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A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurses most appropriate action?
- A. Inform the physician and assess the patient for signs of infection.
- B. Flush the peritoneal catheter with normal saline.
- C. Remove the catheter promptly and have the catheter tip cultured.
- D. Administer a bolus of IV normal saline as ordered.
Correct Answer: A
Rationale: Peritonitis is the most common and serious complication of peritoneal dialysis. The first sign of peritonitis is cloudy dialysate drainage fluid, so prompt reporting to the primary care provider and rapid assessment for other signs of infection are warranted. Administration of an IV bolus is not necessary or appropriate and the physician would determine whether removal of the catheter is required. Flushing the catheter does not address the risk for infection.
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The nurse is caring for a patient who has just returned to the post-surgical unit following renal surgery. When assessing the patients output from surgical drains, the nurse should assess what parameters? Select all that apply.
- A. Quantity of output
- B. Color of the output
- C. Visible characteristics of the output
- D. Odor of the output
- E. pH of the output
Correct Answer: A,B,C
Rationale: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Odor and pH are not normally assessed.
A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m^2. Based on this GFR, the nurse interprets that the patients chronic kidney disease is at what stage?
- A. Stage 1
- B. Stage 2
- C. Stage 3
- D. Stage 4
Correct Answer: C
Rationale: Stages of chronic renal failure are based on the GFR. Stage 3 is defined by a GFR in the range of 30 to 59 mL/min/1.73 m^2. This is considered a moderate decrease in GFR.
The nurse is caring for a patient postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize?
- A. Assessment of the quantity of the patients urine output
- B. Assessment of the patients' incision
- C. Assessment of the patients' abdominal girth
- D. Assessment for flank or abdominal pain
Correct Answer: A
Rationale: After kidney transplantation, the nurse should perform all of the listed assessments. However, oliguria is considered to be more suggestive of rejection than changes to the patients abdomen or incision.
A 45-year-old man with diabetic nephropathy has ESKD and is starting dialysis. What should the nurse teach the patient about hemodialysis?
- A. Hemodialysis is a treatment option that is usually required three times a week.
- B. Hemodialysis is a program that will require you to commit to daily treatment.
- C. This will require you to have surgery and a catheter will need to be inserted into your abdomen.
- D. Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again.
Correct Answer: A
Rationale: Hemodialysis is the most commonly used method of dialysis. Patients receiving hemodialysis must undergo treatment for the rest of their lives or until they undergo successful kidney transplantation. Treatments usually occur three times a week for at least 3 to 4 hours per treatment.
A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason?
- A. Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.
- B. Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this patient.
- C. A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary.
- D. There is great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations.
Correct Answer: A
Rationale: Hematuria is the most common manifestation of renal trauma; its presence after trauma suggests renal injury. Hematuria may not occur, or it may be detectable only on microscopic examination. All urine should be saved and sent to the laboratory for analysis to detect RBCs and to evaluate the course of bleeding. Measuring intake and output is not a function of the laboratory. The laboratory does not save urine to test creatinine clearance at a later time. The laboratory does not monitor the urine for sodium or potassium concentrations.