NURS 1300: Care of Patients with Acute Kidney Injury and Chronic Kidney Disease, Exams of Nursing

Download NURS 1300: Care of Patients with Acute Kidney Injury and Chronic Kidney Disease and more Exams Nursing in PDF only on Docsity! NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK i. The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess first upon initial rounding? a.Woman with a blood pressure of 158/90 mm Hg b. Client with Kussmaul respirations c.Man with skin itching from head to toe d. Client with halitosis and stomatitis ANS: B Kussmaul respirations indicate a worsening of chronic kidney disease (CKD). The client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs. Hypertension is common in most clients with CKD, and skin itching increases with calcium-phosphate imbalances, another common finding in CKD. Ure- mia from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis. DIF: Applying/Application REF: 1420 KEY: Renal system| nursing assessment| respiratory system MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care ii. The charge nurse of the medical-surgical unit is making staff assignments. Which staff member should be assigned to a client with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub? a.Registered nurse who just floated from the surgical unit b. Registered nurse who just floated from the dialysis unit c.Registered nurse who was assigned the same client yesterday d. Licensed practical nurse with 5 years’ experience on this floor ANS: C The client is exhibiting symptoms of pericarditis, which can occur with chronic kidney disease. Continuity of care is important to assess subtle differences in clients. Therefore, the registered nurse (RN) who was assigned to this client previously should again give care to this client. The float nurses would not be as NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK knowledgeable about the unit and its clients. The licensed practical nurse may not have the education level of the RN to assess for pericarditis. DIF: Applying/Application REF: 1421 KEY: Renal system| supervision-assignment| patient-centered care MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care iii. The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which condition would the nurse expect to find in the client’s recent history? a.Pyelonephritis b. Myocardial infarction c.Bladder cancer d. Kidney stones ANS: B Pre-renal causes of AKI are related to a decrease in perfusion, such as with a myocardial infarction. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney stones are post-renal causes of AKI related to urine flow obstruction. DIF: Understanding/Comprehension REF: 1412 KEY: Renal system| pathophysiology| nursing analysis MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation iv. A marathon runner comes into the clinic and states “I have not urinated very much in the last few days.” The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is the priority? a.Give the client a bottle of water immediately. b. Start an intravenous line for fluids. c.Teach the client to drink 2 to 3 liters of water daily. d. Perform an electrocardiogram. ANS: A NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK KEY: Renal system| pathophysiology| dehydration MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation vii. A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurse’s priority action? a.Calculate the mean arterial pressure (MAP). b. Ask for insertion of a pulmonary artery catheter. c.Take the client’s pulse. d. Slow down the normal saline infusion. ANS: D The nurse should assess that the client could be developing fluid overload and respiratory distress and slow down the normal saline infusion. The calculation of the MAP also reflects perfusion. The insertion of a pul- monary artery catheter would evaluate the client’s hemodynamic status, but this should not be the initial ac- tion by the nurse. Vital signs are also important after adjusting the intravenous infusion. DIF: Applying/Application REF: 1416 KEY: Renal system| hemodynamic status| nursing intervention MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care viii. A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, and a urine output of 350 mL/day. What is the best action by the nurse? a.Place the client on a cardiac monitor immediately. b. Teach the client to limit high-potassium foods. c.Continue to monitor the client’s intake and output. d. Ask to have the laboratory redraw the blood specimen. ANS: A The priority action by the nurse should be to check the cardiac status with a monitor. High potassium levels can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but not the best immediate action. DIF: Applying/Application REF: 1421 NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK KEY: Renal system| electrolyte imbalance| nursing intervention MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation ix. A client has just had a central line catheter placed that is specific for hemodialysis. What is the most appro- priate action by the nurse? a.Use the catheter for the next laboratory blood draw. NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK b. Monitor the central venous pressure through this line. c.Access the line for the next intravenous medication. d. Place a heparin or heparin/saline dwell after hemodialysis. ANS: D The central line should have a heparin or heparin/saline dwell after hemodialysis treatment. The central line catheter used for dialysis should not be used for blood sampling, monitoring central venous pressures, or giv- ing drugs or fluids. DIF: Remembering/Knowledge REF: 1435 KEY: Renal system| vascular access device| nursing intervention MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control x. A client in the intensive care unit is started on continuous venovenous hemofiltration (CVVH). Which finding is the cause of immediate action by the nurse? a.Blood pressure of 76/58 mm Hg b. Sodium level of 138 mEq/L c.Potassium level of 5.5 mEq/L d. Pulse rate of 90 beats/min ANS: A Hypotension can be a problem with CVVH if replacement fluid does not provide enough volume to maintain blood pressure. The specially trained nurse needs to monitor for ongoing fluid and electrolyte replacement. The sodium level is normal and the potassium level is slightly elevated, which could be normal findings for someone with acute kidney injury. A pulse rate of 90 beats/min is normal. DIF: Applying/Application REF: 1418 KEY: Renal system| dialysis| nursing intervention MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care xi. A male client with chronic kidney disease (CKD) is refusing to take his medication and has missed NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK goal MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care xiv. A client has a long history of hypertension. Which category of medications would the nurse expect to be or- dered to avoid chronic kidney disease (CKD)? a.Antibiotic b. Histamine blocker c.Bronchodilator d. Angiotensin-converting enzyme (ACE) inhibitor NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK ANS: D ACE inhibitors stop the conversion of angiotensin I to the vasoconstrictor angiotensin II. This category of med- ication also blocks bradykinin and prostaglandin, increases renin, and decreases aldosterone, which promotes vasodilation and perfusion to the kidney. Antibiotics fight infection, histamine blockers decrease inflammation, and bronchodilators increase the size of the bronchi; none of these medications helps slow the progression of CKD in clients with hypertension. DIF: Applying/Application REF: 1427 KEY: Renal system| hypertension| medications| angiotensin-converting enzyme (ACE) inhibitors MSC: Integrat- ed Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies xv. A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtra- tion rate and is not undergoing dialysis. Which result would give the nurse the most concern? a.Albumin level of 2.5 g/dL b. Phosphorus level of 5 mg/dL c.Sodium level of 135 mmol/L d. Potassium level of 5.5 mmol/L ANS: A Protein restriction is necessary with chronic renal failure due to the buildup of waste products from protein breakdown. The nurse would be concerned with the low albumin level since this indicates that the protein in the diet is not enough for the client’s metabolic needs. The electrolyte values are not related to the protein-re- stricted diet. DIF: Applying/Application REF: 1427 KEY: Renal system| nutrition| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential xvi. The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates more teaching is needed? a.“I am thrilled that I can continue to eat fast food.” NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK b. “I will cut out bacon with my eggs every morning.” c.“My cooking style will change by not adding salt.” d. “I will probably lose weight by cutting out potato chips.” ANS: A Fast food restaurants usually serve food that is high in sodium. This statement indicates that more teaching needs to occur. The other statements show a correct understanding of the teaching. DIF: Remembering/Knowledge REF: 1428 KEY: Renal system| nutrition| patient education NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK ANS: C During hemodialysis, the dialysate is warmed to increase diffusion and prevent hypothermia. The client’s tem- perature could reflect the temperature of the dialysate. There is no indication to check the white blood cell count or connect the client to an ECG monitor. The other vital signs are within normal limits. DIF: Applying/Application REF: 1432 KEY: Renal system| dialysis| nursing intervention MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation xx. The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse? a. “My sodium level changes by movement from the blood into the dialysate.” b. “Dialysis works by movement of wastes from lower to higher concentration.” c.“Extra fluid can be pulled from the blood by osmosis.” d. “The dialysate is similar to blood but without any toxins.” ANS: B Dialysis works using the passive transfer of toxins by diffusion. Diffusion is the movement of molecules from an area of higher concentration to an area of lower concentration. The other statements show a correct under- standing about hemodialysis. DIF: Remembering/Knowledge REF: 1432 KEY: Renal system| dialysis| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance xxi. The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV) fistula for he- modialysis in her left arm. Which action by the float nurse would be considered unsafe? a.Palpating the access site for a bruit or thrill b. Using the right arm for a blood pressure reading c.Administering intravenous fluids through the AV fistula d. Checking distal pulses in the left NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK arm ANS: C The nurse should not use the arm with the AV fistula for intravenous infusion, blood pressure readings, or venipuncture. Compression and infection can result in the loss of the AV fistula. The AV fistula should be moni- tored by auscultating or palpating the access site. Checking the distal pulse would be an appropriate assessment. DIF: Applying/Application REF: 1433 KEY: Renal system| patient safety| injury prevention| dialysis MSC: Integrated Process: Nursing Process: Implementation NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control xxii. A client is assessed by the nurse after a hemodialysis session. The nurse notes bleeding from the client’s nose and around the intravenous catheter. What action by the nurse is the priority? a.Hold pressure over the client’s nose for 10 minutes. b. Take the client’s pulse, blood pressure, and temperature. c.Assess for a bruit or thrill over the arteriovenous fistula. d. Prepare protamine sulfate for administration. ANS: D Heparin is used with hemodialysis treatments. The bleeding alerts the nurse that too much anticoagulant is in the client’s system and protamine sulfate should be administered. Pressure, taking vital signs, and assessing for a bruit or thrill are not as important as medication administration. DIF: Applying/Application REF: 1433 KEY: Renal system| patient safety| heparin MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies xxiii. A nurse is caring for a client who is scheduled for a dose of cefazolin and vitamins at this time. Hemodialy- sis for this client is also scheduled in 60 minutes. Which action by the nurse is best? a.Administer cefazolin since the level of the antibiotic must be maintained. b. Hold the vitamins but administer the cefazolin. c.Hold the cefazolin but administer the vitamins. d. Hold all medications since both cefazolin and vitamins are dialyzable. ANS: D Both the cefazolin and the vitamins should be held until after the hemodialysis is completed because they would otherwise be removed by the dialysis process. DIF: Applying/Application REF: 1436 KEY: Renal system| dialysis| medications| antibiotics MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK treatment.” ANS: D The nurse needs to explore the client’s feelings in order to help the client cope and enter a phase of accep- tance or resignation. It is common for clients to be discouraged because of the dependency of the treatment, especially during the first year. Referrals to a mental health provider or social services are possibilities, but only after exploring the client’s feelings first. Telling the client his or her feelings will go away is dismissive of the client’s concerns. DIF: Applying/Application REF: 1436 KEY: Renal system| dialysis| coping MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK xxvii. A client is recovering from a kidney transplant. The client’s urine output was 1500 mL over the last 12-hour period since transplantation. What is the priority assessment by the nurse? a.Checking skin turgor b. Taking blood pressure c.Assessing lung sounds d. Weighing the client ANS: B By taking blood pressure, the nurse is assessing for hypotension that could compromise perfusion to the new kidney. The nurse then should notify the provider immediately. Skin turgor, lung sounds, and weight could give information about the fluid status of the client, but they are not the priority assessment. DIF: Applying/Application REF: 1443 KEY: Renal system| postoperative nursing| transplantation MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential xxviii. A nurse reviews these laboratory values of a client who returned from kidney transplantation 12 hours ago: Sodium 136 mEq/L Potassium 5 mEq/L Blood urea nitrogen (BUN) 44 mg/dL Serum creatinine 2.5 mg/dL What initial intervention would the nurse anticipate? a.Start hemodialysis immediately. b. Discuss the need for peritoneal dialysis. c. Increase the dose of immunosuppression. d. Return the client to surgery for exploration. ANS: C The client may need a higher dose of immunosuppressive medication as evidenced by the elevated BUN and serum creatinine levels. This increased dose may reverse the possible acute rejection of the transplanted kid- ney. The client does not need hemodialysis, peritoneal dialysis, or further surgery at this point. DIF: Applying/Application REF: 1443 KEY: Renal system| transplantation| nursing analysis MSC: Integrated Process: Nursing Process: NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK Analysis NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential MULTIPLE RESPONSE 1.The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for post-renal acute kidney injury (AKI)? (Select all that apply.) a.Man with prostate cancer NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK ANS: A, C, E Many clients with AKI are too ill to meet caloric goals and require tube feedings with kidney-specific formulas that are lower in sodium, potassium, and phosphorus, and higher in calories than are standard formulas. DIF: Remembering/Knowledge REF: 1417 KEY: Renal system| nutritional requirements| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance 4.The nurse is teaching a client with diabetes mellitus how to prevent or delay chronic kidney disease (CKD). Which client statements indicate a lack of understanding of the teaching? (Select all that apply.) a. “I need to decrease sodium, cholesterol, and protein in my diet.” b. “My weight should be maintained at a body mass index of 30.” c.“Smoking should be stopped as soon as I possibly can.” d. “I can continue to take an aspirin every 4 to 8 hours for my pain.” e. “I really only need to drink a couple of glasses of water each day.” ANS: B, D, E Weight should be maintained at a body mass index (BMI) of 22 to 25. A BMI of 30 indicates obesity. The use of nonsteroidal anti-inflammatory drugs such as aspirin should be limited to the lowest time at the lowest dose due to interference with kidney blood flow. The client should drink at least 2 liters of water daily. Diet adjust- ments should be made by restricting sodium, cholesterol, and protein. Smoking causes constriction of blood vessels and decreases kidney perfusion, so the client should stop smoking. DIF: Applying/Application REF: 1422 KEY: Renal system| lifestyle factors| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance 5.A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD). Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.) NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK a. “I can continue to take antacids to relieve heartburn.” b. “I need to ask for an antibiotic when scheduling a dental appointment.” c.“I’ll need to check my blood sugar often to prevent hypoglycemia.” d. “The dose of my pain medication may have to be adjusted.” e. “I should watch for bleeding when taking my anticoagulants.” ANS: B, C, D, E In discharge teaching, the nurse must emphasize that the client needs to have an antibiotic prophylactically be- fore dental procedures to prevent infection. There may be a need for dose reduction in medications if the kid- ney is not excreting them properly (antacids with magnesium, antibiotics, antidiabetic drugs, insulin, opioids, and anticoagulants). NURS 1300: CHAPTER 68: CARE OF PATIENTS WITH ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE NURSING SCHOOL TEST BANK DIF: Applying/Application REF: 1430 KEY: Renal system| patient education| medication safety MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance 6.A client is undergoing hemodialysis. The client’s blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions should the nurse perform to maintain blood pres- sure? (Select all that apply.) a.Adjust the rate of extracorporeal blood flow. b. Place the client in the Trendelenburg position. c.Stop the hemodialysis treatment. d. Administer a 250-mL bolus of normal saline. e. Contact the health care provider for orders. ANS: A, B, D Hypotension occurs often during hemodialysis treatments as a result of vasodilation from the warmed dialysate. Modest decreases in blood pressure, as is the case with this client, can be maintained with rate ad- justment, Trendelenburg positioning, and a fluid bolus. If the blood pressure drops considerably after two bo- luses and cooling dialysate, the hemodialysis can be stopped and the health care provider contacted. DIF: Applying/Application REF: 1436 KEY: Renal system| dialysis| patient safety MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 7.A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are accurate regarding PD? (Select all that apply.) a. “You will not need vascular access to perform PD.” b. “There is less restriction of protein and fluids.” c.“You will have no risk for infection with PD.” d. “You have flexible scheduling for the exchanges.” e. “It takes less time than hemodialysis treatments.”