Question 1

The nurse is caring for a client with hypertension and stage 2 chronic kidney disease (CKD) who is prescribed ramapril. Which of the following laboratory tests should the nurse assess before administration of the medication?

Accepted Answer

Angiotensin-converting enzyme (ACE) inhibitors are frequently used in clients with CKD because they delay the progression of the CKD, but they cause potassium retention.
Therefore, careful monitoring of potassium levels is needed in clients who are at risk for hyperkalemia. The other laboratory values would also be monitored in clients with CKD but would not affect whether the captopril was given or not.

Question 2

Which of the following actions by a client who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?

Accepted Answer

Clients are taught to avoid insertion site infection and should be encouraged to take showers rather than baths to avoid infections at the catheter insertion side. The other client actions indicate good understanding of peritoneal dialysis.

Question 3

Which of the following assessments should the nurse complete before administering sodium polystyrene sulphonate to a client with hyperkalemia?

Accepted Answer

Sodium polystyrene sulphonate should not be given to a client who does not have normal bowel function because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not affect the nurse's decision to give the medication.

Question 4

The nurse is caring for a client with a left arm arteriovenous fistula. Which of the following actions should the nurse include in the plan of care to maintain the patency of the fistula?

Accepted Answer

The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.

Question 5

The nurse is caring for a client with acute kidney injury (AKI) who has an arterial blood pH of 7.30. Which of the following assessment findings should the nurse anticipate?

Accepted Answer

Clients with metabolic acidosis caused by AKI may have Kussmaul's respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the client is likely to have fluid retention, poor skin turgor would not be a finding in AKI.

Question 6

The nurse is caring for a client with severe heart failure who develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet which of the following goals of treatment?

Accepted Answer

The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this client's heart failure is causing AKI, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct.

Question 7

The nurse is interviewing a client with chronic kidney disease (CKD) who brings all home medications to the clinic to be reviewed by the nurse. Which of the following medications being used by the client indicates that client teaching is required?

Accepted Answer

Magnesium is excreted by the kidneys, and clients with CKD should not use
over-the-counter products containing magnesium. The other medications are appropriate for a client with CKD.

Question 8

Which of the following information is most useful to the nurse in evaluating improvement in kidney function for a client who is hospitalized with acute kidney injury (AKI)?

Accepted Answer

GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status. Urine output can be normal or high in clients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.

Question 9

The nurse is taking a history for a client who is a possible candidate for a kidney transplant. Which of the following information indicates that the client is not an appropriate candidate for transplantation?

Accepted Answer

Disseminated malignancies are a contraindication to transplantation. The conditions of the other clients are not contraindications for kidney transplant.

Question 10

The nurse is teaching a client who is receiving hemodialysis about appropriate dietary choices. Which of the following menu choices by the client indicates that the teaching has been effective?

Accepted Answer

Scrambled eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium.
Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.

Question 11

The nurse is caring for a client who has had an insertion of an arteriovenous graft (AVG) in the right forearm and has symptoms of pain and coldness of the right fingers. Which of the following actions should the nurse take?

Accepted Answer

The client's complaints suggest the development of distal ischemia (steal syndrome) and may require revision of the AVG. Elevation of the arm above the heart will decrease perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts.

Question 12

The nurse is caring for a client who had kidney transplantation several years ago. Which of the following findings may indicate that the client is experiencing adverse effects to the prescribed corticosteroid?

Accepted Answer

Aseptic necrosis of the weight-bearing joints can occur when clients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not caused by corticosteroid use.

Question 13

The nurse is caring for a client who requires vascular access for hemodialysis and asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. Which of the following information should the nurse explain is an advantage ofthefistula?

Accepted Answer

AV fistulas are much less likely to clot than grafts although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or client mobility.

Question 14

The nurse is caring for a client with chronic kidney disease (CKD) who is prescribed calcium carbonate. Which of the following parameters should the nurse assess in order to determine the effectiveness of the treatment?

Accepted Answer

Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in clients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium carbonate.

Question 15

The nurse is caring for a client who has had progressive chronic kidney disease (CKD) for several years and is starting hemodialysis. Which of the following information about diet should the nurse include in client teaching?

Accepted Answer

Once the client is started on dialysis and nitrogenous wastes are removed, there is less protein lost; therefore more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.

Question 16

The nurse is assessing a client who had a kidney transplant 8 years ago and is receiving the immunosuppressants tacrolimus, cyclosporin, and prednisone. Which of the following findings is of most concern to the nurse?

Accepted Answer

A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of chronic immuno-suppressive therapy. The elevated glucose, moon face, and hypertension are possible adverse effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of a malignancy.

Question 17

The nurse is caring for a client with stage 2 chronic kidney disease (CKD) who is scheduled for an intravenous pyelogram (IVP). Which of the following prescriptions for the client should the nurse question?

Accepted Answer

The contrast dye used in IVPs is potentially nephrotoxic, and concurrent use of other nephrotoxic medications such as the NSAIDs should be avoided. The suppository and NPO status are necessary to ensure adequate visualization during the IVP. IV fluids are used to ensure adequate hydration, which helps reduce the risk for contrast-induced renal failure.

Question 18

The nurse is teaching a client with stage 5 chronic kidney disease (CKD) about management of CKD. Which of the following client statements indicate that the teaching was effective?

Accepted Answer

The client with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the client with CKD.

Question 19

The nurse is caring for a client with acute glomerulonephritis, acute kidney injury (AKI), and hyperkalemia who is prescribed calcium gluconate IV. Which of the following parameters should the nurse assess to evaluate the effectiveness of the medication?

Accepted Answer

The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate.

Question 20

The nurse is preparing to administer calcium carbonate to a client with chronic kidney disease (CKD). Which of the following laboratory results should the nurse check prior to administration?

Accepted Answer

If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The calcium carbonate should not be given until the phosphate level is lowered. Total cholesterol, creatinine, and potassium values do not affect whether calcium carbonate should be administered.

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