure.

Question 3

To remove fluid during hemodialysis,a positive hydrostatic pressure is applied to the blood and a negative hydrostatic pressure is applied to the dialysate bath.What is this process called?

Accepted Answer

To remove fluid,a positive hydrostatic pressure is applied to the blood,and a negative hydrostatic pressure is applied to the dialysate bath.The two forces together,called transmembrane pressure,pull and squeeze the excess fluid from the blood.The difference between the two values (expressed in millimeters of mercury [mm Hg])represents the transmembrane pressure and results in fluid extraction,known as ultrafiltration,from the vascular space.

Question 4

A patient is admitted with sepsis and acute kidney injury (AKI).The patient is started on continuous renal replacement therapy (CRRT).The nurse knows that fluid that is removed each hour is charted as what on the CRRT flowsheet?

Accepted Answer

The fluid that is removed each hour is not called urine; it is known as ultrafiltrate.Typically,some of the ultrafiltrate is replaced through the continuous renal replacement therapy circuit by a sterile replacement fluid.Diffusion is the movement of solutes along a concentration gradient from a high concentration to a low concentration across a semipermeable membrane.Convection occurs when a pressure gradient is set up so that the water is pushed or pumped across the dialysis filter and carries the solutes from the bloodstream with it.

Question 5

A patient has developed acute kidney injury (AKI)secondary to cardiogenic shock.Which laboratory value would the nurse find helpful in evaluating patient's renal status?

Accepted Answer

Serum creatinine is the most reliable predictor of kidney function.In the acutely ill patient,small changes in the serum creatinine level and urine output may signal important declines in the glomerular filtration rate and kidney function.

Question 6

The practitioner has ordered dialysis for a patient with acute heart failure who is unresponsive to diuretics.Which type of dialysis would the nurse anticipate being started on this patient?

Accepted Answer

Intermittent ultrafiltration using a peripheral venous catheter is more likely to be used to remove excess volume from patients with acute decompensated heart failure when the kidneys are unresponsive to diuretics.

Question 7

One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin.Which statement regarding how this treatment works is accurate?

Accepted Answer

Acute hyperkalemia can be treated temporarily by intravenous administration of insulin and glucose.An infusion of 50 mL of 50% dextrose accompanied by 10 units of regular insulin forces potassium out of the serum and into the cells.

Question 8

A patient with acute kidney injury (AKI)has been started on continuous venovenous hemodialysis (CVVHD).The nurse understands that this type of continuous renal replacement therapy (CRRT)is indicated for the patient who needs what type of treatment?

Accepted Answer

Continuous venovenous hemodialysis (CVVHD)is indicated for patients who require large-volume removal of fluid and solutes.

Question 9

A patient was admitted with an infection that had to be treated with gentamicin,an aminoglycoside antibiotic.After 3 days of administration,the patient developed oliguria,and an elevated blood urea nitrogen and creatinine levels.The nurse suspects the patient has developed what type of kidney injury?

Accepted Answer

Any condition that produces an ischemic or toxic insult directly at parenchymal nephron tissue places the patient at risk for development of intrarenal.Ischemic damage may be caused by prolonged hypotension or low cardiac output.Toxic injury reaction may occur in response to substances that damage the kidney tubular endothelium,such as some antimicrobial medications and the contrast dye used in radiologic diagnostic studies.

Question 10

A patient with acute kidney injury (AKI)has been started on continuous venovenous hemodialysis (CVVHD).The nurse knows the hemodialyzer filter used in this type of therapy is permeable to what substance?

Accepted Answer

A continuous venovenous hemodialysis filter is permeable to solutes such as urea,creatinine,uric acid,sodium,potassium,ionized calcium,and drugs not bound by proteins.

Question 11

What is the recommended nutritional intake of protein to control azotemia in the patient with acute kidney injury?

Accepted Answer

The recommended energy intake is between 20 and 30 kcal/kg/day,with 1.2 to 1.5 g/kg of protein per day to control azotemia (increased blood urea nitrogen level).

Question 12

A patient was admitted with an infection that had to be treated with an aminoglycoside antibiotic.After a few days the patient developed oliguria and elevated blood urea nitrogen and creatinine levels.The patient's vital signs are stable.The nurse would anticipate the practitioner ordering which dialysis method for this patient?

Accepted Answer

As a treatment,hemodialysis separates and removes from the blood excess electrolytes,fluids,and toxins by means of a hemodialyzer.Hemodialysis would be the first choice for managing this patient with medication toxicity.

Question 13

A patient has developed acute kidney injury (AKI)secondary to hemorrhage shock.Which intravenous solution would the nurse expect to be ordered for this patient?

Accepted Answer

Prerenal acute kidney injury (AKI)is caused by decreased perfusion and flow to the kidney.It is often associated with trauma,hemorrhage,hypotension,and major fluid losses.If contrast dye is used,aggressive fluid resuscitation with normal saline is recommended.

Question 14

To assess whether or not an arteriovenous fistula is functioning,what must the nurse do and why?

Accepted Answer

The nurse frequently assesses the quality of blood flow through the fistula.A patent fistula has a thrill when palpated gently with the fingers and a bruit when auscultated with a stethoscope.The extremity should be pink and warm to the touch.No blood pressure measurements,intravenous infusions,or laboratory phlebotomy is performed on the arm with the fistula.

Question 15

A patient with chronic kidney disease was admitted with severe electrolyte disturbances.The patient had been ill and missed several hemodialysis sessions.The patient is disoriented,dizzy,cold,clammy,and complains of severe abdominal cramping.The patient's electrocardiogram appears normal.Which electrolyte disturbance would the nurse suspect the patient may be experiencing?

Accepted Answer

Hyperkalemia,hypocalcemia,hyponatremia,hyperphosphatemia,and acid-base imbalances occur in kidney disease.Signs of hyponatremia include disorientation,muscle twitching,nausea,vomiting,abdominal cramps,headaches,dizziness,cold,clammy skin,tachycardia,and seizures.

Question 16

A patient with acute kidney injury (AKI)has been started on continuous venovenous hemodialysis (CVVHD).The nurse understands the patient should be closely monitored for what patient-related complications of the therapy?

Accepted Answer

Patient-related complications of continuous renal replacement therapy (CRRT)include dehydration,hypotension,electrolyte imbalances,acid-base imbalances,blood loss,hemorrhage,hypotension,and infection.

Question 17

An elderly patient is in a motor vehicle accident and sustains a significant internal hemorrhage.The nurse knows the patient is at risk for developing what type of acute kidney injury (AKI)?

Accepted Answer

Any condition that decreases blood flow,blood pressure,or kidney perfusion before arterial blood reaches the renal artery that supplies the kidney may be anatomically described as prerenal acute kidney injury (AKI).When arterial hypoperfusion caused by low cardiac output,hemorrhage,vasodilation,thrombosis,or other cause reduces the blood flow to the kidney,glomerular filtration decreases,and consequently urine output decreases.Any condition that produces an ischemic or toxic insult directly at parenchymal nephron tissue places the patient at risk for development of intrarenal AKI.Any obstruction that hinders the flow of urine from beyond the kidney through the remainder of the urinary tract may lead to postrenal AKI.

Question 18

A patient was admitted with liver failure and acute kidney injury (AKI).Which intravenous solution should the nurse question if it were ordered for this patient?

Accepted Answer

Lactated Ringer solution is contraindicated for patients with kidney or liver diseases or in lactic acidosis.

Question 19

The practitioner has ordered continuous renal replacement therapy (CRRT)for a patient with acute kidney injury.The patient needs both the removal of fluids and a moderate amount of solutes.Which type of CRRT would the nurse anticipate being started on this patient?

Accepted Answer

Continuous venovenous hemofiltration (CVVH)is indicated when the patient's clinical condition warrants removal of significant volumes of fluid and solutes.Fluid is removed by ultrafiltration in volumes of 5 to 20 mL/min or up to 7 to 30 L/24 h.Removal of solutes such as urea,creatinine,and other small non-protein-bound toxins is accomplished by convection.

Question 20

A patient with acute kidney injury (AKI)has been started on continuous venovenous hemodiafiltration (CVVHDF).The nurse understands the patient should be closely monitored for what circuit-related complications of the therapy?

Accepted Answer

Circuit-related complications of continuous renal replacement therapy include air embolism,clotted hemofilter,poor ultrafiltration,blood leaks,broken filter,disconnection,access failure,and catheter dislodgement

Quiz 26: Kidney Disorders and Therapeutic Management

What is the most common site for short-term vascular access for immediate hemodialysis?

A patient who receives peritoneal dialysis is admitted after a 3-day history of flulike symptoms.The patient reports muscle cramps and is noted to have a low blood pressure and tachycardia.The nurse suspects the patient may be experiencing what condition?

To remove fluid during hemodialysis,a positive hydrostatic pressure is applied to the blood and a negative hydrostatic pressure is applied to the dialysate bath.What is this process called?

A patient is admitted with sepsis and acute kidney injury (AKI) .The patient is started on continuous renal replacement therapy (CRRT) .The nurse knows that fluid that is removed each hour is charted as what on the CRRT flowsheet?

A patient has developed acute kidney injury (AKI) secondary to cardiogenic shock.Which laboratory value would the nurse find helpful in evaluating patient's renal status?

The practitioner has ordered dialysis for a patient with acute heart failure who is unresponsive to diuretics.Which type of dialysis would the nurse anticipate being started on this patient?

One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin.Which statement regarding how this treatment works is accurate?

A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD) .The nurse understands that this type of continuous renal replacement therapy (CRRT) is indicated for the patient who needs what type of treatment?

A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD) .The nurse knows the hemodialyzer filter used in this type of therapy is permeable to what substance?

What is the recommended nutritional intake of protein to control azotemia in the patient with acute kidney injury?

A patient has developed acute kidney injury (AKI) secondary to hemorrhage shock.Which intravenous solution would the nurse expect to be ordered for this patient?

To assess whether or not an arteriovenous fistula is functioning,what must the nurse do and why?

A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD) .The nurse understands the patient should be closely monitored for what patient-related complications of the therapy?

An elderly patient is in a motor vehicle accident and sustains a significant internal hemorrhage.The nurse knows the patient is at risk for developing what type of acute kidney injury (AKI) ?

A patient was admitted with liver failure and acute kidney injury (AKI) .Which intravenous solution should the nurse question if it were ordered for this patient?

The practitioner has ordered continuous renal replacement therapy (CRRT) for a patient with acute kidney injury.The patient needs both the removal of fluids and a moderate amount of solutes.Which type of CRRT would the nurse anticipate being started on this patient?

A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodiafiltration (CVVHDF) .The nurse understands the patient should be closely monitored for what circuit-related complications of the therapy?