LEWIS Ch 46: Acute Kidney Injury and Chronic Kidney Disease
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After the insertion of an arteriovenous graft (AVG) in the right forearm, a 54-year-old patient complains of pain and coldness of the right fingers. Which action should the nurse take?
a. Teach the patient about normal AVG function.
b. Remind the patient to take a daily low-dose aspirin tablet.
c. Report the patients symptoms to the health care provider.
d. Elevate the patients arm on pillows to above the heart level.
c. Report the patients symptoms to the health care provider.
When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of
a. persistent skin tenting
b. rapid, deep respirations.
c. bounding peripheral pulses.
d. hot, flushed face and neck.
b. rapid, deep respirations.
The nurse is planning care for a patient with severe heart failure who has developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary collaborative treatment goal in the plan will be
a. augmenting fluid volume.
b. maintaining cardiac output.
c. diluting nephrotoxic substances.
d. preventing systemic hypertension.
b. maintaining cardiac output.
A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV?
a. Urine volume
b. Calcium level
c. Cardiac rhythm
d. Neurologic status
c. Cardiac rhythm
A 48-year-old patient with stage 2 chronic kidney disease (CKD) is scheduled for an intravenous pyelogram (IVP). Which order for the patient will the nurse question?
a. NPO for 6 hours before procedure
b. Ibuprofen (Advil) 400 mg PO PRN for pain
c. Dulcolax suppository 4 hours before procedure
d. Normal saline 500 mL IV infused before procedure
b. Ibuprofen (Advil) 400 mg PO PRN for pain
Which statement by a 62-year-old patient with stage 5 chronic kidney disease (CKD) indicates that the nurses teaching about management of CKD has been effective?
a. I need to get most of my protein from low-fat dairy products.
b. I will increase my intake of fruits and vegetables to 5 per day.
c. I will measure my urinary output each day to help calculate the amount I can drink.
d. I need to take erythropoietin to boost my immune system and help prevent infection.
c. I will measure my urinary output each day to help calculate the amount I can drink.
Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?
a. Blood pressure
b. Phosphate level
c. Neurologic status
d. Creatinine clearance
b. Phosphate level
Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before administering the medication, the nurse should assess the
a. bowel sounds.
b. blood glucose.
c. blood urea nitrogen (BUN).
d. level of consciousness (LOC).
a. bowel sounds.
Which menu choice by the patient who is receiving hemodialysis indicates that the nurses teaching has been successful?
a. Split-pea soup, English muffin, and nonfat milk
b. Oatmeal with cream, half a banana, and herbal tea
c. Poached eggs, whole-wheat toast, and apple juice
d. Cheese sandwich, tomato soup, and cranberry juice
c. Poached eggs, whole-wheat toast, and apple juice
Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney disease (CKD), the nurse should check laboratory results for
a. potassium level.
b. total cholesterol.
c. serum phosphate.
d. serum creatinine.
c. serum phosphate.
A 37-year-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function?
a. Urine volume
b. Creatinine level
c. Glomerular filtration rate (GFR)
d. Blood urea nitrogen (BUN) level
c. Glomerular filtration rate (GFR)
A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft?
a. A fistula is much less likely to clot.
b. A fistula increases patient mobility.
c. A fistula can accommodate larger needles.
d. A fistula can be used sooner after surgery.
a. A fistula is much less likely to clot.
When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula?
a. Auscultate for a bruit at the fistula site.
b. Assess the quality of the left radial pulse.
c. Compare blood pressures in the left and right arms.
d. Irrigate the fistula site with saline every 8 to 12 hours.
a. Auscultate for a bruit at the fistula site.
A 64-year-old male patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching?
a. Increased calories are needed because glucose is lost during hemodialysis.
b. Unlimited fluids are allowed because retained fluid is removed during dialysis.
c. More protein is allowed because urea and creatinine are removed by dialysis.
d. Dietary potassium is not restricted because the level is normalized by dialysis.
c. More protein is allowed because urea and creatinine are removed by dialysis.
Which action by a 70-year-old patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?
a. The patient leaves the catheter exit site without a dressing.
b. The patient plans 30 to 60 minutes for a dialysate exchange.
c. The patient cleans the catheter while taking a bath each day.
d. The patient slows the inflow rate when experiencing abdominal pain.
c. The patient cleans the catheter while taking a bath each day.
Which information in a patients history indicates to the nurse that the patient is not an appropriate candidate for kidney transplantation?
a. The patient has type 1 diabetes.
b. The patient has metastatic lung cancer.
c. The patient has a history of chronic hepatitis C infection.
d. The patient is infected with the human immunodeficiency virus.
b. The patient has metastatic lung cancer.
Which assessment finding may indicate that a patient is experiencing adverse effects to a corticosteroid prescribed after kidney transplantation?
a. Postural hypotension
b. Recurrent tachycardia
c. Knee and hip joint pain
d. Increased serum creatinine
c. Knee and hip joint pain
A 38-year-old patient who had a kidney transplant 8 years ago is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone). Which assessment data will be of most concern to the nurse?
a. The blood glucose is 144 mg/dL.
b. There is a nontender axillary lump.
c. The patients skin is thin and fragile.
d. The patients blood pressure is 150/92.
b. There is a nontender axillary lump.
19/. The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required?
a. Multivitamin with iron
b. Magnesium hydroxide
c. Acetaminophen (Tylenol)
d. Calcium phosphate (PhosLo)
b. Magnesium hydroxide
Before administration of captopril (Capoten) to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patients
a. glucose.
b. potassium.
c. creatinine.
d. phosphate.
b. potassium.
A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin (Garamycin) 60 mg IV BID. The nurse will monitor for adverse effects of the medication by evaluating the patients
a. blood glucose.
b. urine osmolality.
c. serum creatinine.
d. serum potassium.
c. serum creatinine.
55-year-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication?
a. Creatinine 1.6 mg/dL
b. Oxygen saturation 89%
c. Hemoglobin level 13 g/dL
d. Blood pressure 98/56 mm Hg
c. Hemoglobin level 13 g/dL
Which intervention will be included in the plan of care for a male patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein?
a. Start continuous pulse oximetry.
b. Restrict physical activity to bed rest.
c. Restrict the patients oral protein intake.
d. Discontinue the urethral retention catheter.
b. Restrict physical activity to bed rest.
A 25-year-old male patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider?
a. Serum creatinine level 2.1 mg/dL
b. Serum potassium level 6.5 mEq/L
c. White blood cell count 11,500/L
d. Blood urea nitrogen (BUN) 56 mg/dL
b. Serum potassium level 6.5 mEq/L
A 72-year-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first?
a. Insert urethral catheter.
b. Obtain renal ultrasound.
c. Draw a complete blood count.
d. Infuse normal saline at 50 mL/hour.
a. Insert urethral catheter.e, but should be implemented after the retention catheter.
A 62-year-old female patient has been hospitalized for 8 days with acute kidney injury (AKI) caused by dehydration. Which information will be most important for the nurse to report to the health care provider?
a. The creatinine level is 3.0 mg/dL.
b. Urine output over an 8-hour period is 2500 mL.
c. The blood urea nitrogen (BUN) level is 67 mg/dL.
d. The glomerular filtration rate is <30 mL/min/1.73m2.
b. Urine output over an 8-hour period is 2500 mL.
A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than
were noted on the previous shift. Which action should the nurse take first?
a. Notify the patients health care provider.
b. Document the QRS interval measurement.
c. Check the medical record for most recent potassium level.
d. Check the chart for the patients current creatinine level.
c. Check the medical record for most recent potassium level.
A 42-year-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed actions should the nurse take first?
a. Insert a urinary retention catheter.
b. Place the patient on a cardiac monitor.
c. Administer epoetin alfa (Epogen, Procrit).
d. Give sodium polystyrene sulfonate (Kayexalate).
b. Place the patient on a cardiac monitor.
A patient has arrived for a scheduled hemodialysis session. Which nursing action is most appropriate for the registered nurse (RN) to delegate to a dialysis technician?
a. Teach the patient about fluid restrictions.
b. Check blood pressure before starting dialysis.
c. Assess for causes of an increase in predialysis weight.
d. Determine the ultrafiltration rate for the hemodialysis.
b. Check blood pressure before starting dialysis..
A licensed practical/vocational nurse (LPN/LVN) is caring for a patient with stage 2 chronic kidney disease. Which observation by the RN requires an intervention?
a. The LPN/LVN administers the erythropoietin subcutaneously.
b. The LPN/LVN assists the patient to ambulate out in the hallway.
c. The LPN/LVN administers the iron supplement and phosphate binder with lunch.
d. The LPN/LVN carries a tray containing low-protein foods into the patients room.
c. The LPN/LVN administers the iron supplement and phosphate binder with lunch.
A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2 L inflows. Which information should the nurse report immediately to the health care provider?
a. The patient has an outflow volume of 1800 mL.
b. The patients peritoneal effluent appears cloudy.
c. The patient has abdominal pain during the inflow phase.
d. The patients abdomen appears bloated after the inflow.
b. The patients peritoneal effluent appears cloudy.
The nurse is assessing a patient 4 hours after a kidney transplant. Which information is most important to communicate to the health care provider?
a. The urine output is 900 to 1100 mL/hr.
b. The patients central venous pressure (CVP) is decreased.
c. The patient has a level 7 (0 to 10 point scale) incisional pain.
d. The blood urea nitrogen (BUN) and creatinine levels are elevated.
b. The patients central venous pressure (CVP) is decreased.
During routine hemodialysis, the 68-year-old patient complains of nausea and dizziness. Which action should the nurse take first?
a. Slow down the rate of dialysis.
b. Check patients blood pressure (BP).
c. Review the hematocrit (Hct) level.
d. Give prescribed PRN antiemetic drugs.
b. Check patients blood pressure (BP).
The nurse is titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation. Which parameter will be most important for the nurse to consider?
a. Heart rate
b. Urine output
c. Creatinine clearance
d. Blood urea nitrogen (BUN) level
b. Urine output
A patient complains of leg cramps during hemodialysis. The nurse should first
a. massage the patients legs.
b. reposition the patient supine.
c. give acetaminophen (Tylenol).
d. infuse a bolus of normal saline.
d. infuse a bolus of normal saline.
A 74-year-old who is progressing to stage 5 chronic kidney disease asks the nurse, Do you think I should go on dialysis? Which initial response by the nurse is best?
a. It depends on which type of dialysis you are considering.
b. Tell me more about what you are thinking regarding dialysis.
c. You are the only one who can make the decision about dialysis.
d. Many people your age use dialysis and have a good quality of life.
b. Tell me more about what you are thinking regarding dialysis.
After receiving change-of-shift report, which patient should the nurse assess first?
a. Patient who is scheduled for the drain phase of a peritoneal dialysis exchange
b. Patient with stage 4 chronic kidney disease who has an elevated phosphate level
c. Patient with stage 5 chronic kidney disease who has a potassium level of 3.4 mEq/L
d. Patient who has just returned from having hemodialysis and has a heart rate of 124/min
d. Patient who has just returned from having hemodialysis and has a heart rate of 124/min
Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis (select all that apply)?
a. Avoid commercial salt substitutes.
b. Drink 1500 to 2000 mL of fluids daily.
c. Take phosphate-binders with each meal.
d. Choose high-protein foods for most meals.
e. Have several servings of dairy products daily.
ANS: A, C, D