NUR202 Ch.62 & 63

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 patient’s care?

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• Electrolyte and fluid imbalance

• Mental health status

• Edema and pain

• Cardiac and respiratory status

The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the nurse assess first upon initial rounding?

• Client with skin itching from head to toe

• Client with a blood pressure of 158/90 mm Hg

• Client with Kussmaul respirations

• Client with halitosis and stomatitis

The nurse is caring for a client with a new diagnosis of chronic kidney disease. Which priority complications would the nurse anticipate? (Select all that apply.)

• Dysrhythmias

• Anemia

• Hypertension

• Dehydration

The nurse is admitting a client who has acute glomerulonephritis caused by beta streptococcus. What drug therapy would the nurse expect to be prescribed for this client?

• Antihypertensives

• Antilipidemics

• Antidepressants

• Antibiotics

Which intervention would the nurse perform for a patient with kidney trauma who has a considerable loss of blood?

• Take vital signs every 30 minutes

• Measure and record urine output every 30 minutes

• Report urethral bleeding before urinary catheterization

• Monitor the patient for nausea when fluids are administered

Patients with end-stage renal disease (ESRD) receive maintenance dialysis. The nurse tells a patient with ESRD that dialysis may no longer be required due to which reason?

• The patient has improved kidney function.

• The patient has developed severe dementia.

• The patient will receive a kidney transplant.

• The patient has too many age-related complications.

The nurse is concerned that a patient with CKD is not following an appropriate diet. Which patient education strategy would be the most effective to improve compliance?

• Encourage the patient to keep appointments with the dietician

• Remind the patient about the educational pamphlets provided for diet suggestions

• Explain that the diet is only short-term and encourage the patient to continue to adhere to the diet

• Tell the patient to increase fluid intake if he or she is not able to follow the provided dietary guidelines

The following are  the nursing interventions for the patient with an arteriovenous fistula or arteriovenous graft. Select all that apply. 

• Palpate for thrills and auscultate for bruits over the vascular access site every 4 hours while the patient is awake.

• Do not perform venipunctures or start an IV line in the extremity in which the vascular access is placed.

• Take blood pressure readings using the extremity distal from  the vascular access.

• Check for bleeding at needle insertion sites.

• Instruct the patient not to carry heavy objects or anything that compresses the extremity in which the vascular access is placed.

Which intervention would the nurse perform for a patient with kidney trauma who has a considerable loss of blood?

• Take vital signs every 30 minutes

• Measure and record urine output every 30 minutes

• Report urethral bleeding before urinary catheterization

• Monitor the patient for nausea when fluids are administered

Which clinical manifestations might the nurse expect to find in a patient with acute kidney injury (AKI) during the oliguric phase? Select all that apply. 

• Fatigue

• Neutropenia

• Bounding pulses

• Respiratory alkalosis

• Jugular vein distention