Nokea
The nurse is caring for a patient with hypertension and stage 2 chronic kidney disease (CKD) who is prescribed ramipril. Which of the following laboratory tests should the nurse assess before administration of the medication?
- A. Glucose
- B. Potassium
- C. Creatinine
- D. Phosphate
Correct Answer: B
Rationale: Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not affect whether the ramipril was given or not.
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The nurse is teaching a patient with stage 5 chronic kidney disease (CKD) about management of CKD. Which of the following patient statements indicate that the teaching was effective?
- A. I need to try to get more protein from dairy products.
- B. I will try to increase my intake of fruits and vegetables.
- C. I will measure my urinary output each day to help calculate the amount I can drink.
- D. I need to take the erythropoietin to boost my immune system and help prevent infection.
Correct Answer: C
Rationale: The patient with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.
The nurse is caring for a patient in the oliguric phase of acute renal failure who has a 24-hour fluid output of 150 mL emesis and 250 mL urine. Which of the following amounts in mL should the nurse plan a fluid replacement for the following day?
- A. 400
- B. 800
- C. 1000
- D. 1400
Correct Answer: C
Rationale: Usually fluid replacement should be based on the patient's measured output plus 600 mL/day for insensible losses.
Which of the following actions by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?
- A. The patient slows the inflow rate when experiencing pain.
- B. The patient leaves the catheter exit site without a dressing.
- C. The patient plans 30-60 minutes for a dialysate exchange.
- D. The patient cleans the catheter while taking a bath every day.
Correct Answer: D
Rationale: Patients are taught to avoid insertion site infection and should be encouraged to take showers rather than baths to avoid infections at the catheter insertion side. The other patient actions indicate good understanding of peritoneal dialysis.
The nurse is caring for a patient with acute kidney injury who is dehydrated with symptoms of oliguria, anemia, and hyperkalemia. Which of the following prescribed actions should the nurse take first?
- A. Insert a urinary retention catheter.
- B. Place the patient on a cardiac monitor.
- C. Administer an erythropoiesis-stimulating agent (ESA).
- D. Give sodium polystyrene sulfonate.
Correct Answer: B
Rationale: Since hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. ESA's will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output but does not correct the cause of the renal failure.
The nurse is assessing a patient who is receiving peritoneal dialysis with 2 L inflows. Which of the following information should be reported immediately to the health care provider?
- A. The patient has an outflow volume of 1800 mL.
- B. The patient's peritoneal effluent appears cloudy.
- C. The patient has abdominal pain during the inflow phase.
- D. The patient complains of feeling bloated after the inflow.
Correct Answer: B
Rationale: Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.