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The nurse is caring for a patient receiving hemodialysis three times weekly. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient?
- A. Using a stethoscope for auscultating the fistula is contraindicated.
- B. The patient feels best immediately after the dialysis treatment.
- C. Taking a BP reading on the affected arm can damage the fistula.
- D. The patient should not feel pain during initiation of dialysis.
Correct Answer: C
Rationale: When blood flow is reduced through the access for any reason (hypotension, application of BP cuff/tourniquet), the access site can clot. Auscultation of a bruit in the fistula is one way to determine patency. Typically, patients feel fatigued immediately after hemodialysis because of the rapid change in fluid and electrolyte status. Although the area over the fistula may have some decreased sensation, a needle stick is still painful.
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An 84-year-old woman diagnosed with cancer is admitted to the oncology unit for surgical treatment. The patient has been on chemotherapeutic agents to decrease the tumor size prior to the planned surgery. The nurse caring for the patient is aware that what precipitating factors in this patient may contribute to AKI? Select all that apply.
- A. Anxiety
- B. Low BMI
- C. Age-related physiologic changes
- D. Chronic systemic disease
- E. NPO status
Correct Answer: C,D
Rationale: Changes in kidney function with normal aging increase the susceptibility of elderly patients to kidney dysfunction and renal failure. In addition, the presence of chronic, systemic diseases increases the risk of AKI. Low BMI and anxiety are not risk factors for acute renal disease. NPO status is not a risk, provided adequate parenteral hydration is administered.
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.
A patient with ESKD is scheduled to begin hemodialysis. The nurse is working with the patient to adapt the patients diet to maximize the therapeutic effect and minimize the risks of complications. The patients diet should include which of the following modifications? Select all that apply.
- A. Decreased protein intake
- B. Decreased sodium intake
- C. Increased potassium intake
- D. Fluid restriction
- E. Vitamin D supplementation
Correct Answer: A,B,D
Rationale: Restricting dietary protein decreases the accumulation of nitrogenous wastes, reduces uremic symptoms, and may even postpone the initiation of dialysis for a few months. Restriction of fluid is also part of the dietary prescription because fluid accumulation may occur. As well, sodium is usually restricted to 2 to 3 g/day. Potassium intake is usually limited, not increased, and there is no particular need for vitamin D supplementation.
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.
Renal failure can have prerenal, renal, or postrenal causes. A patient with acute kidney injury is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it?
- A. Heart failure
- B. Glomerulonephritis
- C. Ureterolithiasis
- D. Aminoglycoside toxicity
Correct Answer: A
Rationale: By causing inadequate renal perfusion, heart failure can lead to prerenal failure. Glomerulonephritis and aminoglycoside toxicity are renal causes, and ureterolithiasis is a postrenal cause.