A nurse reviews laboratory results for a client who was admitted for
a myocardial infarction and cardiogenic shock 2 days ago. Which
laboratory test result should the nurse expect to find?
a. Blood
urea nitrogen (BUN) of 52 mg/dL
b. Creatinine of 2.3
mg/dL
c. BUN of 10 mg/dL
d. BUN/creatinine ratio of 8:1
ANS: A
Shock leads to decreased renal perfusion. An elevated BUN
accompanies this condition. The creatinine should be normal because no
kidney damage occurred. A low BUN signifies overhydration,
malnutrition, or liver damage. A low BUN/creatinine ratio indicates
fluid volume excess or acute renal tubular acidosis.
A high BUN level indicates?
dehydration
A low BUN level indiactes?
over hydration, malnutrition or liver damage
A nurse cares for a client with a urine specific gravity of 1.018.
Which action should the nurse take?
a. Evaluate the client's
intake and output for the past 24 hours.
b. Document the finding
in the chart and continue to monitor.
c. Obtain a specimen for a
urine culture and sensitivity.
d. Encourage the client to drink
more fluids, especially water.
ANS: B
This specific gravity is within the normal range for
urine. There is no need to evaluate the client's intake and output,
obtain a urine specimen, or increase fluid intake.
A nurse cares for a client who has elevated levels of antidiuretic
hormone (ADH). Which disorder should the nurse identify as a trigger
for the release of this hormone?
a. Pneumonia
b.
Dehydration
c. Renal failure
d. Edema
ANS: B
ADH increases tubular permeability to water, leading to
absorption of more water into the capillaries. ADH is triggered by a
rising extracellular fluid osmolarity, as occurs in dehydration.
Pneumonia, renal failure, and edema would not trigger the release of ADH.
A nurse reviews a female client's laboratory results. Which results
from the client's urinalysis should the nurse recognize as
abnormal?
a. pH 5.6
b. Ketone bodies present
c.
Specific gravity of 1.020
d. Clear and yellow color
ANS: B
Ketone bodies are by-products of incomplete metabolism of
fatty acids. Normally no ketones are present in urine. Ketone bodies
are produced when fat sources are used instead of glucose to provide
cellular energy. A pH between 4.6 and 8, specific gravity between
1.005 and 1.030, and clear yellow urine are normal findings for a
female client's urinalysis.
The client newly diagnosed with chronic kidney disease recently has
begun hemodialysis. Knowing that the client is at risk for
disequilibrium syndrome, the nurse should assess the client during
dialysis for which associated manifestations?
A. Hypertension,
tachycardia, and fever
B. Hypotension, bradycardia, and
hypothermia
C. Restlessness, irritability, and
generalized weakness
D. Headache, deteriorating level of
consciousness, and twitching
D. Headache, deteriorating level of consciousness, and
twitching
Disequilibrium syndrome is characterized by headache,
mental confusion, decreasing level of consciousness, nausea, vomiting,
twitching, and possible seizure activity. Disequilibrium syndrome is
caused by rapid removal of solutes from the body during hemodialysis.
At the same time, the blood-brain barrier interferes with the
efficient removal of wastes from brain tissue. As a result, water goes
into cerebral cells because of the osmotic gradient, causing increased
intracranial pressure and onset of symptoms. The syndrome most often
occurs in clients who are new to dialysis and is prevented by
dialyzing for shorter times or at reduced blood flow rates.
A client has developed acute kidney injury (AKI) as a complication of
glomerulonephritis. The nurse should assess the client for which
expected manifestation of AKI?
A. Bradycardia
B.
Hypertension
C. Decreased cardiac output
D.
Decreased central venous pressure
B. Hypertension
AKI caused by glomerulonephritis is classified
as intrinsic or intrarenal failure. This form of AKI commonly
manifests with hypertension, tachycardia, oliguria, lethargy, edema,
and other signs of fluid overload. AKI from prerenal causes is
characterized by decreased blood pressure or a recent history of the
same, tachycardia, and decreased cardiac output and central venous
pressure. Bradycardia is not part of the clinical picture for any form
of renal failure.
The nurse is analyzing the post-hemodialysis laboratory test results
for a client with chronic kidney disease. The nurse interprets that
the dialysis is having an expected but nontherapeutic effect if which
value is decreased?
A. Potassium
B. Creatinine
C. Phosphorus
D. Red blood cell (RBC) count
D. Red blood cell (RBC) count
Hemodialysis typically lowers the
amounts of fluid, sodium, potassium, urea nitrogen, creatinine, uric
acid, magnesium, and phosphate levels in the blood. Hemodialysis also
worsens anemia because RBCs are lost during dialysis from blood
sampling and anticoagulation and from residual blood left in the
dialyzer. Although all of these results are expected, only the lowered
RBC count is nontherapeutic and worsens the anemia already caused by
the disease process.
A client with an arteriovenous fistula in the left arm and who is
undergoing hemodialysis is at risk for infection. Which should the
nurse formulate as the best outcome goal for this client problem?
A. The client washes hands at least once per day.
B. The client's temperature remains lower than 101° F.
C. The client avoids blood pressure (BP) measurement in the left
arm.
D. The client's white blood cell (WBC) count remains
within normal limits.
D. The client's white blood cell (WBC) count remains within normal
limits.
General indicators that the client is not experiencing
infection include a temperature and WBC count within normal limits.
The client also should use proper hand washing technique as a general
preventive measure. Hand washing once per day is insufficient. It is
true that the client should avoid BP measurement in the affected arm;
however, this would relate more closely to the problem of risk for injury.
The nurse is giving general instructions to a client receiving
hemodialysis. Which statement would be most appropriate for the nurse
to include?
A. "It is acceptable to eat whatever you want on
the day before hemodialysis."
B. "It is
acceptable to exceed the fluid restriction on the day before
hemodialysis."
C. "Medications should be
double-dosed on the morning of hemodialysis because of potential
loss."
D. "Several types of medications should
be withheld on the day of dialysis until after the procedure."
D. "Several types of medications should be withheld on the day
of dialysis until after the procedure."
Many medications are
dialyzable, which means that they are extracted from the bloodstream
during dialysis. Therefore many medications may be withheld on the day
of dialysis until after the procedure. It is not typical for
medications to be double-dosed, because there is no way to be certain
how much of each medication is cleared by dialysis. Clients receiving
hemodialysis are not routinely taught that it is acceptable to
disregard dietary and fluid restrictions
A client undergoing hemodialysis is at risk for bleeding from the
heparin used during the hemodialysis treatment. The nurse assesses for
this occurrence by periodically checking the results of which
laboratory test?
A. Bleeding time
B. Thrombin
time
C. Prothrombin time (PT)
D. Partial
thromboplastin time (PTT)
D. Partial thromboplastin time (PTT)
Heparin is the
anticoagulant used most often during hemodialysis. The hemodialysis
nurse monitors the extent of anticoagulation by checking the PTT,
which is the appropriate measure of heparin effect. Thrombin and
bleeding times are not used to measure the effect of heparin therapy,
although they are useful in the diagnosis of other clotting
abnormalities. The PT is one test used to monitor the effect of
warfarin (Coumadin) therapy
The nurse is monitoring the fluid balance of an assigned client. The
nurse determines that the client has proper fluid balance if which
24-hour intake and output totals are noted?
A. Intake
1500 mL, output 800 mL
B. Intake 3000 mL, output 2000
mL
C. Intake 2400 mL, output 2900 mL
D.
Intake 1800 mL, output 1750 mL
D. Intake 1800 mL, output 1750 mL
For the client taking a normal
diet, the normal fluid intake is approximately 1200 to 1800 mL of
measurable fluids per day. The client's output in the same period
should be about the same and does not include insensible losses, which
are extra. Insensible losses are offset by the fluid in solid foods,
which also is not measured.
The registered nurse is instructing a new nursing graduate about
hemodialysis. Which statement, if made by the new nursing graduate,
would indicate an understanding of the procedure for hemodialysis?
Select all that apply.
A. "Sterile dialysate must be
used."
B. "Dialysate contains metabolic waste
products."
C. "Heparin sodium is administered
during dialysis."
D. "Dialysis cleanses the
blood of accumulated waste products."
E.
"Warming the dialysate increases the efficiency of diffusion."
C. "Heparin sodium is administered during
dialysis."
D. "Dialysis cleanses the blood of
accumulated waste products."
E. "Warming the dialysate
increases the efficiency of diffusion."
Heparin sodium is
used during dialysis, and it inhibits the tendency of blood to clot
when it comes in contact with foreign substances. Option 4 is the
purpose of dialysis. The dialysate is warmed to approximately 100° F
to increase the efficiency of diffusion and to prevent a decrease in
the client's blood temperature. Dialysate is made from clear water and
chemicals and is free from any metabolic waste products or
medications. Bacteria and other microorganisms are too large to pass
through the membrane; therefore the dialysate does not need to be sterile.
The nurse is caring for a client with acute kidney injury (AKI). When
performing an assessment, the nurse would expect to note which
breathing pattern?
A. Apnea
B. Kussmaul's
respirations
C. Decreased respirations
D.
Cheyne-Stokes respirations
B. Kussmaul's respirations
Clinical manifestations associated
with AKI occur as a result of metabolic acidosis. The nurse would
expect to note Kussmaul's respirations as a result of the metabolic
acidosis because the bodily response is to exhale excess carbon
dioxide. The breathing patterns noted in options 1, 3, and 4 are not
characteristic of AKI.
The nursing student is assigned to care for a client with a diagnosis
of acute kidney injury (AKI), diuretic phase. The nursing instructor
asks the student about the primary goal of the treatment plan for this
client. Which goal, if stated by the nursing student, would indicate
an adequate understanding of the treatment plan for this client?
A. Prevent fluid overload.
B. Prevent loss of
electrolytes.
C. Promote the excretion of wastes.
D. Reduce the urine specific gravity.
B. Prevent loss of electrolytes.
In the diuretic phase, fluids
and electrolytes are lost in the urine. As a result, the plan of care
focuses on fluid and electrolyte replacement and monitoring. Options
1, 3, and 4 are not the primary concerns in this phase of acute kidney injury.
The nurse instructs a client about continuous ambulatory peritoneal
dialysis (CAPD). Which statement, if made by the client, indicates an
accurate understanding of CAPD?
A. "No machinery is
involved, and I can pursue my usual activities."
B.
"A cycling machine is used, so the risk for infection is
minimized."
C. "The drainage system can be used
once during the day and a cycling machine for three cycles at
night."
D. "A portable hemodialysis machine is
used so that I will be able to ambulate during the treatment."
A. "No machinery is involved, and I can pursue my usual
activities."
CAPD closely approximates normal renal
function, and the client will need to infuse and drain the dialysis
solution several times a day. No machinery is used, and CAPD is a
manual procedure.
The nurse tests the urine of a client with acute kidney injury (AKI)
with a multitest reagent strip. The strip tests highly positive for
proteinuria. The nurse plans care, knowing that this result is
consistent with which type of AKI?
A. Prerenal
B. Postrenal
C. Intrinsic
D. Atypical
C. Intrinsic
With intrinsic failure, there is a fixed specific
gravity and the urine tests positive for proteinuria. In prerenal
failure, the specific gravity is high and there is very little or no
proteinuria. In postrenal failure, there is a fixed specific gravity
and little or no proteinuria. There is no disorder known as atypical
renal failure.
A client with chronic kidney disease (CKD) is about to begin
hemodialysis therapy. The client asks the nurse about the frequency
and scheduling of hemodialysis treatments. The nurse's response is
based on an understanding that which represents the typical
schedule?
A. 5 hours of treatment 2 days per week
B. 2 hours of treatment 6 days per week
C. 3 to 4
hours of treatment 3 days per week
D. 2 to 3 hours of
treatment 5 days per week
C. 3 to 4 hours of treatment 3 days per week
The typical
schedule for hemodialysis is 3 to 4 hours of treatment 3 days per
week. Individual adjustments are made according to variables such as
the size of the client, type of dialyzer, rate of blood flow, personal
client preferences, and other factors.
A client is about to begin hemodialysis. Which measure(s) should the
nurse employ in the care of the client? Select all that apply.
A. Using sterile technique for needle insertion
B.
Using standard precautions in the care of the client
C.
Giving the client a mask to wear during connection to the
machine
D. Wearing full protective clothing such as
goggles, mask, gloves, and apron
E. Covering the
connection site with a bath blanket to enhance extremity warmth
A. Using sterile technique for needle insertion
B. Using
standard precautions in the care of the client
C. Giving the
client a mask to wear during connection to the machine
D. Wearing
full protective clothing such as goggles, mask, gloves, and
apron
Infection is a major concern with hemodialysis. For that
reason, the use of sterile technique and the application of a face
mask for both nurse and client are extremely important. It also is
imperative that standard precautions be followed, which includes the
use of goggles, mask, gloves, and an apron. The connection site should
not be covered; it should be visible so that the nurse can assess for
bleeding, ischemia, and infection at the site during the hemodialysis procedure.
List the Complications of Hemodialysis:
Major complication: cardiovascular
Anemia, Air embolism
Chest pain, Calcification of blood vessels
Dysrhythmias, Dialysis Disequilibrium
Exsanguination
Hypertriglycerdies, Hypotension
Naseau/vomitting
Painful muscles
sleep problems, SOB
Dialysis Disequilibrium is:
complication of HD results from cerebral shifts (head injury from dialysis)
S/S of dialysis disequilibrium:
headache, N/V, restlessness, decreased LOC, seizures
When does dialysis disequilibrium most often occur?
in AKI when BUN levels are super high reaching above 150
check for this when your patient comes back from dialysis
The nurse is working on a medical-surgical nursing unit and is caring
for several clients with chronic kidney disease. The nurse interprets
that which client is best suited for peritoneal dialysis as a
treatment option?
A. A client with severe heart failure
B. A client with a history of ruptured diverticula
C. A client with a history of herniated lumbar disk
D. A client with a history of three previous abdominal surgeries
A. A client with severe heart failure
Peritoneal dialysis may be
the treatment option of choice for clients with severe cardiovascular
disease. Severe cardiac disease can be worsened by the rapid shifts in
fluid, electrolytes, urea, and glucose that occur with hemodialysis.
For the same reason, peritoneal dialysis may be indicated for the
client with diabetes mellitus. Contraindications to peritoneal
dialysis include diseases of the abdomen such as ruptured diverticula
or malignancies; extensive abdominal surgeries; history of
peritonitis; obesity; and a history of back problems, which could be
aggravated by the fluid weight of the dialysate. Severe disease of the
vascular system also may be a relative contraindication.
A client is being discharged to home while recovering from acute
kidney injury (AKI). A reduction in which substance indicates to the
nurse that the client understands the dietary teaching?
A. Fats
B. Vitamins
C. Potassium
D. Carbohydrates
C. Potassium
The excretion of potassium and maintenance of
potassium balance are normal functions of the kidneys. In the client
with acute kidney injury or chronic kidney disease, potassium intake
must be restricted as much as possible (to 60 to 70 mEq/day). The
primary mechanism of potassium removal during AKI is dialysis.
Vitamins, carbohydrates, and fats are not normally restricted in the
client with AKI unless a secondary health problem warrants the need to
do so. The amount of fluid permitted is generally calculated to be
equal to the urine volume plus the insensible loss volume of 500 mL.
Before providing care for a client in the late stages of chronic
kidney disease (CKD), the nurse should review the results of which
most relevant laboratory study?
A. Urinalysis, hematocrit, hemoglobin
B. Culture and sensitivity testing, serum sodium
C. Urine specific gravity, intravenous pyelogram
D. Fasting blood glucose, serum potassium, serum calcium
D. Fasting blood glucose, serum potassium, serum calcium
Because
of the potentially life-threatening outcomes associated with
hyperglycemia, hyperkalemia, and hypocalcemia, they are the most
relevant to nursing management of the client with CKD. The diagnostic
tests in the remaining options may be helpful in diagnosing CKD or in
monitoring treatment but are not the most relevant. Additionally,
decreased hematocrit and hemoglobin occur in CKD because of the
decreased level of erythropoietin. However, a decrease in hematocrit
and hemoglobin may be reflective of various health alterations.
In performing a physical assessment of a client with chronic kidney
disease (CKD), which finding should the nurse anticipate to note?
A. Glycosuria
B. Polyphagia
C. Crackles auscultated in lungs
D. Blood pressure 98/58 mm Hg
C. Crackles auscultated in lungs
Chronic kidney disease is a
condition in which the kidneys have progressive problems in clearing
nitrogenous waste products and controlling fluid and electrolyte
balance within the body. Cardiovascular symptoms of heart failure and
hypertension are caused by the fluid volume overload resulting from
the kidney's inability to excrete water. Signs and symptoms of heart
failure include jugular venous distention, S3 heart sound, pedal
edema, increased weight, shortness of breath, and crackles auscultated
in the lungs. The typical signs and symptoms of CKD include
proteinuria or hematuria, not glycosuria. The nurse would observe
anorexia and nausea in this client, not polyphagia.