AKI
A hospitalized client has a rising creatinine and urine output of 350 mL over 24 hours. Which phase of AKI is the client most likely experiencing?
Oliguric phase
Rationale: The oliguric phase of AKI is characterized by significantly decreased urine output and retention of waste products, causing BUN and creatinine to rise.
A client with advanced CKD reports increasing fatigue and weakness. The hemoglobin is 8.7 g/dL. What alteration in kidney function contributes to this finding?
Decreased erythropoietin production
Rationale: Diseased kidneys produce less erythropoietin, resulting in decreased stimulation of the bone marrow to produce RBCs and development of anemia.
Before using an AV fistula for hemodialysis, which two findings should the nurse assess to verify that the access is patent?
A palpable thrill and an audible bruit
Rationale: Blood flowing through a functioning AV fistula produces a palpable vibration called a thrill and a sound heard with auscultation called a bruit. Absence can indicate impaired blood flow or thrombosis.
Following kidney transplantation, what class of medications must the client take long term to decrease the risk of organ rejection?
Immunosuppressive medications
Rationale: Immunosuppressants suppress the recipient's immune response against the transplanted kidney, decreasing the risk of rejection
A client with kidney failure has a potassium of 6.5 mEq/L. Which body system requires the nurse's priority assessment?
Cardiovascular/cardiac system
Rationale: Severe hyperkalemia can alter cardiac conduction and cause potentially fatal dysrhythmias. The nurse should prioritize cardiac assessment and ECG monitoring.
A client develops AKI following several days of severe vomiting and diarrhea. What type of AKI should the nurse suspect?
Prerenal AKI
Rationale: Significant fluid loss causes hypovolemia and decreased renal perfusion. The problem occurs before the kidneys themselves, making this prerenal AKI.
A client with CKD has muscle weakness and palpitations. The ECG shows tall, peaked T waves. Which electrolyte imbalance should the nurse suspect?
Hyperkalemia
Rationale: Decreased renal function reduces potassium excretion, causing potassium to accumulate. Hyperkalemia can cause cardiac conduction changes and life-threatening dysrhythmias.
A client becomes dizzy and nauseated shortly after completing hemodialysis. The blood pressure has decreased from 146/82 to 88/52 mm Hg. What complication should the nurse suspect?
Hypotension related to rapid fluid removal
Rationale: Hypotension is a common complication of hemodialysis and can occur when fluid is removed from the intravascular space faster than it can be replaced.
A kidney transplant recipient taking immunosuppressive medications develops a temperature of 101.4°F (38.6°C). What complication should the nurse suspect?
Infection
Rationale: Immunosuppressive therapy decreases the client's ability to fight infection. Fever in an immunosuppressed transplant recipient requires prompt evaluation
A client with kidney failure has gained 3 kg in 3 days and develops bilateral crackles and dyspnea. What complication should the nurse suspect?
Fluid volume excess/pulmonary edema
Rationale: Impaired renal excretion causes sodium and water retention. Rapid weight gain, crackles, and dyspnea indicate significant fluid accumulation affecting the lungs.
A client with AKI enters the diuretic phase and produces 4,000 mL of urine in 24 hours. Which complication should the nurse monitor for?
Hypovolemia/dehydration and electrolyte loss.
Rationale: During the diuretic phase, the kidneys begin producing large amounts of urine before they fully regain the ability to concentrate it. Excessive fluid and electrolyte losses can cause dehydration, hypotension, and electrolyte imbalances.
A client with CKD develops metabolic acidosis. What decreased kidney function contributes to this acid-base imbalance?
The kidneys are unable to adequately excrete hydrogen ions (acid).
Rationale: As kidney function declines, the kidneys lose the ability to effectively remove acids from the blood and maintain acid-base balance, which can result in metabolic acidosis.
During peritoneal dialysis, the nurse observes cloudy outflow and the client reports new abdominal pain. What complication should the nurse suspect?
Peritonitis
Rationale: Cloudy dialysate effluent accompanied by abdominal pain is concerning for peritoneal infection/peritonitis and requires prompt evaluation
A kidney transplant recipient develops decreased urine output, increasing creatinine, and tenderness over the transplanted kidney. What complication should the nurse suspect?
Kidney transplant rejection
Rationale: Deteriorating renal function, decreased urine output, and graft tenderness are concerning findings for rejection of the transplanted kidney.
Which prescription should the nurse question for a client with a functioning AV fistula in the left arm?
A. Obtain daily weights
B. Measure blood pressure in the left arm every 4 hours
C. Assess the fistula for a thrill each shift
D. Auscultate the fistula for a bruit
B. Measure blood pressure in the left arm every 4 hours
Rationale: Blood pressure measurements, venipunctures, and IV access should be avoided in the extremity containing an AV fistula because compression or trauma can compromise the vascular access.
A client develops AKI after receiving an aminoglycoside antibiotic. The nurse recognizes this as which type of kidney injury?
Intrarenal (intrinsic) AKI.
Rationale: Nephrotoxic medications can directly damage renal tissue, resulting in intrinsic/intrarenal AKI.
A client with advanced CKD has the following findings. Which requires the nurse's priority intervention?
A. Hemoglobin 9.1 g/dL
B. Phosphorus 5.5 mg/dL
C. Potassium 6.2 mEq/L
D. Creatinine 4.8 mg/dL
C. Potassium 6.2 mEq/L
Rationale: Hyperkalemia can cause life-threatening cardiac dysrhythmias and therefore takes priority. Anemia, hyperphosphatemia, and elevated creatinine are important manifestations of CKD but do not pose the same immediate threat.
During peritoneal dialysis, the prescribed amount of dialysate is instilled, but significantly less fluid returns during drainage. Which action should the nurse take FIRST?
A. Add additional dialysate
B. Reposition the client and assess the tubing for kinks
C. Immediately discontinue peritoneal dialysis permanently
D. Increase the concentration of the dialysate
B. Reposition the client and assess the tubing for kinks
Rationale: Poor outflow can result from catheter positioning or obstruction of the tubing. The nurse should first assess for a mechanical cause and reposition the client to promote drainage.
Which statement by a kidney transplant recipient taking tacrolimus indicates a need for additional teaching?
A. “I will take my medication at the same time every day.”
B. “I will report signs of infection to my provider.”
C. “I can stop taking this medication once my kidney function returns to normal.”
D. “I will keep my scheduled laboratory appointments.”
C. “I can stop taking this medication once my kidney function returns to normal.”
Rationale: Immunosuppressive therapy must be taken consistently to prevent rejection. Clients should not discontinue immunosuppressants simply because the transplanted kidney is functioning normally.
The nurse receives report on four renal clients. Which client should be assessed FIRST?
A. CKD client with hemoglobin 9.0 g/dL who reports fatigue
B. Peritoneal dialysis client with cloudy effluent and abdominal pain
C. AKI client with creatinine 3.2 mg/dL and urine output 25 mL/hr
D. Hemodialysis client with BP 102/64 mm Hg after treatment
B. Peritoneal dialysis client with cloudy effluent and abdominal pain
Rationale: Cloudy effluent and abdominal pain suggest peritonitis, a potentially serious infection requiring prompt treatment. The other findings can occur with the clients' underlying renal conditions or following dialysis and are not as immediately concerning based on the information provided.
A nurse is caring for four clients with AKI. Which client requires immediate intervention?
A. Creatinine 3.2 mg/dL with urine output 25 mL/hr
B. Potassium 6.4 mEq/L with peaked T waves
C. BUN 48 mg/dL with nausea and decreased appetite
D. 2+ dependent edema with a 2-lb weight gain
B. Potassium 6.4 mEq/L with peaked T waves
Rationale: Severe hyperkalemia with ECG changes indicates cardiac involvement and places the client at immediate risk for a life-threatening dysrhythmia. The other findings are concerning but are not as immediately life-threatening.
A client with advanced CKD develops dyspnea, bilateral crackles, hypertension, and an oxygen saturation of 88%. Which complication should the nurse recognize as the priority?
Fluid volume excess causing pulmonary congestion
Rationale: Impaired sodium and water excretion can cause severe fluid overload and pulmonary congestion. The client's crackles, dyspnea, and hypoxemia indicate a breathing/oxygenation problem requiring immediate attention.
A client undergoing hemodialysis suddenly develops headache, nausea, confusion, and restlessness. Which complication should the nurse suspect?
A. Peritonitis
B. Dialysis disequilibrium syndrome
C. Hypercalcemia
D. Renal osteodystrophy
B. Dialysis disequilibrium syndrome
Rationale: Dialysis disequilibrium syndrome can occur when rapid changes in blood solute concentrations during hemodialysis cause fluid shifts into brain cells, resulting in cerebral edema. Neurologic manifestations can include headache, nausea, restlessness, confusion, and seizures.
The nurse receives calls from four kidney transplant recipients. Which client should the nurse instruct to seek immediate evaluation?
A. Client reporting mild incisional itching
B. Client reporting increased appetite after discharge
C. Client reporting decreased urine output, fever, and graft tenderness
D. Client asking whether daily weights are still necessary
C. Decreased urine output, fever, and graft tenderness
Rationale: These findings indicate possible transplant rejection and/or infection and require immediate evaluation. Both can threaten graft function and the client's health.
The nurse is caring for four clients. Which client requires IMMEDIATE intervention?
A. A CKD client with phosphorus 5.4 mg/dL and generalized itching
B. A kidney transplant recipient with creatinine increasing from 1.1 to 1.8 mg/dL
C. A hemodialysis client with an absent thrill and bruit in the AV fistula
D. An AKI client with potassium 6.8 mEq/L and widening QRS complexes
D. AKI client with K⁺ 6.8 mEq/L and widening QRS complexes
Rationale: Severe hyperkalemia accompanied by ECG changes indicates an immediate risk for a life-threatening ventricular dysrhythmia or cardiac arrest. The other clients also require follow-up, particularly the absent fistula thrill/bruit and rising creatinine after transplant, but neither takes priority over an active cardiac conduction abnormality.