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A client in chronic kidney disease becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which lab value?
- A. Elevated urea levels
- B. Hyperkalemia
- C. Hypocalcemia
- D. Elevated white blood cells
Correct Answer: B
Rationale: Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic, confused, and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.
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An instructor is teaching a group of students about how to perform peritoneal dialysis. Which statement would indicate to the instructor that the students need additional teaching?
- A. It is important to use strict aseptic technique.
- B. It is appropriate to warm the dialysate in a microwave.
- C. The infusion clamp should be open during infusion.
- D. The effluent should be allowed to drain by gravity.
Correct Answer: B
Rationale: The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.
A client is diagnosed with polycystic kidney disease. Which symptom would the nurse most likely assess?
- A. Hypertension
- B. Flank pain
- C. Fever
- D. Periorbital edema
Correct Answer: A
Rationale: Hypertension is often present in clients with polycystic kidney disease at the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and abdominal pain also may be noted based on the size and effects of the cysts. Fever would suggest an infection. Periorbital edema is noted with acute glomerulonephritis.
The home health nurse reviews medications taken by the client with polycystic kidney disease. Which medication should be addressed first?
- A. Lovastatin
- B. Methylprednisolone
- C. Furosemide
- D. Ibuprofen
Correct Answer: D
Rationale: Nephrotoxic drugs are not administered to clients with renal disease unless no other therapeutic agent is available. Ibuprofen (Motrin) is a nephrotoxic drug and nephrotoxic medications, such as nonsteroidal anti-inflammatory drugs and cephalosporin antibiotics, should be avoided in treating clients with polycystic kidney disease. Lovastatin (Mevacor) (antihyperlipidemic agent) and methylprednisolone (Depo-Medrol) (steroid) are drugs presently being reviewed for slowing the rate of disease progression in clients with polycystic kidney disease and are not considered nephrotoxic. Furosemide (Lasix) is a diuretic and has no significance in causing renal damage.
The nurse is providing education to a client with acute glomerulonephritis. What should the nurse include in the teaching? Select all that apply.
- A. Identify high-sodium foods to include in the diet to increase dietary sodium.
- B. Explain the purpose of diuretic therapy or other prescribed medications, the dosing regimen, and side effects.
- C. Recommend regular blood pressure monitoring.
- D. Caution the client to avoid contact with persons who have infections.
- E. Advise the client that weight gain is an expected outcome.
Correct Answer: B,C,D
Rationale: The nurse should explain the purpose of diuretic therapy or other prescribed medications, the dosing regimen, and side effects, recommend regular blood pressure monitoring, and caution the client to avoid contact with persons who have infections. The nurse should identify the specific amount of sodium that the client is allowed and identify sources of sodium to avoid. The nurse should also advise the client to contact the primary provider if urinary volumes diminish, or if headaches, nosebleeds, or unexpected weight gain occur.
The hemodialysis client is scheduled to receive weekly injections of epoetin. Which is the most important consideration to be taken by the nurse in the administration of this medication?
- A. Schedule injection on non-dialysis day.
- B. Administer immediately after dialysis.
- C. Monitor complete blood count percent dose.
- D. Administer with low-dose aspirin to prevent clot formation.
Correct Answer: A
Rationale: After dialysis, do not administer injections for 2 to 4 hours to allow time for the metabolism and excretion of heparin (which is administered during dialysis). Serum laboratory tests are performed on a routine basis to identify normal and abnormal findings. Aspirin use is not indicated with epoetin use.