Question 1

A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD).Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.)

Accepted Answer

In discharge teaching,the nurse must emphasize that the client needs to have an antibiotic prophylactically before dental procedures to prevent infection.There may be a need for dose reduction in medications if the kidney is not excreting them properly (antacids with magnesium,antibiotics,antidiabetic drugs,insulin,opioids,and anticoagulants).

Question 2

A client is assessed by the nurse after a hemodialysis session.The nurse notes bleeding from the client's nose and around the intravenous catheter.What action by the nurse is the priority?

Accepted Answer

Heparin is used with hemodialysis treatments.The bleeding alerts the nurse that too much anticoagulant is in the client's system and protamine sulfate should be administered.Pressure,taking vital signs,and assessing for a bruit or thrill are not as important as medication administration.

Question 3

The nurse is teaching a client with diabetes mellitus how to prevent or delay chronic kidney disease (CKD).Which client statements indicate a lack of understanding of the teaching? (Select all that apply.)

Accepted Answer

Weight should be maintained at a body mass index (BMI)of 22 to 25.A BMI of 30 indicates obesity.The use of nonsteroidal anti-inflammatory drugs such as aspirin should be limited to the lowest time at the lowest dose due to interference with kidney blood flow.The client should drink at least 2 liters of water daily.Diet adjustments should be made by restricting sodium,cholesterol,and protein.Smoking causes constriction of blood vessels and decreases kidney perfusion,so the client should stop smoking.

Question 4

A client in the intensive care unit with acute kidney injury (AKI)must maintain a mean arterial pressure (MAP)of 65 mm Hg to promote kidney perfusion.What is the client's MAP if the blood pressure is 98/50 mm Hg? (Record your answer using a whole number.)_____ mm Hg

Accepted Answer

The answer of A client in the intensive care unit...

Question 5

A client is undergoing hemodialysis.The client's blood pressure at the beginning of the procedure was 136/88 mm Hg,and now it is 110/54 mm Hg.What actions should the nurse perform to maintain blood pressure? (Select all that apply.)

Accepted Answer

Hypotension occurs often during hemodialysis treatments as a result of vasodilation from the warmed dialysate.Modest decreases in blood pressure,as is the case with this client,can be maintained with rate adjustment,Trendelenburg positioning,and a fluid bolus.If the blood pressure drops considerably after two boluses and cooling dialysate,the hemodialysis can be stopped and the health care provider contacted.

Question 6

The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV)fistula for hemodialysis in her left arm.Which action by the float nurse would be considered unsafe?

Accepted Answer

The nurse should not use the arm with the AV fistula for intravenous infusion,blood pressure readings,or venipuncture.Compression and infection can result in the loss of the AV fistula.The AV fistula should be monitored by auscultating or palpating the access site.Checking the distal pulse would be an appropriate assessment.

Question 7

A nurse reviews these laboratory values of a client who returned from kidney transplantation 12 hours ago:

What initial intervention would the nurse anticipate?

Accepted Answer

The client may need a higher dose of immunosuppressive medication as evidenced by the elevated BUN and serum creatinine levels.This increased dose may reverse the possible acute rejection of the transplanted kidney.The client does not need hemodialysis,peritoneal dialysis,or further surgery at this point.

Question 8

The nurse is caring for five clients on the medical-surgical unit.Which clients would the nurse consider to be at risk for post-renal acute kidney injury (AKI)? (Select all that apply.)

Accepted Answer

Urine flow obstruction,such as prostate cancer,blood clots in the urinary tract,and kidney stones (ureterolithiasis),causes post-renal AKI.Severe burns would be a pre-renal cause.Lupus would be an intrarenal cause for AKI.

Question 9

A client is hospitalized in the oliguric phase of acute kidney injury (AKI)and is receiving tube feedings.The nurse is teaching the client's spouse about the kidney-specific formulation for the enteral solution compared to standard formulas.What components should be discussed in the teaching plan? (Select all that apply.)

Accepted Answer

Many clients with AKI are too ill to meet caloric goals and require tube feedings with kidney-specific formulas that are lower in sodium,potassium,and phosphorus,and higher in calories than are standard formulas.

Question 10

A client with chronic kidney disease states,"I feel chained to the hemodialysis machine." What is the nurse's best response to the client's statement?

Accepted Answer

The nurse needs to explore the client's feelings in order to help the client cope and enter a phase of acceptance or resignation.It is common for clients to be discouraged because of the dependency of the treatment,especially during the first year.Referrals to a mental health provider or social services are possibilities,but only after exploring the client's feelings first.Telling the client his or her feelings will go away is dismissive of the client's concerns.

Question 11

A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery.Which findings by the nurse should prompt immediate action to prevent acute kidney injury? (Select all that apply.)

Accepted Answer

The low urine output,sediment,and blood pressure should be reported to the provider.Postoperatively,the nurse should measure intake and output,check the characteristics of the urine,and report sediment,hematuria,and urine output of less than 0.5 mL/kg/hour for 3 to 4 hours.A urine output of 100 mL is low,but a urine output of 500 mL in 12 hours should be within normal limits.Perfusion to the kidneys is compromised with low blood pressure.The amber odorless urine is normal.

Question 12

A client is recovering from a kidney transplant.The client's urine output was 1500 mL over the last 12-hour period since transplantation.What is the priority assessment by the nurse?

Accepted Answer

By taking blood pressure,the nurse is assessing for hypotension that could compromise perfusion to the new kidney.The nurse then should notify the provider immediately.Skin turgor,lung sounds,and weight could give information about the fluid status of the client,but they are not the priority assessment.

Question 13

A client is unsure of the decision to undergo peritoneal dialysis (PD)and wishes to discuss the advantages of this treatment with the nurse.Which statements by the nurse are accurate regarding PD? (Select all that apply.)

Accepted Answer

PD is based on exchanges of waste,fluid,and electrolytes in the peritoneal cavity.There is no need for vascular access.Protein is lost in the exchange,which allows for more protein and fluid in the diet.There is flexibility in the time for exchanges,but the treatment takes a longer period of time compared to hemodialysis.There still is risk for infection with PD,especially peritonitis.

Question 14

A nurse is caring for a client who is scheduled for a dose of cefazolin and vitamins at this time.Hemodialysis for this client is also scheduled in 60 minutes.Which action by the nurse is best?

Accepted Answer

Both the cefazolin and the vitamins should be held until after the hemodialysis is completed because they would otherwise be removed by the dialysis process.

Question 15

The nurse is teaching a client how to increase the flow of dialysate into the peritoneal cavity during dialysis.Which statement by the client demonstrates a correct understanding of the teaching?

Accepted Answer

Inflow and outflow problems of the dialysate are best controlled by preventing constipation.A daily stool softener is the best option for the client.The drainage bag should be below the level of the abdomen.Flushing the tubing will not help with the flow.A diet high in fiber will also help with a constipation problem.

Question 16

A client is having a peritoneal dialysis treatment.The nurse notes an opaque color to the effluent.What is the priority action by the nurse?

Accepted Answer

An opaque or cloudy effluent is the first sign of peritonitis.A sample of the effluent would need to be sent to the laboratory for culture and sensitivity in order to administer the correct antibiotic.Warming the dialysate in a microwave and flushing the tubing are not safe actions by the nurse.Checking the catheter for obstruction is a viable option but will not treat the peritonitis.

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

A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD) .Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.)

A client is assessed by the nurse after a hemodialysis session.The nurse notes bleeding from the client's nose and around the intravenous catheter.What action by the nurse is the priority?

The nurse is teaching a client with diabetes mellitus how to prevent or delay chronic kidney disease (CKD) .Which client statements indicate a lack of understanding of the teaching? (Select all that apply.)

A client in the intensive care unit with acute kidney injury (AKI)must maintain a mean arterial pressure (MAP)of 65 mm Hg to promote kidney perfusion.What is the client's MAP if the blood pressure is 98/50 mm Hg? (Record your answer using a whole number.)_____ mm Hg

A client is undergoing hemodialysis.The client's blood pressure at the beginning of the procedure was 136/88 mm Hg,and now it is 110/54 mm Hg.What actions should the nurse perform to maintain blood pressure? (Select all that apply.)

The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm.Which action by the float nurse would be considered unsafe?

A nurse reviews these laboratory values of a client who returned from kidney transplantation 12 hours ago: What initial intervention would the nurse anticipate?

The nurse is caring for five clients on the medical-surgical unit.Which clients would the nurse consider to be at risk for post-renal acute kidney injury (AKI) ? (Select all that apply.)