Question 1

A client is taking furosemide (Lasix)40 mg/day for management of chronic kidney disease (CKD).To detect the positive effect of the medication,what action of the nurse is best?

Accepted Answer

Furosemide (Lasix)is a loop diuretic that helps reduce fluid overload and hypertension in clients with early stages of CKD.One kilogram of weight equals about 1 liter of fluid retained in the client,so daily weights are necessary to monitor the response of the client to the medication.Heart and breath sounds should be assessed if there is fluid retention,as in heart failure.Palpation of the client's abdomen is not necessary,but the nurse should check for edema.The diet history of the client would be helpful to assess electrolyte replacement since potassium is lost with this diuretic,but this does not assess the effect of the medication.

Question 2

A client has a serum potassium level of 6.5 mmol/L,a serum creatinine level of 2 mg/dL,and a urine output of 350 mL/day.What is the best action by the nurse?

Accepted Answer

The priority action by the nurse should be to check the cardiac status with a monitor.High potassium levels can lead to dysrhythmias.The other choices are logical nursing interventions for acute kidney injury but not the best immediate action.

Question 3

A client has just had a central line catheter placed that is specific for hemodialysis.What is the most appropriate action by the nurse?

Accepted Answer

The central line should have a heparin or heparin/saline dwell after hemodialysis treatment.The central line catheter used for dialysis should not be used for blood sampling,monitoring central venous pressures,or giving drugs or fluids.

Question 4

A client with acute kidney injury has a blood pressure of 76/55 mm Hg.The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion.The client is starting to develop shortness of breath.What is the nurse's priority action?

Accepted Answer

The nurse should assess that the client could be developing fluid overload and respiratory distress and slow down the normal saline infusion.The calculation of the MAP also reflects perfusion.The insertion of a pulmonary artery catheter would evaluate the client's hemodynamic status,but this should not be the initial action by the nurse.Vital signs are also important after adjusting the intravenous infusion.

Question 5

A client has a long history of hypertension.Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)?

Accepted Answer

ACE inhibitors stop the conversion of angiotensin I to the vasoconstrictor angiotensin II.This category of medication also blocks bradykinin and prostaglandin,increases renin,and decreases aldosterone,which promotes vasodilation and perfusion to the kidney.Antibiotics fight infection,histamine blockers decrease inflammation,and bronchodilators increase the size of the bronchi; none of these medications helps slow the progression of CKD in clients with hypertension.

Question 6

The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI).Which condition would the nurse expect to find in the client's recent history?

Accepted Answer

Pre-renal causes of AKI are related to a decrease in perfusion,such as with a myocardial infarction.Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage.Bladder cancer and kidney stones are post-renal causes of AKI related to urine flow obstruction.

Question 7

The nurse is caring for four clients with chronic kidney disease.Which client should the nurse assess first upon initial rounding?

Accepted Answer

Kussmaul respirations indicate a worsening of chronic kidney disease (CKD).The client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs.Hypertension is common in most clients with CKD,and skin itching increases with calcium-phosphate imbalances,another common finding in CKD.Uremia from CKD causes ammonia to be formed,resulting in the common findings of halitosis and stomatitis.

Question 8

The nurse is taking the vital signs of a client after hemodialysis.Blood pressure is 110/58 mm Hg,pulse 66 beats/min,and temperature is 99.8° F (37.6° C).What is the most appropriate action by the nurse?

Accepted Answer

During hemodialysis,the dialysate is warmed to increase diffusion and prevent hypothermia.The client's temperature could reflect the temperature of the dialysate.There is no indication to check the white blood cell count or connect the client to an ECG monitor.The other vital signs are within normal limits.

Question 9

A client is placed on fluid restrictions because of chronic kidney disease (CKD).Which assessment finding would alert the nurse that the client's fluid balance is stable at this time?

Accepted Answer

The absence of adventitious sounds upon auscultation of the lungs indicates a lack of fluid overload and fluid balance in the client's body.Decreased calcium levels and increased phosphorus levels are common findings with CKD.Edema would indicate a fluid imbalance.

Question 10

A client in the intensive care unit is started on continuous venovenous hemofiltration (CVVH).Which finding is the cause of immediate action by the nurse?

Accepted Answer

Hypotension can be a problem with CVVH if replacement fluid does not provide enough volume to maintain blood pressure.The specially trained nurse needs to monitor for ongoing fluid and electrolyte replacement.The sodium level is normal and the potassium level is slightly elevated,which could be normal findings for someone with acute kidney injury.A pulse rate of 90 beats/min is normal.

Question 11

The charge nurse of the medical-surgical unit is making staff assignments.Which staff member should be assigned to a client with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub?

Accepted Answer

The client is exhibiting symptoms of pericarditis,which can occur with chronic kidney disease.Continuity of care is important to assess subtle differences in clients.Therefore,the registered nurse (RN)who was assigned to this client previously should again give care to this client.The float nurses would not be as knowledgeable about the unit and its clients.The licensed practical nurse may not have the education level of the RN to assess for pericarditis.

Question 12

A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN)of 24 mL/dL.What question should the nurse ask first when taking this client's history?

Accepted Answer

There are some medications that are nephrotoxic,such as the nonsteroidal anti-inflammatory drugs ibuprofen,aspirin,and naproxen.This would be a good question to initially ask the client since both the serum creatinine and BUN are elevated,indicating some renal problems.A family history of renal failure and kidney transplantation would not be part of the questioning and could cause anxiety in the client.A diet high in protein could be a factor in an increased BUN.

Question 13

The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease.Which statement by the client indicates a need for further teaching by the nurse?

Accepted Answer

Dialysis works using the passive transfer of toxins by diffusion.Diffusion is the movement of molecules from an area of higher concentration to an area of lower concentration.The other statements show a correct understanding about hemodialysis.

Question 14

A male client with chronic kidney disease (CKD)is refusing to take his medication and has missed two hemodialysis appointments.What is the best initial action for the nurse?

Accepted Answer

The initial action for the nurse is to assess anxiety,coping styles,and the client's acceptance of the required treatment for CKD.The client may be in denial of the diagnosis.While rescheduling hemodialysis appointments may help,and referral to a mental health practitioner and the possibility of peritoneal dialysis are all viable options,assessment of the client's acceptance of the treatment should come first.

Question 15

The nurse is teaching a client with chronic kidney disease (CKD)about the sodium restriction needed in the diet to prevent edema and hypertension.Which statement by the client indicates more teaching is needed?

Accepted Answer

Fast food restaurants usually serve food that is high in sodium.This statement indicates that more teaching needs to occur.The other statements show a correct understanding of the teaching.

Question 16

A client is admitted with acute kidney injury (AKI)and a urine output of 2000 mL/day.What is the major concern of the nurse regarding this client's care?

Accepted Answer

This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding the fluid in the filtrate,causing polyuria.Electrolyte loss and fluid balance is essential.Edema and pain are not usually a problem with fluid loss.There could be changes in the client's cardiac,respiratory,and mental health status if the electrolyte imbalance is not treated.

Question 17

A client is diagnosed with chronic kidney disease (CKD).What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema?

Accepted Answer

With an optimal fluid balance,the client will be more able to eject blood from the left ventricle without increased pressure in the left ventricle and pulmonary vessels.Other ideal goals are oxygen saturations greater than 92%,no auscultated crackles or wheezes,and no demonstrated shortness of breath.

Question 18

A marathon runner comes into the clinic and states "I have not urinated very much in the last few days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg.Which action by the nurse is the priority?

Accepted Answer

This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood pressure.The nurse can start hydrating the client with a bottle of water first,followed by teaching the client to drink 2 to 3 liters of water each day.An intravenous line may be ordered later,after the client's degree of dehydration is assessed.An electrocardiogram is not necessary at this time.

Question 19

A client with chronic kidney disease (CKD)is experiencing nausea,vomiting,visual changes,and anorexia.Which action by the nurse is best?

Accepted Answer

These signs and symptoms are indications of digoxin (Lanoxin)toxicity.The nurse should check the level of this medication.Administering antiemetics,asking if the client can eat,and obtaining a referral to a specialist all address the client's symptoms but do not lead to the cause of the symptoms.

Question 20

A 70-kg adult with chronic renal failure is on a 40-g protein diet.The client has a reduced glomerular filtration rate and is not undergoing dialysis.Which result would give the nurse the most concern?

Accepted Answer

Protein restriction is necessary with chronic renal failure due to the buildup of waste products from protein breakdown.The nurse would be concerned with the low albumin level since this indicates that the protein in the diet is not enough for the client's metabolic needs.The electrolyte values are not related to the protein-restricted diet.

Quiz 68: Care of Patients with Acute Kidney Injury and Chronic Kidney Disease

A client is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD) .To detect the positive effect of the medication,what action of the nurse is best?

A client has a serum potassium level of 6.5 mmol/L,a serum creatinine level of 2 mg/dL,and a urine output of 350 mL/day.What is the best action by the nurse?

A client has just had a central line catheter placed that is specific for hemodialysis.What is the most appropriate action by the nurse?

A client with acute kidney injury has a blood pressure of 76/55 mm Hg.The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion.The client is starting to develop shortness of breath.What is the nurse's priority action?

A client has a long history of hypertension.Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD) ?

The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI) .Which condition would the nurse expect to find in the client's recent history?

The nurse is caring for four clients with chronic kidney disease.Which client should the nurse assess first upon initial rounding?

The nurse is taking the vital signs of a client after hemodialysis.Blood pressure is 110/58 mm Hg,pulse 66 beats/min,and temperature is 99.8° F (37.6° C) .What is the most appropriate action by the nurse?

A client is placed on fluid restrictions because of chronic kidney disease (CKD) .Which assessment finding would alert the nurse that the client's fluid balance is stable at this time?

A client in the intensive care unit is started on continuous venovenous hemofiltration (CVVH) .Which finding is the cause of immediate action by the nurse?

The charge nurse of the medical-surgical unit is making staff assignments.Which staff member should be assigned to a client with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub?

A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mL/dL.What question should the nurse ask first when taking this client's history?

The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease.Which statement by the client indicates a need for further teaching by the nurse?

A male client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments.What is the best initial action for the nurse?

The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension.Which statement by the client indicates more teaching is needed?

A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day.What is the major concern of the nurse regarding this client's care?

A client is diagnosed with chronic kidney disease (CKD) .What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema?

A marathon runner comes into the clinic and states "I have not urinated very much in the last few days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg.Which action by the nurse is the priority?

A client with chronic kidney disease (CKD) is experiencing nausea,vomiting,visual changes,and anorexia.Which action by the nurse is best?

A 70-kg adult with chronic renal failure is on a 40-g protein diet.The client has a reduced glomerular filtration rate and is not undergoing dialysis.Which result would give the nurse the most concern?