Nokea
The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The patient has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the patient to take the prescribed phosphorus-binding medication at what time?
- A. Only when needed
- B. Daily at bedtime
- C. First thing in the morning
- D. With each meal
Correct Answer: D
Rationale: Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding medications must be administered with food to be effective.
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A nurse on the renal unit is caring for a patient who will soon begin peritoneal dialysis. The family of the patient asks for education about the peritoneal dialysis catheter that has been placed in the patients peritoneum. The nurse explains the three sections of the catheter and talks about the two cuffs on the dialysis catheter. What would the nurse explain about the cuffs? Select all that apply.
- A. The cuffs are made of Dacron polyester.
- B. The cuffs stabilize the catheter.
- C. The cuffs prevent the dialysate from leaking.
- D. The cuffs provide a barrier against microorganisms.
- E. The cuffs absorb dialysate
Correct Answer: A,B,C,D
Rationale: Most of these catheters have two cuffs, which are made of Dacron polyester. The cuffs stabilize the catheter, limit movement, prevent leaks, and provide a barrier against microorganisms. They do not absorb dialysate.
A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine level of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders?
- A. Monitor the patients electrolyte values every hour before the procedure.
- B. Preprocedure hydration and administration of acetylcysteine
- C. Hemodialysis immediately prior to the CT scan
- D. Obtain a creatinine clearance by collecting a 24-hour urine specimen.
Correct Answer: B
Rationale: Radiocontrast-induced nephropathy is a major cause of hospital-acquired acute kidney injury. Baseline levels of creatinine greater than 2 mg/dL identify the patient as being high risk. Preprocedure hydration and prescription of acetylcysteine (Mucomyst) the day prior to the test is effective in prevention. The nurse would not monitor the patients electrolytes every hour preprocedure. Nothing in the scenario indicates the need for hemodialysis. A creatinine clearance is not necessary prior to a CT scan with contrast.
The nurse is caring for acutely ill patient. What assessment finding should prompt the nurse to inform the physician that the patient may be exhibiting signs of acute kidney injury (AKI)?
- A. The patient is complains of an inability to initiate voiding.
- B. The patients urine is cloudy with a foul odor.
- C. The patients average urine output has been 10 mL/hr for several hours.
- D. The patient complains of acute flank pain.
Correct Answer: C
Rationale: Oliguria (<500 mL/d of urine) is the most common clinical situation seen in AKI. Flank pain and inability to initiate voiding are not characteristic of AKI. Cloudy, foul-smelling urine is suggestive of a urinary tract infection.
A patient with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the patients abdomen is increasing in girth. What is the nurses most appropriate action?
- A. Advance the catheter 2 to 4 cm further into the peritoneal cavity.
- B. Reposition the patient to facilitate drainage.
- C. Aspirate from the catheter using a 60-mL syringe.
- D. Infuse 50 mL of additional dialysate.
Correct Answer: B
Rationale: If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the patient from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. It would be unsafe to aspirate or to infuse more dialysate.
A patient is brought to the renal unit from the PACU status post resection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this patient?
- A. Increasing oral intake
- B. Managing postoperative pain
- C. Managing dialysis
- D. Increasing mobility
Correct Answer: B
Rationale: The patient requires frequent analgesia during the postoperative period and assistance with turning, coughing, use of incentive spirometry, and deep breathing to prevent atelectasis and other pulmonary complications. Increasing oral intake and mobility are not priority nursing actions in the immediate postoperative care of this patient. Dialysis is not necessary following kidney surgery.