Deck 49: Nursing Management: Acute Kidney Injury and Chronic Kidney Disease

Question 1

After noting increasing QRS intervals in a patient with ARF,which action should the nurse take first?

A) Notify the patient's physician.
B) Check the chart for the most recent blood potassium level.
C) Look at the patient's current BUN and creatinine levels.
D) Document the QRS interval.

Answer 1

Check the chart for the most recent blood potassium level.

Question 2

Chronic uremia affects multiple body systems.Which of the following is a clinical manifestation of the integumentary system that is often seen in patients with chronic uremia?

A) Petechiae
B) Dermatitis
C) Ecchymosis
D) Spider nevi

Answer 2

Ecchymosis

Question 3

A patient with CKD has a nursing diagnosis of disturbed sensory perception related to central nervous system changes induced by uremic toxins.What is an appropriate nursing intervention for this problem?

A) Convey a caring attitude and foster the nurse-patient relationship.
B) Avoid fruits and vegetables as sources of high potassium in the diet.
C) Ensure restricted protein intake to prevent nitrogenous product accumulation.
D) Provide an opportunity for the patient to discuss concerns about his condition.

Answer 3

Ensure restricted protein intake to prevent nitrogenous product accumulation.

Question 4

A patient is hospitalized with a severe myocardial infarction (MI)accompanied by cardiogenic shock.A week following his MI,his urinary output falls to 380 mL/day,and his blood urea nitrogen (BUN)and serum creatinine levels indicate that he is in the maintenance phase of acute renal failure (ARF).Which clinical finding would the nurse expect during this phase?

A) Hypotension
B) Hypernatremia
C) Low urine specific gravity
D) Epithelial cell casts in the urine

Question 5

When administering treatment for a patient who has hyperkalemia,the nurse will anticipate administration of which of the following to cause the potassium to move into the cells?

A) Calcium gluconate
B) Sodium bicarbonate
C) Furosemide
D) Insulin

Question 6

Before administration of calcitriol (Rocaltrol)to a patient with CKD,the nurse should check the laboratory value for which of the following?

A) Serum phosphate
B) Total cholesterol
C) Creatinine
D) Potassium

Question 7

A patient is diagnosed with stage 3 chronic kidney disease (CKD).The patient is treated with conservative management,including erythropoietin injections.After teaching the patient about management of CKD,the nurse determines that teaching has been effective when the patient states which of the following?

A) "I will measure my urinary output each day to help calculate the amount I can drink."
B) "I need to take the erythropoietin to boost my immune system and help prevent infection."
C) "I need to try to get more protein from dairy products."
D) "I will try to increase my intake of fruits and vegetables."

Question 8

A patient in the oliguric phase of ARF has a 24-hour fluid output of 150 mL emesis and 250 mL urine.The nurse plans for which amount of fluid replacements for the following day?

A) 400 mL
B) 800 mL
C) 1000 mL
D) 1400 mL

Question 9

A patient with congestive heart failure and pulmonary edema develops early symptoms of ARF.The nurse plans care for the patient based on the knowledge that collaborative care of the renal failure will be directed toward which of the following goals?

A) Promoting diuresis
B) Replacing fluid volume
C) Maintaining cardiac output
D) Diluting nephrotoxic substances

Question 10

In preparation for hemodialysis,a patient has an arteriovenous native fistula created in the left forearm.To assess and maintain the patency of the fistula postoperatively,what should the nurse do?

A) Auscultate the fistula site for a bruit.
B) Assess the rate and quality of the radial pulse.
C) Assess the blood pressure in the affected arm.
D) Irrigate the fistula site daily with low-dose heparin.

Question 11

The nurse would expect that the most pronounced elevations in serum potassium and BUN would occur in patients who have ARF resulting from which of the following conditions?

A) Cardiogenic shock
B) Nephrotoxic drugs
C) Severe crushing injuries
D) Renal vascular obstruction

Question 12

A patient in ARF has a gradual increase in urinary output to 3400 mL a day with a BUN of 33 mmol/L (92 mg/dL)and a serum creatinine of 371 micromol/L (4.2 mg/dL).The nurse should plan to do which of the following?

A) Use a urine dipstick to monitor for proteinuria.
B) Auscultate the lungs to assess for pulmonary edema.
C) Take the blood pressure to check for hypotension.
D) Draw blood to monitor for hyperkalemia.

Question 13

A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous fistula and a graft.What should the nurse explain is one advantage of the fistula over the graft?

A) It increases patient mobility.
B) It is much less likely to clot.
C) It can accommodate larger needles.
D) It can be used sooner after the surgery.

Question 14

A patient is being initiated on peritoneal dialysis.What should the nurse teach the patient in relation to fluid allowance?

A) Limit intake to 1000 mL per day.
B) Adjust intake to equal output plus 300 mL per day.
C) Adjust intake to equal output plus 600 mL per day.
D) Often there is no fluid restriction.

Question 15

To prevent the most common cause of death of patients in acute kidney injury (AKI),what should the nurse do?

A) Restrict fluids to 500 to 600 mL/day.
B) Monitor cardiac function to detect early dysrhythmia.
C) Observe and accurately record all fluid intake and output.
D) Maintain meticulous medical and surgical asepsis in the delivery of all care.

Question 16

The nurse has instructed a patient who is receiving hemodialysis about dietary management.Which diet choice by the patient indicates that the teaching has been successful?

A) Scrambled eggs,English muffin,and apple juice
B) Cheese sandwich,tomato soup,and cranberry juice
C) Split-pea soup,whole-wheat toast,and nonfat milk
D) Oatmeal with cream,half a banana,and herbal tea

Question 17

Before administering sodium polystyrene sulphonate (Kayexalate)to a patient with hyperkalemia,what should the nurse assess for?

A) BUN and creatinine
B) Blood glucose level
C) Patient's bowel sounds
D) Level of consciousness

Question 18

As the nurse and the dietitian review a diet plan with a patient with diabetes with newly diagnosed renal insufficiency,the patient becomes very angry,shouting that with her diabetes and now the kidney failure,there is just nothing she can eat.She says she might as well eat what she wants because these diseases will kill her anyway.Based on the patient's response,the nurse identifies which of the following nursing diagnoses?

A) Ineffective coping related to emotional lability
B) Risk for noncompliance related to feelings of anger
C) Anticipatory grieving related to actual and perceived losses
D) Risk for ineffective health maintenance related to complexity of therapeutic regimen

Question 19

A patient with ARF has an arterial blood pH of 7.30.Which of the following will the nurse assess for?

A) Tachycardia
B) Rapid respirations
C) Poor skin turgor
D) Vasodilation

Question 20

A patient admitted with sepsis has had several episodes of severe hypotension.Laboratory results indicate a BUN of 10.7 mmol/L (30 mg/dL),serum creatinine of 177 micromol/L (2.0 mg/dL),urine sodium of 70 mmol/L,urine specific gravity of 1.01,and cellular casts and debris in the urine.The nurse knows these findings are consistent with which condition?

A) Uremia
B) Prerenal failure
C) Post renal failure
D) Acute tubular necrosis

Question 21

A patient who has been on CAPD for 8 months is hospitalized with a detached retina.She is receiving CAPD with four exchanges a day while she is hospitalized.During the dialysate inflow,the patient tells the nurse that she is having abdominal pain and pain in her right shoulder.What should the nurse do?

A) Massage the patient's abdomen.
B) Decrease the rate of dialysate infusion.
C) Stop the infusion and notify the physician.
D) Ask the patient whether she can empty her bowel.

Question 22

In the immediate postoperative period,when caring for a patient who is a recipient of a kidney transplant,the nurse would expect that fluid therapy would involve administration of which of the following IV fluid infusion principles?

A) Maintain at a minimum rate of 100 mL/hour to perfuse the kidney.
B) Maintain at a rate to keep blood pressure within a normal range.
C) Determine rate maintenance hourly,based on every millilitre of urinary output.
D) Administer at a rate to keep urine clear,without evidence of blood clots.

Question 23

A patient with hypertension and stage 2 CKD is receiving captopril (Capoten).Before administration of the medication,the nurse will check the level of which of the following?

A) Creatinine
B) Glucose
C) Phosphate
D) Potassium

Question 24

A patient complains of leg cramps during hemodialysis.What should the nurse do?

A) Give acetaminophen.
B) Infuse a bolus of normal saline.
C) Massage the patient's legs.
D) Reposition the patient.

Question 25

A patient with CKD brings all home medications to the clinic to be reviewed by the nurse.Which medication being used by the patient indicates that patient teaching is required?

A) Milk of magnesia 30 mL administered orally
B) Oral acetaminophen (Tylenol)650 mg
C) Multivitamin with iron
D) Calcium phosphate (PhosLo)

Question 26

A patient with CKD is started on hemodialysis,and after the first treatment,the patient complains of nausea and a headache.The nurse notes mild jerking and twitching of the patient's extremities.The nurse will anticipate the need to do which of the following?

A) Increase the time for the next dialysis to remove wastes more completely.
B) Switch to continuous renal replacement therapy to improve dialysis efficiency.
C) Administer medications to control these symptoms before the next dialysis.
D) Slow the rate for the next dialysis to decrease the speed of solute removal.

Question 27

A new order for IV gentamicin (Garamycin)60 mg twice daily is received for a patient with diabetes who has pneumonia.When evaluating for adverse effects of the medication,the nurse will plan to monitor the patient for which of the following?

A) Blood glucose
B) Serum potassium
C) BUN and creatinine
D) Urine osmolality

Question 28

A 54-year-old patient with diabetes and CKD is considering using continuous ambulatory peritoneal dialysis (CAPD)as her renal failure becomes worse.In discussing this treatment option with the patient,what should the nurse tell the patient?

A) Patients with diabetes respond better to CAPD than to hemodialysis.
B) Home CAPD requires more extensive equipment than does home hemodialysis.
C) CAPD is contraindicated for patients who may eventually want a kidney transplant.
D) Patients receiving CAPD have more dietary restrictions than are required with hemodialysis.

Question 29

A patient is receiving immunosuppressive drugs following a living related-donor kidney transplant.To monitor for corticosteroid-related complications,the nurse teaches the patient to report which of the following?

A) Pain at the donor kidney site
B) Dizziness with position change
C) Changes in the character of the urine
D) Pain in the hips,knees,and other joints

Question 30

A patient receiving peritoneal dialysis using 2 L of dialysate per exchange has an outflow of 1200 mL.Which of the following actions should the nurse take first?

A) Infuse 1200 mL of dialysate during the inflow.
B) Assist the patient in changing position.
C) Administer a laxative to the patient.
D) Notify the physician about the outflow problem.

Question 31

Which of the following is the preferred hemodialysis vascular access site?

A) Nontunnelled central venous catheter
B) Arteriovenous fistula
C) Tunnelled central venous catheter
D) Arteriovenous graft

Question 32

Two hours after a kidney transplant,the nurse obtains all of the following data when assessing the patient.Which information is most important to communicate to the physician?

A) The BUN and creatinine levels are elevated.
B) The urinary output is 900 to 1100 mL/hour.
C) The patient's central venous pressure (CVP)is decreased.
D) The patient has level 8 (on a 10-point scale)incision pain when coughing.

Question 33

When teaching a patient about potassium-containing foods,which of the following foods would the nurse recommend as having an extremely high amount of potassium (>10 mmol per serving)?

A) Apple juice
B) Tomatoes
C) Carrots
D) Squash

Question 34

Which data obtained when assessing a patient who had a kidney transplant 8 years ago and who is receiving the immunosuppressants tacrolimus (Prograf),cyclosporine (Sandimmune),and prednisone (Deltasone)will be of most concern to the nurse?

A) The blood glucose is 8 mmol/L (144 mg/dL).
B) The patient has a round,moonlike face.
C) The patient has a nontender lump in the axilla.
D) The patient's blood pressure is 150/92 mm Hg.

Question 35

The nurse is assessing a patient who is receiving peritoneal dialysis with 2-L inflows.Which information should be reported immediately to the physician?

A) The patient is complaining of feeling bloated after the inflow.
B) The patient's peritoneal effluent appears cloudy.
C) The patient has abdominal pain during the inflow phase.
D) The patient has an outflow volume of 1600 mL.