Renal Review

Renal Review1. Discuss the relationship between cardiac output and renal function

Kidney receives 20 – 25% of cardiac output

2. Discuss the anatomy and physiology of a nephron paying particular attention to the function of the glomerulus

Glomerular Filtrationo First step in urine formationo Water, electrolytes, creatinine, urea nitrogen, and glucose filtered across

glomerular membrane into Bowman’s capsule and then into PCT to form filtrateo Kidneys self-regulate renal BP and blood flow to keep GFR constant

GFR: 125 ml/min Decreases with age Will remain constant if blood pressure remains at 80-180

o If blood pressure is low… the Afferent arterial will dilate to allow more blood flow into Kidney and efferent arterial will constrict to maintain blood and pressure

3. What is the regulatory function of the kidney and discuss the process that results in urine formation

Maintain blood volume with proper balance of water, electrolytes, and pH through formation of urine by glomerular filtration, tubular reabsorption, and tubular secretion

1. Glomerular filtrationo Water, electrolytes, creatinine, urea nitrogen, and glucose filtered across

glomerular membrane into Bowman’s capsule and then into PCT to form filtrate (early urine)

2. Tubular Reabsorptiono Most filtrate reabsorbed returning water and particles to blood while passing

through tubular parts of nephron Sodium, chloride, potassium, bicarbonate, calcium, phosphorus Selectively reabsorbs about 50% of urea but NO creatinine (.7 – 1.4) Glucose should be reabsorbed but there is a renal threshold

3. Tubular Secretiono Substances move from blood into early urine

4. What are the hormonal functions of the kidney including a thorough discussion of the role of renin

Erythropoietin- triggers RBC productiono Anemia

Vitamin D Activation- absorption of Ca in GI tracto At risk for osteoporosis

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Renin- regulation of blood pressureo RAAS

5. Discuss BUN and creatinine. Why are these good measures of kidney function? Why is creatinine clearance the best?

Serum Creatinine 0.5-1.2mg/dLo Measures end product of muscle and protein metabolism o Creatinine Clearance

Don’t collect initial morning void…. Collect every other one for 24 hours… if you miss one you have to start over.

If they have kidney disease: It should be decreased in urine…. Blood creatinine will be increased

BUN (Blood Urea Nitrogen) 10-20mg/dLo Measures renal filtration and excretion of urea nitrogen (byproduct of protein

breakdown in liver) BUN Creatinine ratio:

o If bun is high and creatinine is normal…. Its not renal… If you have both of them raising in ratio together… its kidney…

6. Why should protein, glucose, and ketones not be present in the urine? What does their presence mean?

Proteino Caused by leaking glomerulus

Ketoneso Fat being used instead of glucose for energy

Glucoseo Amount goes past renal threshold

7. Discuss the side effects and post procedure management required when IV dye is given particularly in the patient with kidney disease

Dye is nephrotoxic Need consent, watch for allergies, NPO, bowel prep, monitor kidney function post

procedure

8. What are necessary nursing considerations for a patient receiving ESWL or a renal biopsy both pre-op and post-op?

ESWLo Usually done for impassible stones… Give shock waves to break up stones…o Need consento Will have ecchymosis and bruising… watch for hematomao Need to be on EKG and deliver shock on R wave

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o May insert stent to help pass the fragments Renal biopsy

o NPO, assess coagulation status, conscious sedation, sterilityo Post- OP- monitor for bleeding both internal and external

Bed rest 2-6 hours post procedure Will have hematuria

9. What are common causes, S&S, laboratory monitoring, and treatment associated with UTI and acute and chronic pyelonephritis

Pyelonephritis (upper UTI)o Acute

Fever, chills Tachycardia and/or tachypnea Flank, back or loin pain Burning, urgency, frequency, nocturia

o Chronic Stimulates RAAS

o Hypertension Nocturia Hyperkalemia and inability to conserve sodium Acidosis

o Treatment Antibiotics 2-3 L of fluid daily & increase fiber intake Surgery for structural defects

o Pyelolithotomy (stone)o Nephrectomy (remove kidney)

UTIo Presence of leukocyte esterase and nitrates = 60 – 88% chance there is a UTIo Bactrum (antibiotics) – Sulfa is in it…. Watch for allergy…

For E.Colio If over 20 epithelial cells (skin cells) = contaminated sampleo Left shift (more band cells) = patient may have urosepsiso Treatment

Remove foleys, force fluids (2-3 L/day), rest, void frequently Antibiotics, antifungals, antispasmodics

10. Discuss the different types of incontinence, their cause, and relevant management Most common incontinence is Stress Incontinence

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o Loss of small amounts of urine during activities that increase abdominal and detrusor pressure

o Common with older women, women with children, and obese patients Urge Incontinence (overactive bladder)

o Cannot suppress signal… end up wetting themselves Seen with stroke, diuretics, etc. Need to train their bladder to hold it better…. Every 15… then every 30…

then every hour… etc…o Cain give anticholinergics to help

Overflow/reflex Incontinenceo Normally there is an obstruction

With males it can be the prostate Can be spinal cord injury patients

o Detrusor muscle no longer contracts so they no longer void You will see very small amounts of urine leaking out because the

bladder is so fullo Urecholine - medicationo May need lifelong straight cathing

Never foley cath a patient for incontinenceo Nursing Interventions

Crede methodo Physical pressure on bladder to stimulate

Valsalva maneuvero Hold breath and bare down

Functional Incontinenceo Leakage of urine by factors other than abnormal function of bladder/urethrao Habit training, containment

11. Discuss the pathophysiology of Urothelial cancer, its causes, and treatment Any cancer of the urinary lining

o Most commonly happens in the bladder No S&S until tumor is large enough to cause obstruction… usually late in

the cancer First sign is painless hematuria High reoccurrence rate

o Causes Smoking is high risk factor

o Normally over 60 years of age Need to be exposed to toxins for a long period of time

o Treatment

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If small tumor they can excise it If bigger they can give intravesicular treatment

o Chemo liquid put into bladder… Let it sit for a few hours…. Then drain it out

Bacille Calmette-Guerin (BCG) – prophylactic… decreases recurrence of cancer

o Live virus Can be excreted in excrement

o Make sure they are double flushing and not sharing toilet

12. What are various methods of urinary diversion post-cystectomy and the nursing considerations for managing each

Rescetiono Removal of part of the bladder

Total cystectomyo Removal of entire bladder

Illeal loop conduito Will have an ostomy bag (stoma)… draining urine…o Nursing considerations?

Skin care!!! Because of acidic urine Incontinent!!!!

Ureterostomieso Open ureterors to abdominal wall…. There is no stoma…o Watch for infection!!!!

Sigmoidostomyo Urine diverted to end part of colon… secret urine with stool

Will have loose stool and rectal irritation Illeal reservoir (kock’s pouch)

o Straight cath through the stoma that is attached to manmade pouch in abdominal wall… can get blocked easily…

o Continent!!!!!

13. Discuss the pathophysiology, S&S, assessment, and treatment for: Polycystic Kidney Disease

o Genetic disease…. 2 forms Autosomal dominant

o More common formo If they get the gene they have the diseaseo Much less severe

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Autosomal recessiveo Get more cysts than dominant…. Affected will die earlier in life

RAAS system causes more problems in the kidneyo You need to control the hypertension!

o Patient will have More and more cysts with age

o Starts to cause nonfunctioning nephrons Stimulates the RAAS system when GFR starts to fall Cysts look like a clumps of grapes

o Kidneys get 2 – 3 times as large as normal Cysts can by palpated

o If cysts rupture = Brownish-reddish color urine

Hallmark: fatigue, nausea, vomiting, pain Flank pain and constipation Nocturia

o Kidney can’t concentrate the urine so they will be up all night urinating

Proteinuriao Caused by leaking glomerulus

AZOTEMIAo A buildup of nitrogenous waste

UREMIA o S&S of buildup from azotemia are now present

o Treatment Diet

o Give low sodium for HTNo Give high fiber for constipation

Medicationso Give for hypertension

ACE inhibitors (PRILS) and ARBS? (TANS)

Glomerular Nephritis (acute and chronic)o Immunologic disease

Immune complex: Antigen and antibodies come together and are

deposited within kidneys and cause damageo Causes inflammatory response

Causes cell leakage – will see protein in urine

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o Causes stimulation of the RASS system

o Acute and Chronic form Acute

o Self-limitingo Triggered by previous infection or diseaseo Once you treat underlying cause (infection) they usually have

complete recoveryo Reduced Renal Reserve

Higher risk for damage… Much more sensitive to insultso Will have decreased blood level from proteino May need plasmapheresis

Gets rid of antigen/antibody complexeso Fluids: I = O + 500ml

Chronico Deterioration over 20 – 30 yearso Need autopsy to know the cause…. Often not identifiedo Need a kidney transplant or lifelong dialysis

Nephrotic Syndromeo Increased glomerular permeability often as a result of an immune or

inflammatory process Anything that causes damage to the nephrons can cause nephrotic

syndromeo Can only see cause by autopsyo Glomerulus leaks a lot

Wastes a lot of protein… If GFR is high enough you need to give proteino Increase of lipid levels

Do to liver problemso Monitor HTN

14. Discuss the 3 causes of acute renal failure describing the causes, S&S, and treatment of each Prerenal Azotemia

o Anything that happens before the kidney Decreased cardiac output (hypovolemia)

o Decreases blood flow to the kidneyso S&S are the same as hypovolemia

Intrarenal AKI (acute tubular necrosis)o Anything that happens to the kidney

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Most common cause = Medication (prolonged NSAIDS, nephrotoxic antibiotics, dye from a procedure)

S&S = < 30cc/hr urine (oliguria), anuriao Retaining fluid….

You will see S&S for fluid overload and buildup of nitrogenous waste

Postrenal Azotemiao Anything that happens from the kidney to the outside (urine flow)o Most common cause = obstructiono S&S = similar to Intrarenal AKI

15. Describe the stages and progression of CKD and the decline in GFR Stages progress as Glomerular filtration rate declines

o 1: Kidneys function fine > 90 mL/min

o 2: Watch diet, manage HTN and diabetes… compensation is happening 60 – 89 mL/min

o 3: Increase in BUN and creatine… problem with managing metabolic wastes 30 – 59 mL/min

o 4: Plan for renal replacement therapy 15 – 29 mL/min

o 5: On dialysis for remainder of life or get kidney transplant < 15 mL/min

16. Discuss the causes of CKD, the S&S associated with the disease (per body system) and their origin, and the management of the disease

Hematologico Anemia

Decreased erythropoietin & RBC survival time Urinary

o Proteinuria, hematuriao Change in amount and composition of urine

Gastrointestinal o Uremic fetoro Anorexia, N/V, hiccupso Peptic ulcer diseaseo Uremic colitis

Respiratoryo Tachypnea, hyperpnea, Kussmaul respirationso Deep sighing, yawning, SOBo Uremic lung

Skino Pruritus

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o Uremic frost (caused by excess sweat)o Bruising

Neurologico Uremic encephalopathy

Lethargy, coma, seizures, slurred speech, asterixis, tremors, twitching, paresthesisas

17. Describe the CKD diet and why certain restrictions are required LOW Protein (around 40 grams daily)

o Prevent negative nitrogen balance/symptoms of uremiao May consume more on dialysis or if lost in urineo Monitor BUN and albumin levels for adequacy of protein intake

LOW Sodium (around 2 grams daily)o Needed in those with little to no urine outputo Monitor weight and BP

LOW Fluidso Consider all intake!! (PO, IV, tube feeding)o Fluid = to urine output + 500mL

LOW Potassium(60-70 mEq daily)o Prevention of dysrhythmias

LOW Phosphoruso Prevention of osteodystrophyo Dietary restrictions and phosphate binders at mealtime

Vitamin supplementationo Low protein diets low in vitamins; water soluble vitamins removed during HDo Iron supplementation for anemia

18. When is hemodialysis indicated for a patient with CKD Do not start hemodialysis until patient exhibits S&S or until patient is in stage 4 or 5 CKD

o PT is experiencing neurological changes, nausea, and vomiting Symptoms…. Not GFR

19. What is the purpose of HD, by what mechanisms is it delivered, and what are potential side effects of the treatment

Renal replacement therapies (done for life)o Hemodialysis

Blood is filtered by machineo Diffusion (High to low) and osmosis brings waste and water out

of blood into machine Done in hospital or outpatient

o Every other day for 2 – 4 hours Ultrafiltration

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o If PT has low blood pressure they just regulate the waste by diffusion

Give albumin boluso Raises the blood pressure

Given heparin during treatmento Monitor for hemorrhaging

Give protamine sulfate (heparin antidote) Dialysable medications

o Medications that are removed by dialysis…. Need to know if you need to give meds

o Paratoneal dialysis Done at home Put into abdomen and let sit then drain…

o If drain is stopped, check position of client, position of drainage bag, cath kinks, constipation

20. Why would a patient receive peritoneal dialysis over HD, by what mechanisms is it delivered, and what are potential complications

Cardiac patients are best because sudden fluid drop can be problematico Patient has to be highly motivated

More effective in clearing out waste and toxinso Done on a daily basis

Dialysate fluid should be warmedo Fill, dwell, drain

In the abdominal cavity Hook up IV bag full of fluid and let it drain into the abdominal cavity

o They let it sit for a determined amount of time (dwell time) Then they drain (should not look cloudy!!!)(means

infection)o The higher amount of dextrose in the IV the more fluid it will pull out of the

body Main complications

o Infection at the peritoneal dialysis catheter siteo Peritonitis

Infection travels down 10cuff catheter and infects the peritoneal liningo Constipation

Can put pressure on 10cuff catheter and cause a problem with flow

21. Who is/is not a candidate for renal transplantation and what are potential adverse consequences post-op

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If PT has cardiac problems, peptic ulcer disease, cancer, alcohol, or drugs they cannot receive a transplant

Potential adverse consequenceso Transplant rejection

Hyperacute (within 48 hours)o Transplant has to be removed immediately

Acute (1 – 2 weeks)o Easy to treat

Need to do weekly biopsies to make sure it isn’t ATN Chronic

o Usually means they need a new transplant/ end up on dialysis Acute Tubular Necrosis

o One of the main causes for intrarenal failure Caused by hypoxia from delay in transplantation… may

need temporary dialysis

Situation: Your patient is a 22-year-old woman with pyelonephritis. She presented to your clinic 2 days ago and was placed on a broad-spectrum antibiotic. She has minimal insurance and limited prescription benefits. You are speaking to her during a routine follow-up call when the physician tells you he wants to change her antibiotic. Why has the physician changed antibiotics for this patient?

A) She developed an allergic reaction to the initial antibiotic.

B) The initial antibiotic prescribed is non-formulary and is unavailable with her health plan.

C) This antibiotic has fewer side effects.

D) This antibiotic is specific, based on the urine culture and sensitivity reports.

Situation: Your patient is a 22-year-old woman with pyelonephritis. She presented to your clinic 2 days ago and was placed on a broad-spectrum antibiotic. She has minimal insurance and limited prescription benefits. You are speaking to her during a routine follow-up call when the physician tells you he wants to change her antibiotic. The physician prescribes nitrofurantoin (Macrodantin). What is your understanding of this medication?

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A) It is a narcotic analgesic drug.

B) It is a nonsteroidal anti-inflammatory drug (NSAID).

C) It is a urinary antiseptic drug.

D) It is a non-narcotic analgesic drug.Situation: Your patient has been admitted to the ICU after an MVA. The patient received trauma to the back and flank area. The physician is concerned that the kidneys have been injured in the accident and is concerned about the patient's fluid volume. What type of IV would you expect to start on this patient?

A) D10% with potassium

B) D5% and .45% normal saline

C) 3% normal saline

D) D5%W

Situation: Your patient has been admitted to the ICU after an MVA. The patient received trauma to the back and flank area. The physician is concerned that the kidneys have been injured in the accident and is concerned about the patient's fluid volume. You have started the IV and have received lab values that show a low Hgb and Hct. What would you expect the physician to prescribe for this patient?

A) A 1000-mL fluid challenge

B) A 500-mL fluid challenge

C) 1 unit of whole blood

D) 1 unit of plasma

Situation: Your patient is a 22-year-old woman with pyelonephritis. She presented to your clinic 2 days ago and was placed on a broad-spectrum antibiotic. She has minimal insurance and limited prescription benefits. You are speaking to her during a routine follow-up call when the physician tells you he wants to change her antibiotic. What should your medication instructions to her include? Select all that apply.

A) Stop the medication if nausea occurs.

B) Complete the antibiotic regimen.

C) Report any side effects to the physician rather than stop the medication.

D) Discontinue the antibiotic 24 hours after the fever resolves.

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Situation: Your patient has been admitted to the ICU after an MVA. The patient received trauma to the back and flank area. The physician is concerned that the kidneys have been injured in the accident and is concerned about the patient's fluid volume. You have started the IV and have received lab values that show a low Hgb and Hct. During the infusion of fluids and blood products, what should you as a nurse monitor in this patient? Select all that apply.

A) I&O

B) Blood glucose levels

C) Blood pressure

D) Heart rate

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Which statement by the client with diabetic nephropathy indicates a need for further education about their disease?

A) ''Diabetes is the leading cause of renal failure.''

B) ''I need less insulin, so I am getting better.''

C) ''I may need to reduce my insulin.''

D) ''I must call my provider if the urine dipstick shows protein.''

During discharge teaching for most clients with renal disease, what does the nurse teach the client to do at the same time each day?

A) Drink 2 liters of fluid and urinate.

B) Eat breakfast and go to bed.

C) Check blood sugar and do a urine dipstick test.

D) Weigh yourself and take your blood pressure.

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What does the nurse teach the client to prevent the risk for urinary tract infection (UTI)?

A) Limit fluid intake.

B) Increase caffeine consumption.

C) Limit sugar intake.

D) Drink about 3 L of fluid daily.

The nurse is questioning the female client with a UTI about her antibiotic drug regimen. Which statement by the client indicates a need for further instruction?

A) ''I only take my medication when I have symptoms.''

B) ''I always wipe front to back.''

C) ''I don't use bubble baths and other scented bath products.''

D) ''I try to drink 3 liters of fluid a day.''

The school nurse is counseling a teenage student about how to prevent renal trauma. Which statement by the student indicates a need for further teaching?

A) ''I can't play any type of contact sports because my brother had renal cancer.''

B) ''I avoid riding motorcycles.''

C) ''I always wear pads when playing football.''

D) ''I always wear a seat belt in the car.''

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The nurse is assessing the client who is suspected to have acute pyelonephritis. Which question contains the most appropriate language to ask the client?

A) ''Have you ever been assessed for renal calculi?''

B) ''Do you know if you have kidney stones?''

C) ''What is your history with UTIs?''

D) ''Are you on any immunosuppressive therapy?''

The client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the nurse's best response?

A) ''Don't worry, no one else will know.''

B) ''Take your time. What is bothering you the most?''

C) ''Why are you hesitant?''

D) ''You need to tell me so we can determine what is wrong.''

The nurse is performing discharge teaching for the client after a nephrectomy for renal carcinoma. Which statement by the client indicates that teaching has been effective?

A) ''Because renal carcinoma usually affects both kidneys, I'll need to be watched closely.''

B) ''I'll eventually require some type of renal replacement therapy.''

C) ''I'll need to decrease my fluid intake to prevent stress to my remaining kidney.''

D) ''My remaining kidney should provide me with normal renal function.''

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The client, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which statement by the client indicates a need for further education about her disease?

A) ''By maintaining a low-salt diet in our house, I can prevent ADPKD in my children.''

B) ''Even though my children don't have symptoms at the same age I did, they can still have ADPKD.''

C) ''If my children have the ADPKD gene, they will have renal cysts by the age of 30.''

D) ''My children have a 50% chance of inheriting the ADPKD gene that causes the disease.''

Which clinical manifestation in the client with pyelonephritis indicates that treatment has been effective?

A) Decreased urine output

B) Decreased urine white blood cells

C) Increased red blood cell count

D) Increased urine specific gravity

Which factor is an indicator for a diagnosis of hydronephrosis?

A) History of nocturia

B) History of urinary stones

C) Recent weight loss

D) Urinary incontinence

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The client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the nurse's best response?

A) ''Because the kidneys cannot get rid of fluid, blood pressure goes up.''

B) ''The damaged kidneys no longer release a hormone that prevents high blood pressure.''

C) ''The waste products in the blood interfere with other mechanisms that control blood pressure.''

D) ''This is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products.''

The client with pyelonephritis has been prescribed urinary antiseptic medication. What purpose does this medication serve?

A) Decreases bacterial count

B) Destroys white blood cells

C) Enhances action of antibiotics

D) Provides comfort

Within 24 hours after a nephrectomy, the client's abdomen is distended. What does the nurse do next?

A) Checks vital signs

B) Calls the surgeon

C) Nothing. This is normal.

D) Places a nasogastric (NG) tube

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Situation: Your patient is a 74-year-old man with chronic kidney disease (CKD). He is admitted from the emergency department with shortness of breath, crackles in the bases of both lungs, and anxiety. He has a history of hypertension, diabetes, and coronary artery disease. His medications include spironolactone (Aldactone), metoprolol (Lopressor), and enalapril (Vasotec). The physician prescribes furosemide (Lasix) 40 mg IV. What risk must you be aware of when administering Lasix to a patient with CKD?

A) Hyperkalemia

B) Hypercalcemia

C) Ototoxicity

D) Liver failure

Situation: Your patient is a 74-year-old man with chronic kidney disease. He is admitted from the emergency department with shortness of breath, crackles in the bases of both lungs, and anxiety. He has a history of hypertension, diabetes, and coronary artery disease. His medications include spironolactone (Aldactone), metoprolol (Lopressor), and enalapril (Vasotec). Morphine sulfate 2 mg IV is prescribed. What physiologic effects will this have on him?

A) Decrease heart rate

B) Increase preload

C) Reduce ventricular preload and serum potassium

D) Reduce myocardial oxygen demand and provide sedation

Situation: Your patient is a 46-year-old male with acute renal failure (ARF). He is experiencing hypovolemic shock due to excessive blood loss from an MVA. His BUN and creatinine are high, and urine output is minimal. The physician has prescribed furosemide (Lasix) and a calcium channel blocker for him. What is the purpose of the calcium channel blocker?

A) To improve urine output

B) To maintain kidney cell integrity

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C) To decrease fluid overload for ARF

D) To decrease urine output

Situation: Your patient is a 46-year-old male with acute renal failure. He is experiencing hypovolemic shock due to excessive blood loss from an MVA. His BUN and creatinine are high, and urine output is minimal. The physician has prescribed furosemide (Lasix) and a calcium channel blocker for him. Your patient is very weak and unable to eat enough food. What type of nutritional support would you expect him to receive?

A) Enteral nutrition via an NGT

B) Parenteral nutrition with D5W

C) Parenteral nutrition with TPN

D) Oral nutrition divided into 10 small meals

Situation: Your patient is a 46-year-old male with acute renal failure. He is experiencing hypovolemic shock due to excessive blood loss from an MVA. His BUN and creatinine are high, and urine output is minimal. The physician has prescribed furosemide (Lasix) and a calcium channel blocker for him. Your patient is very weak and unable to eat enough food. The physician has added IV nutrition and an Intralipid infusion once daily. What is the purpose of this prescription?

A) To increase calories

B) To decrease the need for liquid nutrition

C) To provide a non-protein source of calories

D) To provide a protein source of calories

Situation: Your patient is a 74-year-old man with chronic kidney disease (CKD). He is admitted from the emergency department with shortness of breath, crackles in the bases of both lungs, and anxiety. He has a history of hypertension, diabetes, and coronary artery disease. His medications include spironolactone (Aldactone), metoprolol (Lopressor), and enalapril (Vasotec). Why are diuretics prescribed for your patient with CKD? Select all that apply.

A) Diuretics are seldom used for patients with CKD.

B) Diuretics help control blood pressure.

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C) Diuretics are used for the treatment of fluid overload.

D) Diuretics reduce the need to place the patient on a sodium-restricted diet.

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Which clients are at risk for acute renal failure (ARF)? (Select all that apply.)

A) Football player in preseason practice

B) Client who underwent contrast dye radiology

C) Accident victim recovering from a severe hemorrhage

D) Accountant with renal calculi

E) Client in the intensive care unit on high doses of antibiotics

F) Client recovering from a severe case of influenza

The nurse is concerned about the exposure of nephrotoxins to the clients in the acute care unit. Which question by the nurse to members of the health care team will result in reducing client exposure?

A) ''Should we filter air circulation?''

B) ''Can we use less radiographic contrast dye?''

C) ''Should we add low-dose dopamine?''

D) ''Should we increase IV rates?''

The newly admitted client has severe chronic kidney disease (CKD). Which intervention addresses the nursing diagnosis "Risk for Injury related to severe kyphosis?"

A) Ensuring the client eats a diet high in protein

B) Providing a low-air-loss mattress

C) Directing the UAP to take the client's temperature orally

D) Administering opiates to the client for bone pain

The client is receiving immunosuppressive therapy after renal transplantation. Which infection control measure is the most important for the nurse to implement?

A) Adherence to the therapy

B) Handwashing

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C) Monitoring for low-grade fever

D) Strict clean technique

To prevent dehydration and renal failure, which person is encouraged the most to increase fluid consumption? (Select all that apply.)

A) Construction worker in the summer

B) Office worker in the summer

C) Road worker in the summer

D) Schoolteacher in the winter

E) Truck driver in the spring

The nurse is caring for the client demonstrating hypovolemic shock related to multitrauma. This client is at risk for prerenal failure related to which factor?

A) Decreased perfusion to the kidneys

B) Direct trauma to the kidneys

C) Obstruction to urine flow

D) Vasodilation of renal arterioles

The nurse is performing discharge teaching for the client recovering from kidney transplantation. Which important information about the antirejection medication does the nurse include?

A) Follow the medication regimen as prescribed.

B) Take the medication as needed.

C) Take the medication on an empty stomach.

D) Drink 8 ounces of water with the medication.

The client is being treated for renal failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle?

A) ''All of this is new. What can't you do?''

B) ''Are you afraid of dying?''

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C) ''How are you doing this morning?''

D) ''What concerns do you have about being discharged tomorrow?''

The client has been newly diagnosed with chronic renal failure. Which statement by the client requires intervention by the nurse?

A) ''After a few weeks of dialysis, my kidneys will work again.''

B) ''Hemodialysis is taking the place of my kidneys.''

C) ''I am trying to change my diet.''

D) ''I'll never be the way I was before.''

During discharge teaching, the client who recently has had renal transplantation asks the nurse about additional support. What is the best resource for the nurse to suggest?

A) Directory of Kidney and Urologic Disease Organizations

B) National Kidney Foundation

C) National Renal Administrators Association

D) Renal Physicians Association

Which condition is a risk factor for kidney disease?

A) Infection

B) Hypertension

C) Septic shock

D) Tubular ischemia

Which clinical manifestation indicates the need for increased fluids in the client with renal failure?

A) Increased blood urea nitrogen

B) Increased creatinine

C) Pale urine

D) Decreased sodium

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Which intervention prevents the most common forms of acute renal failure (ARF) for the client in intensive care?

A) Restriction of nephrotoxin administration

B) Hourly assessment of intake and output

C) Monitoring of laboratory data

D) Oxygen therapyThe client is receiving peritoneal dialysis (PD) for chronic kidney disease. Why does the client need adequate protein in their diet?

A) Blood loss associated with PD decreases protein levels.

B) Protein levels determine the effectiveness of dialysis therapy.

C) Protein is lost during the dialysis procedure.

D) The systemic uremia interferes with protein synthesis.

The client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? (Select all that apply.)

A) Demonstration of how to assess for infection

B) Demonstration of how to find distal pulses

C) Discussion of why blood pressure measurements must not be taken in the affected arm

D) Discussion of ways to modify activities to allow for complete arm rest

E) Information on how to assess for bruit

F) Information on proper nutrition

The home care nurse is evaluating how the client administers peritoneal dialysis. Which action by the client requires intervention by the nurse?

A) Using soap and water to clean the ports before connecting the dialysis tubing

B) Warming the dialysate before starting the infusion

C) Weighing self before starting the process

D) Wearing sterile gloves when connecting and disconnecting the tubing

Which finding in the first 24 hours after kidney transplantation requires immediate intervention?

A) Abrupt decrease in urine output

B) Blood-tinged urine

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C) Incisional pain

D) Increase in urine output

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