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Renal Issues
Chronic Renal Issues and Transplant
| Question | Answer |
|---|---|
| A patient is admitted to the hospital with chronic kidney disease (CKD). The nurse understands that this condition is characterized by | progressive irreversible destruction of the kidneys |
| Patients with chronic kidney disease (CKD) experience an increase incidence of cardiovascular disease related to | hypertension, vascular calcifications, and hyperinsulinemia causing dyslipidemia |
| An end-stage renal disease (ESRD) patient receiving hemodialysis (HD) is considering asking a relative to donate a kidney for transplantation. In assisting the patient t make a decision about treatment, the nurse informs the patient that | successful transplantation usually provides a better quality of life than that offered by dialysis |
| To assess the potency of a newly placed arteriovenous graft for dialysis, the nurse should | palpate the area of the graft to feel a normal thrill, listen with a stethoscope over the graft to deter a bruit, and frequently monitor the pulses and neuromuscular status distal to the graft |
| A major advantage of peritoneal dialysis is | the diet is less restricted and dialysis can be performed at home |
| A kidney transplant recipient complains of having fever, chills, and dysuria over the past 2 weeks. What is the first action the nurse should take? | assess temperature and initiate workup to rule out infectionIn |
| In replying to a patient's questions about the seriousness of her chronic kidney disease (CKD), the nurse knows that the stage of CKD is based on what? | glomerular filtration rate (GFR) |
| The patient with chronic kidney disease (CKD) is receiving dialysis, and the nurse observes excoriations on the patient's skin. What pathophysiologic changes in CKD most likely occur that can contribute to this finding? | dry skin, sensory neuropathy, and calcium-phosphate skin deposits. |
| What causes the GI manifestations of stomatitis in the patient with chronic kidney disease (CKD)? | increased ammonia from bacterial breakdown of urea |
| The patient with chronic kidney disease (CKD) is brought to the ED with Kussmaul respirations. What does the nurse know about CKD that could cause this patient's Kussmaul respirations? | they are caused by respiratory compensation for metabolic acidosis |
| Which serum laboratory value indicates to the nurse that the patient's chronic kidney disease (CKD) is getting worse? | decreased calculated GFR |
| What is the most serious electrolyte disorder associated with kidney disease? | hyperkalemia |
| What is the most appropriate snack for the nurse to offer a patient with stage 4 chronic kidney disease (CKD)? | hard candy |
| Which complication of chronic kidney disease (CKD) is treated with erythropoietin? | anemia |
| The patient with chronic kidney disease (CKD) is considering whether to use hemodialysis (HD) or peritoneal dialysis (PD). What are the advantages of PD when compared to HD? | less cardiovascular stress and it requires fewer dietary restrictions |
| To prevent the most common serious complication of peritoneal dialysis, what is most important for the nurse to do? | use strict aseptic technique in the dialysis procedure |
| A man with end-stage renal disease (ESRD) is scheduled for hemodialysis following the healing of an arteriovenous fistula. What should the nurse explain to him that will occur during dialysis? | he will be able to visit, read, sleep, or watch TV while reclining in a chair |
| A patient rapidly progressing toward end-stage renal disease (ESRD) asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that what isa contradiction to kidney transplantation. | extensive vascular disease |
| During the immediate postoperative care of a recipient of a kidney transplant, what is a priority for the nurse to do? | regulate fluid intake hourly based on urine output |
| A patient received a kidney transplant last month. Because of the effects of immunosuppressive drugs and chronic kidney disease (CKD), what complication of transplantation should the nurse be assessing the patient for? | infection |
| The home care nurse visits a 34-year-old woman receiving peritoneal dialysis. Which statement indicates a need for immediate follow-up by the nurse? | "The fluid draining from the catheter is cloudy." |
| The nurse is preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD). Which laboratory result will the nurse monitor to determine if the desired effect was achieved? | phosphorus |
| Which statement regarding continuous ambulatory peritoneal dialysis (CAPD) would be most important when teaching a patient new to the treatment? | "It is essential that you maintain aseptic technique to prevent peritonitis." |
| A patient with end-stage renal disease (ESRD) secondary to diabetes mellitus has arrived at the outpatient dialysis unit for hemodialysis. Which assessment(s) should the nurse perform as a priority before, during, and after the treatment? | blood pressure and fluid balance |
| A patient is recovering in the intensive care unit (ICU) 24 hours after receiving a kidney transplant. What is an expected assessment finding during the earliest stage of recovery? | large urine output |
| A patient with a 25-year history of type I DM is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse notes newly developed hypertension and uncontrolled blood sugars. Which diagnostic study is most indicative of CKD? | calculated glomerular filtration rate (GFR) |
| A 78-year-old patient has stage 3 chronic kidney disease (CKD) and is being taught about low-potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat? | apple, green beans, and a roast beef sandwich |
| During hemodialysis, the patient develops lightheadedness and nausea. What should the nurse do first? | decrease the rate of fluid removal |
| A 24-year-old woman donated a kidney via a laparoscopic donor nephrectomy to a non related recipient. The patient is experiencing significant pain and refuses to get up to walk. How should the nurse respond? | encourage even a short walk to avoid complications of surgery |
| Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD)? | anemia, hypertension, and increased risk for fractures |
| The nurse is caring for a patient with chronic kidney disease (CKD) after hemodialysis. Which patient care action should the nurse delegate to the experienced unlicensed assistive personnel (UAP)? | check the patient's post dialysis blood pressure and weight |
| After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take? | report the patient's symptoms to the health care provider |
| Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurses teaching about management of CKD has been effective? | I will measure my urinary output each day to help calculate the amount I can drink. |
| Which patient information will the nurse plan obtain in order to determine the effectiveness of the prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? | phosphate level |
| Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess the | patient's bowel sounds |
| The nurse has instructed a patient who is receiving hemodialysis (HD) about appropriate dietary choices. Which menu choice by the patient indicates that the teaching has been successful? | scrambled eggs, english muffin, and apple juice |
| A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it | is much less likely to clot |
| When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the potency of the fistula? | check the fistula site for a bruit and thrill |
| When a patient who has had progressive chronic kidney disease (CKD) for several years is started on hemodialysis, which information about diet will the nurse include in patient teaching? | more protein will be allowed because of the removal of urea and creatinine by dialysis |
| Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? | the patient cleans the catheter while taking a bath every day |
| When the nurse is taking a history of a patient who is a possible candidate for a kidney transplant, which information about the patient indicates that the patient is not an appropriate candidate for transplantation? | the patient has metastatic lung cancer |
| The nurse is caring for a patient who had kidney transplantation several years ago. Which assessment finding may indicate that the patient is experiencing adverse effects to the prescribed corticosteroid? | joint pain |
| Which data obtained when assessing a patient who had a kidney transplant 8 years ago and who is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone) will be of most concern to the nurse? | there is a nontender lump in the axilla |
| A patient with chronic kidney disease (CKD) brings all home medications to the clinic to be reviewed by the nurse. Which medication being used by the patient indicates that patient teaching is required? | milk of magnesia 30 mL (CKD already causes hypermagnesemia, and this only increases it more) |
| Which of the following information obtained by the nurse who is caring for a patient with end-stage renal disease (ESRD) indicates the nurse should consult with the healthcare provider before giving the prescribed epoetin alfa (Procrit)? | hemoglobin level 13 g/dL |
| Which nursing action for a patient who has arrived for a scheduled hemodialysis (HD) session is most appropriate for the RN to delegate to a dialysis technician? | check blood pressure before starting dialysis |
| The nurse is assessing a patent who is receiving peritoneal dialysis (PD) with 2L inflows. Which information should be reported immediately to the health care provider? | the patients peritoneal effluent appears cloudy |
| Two hours after kidney transplant, the nurse obtains all of the following data when assessing the patient. Which information is most important to communicate to the health care provider? | the patient's central venous pressure (CVP) is decreased |
| During hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first? | check the patient's blood pressure |
| Which parameter will be most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation? | urine output |
| A patient complains of leg cramps during hemodialysis. The nurse should first | infuse a bolus of normal saline |
| A client with end-stage renal failure has an internal arteriovenous fistula in the left arm for vascular access during hemodialysis. What should the nurse instruct the client to do? | avoid sleeping on the left arm, wear wristwatch on the right arm, and assess fingers on the left arm for warmth |
| A client with chronic renal failure is receiving hemodialysis three times a week. In order to protect the fistula, the nurse should | report the loss of a thrill or bruit on the arm with the fistula |
| A client with chronic renal failure who receives hemodialysis 3 times a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? | have limited amounts of fluid only when thirsty, keep all dialysis appointments, and eat smaller, more frequent meals |
| The dialysis solution is warmed before use in peritoneal dialysis primarily to | encourage the removal of serum urea |
| A client is receiving peritoneal dialysis. While the dialysis solution is dwelling in the client's abdomen, the nurse should | observe respiratory status |
| During the peritoneal dialysis (PD), the nurse observes that the solution draining from the client's abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. The nurse should recognize that the bleeding | indicates abdominal blood vessel damage |
| During peritoneal damage (PD), the nurse observes that the flow of dialysate stops before all the solution has drained out. The nurse should | turn the client from side to side |
| A client undergoing long term peritoneal dialysis (PD) at home is currently experiencing a reduced outflow from the dialysis catheter. To determine if the cather is obstructed, the nurse should inquire whether the client has | constipation |
| Which should be included in the client's plan of care during dialysis therapy? | monitor the client's blood pressure |
| The client performs self peritoneal dialysis (PD). What should the nurse teach the client about preventing peritonitis? | broad-spectrum antibiotics may be administered to prevent infection and added to the dialysate to treat peritonitis; peritonitis is characterized by cloudy dialysate drainage, abdominal discomfort, and is the most common and serious complication of PD |
| After completion of peritoneal dialysis (PD), the nurse should assess the client for | weight loss |
| The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate? | low-protein, low-sodium, low-potassium |
| A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory PD program (CAPD). The nurse should explain that the major advantage of this approach is that it | allows the client to be more independent |
| A client is receiving continuous ambulatory peritoneal dialysis (CAPD). The nurse should assess the client for which sign of peritoneal infection? | cloudy dialysate fluid |
| A nurse is teaching a client who has chronic kidney disease (CKD) and is to begin hemodialysis. Which of the following information should the nurse include in the teaching? | hemodialysis returns a balance to blood electrolytes |
| A nurse is preparing to initiate hemodialysis for a client who has acute kidney injury (AKI). Which of the following actions should the nurse take? | review the medications the client currently takes, assess the AV fistula for a bruit, measure the client's weight, and check blood electrolytes |
| A nurse is planning post procedure care for a client who received hemodialysis. Which of the following interventions should the nurse include in the plan of care? | check BUN and blood creatinine, administer medications the nurse withheld prior to dialysis, observe for findings of hypovolemia, and assess the access site for bleeding |
| A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take? | assess level of consciousness |
| A nurse is planning care for a client who will undergo peritoneal dialysis (PD). Which of the following actions should the nurse take? | monitor blood glucose levels, report cloudy dialysate return, assess for shortness of breath, and check the access site dressing for wetness |
| A nurse is assessing a client who has end-stage kidney disease. Which of the following findings should the nurse expect? | anuria, marked azotemia, crackles in the lungs, and proteinuria |
| A nurse is planning postoperative care for a client following a kidney transplant. Which of the following actions should the nurse include? | obtain daily weights, assess dressings for bloody drainage, replace hourly urine output with IV fluids, and monitor blood electrolytes |
| A nurse is teaching a client who is scheduled for a kidney transplant about organ rejection. Which of the following statements should the nurse include? | "expect an immediate removal of the donor kidney for a hyper acute rejection," "a fever is a manifestation of an acute rejection," and "fluid retention is a manifestation of an acute rejection" |
| The nurse is assessing the patency of a client's left arm AV fistula prior to initiating hemodialysis (HD). Which findings indicate that the fistula is patent? | palpation of a thrill over the fistula |
| The nurse monitoring the client receiving peritoneal dialysis (PD) notes that the client's outflow is less than the inflow. Which actions should the nurse take? | check the level of the drainage bag, reposition the client to their side, place the client in good body alignment, and check the PD system for kinks |
| A hemodialysis (HD) client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication? | pallor, diminished pulse, and pain in the left hand |
| The nurse is reviewing a client's record and notes that the health care provider has documented that the client has chronic kidney disease (CKD). On review of the laboratory results, the nurse most likely would expect to note which finding? | elevated creatinine level |
| A client with chronic kidney disease (CKD) returns to the nursing unit following a hemodialysis (HD) treatment. On assessment, the nurse notes that the client's temperature is 101.2. Which nursing action is most appropriate? | notify the healthcare provider |
| The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is a priority nursing action? | notify the healthcare provider |
| A client presents with a 101 temperature, elevated BP, and tenderness over the kidneys. Serum creatinine is rising and urine output is decreased. X-ray indicates that the kidney transplanted last week is enlarged. The nurse can anticipate which treatment? | increased immunosuppression therapy |
| A client newly diagnosed with chronic kidney disease (CKD) has recently begun hemodialysis (HD). Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? | headache, deteriorating LOC, and twitching |
| The nurse is preparing to administer a dose of PhosLo to a patient with chronic kidney disease. This medication should have a beneficial effect on which laboratory value? | phosphorus |
| Measures indicated in the conservative therapy of chronic kidney disease (CKD) include | decreased fluid intake and protein intake; increased carbohydrate intake |
| The advantage of continuous replacement therapy over hemodialysis is its ability to | remove fluid without the use of a dialysate |
| A 55-year-old male patient is diagnosed with chronic kidney disease (CKD). The patient's recent GFR was 25 mL/min. What stage of chronic kidney disease is this known as? | Stage 4 (GFR is 15-29 mL/min) |
| A patient with chronic kidney disease (CKD) has a low erythropoietin (EPO) level. The patient is at risk for | anemia |
| A 65-year-old male patient has a GFR of 55 mL/min. The patient has a history of uncontrolled HTN and CAD. Which medication ordered by the physician will help treat the patient's hypertension along with providing a protective mechanism to the kidney? | lisinopril [there are two types of drugs that can be used to treat hypertension and protect the kidneys in patients with CKD: ACE inhibitors and angiotensin receptor blockers (ARBs)] |
| Which patient is NOT at risk for developing chronic kidney disease? | a 45-year-old female with polycystic ovarian disease |
| A patient with Stage 5 chronic kidney disease (CKD) is experiencing extreme pruritus and has several areas of crystallized white deposits on the skin. As the nurse, you know this is due to excessive amounts of what substance found in the blood? | urea |
| A patient with CKD is scheduled for dialysis in the AM. While examining the patient's tele-strip, you note tall peaked T-waves. You notify the physician who orders a STAT basic metabolic panel (BMP). What result from the BMP confirms the EKG abnormality? | potassium 7.1 mEq/L |
| You are providing education to the patient with chronic kidney disease (CKD) about calcium acetate. Which statement by the patient demonstrated they understood your teaching abut this medication? | "I will take this medication with meals or immediately after." & "This medication will help prevent my phosphate level from increasing." (calcium acetate/PhosLo) |
| While assessing morning labs on your patient with chronic kidney disease (CKD). You note the patient's phosphate level is 6. mg/dL. As the nurse, you expect to find the calcium level to be? | low |
| A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain the patient should follow a | low protein, low sodium, low potassium, low phosphate diet |
| The kidneys are responsible for performing all the following functions except | maintaining cortisol production (the kidneys activate vitamin D, secrete renin, and secrete erythropoietin) |
| What percentage of cardiac output goes to the kidneys? | 20% |
| What percentage of plasma that goes to the kidneys actually gets filtered? | 20% |
| The glomerular filtration rate (GFR) is the sum of | the filtration rates in all of the functioning nephrons |
| The _______ gives a rough measure of the number of functioning nephrons. | glomerular filtration rate (GFR) |
| What is the average GFR in males and then in females? | average GFR in males = 125 mL/min; average GFR in females = 115 mL/min |
| In replying to a patient's question about her labs, the nurse knows that a reduction in GFR can indicate what? | progression of an underlying disease and/or development of a reversible problem, such as decreased renal perfusion due to volume depletion |
| _________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed back into the bloodstream but is excreted through the urine. | creatinine (it is a waste product from muscle breakdown and is removed from the bloodstream via the glomerulus of the nephron & is the only substance that is solely filtered out of the blood but NOT reabsorbed back into the system) |
| A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms may this patient present with? | hypervolemia and increased BUN level (a GFR of 40 mL/min indicates that the kidney’s ability to filter the blood is decreased) |
| You're assessing morning lab values on a female patient who is recovering from a myocardial infraction. Which lab value below requires you to notify the physician? | creatinine clearance 35 mL/min [a normal creatinine clearance level in a female should be 85-125 mL/min (95-140 mL/min males)] |
| A 55-year-old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury? | pre-renal injury [it is due to decreased perfusion to the kidneys secondary to a cause (massive GI bleeding…patient is losing blood volume)] |
| A patient with acute kidney injury has the following labs: GFR 92 mL/min, BUN 17 mg/dL, potassium 4.9 mEq/L, and creatinine 1 mg/dL. The patient's 24 hour urinary output is 1.75 Liters. Based on these findings, what stage of AKI is this patient in? | recovery |
| A 36-year-old male patient is diagnosed with acute kidney injury. The patient is voiding 4 L/day of urine. What complication can arise based on the stage of AKI this patient is in? | hypotension, low urine specific gravity, and hypokalemia (this patient is in the DIURESIS stage of AKI, meaning the nephrons are now starting to filter out waste but cannot concentrate the urine) |
| You're developing a nursing care plan for a patient in the diuresis stage of acute kidney injury (AKI). What nursing diagnosis would you include in the care plan? | risk for electrolyte imbalance |
| While educating a group of nursing students about the stages of acute kidney injury, a student asks how long the oliguric stage lasts. You explain to the student this stage can last? | 1-2 weeks (regarding the other stages of AKI: Initiation: few hours to several days, diuresis: 1-3 weeks, and recovery: 12 months or more) |
| A patient with AKI has a urinary output of 350 mL/day. In addition, morning labs showed an increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by the physician is most appropriate for this patient? | low-protein, low-potassium, and low-sodium |
| A 56-year-old male presents with metabolic acidosis, decreased GFR, increased BUN/Creatinine, hyperkalemia, edema, and urinary output 350 mL/day. Based on what we know of acute kidney injury (AKI), this patient is in what stage of AKI? | oliguric stage |
| True or false: There is an exact correlation between the loss of functional nephrons and the loss of GFR. | False |
| The cause of kidney disease can only be found using what screenings and/or tests? | urinalysis, measurement of urinary protein excretion, and, if necessary, radiologic studies and/or kidney biopsy. |
| Why is plasma Cr a fairly good measure of GFR and renal function? | because of its constant rate of production in the body (from metabolism of protein by active muscle) and because all filtered creatinine is subsequently excreted in the urine |
| Plasma creatinine levels can be determined by analyzing a venous blood sample and is generally included in what laboratory panels? | the ‘basic metabolic panel’ (BMP) or Chem 7 lab panel |
| Creatinine production is dependent on | lean body mass |
| Creatinine clearance is used when determining renal function. How is it measured? | Rate of creatinine clearance is measured by first collecting a 24 hour urine sample; then, the amount of excreted creatinine is measured and compared with the amount of circulating serum creatinine. |
| What is/are the equation(s) for creatinine clearance? | CrCl = [urine creatinine (mg/dL) X Urine volume (ml/min)]/[Serum creatinine (mg/dL)] CrCl = body weight (in kg) x (140 – age)/ Serum Cr x 72 |
| What are the normal levels of creatinine clearance in males and females? | adult male: 85-125 mL/min; adult female: 75-115 mL/min |
| Urea is a molecule that is formed by what organ? | the liver, from ammonia |
| Approximately how much of urea filtered by the glomerular membrane is reabsorbed in renal tubules? | 50% |
| Why is BUN a good measure of a patient's hydration status? | the amount of urea reabsorbed will increase when a patient becomes dehydrated |
| What is the normal plasma BUN level? | Normal Plasma BUN:10-20 mg/dL |
| The most common cause of transplant loss is death with a functional transplant due to | heart disease, infections, and malignancies |
| Immunosuppressant drugs are essential to prevent | immunological loss of the transplant but side effects can also lead to transplant loss |
| What are the contraindications of renal transplantation? | active malignancy, cirrhosis (unless simultaneous liver transplant planned); severe myocardial dysfunction; active mental illness/dementia; severe pulmonary hypertension; active substance abuse; extreme obesity; non-adherence; no financial/social support |
| The length of time donated organs and tissues can be kept outside the body varies. What are the different lengths of time for each organ/tissue? | heart: 4-6 hours; liver: 12-24 hours; kidney: 48-72 hours; heart-lung: 4-6 hours; lung: 4-6 hours |
| What is the matching criteria for renal transplantation? | blood type, HLA (tissue typing), serology, time waiting, medical urgency, antibody level, geographic areas/availability |
| True or False: ABO groups must match during renal transplantation, to prevent immediate rejection response. | True |
| The genes for HLA proteins are inherited, one set from each parent. Due to inheritance patterns, what is the likelihood of being an identical match to a sibling? | there is a 25% chance of being an identical match to a sibling, a 25% chance of not matching any sibling, and a 50% chance of a partial match |
| True or False: Individuals can develop antibodies at any point. | Antibodies develop due to transfusions, transplants, or pregnancies, so frequent testing is necessary. |
| Maintenance immunosuppressant therapy is on-going to prevent acute rejection and includes what? | (1) a calcineurin inhibitor (cyclosporine or tacrolimus), (2) an antimetabolite (mycophenolate or azathioprine), and (3) Prednisone |
| What is calcineurin and what is an example of a calcineurin inhibitor? | Calcineurin is an intracellular messenger. It activates interleukin-2, which stimulates T cells. Cyclosporine is a calcineurin inhibitor, as is tacrolimus. |
| What is the significance of a calcineurin inhibitor? | It inhibits T cells, which puts the client at significant risk for infections and for possible bone marrow suppression, but this is the trade off for preventing organ rejection. |
| What are the adverse/common side effects of cyclosporin? | Reversible encephalopathy; seizures. Hepatotoxicity. Hypertension; tremors. Nephrotoxicity. |
| A patient has just been prescribed Gengraf after renal transplantation. What does the nurse need to assess after administration? | Assess for signs of opportunistic infection of the brain. Monitor for symptoms of encephalopathy. May cause nephrotoxicity and/or hepatotoxicity, so monitor serum creatinine levels, and LFTs |
| A nurse is teaching a client who just received a kidney transplant and is now taking cyclosporin. Which of the following information should the nurse include in the teaching? | Take medication at the same day each day, with meals. Take missed doses within 12 hours. Do not discontinue drug. Notify provider for diarrhea or hematuria. Avoid grapefruit juice. Ensure appropriate oral hygiene. |
| What is the suffix of calcineurin inhibitors? | -rolimus [tacrolimus (Prograf), sirolimus (Rapamune), evirolimus (Afinitor)] |
| What is the suffix of cellular inhibitors? | -cept [mycophenolate (CellCept), belatacept (Nulojix)] |
| What is the mechanism of action of mycophenolate (CellCept)? | it inhibits the enzymes involved in purine synthesis, resulting in suppression of T- and B-lymphocyte proliferation. |
| What are the adverse/common side effects of mycophenolate (CellCept)? | GI Bleed.Anxiety; dizziness; headache. Hypertension; edema. Hypercholesterolemia; hyperglycemia; hyperkalemia; hypocalcemia. GI upset. Fever; infection. |
| When should you prescribe mycophenolate? | Prevention of rejection in renal, hepatic and cardiac transplantation. SLE |
| What is the mechanism of action of basiliximab (Simulect)? | Binds to and blocks specific interleukin-2 receptor sites on activated T-lymphocytes. Prevents acute organ rejection. |
| What are the adverse/common side effects of basiliximab? | Anaphylaxis. Heart failure.Dizziness; headache. Edema; hypertension. Abdominal pain; constipation; nausea. |
| A patient has just been prescribed Simulect after a kidney transplant. What does the nurse need to assess after administration? | Monitor for signs of anaphylaxis at each dose. Monitor for infection. |
| Basiliximab is also prescribed with what other medications? | corticosteroids and cyclosporine |
| A diagnosis of chronic kidney disease requires which of the following? | decline of kidney function for 3 months or more AND evidence of kidney damage (e.g. albuminuria or abnormal biopsy) ORGFR <60 mL/min/1.73 m2 |
| Each patient is classified into one of the 5 stages of CKD because management and prognosis varies according to the progression of damage. What is the significance of each stage? | Stage 1: Kidney damage with normal or increased GFR (>90 mL/min) Stage 2: Mild reduction in GFR (60-89 mL/min) Stage 3: Moderate reduction in GFR (30-59 mL/min) Stage 4: Severe reduction in GFR (15-29 mL/min) Stage 5: Kidney failure (GFR <15 mL/min) |
| True or False: Once half of the total nephrons have lost function, CKD progresses similarly regardless of etiology. | True |
| What are the most common causes of chronic, progressive renal failure? | diabetes mellitus (DM) and hypertension, which increases the risk of atherosclerosis in the renal arteries. |
| Why does hypertension lead to increased risk of atherosclerosis in the renal arteries? | elevated systemic blood pressures leads to thickening of the large and small vasculature; the mechanisms are compensatory at first but later lead to glomerular damage |
| How does diabetic nephropathy relate to chronic hyperglycemia? | long term complications of diabetes involve degenerative disorders of capillary endothelial cells in the retina, the glomerulus, and neurons of the peripheral nerves |
| Which cells do not require insulin for glucose uptake and metabolism? | neurons, lens in eye, some renal tissue, vascular tissue, and RBCs |
| True or False: Cells that do not require insulin for glucose uptake and metabolism are unable to control glucose influx. | True |
| When exposed to hyperglycemia, how do cells keep their internal glucose concentration constant? | most cells are able to reduce transport of glucose into the cell; downregulation of insulin receptors |
| What is the polyol pathway? | once inside of the cell, glucose that is not immediately needed for ATP production is moved down this metabolic pathway where glucose is converted to sorbitol and eventually fructose |
| What causes over-activation of the polyol pathway? | hyperglycemia, which allows too much glucose into the cell |
| What happens to the body of an overactive polyol pathway? | the accumulation of sorbitol increases the osmotic pressure of the cytoplasm which draws water into these cells; the consequence is cellular swelling, which leads to cell dysfunction/injury; it increases the susceptibility of the cell to oxidative stress |
| What are the consequences of shunting large amounts of glucose via the polyol pathway? | disruption of neuron/nerve conduction leading to neurological problems, and swelling and stiffening of the RBCs which can lead to premature hemolysis |
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