What suddenly happened to Billy's kidney?
What is the most common initial manifestation of acute tubular necrosis (ATN)?
Oliguria, in which urine output generally decreases to less than 400 mL/24 hr.
George is currently at stage 4 of his chronic kidney disease. He asks you about the range for the GFR at this stage. What is it?
15–29 (med-surg textbook)
15-30 (RNAO table)
______ is a method of removing waste products and excess fluid from the blood using a natural semipermeable membrane, the peritoneum. What is this called?
Peritoneal dialysis
Name 2 complications of kidney transplantation.
Rejection
Infection
Cardiovascular disease
Malignancies
Recurrence of Original Renal Disease
Corticosteroid-Related Complications
A client asks a nurse how chronic kidney disease is defined. The nurse stated that the Kidney Disease Outcomes Quality Initiative (KDOQI) defines CKD as either kidney damage or GFR less than ______. The nurse forgot the exact criteria and asks for your help to finish the rest of the sentence. What is the correct answer?
The Kidney Disease Outcomes Quality Initiative (KDOQI) defines CKD as either kidney damage or GFR less than 60 mL/min/1.73 m2 for 3 months or longer
Billy is worried about the primary cause of death for an acute kidney injury. What is the primary cause?
Infection
Clients with CKD experience an increased incidence of cardiovascular disease related to which of the following? (Select all that apply.)
a. Vascular calcification
b. Genetic predisposition
c. Hypertension
d. Increased high-density lipoproteins
a. Vascular calcification
c. Hypertension
_______ is an alternative or adjunctive method for treating AKI. It provides a means by which uremic toxins and fluids are removed from a patient who is hemodynamically unstable, while acid–base status and electrolytes are adjusted slowly and continuously. What is this called?
Continuous renal replacement therapy (CRRT)
________is another option that allows a living donor to donate a kidney to a different compatible recipient, with the intent that another donor will donate to the first donor’s designated recipient. What is this called?
Paired organ donation
Nurses need to educate clients at risk for developing CKD. Which of the following individuals are considered to be at increased risk? (Select all that apply.)
a. Older Canadians who are Black
b. People who are older than age 60 years
c. Clients with a history of pancreatitis
d. Individuals with obesity
a. Older Canadians who are Black
b. People who are older than age 60 years
d. Individuals with obesity
In the diuretic phase in acute kidney injury, which of the following is NOT correct (identify all that apply):
• Continued decline in BUN and creatinine
• Continued decline in creatinine clearance and glomerular filtration rate
• Hyperkalemia
• Hypokalemia
• Hyponatremia
• Hypernatremia
• Hypovolemia
• Hyperkalemia
• Hypernatremia
Clients with CKD stages 3–4 require an interprofessional approach to care that focuses on delaying the progression of CKD by which of the following?
a. Educating clients and caregivers about BP control
b. Instructing clients to significantly restrict protein in their diet
c. Instructing clients that radiocontrast agents are not harmful at this stage of CKD
d. Educating clients to restrict their sodium intake to 3.5 g/day
a. Educating clients and caregivers about BP control
Which of the following interventions should the nurse undertake to assess the patency of a newly placed arteriovenous graft for dialysis?
a. Irrigate the graft daily with low-dose heparin.
b. Monitor for any increase in blood pressure in the affected arm.
c. Listen with a stethoscope over the graft for the presence of a bruit.
d. Frequently monitor the pulses and the neurovascular status distal to the graft.
c. Listen with a stethoscope over the graft for the presence of a bruit.
Which of the following is NOT a contraindication to kidney transplantation:
-disseminated malignancies
-hepatitis B or C
-refractory or untreated cardiac disease
-chronic respiratory failure
-extensive vascular disease
-chronic infection
-unresolved psychosocial disorders (e.g., alcoholism, drug addiction)
-nonadherence to medical regimens
The presence of hepatitis B or C is not a contraindication to transplantation.
Saxena and Rizk (2014) identified 2 of the crucial elements central to the success of the interdisciplinary model. As a nurse you want to consider these in the care of your client with CKD. What are these?
Timely referral and psychosocial education, especially when provided by advanced practitioners
Acute tubular necrosis (ATN) is the most common intrarenal cause of AKI and is primarily the result of ischemia, nephrotoxins, or sepsis. Name two of the possible pathological processes involved in ATN.
1. Hypovolemia and decreased renal blood flow stimulate renin release, which activates the renin–angiotensin–aldosterone system and results in constriction of the peripheral arteries and the renal afferent arterioles. With decreased renal blood flow, there is decreased glomerular capillary pressure and GFR as well as tubular dysfunction and, ultimately, oliguria.
2. Ischemia alters glomerular epithelial cells and decreases glomerular capillary permeability. This reduces the GFR, which significantly reduces blood flow and leads to tubular dysfunction.
3. When tubules are damaged, interstitial edema occurs, and necrotic epithelial cells accumulate in the tubules. The debris lowers the GFR by obstructing the tubules and increasing intratubular pressure.
4. Glomerular filtrate leaks back into plasma through holes in the damaged tubular membranes, which decreases intratubular fluid flow.
Which systemic effect best characterizes chronic kidney disease (CKD)?
a. Progressive irreversible damage of the kidneys
b. Rapid decrease in urinary output with an elevated blood urea nitrogen (BUN)
c. Progressive increase in creatinine clearance
d. Rapid rise in serum creatinine from baseline
a. Progressive irreversible damage of the kidneys
Name 3 potential complications of hemodialysis.
Hypotension
Muscle cramps
Loss of blood
Hepatitis
Sepsis
Disequilibrium Syndrome
Following a kidney transplantation, which signs of rejection would the nurse include in the client education?
a. Fever, weight loss, increased urinary output, increased blood pressure (BP)
b. Fever, weight gain, increased urinary output, increased BP
c. Fever, weight loss, decreased urinary output, decreased BP
d. Fever, weight gain, decreased urinary output, increased BP
d. Fever, weight gain, decreased urinary output, increased BP
Saxena and Rizk (2014) developed a Model of an ideal interdisciplinary clinic. As a nurse you want to involve different providers in the care of your client with CKD. Aside from the primary care provider, name 3 different types of providers included in the model.
-advanced practitioner
-social worker
-dietitian
-pharmacist
-diabetes educator
-kidney specialist
Billy wonders if his acute kidney injury can be seen through changes in his respiratory system. What are possible clinical manifestations?
Kussmaul’s respirations
Pleural effusions
Pulmonary edema
George wants to know about clinical manifestations of chronic uremia on the hematological system. Name all 3.
Anemia
Bleeding tendencies
Infections
Name 1 potential contraindications for PD.
1. History of multiple abdominal surgical procedures or severe abdominal pathological condition (e.g., severe pancreatitis, diverticulitis)
2. Recurrent abdominal wall or inguinal hernias
3. Excessive obesity with large abdominal wall and fat deposits
4. Pre-existing vertebral disease (e.g., chronic back pain)
5. Severe obstructive pulmonary disease
Where is the transplanted kidney usually placed in the body?
extraperitoneally in the iliac fossa
The nurse monitors the client in the diuretic phase of AKI for which serum electrolyte imbalances?
a. Hyperkalemia and hyponatremia
b. Hyperkalemia and hypernatremia
c. Hypokalemia and hyponatremia
d. Hypokalemia and hypernatremia
c. Hypokalemia and hyponatremia