Podcast
Questions and Answers
Which prescribed therapy should the nurse implement first for a 72-yr-old patient with acute urinary retention?
Which prescribed therapy should the nurse implement first for a 72-yr-old patient with acute urinary retention?
- Obtain renal ultrasound
- Infuse normal saline at 50 mL/hour
- Insert urethral catheter (correct)
- Draw a complete blood count
Which information is most important for the nurse to report for a 62-yr-old female patient with acute kidney injury?
Which information is most important for the nurse to report for a 62-yr-old female patient with acute kidney injury?
- The blood urea nitrogen (BUN) level is 67 mg/dL
- Urine output over an 8-hour period is 2500 mL (correct)
- The creatinine level is 3.0 mg/dL
- The glomerular filtration rate is less than 30 mL/min/1.73 m2
Which action should the nurse take first for a patient with longer QRS intervals on the ECG?
Which action should the nurse take first for a patient with longer QRS intervals on the ECG?
- Notify the patient's health care provider
- Check the medical record for the most recent potassium level (correct)
- Review the chart for the patient's current creatinine level
- Document the QRS interval measurement
Which prescribed action should the nurse take first for a patient with acute kidney injury, oliguria, anemia, and hyperkalemia?
Which prescribed action should the nurse take first for a patient with acute kidney injury, oliguria, anemia, and hyperkalemia?
Which nursing action is most appropriate for the registered nurse (RN) to delegate to a dialysis technician?
Which nursing action is most appropriate for the registered nurse (RN) to delegate to a dialysis technician?
Which observation by the RN requires intervention when the LPN/LVN administers medication to a patient with stage 2 chronic kidney disease?
Which observation by the RN requires intervention when the LPN/LVN administers medication to a patient with stage 2 chronic kidney disease?
Which information should the nurse report promptly for a patient receiving peritoneal dialysis?
Which information should the nurse report promptly for a patient receiving peritoneal dialysis?
Which information is most important to communicate after assessing a patient 4 hours after a kidney transplant?
Which information is most important to communicate after assessing a patient 4 hours after a kidney transplant?
Which action should the nurse take first when a patient complains of nausea and dizziness during hemodialysis?
Which action should the nurse take first when a patient complains of nausea and dizziness during hemodialysis?
Which parameter will be most important for the nurse to consider when titrating the IV fluid infusion rate after kidney transplantation?
Which parameter will be most important for the nurse to consider when titrating the IV fluid infusion rate after kidney transplantation?
What should the nurse administer for muscle cramps during dialysis?
What should the nurse administer for muscle cramps during dialysis?
Which initial response is best for a 74-yr-old patient asking about going on dialysis?
Which initial response is best for a 74-yr-old patient asking about going on dialysis?
Which patient should the nurse assess first after receiving change-of-shift report?
Which patient should the nurse assess first after receiving change-of-shift report?
Which information will be included when the nurse is teaching self-management to a patient receiving peritoneal dialysis? (Select all that apply)
Which information will be included when the nurse is teaching self-management to a patient receiving peritoneal dialysis? (Select all that apply)
What is the patient's fluid restriction for the next 24 hours with a urine output of 250 mL and emesis of 100 mL?
What is the patient's fluid restriction for the next 24 hours with a urine output of 250 mL and emesis of 100 mL?
After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take?
After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take?
When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of:
When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of:
The nurse is planning care for a patient with severe heart failure who has developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary treatment goal in the plan will be:
The nurse is planning care for a patient with severe heart failure who has developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary treatment goal in the plan will be:
A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV?
A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV?
Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective?
Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective?
Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?
Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?
Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before administering the medication, the nurse should assess the:
Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before administering the medication, the nurse should assess the:
Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's teaching has been successful?
Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's teaching has been successful?
Before administration of calcium carbonate to a patient with chronic kidney disease (CKD), the nurse should check laboratory results for:
Before administration of calcium carbonate to a patient with chronic kidney disease (CKD), the nurse should check laboratory results for:
A 37-yr-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function?
A 37-yr-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function?
A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft?
A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft?
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?
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 patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching?
A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching?
Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?
Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?
Which information in a patient's history indicates to the nurse that the patient is not an appropriate candidate for kidney transplantation?
Which information in a patient's history indicates to the nurse that the patient is not an appropriate candidate for kidney transplantation?
Which assessment finding may indicate that a patient is experiencing adverse effects to a corticosteroid prescribed after kidney transplantation?
Which assessment finding may indicate that a patient is experiencing adverse effects to a corticosteroid prescribed after kidney transplantation?
A 38-yr-old patient who had a kidney transplant 8 years ago is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone. Which assessment data will be of most concern to the nurse?
A 38-yr-old patient who had a kidney transplant 8 years ago is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone. Which assessment data will be of most concern to the nurse?
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?
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?
Before administration of captopril to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patient's:
Before administration of captopril to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patient's:
A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin 60 mg IV BID. The nurse will monitor for adverse effects of the medication by evaluating the patient's:
A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin 60 mg IV BID. The nurse will monitor for adverse effects of the medication by evaluating the patient's:
A 55-yr-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 before giving the medication?
A 55-yr-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 before giving the medication?
Which intervention will be included in the plan of care for a patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein?
Which intervention will be included in the plan of care for a patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein?
A 25-yr-old male patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider?
A 25-yr-old male patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider?
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Study Notes
Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) Nursing Interventions
- Pain and coldness in fingers after arteriovenous graft (AVG) insertion may indicate ischemia; report symptoms to the healthcare provider.
- In acute kidney injury (AKI) with metabolic acidosis, Kussmaul respirations may be present; monitor respiratory pattern.
- Treatment for heart failure-related AKI should prioritize maintaining cardiac output.
- Monitor cardiac rhythm in patients with hyperkalemia receiving calcium gluconate to prevent dysrhythmias.
CKD Management and Dietary Considerations
- In stage 5 CKD, patients should measure urine output daily to determine fluid intake.
- Calcium carbonate is prescribed in CKD to bind phosphorus; phosphate levels should be monitored for effectiveness.
- Sodium polystyrene sulfonate (Kayexalate) requires assessment of bowel sounds before administration to prevent bowel necrosis.
- Hemodialysis patients should choose low-potassium options, such as poached eggs and apple juice.
Assessing Kidney Function and Laboratory Values
- GFR is the best indicator of renal function improvement in AKI patients; BUN and creatinine levels fluctuate based on other factors.
- Patients require education on dietary protein intake during dialysis since nitrogenous waste removal allows for increased protein consumption.
- For patients using peritoneal dialysis, cleanliness is vital; showers are preferred over baths to prevent infection.
Contraindications and Patient Safety
- Metastatic lung cancer is a contraindication for kidney transplantation.
- Long-term corticosteroid use post-transplant can lead to joint pain due to aseptic necrosis.
- Monitor serum creatinine levels in patients receiving nephrotoxic medications like gentamicin.
- Erythropoietin should not be administered if hemoglobin is above 12 g/dL due to increased thromboembolic risks.
Acute Situations in Kidney Care
- Acute urinary retention in a patient with elevated BUN and creatinine levels warrants immediate catheter insertion to prevent postrenal failure.
- High urinary output in a dehydrated AKI patient necessitates fluid intake adjustment to prevent hypovolemia.
- Hyperkalemia from severe injuries may lead to cardiac arrest; it is critical to report serum potassium levels promptly.
Long-term and Postoperative Considerations
- A fistula for dialysis is advantageous due to a lower likelihood of clotting compared to grafts.
- Proteins may need to be limited in early-stage CKD; however, elevated creatinine levels in severe cases require careful management of potassium.
- Elevating the arm with an AVG above heart level is contraindicated, as it worsens perfusion.
- Patients on immunosuppressants need careful monitoring for malignancies, particularly if they present with unusual lumps.### Patient Monitoring and Response
- Increasing QRS interval indicates hyperkalemia, necessitating potassium level checks and immediate notification of healthcare provider.
- Elevated BUN and creatinine levels in acute kidney injury (AKI) do not impact ECG directly.
- Documentation of QRS interval is essential, but potassium level management is critical to prevent life-threatening dysrhythmias.
Nursing Actions for AKI
- In a patient with AKI and hyperkalemia, monitoring cardiac rhythm is the first priority.
- Treatments like Kayexalate (sodium polystyrene sulfonate) and epoetin alfa take time and are secondary to immediate cardiac monitoring.
- Catheterization for urine output monitoring does not address renal failure causes.
Hemodialysis Protocols
- Blood pressure checks before dialysis are suitable tasks for dialysis technicians.
- RN responsibilities include assessing and adjusting ultrafiltration rates and patient education.
Chronic Kidney Disease Management
- Phosphate binders should not be administered concurrently with iron supplements; timing is crucial for absorption.
- Erythropoietin administration is acceptable; ambulation support is also appropriate for chronic kidney disease patients.
Peritoneal Dialysis Indicators
- Cloudy peritoneal effluent is a sign of peritonitis and requires immediate reporting to a healthcare provider.
- Other post-inflow abdominal issues can be addressed through nursing interventions.
Post-Kidney Transplant Care
- Decreased central venous pressure (CVP) after kidney transplant suggests hypovolemia and requires prompt correction to prevent renal damage.
- High urine output (900-1100 mL/hr) is typical post-transplant but does not require immediate concern compared to CVP levels.
Handling Dialysis-Related Symptoms
- Nausea and dizziness during dialysis suggests hypotension, prompting immediate blood pressure assessment as the priority action.
- Fluid volume should be titrated based on urine output following transplant, which can be significantly high.
Addressing Leg Cramps in Dialysis
- Muscle cramps during dialysis arise from rapid sodium removal; normal saline infusion provides effective relief.
Patient Decision-Making on Dialysis
- Encouraging patient dialogue regarding dialysis preferences ("Tell me more about what you are thinking regarding dialysis") fosters understanding and support for decision-making.
Prioritization of Nursing Assessments
- Post-hemodialysis tachycardia (heart rate of 124/min) signifies potential bleeding or hypovolemia, demanding immediate assessment over other patients with non-critical issues.
Self-Management in Peritoneal Dialysis
- Patients on peritoneal dialysis should avoid commercial salt substitutes, take phosphate binders with meals, and prioritize high-protein intake.
- Fluid restrictions are flexible unless blood pressure and weight are unregulated; dairy intake is often limited due to phosphate content.
Fluid Calculation During Oliguria
- For a patient in the oliguric phase after AKI, fluid restriction is calculated by summing prior fluid losses (urine and emesis) and adding 600 mL for insensible loss, totaling 950 mL for the next 24 hours.
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