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Acute renal failure and chronic kidney disease


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Acute tubular necrosis is a type of acute renal failure that results primarily from
renal ischemia, nephrotoxic injury
renal ishemia leads to acute tubular necrosis by disrupting the ______?
basement membrane and causing patchy destruction of the tubular epithelium
Nephrotoxic agents cause necrosis of the _____?
tubular epithelium that sloughs off and blocks the tubules
Acute tubular necrosis from nephrotoxic injury is more likely to be reversible because the _______?
basement membrane is usually not initially destroyed
The nurse determines that a patient with oliguria has prerenal oliguria when _____?
reversal of the oliguria occurs with fluid replacement
Tubular damage is indicated in the patient with acute renal failure by urinalysis finding of ______?
specific gravity fixed at 1.010
Metabolic acidosis occurs in the oliguric phase of acute renal failure as a result of impaired _______?
ammonia synthesis
Although both BUN and serum creatinine levels are increased in renal failure, a BUN of 85 mg/dl (30.3 mmol/L) and a serum creatine of 3.8 mg/dl (336mol/l) would most likely occur in a patient with acute renal failure caused by _____?
massive trauma
The nurse determines that a patient with acute renal failure is in the recovery phase when the patient experiences ____?
decreasing BUN and creatinine levels
While caring for the patient in the oliguric phase of acute renal failure, the nurse monitors the patient for associated collaborative problems, notifying the physican when ______?
the patient experiences increasing muscle weakness and abdominal cramping
The most common cause of death in acute renal failure is
Serum potassium and urea _____?
are increased during catabolism of body protein
During the oliguric phase of acute renal failure daily fluid intake is limited to _____?
600 ml plus the prior day's measureable fluid loss
Dietary sodium and potassium during the oliguric phase of acute renal failure managed accoring to the patient's_______?
sodium and potassium serum levels
One of the most important nursnig measures in managing fluid balance in the patient in acute renal failure is ______?
accurate daily weights
A patient with acute renal failure has a serum potassium level of 6.8 mEq/L (6.8 mmol/L) and the following arterial blood gas results : pH 7.28, PaCO2 30mm Hg, PaO2 86 mm Hg, HCO3- 18mEq/L (18 mmol/L). The nurse recognizes that treatment of the acid-base
potassium level
In replying to a patient's questions about the seriousness of her chronic kidney disease, the nurse knows that the stage of chronic kidney disease is based on _____?
the glomerular filtration rate
A patient with a creatine clearance test of 30 ml/min would have a glomerular filtration rate of ______?
30 ml/min/17.3m2 and stage 3 chronic kidney disease
The nurse identifies a nursing a nursing diagnosis of risk for injury: fracture related to alteration in calcium and phosphorus metabolism for a patient with chronic renal disease. The pathologic process directly related to the risk for fracture is _____
impaired vitamin D activation resulting in decreased GI absorption of calcium
A patient with chronic renal insufficency weighs 70 kg and has the following lab results: creatine clearance 18ml/min, potasssium 6.2 mEQ/L (6.2 mmol/L), BUN 75 mg/dl (26.8 mmol/L), serum creatine 6.3 mg/dl (557 mmol/L) An appropriate dietary modificatio
a potassium restriction of 2.3g/day
In implementing care for the patient on peritoneal dialysis, the nurse recognizes that dietary needs include an increased amount of _____?
The most appropriate snack for the nurse to offer the patient with chronic renal dissease is _____?
hard candy
A nutrient that is commonly supplemented for the patient on dialysis because it is dialyzable is _______?
folic acid
The syndrome that includes all the signs and sympoms seen in the various body systems in chronic kidney disease is ____?
The use of calcium based phosphate binders in the patient with chronic kidney disease is contraindicated when ______?
serum phosphate levels are increased
The use of meperidine (demerol) is contraindicated in the patient with ________?
chronic kidney disease because accumulation of its metabolites may cause seizures.
During the nursing assessment of the patient with renal insufficency, the nurse asks the patient specifically about a history of _______?
When teaching a patient with chronic kidney disease about prevention of complications, the nurse instructs the patient to _______?
weight daily and report a gain of greater than 4 pounds.
The patient with end stage renal disease tells the nurse that she hates the thought of being tied to the machine, but is also glad to start dialysis because she will be able to eat and drink what she wants. Based on this informatinon, the nurse identifie
ineffective management of therapeutic regimen related to lack of knowledge of treatment plan.
The dialysate for peritoneal dialysis contains ______?
glucose in higher concentration than in the blood
An exchange in peritoneal dialysis includes the phases of
fill, dwell, and drain.
The amount of peritoneal dialysate used for one exchange is usually ______?
2 liters
The patient using automated peritoneal dialysis usually dialysizes ______?
during sleep and leaves the fluid in the abdomen during the day.
To prevent the most common serious complication of peritoneal dialysis, it is important for the nurse to ______?
use strict aseptic technique in the dialysis procedures
The composition of the perioteoneal diaysate solution requires careful monitoring of the patient who also has ____?
A patient on hemodialysis develops a thrombus of a solution AV graft requiring its removal. While waiting for a replacement for a replacement graft or fistula, the patient is most likely to have _____?
a silastic catheter tunneled subcutaneously to jugular vein.
A patient with end-stage renal failure is scheduled for hemodialysis following healing of an AV fistula. The nurse explains that during dialysis _____?
he will be able to visit, read, sleep, or watch TV while reclining in a chair.
The nurse evaluates the patency of an AV graft by ____?
auscultating for the presence of bruit at the site
A patient returns from her initial hemodialysis treatment with nausea, confusion, twitching, and jerking. The pathophysiolgic mechanism of diaylysis responsible for these signs and symptoms is a _____?
high osmotic gradient in the brain causing cerebral edema.
A patient in acute renal failure is a candidate for continuous renal replacement therapy (CRRT). The most common indication for use of CRRT is ____?
fluid overload.
A patient rapidly progressing toward end-stage renal disease asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that contraindication to kidney transplantation include _____?
extensive vascular disease.
A patient in end-stage renal disease is being evaluated for kidney transplant from a live related donor. Results of histocompatiblility testing that would indicate the best match of the patient and the donor include _____?
ABO compatiblility and six-HLA match.
During the immediate postoperative care of the receipent of a kidney transplant, the nurse expects to ______?
regulate fluid intake hourly based on urine output.
Signs and symptoms of chronic rejection of the kidney are used by _____?
gradual occlusion of the renal blood vessels.
Signs and symptoms of acute rejection that the nurse should teach the patient to observe for include _____?
fever and painful transplant site.

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