Brunner Chapter 54 Test Bank: Management of Patients with Kidney Disorders
The critical care nurse is monitoring the patient's urine output and drains following renal surgery. What should the nurse promptly report to the physician? Increased pain on movement Absence of drain output Increased urine output Bloodtinged serosanguineous drain output
Absence of drain output Feedback: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Decreased or absent drainage is promptly reported to the physician because it may indicate obstruction that could cause pain, infection, and disruption of the suture lines. Reporting increased pain on movement has nothing to do with the scenario described. Increased urine output and serosanguineous drainage are expected.
The nurse is caring for a patient with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply. Percuss for pain in the right lower abdominal quadrant. Assess for the presence of peripheral edema. Auscultate the patient's apical heart rate for dysrhythmias. Assess the patient's BP. Assess the patient's orientation and judgment.
Assess for the presence of peripheral edema. Assess the patient's BP. Feedback: Most patients with acute glomerular inflammation have some degree of edema and hypertension. Dysrhythmias, RLQ pain, and changes in mental status are not among the most common manifestations of acute glomerular inflammation.
The nurse is caring for a patient who has returned to the postsurgical suite after postanesthetic recovery from a nephrectomy. The nurse's most recent hourly assessment reveals a significant drop in level of consciousness and BP as well as scant urine output over the past hour. What is the nurse's best response? Assess the patient for signs of bleeding and inform the physician. Monitor the patient's vital signs every 15 minutes for the next hour. Reposition the patient and reassess vital signs. Palpate the patient's flanks for pain and inform the physician.
Assess the patient for signs of bleeding and inform the physician. Feedback: Bleeding may be suspected when the patient experiences fatigue and when urine output is less than 30 mL/h. The physician must be made aware of this finding promptly. Palpating the patient's flanks would cause intense pain that is of no benefit to assessment.
A patient admitted with nephrotic syndrome is being cared for on the medical unit. When writing this patient's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include? Constipation related to immobility Risk for injury related to altered thought processes Hyperthermia related to the inflammatory process Excess fluid volume related to generalized edema
Excess fluid volume related to generalized edema*** Feedback: The major clinical manifestation of nephrotic syndrome is edema, so the appropriate nursing diagnosis is "Excess fluid volume related to generalized edema." Edema is usually soft, pitting, and commonly occurs around the eyes, in dependent areas, and in the abdomen.
The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? Hematuria Precipitous decrease in serum creatinine levels Hypotension unresolved by fluid administration Glucosuria
Hematuria Feedback: The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Some degree of edema and hypertension is noted in most patients.
A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason? Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential. Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this patient. A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary. There is great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations.
Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.***** Feedback: Hematuria is the most common manifestation of renal trauma; its presence after trauma suggests renal injury. Hematuria may not occur, or it may be detectable only on microscopic examination. All urine should be saved and sent to the laboratory for analysis to detect RBCs and to evaluate the course of bleeding. Measuring intake and output is not a function of the laboratory. The laboratory does not save urine to test creatinine clearance at a later time. The laboratory does not monitor the urine for sodium or potassium concentrations.
The nurse is creating an education plan for a patient who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan? The importance of increased fluid intake Signs and symptoms of rejection Inspection and care of the incision Techniques for preventing metastasis
Inspection and care of the incision Feedback: The nurse teaches the patient to inspect and care for the incision and perform other general postoperative care, including activity and lifting restrictions, driving, and pain management. There would be no need to teach the signs or symptoms of rejection as there has been no transplant. Increased fluid intake is not normally recommended and the patient has minimal control on the future risk for metastasis.
The nurse is caring for a patient after kidney surgery. The nurse is aware that bleeding is a major complication of kidney surgery and that if it goes undetected and untreated can result in hypovolemia and hemorrhagic shock in the patient. When assessing for bleeding, what assessment parameter should the nurse evaluate? Oral intake Pain intensity Level of consciousness Radiation of pain
Level of consciousness Feedback: Bleeding is a major complication of kidney surgery. If undetected and untreated, this can result in hypovolemia and hemorrhagic shock. The nurse's role is to observe for these complications, to report their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision, and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood, and fluid volume and cardiac output. Bleeding is not normally evidenced by changes in pain or oral intake.
The nurse has identified the nursing diagnosis of "risk for infection" in a patient who undergoes peritoneal dialysis. What nursing action best addresses this risk? Maintain aseptic technique when administering dialysate. Wash the skin surrounding the catheter site with soap and water prior to each exchange. Add antibiotics to the dialysate as ordered. Administer prophylactic antibiotics by mouth or IV as ordered.
Maintain aseptic technique when administering dialysate. Feedback: Aseptic technique is used to prevent peritonitis and other infectious complications of peritoneal dialysis. It is not necessary to cleanse the skin with soap and water prior to each exchange. Antibiotics may be added to dialysate to treat infection, but they are not used to prevent infection.
A patient is brought to the renal unit from the PACU status post resection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this patient? Increasing oral intake Managing postoperative pain Managing dialysis Increasing mobility
Managing postoperative pain Feedback: The patient requires frequent analgesia during the postoperative period and assistance with turning, coughing, use of incentive spirometry, and deep breathing to prevent atelectasis and other pulmonary complications. Increasing oral intake and mobility are not priority nursing actions in the immediate postoperative care of this patient. Dialysis is not necessary following kidney surgery.
A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine level of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders? Monitor the patient's electrolyte values every hour before the procedure . Preprocedure hydration and administration of acetylcysteine Hemodialysis immediately prior to the CT scan Obtain a creatinine clearance by collecting a 24hour urine specimen.
Preprocedure hydration and administration of acetylcysteine Feedback: Radiocontrastinduced nephropathy is a major cause of hospitalacquired acute kidney injury. Baseline levels of creatinine greater than 2 mg/dL identify the patient as being high risk. Preprocedure hydration and prescription of acetylcysteine (Mucomyst) the day prior to the test is effective in prevention. The nurse would not monitor the patient's electrolytes every hour preprocedure. Nothing in the scenario indicates the need for hemodialysis. A creatinine clearance is not necessary prior to a CT scan with contrast.
The nurse is caring for a patient who has just returned to the postsurgical unit following renal surgery. When assessing the patient's output from surgical drains, the nurse should assess what parameters? Select all that apply. Quantity of output Color of the output Visible characteristics of the output Odor of the output pH of the output
Quantity of output Color of the output Visible characteristics of the output Feedback: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Odor and pH are not normally assessed.
The nurse is providing a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants' risks of renal carcinoma? Avoiding heavy alcohol use Control of sodium intake Smoking cessation Adherence to recommended immunization schedules
Smoking cessation Feedback: Tobacco use is a significant risk factor for renal cancer, surpassing the significance of high alcohol and sodium intake. Immunizations do not address an individual's risk of renal cancer.
A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the patient's chronic kidney disease is at what stage? Stage 1 Stage 2 Stage 3 Stage 4
Stage 3 Feedback: Stages of chronic renal failure are based on the GFR. Stage 3 is defined by a GFR in the range of 30 to 59 mL/min/1.73 m2. This is considered a moderate decrease in GFR.
A 15yearold is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event? Psychosocial stress Hypersensitivity to an immunization Menarche Streptococcal infection
Streptococcal infection Feedback: Postinfectious causes of postinfectious glomerular disease are group A betahemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks. Menarche, stress, and hypersensitivity are not typical causes.