Chapter 63: Concepts of Care for Patients
with Acute Kidney Injury and Chronic
Kidney Disease
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client with chronic kidney disease (CKD) is refusing to take his medication and has
missed two hemodialysis appointments. What is the best initial action for the nurse?
a. Discuss what the treatment regimen means to the client.
b. Refer the client to a mental health nurse practitioner.
c. Reschedule the appointments to another date and time.
d. Discuss the option of peritoneal dialysis.
ANS: A
The initial action for the nurse is to assess anxiety, coping styles, and the client’s
acceptance of the required treatment for CKD. The client may be in denial of the
diagnosis. While rescheduling hemodialysis appointments may help, and referral to a
mental health practitioner and the possibility of peritoneal dialysis are all viable
options, assessment of the client’s acceptance of the treatment would come first.
DIF: Applying TOP: Integrated Process: Caring KEY: Chronic
kidney disease, Coping MSC: Client Needs Category: Psychosocial
Integrity
,2. A client is taking furosemide 40 mg/day for management of early chronic kidney
disease (CKD). To assess the therapeutic effect of the medication, what action of the
nurse is best?
a. Obtain daily weights of the client.
b. Auscultate heart and breath sounds.
c. Palpate the client’s abdomen.
d. Assess the client’s diet history.
ANS: A
Furosemide is a loop diuretic that helps reduce fluid overload and hypertension in
patients with early stages of CKD. One kilogram of weight equals about 1 L of fluid
retained in the client, so daily weights are necessary to monitor the response of the
client to the medication. Heart and breath sounds would be assessed if there is fluid
retention, as in heart failure. Palpation of the client’s abdomen is not necessary, but
the nurse would check for edema. The diet history of the client would be helpful to
assess electrolyte replacement since potassium is lost with this diuretic, but this does
not assess the effectiveness of the medication.
DIF: Applying TOP: Integrated Process: Nursing Process: Evaluation
KEY: Chronic kidney disease, Drug therapy MSC: Client
Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
3. A 70-kg adult client with chronic kidney disease (CKD) is on a 40-g protein diet. The
patient has a reduced glomerular filtration rate and is not undergoing dialysis. Which
result would be of most concern to the nurse?
a. Albumin level of 2.5 g/dL (3.63 mcmol/L)
b. Phosphorus level of 5 mg/dL (1.62 mmol/L)
c. Sodium level of 135 mEq/L (135 mmol/L)
d. Potassium level of 5.5 mEq/L (5.5 mmol/L)
ANS: A
, Protein restriction is necessary with CKD due to the buildup of waste products from
protein breakdown. The nurse would be concerned with the low albumin level since
this indicates that the protein in the diet is not enough for the client’s metabolic needs.
The electrolyte values are not related to the protein-restricted diet.
DIF: Analyzing TOP: Integrated Process: Nursing Process: Analysis
KEY: Chronic kidney disease, Diet therapy MSC: Client Needs
Category: Physiological Integrity: Reduction of Risk Potential
4. The nurse is teaching a client with chronic kidney disease (CKD) about the sodium
restriction needed in the diet to prevent edema and hypertension. Which statement by
the client indicates that more teaching is needed?
a. “I will probably lose weight by cutting out potato chips.”
b. “I will cut out bacon with my eggs every morning.”
c. “My cooking style will change by not adding salt.”
d. “I am thrilled that I can continue to eat fast food.”
ANS: D
Fast-food restaurants usually serve food that is high in sodium. This statement
indicates that more teaching needs to occur. The other statements show a correct
understanding of the teaching.
DIF: Remembering TOP: Integrated Process: Teaching/Learning
KEY: Chronic kidney disease, Renal diet MSC: Client Needs
Category: Physiological Integrity: Reduction of Risk Potential
5. A client is placed on fluid restriction because of chronic kidney disease (CKD). Which
assessment finding would alert the nurse that the client’s fluid balance is stable at this
time?
a. Decreased calcium levels
b. Increased phosphorus levels
c. No adventitious sounds in the lungs
with Acute Kidney Injury and Chronic
Kidney Disease
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client with chronic kidney disease (CKD) is refusing to take his medication and has
missed two hemodialysis appointments. What is the best initial action for the nurse?
a. Discuss what the treatment regimen means to the client.
b. Refer the client to a mental health nurse practitioner.
c. Reschedule the appointments to another date and time.
d. Discuss the option of peritoneal dialysis.
ANS: A
The initial action for the nurse is to assess anxiety, coping styles, and the client’s
acceptance of the required treatment for CKD. The client may be in denial of the
diagnosis. While rescheduling hemodialysis appointments may help, and referral to a
mental health practitioner and the possibility of peritoneal dialysis are all viable
options, assessment of the client’s acceptance of the treatment would come first.
DIF: Applying TOP: Integrated Process: Caring KEY: Chronic
kidney disease, Coping MSC: Client Needs Category: Psychosocial
Integrity
,2. A client is taking furosemide 40 mg/day for management of early chronic kidney
disease (CKD). To assess the therapeutic effect of the medication, what action of the
nurse is best?
a. Obtain daily weights of the client.
b. Auscultate heart and breath sounds.
c. Palpate the client’s abdomen.
d. Assess the client’s diet history.
ANS: A
Furosemide is a loop diuretic that helps reduce fluid overload and hypertension in
patients with early stages of CKD. One kilogram of weight equals about 1 L of fluid
retained in the client, so daily weights are necessary to monitor the response of the
client to the medication. Heart and breath sounds would be assessed if there is fluid
retention, as in heart failure. Palpation of the client’s abdomen is not necessary, but
the nurse would check for edema. The diet history of the client would be helpful to
assess electrolyte replacement since potassium is lost with this diuretic, but this does
not assess the effectiveness of the medication.
DIF: Applying TOP: Integrated Process: Nursing Process: Evaluation
KEY: Chronic kidney disease, Drug therapy MSC: Client
Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
3. A 70-kg adult client with chronic kidney disease (CKD) is on a 40-g protein diet. The
patient has a reduced glomerular filtration rate and is not undergoing dialysis. Which
result would be of most concern to the nurse?
a. Albumin level of 2.5 g/dL (3.63 mcmol/L)
b. Phosphorus level of 5 mg/dL (1.62 mmol/L)
c. Sodium level of 135 mEq/L (135 mmol/L)
d. Potassium level of 5.5 mEq/L (5.5 mmol/L)
ANS: A
, Protein restriction is necessary with CKD due to the buildup of waste products from
protein breakdown. The nurse would be concerned with the low albumin level since
this indicates that the protein in the diet is not enough for the client’s metabolic needs.
The electrolyte values are not related to the protein-restricted diet.
DIF: Analyzing TOP: Integrated Process: Nursing Process: Analysis
KEY: Chronic kidney disease, Diet therapy MSC: Client Needs
Category: Physiological Integrity: Reduction of Risk Potential
4. The nurse is teaching a client with chronic kidney disease (CKD) about the sodium
restriction needed in the diet to prevent edema and hypertension. Which statement by
the client indicates that more teaching is needed?
a. “I will probably lose weight by cutting out potato chips.”
b. “I will cut out bacon with my eggs every morning.”
c. “My cooking style will change by not adding salt.”
d. “I am thrilled that I can continue to eat fast food.”
ANS: D
Fast-food restaurants usually serve food that is high in sodium. This statement
indicates that more teaching needs to occur. The other statements show a correct
understanding of the teaching.
DIF: Remembering TOP: Integrated Process: Teaching/Learning
KEY: Chronic kidney disease, Renal diet MSC: Client Needs
Category: Physiological Integrity: Reduction of Risk Potential
5. A client is placed on fluid restriction because of chronic kidney disease (CKD). Which
assessment finding would alert the nurse that the client’s fluid balance is stable at this
time?
a. Decreased calcium levels
b. Increased phosphorus levels
c. No adventitious sounds in the lungs
