Dialysis Decisions
The nurse assesses an AV fistula before dialysis. These two findings indicate that the vascular access is patent.
What are a palpable thrill and audible bruit?
A patient with CKD is prescribed calcium carbonate. The nurse teaches the patient to take it at this time to decrease phosphate absorption.
What is with meals?
A patient with renal calculi should be instructed to perform this action with all urine to help identify the stone composition.
What is strain all urine?
A patient reports urinary frequency, urgency, stress incontinence, and a sensation of vaginal fullness. Which reproductive disorder should the nurse suspect?
What is a cystocele?
A patient with CKD has been instructed to limit fluid intake. The nurse knows that this measurement taken at the same time every day is the best indicator of fluid balance.
What is daily weight?
A nursing assistant prepares to obtain a blood pressure from the arm containing an AV fistula. The nurse should take this action.
What is stop the procedure and use the opposite arm?
A CKD patient has hemoglobin 8.1 g/dL and persistent fatigue. The nurse anticipates this medication to stimulate RBC production.
What is epoetin alfa/erythropoietin?
A patient has a nephrostomy tube following treatment for urinary obstruction. The nurse should never perform this action because it can obstruct urinary drainage.
What is clamp the nephrostomy tube?
A patient with uterine fibroids reports increasingly heavy menstrual bleeding. Which laboratory value should the nurse monitor most closely for a complication of this bleeding?
What is hemoglobin/hematocrit?
A CKD patient has an ABG with a pH of 7.28 and HCO₃⁻ of 18 mEq/L. This acid-base imbalance is present.
What is metabolic acidosis?
The most useful comparison for estimating the amount of fluid removed during hemodialysis is this.
What are pre- and post-dialysis weights?
A patient with AKI has crackles, increasing dyspnea, peripheral edema, and rapidly increasing weight. The nurse should recognize this major complication.
What is fluid volume overload/pulmonary edema?
Four patients require assessment. The nurse should see this patient FIRST:
A. UTI with dysuria and frequency
B. Kidney stone with pain rated 8/10
C. CKD with K⁺ 6.9 mEq/L and peaked T waves
D. BPH with nocturia three times overnight
Who is C — the patient with hyperkalemia and peaked T waves?
A patient receiving continuous bladder irrigation following TURP has 3,000 mL of irrigation infused and 3,450 mL in the drainage bag. The patient's actual urine output is this amount.
What is 450 mL?
A patient with CKD receives digoxin. The nurse should monitor closely for toxicity because impairment of this organ can decrease medication clearance.
What are the kidneys?
During peritoneal dialysis, the drainage becomes cloudy. The nurse should suspect this complication.
What is peritonitis?
A patient with an AKI has K⁺ 6.7 mEq/L, phosphorus 6.1 mg/dL, increasing confusion, and pulmonary edema. This therapy may be required because of the combination of electrolyte, neurologic, and fluid complications.
What is dialysis?
A patient with glomerulonephritis has generalized edema, oliguria, hypertension, and reddish-brown urine. The edema is primarily related to a decrease in this measurement.
What is GFR (glomerular filtration rate)?
Twelve hours after TURP, the nurse notes light pink urinary drainage. The nurse should interpret this finding in this way.
What is an expected postoperative finding?
A patient with glomerulonephritis develops a 2-kg weight gain in 24 hours, decreasing urine output, hypertension, and new bilateral crackles. Of these findings, this one indicates the most immediate threat to the patient.
What are new bilateral crackles?
Following hemodialysis, a patient develops nausea, vomiting, confusion, and then a seizure. The nurse suspects this complication caused by overly rapid changes in BUN, fluid, and electrolytes.
What is dialysis disequilibrium syndrome?
A patient with AKI enters the diuretic phase and is producing 4–5 L of urine per day. Which complication should the nurse monitor for most closely?
What is fluid volume deficit and electrolyte imbalance?
A patient has been vomiting for 3 days. BP is 82/46 mm Hg, urine output is 15 mL/hr, and creatinine has increased. The nurse should initially classify the AKI as this type and identify this underlying problem.
What is prerenal AKI caused by decreased renal perfusion/hypovolemia?
A patient after radical prostate surgery reports urinary leakage. The nurse should teach this exercise to strengthen pelvic floor muscles and improve continence.
What are Kegel exercises/pelvic floor muscle exercises?
The nurse receives report on four patients. Which should be assessed FIRST?
A. Fibroids with heavy menstrual bleeding and Hgb 10.2
B. BPH with difficulty starting the urinary stream
C. Hemodialysis patient with absent thrill over the AV fistula
D. Endometriosis with pelvic pain rated 7/10
Who is C — the hemodialysis patient with an absent thrill?