Renal Failure
A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this client’s care?
a. Electrolyte and fluid imbalance
b. Edema and pain
c. Hyperglycemia
d. Cardiac and respiratory status
a. electrolyte and fluid imbalance
This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance is essential. Edema and pain are not usually a problem with fluid loss. There could be changes in the client’s cardiac, respiratory if the electrolyte imbalance is not treated. Hyperglycemia is not associated with the diuretic phase.
A client has a serum ferritin level of 8 ng/mL and microcytic red blood cells. What action by the nurse is best?
a. Encourage high-protein foods.
b. Perform a Hemoccult test on the clients stools.
c. Offer frequent oral care.
d. Prepare to administer cobalamin (vitamin B12).
b. Perform a Hemoccult test on the clients stools..
This client has laboratory findings indicative of iron deficiency anemia. The most common cause of this disorder is blood loss, often from the GI tract. The nurse should perform a Hemoccult test on the client’s stools. High-protein foods may help the condition, but dietary interventions take time to work. That still does not determine the cause. Folic acid is for folic acid deficiency anemia. Cobalamin injections are for pernicious anemia.
A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first?
a. Administer 25 mL dextrose 50% (D50) IV push
b. Insert a new intravenous access line.
c. Encourage the client to drink orange juice.
d. Administer 1 mg of intramuscular glucagon.
d. Administer 1 mg of intramuscular glucagon.
The client’s blood glucose level is dangerously low. The nurse needs to administer glucagon IM immediately to increase the client’s blood glucose level. The nurse should insert a new IV after administering the glucagon and can use the new IV site for future doses of D50 if the client’s blood glucose level does not rise. Once the client is awake, orange juice may be administered orally along with a form of protein such as a peanut butter.
The nurse is caring for a client after kidney surgery. When assessing for bleeding, what assessment parameter should the nurse evaluate?
A. Pain Intensity
B. Oral Intake
C. Radiation of pain
D. Level of Consciousness
D. Level of consciousness
Bleeding is a major complication of kidney surgery. The nurse's role is to observe for these complications, to report their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision, and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood, and fluid volume and cardiac output. Bleeding is not normally evidenced by changes in pain or oral intake.
A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first?
A. Assess tactile sensation in the client’s hands.
B. Examine the client’s feet for signs of injury.
C. Notify the health care provider.
D. Clip the client's toe nails.
B. Examine the client's feet for signs of injury
Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurse should inspect them for any signs of injury. After assessment, the nurse should document findings in the client’s chart. Testing sensory perception in the hands may or may not be needed. The health care provider can be notified after assessment and documentation have been completed. Toe nail clipping in the acute care setting is limited to a podiatrist.
What is true about the urine osmolality when the kidney is adequately functioning?
a. Equal to the osmolality of the serum
b. Approximately half of the serum
c. In a ratio of 10:1 with the serum
d. Equal to the excretion of urea
a. Equal to the osmolality of the serum
If the blood osmolality is high, the kidneys need to dilute the blood and excrete more concentrated urine, and the reverse is true. The osmolality of the serum and the urine should be equal.
A 52-yr-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states,
a."I need to start eating more red meat and liver."
b."I will stop having a glass of wine with dinner."
c."I could choose nasal spray rather than injections of vitamin B12."
d."I will need to take a proton pump inhibitor such as omeprazole (Prilosec)."
c."I could choose nasal spray rather than injections of vitamin B12."
Because pernicious anemia prevents the absorption of vitamin B12, this patient requires injections or intranasal administration of cobalamin. Alcohol use does not cause cobalamin deficiency. Proton pump inhibitors decrease the absorption of vitamin B12. Eating more foods rich in vitamin B12 is not helpful because the lack of intrinsic factor prevents absorption of the vitamin.
A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to
a. send a glass of milk or orange juice to the patient in the diagnostic testing area.
b. Take the lunch tray to the patient in the diagnostic testing area.
c. ask that diagnostic testing area staff to start a 5% dextrose IV.
d. request that if testing is further delayed, the patient be returned to the unit to eat.
d. request that if testing is further delayed, the patient be returned to the unit to eat.
Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia. Administration of an IV solution is unnecessarily invasive for the patient. A glass of milk or juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in these items. Patients are not allowed to eat in the diagnostic testing areas.
A 56-yr-old female patient is admitted to the hospital with new-onset nephrotic syndrome. Which assessment data will the nurse expect?
a. Decreased blood pressure
b. Elevated urine ketones
c. Increased urine output
d. Recent weight gain
d. Recent weight gain
The patient with a nephrotic syndrome will have weight gain associated with edema. Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal because of the edema. Urine protein is high. Ketones are not related to nephrotic syndrome. Decreased urine output is the typical symptom of nephrotic syndrome.
The health care provider suspects the Somogyi effect in a 50-yr-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?
a. Check the blood glucose during the night
b. Limit simple carbohydrates in your diet.
c. Increase the long-acting insulin dose.
d. Start taking your blood glucose before each meal and use a sliding scale to maintain glucose control.
a. check the blood glucose during the night
If the Somogyi effect is causing the patient’s increased morning glucose level, the patient will experience hypoglycemia between 2:00 and 4:00 AM. The dose of insulin will be reduced, rather than increased. A bedtime snack is used to prevent hypoglycemic episodes during the night. Glucose and carbohydrate control during the day does not have an effect the Somogyi effect.
The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform the physician that the client may be exhibiting signs of acute kidney injury (AKI)?
a. The client's urine is cloudy with a foul odor.
b. The client reports an inability to initiate voiding.
c. The client complains of acute flank pain.
d. The client's average urine output has been 10 mL/hr for several hours.
d. The client's average urine output has been 10 mL/hr for several hours.
Oliguria (500 mL/day of urine) is the most common clinical situation seen in AKI. Flank pain and inability to initiate voiding are not characteristic of AKI. Cloudy, foul-smelling urine is suggestive of a urinary tract infection.
The nurse is preparing to administer a unit of platelets to an adult client. When administering this blood product, which of the following actions should the nurse perform?
A) Administer the platelets as rapidly as the patient can tolerate.
B) Establish IV access as soon as the platelets arrive from the blood bank.
C) Ensure that the patient has a patent central venous catheter.
D) Aspirate 10 to 15 mL of blood from the patients IV immediately following the transfusion.
A) Administer the platelets as rapidly as the client can tolerate
The nurse should infuse each unit of platelets as fast as patient can tolerate to diminish platelet clumping during administration. IV access should be established prior to obtaining the platelets from the blood bank. A central line is appropriate for administration but peripheral IV access (22-gauge or larger) is sufficient. There is no need to aspirate after the transfusion.
A diabetes nurse is assessing a client's knowledge of self-care skills. What would be the most appropriate way for the educator to assess the client's knowledge of nutritional therapy in diabetes?
A. Ask the client to keep a food diary and review it with the nurse.
B. Have the client describe an optimally healthy meal.
C. Ask the client to describe a typical day's food intake.
D. Have the client's family describe what he typically eats.
A. Ask the client to keep a food diary and review it with the nurse.
Reviewing the client's actual food intake is the most accurate method of gauging the client's diet. Ask the client to describe a typical day's food intake.
Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective?
a. The periorbital and peripheral edema are resolved.
b. The patient denies frequency with voiding
c. The patient denies burning with voiding.
d. The antistreptolysin-O (ASO) titer has decreased.
a. the periorbital and peripheral edema are resolved
Because edema is a common clinical manifestation of glomerulonephritis, resolution of the edema indicates that the prescribed therapies have been effective. Nitrites will be negative and the patient will not experience dysuria because the patient does not have a urinary tract infection. Antibodies to streptococcus will persist after a streptococcal infection.
A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia?
a. 4:00 PM
b. 10:00 AM
c. 2:00 PM
d. 12:00 PM
b. 10:00 AM
The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at the other listed times, although hypoglycemia may occur.
A patient has renal damage because of diabetes. What is the highest risk for this patient?
a. Hypercalcemia
b. Hypocalcemia
c. Hyperkalemia
d. Hypokalemia
c. Hyperkalemia
When the renal system cannot rid the body of enough K+, this electrolyte builds up and a condition called hyperkalemia develops.
A client has a platelet count of 9000/mm3. The nurse finds the client confused and mumbling. What action takes priority?
a. Calling the Rapid Response Team
b. Delegating taking a set of vital signs
c. Instituting bleeding precautions
d. Placing the client on bedrest
a. Calling the Rapid Response Team
With a platelet count this low, the client is at high risk of spontaneous bleeding. The most disastrous complication would be intracranial bleeding. The nurse needs to call the Rapid Response Team as this client has manifestations of a sudden neurologic change. The nurse should not delegate the vital signs as the client is no longer stable. Bleeding precautions will not address the immediate situation. Placing the client on bedrest or putting the client back into bed is important, but the critical action is to call for immediate medical attention.
A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary team meeting? (Select all that apply.)
a. clinical pharmacist
b. health care provider
c. respiratory therapist
d. occupational therapist
e. registered dietitian
a. clinical pharmacist
b. health care provider
e. registered dietitian
When planning care for a client newly diagnosed with diabetes mellitus, the nurse should collaborate with a registered dietitian, clinical pharmacist, and health care provider. The focus of treatment for a newly diagnosed client would be nutrition, medication therapy, and education. The nurse could also consult with a diabetic educator. There is no need for occupational therapy or respiratory therapy at this time.
WOW YOU'RE DOING INCREDIBLE
DONT GIVE UP
A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement should the nurse include in this client’s teaching?
a. “If you miss a dose of this drug, notifiy your health care provider immediately."
b. “Change positions slowly when you get out of bed.”
c. “Discontinue the medication if you develop a urinary infection.”
d. "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDS)"
d. "Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDS)"
NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not applicable to glipizide.
A nurse is planning the care for an older adult patient. Which age-related changes in kidney function should the nurse consider when providing care to this patient? (Select all that apply.)
a. Thinning of nephron membranes
b. Sclerosis of renal blood vessels
c. Decreasing glomerular filtrations
d. Decreasing ability to concentrate or dilute urine
e. Decreasing erythropoietin
b. Sclerosis of renal blood vessels
c. Decreasing glomerular filtrations
d. Decreasing ability to concentrate or dilute urine
e. Decreasing erythropoietin
Sclerosis of renal blood vessels, decreasing glomerular filtration, decreasing ability to concentrate urine, and decreasing erythropoietin are associated with aging.
Which foods should a nurse include in a nutrition teaching plan for a patient with iron deficiency anemia?
a. Beans and dried fruit
b. Apples and white rice
c. Yogurt and cooked carrots
d. Yellow squash and tortillas
ANS: A
Iron-rich foods include beans, dried fruit, liver, red meat, fish, and whole-grain breads.
A nurse is teaching a client with diabetes mellitus who asks, “Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?” How should the nurse respond?
a. “Glucose in the blood prevents the formation of lactic acid and prevents acidosis.”
b. “If your blood sugar isn't high enough you will get sick.”
c. “Glucose is the only fuel used by the body to produce the energy that it needs.”
d. “Your brain needs a constant supply of glucose because it cannot store it.”
d. “Your brain needs a constant supply of glucose because it cannot store it.”
Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body’s circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation. Although "you will get sick" is correct, the other option more specific teaching.
The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about treatment with
a. antibiotics.
b. anticoagulants.
c. diuretics.
d. antihypertensives.
b. anticoagulants
Flank pain in a patient with nephrotic syndrome suggests a renal vein thrombosis and anticoagulation is needed. Antibiotics are used to treat a patient with flank pain caused by pyelonephritis. Fungal pyelonephritis is uncommon and is treated with antifungals. Antihypertensives are used if the patient has high blood pressure. Diuretics are not indicated.
After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for additional teaching?
a. “The lower abdomen is the best location because it is closest to the pancreas.”
b. “Changing injection sites from the thigh to the arm will change absorption rates.”
c. “I can reach my thigh the best, so I will use the different areas of my thighs.”
d. “By rotating the sites in one area, my chance of having a reaction is decreased.”
a.“The lower abdomen is the best location because it is closest to the pancreas.”
The abdominal site has the fastest rate of absorption because of blood vessels in the area, not because of its proximity to the pancreas. The other statements are accurate assessments of insulin administration.