Chronic/Acute Kidney Failure

Question 1

What labs will you anticipate for a pt. with acute/chronic renal failure?

Answer 1

Increased: BUN, Cr, K+, Mg+, Phos
Decreased: Ca+, GFR, RBC, Hgb, Hct

Question 2

With Chronic renal failure, why would Hgb, RBC, and Hct be decreased?

Answer 2

The kidneys make erythropoietin. When is failure, they do not make it or do not make enough.

Question 3

3 essential assessments for RF

Answer 3

Fluid volume overload
Electrolyte imbalance
Dialysis access

Question 4

3 extreme signs and symptoms of RF

Answer 4

Peri-orbital Edema
Uremic Frost
Extreme fatigue

Question 5

Pt with renal failure has decreased CO2 levels. Why do you think this is?

Answer 5

Most often RF pt. are in metabolic acidosis. Because they are retaining more H+. Lungs try to compensate for by excreting more CO2.

Question 6

What is one of your main goal when treating RF pt.?

Answer 6

Manage fluid/electrolyte imbalances

Question 7

What dietary restrictions does a RF pt. need to be on?

Answer 7

Limit fluids, Na+, K+, Phos

Question 8

What kind of diet should a RF pt. intake?

Answer 8

Diet high in calories with vitamin supplements

Proteins, Sodium, Potassium, and Phosphorus strictly monitored

Question 9

What is important to know about pt. protein diet?

Answer 9

It is carefully regulated. Pt. will receive foods high in protein but it is carefully portioned.

Question 10

What kind of food can a RF pt. eat?

Answer 10

Pasta, white bread, white rice, olive oil, apples, peaches, green beans, carrots, grapes, grits - food low in K+, Na+, phos

Question 11

What is a major nursing consideration when pt. goes to dialysis?

Answer 11

Meds that may be taken out. Especially water-soluble meds

Question 12

Main risks when pt. goes to dialysis?

Answer 12

Infection
FVD
Loss of dialysis access site

Question 13

A Pt. on hemodialysis is prescribed vitamin C. What is most important to teach patient?

Answer 13

Take vitamin C after dialysis (b/c water-soluble)

Question 14

What are examples of prerenal RF?

Answer 14

Dehydration, Blood loss, occlusion in blood vessel leading to kidney

Question 15

A pt. comes in exhibiting: low urine output, high Na+, K+, and Mg+, Bun, and Cr. The pt. has been taking excessive amounts of Ibuprofen for the past 2 weeks. What can the cause of RF be classified as?

Answer 15

Intrarenal

Question 16

Examples of intrarenal RF?

Answer 16

Infection, Med that are nephrotoxic (NSAIDS), Direct injury to the kidney

Question 17

Examples of postrenal RF?

Answer 17

Renal stones, Prostate enlargement (complete obstructions)

Question 18

Pt. with acute RF caused by severe dehydration ask will I have to stay on this diet forever? What is the nurse’s response?

Answer 18

No if we can fix your RF in time it will not be permanent. Treat the severe dehydration to fix RF

Question 19

What is the cure for chronic RF?

Answer 19

Transplant

Question 20

At what stage of acute RF will the nurse note 3-5 L of urine output per day?

Answer 20

Diuretic Stage - Stage 3

Question 21

In the Diuretic Stage of acute RF. What is the nurse’s greatest concern?

Answer 21

electrolyte depletion

Question 22

What is stage 1 of acute RF?

Answer 22

When the renal injury occurs

Question 23

What are the number one causes of RF?

Answer 23

Long-term/uncontrolled Diabetes and HTN

Question 24

What is the biggest risk with Peritoneal Dialysis?

Answer 24

Infection

Question 25

What assessments should the nurse preform on a Graft dialysis site?

Answer 25

Palpate for thrill Auscultate for bruit Assess for bleeding and infection

Question 26

If a thrill or bruit is not felt/heard on a graft dialysis site. What might the nurse suspect?

Answer 26

May be occluded | If hematoma present - ruptured vessels

Question 27

Pt. comes back from dialysis with a HR 160 and BP 90/50. What might the nurse suspect happened?

Answer 27

Dialysis removed too much fluid

Question 28

Pt. comes back from dialysis with a HR 160 and BP 90/50. Nurse suspects too much fluid removed. What is the Tx? What is the assessment afterward?

Answer 28

Fluid bolus | Assess for: fluid overload, BP (want to come up)

Question 29

Pt. comes back from dialysis with a HR 160 and BP 90/50. Nurse treats with Fluid bolus. The BP still reads 94/57. What is next Tx

Answer 29

More fluids!

Question 30

Pt. with RF, GFR is 60. the nurse watches this lab and the next shift is is below 15. What is Tx?

Answer 30

Immediate dialysis

Question 31

What is the nurse's intervention for a pt. in acute RF in stage 2?

Answer 31

Restrict fluids

Question 32

In stage 3 acute RF, what labs should the nurse be watching?

Answer 32

Electrolytes , there is no retention of electrolytes, may need to replace or rehydrate pt.

Question 33

Risk in stage 3 acute RF

Answer 33

Dehydrations, Dysrhythmias (heart monitor)

Question 34

Pt. on RF diet needs protein what is the best source? a. ) Mac and Cheese b. ) Ham c. ) Eggs d. ) Corn

Answer 34

C - all others are good sources of protein, but eggs have the least amount of salt in them

Question 35

The nurse is caring for a patient diagnosed with chronic kidney disease whose hemoglobin level is 10 g/dL yet remains asymptomatic. The nurse should anticipate the administration of which treatments? Select all that apply. a. ) Folic acid supplements b. ) Oral iron supplements c. )Daily blood transfusion d. ) Erythropoietin subcutaneously e. ) Aminoglycoside therapy

Answer 35

A, B, D

Question 36

The nurse is caring for a patient diagnosed with acute kidney injury. Which medication order should the nurse question? a. ) Furosemide b. ) Potassium chloride c. ) Mannitol d. ) Bumetanide

Answer 36

B

Question 37

Which assessment findings should the nurse report to the healthcare provider as being indicative of possible kidney injury? Select all that apply. a. ) Urine output less than 400 mL/day b. ) Decreased potassium level c. ) Increasing glomerular filtration rate d. ) Dyspnea e. ) Fixed specific gravity 1.010

Answer 37

A, D, E

Question 38

A patient experiences severe blood loss and hypovolemia following a motor vehicle crash. The nurse should assess for signs and symptoms of which condition most likely to affect the patient? a. ) Prerenal acute kidney injury b. ) Intrarenal acute kidney injury c. ) Postrenal acute kidney injury d. ) Chronic kidney disease

Answer 38

A

Question 39

The healthcare provider alerts the nurse that a patient is at risk for chronic kidney disease. Which risk factors should the nurse expect to find in this patient’s chart? Select all that apply. a. ) Diabetes mellitus b. ) Recent surgery c. ) Hypertension d. ) Obesity e. ) Acute urinary tract infection

Answer 39

A, C, D

Question 40

The nurse should recognize which of the following as risk factors for acute kidney injury? Select all that apply. a. ) Dehydration b. ) Trauma c. ) Edema d. ) Hypovolemia e. ) Hypervolemia

Answer 40

A, B, D

Question 41

The nurse should recognize that which assessment findings are consistent with chronic kidney disease? Select all that apply. a. ) Slow manifestation of symptoms b. ) Decreased creatinine clearance c. ) Increased serum creatinine levels d. ) Trace of protein in the urine e. ) History of hypertension

Answer 41

A, B, C, E

Question 42

What is the priority teaching point when the nurse is discussing the treatment regimen with a patient who has received a kidney transplant for end stage renal disease? a. ) To take medications daily at the same time b. ) To keep all follow-up appointments as scheduled c. ) The need for meticulous immediate and lifelong care d. ) To inform patient of scarring at the incision site

Answer 42

C

Question 43

The nurse should include which information in the discharge teaching plan for a patient who underwent peritoneal dialysis catheter placement? Select all that apply. a. ) Notify the provider if fluid appears cloudy. b. ) Review numerous dietary restrictions. c. ) Purulent drainage is expected at insertion site. d. ) Notify provider if any redness is noted. e. ) Pain at the insertion site may indicate infection.

Answer 43

A, D, E

Question 44

The nurse manager has taught a new staff nurse about assessing and caring for an arteriovenous graft. The staff nurse demonstrates understanding of appropriate care when performing which action? a. ) Feel for buzzing sensation. b. ) Auscultate carotid pulses. c. ) Palpate for a bruit. d. ) Access graft for labs.

Answer 44

A

Question 45

Dietary restrictions for kidney failure patients

Answer 45

Fluid Sodium Potassium Phosphate

Question 46

Foods high in Na+

Answer 46

cheese processed meats (deli meat, bacon, etc) salted butter margarine canned vegetables canned soups

Question 47

Foods high in K+

Answer 47

``` bananas potatoes tomatoes avocadoes green leafy vegetables milk citrus fruit/juice pineapple squash beans ```

Question 48

Foods high in Phos

Answer 48

``` whole-grain products most cereals milk and cheese beans nuts ```

Question 49

Before dialysis how much protein can the pt. w/ renal failure have?

Answer 49

0.6 – 0.8 g/kg/day

Question 50

After the pt. is on dialysis how much can the pt. w/ renal failure have?

Answer 50

1.2-1.3 g/kg/day

Question 51

If a pt. is on dialysis how much weight do you not want the patient to gain/lose between dialysis Tx

Answer 51

1.5 kg/3 lb.