Question 1

The nurse is caring for a client with a history of benign prostatic hyperplasia (BPH) with acute urinary retention and an elevated blood urea nitrogen (BUN) and creatinine. Which of the following prescribed therapies should the nurse implement first?

Accepted Answer

The client's elevation in BUN is most likely associated with hydronephrosis caused by the acute urinary retention, so the insertion of a retention catheter is the first action to prevent ongoing postrenal failure for this client. The other actions also are appropriate but should be implemented after the retention catheter.

Question 2

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

Accepted Answer

The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a client after a transplant.

Question 3

The nurse is caring for a client with acute kidney injury who is dehydrated with symptoms of oliguria, anemia, and hyperkalemia. Which of the following prescribed actions should the nurse take first?

Accepted Answer

Since hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. ESA's will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output, but does not correct the cause of the renal failure.

Question 4

The nurse is caring for a client who is receiving hemodialysis and has symptoms of nausea, vomiting, and a headache. Which of the following actions is priority?

Accepted Answer

The client's symptoms suggest disequilibrium syndrome, which is a rare complication of modern HD and develops as a result of very rapid changes in the composition of the extracellular fluid. Urea, sodium, and other solutes are removed more rapidly from the blood than from the cerebro-spinal fluid and the brain. This creates a high osmotic gradient in the brain resulting in the shift of fluid into the brain, causing cerebral edema. Manifestations include nausea, vomiting, confusion, restlessness, headaches, twitching and jerking, and seizures. Treatment consists of slowing or stopping dialysis and infusing hypertonic saline solution, albumin, or mannitol to draw fluid from the brain cells back into the systemic circulation.

Question 5

Which of the following parameters is most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a client has had kidney transplantation?

Accepted Answer

Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a litre an hour. The other data will be monitored but are not the most important determinants of fluid infusion rate.

Question 6

The nurse is caring for a client in the oliguric phase of acute renal failure who has a

Accepted Answer

Usually fluid replacement should be based on the client's measured output plus 600 mL/day for insensible losses.

Question 7

The nurse is caring for a client with diabetes who has been admitted with pneumonia and is prescribed gentamicin 60 mg IV. Which of the following parameters should the nurse monitor to evaluate the client for adverse effects of the medication?

Accepted Answer

When a client at risk for chronic kidney disease (CKD) receives a nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in determining the effect of the gentamicin.

Question 8

After noting lengthening QRS intervals in a client with acute kidney injury (AKI), which of the following actions should the nurse take first?

Accepted Answer

The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the client's health care provider. The BUN and creatinine will be elevated in a client with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval also is appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening bradycardia.

Question 9

The nurse is caring for a client with acute kidney injury (AKI) who requires hemodialysis and a temporary vascular access is obtained by placing a catheter in the left femoral vein. Which of the following interventions should be included in the plan ofcare?

Accepted Answer

The client with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the client is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the client needs continuous pulse oximetry.

Question 10

The nurse is caring for a client who was admitted 10 days previously with acute kidney injury (AKI) caused by dehydration. Which of the following findings is most important for the nurse to report to the health care provider?

Accepted Answer

The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The other information is typical of AKI and will not require a change in therapy.

Question 11

The RN observes a nursing student carrying out all of these actions while caring for a client with stage 2 chronic kidney disease. Which of the following actions require the RN to intervene?

Accepted Answer

Oral phosphate binders should not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder should be given with a meal and the iron given at a different time. The other actions by the RN student are appropriate for a client with renal insufficiency.

Question 12

The nurse is caring for a client who has been admitted with a severe crushing injury after an industrial accident. Which of the following laboratory results is most important to report to the health care provider?

Accepted Answer

The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately. The nurse will also report the other laboratory values, but abnormalities in these are not immediately life-threatening.

Question 13

The nurse is caring for a client who has leg cramps during hemodialysis. Which of the following actions should the nurse implement first?

Accepted Answer

Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.

Question 14

The nurse is caring for a client with end-stage renal disease (ESRD). Which of the following findings indicate that the nurse should consult with the health care provider before giving the prescribed erythropoiesis-stimulating agent (ESA)?

Accepted Answer

High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when ESA is administered to a target hemoglobin of 110 g/L with a range of 100-120 g/L). Hemoglobin levels higher than 120 g/L indicate a need for a decrease in erythropoiesis-stimulating agent dose. The other information will also be reported to the health care provider but will not affect whether the medication is administered.

Question 15

The nurse is caring for a client receiving hemodialysis who has symptoms of nausea and dizziness. Which of the following actions should the nurse take first?

Accepted Answer

The client's complaints of nausea and dizziness suggest hypotension, so the initial action should be to check the BP. The other actions may also be appropriate, based on the blood pressure obtained.

Question 16

The nurse is assessing a client who is receiving peritoneal dialysis with 2 L inflows. Which of the following information should be reported immediately to the health care provider?

Accepted Answer

Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the client.

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