Nursing Management of Acute Kidney Injury and Chronic Kidney Disease: Test Bank, Exams of Nursing

Download Nursing Management of Acute Kidney Injury and Chronic Kidney Disease: Test Bank and more Exams Nursing in PDF only on Docsity! BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 5/10/17, 1:24 PM Page 1 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease Nursing School Test Banks Chapter 47: Nursing Management: Acute Kidney In- jury and Chronic Kidney Disease Chapter 47: Nursing Management: Acute Kidney Injury and Chronic Kidney Disease Test Bank MULTIPLE CHOICE 1. After the insertion of an arteriovenous graft (AVG) in the right forearm, a 54-year-old patient com- plains 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 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 5/10/17, 1:24 PM Page 2 of 30 The patient’s complaints suggest the development of distal ischemia (steal syndrome) and may require BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 5/10/17, 1:24 PM Page 5 of 30 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: 1105 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 5. A 48-year-old patient with stage 2 chronic kidney disease (CKD) is scheduled for an intravenous pyel- ogram (IVP). Which order for the patient will the nurse question? a. NPO for 6 hours before procedure b. Ibuprofen (Advil) 400 mg PO PRN for pain c. Dulcolax suppository 4 hours before procedure d. 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 med- ications 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 en- sure adequate hydration, which helps reduce the risk for contrast-induced renal failure. BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 5/10/17, 1:24 PM Page 6 of 30 DIF: Cognitive Level: Apply (application) REF: 1115 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 6. Which statement by a 62-year-old 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 kidney 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: 1115 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 7. Which information will the nurse monitor in order to determine the effectiveness of prescribed calci- um carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a. Blood pressure BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 5/10/17, 1:24 PM Page 7 of 30 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: 1113 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 8. Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before admin- istering 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 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 5/10/17, 1:24 PM Page 10 of 30 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: Apply (application) REF: 1112 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 12. A patient will need vascular access for hemodialysis. Which statement by the nurse accurately de- scribes 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 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 5/10/17, 1:24 PM Page 11 of 30 have an impact on needle size or patient mobility. DIF: Cognitive Level: Understand (comprehension) REF: 1120 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 13. 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 quali- ty 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: 1120 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 14. 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 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 5/10/17, 1:24 PM Page 12 of 30 teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. Unlimited fluids are allowed because retained fluid is removed during dialysis. c. More protein is allowed because urea and creatinine are removed by dialysis. d. 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 short- ness 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: 1114-1115 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 15. Which action by a 70-year-old 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. BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 5/10/17, 1:24 PM Page 15 of 30 c. The patient’s skin is thin and fragile. d. The patient’s blood pressure is 150/92. ANS: B 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 ef- fects of the prednisone and should be addressed, but they are not as great a concern as the possibility of a malignancy. DIF: Cognitive Level: Apply (application) REF: 1128 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 19. 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. Multivitamin with iron b. Magnesium hydroxide c. Acetaminophen (Tylenol) d. Calcium phosphate (PhosLo) BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 5/10/17, 1:24 PM Page 16 of 30 ANS: B 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: 1113 | 1115-1116 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 20. Before administration of captopril (Capoten) 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: 1113 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 5/10/17, 1:24 PM Page 17 of 30 21. A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin (Garamycin) 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: 1102 | 1114 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 22. A 55-year-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 be- fore giving the medication? a. Creatinine 1.6 mg/dL b. Oxygen saturation 89% 5/10/17, 1:24 PM Page 20 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease MSC: NCLEX: Physiological Integrity 5/10/17, 1:24 PM Page 21 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 25. A 72-year-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute uri- nary 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 uri- nary retention, so the insertion of a retention catheter is the first action to prevent ongoing postrenal fail- ure for this patient. The other actions also are appropriate, but should be implemented after the retention catheter. DIF: Cognitive Level: Apply (application) REF: 1102-1103 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 26. A 62-year-old female patient has been hospitalized for 8 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? 5/10/17, 1:24 PM Page 22 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease a. The creatinine level is 3.0 mg/dL. 5/10/17, 1:24 PM Page 25 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease ANS: C 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 pre- vent life-threatening dysrhythmias. DIF: Cognitive Level: Apply (application) REF: 1112 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 28. A 42-year-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed actions 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 5/10/17, 1:24 PM Page 26 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease catheter allows monitoring of the urine output but does not correct the cause of the renal failure. 5/10/17, 1:24 PM Page 27 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease DIF: Cognitive Level: Apply (application) REF: 1104 | 1109 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 29. 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 ap- propriate ultrafiltration rate, and patient teaching require the education and scope of practice of an RN. DIF: Cognitive Level: Apply (application) REF: 15-16 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 30. A licensed practical/vocational nurse (LPN/LVN) is caring for a patient with stage 2 chronic kidney 5/10/17, 1:24 PM Page 30 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 5/10/17, 1:24 PM Page 31 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease d. The patient’s abdomen appears bloated after the inflow. 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 interven- tions such as slowing the inflow and repositioning the patient. DIF: Cognitive Level: Apply (application) REF: 1119 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 32. The nurse is assessing a patient 4 hours after a kidney transplant. Which information is most impor- tant 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 hypoper- 5/10/17, 1:24 PM Page 32 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease fusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant. 5/10/17, 1:24 PM Page 35 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 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: Apply (application) REF: 1122 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 35. A patient complains of leg cramps during hemodialysis. The nurse should first a. massage the patient’s legs. b. reposition the patient supine. c. give acetaminophen (Tylenol). 5/10/17, 1:24 PM Page 36 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease d. infuse a bolus of normal saline. 5/10/17, 1:24 PM Page 37 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease ANS: D Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes in- fusion of normal saline. The other actions do not address the reason for the cramps. DIF: Cognitive Level: Apply (application) REF: 1127 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 36. A 74-year-old 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 pa- 5/10/17, 1:24 PM Page 40 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease 1. Which information will be included when the nurse is teaching self-management to a patient who is 5/10/17, 1:24 PM Page 41 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease receiving peritoneal dialysis (select all that apply)? a. Avoid commercial salt substitutes. b. Drink 1500 to 2000 mL of fluids 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 tak- en with meals to help control serum phosphate and calcium levels. Commercial salt substitutes are high in potassium and should be avoided. Fluid intake is limited in patients requiring dialysis. Dairy products are high in phosphate and usually are limited. DIF: Cognitive Level: Apply (application) REF: 1119 | 1115 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity SHORT ANSWER 1. A patient in the oliguric phase after an acute kidney injury has had a 250 mL urine output and an eme- sis of 100 mL in the past 24 hours. What is the patient’s fluid restriction for the next 24 hours? 5/10/17, 1:24 PM Page 42 of 30 BIO 2711 lewis Chapter 47 Nursing Management Acute Kidney Injury and Chronic Kidney Disease ANS: