NCLEX Q's AKI and CKD

NCLEX Q's AKI and CKD 5.0 (8 reviews) Students also studied Terms in this set (109) Northern Virginia Community College NSG 252 Save Acute Renal Injury & CKD - NCLEX 26 terms NurseLouPreview Renal Disorders/Dialysis & Peritone...132 terms rnin2018Preview Exam 4- Cirrhosis NCLEX Teacher 26 terms RegisteredNurse22 Preview Nclex Q 32 terms kar 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.Elevate the patients arm above the level of the heart.b.Report the patients symptoms to the health care provider.c.Remind the patient about the need to take a daily low- dose aspirin tablet.d.Educate the patient about the normal vascular response after AVG insertion.

ANS: B

The patients 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.

• A patient with acute kidney injury (AKI) has an arterial

blood pH of 7.30. The nurse will assess the patient for a.vasodilation.b.poor skin turgor.c.bounding pulses.d.rapid respirations.

ANS: D

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.

• A patient with severe heart failure develops elevated

blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet the goal of a.replacing fluid volume.b.preventing hypertension.c.maintaining cardiac output.d.diluting nephrotoxic substances.

ANS: C

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 patients 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.

• A patient who has acute glomerulonephritis is

hospitalized with acute kidney injury (AKI) and hyperkalemia. Which information will the nurse obtain to evaluate the effectiveness of the prescribed calcium gluconate IV?a.Urine output 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.

• A patient with stage 2 chronic kidney disease (CKD) is

scheduled for an intravenous pyelogram (IVP). Which of these orders for the patient will the nurse question?a.NPO for 6 hours before IVP procedure b.Normal saline 500 mL IV before procedure c.Ibuprofen (Advil) 400 mg PO PRN for pain d.Dulcolax suppository 4 hours before IVP procedure

ANS: C

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.

• Which statement by a patient with stage 5 chronic

kidney disease (CKD) indicates that the nurses teaching about management of CKD has been effective?a.I need to try to get more protein from dairy products.b.I will try to increase my intake of fruits and vegetables.c.I will measure my urinary output each day to help calculate the amount I can drink.d.I need to take the 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.

• Which patient information will the nurse plan to obtain

in order to determine the effectiveness of the 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.

• Before administering sodium polystyrene sulfonate

(Kayexalate) to a patient with hyperkalemia, the nurse should assess the a.blood urea nitrogen (BUN) and creatinine.b.blood glucose level.c.patients bowel sounds.d.level of consciousness (LOC).

ANS: C

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 nurses decision to give the medication.

• The nurse has instructed a patient who is receiving

hemodialysis about appropriate dietary choices. Which menu choice by the patient indicates that the teaching has been successful?a.Scrambled eggs, English muffin, and apple juice b.Oatmeal with cream, half a banana, and herbal tea c.Split-pea soup, whole-wheat toast, and nonfat milk d.Cheese sandwich, tomato soup, and cranberry juice

ANS: A

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.

• Before administration of calcium carbonate (Caltrate)

to a patient with chronic kidney disease (CKD), the nurse should check the laboratory value for a.creatinine.b.potassium.c.total cholesterol.d.serum phosphate.

ANS: D

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.

• Which information will be most useful to the nurse in

evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)?a.Blood urea nitrogen (BUN) level b.Urine output c.Creatinine level d.Calculated glomerular filtration rate (GFR)

ANS: D

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 patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.

• A patient needing vascular access for hemodialysis

asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it a.is much less likely to clot.b.increases patient mobility.c.can accommodate larger needles.d.can be used sooner after surgery.

ANS: A

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.