Labs and Diagnostic Procedures
A client completes a 24-hour urine collection, and serum creatinine is measured during the collection. Which calculated result best estimates the amount of plasma filtered by the glomeruli each minute?
Creatinine clearance
A client with septic shock has a MAP of 55 mm Hg, oliguria, and rising creatinine. Ultrasound shows no urinary obstruction. Which AKI category is most likely?
Prerenal AKI from decreased kidney perfusion
A client with kidney dysfunction gains 5lb in 48 hours and develops JVD, bilateral crackles, and ankle edema. Identify the imbalance and estimate the retained fluid.
Fluid volume excess with approximately 2,500 mL of retained fluid
A blood pressure was accidentally taken on the arm with an AV fistula. The nurse can no longer feel a thrill. What is the priority response?
Stop using the arm, assess for a bruit, and notify the dialysis or vascular team immediately
A client taking an antibiotic for cystitis says, "The orange urine means the infection is gone, so I can stop the antibiotic." Which medication caused the color, and how should the nurse respond?
Phenazopyridine (Pyridium) caused the orange urine; it relieves discomfort but does not treat the infection, so the antibiotic must be completed as prescribed
A stable client with CKD needs a morning weight, lung assessment, renal-diet teaching, and evaluation of edema. Which task can the RN delegate to assistive personnel?
Obtain and report the morning weight using the same scale and similar clothing
After two days of vomiting and diarrhea, a client has dry mucous membranes, orthostatic hypotension, and scant dark urine. Which urine result is most consistent with this condition?
A high urine specific gravity (greater than 1.025)
Forty-eight hours after iodinated contrast, a client remains oliguric and creatinine continues to rise despite correction of dehydration. Which cause of AKI now requires the most concern?
Intrarenal AKI from acute tubular injury
A client with CKD has potassium 6.2 mEq/L, muscle weakness, and peaked T waves. Which problem is the immediate priority, and why?
Hyperkalemia because it can cause a lethal dysrhythmia
Which history should make the dialysis team reconsider continuous ambulatory peritoneal dialysis: partial vision loss, transplant evaluation, anemia during hemodialysis, or recurrent diverticulitis?
Recurrent diverticulitis
A client leaks with coughing and also loses urine before reaching the toilet after a sudden intense urge. Which type of incontinence best describes the combined pattern?
Mixed incontinence
Which assignment is most appropriate for an LPN: assess a new transplant admission, teach a new peritoneal dialysis exchange, change an established ileal conduit pouch, or evaluate sudden oliguria?
Change the established ileal conduit pouch
A client scheduled for an IV urogram reports prior throat swelling after iodinated contrast. What is the nurse's priority action before the study?
Withhold the procedure and notify the provider or radiology team of the previous severe contrast reaction
An older adult with benign prostatic hyperplasia has an enlarged bladder, bilateral hydronephrosis, minimal urine output, and a rising creatinine. Which AKI category and treatment priority fit these findings?
Postrenal AKI; relieve the urinary obstruction
A client develops perioral tingling, hyperactive reflexes, carpopedal spasm during a blood pressure check, and a prolonged QT interval. Which imbalance best explains the cluster?
Hypocalcemia
A client receiving peritoneal dialysis develops cloudy effluent, abdominal pain, and fever. What should the nurse do before antibiotics are started?
Notify the provider and obtain a dialysate specimen for cell count, and culture as prescribed
The nurse suspects Peritonitis
An older adult has fever, flank pain, dysuria, hypotension, and acute confusion. What does the nurse suspects and which action should occur promptly before the first antibiotic dose?
The nurse suspects urosepsis and shall obtain orders for urine and blood cultures, then begin prescribed antibiotics promptly
Which client should the RN assess first: painless hematuria awaiting imaging, a stone client whose pain is now 2 of 10, stable PKD with BP 148/86, or pyelonephritis with temperature 39.4 C, BP 86/50, and confusion?
The client with pyelonephritis, hypotension, high fever, and confusion
One hour after renal angiography through the femoral artery, the affected foot is cooler and its pedal pulse is weaker than at baseline. What should the nurse do next?
Maintain the leg straight and notify the provider promptly
During the diuretic phase of AKI, urine output rises sharply while blood pressure falls and mucous membranes become dry. What complication is the priority?
Fluid volume deficit
A client with kidney failure has pH 7.24, bicarbonate 15 mEq/L, and deep rapid respirations. Identify the disorder, explain the breathing pattern, and name the escalation if it remains severe despite treatment.
Metabolic acidosis; the lungs are compensating by removing carbon dioxide; prepare for dialysis
A client with kidney failure develops sharp chest pain with a pericardial friction rub and increasing confusion. What treatment should the nurse anticipate?
Urgent dialysis
After Extracorporeal shock wave lithotripsy (ESWL), a client reports worsening flank pain and passes clots but then produces almost no urine. Which complication is the priority concern?
Urinary obstruction from stone fragments or clots
A client in the oliguric phase of AKI has gained weight and has a strict fluid limit. Which action by assistive personnel requires immediate correction?
Refilling the water pitcher without checking the prescribed fluid allowance
After cystoscopy, a client has mild burning and pink-tinged urine but voids only 40 mL in three hours despite adequate fluid intake and reports increasing suprapubic pressure. Which finding changes this from expected recovery to a complication?
Low urine output with suprapubic pressure suggests urinary retention or obstruction
A client with advanced CKD has fatigue, pallor, hemoglobin 8.4 g/dL, and no evidence of bleeding. Which lost kidney function best explains the anemia?
Decreased erythropoietin production
A client taking a loop diuretic has abdominal distention, decreased bowel sounds, generalized weakness, and an irregular rhythm. Which electrolyte result should the nurse anticipate?
A low potassium level indicating hypokalemia
Two weeks after kidney transplant, a client has a rising creatinine, graft tenderness, fever, and decreasing urine output. What complication is most likely, and what should the nurse do?
Acute rejection; notify the transplant team promptly and anticipate intensified immunosuppression
An adult has an inherited disorder that forms many cysts in both kidneys and gradually lowers GFR. Name the disorder and the key long-term teaching point.
Autosomal dominant polycystic kidney disease; it has no cure and may eventually require kidney replacement therapy
Four hours after nephrectomy, a client becomes restless, then sleepy, with BP 82/48, HR 126, cool skin, dyspnea, and falling urine output. What is the nurse's priority response?
Give your top 4 interventions in order...
Activate rapid response, assess for postoperative hemorrhage and shock, support oxygenation and circulation, and notify the surgeon