Deck 71: Care of Patients With Acute Kidney Injury and Chronic Kidney Disease

Question 1

A client has been diagnosed with acute postrenal kidney injury.Which assessment finding does the nurse assess most carefully for?

A) Blood urea nitrogen (BUN), 35 mg/dL
B) Creatinine, 2.5 mg/dL
C) Feeling of urgency
D) Weight gain and edema

Answer 1

Feeling of urgency

Question 2

A client with acute kidney injury is placed on a fluid restriction.To determine whether outcomes related to fluid balance are being met,the nurse assesses for which finding?

A) Absence of lung crackles
B) Decreased serum creatinine level
C) Decreased serum potassium level
D) Increased muscle strength

Answer 2

Absence of lung crackles

Question 3

Which staff member does the charge nurse assign to care for a client newly diagnosed with chronic kidney disease?

A) Licensed practical nurse who usually works on the unit
B) Registered nurse floated from the hemodialysis unit
C) Registered nurse who has taken care of this client before
D) Registered nurse with the most years of experience

Answer 3

Registered nurse who has taken care of this client before

Question 4

During a hot summer day,an older adult client tells the clinic nurse,"I am not drinking or voiding that much these days." The nurse notes a heart rate of 100 beats/min and a blood pressure of 90/60 mm Hg.Which action does the nurse take first?

A) Give the client something to drink.
B) Insert an intravenous catheter.
C) Teach the client to drink 2 to 3 liters a day.
D) Perform a bladder scan to assess urine volume.

Question 5

Assessment findings reveal that a client with chronic kidney disease is refusing to take prescribed medications because of the "cost." The client also is having difficulty performing activities of daily living and prefers to sleep most of the day.To which health care team member does the nurse refer the client?

A) Home health aide
B) Physical therapist
C) Psychiatric nurse practitioner
D) Physician

Question 6

A client is admitted to the hospital with a serum creatinine level of 2 mg/dL.When taking the client's history,which question does the nurse ask first?

A) "Do you take any nonprescription medications?"
B) "Does anyone in your family have kidney disease?"
C) "Do you have yearly blood work done?"
D) "Is your diet low in protein?"

Question 7

A client with chronic hypertension is seen in the clinic.Which assessment indicates that the client's hypertension is not under control?

A) Heart rate of 55 beats/min
B) Serum creatinine level of 1.9 mg/dL
C) Blood glucose level of 128 mg/dL
D) Irregular heart sounds

Question 8

A client with acute kidney failure and on dialysis asks how much fluid will be permitted each day.Which is the nurse's best response?

A) "This is based on the amount of damage to your kidneys."
B) "You can drink an amount equal to your urine output, plus 700 mL."
C) "It is based on your body weight and changes daily."
D) "You can drink approximately 2 liters of fluid each day."

Question 9

A client is scheduled to have dialysis in 30 minutes and is due for the following medications: vitamin C,B-complex vitamin,and cimetidine (Tagamet).Which action by the nurse is best?

A) Give medications with a small sip of water.
B) Hold all medications until after dialysis.
C) Give the supplements, but hold the Tagamet.
D) Give the Tagamet, but hold the supplements.

Question 10

A client has a serum creatinine level of 2.5 mg/dL,a serum potassium level of 6 mmol/L,an arterial pH of 7.32,and a urine output of 250 mL/day.Which phase of acute kidney failure is the client experiencing?

A) Intrarenal
B) Nonoliguric
C) Oliguric
D) Postrenal

Question 11

A client with chronic kidney disease is scheduled to be given the following medications: digoxin (Lanoxin)and epoetin alfa (Epogen).The client reports nausea and vomiting and wishes to wait to take the medications.Which action by the nurse is most appropriate?

A) Administer both medications with soda crackers.
B) Allow the client to wait an hour before taking the medications.
C) Review today's potassium level and notify the health care provider.
D) Call the health care provider to get an order for anti-nausea medication.

Question 12

Which statement by a client who has undergone kidney transplantation indicates a need for more teaching?

A) "I will need to continue to take insulin for my diabetes."
B) "I will have to take my cyclosporine for the rest of my life."
C) "I will take the antibiotics three times daily until the medication is finished."
D) "My new kidney is working fine. I do not need to take medications any longer."

Question 13

Which client is most at risk for developing postrenal kidney failure?

A) Client diagnosed with renal calculi
B) Client with congestive heart failure
C) Client taking NSAIDs for arthritis pain
D) Client recovering from glomerulonephritis

Question 14

A client has been missing some scheduled hemodialysis sessions.Which intervention is most important for the nurse to implement?

A) Discussing with the client his or her acceptance of the disease
B) Discussing with the client the option of peritoneal dialysis
C) Rescheduling the sessions to another day or another time
D) Stressing to the client the importance of going to the sessions

Question 15

A client is taking furosemide (Lasix).To detect a common adverse effect,the nurse obtains which assessment as a priority?

A) Breath sounds
B) Heart sounds
C) Intake and output
D) Nutritional patterns

Question 16

A client who has chronic kidney disease is being discharged from the hospital after receiving treatment for a hip fracture.Which information is most important for the nurse to provide to the client before discharge?

A) "Increase your intake of foods with protein."
B) "Monitor your daily intake and output."
C) "Maintain bedrest until the fracture is healed."
D) "Take your aluminum hydroxide (Nephrox) with meals."

Question 17

A client with a decreased glomerular filtration rate asks how to prevent further damage to the kidneys.Which is the nurse's best response?

A) "The diuretics you are taking will prevent further damage."
B) "Kidney damage is inevitable as you age."
C) "Avoid taking NSAIDs."
D) "You will need to follow a high-protein diet."

Question 18

When evaluating the effects of a low-protein diet in a client with chronic kidney disease,the nurse is most concerned with which result?

A) Albumin level of 2 g/dL
B) Calcium level of 8.0 mg/dL
C) Potassium level of 5.2 mmol/L
D) Magnesium level of 3 mEq/L

Question 19

A client has a serum creatinine level of 2 mg/dL and a urine output of 1000 mL/day.How does the nurse categorize the client's kidney injury?

A) Intrarenal
B) Nonoliguric
C) Prerenal
D) Postrenal

Question 20

Which intervention is most important for the nurse to implement in a client after kidney transplant surgery?

A) Promote acceptance of new body image.
B) Monitor magnesium levels daily.
C) Place the client on protective isolation.
D) Remove the indwelling (Foley) catheter as soon as possible.

Question 21

The nurse is caring for a client who is receiving peritoneal dialysis (PD).Which nursing intervention has the greatest priority when a dialysis exchange is performed?

A) Adding potassium and antibiotic to the dialysate bags
B) Positioning the client on either side
C) Using sterile technique when hooking up dialysate bags
D) Warming the dialysate fluid in a microwave oven

Question 22

A client is receiving continuous arteriovenous hemofiltration (CAVH).Which laboratory value does the nurse monitor most closely?

A) Hemoglobin
B) Glomerular filtration rate
C) Sodium
D) White blood cells

Question 23

During hemodialysis,a client with chronic kidney disease develops headache,nausea,vomiting,and restlessness.After notifying the health care provider,which action by the nurse is most appropriate?

A) Administer a bolus of dextrose solution.
B) Draw blood for sodium and potassium.
C) Order a blood urea nitrogen level stat.
D) Prepare to administer phenytoin (Dilantin),

Question 24

Which response by a client indicates an understanding of measures to facilitate the flow of peritoneal dialysate fluid?

A) "I will take my stool softeners every day."
B) "I will keep the drainage bag at the level of my abdomen."
C) "Flushing the catheter is needed with each exchange."
D) "Warmed dialysate infusion increases the speed of flow."

Question 25

A client who is admitted to the hospital with a history of kidney disease begins to have difficulty breathing.Vital signs are as follows: blood pressure,90/70 mm Hg; heart rate,difficult to feel peripheral pulses.His heart sounds are difficult to hear.Which intervention does the nurse prepare for?

A) Administration of digoxin (Lanoxin)
B) Draining of pericardial fluid with a needle
C) Emergency hemodialysis
D) Placement of a pacemaker

Question 26

Which assessment parameter does the nurse monitor in a client with chronic kidney disease to determine fluid and sodium retention status?

A) Capillary refill
B) Intake and output
C) Muscle strength
D) Weight and blood pressure

Question 27

The nurse is providing dietary teaching to a client who was just started on peritoneal dialysis (PD).Which instruction does the nurse provide to this client regarding protein intake?

A) "Your protein needs will not change, but you may take more fluids."
B) "You will need more protein now because some protein is lost by dialysis."
C) "Your protein intake will be adjusted according to your predialysis weight."
D) "You no longer need to be on protein restriction."

Question 28

The nurse is caring for a client with chronic kidney disease who has developed uremia.Which assessment finding does the nurse correlate with this problem?

A) Decreased breath sounds
B) Foul-smelling urine
C) Heart rate of 50 beats/min
D) Respiratory rate of 40 breaths/min

Question 29

A client was just admitted to the emergency department for new-onset confusion.As the nurse starts the IV line,the client says he just finished a hemodialysis session.The IV site is bleeding briskly.What action by the nurse takes priority?

A) Assess for a bruit and thrill over the vascular access site.
B) Draw blood for coagulation studies and white blood cell count.
C) Prepare to administer protamine sulfate.
D) Hold constant firm pressure with a gauze pad for 5 minutes.

Question 30

A client who is 2 days post-femoral vein cannulation begins to have difficulty with outflow of blood during dialysis.For which complication does the nurse assess?

A) Hematoma at cannula insertion site
B) Infection
C) Oliguria
D) Skin necrosis at cannula insertion site

Question 31

A client has end-stage kidney disease (ESKD).Which food selection by the client demonstrates understanding of a low-sodium,low-potassium diet?

A) Bananas
B) Ham
C) Herbs and spices
D) Salt substitutes

Question 32

When providing care for a client receiving peritoneal dialysis,the nurse notices that the effluent is cloudy.Which intervention is most important for the nurse to carry out?

A) Irrigate the peritoneal catheter with saline.
B) Send a specimen for culture and sensitivity.
C) Document the finding in the client's chart.
D) Change the dialysate solution and catheter tubing.

Question 33

A client hospitalized for worsening kidney injury suddenly becomes restless and agitated.Assessment reveals tachycardia and crackles bilaterally at the bases of the lungs.Which is the nurse's first intervention?

A) Begin ultrafiltration.
B) Administer an antianxiety agent.
C) Place the client on mechanical ventilation.
D) Place the client in high Fowler's position.

Question 34

The RN has assigned a client with a newly placed arteriovenous (AV)fistula in the right arm to an LPN.Which information about the care of this client is most important for the RN to provide to the LPN?

A) "Avoid movement of the right extremity."
B) "Place gentle pressure over the fistula site after blood draws."
C) "Start any IV lines below the site of the fistula."
D) "Take blood pressure in the left arm."

Question 35

A client with chronic kidney disease states that he will be going to the dentist for a planned tooth extraction.Which is the nurse's best response?

A) "Rinse your mouth with an antiseptic solution after the procedure."
B) "Kidney disease is probably what caused your dental decay."
C) "You should receive prophylactic antibiotics before any dental procedure."
D) "You may take any medication for pain that the dentist prescribes."

Question 36

A client is admitted with a 3-day history of vomiting and diarrhea.The client's vital signs are blood pressure,85/60 mm Hg; and heart rate,105 beats/min.Which intervention by the nurse takes priority?

A) Obtain blood and urine cultures.
B) Start an IV of normal saline as ordered.
C) Administer antiemetic medications.
D) Assess the client's recent travel history.

Question 37

The nurse is providing a client with a peritoneal dialysis exchange.The nurse notes the presence of cloudy peritoneal effluent.Which action by the nurse is most appropriate?

A) Document the finding in the client's chart.
B) Collect a sample to send to the laboratory.
C) Reposition the client on the left side.
D) Increase the free water content in the next bag.

Question 38

A client has end-stage kidney disease (ESKD).The nurse observes tall,peaked T waves on the client's cardiac monitor.Which action by the nurse is best?

A) Check the serum potassium level.
B) Document the finding in the client's chart.
C) Prepare to give sodium bicarbonate.
D) Call the health care provider to request an electrocardiogram (ECG).

Question 39

A client's temperature after dialysis is 99° F (37.2° C)and was normal before dialysis.Which is the nurse's best action?

A) Continue to monitor the temperature.
B) Encourage the client to drink fluids.
C) Obtain a white blood cell count.
D) Prepare to culture the fistula site.

Question 40

A client with acute kidney injury had normal assessments 1 hour ago.Now the nurse finds that the client's respiration rate is 44 breaths/min and the client is restless.Which assessment does the nurse perform?

A) Obtain an oxygen saturation level.
B) Send blood for a creatinine level.
C) Assess the client for dehydration.
D) Perform a bedside blood glucose.

Question 41

A client is 12 hours post-kidney transplantation.The nurse notes that the client has put out 2000 mL of urine in 10 hours.Which assessment does the nurse carry out first?

A) Skin turgor
B) Blood pressure
C) Serum blood urea nitrogen (BUN) level
D) Weight of the client

Question 42

The nurse is assessing a client with acute kidney injury and hears the following sound when auscultating the lungs.For what complication does the nurse plan care? (Click the media button to hear the audio clip.)

A) ac tamponade
B) Pericarditis
C) Pulmonary edema
D) Myocardial Infarction

Question 43

A client who underwent kidney transplantation 7 days ago has developed the following signs: urine output,50 mL/12 hr; temperature,102.2° F (39° C); lethargy; serum creatinine,2.1 mg/dL; blood urea nitrogen (BUN),54 mg/dL; and potassium,5.6 mEq/L.Which initial intervention does the nurse anticipate for this client?

A) Immediate hemodialysis
B) Increased dose of immune suppressive drugs
C) Initiation of IV antibiotics after cultures are obtained
D) Placement of a catheter for peritoneal dialysis

Question 44

A client asks the nurse,"What are the advantages of peritoneal dialysis over hemodialysis?" Which response by the nurse is accurate?

A) "It will give you greater freedom in your scheduling."
B) "You have less chance of getting an infection."
C) "You need to do it only three times a week."
D) "You do not need a machine to do it."
E) "You will have fewer dietary restrictions."