Renal practice 23Q QZ

A nurse is reviewing the medical history of a client with newly diagnosed acute kidney injury (AKI). Which factors from the client’s history likely contributed to AKI? Select all that apply.

• Long-term use of diuretics leading to dehydration

• Recent myocardial infarction with hypotension

• Intermittent acetaminophen use for chronic joint pain

• History of prostate enlargement and recent urinary retention

• Undergoing a contrast-enhanced imaging study within the past 48 hours

Answer explanation

Rationale:
Several factors may contribute to AKI, including contrast exposure, which increases the risk of contrast-induced nephropathy, and recent myocardial infarction, which could impair renal perfusion. Diuretic use leading to dehydration and urinary retention from prostate issues are also potential causes. Acetaminophen use and a remote stroke are unlikely to be direct contributors to acute kidney dysfunction.

A nurse is caring for a client with acute kidney injury (AKI) following contrast exposure. Which intervention should the nurse prioritize?

• Ensure adequate hydration and monitor renal function closely

• Temporarily discontinue all nephrotoxic medications

• Administer a diuretic to increase urine output

• Adjust dietary intake to reduce protein consumption

Answer explanation

Rationale:
Contrast-induced nephropathy can lead to AKI, and hydration is the key intervention to flush contrast material and maintain kidney perfusion. Stopping nephrotoxic drugs may be considered, but hydration remains the primary focus. Diuretics could exacerbate dehydration, and dietary protein adjustments do not immediately impact acute contrast-related kidney injury.

A nurse cares for multiple clients. Which client should be assessed first?

• A client with heart failure and urine output of 250 mL over 10 hours

• A client with stable chronic kidney disease and a serum creatinine of 1.8 mg/dL

• A client recovering from pneumonia with intermittent expiratory wheezing

• A client reporting mild swelling in the feet after prolonged standing

Answer explanation

Oliguria in a heart failure client suggests potential worsening acute kidney injury, requiring immediate assessment. Stable chronic kidney disease, mild respiratory symptoms, and routine swelling do not indicate urgent intervention needs.

The nurse has received the client assignment for the day. Which client would the nurse care for first?

• The 43-year-old client admitted for observation who has absence of bowel sounds

• The 53-year-old client with CKD and heart failure who has gained 4 lb. (1.8 kg) since yesterday and is short of breath

• The 49-year-old client who is scheduled for surgery within the next 4 hours will undergo a hysterectomy

• The 12-hour postoperative client who has undergone pneumonectomy and is completing a blood transfusion

Answer explanation

Rationale:
Airway, breathing, and circulation take precedence in that order of priority. The client with shortness of breath takes priority over the other clients. The clients in options C and D would be cared for next, followed by assessment of the client who was admitted for observation.

A nurse is reviewing lab results for a client diagnosed with chronic kidney disease (CKD). Which findings indicate worsening renal function?

• Calcium 8.8 mg/dL, sodium 138 mEq/L

• Potassium 6.1 mEq/L, phosphorus 5.6 mg/dL

• ALT level of 22 U/L and ammonia level of 30 mcg/dL

• Fasting glucose 94 mg/dL, chloride 102 mEq/L

Answer explanation

The kidneys normally clear excess potassium and phosphorus. When glomerular filtration falls—as happens when CKD worsens—these electrolytes build up in the blood, so markedly elevated values (potassium 6.1 mEq/L and phosphorus 5.6 mg/dL) are strong warning signs that renal function is declining. The other choices list values that are either within normal limits (calcium 8.8, sodium 138, fasting glucose 94, chloride 102) or relate mainly to liver function (ALT, ammonia). Because they do not directly reflect the kidney’s ability to filter and excrete waste, they are less useful for spotting acute deterioration in CKD.

A nurse is evaluating a client with chronic kidney disease (CKD) who has a serum sodium level of 127 mEq/L. Which symptom is most likely related to this electrolyte imbalance?

• Confusion and nausea

• Widened QRS complex on ECG

• Severe muscle spasms and joint pain

• Hypertension and increased urinary output

Answer explanation

A low serum sodium level (127) which commonly presents with confusion, nausea, vomiting, and muscle cramps due to altered neurological and fluid balance. Muscle spasms are more typical in hypocalcemia, widened QRS occurs in hyperkalemia, and hypertension is not an expected finding in hyponatremia.

A nurse is checking on four clients. Which client should the nurse see first?

• Potassium 4.4 mEq/L and eating well after the flu

• Urine output 90 mL in the last 8 hours and leg swelling

• BP 148/88 and a dull headache after missing this morning’s antihypertensive dose

• Post-operative client who is 6 hr. post appendectomy with incisional pain rated 7/10

Answer explanation

Prioritize the client with only 90 mL of urine in 8 hours and new leg swelling. Urine output below 30 mL/hr signals poor kidney perfusion or early acute kidney injury, and the added edema shows fluid is backing up instead of being excreted circulation problem that can worsen rapidly. By ABC standards, this threat to circulation outranks the other situations: a potassium of 4.4 mEq/L is normal, a BP of 148/88 with a mild headache is below crisis level, and post-operative pain of 7/10 is important for comfort but not immediately life-threatening.

A nurse is reviewing meal options for a client with chronic kidney disease (CKD). Which selection is the best choice for supporting renal function?

• Beef stir-fry with spinach and brown rice

• Grilled salmon with rice and roasted cauliflower

• Turkey sandwich with cheese on whole wheat bread

• Baked potato topped with cheddar cheese and bacon

Answer explanation

Rationale:
Grilled salmon provides high-quality protein that is easier on the kidneys, while cauliflower and rice are lower in potassium, making this meal appropriate for CKD. Processed meats, spinach, potatoes, and cheese contain excessive sodium, potassium, or phosphorus, which can worsen kidney function.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action?

• Monitor the client.

• Elevate the head of the bed.

• Assess the fistula site and dressing.

• Perform a focused neurological check.

Answer explanation

 The triad of headache, nausea, and restlessness immediately after hemodialysis suggests dialysis disequilibrium syndrome, in which rapid osmotic shifts can increase intracranial pressure. The fastest bedside intervention to promote venous drainage from the brain and limit further pressure rise is to elevate the head of the bed. Once the client is positioned, the nurse should quickly proceed to check vital signs and perform a focused neuro assessment, then notify the physician for further orders (e.g., mannitol, slower future dialysis rates). Simply “monitoring” does not intervene, and inspecting the fistula is important but not life-preserving in this moment.

During client teaching, a nurse reviews key self-care measures with a client receiving peritoneal dialysis. Which instructions are most appropriate to help minimize the risk of complications?

• Report immediately if you notice your dialysate appears cloudy or has an unusual odor

• Follow strict aseptic techniques, especially during catheter care, to reduce the chance of exit site infections

• Avoid any activities that might place pressure on or disrupt the catheter site, which could lead to leakage

• Monitor your weight daily to detect early signs of fluid overload

• Incorporate a diet high in potassium to enhance dialysis efficiency

Answer explanation

Cloudy, foul-smelling fluid is the first warning of peritonitis. Most infections start at the catheter, so clean handling and protecting the exit site are your best defenses. Pulling or leaking around the tube invites germs and fluid loss. Daily weights flag fluid overload if dialysis isn’t removing enough water. A high-potassium diet isn’t listed because people on peritoneal dialysis usually need to limit potassium, not add more.