Acute Kidney Injury and Chronic Kidney Disease Management, Exams of Medicine

Download Acute Kidney Injury and Chronic Kidney Disease Management and more Exams Medicine in PDF only on Docsity! GU EAQ A client with an acute kidney injury has peritoneal dialysis (PD) prescribed and asks why the procedure is necessary. Which response statement would the nurse use? 1 "PD prevents the development of serious heart problems by removing the damaged tissues." 2 "PD helps perform some of the work usually performed by your kidneys." 3 "PD stabilizes the kidney damage and may 'restart' your kidneys to perform better than before." 4 "PD speeds recovery because the kidneys are not responding to regulating hormones." - ANS 2 (PD removes chemicals, wastes, and fluids usually removed from the body by the kidneys. The mention of heart problems is a threatening response and may cause increased fear or anxiety. Telling the patient that PD may 'restart' your kidneys so that they perform better than before is misleading. PD helps maintain fluid and electrolytes; in acute kidney injury, damage occurs in the nephrons, so the PD may or may not speed recovery.) Which information would the nurse include in response to a client's questioning a protein-restricted dietary change required for his or her acute kidney injury? 1 "A high-protein intake ensures an adequate daily supply of amino acids to compensate for losses." 2 "Essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis." 3 "This diet supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys." 4 "Currently, your body is unable to synthesize amino acids, so the nitrogen for amino acid synthesis must come from the dietary protein." - ANS 3 (The amount of protein permitted in the diet depends on the extent of kidney function; excess protein causes an increase in urea concentration, excess metabolic waste, and added stress on the kidneys. The restricted protein diet prevents overburdening the client's kidneys at this time. When experiencing acute kidney injury, the kidneys are unable to eliminate the waste products of a high-protein diet. The body is able to synthesize the nonessential amino acids. Urea is a waste product of protein metabolism; the body is able to synthesize the nonessential amino acids.) A client with acute kidney injury states, "Why am I experiencing twitching and tingling of my fingers and toes?" Which process would the nurse consider when formulating a response to this client? 1 Acidosis 2 Calcium depletion 3 Potassium retention 4 Sodium chloride depletion - ANS 2 (In kidney failure, as the glomerular filtration rate decreases, phosphorus is retained. As hyperphosphatemia occurs, calcium is excreted. Calcium depletion hypocalcemia causes tetany, which causes twitching and tingling of the extremities, among other symptoms. Acidosis, potassium retention, and sodium chloride depletion are not characterized by twitching and tingling of the extremities.) A client is diagnosed with acute kidney failure secondary to dehydration. An intravenous (IV) infusion of 50% glucose with regular insulin is prescribed to address which purpose? 1 To correct hyperkalemia 2 To increase urinary output 3 To prevent respiratory acidosis 4 To increase serum calcium levels - ANS 1 (The 50% glucose and regular insulin infusion treats the hyperkalemia associated with kidney failure; it moves potassium from the intravascular compartment into the intracellular compartment. Insulin will not increase urinary output. Insulin is not a treatment for respiratory acidosis. Insulin and glucose do not increase serum calcium levels.) The nurse is notified that the latest potassium level for a client who has acute kidney injury is 6.2 mEq (6.2 mmol/L). Which action would the nurse take? 1 concentration of particles, thereby removing waste products into the dialysate, which is then drained from the abdomen. The principle of ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal dialysis uses the peritoneal membrane for indirect cleansing of the blood. Dialysate does not clear toxins in a short time; exchanges may occur four or five times a day.) Which element would the nurse teach the client with chronic kidney disease to limit as an intervention to control uremia associated with end-stage renal disease? 1 Fluid 2 Protein 3 Sodium 4 Potassium - ANS 2 (The waste products of protein metabolism are the main cause of uremia. The severity of the chronic kidney disease determines the degree of protein restriction. Fluid restriction may be necessary to prevent edema, heart failure, or hypertension; fluid intake does not directly influence uremia. Sodium restrictions control fluid retention, not uremia. Potassium restrictions prevent hyperkalemia, not uremia.) The nurse teaches a client with chronic kidney disease to avoid all salt substitutes in his or her diet. Which rationale supports the nurse's instruction? 1 A person's body tends to retain fluid when a salt substitute is included in the diet. 2 Limiting salt substitutes in the diet prevents a buildup of waste products in the blood. 3 Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats. 4 The salt substitute substances interfere with capillary membrane transfer, resulting in anasarca. - ANS 3 (Salt substitutes usually contain potassium, which can lead to hyperkalemia; dysrhythmias are associated with hyperkalemia. Chronic kidney disease already places the client at a higher risk for hyperkalemia because of poor elimination of fluids and electrolytes. Sodium, not salt substitutes, in the diet causes retention of fluid. Salt substitutes do not contain substances that influence blood urea nitrogen and creatinine levels; these are the result of protein metabolism. There is not a substance in the salt substitute that interferes with capillary membrane transfer. Anasarca is extensive fluid in the tissues throughout the body and more extensive than typical edema.) The nurse reviews the medical record of an older adult client admitted with chronic kidney disease. Which clinical finding is the priority requiring collaboration with the primary health care provider? 1 Sodium level: 135 2 Potassium level: 6 3 Creatinine results: 20 4 Blood pressure results: 150/100 - ANS 2 (The client has an increased potassium level outside the expected range for an adult, placing the client at risk for a cardiac dysrhythmia; the higher priority is treatment for the increased potassium, because elevated levels can be lethal. The serum sodium of 135 mEq/L (135 mmol/L) is expected because of the electrolyte imbalance and the anemia related to the decreased production of erythropoietin by the kidney in the presence of chronic kidney failure. A creatinine clearance of 20 mL/min (0.33 mL/s) is low (normal range 95 mL/min in young women; 120 mL/min in young men); however, the client has chronic renal disease and this value reflects the disease process. The priority is the high potassium level. Clients with chronic kidney disease usually have hypertension, and notification is unnecessary.) The primary health care provider for a client with chronic kidney disease prescribed immediate hemodialysis for the first time. Which clinical manifestation indicates the need for immediate hemodialysis in this client? 1 Ascites 2 Acidosis 3 Hypertension 4 Hyperkalemia - ANS 4 (Protein breakdown liberates cellular potassium ions, leading to hyperkalemia, which can cause a cardiac dysrhythmia and standstill. The failure of the kidneys to maintain a balance of potassium is one of the main indications for dialysis. Ascites occurs in liver disease and is not an indication for dialysis. Dialysis is not the usual treatment for acidosis; usually acidosis responds to administration of alkaline medications. Dialysis is not a treatment for hypertension. Treatment for hypertension includes antihypertensive medications and diet.) Which type of cytokine is used to treat anemia secondary to chronic kidney disease? 1 α-Interferon 2 Interleukin-2 3 Interleukin-11 4 Erythropoietin - ANS 4 (Cytokines are signaling cells. Erythropoietin is used to treat anemia related to chronic kidney disease. The failing kidneys are not able to produce erythropoietin to signal the bone marrow to produce red blood cells, resulting in anemia. α-Interferon is used to treat hairy cell leukemia or malignant melanoma. Interleukin-2 is used to treat metastatic renal carcinoma. Interleukin-11 is used to prevent thrombocytopenia after chemotherapy.) Which assessment is necessary for the nurse to complete in a client with chronic kidney disease receiving loop diuretics? 1 Hemoglobin levels 2 Occurrence of nausea 3 Presence of constipation 4 Intake and output measurement - ANS 4 (Diuretics are administered to increase urine output, so the measure of intake and output are very important to diuretic use. Hemoglobin levels are important to monitor in the use of erythropoietin in the chronic kidney disease client. Nausea and constipation are important to monitor with the administration of iron-containing vitamins and mineral supplements.) Which sign and symptom is an associated complication of chronic kidney disease while undergoing peritoneal dialysis? 1 4 Removing toxins and metabolic wastes - ANS 4 (Peritoneal dialysis uses the peritoneum as a selectively permeable membrane for diffusion of toxins and wastes from the blood into the dialyzing solution. Peritoneal dialysis acts as a substitute for kidney function; it does not reestablish kidney function. The dialysate does not clean the peritoneal membrane; the semipermeable membrane allows toxins and wastes to pass into the dialysate within the abdominal cavity. Fluid in the abdominal cavity does not enter the intracellular compartment.) A client receiving peritoneal dialysis develops symptoms of severe respiratory difficulty during the infusion of the dialysate solution. Which action would the nurse take? 1 Increase the rate of infusion. 2 Auscultate the lungs for breath sounds. 3 Place the client in a supine position. 4 Drain the fluid from the peritoneal cavity. - ANS 4 (Pressure from the fluid may cause upward displacement of the diaphragm; draining the solution reduces intra-abdominal pressure, which allows the thoracic cavity to expand on inspiration. Additional fluid will aggravate the problem. Auscultation is important, but it does not alleviate the problem. The client should be placed in the semi-Fowler position for peritoneal dialysis; this allows inflow of fluid while not impinging on the thoracic cavity.) Which action would the nurse take before a client's scheduled hemodialysis treatment? 1 Obtain the client's urine specimen to evaluate kidney function. 2 Weigh the client to establish a baseline for later comparison. 3 Administer medications that are scheduled to be given within the next hour. 4 Explain that the peritoneum serves as a semipermeable membrane to remove wastes. - ANS 2 (A baseline weight must be obtained to be able to determine the net fluid loss from dialysis. Obtaining a urine specimen to evaluate kidney function is not necessary; clients with advanced kidney disease may not produce urine. Medications often are delayed until after dialysis to prevent them from being filtered into the dialysate. Explaining that the peritoneum serves as a semipermeable membrane to remove wastes applies to peritoneal dialysis, not hemodialysis.) A client with end-stage renal failure begins hemodialysis for the first time. Which prescribed hemodialysis protocol would the nurse implement when the client reports nausea and a headache, and then appears to become confused? 1 Administer an analgesic for the headache. 2 Administer an antiemetic for the nausea. 3 Decrease the rate of the hemodialysis exchange. 4 Discontinue the procedure immediately. - ANS 3 (Headache, nausea, and confusion are signs and symptoms of disequilibrium syndrome, which results from rapid changes in composition of the extracellular fluid; therefore the nurse would decrease the rate of hemodialysis exchange. Although an analgesic may relieve the headache, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Although administering an antiemetic may relieve the nausea, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Discontinuing the procedure is unnecessary; reducing the rate of exchange should reduce the adaptations of disequilibrium syndrome.) Which food would the nurse encourage the client requiring hemodialysis to include in his or her dietary intake? 1 Rice 2 Potatoes 3 Canned salmon 4 Barbecued beef - ANS 1 (Foods high or moderately high in carbohydrates and low in protein, sodium, and potassium are encouraged for clients on hemodialysis. Potatoes are high in potassium, which is restricted. Canned salmon is high in protein and sodium, which usually are restricted. Barbecued beef is high in protein, sodium, and potassium, which usually are restricted.) A client receiving hemodialysis undergoes surgery to create an arteriovenous fistula. Before discharge, the nurse discusses care at home with the client and his wife. Which statement by the client's wife indicates that further teaching is required? 1 "I must touch the shunt several times a day to feel for the bruit." 2 "I have to take his blood pressure every day in the arm with the fistula." 3 "He will have to be very careful at night not to lie on the arm with the fistula." 4 "We really should check the fistula every day for signs of redness and swelling." - ANS 2 (Taking the blood pressure in the affected arm may injure the fistula. The presence of a bruit indicates that the circulation is not obstructed by a thrombus. Hemorrhage can occur in a matter of minutes if the cannula is dislodged. It is correct that the patient should not lie on the arm with the fistula. Redness and swelling are signs of infection, which is a complication of cannulization.) Where is the blood pressure cuff placed on a client with a dialysis access fistula in the right arm? 1 On the left arm 2 Over the fistula 3 Below the fistula 4 Above the fistula - ANS 1 (If the fistula is located in the right arm, then the left arm should be used for blood pressure cuff placement. Blood pressure cuffs or any other restrictive devices should not be placed on the arm with a dialysis access fistula including above, below, or over the fistula site.Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers.) A client who is receiving peritoneal dialysis reports severe respiratory difficulty. Which immediate action would the nurse implement? 1 Auscultate the lungs. 2 1 Low sedimentation rate 2 Increased serum complement 3 Increased antistreptolysin O (ASO) titer 4 Decreased blood urea nitrogen level - ANS 3 (An increased ASO titer indicates the presence of a previous streptococcal infection; levels are highest with AGN, bacterial endocarditis, and scarlet fever. The sedimentation rate is increased in glomerulonephritis; it signifies an inflammatory process. A reduction in serum complement (C3) activity occurs early in the disease process of glomerulonephritis; activity increases as the child improves. The blood urea nitrogen level is increased, not decreased, with glomerulonephritis because of impaired glomerular function, with azotemia occurring as a result.) The parents of a 7-year-old child who has acute glomerulonephritis (AGN) are fearful that their other child may contract the illness. Which would the nurse explain to them about the disorder? 1 The cause of AGN is unknown, so it is difficult to know how to prevent it. 2 AGN is inherited as a sex-linked recessive trait that usually occurs only in males. 3 The cause of AGN is the formation of a clot in the renal tubules resulting from a systemic infection. 4 AGN is caused by an antigen-antibody response that is usually associated with Streptococcus infection. - ANS 4 (AGN is usually the sequela of a beta-hemolytic streptococcal infection; it is not contagious. The cause is known; prevention depends on treating individuals who contract a streptococcal infection with antibiotics to eliminate the organism. AGN is an acquired, not an inherited, disorder, although incidence in males outnumbers that in females 2:1. The precipitating streptococcal infection is usually a localized pharyngitis, and clots do not form in the small renal tubules.) A child who has a history of a 5-lb (2.3 kg) weight gain in 1 week and periorbital edema is admitted with a diagnosis of acute glomerulonephritis. How can the nurse obtain the most accurate information on the status of the child's edema? 1 Weighing daily 2 Observing body changes 3 Measuring intake and output 4 Monitoring electrolyte values - ANS 1 (Weight monitoring is the most useful meANS of assessing fluid balance and changes in the edematous state; 1 L of fluid weighs about 2.2 lb (1 kg). Visual inspection is subjective and generally inaccurate. Measuring intake and output is not as accurate as daily weights; fluid may be trapped in the third compartment. Monitoring of electrolyte values is unreliable; they may or may not be altered with fluid shifts.) A school-age child is admitted with hypertensive acute glomerulonephritis. Which medication would the nurse anticipate being prescribed initially in addition to hydralazine? 1 Digoxin 2 Alprazolam 3 Phenytoin 4 Furosemide - ANS 4 (Furosemide is a loop diuretic that is recommended for the treatment of acute glomerulonephritis; it promotes the excretion of fluid and thus limits fluid retention. Digoxin is not used because there is no cardiac involvement. An anxiolytic is unnecessary. Phenytoin may be used only if hypertensive encephalopathy causes seizures.) A child who has nephrotic syndrome is prescribed steroid therapy. Which explanation would the nurse give the parents regarding the goal of this treatment? 1 Prevents infection 2 Stimulates diuresis 3 Provides hemopoiesis 4 Reduces blood pressure - ANS 2 (Although the exact mechanism is unknown, steroids produce diuresis in most children with nephrotic syndrome. Steroids will not prevent infection and will mask the signs and symptoms of infection. Steroids have no effect on the production of red blood cells. Steroids do not reduce hypertension, and hypertension is not a common finding in children with nephrotic syndrome.) Monitoring vital signs, particularly the blood pressure and the pulse rate and quality, is essential in detecting physiological adaptations in a preschool child with nephrotic syndrome. Which clinical manifestation would the nurse be able to detect from these vital signs? 1 Heart failure 2 Hypovolemia 3 Pulmonary embolus 4 Increased serum potassium - ANS 2 (The shift of fluid from the intravascular to the interstitial compartment predisposes the child to hypovolemia; a weak, thready pulse and hypotension are signs of impending shock. Heart failure is usually not a complication of nephrotic syndrome; however, it is a major complication of glomerulonephritis. The development of a pulmonary embolus is not a complication of nephrotic syndrome. Chest pain and dyspnea are signs of a pulmonary embolus. Hypokalemia, not hyperkalemia, occurs. Tubular reabsorption of sodium is increased to replenish the vascular volume; therefore, potassium is excreted.) Which foods would the nurse encourage the client to eat to prevent constipation after a suprapubic prostatectomy? Select all that apply. One, some, or all responses may be correct. 1 Milk 2 Apples 3 Oatmeal 4 Green peas 5 Which instruction would the nurse provide to a client receiving brachytherapy for prostate cancer to prevent injury? 1 "Use bleach when doing laundry." 2 "Wear a mask when around others." 3 "Flush the toilet several times after use." 4 "Refrain from close contact with others." - ANS 4 (Brachytherapy involves the implantation of radioactive isotopes near the tumor to destroy cancer cells. Clients are radioactive while receiving treatment, making them potentially hazardous to others. Therefore, the nurse will instruct clients to refrain from close contact with others. Using bleach with the laundry and flushing the toilet several times are instructions for clients receiving chemotherapy. Clients who are immunosuppressed will be instructed to wear a face mask to help prevent infections.) A 75-year-old male who has a history of prostate cancer is admitted for a prostatectomy. The client's prostate specific antigen (PSA) levels have been increasing. Which intervention would the nurse to include in the client's plan of care? 1 Encourage the client to drink extra fluids. 2 Institute seizure precautions. 3 Monitor the plasma pH for acidosis. 4 Handle the client gently when turning. - ANS 4 (Increasingly elevated PSA levels may indicate a worsening of the client's condition with possible metastasis to the bone, increasing the risk of pathological fractures; therefore handling must be gentle. Additional fluids will not improve the PSA level. Seizure precautions are not necessary; a PSA elevation indicates bone, not brain, involvement. Elevated PSA levels do not significantly affect the plasma pH.) Sildenafil is prescribed for a man with erectile dysfunction. Which side effects of this medication would the nurse mention in teaching? Select all that apply. One, some, or all responses may be correct. 1 Flushing 2 Headache 3 Dyspepsia 4 Constipation 5 Hypertension - ANS 1, 2, 3 (Flushing is a common central nervous system response to sildenafil. Headache is a common central nervous system response to sildenafil. Dyspepsia is a common gastrointestinal response to sildenafil. Diarrhea, not constipation, is a common gastrointestinal response to sildenafil. Hypotension, not hypertension, is a cardiovascular response to sildenafil. It should not be taken with anti-hypertensives and nitrates because medication interactions can precipitate cardiovascular collapse.) 1. calorie malnutrition 2. lack of protein quality/quantity ("pot belly" sign) 3. combined energy and protein malnutrition - ANS marasmus, kwashiorkor, marasmic-kwashiorkor normal BMI range - ANS 18.5-24.9 HCT: F, m HGB: F, m BUN: Creatinine: Albumin: Potassium: Phosphorus: - ANS Hct: F: 12-15, M: 13.5-17.5 Hgb: F: 35-45%, M: 38.8-50% BUN: 10-20 Creatinine: 0.5-1.1 Albumin 3.5-5 Potassium: 3.5-5 Phosphorus: 2.4-4.1 Drugs to stimulate appetite - ANS Periactin (antihistamine), Megace, multivitamins A PT with a history of CKD is admitted with acute shoulder pain. What order should you question 1. Metoprolol 50mg PO bid 2. Digoxin 0.125mg daily 3. Ibuprofen 800mg q4hr for pain 4. Pan cultures for a temperature >38.5 C - ANS 3 Which patient is most likely to have renal compromise assessed by decreased urine production? 1. 10 year history of diabetes mellites 2. Recent history of stroke 3. White blood cell count of 12,000 4. Blood pressure of 82/40 for 12 hours - ANS 4 You have a patient with pre-renal AKI. Which condition would you expect to find in the patients history 1. Pyelonephritis 2. Myocardial infarction 3. Bladder cancer 4. Kidney stones - ANS 3 Which patient statement about nutrition and nephrotic syndrome which normal GFR is correct a. I must decrease my intake of fat b. I will increased my intake of protein c. A decreased intake of carbohydrates will be required d. An increased intake of vitamin C in necessary - ANS b Which is a result of stimulation of erythropoietin production in the kidney tissue