Lewis Med-Surg Ch. 46 Acute Kidney Injury and CKD

After the insertion of an arteriovenous graft (AVG) in the right forearm, a 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 patient's symptoms to the health care provider.

d. Elevate the patient's arm on pillows to above the heart level.

ANS: C

The patient'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 further decrease

perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used

to maintain grafts.

DIF: Cognitive Level: Apply (application) REF: 1088

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

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. hot, flushed face and neck.

d. bounding peripheral pulses.

ANS: B

Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the lungs

try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with

metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor

would not be a finding in AKI.

DIF: Cognitive Level: Apply (application) REF: 1072

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

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 treatment goal in the plan will

be

a. augmenting fluid volume. .

b. maintaining cardiac output.

c. diluting nephrotoxic substances

d. preventing systemic hypertension.

ANS: B

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 patient'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.

DIF: Cognitive Level: Apply (application) REF: 1073

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

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

ANS: C

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.

DIF: Cognitive Level: Apply (application) REF: 1073

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the

nurse's 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."

ANS: C

The patient 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 patient with CKD.

DIF: Cognitive Level: Apply (application) REF: 1082

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

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

ANS: B

Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in

patients with CKD. The other data will not be helpful in evaluating the effectiveness of

calcium carbonate.

DIF: Cognitive Level: Apply (application) REF: 1081

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

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).

ANS: A

Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic

ileus (as indicated by absent bowel sounds) because bowel necrosis can occur. The BUN and

creatinine, blood glucose, and LOC would not affect the nurse's decision to give the

medication.

DIF: Cognitive Level: Apply (application) REF: 1080

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's

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

ANS: C

Poached eggs would provide high-quality protein, and apple juice is low in potassium. Cheese

is high in salt and phosphate, and tomato soup is high in potassium. Split-pea soup is high in

potassium, and dairy products are high in phosphate. Bananas are high in potassium, and

cream is high in phosphate.

DIF: Cognitive Level: Apply (application) REF: 1087

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

Before administration of calcium carbonate 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.

ANS: C

If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification.

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.

DIF: Cognitive Level: Apply (application) REF: 1081

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

A 37-yr-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

ANS: C

GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based

on factors such as fluid volume status and protein intake. Urine output can be normal or high

in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not

an accurate reflection of renal function.

DIF: Cognitive Level: Analyze (analysis) REF: 1079

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

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.

ANS: A

Arteriovenous (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 patient mobility.

DIF: Cognitive Level: Understand (comprehension) REF: 1088

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

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.

ANS: A

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.

DIF: Cognitive Level: Understand (comprehension) REF: 1087

TOP: Nursing Process: Planning MSC: NCLEX: Physiological

A 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. More protein is allowed because urea and creatinine are removed by dialysis.

c. Dietary potassium is not restricted because the level is normalized by dialysis.

d. Unlimited fluids are allowed because retained fluid is removed during dialysis.

ANS: B

When the patient is started on dialysis and nitrogenous wastes are removed, 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.

DIF: Cognitive Level: Apply (application) REF: 1087

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

Which action by a 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.

ANS: C

Patients are encouraged to take showers rather than baths to avoid infections at the catheter

insertion side. The other patient actions indicate good understanding of peritoneal dialysis.

DIF: Cognitive Level: Apply (application) REF: 1086

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

Which information in a patient's 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 human immunodeficiency virus.

ANS: B

Disseminated malignancies are a contraindication to transplantation. The conditions of the

other patients are not contraindications for kidney transplant.

DIF: Cognitive Level: Understand (comprehension) REF: 1092

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

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

ANS: C

Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids

over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are

not caused by corticosteroid use.

DIF: Cognitive Level: Apply (application) REF: 1096

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

A 38-yr-old patient who had a kidney transplant 8 years ago is receiving the

immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone .

Which assessment data will be of most concern to the nurse?

a. Skin is thin and fragile.

b. Blood pressure is 150/92.

c. A nontender axillary lump.

d. Blood glucose is 144 mg/dL.

ANS: C

A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result

of chronic immunosuppressive therapy. The elevated glucose, skin change, and hypertension

are possible side effects of the prednisone and should be addressed, but they are not as great a

concern as the possibility of a malignancy.

DIF: Cognitive Level: Analyze (analysis) REF: 1096

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

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. Acetaminophen

b. Calcium phosphate

c. Magnesium hydroxide

d. Multivitamin with iron

ANS: C

Magnesium is excreted by the kidneys, and patients with CKD should not use

over-the-counter products containing magnesium. The other medications are appropriate for a

patient with CKD.

DIF: Cognitive Level: Apply (application) REF: 1081

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

Before administration of captopril to a patient with stage 2 chronic kidney disease (CKD), the

nurse will check the patient's

a. glucose..

b. potassium.

c. creatinine

d. phosphate.

ANS: B

Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD

because they delay the progression of the CKD, but they cause potassium retention. Therefore

careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia.

The other laboratory values would also be monitored in patients with CKD but would not

affect whether the captopril was given or not.

DIF: Cognitive Level: Apply (application) REF: 1075

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin 60

mg IV BID. The nurse will monitor for adverse effects of the medication by evaluating the

patient's

a. blood glucose.

b. urine osmolality.

c. serum creatinine.

d. serum potassium.

ANS: C

When a patient at risk for chronic kidney disease (CKD) receives a potentially nephrotoxic

medication, it is important to monitor renal function with BUN and creatinine levels. The

other laboratory values would not be useful in assessing for the adverse effects of the

gentamicin.

DIF: Cognitive Level: Apply (application) REF: 1083

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

A 55-yr-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

ANS: C

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 erythropoietin (EPO) is administered to a target hemoglobin of greater than 12 g/dL.

Hemoglobin levels higher than 12 g/dL indicate a need for a decrease in epoetin alfa dose.

The other information also will be reported to the health care provider but will not affect

whether the medication is administered.

DIF: Cognitive Level: Apply (application) REF: 1081

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

Which intervention will be included in the plan of care for a 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 patient's oral protein intake.

d. Discontinue the urethral retention catheter.

ANS: B

The patient 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 patient 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 patient needs continuous pulse oximetry.

DIF: Cognitive Level: Apply (application) REF: 1088

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A 25-yr-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 of 2.1 mg/dL

b. Serum potassium level of 6.5 mEq/L

c. White blood cell count of 11,500/μL

d. Blood urea nitrogen (BUN) of 56 mg/dL

ANS: B

The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be

treated immediately. The nurse also will report the other laboratory values, but abnormalities

in these are not immediately life threatening.

DIF: Cognitive Level: Analyze (analysis) REF: 1072

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

A 72-yr-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.

ANS: A

The patient'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 patient. The other actions also are appropriate but should be

implemented after the retention catheter.

DIF: Cognitive Level: Analyze (analysis) REF: 1071

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity

A 62-yr-old female patient has been hospitalized for 4 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 less than 30 mL/min/1.73 m2

ANS: B

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.

DIF: Cognitive Level: Analyze (analysis) REF: 1072

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

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 patient's health care provider.

b. Document the QRS interval measurement.

c. Review the chart for the patient's current creatinine level.

d. Check the medical record for the most recent potassium level.

ANS: D

The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the

most recent potassium and then notify the patient's health care provider. The BUN and

creatinine will be elevated in a patient with AKI, but they would not directly affect the

electrocardiogram (ECG). Documentation of the QRS interval is also appropriate, but

interventions to decrease the potassium level are needed to prevent life-threatening

dysrhythmias.

DIF: Cognitive Level: Analyze (analysis) REF: 1072

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity

A 42-yr-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia,

and hyperkalemia. Which prescribed action 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).

ANS: B

Because hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to

monitor the cardiac rhythm. Kayexalate and Epogen 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.

DIF: Cognitive Level: Analyze (analysis) REF: 1073

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity

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.

ANS: B

Dialysis technicians are educated in monitoring for blood pressure. Assessment, adjustment of

the appropriate ultrafiltration rate, and patient teaching require the education and scope of

practice of an RN.

DIF: Cognitive Level: Apply (application) REF: 1089

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning

MSC: NCLEX: Safe and Effective Care Environment

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 patient's room.

ANS: C

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 LPN/LVN are appropriate for a patient with

renal insufficiency.

DIF: Cognitive Level: Apply (application) REF: 1082

OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation

MSC: NCLEX: Safe and Effective Care Environment

A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L

inflows. Which information should the nurse report promptly to the health care provider?

a. The patient has an outflow volume of 1800 mL.

b. The patient's peritoneal effluent appears cloudy.

c. The patient's abdomen appears bloated after the inflow.

d. The patient has abdominal pain during the inflow phase.

ANS: B

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

patient.

DIF: Cognitive Level: Apply (application) REF: 1087

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

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 patient's 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.

ANS: B

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 patient

after a transplant.

DIF: Cognitive Level: Analyze (analysis) REF: 1095

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

During routine hemodialysis, a patient complains of nausea and dizziness. Which action

should the nurse take first?

a. Slow down the rate of dialysis.

b. Check the blood pressure (BP).

c. Review the hematocrit (Hct) level.

d. Give prescribed PRN antiemetic drugs.

ANS: B

The patient'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.

DIF: Cognitive Level: Analyze (analysis) REF: 1090

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity

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

ANS: B

Fluid volume is replaced based on urine output after transplant because the urine output can

be as high as a liter an hour. The other data will be monitored but are not the most important

determinants of fluid infusion rate.

DIF: Cognitive Level: Analyze (analysis) REF: 1095

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity

A patient complains of leg cramps during hemodialysis. The nurse should

a. massage the patient's legs.

b. reposition the patient supine.

c. give acetaminophen (Tylenol).

d. infuse a bolus of normal saline.

ANS: D

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.

DIF: Cognitive Level: Apply (application) REF: 1091

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

A 74-yr-old patient 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."

ANS: B

The nurse should initially clarify the patient's concerns and questions about dialysis. The

patient is the one responsible for the decision, and many people using dialysis do have good

quality of life, but these responses block further assessment of the patient's concerns.

Referring to which type of dialysis the patient might use only indirectly responds to the

patient's question.

DIF: Cognitive Level: Analyze (analysis) REF: 1091

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Psychosocial Integrity

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

ANS: D

The patient who has tachycardia after hemodialysis may be bleeding or excessively

hypovolemic and should be assessed immediately for these complications. The other patients

also need assessments or interventions but are not at risk for life-threatening complications.

DIF: Cognitive Level: Analyze (analysis) REF: 1091

OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

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. Restrict fluid intake to 1000 mL 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

Patients who are receiving peritoneal dialysis should have a high-protein diet. Phosphate

binders are taken with meals to help control serum phosphate and calcium levels. Commercial

salt substitutes are high in potassium and should be avoided. Fluid intake is not limited unless

weight and blood pressure are not controlled. Dairy products are high in phosphate and

usually are limited.

DIF: Cognitive Level: Apply (application) REF: 1087

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A patient in the oliguric phase after an acute kidney injury has had a 250-mL urine output and

an emesis of 100 mL in the past 24 hours. What is the patient's fluid restriction for the next 24

hours?

ANS:

950 mL

The general rule for calculating fluid restrictions is to add all fluid losses for the previous 24

hours, plus 600 mL for insensible losses: (250 + 100 + 600 = 950 mL).

DIF: Cognitive Level: Understand (comprehension) REF: 1073

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity