Question 1

The nurse is planning care for a client diagnosed with chronic kidney disease (CKD)and osteoporosis.Based on this information,which should be the nurse's priority diagnosis for this client?
A)Anxiety
B)Disturbed Body Image
C)Risk for Injury
D)Risk for Bleeding

Accepted Answer

In clients with CKD, there is an increased risk for injury due to mineral and electrolyte imbalances as well as anemia which may cause weakness and falls. Osteoporosis also increases the risk for fractures that can further exacerbate the client's condition. Therefore, the priority diagnosis should be "Risk for Injury" to ensure measures are taken to prevent falls and other hazards. Anxiety and Disturbed Body Image may also be concerns, but they are not as immediate as the Risk for Injury. Risk for Bleeding is not applicable in this client's situation.

Question 2

What is the most frequent complication during hemodialysis?
A)Hemorrhage
B)Hypotension
C)Localized infection
D)Hypertension

Accepted Answer

The most common complication during hemodialysis is hypotension, which occurs in up to 20-30% of treatments. This is due to rapid fluid removal during the treatment and can lead to symptoms such as dizziness, nausea, and headache, and in severe cases, can result in cardiac arrest or stroke. Therefore, monitoring blood pressure and adjusting fluid removal rates are crucial during hemodialysis.

Question 3

The nurse is caring for a client from another country who was admitted to the hospital with a diagnosis of hypertension and chronic kidney disease.The client is receiving hemodialysis three times a week.When the nurse inquires about diet,the client reports the use of salt substitutes.Why should the nurse teach the client to avoid these products?
A)They will increase the risk of AV fistula infection.
B)They will cause the client to retain fluid.
C)They will interact with the client's antihypertensive medications.
D)They can contribute to hyperkalemia.

Accepted Answer

Salt substitutes typically contain potassium chloride, which can lead to increased levels of potassium in the blood (hyperkalemia). In clients with chronic kidney disease, their kidneys may not function properly to remove excess potassium from their body, which can lead to serious complications such as heart arrhythmias. Therefore, the nurse should teach the client to avoid salt substitutes.

Question 4

The nurse is caring for a client diagnosed with chronic kidney disease (CKD)who is pale and experiencing fatigue.The nurse attributes these symptoms to anemia secondary to CKD.The client's spouse asks why the client is anemic.Which response by the nurse is the most appropriate?
A)"Your spouse has a genetic tendency for the development of anemia."
B)"The increased metabolic waste products in your spouse's body depress the bone marrow and cause anemia."
C)"Your spouse's kidneys are producing reduced amounts of the hormone erythropoietin,and this is the cause of the anemia."
D)"Your spouse is not eating enough iron-rich foods,and this has led to anemia."

Accepted Answer

The most common cause of anemia in CKD is decreased production of erythropoietin by the kidneys. Erythropoietin is a hormone that stimulates the bone marrow to produce red blood cells. As the kidneys fail, they produce less erythropoietin, leading to anemia. Option A is incorrect because anemia in CKD is not usually genetic. Option B is incorrect because metabolic waste products do not directly cause anemia. Option D is incorrect because while inadequate intake of iron can cause anemia, it is not the primary cause in CKD.

Question 5

Which laboratory finding suggests that a client is experiencing acute kidney injury (AKI)as a result of glomerular damage?
A)Hyperkalemia
B)Proteinuria
C)Urine specific gravity of 1.010
D)Moderate anemia

Accepted Answer

Proteinuria is the presence of excess protein in the urine and is a characteristic feature of glomerular damage, which can lead to AKI. Hyperkalemia can be a complication of AKI, but it is not specific to glomerular damage. Urine specific gravity of 1.010 is within the normal range and does not necessarily indicate AKI. Moderate anemia can be associated with various conditions and is not specific to AKI or glomerular damage.

Question 6

The nurse is planning care for a client diagnosed with acute kidney injury (AKI).The nurse plans the client's care based on the nursing diagnosis of Excess Fluid Volume.Which assessment data supports this nursing diagnosis?
A)Pitting edema in the lower extremities
B)Bowel sounds positive in four quadrants
C)Wheezing in the lungs
D)Generalized weakness

Accepted Answer

Pitting edema in the lower extremities indicates the presence of excess fluid volume. Bowel sounds, wheezing, and weakness may indicate other health problems, but they do not specifically support the nursing diagnosis of excess fluid volume.

Question 7

The nurse is concerned that an older adult client is at risk for developing acute kidney injury (AKI).Which data in the client's history supports the nurse's concern? Select all that apply.
A)Diagnosed with hypotension
B)Recent aortic valve replacement surgery
C)Prescribed high doses of intravenous antibiotics
D)Total hip replacement surgery 5 years ago
E)Taking medication for type 2 diabetes mellitus

Accepted Answer

A)Older adults develop acute kidney injury more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for acute kidney injury. Hypotension, aortic valve replacement surgery, and receipt of high doses of intravenous antibiotics increase this client's risk for developing acute kidney injury. A previous history of hip replacement surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute kidney injury.
B)Older adults develop acute kidney injury more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for acute kidney injury. Hypotension, aortic valve replacement surgery, and receipt of high doses of intravenous antibiotics increase this client's risk for developing acute kidney injury. A previous history of hip replacement surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute kidney injury.
C)Older adults develop acute kidney injury more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for acute kidney injury. Hypotension, aortic valve replacement surgery, and receipt of high doses of intravenous antibiotics increase this client's risk for developing acute kidney injury. A previous history of hip replacement surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute kidney injury.
D)Older adults develop acute kidney injury more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for acute kidney injury. Hypotension, aortic valve replacement surgery, and receipt of high doses of intravenous antibiotics increase this client's risk for developing acute renal failure. A previous history of hip replacement surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute kidney injury.
E)Older adults develop acute kidney injury more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for acute kidney injury. Hypotension, aortic valve replacement surgery, and receipt of high doses of intravenous antibiotics increase this client's risk for developing acute kidney injury. A previous history of hip replacement surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute kidney injury.

Question 8

A client diagnosed with acute kidney injury (AKI)has jugular vein distention,lower extremity edema,and elevated blood pressure.Based on this data,which nursing diagnosis is most appropriate?
A)Ineffective Renal Tissue Perfusion
B)Excess Fluid Volume
C)Risk for Decreased Cardiac Tissue Perfusion
D)Risk for Infection

Accepted Answer

The jugular vein distention, lower extremity edema, and elevated blood pressure indicate fluid overload, which is consistent with the nursing diagnosis of Excess Fluid Volume. In AKI, the kidneys are unable to effectively remove excess fluid, leading to fluid accumulation in the body. Ineffective Renal Tissue Perfusion would be appropriate for other signs and symptoms such as decreased urine output or increased serum creatinine levels. Risk for Decreased Cardiac Tissue Perfusion may be appropriate in other conditions, such as heart failure, but is not indicated in this case. Risk for Infection may be appropriate if the AKI is caused by an infectious process, but there is no indication of this in the data given.

Question 9

A client agrees to receive long-term hemodialysis to treat acute kidney injury (AKI).Based on this information,the nurse should prepare the client for which surgical procedure?
A)Insertion of a double-lumen catheter into the subclavian artery
B)Placement of a peritoneal catheter
C)Insertion of a subarachnoid-peritoneal shunt
D)Placement of an arteriovenous fistula

Accepted Answer

For long-term hemodialysis, the preferred surgical procedure is placement of an arteriovenous fistula. This creates a direct connection between an artery and a vein, allowing for easy access for hemodialysis. Insertion of a double-lumen catheter into the subclavian artery is usually used for short-term hemodialysis or in emergency situations. Placement of a peritoneal catheter is used for peritoneal dialysis, not hemodialysis. Insertion of a subarachnoid-peritoneal shunt is used to manage hydrocephalus, not AKI.

Question 10

The nurse is caring for an older adult client diagnosed with chronic kidney disease (CKD).The client reports no bowel movements in the past 2 days.Based on this data,which condition is the client at risk for developing?
A)Metabolic acidosis
B)Hypercalcemia
C)Increased serum creatinine levels
D)Hyperkalemia

Accepted Answer

The client with CKD is at risk for developing hyperkalemia due to decreased kidney function and reduced ability to excrete potassium. A lack of bowel movements can exacerbate this risk as excess potassium may accumulate in the bowels and be reabsorbed into the bloodstream. Adequate bowel movements are important for the removal of excess potassium through fecal excretion.

Question 11

Which symptom suggests that a client is entering the maintenance phase of acute kidney injury (AKI)?
A)Onset of metabolic acidosis
B)Onset of diuresis
C)Increase in glomerular filtration rate
D)Decrease in serum potassium levels

Accepted Answer

A)The maintenance phase of AKI is characterized by a significant fall in glomerular filtration rate (GFR)and tubular necrosis. Oliguria, azotemia, fluid retention, electrolyte imbalances, and metabolic acidosis may all develop. Also during this phase, impaired potassium excretion leads to hyperkalemia, or increased serum potassium levels. Onset of diuresis and an increasing glomerular filtration rate are suggestive of the recovery phase, not the maintenance phase.
B)The maintenance phase of AKI is characterized by a significant fall in glomerular filtration rate (GFR)and tubular necrosis. Oliguria, azotemia, fluid retention, electrolyte imbalances, and metabolic acidosis may all develop. Also during this phase, impaired potassium excretion leads to hyperkalemia, or increased serum potassium levels. Onset of diuresis and an increasing glomerular filtration rate are suggestive of the recovery phase, not the maintenance phase.
C)The maintenance phase of AKI is characterized by a significant fall in glomerular filtration rate (GFR)and tubular necrosis. Oliguria, azotemia, fluid retention, electrolyte imbalances, and metabolic acidosis may all develop. Also during this phase, impaired potassium excretion leads to hyperkalemia, or increased serum potassium levels. Onset of diuresis and an increasing glomerular filtration rate are suggestive of the recovery phase, not the maintenance phase.
D)The maintenance phase of AKI is characterized by a significant fall in glomerular filtration rate (GFR)and tubular necrosis. Oliguria, azotemia, fluid retention, electrolyte imbalances, and metabolic acidosis may all develop. Also during this phase, impaired potassium excretion leads to hyperkalemia, or increased serum potassium levels. Onset of diuresis and an increasing glomerular filtration rate are suggestive of the recovery phase, not the maintenance phase.

Question 12

A client diagnosed with recurrent urinary tract calculi would be at elevated risk for which of the following types of acute kidney injury (AKI)?
A)Prerenal AKI
B)Intrinsic AKI
C)Postrenal AKI
D)Intrarenal AKI

Accepted Answer

Recurrent urinary tract calculi can lead to obstruction of the urinary tract, resulting in postrenal AKI. The obstruction can cause a backup of urine and increase pressure within the kidneys, leading to impaired kidney function.

Question 13

A client diagnosed with acute kidney injury (AKI)is receiving peritoneal dialysis.The nurse is explaining the dialysis process to the client and family.Which statement should the nurse include in this discussion?
A)"The peritoneum is more permeable because of the presence of excess metabolites."
B)"The metabolites will diffuse from the interstitial space to the bloodstream mainly through diffusion and ultrafiltration."
C)"The peritoneum acts as a semipermeable membrane through which wastes move by diffusion and osmosis."
D)"The solutes in the dialysate will enter the bloodstream through the peritoneum."

Accepted Answer

The peritoneum acts as a semipermeable membrane through which wastes move by diffusion and osmosis. This is the basis of peritoneal dialysis, where dialysate fluid is instilled into the peritoneal cavity and waste products diffuse from the bloodstream across the peritoneum into the dialysate fluid. Ultrafiltration also occurs, but it is not the main mechanism of waste removal in peritoneal dialysis. Option A is incorrect because excess metabolites do not lead to increased permeability of the peritoneum. Option B is incorrect because ultrafiltration is not the main mechanism of waste removal in peritoneal dialysis. Option D is incorrect because solutes in the dialysate do not enter the bloodstream through the peritoneum; rather, waste products in the bloodstream diffuse across the peritoneum into the dialysate fluid.

Question 14

Which medication is used to increase renal blood flow in clients with acute kidney injury?
A)Furosemide (Lasix)
B)Mannitol (Osmitrol)
C)Bumetanide (Bumex)
D)Dopamine (Intropin)

Accepted Answer

Dopamine is a medication that can be used to increase renal blood flow in clients with acute kidney injury. It can help to dilate blood vessels in the kidneys, improving blood flow and potentially promoting urine output. Furosemide, mannitol, and bumetanide are all diuretics that can increase urine output, but they do not specifically increase renal blood flow.

Question 15

A client with acute kidney failure is complaining of a metallic taste in the mouth and has no appetite.Based on this data,which intervention by the nurse is the most appropriate?
A)Provide mouth care before meals.
B)Administer an antiemetic as prescribed.
C)Restrict fluids.
D)Encourage the intake of protein,salt,and potassium.

Accepted Answer

Providing mouth care before meals can help to reduce the metallic taste in the client's mouth and may also help to stimulate appetite. Administering an antiemetic or restricting fluids would not necessarily address the metallic taste or lack of appetite. Encouraging the intake of protein, salt, and potassium may not be appropriate or safe for all clients with acute kidney failure.

Question 16

The community nurse visits the home of a young child who is home from school because of sudden onset of nausea,vomiting,and lethargy.The nurse suspects acute kidney injury (AKI).Which clinical manifestations support the nurse's suspicions? Select all that apply.
A)Elevated blood pressure
B)Postural hypotension
C)Wheezing
D)Edema
E)Hematuria

Accepted Answer

A)Pediatric manifestations of acute kidney injury characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute kidney injury in an older person. Wheezing is not a manifestation of acute kidney injury.
B)Pediatric manifestations of acute kidney injury characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute kidney injury in an older person. Wheezing is not a manifestation of acute kidney injury.
C)Pediatric manifestations of acute kidney injury characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute kidney injury in an older person. Wheezing is not a manifestation of acute kidney injury.
D)Pediatric manifestations of acute kidney injury characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute kidney injury in an older person. Wheezing is not a manifestation of acute kidney injury.
E)Pediatric manifestations of acute kidney injury characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute kidney injury in an older person. Wheezing is not a manifestation of acute kidney injury.

Question 17

The nurse is caring for a client diagnosed with acute kidney injury (AKI).When reviewing the client's laboratory data,which findings should indicate to the nurse that the client has met the expected outcomes? Select all that apply.
A)Decreasing serum creatinine
B)Decreasing blood urea nitrogen (BUN)
C)Decreasing neutrophil count
D)Decreasing lymphocyte count
E)Decreasing erythrocyte count

Accepted Answer

Decreasing serum creatinine and decreasing blood urea nitrogen (BUN) are indicators of improved kidney function and are expected outcomes in the management of acute kidney injury. Decreasing neutrophil count, decreasing lymphocyte count, and decreasing erythrocyte count are not necessarily related to AKI and may indicate other medical conditions or infectious processes.

Question 18

A young school-age client is in the hospital with an acute kidney injury diagnosis following a streptococcus infection.The client's parents primarily speak Spanish but have a limited ability to understand English.Through an interpreter,the parents ask the nurse what mistake they made that caused their child to be so sick.Which response by the nurse is the most appropriate?
A)"Your child does not eat enough dietary protein."
B)"Your child has a congenital defect that led to renal failure."
C)"Your child's renal failure has been caused by a low calcium level."
D)"Your child's recent infection may have caused the renal failure."

Accepted Answer

Option D is the most appropriate response as it provides factual information that is relevant to the current situation. It explains that the child's renal failure may have been caused by the recent streptococcus infection, which is a known risk factor for acute kidney injury. Option A assumes that the parents did something wrong, which may not be the case, and may make the parents feel guilty or ashamed. Option B is unlikely as it is rare for renal failure to be caused by a congenital defect alone. Option C is also unlikely as low calcium levels are not a common cause of acute kidney injury.

Question 19

A client diagnosed with acute kidney injury (AKI)will be discharged to home in the next few days.When conducting dietary instruction,the nurse should teach the client to choose proteins that are high in biological value.Which client statement indicates that this teaching has been effective?
A)"I will be sure to include eggs in my diet."
B)"I should include vegetables at every meal."
C)"Legumes should be included in my diet,because they are complete proteins."
D)"I will eat nuts daily because they are high in protein."

Accepted Answer

Eggs are high in biological value protein, meaning they contain all the essential amino acids that the body needs to build new proteins. This makes them a good choice for someone with AKI who needs to focus on consuming high-quality protein sources. The other options mentioned, while still nutritious, do not necessarily provide the same level of essential amino acids as eggs.

Question 20

The nurse is planning care for a client admitted with a diagnosis of heart failure.Based on this diagnosis,which type of kidney failure is the client at an increased risk for experiencing?
A)Prerenal hypovolemia
B)Intrarenal glomerular injury
C)Intrarenal acute tubular necrosis
D)Prerenal low cardiac output

Accepted Answer

A)Heart failure is one possible cause of prerenal kidney failure due to low cardiac output. In comparison, causes of prerenal kidney failure due to hypovolemia include hemorrhage, dehydration, burns, wounds, and excess fluid loss from the gastrointestinal tract. Causes of intrarenal kidney failure due to glomerular injury include glomerulonephritis, disseminated intravascular coagulation, vasculitis, hypertension, toxemia of pregnancy, and hemolytic uremic syndrome. Finally, causes of intrarenal kidney failure due to acute tubular necrosis include ischemia resulting from conditions associated with prerenal failure, toxins, hemolysis, and rhabdomyolysis.
B)Heart failure is one possible cause of prerenal kidney failure due to low cardiac output. In comparison, causes of prerenal kidney failure due to hypovolemia include hemorrhage, dehydration, burns, wounds, and excess fluid loss from the gastrointestinal tract. Causes of intrarenal kidney failure due to glomerular injury include glomerulonephritis, disseminated intravascular coagulation, vasculitis, hypertension, toxemia of pregnancy, and hemolytic uremic syndrome. Finally, causes of intrarenal kidney failure due to acute tubular necrosis include ischemia resulting from conditions associated with prerenal failure, toxins, hemolysis, and rhabdomyolysis.
C)Heart failure is one possible cause of prerenal kidney failure due to low cardiac output. In comparison, causes of prerenal kidney failure due to hypovolemia include hemorrhage, dehydration, burns, wounds, and excess fluid loss from the gastrointestinal tract. Causes of intrarenal kidney failure due to glomerular injury include glomerulonephritis, disseminated intravascular coagulation, vasculitis, hypertension, toxemia of pregnancy, and hemolytic uremic syndrome. Finally, causes of intrarenal kidney failure due to acute tubular necrosis include ischemia resulting from conditions associated with prerenal failure, toxins, hemolysis, and rhabdomyolysis.
D)Heart failure is one possible cause of prerenal kidney failure due to low cardiac output. In comparison, causes of prerenal kidney failure due to hypovolemia include hemorrhage, dehydration, burns, wounds, and excess fluid loss from the gastrointestinal tract. Causes of intrarenal kidney failure due to glomerular injury include glomerulonephritis, disseminated intravascular coagulation, vasculitis, hypertension, toxemia of pregnancy, and hemolytic uremic syndrome. Finally, causes of intrarenal kidney failure due to acute tubular necrosis include ischemia resulting from conditions associated with prerenal failure, toxins, hemolysis, and rhabdomyolysis.

Quiz 6: Fluids and Electrolytes

The nurse is planning care for a client diagnosed with chronic kidney disease (CKD) and osteoporosis.Based on this information,which should be the nurse's priority diagnosis for this client?

What is the most frequent complication during hemodialysis?

The nurse is caring for a client diagnosed with chronic kidney disease (CKD) who is pale and experiencing fatigue.The nurse attributes these symptoms to anemia secondary to CKD.The client's spouse asks why the client is anemic.Which response by the nurse is the most appropriate?

Which laboratory finding suggests that a client is experiencing acute kidney injury (AKI) as a result of glomerular damage?

The nurse is planning care for a client diagnosed with acute kidney injury (AKI) .The nurse plans the client's care based on the nursing diagnosis of Excess Fluid Volume.Which assessment data supports this nursing diagnosis?

The nurse is concerned that an older adult client is at risk for developing acute kidney injury (AKI) .Which data in the client's history supports the nurse's concern? Select all that apply.

A client diagnosed with acute kidney injury (AKI) has jugular vein distention,lower extremity edema,and elevated blood pressure.Based on this data,which nursing diagnosis is most appropriate?

A client agrees to receive long-term hemodialysis to treat acute kidney injury (AKI) .Based on this information,the nurse should prepare the client for which surgical procedure?

The nurse is caring for an older adult client diagnosed with chronic kidney disease (CKD) .The client reports no bowel movements in the past 2 days.Based on this data,which condition is the client at risk for developing?

Which symptom suggests that a client is entering the maintenance phase of acute kidney injury (AKI) ?

A client diagnosed with recurrent urinary tract calculi would be at elevated risk for which of the following types of acute kidney injury (AKI) ?

A client diagnosed with acute kidney injury (AKI) is receiving peritoneal dialysis.The nurse is explaining the dialysis process to the client and family.Which statement should the nurse include in this discussion?

Which medication is used to increase renal blood flow in clients with acute kidney injury?

A client with acute kidney failure is complaining of a metallic taste in the mouth and has no appetite.Based on this data,which intervention by the nurse is the most appropriate?

The community nurse visits the home of a young child who is home from school because of sudden onset of nausea,vomiting,and lethargy.The nurse suspects acute kidney injury (AKI) .Which clinical manifestations support the nurse's suspicions? Select all that apply.

The nurse is caring for a client diagnosed with acute kidney injury (AKI) .When reviewing the client's laboratory data,which findings should indicate to the nurse that the client has met the expected outcomes? Select all that apply.

A client diagnosed with acute kidney injury (AKI) will be discharged to home in the next few days.When conducting dietary instruction,the nurse should teach the client to choose proteins that are high in biological value.Which client statement indicates that this teaching has been effective?

The nurse is planning care for a client admitted with a diagnosis of heart failure.Based on this diagnosis,which type of kidney failure is the client at an increased risk for experiencing?