Acute Kidney Injury and Chronic Kidney Disease

Acute Kidney Injury and Chronic Kidney Disease NCLEX Leave the first rating Terms in this set (38) Lander UniversityNURN 304 Save When a pt with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of

• persistent skin tenting
• rapid, deep respirations.
• bounding peripheral pulses.
• hot, flushed face and neck.

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 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

• augmenting fluid volume.
• maintaining cardiac output.
• diluting nephrotoxic substances.
• 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 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 hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV?

• Urine volume
• Calcium level
• Cardiac rhythm
• 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 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?

• NPO for 6 hours before procedure
• Ibuprofen (Advil) 400 mg PO PRN

for pain

• Dulcolax suppository 4 hours

before procedure

• Normal saline 500 mL IV infused

before procedure

ANS: B

The contrast dye used in IVPs is potentially nephrotoxic, and concurrent use of other nephrotoxic medications such as the nonsteroidal anti-inflammatory drugs (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 failur Sodium polystyrene sulfonate (Kayexalate) is ordered for a pt with hyperkalemia. Before administering the medication, the nurse should assess the

• bowel sounds.
• blood glucose.
• blood urea nitrogen (BUN).
• 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 nurses decision to give the medication

Which menu choice by the patient who is receiving hemodialysis indicates that the nurses teaching has been successful?

• Split-pea soup, English muffin, and

nonfat milk

• Oatmeal with cream, half a

banana, and herbal tea

• Poached eggs, whole-wheat toast,

and apple juice

• 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 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 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?

• Urine volume
• Creatinine level
• Glomerular filtration rate (GFR)
• 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 A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft?

• A fistula is much less likely to clot.
• A fistula increases patient mobility.
• A fistula can accommodate larger

needles.

• 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

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?

• Auscultate for a bruit at the fistula

site.

• Assess the quality of the left radial

pulse.

• Compare blood pressures in the

left and right arms.

• 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 fistul 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?

• Increased calories are needed

because glucose is lost during hemodialysis.

• Unlimited fluids are allowed

because retained fluid is removed during dialysis.

• More protein is allowed because

urea and creatinine are removed by dialysis.

• Dietary potassium is not restricted

because the level is normalized by dialysis.

ANS: C

Once 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