Fluid And Electrolyte Imbalance Acute Renal – Flashcards
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*What are the some of the methods by which body fluids move across fluid compartments? (Select all that apply.) a) Osmosis b) Filtration c) Third spacing d) Hypoperfusion e) Compensation
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a) Osmosis b) Filtration Compensation is the body's attempt to adjust for a fluid and electrolyte imbalance. Hypoperfusion is decreased blood flow through an organ. Third spacing is a shifting of fluid into interstitial spaces. Osmosis is the movement of water across cell membranes, from the less concentrated solution to the more concentrated solution. Filtration is a process whereby fluid and solutes move together across a membrane from one compartment to another. The movement is from an area of higher pressure to one of lower pressure.
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*A 6-month-old infant is admitted with severe dehydration. Effectiveness of therapy is evaluated with which of the following assessment measures? (Select all that apply.) a) Intake and output b) Abdominal girth c) Mucous membrane assessment for moisture d) Daily weights e) Level of consciousness
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a) Intake and output c) Mucous membrane assessment for moisture d) Daily weights e) Level of consciousness All of the choices represent assessment measures that measure the effectiveness of therapy except abdominal girth, which does not provide information regarding hydration status. NOT ABDOMINAL GIRTH!!!
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*A client is admitted to the emergency department with hypovolemia. Which intravenous solution would the nurse anticipate administering? a) Ringer's solution b) 10% dextrose in water c) 3% sodium chloride d) 0.45% sodium chloride
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a) Ringer's solution Ringer's solution is an isotonic, balanced electrolyte solution that can expand plasma volume and help restore electrolyte balance. Hypertonic solutions such as 10% dextrose and 3% sodium chloride pull interstitial and intracellular fluid into the vascular system, leading to cellular dehydration. A hypotonic solution such as 0.45% sodium chloride may be used to treat cellular dehydration.
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*When assessing a client with fluid volume deficit, the nurse would expect to find: a) Dyspnea and respiratory crackles. b) Headache and muscle cramps. c) Increased pulse rate and blood pressure. d) Orthostatic hypotension and flat neck veins.
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d) Orthostatic hypotension and flat neck veins. In fluid volume deficit, there is less volume in the vascular system, which decreases venous return and cardiac output, leading to manifestations of dizziness, orthostatic hypotension, and flat neck veins. The heart rate increases and the blood pressure falls. Dyspnea and crackles usually are associated with excess fluid volume. Headache and muscle cramps are often due to electrolyte imbalance, not fluid loss.
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*Laboratory results for a client show a serum potassium level of 2.2 mEq/L. Which of the following nursing actions is of highest priority for this client? a) Initiate seizure precautions. b) Initiate cardiac monitoring. c) Keep the client on bed rest. d) Start oxygen at 2 L/min.
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b) Initiate cardiac monitoring. Hypokalemia affects nerve impulse transmission, including the transmission of cardiac impulses. The client may develop ECG changes and atrial or ventricular dysrhythmias. Although hypokalemia can lead to muscle weakness and activity intolerance, bed rest generally is unnecessary. Starting oxygen would be appropriate only if the client is in respiratory distress. The client is more likely to experience cardiac arrest, not seizures; in any case, the priority is cardiac monitoring. The client is not hypoxic, so oxygen is not needed.
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*The nurse caring for a client with acute hypernatremia includes which of the following in the plan of care? (Select all that apply.) a) Conduct frequent neurologic checks. b) Limit length of visits. c) Orient to time, place, and person frequently. d) Restrict fluids to 1500 mL per day. e) Maintain intravenous access.
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a) Conduct frequent neurologic checks. c) Orient to time, place, and person frequently. e) Maintain intravenous access. Frequent neurological checks are necessary as hypernatremia draws water out of brain cells, causing them to shrink. As the brain shrinks, tension is placed on cerebral vessels, which may cause them to tear and bleed. Hypernatremia affects mental status and brain function (including orientation to time, place, and person), as can rapid correction of hypernatremia. Fluid replacement is the primary treatment for hypernatremia. Maintaining intravenous access is necessary for administration of fluids and possible emergency medications. There is no reason to limit visit length.
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* The neonatal nurse explains to new parents that infants are at greater risk for fluid and electrolyte imbalance than are older children. Which of the following parent comments would indicate that further education is needed? a) "Infants lose water through their skin, and they have a larger proportion of skin surface area than older children do." b) "Infants maintain their temperature by losing heat through their heads." c) "Infants have a higher metabolic rate than older children do." d) "An infant has little body water for reserve, as compared with an adult."
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b) "Infants maintain their temperature by losing heat through their heads." Losing heat through their heads will have minimal effect on fluid loss in infants. All the other answers are appropriate responses.
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* A client with chronic renal failure has been prescribed diuretics. What are some important nursing activities for this client's care? (Select all that apply.) a) Check for swallowing problems b) Check temperature regularly c) Monitor intake and output d) Check hydration status e) Monitor client for anxiety
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c) Monitor intake and output d) Check hydration status Temperature alteration, anxiety, and swallowing disorders are not normally associated with the administration of diuretics. The accurate measurement of intake and urine output is significant since diuretics increase urine excretion of both water and electrolytes. Understanding Diuretics can affect hydration status.
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* An appropriate goal of nursing care for a client with end-stage renal disease is that the client will be able to: a) Identify a live-in caregiver. b) Demonstrate the ability to independently perform hemodialysis in the home. c) State the advantages and disadvantages of hemodialysis, peritoneal dialysis, and kidney transplant as renal replacement therapies. d) Relate the hospice philosophy and identify indicators of the need for hospice care.
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c) State the advantages and disadvantages of hemodialysis, peritoneal dialysis, and kidney transplant as renal replacement therapies. The client's ability to state renal replacement therapies indicates understanding of treatment options and the ability to make informed decisions on treatment. Clients may be able to live independently, or with the assistance of a part-time caregiver. Home hemodialysis would require a helper for safety reasons to monitor the client's response. Hospice care is not needed for ESRD.
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*Following a kidney transplant, the nurse notes that the client's urine is cloudy. The most appropriate action by the nurse is to: a) Record the finding. b) Notify the physician. c) Increase the intravenous flow rate. d) Irrigate the urinary catheter.
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b) Notify the physician. Cloudy urine could be a symptom of an infection. Prompt treatment is vital to preserve integrity of the transplanted organ in an immunosuppressed client. Recording the finding is insufficient; action must be taken. The nurse does not increase the intravenous flow rate without a physician's order. Irrigation of the urinary catheter would introduce possible contaminants into an immunosuppressed client.
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*Which finding by the nurse would be an accurate indicator of fluid volume status in an oliguric or aneuric client? a) Level of thirst b) Intake and output c) Weight changes d) BUN and creatinine levels
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c) Weight changes The client with little or no urine output is best assessed for fluid volume status by weight changes because retained fluid has weight. Lack of output would exclude intake and output as accurate data for assessment. The client's thirst does not indicate fluid status because the client on fluid restriction will be thirsty even with fluid volume excess. BUN and creatinine are used to assess kidney function; while BUN increases with dehydration, it is not the best indicator of fluid status
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*A client with chronic renal failure has a serum potassium of 6.6 mEq/L. The nurse should anticipate an order for: a) sodium polystyrene sulfonate (Kayexalate). b) aluminum hydroxide (Amphojel). c) propranolol (Inderal). d) furosemide (Lasix).
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a) sodium polystyrene sulfonate (Kayexalate). The client with renal failure with a potassium level above 6.5 mEq/L is treated with sodium polystyrene sulfonate (Kayexalate SPS suspension). Sodium polystyrene exchanges sodium ions for potassium in the intestines. Furosemide (Lasix) removes sodium and excess fluid. Aluminum hydroxide (Amphojel) is used to control hyperphosphatemia. Propranolol (Inderal) may control hypertension.
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*A client with chronic renal failure has had an arteriovenous fistula created for hemodialysis. The nurse should assess this client for: a) homan's sign. b) a renal bruit. c) a bruit and a thrill. d) periorbital edema.
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c) a bruit and a thrill. The client needs to be assessed for a functional arteriovenous fistula by palpating a thrill and auscultating a bruit. Clients may have edema, which is usually peripheral. A renal bruit indicates turbulent blood flow in the renal artery. A positive Homan's sign may indicate a deep vein thrombosis.
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*A client with end-stage renal disease has received a kidney transplant. The client asks, "Why do I need to take cyclosporine (Sandimmune)?" What is the best response by the nurse? a) "It will help prevent rejection of the kidney by suppressing your immune system." b) "It will increase your immune system to prevent rejection." c) "It increases bone marrow cell production to assist in preventing rejection." d) "It will help prevent infection."
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a) "It will help prevent rejection of the kidney by suppressing your immune system." Unless a kidney is received from an identical twin, the body will produce antibodies and will begin to reject the kidney. Immunosuppressants suppress the immune system and the inflammatory response. Bone marrow production is part of the suppressed immune system. The risk for infection is greater with this treatment because the immune system is suppressed
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*A client has just returned from hemodialysis. For which should the nurse assess this client? a) Hyperkalemia. b) Peripheral edema and headache. c) Signs of disequilibrium syndrome. d) Congestive heart failure.
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c) Signs of disequilibrium syndrome. Dialysis can cause disequilibrium syndrome if fluid is withdrawn too quickly. The nurse should assess for headache, nausea, vomiting, change in level of consciousness, and hypertension. Congestive heart failure is fluid overload. The client is more likely to experience hypokalemia. Peripheral edema is a sign of fluid overload.
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*The nurse instructs a client who is on peritoneal dialysis to remain in which of the position? a) Dorsal recumbent b) Semi-Fowler's c) Supine d) Lateral Sims's
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b) Semi-Fowler's Respiratory distress due to increased pressure from the dialysate may occur unless the client remains in semi-Fowler's or Fowler's position. Lateral, supine, or dorsal recumbent positions may increase the risk of respiratory distress.
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The healthcare provider ordered a diuretic that inhibits sodium and chloride reabsorption in the ascending loop of Henle. The nurse recognizes that this medication is part of what class of​ diuretics? a) Thiazide b) Potassium sparing c) Osmotic d) Loop
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d) Loop Loop diuretics inhibit sodium and chloride reabsorption in the ascending loop of Henle. Thiazide diuretics promote the excretion of​ sodium, chloride,​ potassium, and water by decreasing absorption in the distal tubule.​ Potassium-sparing diuretics promote excretion of sodium and water by inhibiting sodiumdash-potassium exchange in the distal tubule. Osmotic diuretics do not inhibit sodium and chloride reabsorption in the ascending loop of Henle.
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The nurse is planning care for a client admitted for congestive heart failure who has a priority problem of fluid volume excess. What is occurring in the body that places the client at risk for retaining​ fluids? a) Retention of water and sodium b) Impaired renal excretion of potassium c) Decrease in ADH and aldosterone d) Low serum osmolality level stimulates the thirst center
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a) Retention of water and sodium Fluid volume excess results from conditions that cause retention of water and sodium. Impaired renal excretion of potassium is not related to fluid volume excess. There will be an increase in ADH and aldosterone when the stress response is activated with fluid volume excess. An increase in serum osmolality stimulates the thirst​ center, not a low serum​ osmolality, which could affect fluid volume.
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A client admitted for nausea and vomiting has a​ urine-specific gravity of 1.061. Upon assessment of the​ client, the nurse finds that the client is experiencing orthostatic hypotension and has dry skin and flat neck veins. What is the priority nursing diagnosis for this client when planning​ care? a) Ineffective tissue perfusion b) Deficient fluid volume c) Impaired gas exchange d) Impaired skin integrity
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b) Deficient fluid volume Fluid volume deficit can be caused by nausea and vomiting with assessment findings of orthostatic​ hypotension, dry​ skin, and flat neck​ veins, which will lead to the priority nursing diagnosis of deficient fluid volume. The client is demonstrating fluid volume deficit.​ Therefore, ineffective tissue​ perfusion, impaired gas​ exchange, and impaired skin integrity are not priority nursing diagnoses for this client.
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The nurse is completing discharge teaching with a client diagnosed with congestive heart failure.​ Which symptoms will the nurse teach the client to immediately report to the healthcare​ provider? (Select all that apply) a) Dry mouth b) Dizziness when standing c) Cough with increased sputum production d) Urine output of 320 mL in 8 hours e) Five-pound weight gain in a week
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c) Cough with increased sputum production e) Five-pound weight gain in a week The client with congestive heart failure it at risk for developing fluid volume excess. Weight gain of more than 5 pounds in a week and a cough with increased sputum production are indications of excess fluid​ volume, and the healthcare provider must be notified of these findings. Dizziness when standing and a dry mouth are not signs of fluid volume excess and do not need to be reported to the healthcare provider. A urine output of 320 mL in 8 hours is not a finding that needs to be reported to the healthcare provider.
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The nurse is reviewing client data to begin planning care. Which client is at greatest risk for developing fluid volume​ excess? a) A client admitted for oral surgery b) A client admitted for overuse of laxatives c) A client admitted for nausea and vomiting d) A client admitted for cirrhosis
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d) A client admitted for cirrhosis A client admitted for liver cirrhosis is at greatest risk for developing fluid volume excess. Clients admitted for nausea and​ vomiting, overuse of​ laxatives, or oral surgery are not at risk for developing fluid volume excess.
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A client is admitted with a serum sodium level of 140​ mEq/L, hematocrit level of​ 31%, and generalized edema. Which priority intervention is indicated for this​ client? a) Increase sodium intake in the diet b) Prepare to administer a blood transfusion c) Restrict fluid intake d) Encourage the client to drink ginger ale
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c) Restrict fluid intake This client is experiencing fluid volume excess.​ Therefore, the priority nursing intervention is restricting fluid intake. Preparing to administer a blood​ transfusion, encouraging the client to drink ginger​ ale, and encouraging the client to increase sodium intake are not priority nursing interventions because this client is experiencing fluid volume excess.
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When ADH and aldosterone are​ secreted, what change occurs in the​ body? a) Intracellular fluid is depleted. b) Sodium and water are retained by the kidneys. c) Urine output is increased. d) Third-space shifting occurs.
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b) Sodium and water are retained by the kidneys. The release of ADH and aldosterone causes sodium and water to be retained by the kidneys. The secretion of ADH and aldosterone are part of the renindash-angiotensindash-aldosterone system.
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What is the result of the fluid in third​ spacing? a) Fluid from the vascular space becomes unavailable for physiological functioning. b) Fluid shifts into the subcutaneous tissue. c) Fluid is excreted from the body through stimulation of urine production. d) Fluid returns to the intracellular space.
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a) Fluid from the vascular space becomes unavailable for physiological functioning. In third​ spacing, fluid moves from the vascular space into an area where it is not available to support normal physiological functioning. The fluid may locate into the peritoneal space or​ pleura, where it is trapped. The unavailable fluid in third spacing may be located in the bowel or peritoneal cavity. The fluid loss attributable to third spacing may be difficult to detect because the client​'s weight may remain stable and intake and output records may not indicate a fluid loss. Fluid does not leave the body or enter the intracellular space or subcutaneous tissue.
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Which diagnostic test assesses kidney​ function? a )Hematocrit b) Serum osmolality c) Serum creatinine d) Hemoglobin
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c) Serum creatinine A diagnostic test used to assess kidney function is serum creatinine levels. Hemoglobin and hematocrit are used to assess hemoconcentration in the blood. Serum osmolality helps to differentiate isotonic fluid loss from water loss.
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Which electrolyte imbalance is treated with calcium​ gluconate? a) Hyperkalemia b) Hypochloremia c) Hyponatremia d) Hypernatremia
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a) Hyperkalemia Calcium gluconate is used to treat hyperkalemia. Hypernatremia is treated with fluid replacement. Hypochloremia is treated with increasing dietary salt and adding chloride to the IV fluid. Hyponatremia is treated by increasing dietary sodium and administering sodium containing IV fluids.
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Which interventions would you include in a plan of care for a client with fluid volume​ excess? ​(Select all that ​apply.) a) Reducing intake of caffeinated drinks b) Keeping track of how many cups of fluid they drink c) Elevating legs and feet when sitting d) Monitoring daily weight e) Reading food labels to note fiber content
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b) Keeping track of how many cups of fluid they drink c) Elevating legs and feet when sitting d) Monitoring daily weight For a client with fluid volume​ excess, appropriate interventions would include monitoring fluid intake to stay within fluid​ restrictions; monitoring weight daily and reporting significant increases to the healthcare​ provider; and elevating the legs and feet to reduce dependent edema. The client should read labels on food products for sodium content. Caffeinated drinks produce a diuretic effect and would not need to be reduced.
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How often should the nurse reposition a client with fluid volume​ deficit? a) Every 180 minutes b) Every 90 minutes c) Every 120 minutes d) Every 30 minutes
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c) Every 120 minutes The client with fluid volume deficit should be repositioned every 2​ hours, or 120 minutes.
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Mrs. Rivera reports experiencing vomiting and diarrhea for the past 2​ days, resulting in a​ 5% weight loss. In addition to diminished skin​ turgor, which assessment would you expect to note with Mrs.​ Rivera? a) Tachycardia b) ​Warm, flushed skin c) Ascites d) Dyspnea
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a) Tachycardia When a client experiences a deficiency in fluid​ volume, the heart rate will increase​ (tachycardia) in an attempt to improve circulation.​ Warm, flushed skin is typically seen with a fever. Ascites and dyspnea are frequently noted with fluid volume excess.
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You are providing care for James​ Dand, who has been determined to have fluid volume excess. Laboratory values indicate that Mr. Dand is experiencing hypokalemia. Which therapy do you anticipate will be prescribed for Mr. Hernandez based on this​ information? a) Oral fluid solutions b) Loop diuretics c) Isotonic electrolyte solutions ​d) Potassium-sparing diuretics
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​d) Potassium-sparing diuretics A client experiencing fluid volume excess with hypokalemia would be prescribed​ potassium-sparing diuretics. Loop diuretics would be prescribed for a client with hyperkalemia. Oral fluid solutions and isotonic electrolyte solutions are appropriate therapies for a client with fluid volume​ deficit, not excess.
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You are providing discharge instructions for Mr.​ Dickson, who has had frequent episodes of fluid volume excess requiring hospitalization. He will continue to take furosemide​ (Lasix) after discharge. Which statement by Mr. Dickson would indicate that there is a need for additional​ instruction? a) "It is important to change positions​ frequently." b) ​"I will eat a banana every​ day." c) "I will weigh myself weekly and notify my healthcare provider if I gain more than 1​ pound." d) ​"I will wear shoes that fit well and not walk​ barefoot."
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c) "I will weigh myself weekly and notify my healthcare provider if I gain more than 1​ pound." It is important for the client to weigh himself​ daily, not​ weekly, after discharge for fluid volume excess. Eating foods rich in​ potassium, wearing shoes that fit well and not walking​ barefoot, and changing positions frequently are all responses that indicate understanding of the discharge instructions provided by the nurse.
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The nurse is completing a physical examination of a client with acute renal failure. Which piece of data should the nurse collect during the physical​ examination? (Select all that​ apply.) a) Edema b) Peripheral pulses c) Mental status d) Bowel sounds e) Weight
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a) Edema b) Peripheral pulses d) Bowel sounds e) Weight Specific data that the nurse needs to collect during a physical examination of a client in acute renal failure include​ weight, peripheral​ pulses, edema, and bowel sounds. Altered mental status is not a factor in the physical examination of a client in acute renal failure.
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A client with renal failure will be undergoing a diagnostic test that will differentiate between acute and chronic renal failure. For which diagnostic test should the nurse provide​ education? a) CT scan b) MRI c) Renal biopsy d) Renal ultrasonography
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c) Renal biopsy A renal biopsy is done to differentiate between acute and chronic renal​ failure, so the nurse should provide education for this diagnostic test. A renal ultrasonogram identifies obstructive causes of renal failure and does not differentiate between acute and chronic renal failure.​ Therefore, the nurse should not provide education for this diagnostic test. A CT scan or an MRI evaluates kidney size and identifies possible​ obstructions, but it does not differentiate between acute and chronic renal​ failure; therefore, the nurse should not provide education for these diagnostic tests.
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Which nursing intervention would be implemented for a client with fluid volume overload due to acute renal​ failure? ​(Select all that​ apply.) a) Encouraging liberal fluid intake b) Weighing daily c) Placing in​ semi-Fowler position d) Administering potassium replacements e) Maintaining intake and output records
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b) Weighing daily c) Placing in​ semi-Fowler position e) Maintaining intake and output records Nursing care for clients with fluid volume overload caused by acute renal failure includes maintaining intake and output measurements and daily weighing to assist in tracking fluid balance. The​ semi-Fowler position helps improve respiratory excursion of the client with fluid overload. Clients with acute renal failure have hyperkalemia and should not be given potassium supplements. Liberal fluid intake is contraindicated in clients with acute renal failure because of their inability to excrete excess fluid
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The nurse is caring for a client in the maintenance phase of acute renal failure. Which manifestation typically is more severe if the client is experiencing​ oliguria? a) Anemia b) Dehydration c) Muscle weakness d) Azotemia
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d) Azotemia A client in the maintenance phase of acute renal failure will experience​ azotemia, which is more severe in a client with oliguria. Muscle​ weakness, anemia, and dehydration typically are not more severe when experiencing oliguria.
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The nurse is caring for a client diagnosed with acute renal failure. Which condition most likely caused prerenal acute renal failure in this​ client? a) Renal calculi b) Fluid retention c) Glomerulonephritis d) Sepsis
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d) Sepsis Sepsis causes prerenal acute renal failure because it causes altered vascular resistance. Fluid retention is not a cause of prerenal acute renal failure. Renal calculi are not a cause of prerenal acute renal failure but are the cause of postrenal acute renal failure. Glomerulonephritis is not the cause of prerenal acute renal failure but is the cause of intrarenal acute renal failure.
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The nurse identifies that a client in acute renal failure is experiencing hyperkalemia. For which manifestation should the nurse monitor the​ client? a) Electrocardiographic changes b) Hypotension c) Constipation d) Weight gain
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a) Electrocardiographic changes Impaired potassium excretion leads to​ hyperkalemia, which causes electrocardiographic changes.​ Hypotension, constipation, and weight gain are not manifestations of hyperkalemia.
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Which symptom may indicate acute renal failure in an older adult​ client? a) Nausea b) Gross hematuria c) Uremia d) Orthostatic hypotension
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d) Orthostatic hypotension An older adult client may experience orthostatic hypotension with acute renal failure.​ Nausea, uremia, and gross hematuria are symptoms typically experienced by children with acute renal failure.
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Which critical illness is a risk factor for acute renal​ failure? ​(Select all that ​apply.) a) Hemorrhage b) Severe heart failure c) Major trauma d) Cerebrovascular disease e) Radiologic contrast media
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a) Hemorrhage b) Severe heart failure c) Major trauma e) Radiologic contrast media Major​ trauma, heart​ failure, and hemorrhage are risk factors for acute renal failure because they can reduce blood flow to the kidneys. Radiologic contrast media can be nephrotoxic and cause acute renal failure. Cerebrovascular disease is not a risk factor for acute renal failure because it does not reduce blood flow to the kidneys and it does not cause nephrotoxicity.
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Which diagnostic test assesses kidney​ function? a) Serum osmolality b) Hemoglobin c) Hematocrit d) Serum creatinine
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d) Serum creatinine A diagnostic test used to assess kidney function is serum creatinine levels. Hemoglobin and hematocrit are used to assess hemoconcentration in the blood. Serum osmolality helps to differentiate isotonic fluid loss from water loss.
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Which electrolyte imbalance is treated with calcium​ gluconate? a) Hypochloremia b) Hyperkalemia c) Hyponatremia d) Hypernatremia
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b) Hyperkalemia Calcium gluconate is used to treat hyperkalemia. Hypernatremia is treated with fluid replacement. Hypochloremia is treated with increasing dietary salt and adding chloride to the IV fluid. Hyponatremia is treated by increasing dietary sodium and administering sodium containing IV fluids.
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How much urine output is considered normal for a client experiencing acute renal​ failure? a) 25​ mL/hr b) 30​ mL/hr c) 20​ mL/hr d) 15​ mL/hr
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b) 30​ mL/hr The normal output for an individual with acute renal failure is considered to be 30​ mL/hr. If a client experiencing acute renal failure has a urine output less than 30​ mL/hr, the healthcare provider needs to be notified.
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Which pieces of data should the nurse collect when completing a physical examination on a client in acute renal​ failure? ​(Select all that​ apply.) a) Weight b) Lung sounds c) Reports of edema d) Skin color e) History of diabetes mellitus
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a) Weight b) Lung sounds d) Skin color When completing a physical examination on a client experiencing renal​ failure, the nurse needs to note the client​'s ​weight, skin​ color, and lung sounds. Reports of edema and having a history of diabetes mellitus is information collected when obtaining a client​'s health history.
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Rosa Serrano is a​ 6-year-old child admitted to a medical unit. You notice that Rosa is lethargic and has generalized edema. When reviewing the laboratory​ results, the nurse finds that Rosa is experiencing gross hematuria. Which further information would the nurse obtain from the parents to assist with the diagnosis of acute renal​ failure? a) Recent acute gastrointestinal illness b) Past infections c) Current medications d) Previous major surgery
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a) Recent acute gastrointestinal illness Children are at greatest risk for developing acute renal failure from acute gastrointestinal illnesses.​ Therefore, the nurse needs to further question​ Rosa's parents about recent acute gastrointestinal illnesses. Major​ surgery, infections, and certain medications that are nephrotoxic can increase the risk for acute renal failure in older adult clients.
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Benjamin Sanger is a​ 63-year-old man admitted to the hospital with postrenal failure because of a kidney stone. During the past 24​ hours, he has voided 250 mL of urine. He has not had any other type of output. How much fluid should Mr. Sanger receive over the next 24​ hours? ​a) 1,250 mL b) 750 mL c) ​3,000 mL d) 2,750 mL
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b) 750 mL Fluid intake for clients with renal failure is usually restricted because the kidneys cannot eliminate fluids normally. Fluid intake is calculated for these clients by adding the amount of output for the previous 24 hours to 500 mL to allow for insensible losses. Mr.​ Sanger's output for the past 24 hours was 250​ mL; added to 500​ mL, the fluid volume calculation equals 750 mL. A fluid intake of​ 1,250, 2,750, or​ 3,000 mL would be too much fluid for Mr. Sanger and put him at risk for fluid overload.
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James Hill is an​ 80-year-old man who was admitted to the hospital with gastrointestinal bleeding and hemorrhagic shock. Despite blood product administration and cauterization of his duodenal​ ulcer, his serum creatinine has risen to 2.2 from 1.1​ mg/dL over the past 10 hours. His serum potassium level is 4.0​ mEq/L. Which interventionwould the nurse include in the care plan for Mr.​ Hill? a) Reporting urine output of less than 30​ mL/hr b) Administering potassium replacement c) Removing the indwelling urinary catheter d) Administering intravenous gentamicin as prescribed
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a) Reporting urine output of less than 30​ mL/hr Mr.​ Hill's rising serum creatinine indicates that he is developing renal dysfunction. The nurse should monitor his urine output and report a rate of less than 30​ mL/hr so that early interventions can be implemented to help restore renal function. Renal dysfunction alters the​ kidney's ability to excrete potassium and can result in hyperkalemia.​ However, a serum potassium levelof 4.0​ mEq/L is within normal limits.​ Therefore, Mr. Hill should not receive a potassium supplement. Gentamicin is a nephrotoxic drug and should not be administered to Mr. Hill given his compromised renal function. Mr.​ Hill's indwelling urinary catheter should remain in place so his urine output can be closely monitored.
