Chapter 54: Management of Patients with Kidney Disorders (Exam 2)
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: thrush and circumoral pallor. nausea and vomiting. dyspnea and cyanosis. fatigue and weakness.
fatigue and weakness. RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.
The nurse cares for a client diagnosed with chronic glomerulonephritis. The nurse will observe the client for the development of anemia. hypophosphatemia. metabolic alkalosis. hypokalemia.
anemia. Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur during chronic glomerulonephritis.
The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL? 750 mL 500 mL 1,000 mL 250 mL
1,000 mL The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1-kg weight gain is equal to 1,000 mL of retained fluid.
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? Calcium Magnesium Phosphorus Sodium
Calcium Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.
The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium? Butter Citrus fruits Cooked white rice Salad oils
Citrus fruits Foods and fluids containing potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee) are restricted.
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? Dehydration Hypertension Crackles Hyperkalemia
Dehydration The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? A GFR of 90 mL/min/1.73 m2 A GFR of 30-59 mL/min/1.73 m2 A GFR of 120 mL/min/1.73 m2 A GFR of 85 mL/min/1.73 m2
A GFR of 30-59 mL/min/1.73 m2 Stage 3 of chronic kidney disease is defined as having a GFR of 30-59 mL/min/1.73 m2
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? Diuresis Fever Absence of pain Weight loss
Fever Fever is an indicator of infection or transplant rejection.
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? Glomerulonephritis Hypovolemia Ureteral calculus Dysrhythmia
Glomerulonephritis Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. Tall, peaked T waves Prolonged ST segment Multiple spiked P waves Shortened QRS complex
Tall, peaked T waves Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.
Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective? "There are few complications with renal replacement therapies." "A family member can help me perform hemodialysis in my home." "Ultrafiltration methods take much longer than hemodialysis." "A special access is created in my vein for peritoneal dialysis."
"Ultrafiltration methods take much longer than hemodialysis." Ultrafiltration methods (CVVH, CVVHD) are better tolerated by unstable clients as fluid is removed slowly, resulting in mild hemodynamic effects.
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? Acute renal failure Acute glomerulonephritis Chronic renal failure Nephrotic syndrome
Acute glomerulonephritis Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? Azotemia Proteinuria Hematuria Bacteremia
Azotemia The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.
The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? Hypotension Hyperalbuminemia Peripheral neuropathy Cola-colored urine
Cola-colored urine Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.
A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? Decrease in the blood flow through the kidneys Obstruction of urine flow from the kidneys Blood clot formed in the kidneys interfered with the flow Structural damage occurred in the nephrons of the kidneys
Decrease in the blood flow through the kidneys Acute renal failure can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.
A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? Elevated serum creatinine Hyperkalemia Hyperphosphatemia Elevated urea and nitrogen
Hyperphosphatemia Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia (An excess of urea and other nitrogenous waste in the blood)? Increase fat intake and limit carbohydrates. Eliminate fat intake and increase protein intake. Increase carbohydrates and limit protein intake. Increase protein, carbohydrates, and fat intake.
Increase carbohydrates and limit protein intake. Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.
What is used to decrease potassium level seen in acute renal failure? Sodium polystyrene sulfonate Sorbitol IV dextrose 50% Calcium supplements
Sodium polystyrene sulfonate The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure? Kidney function will improve with transplant. Once on dialysis, the need will be permanent. The kidneys can improve over a period of months. Acute renal failure tends to turn to end-stage failure.
The kidneys can improve over a period of months. The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute renal failure can progress to chronic renal failure.
The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse? Push the catheter further into the abdomen. Lower the head of the bed. Notify the health care provider. Turn the client from side to side.
Turn the client from side to side. If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the client from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. Other measures to promote drainage include checking the patency of the catheter by inspecting for kinks, closed clamps, or an air lock.
A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? Perform deep-breathing exercises vigorously. Wear a mask when performing exchanges. Auscultate the lungs frequently. Avoid carrying heavy items.
Wear a mask when performing exchanges. The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.
The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? pH 7.47, PaCO2 45, HCO3 33- pH 7.20, PaCO2 36, HCO3 14- pH 7.31, PaCO2 48, HCO3 24- pH 7.50, PaCO2 29, HCO3 22-
pH 7.20, PaCO2 36, HCO3 14- Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.
Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? Urine output of 35 to 40 mL/hour Pain of 3 out of 10, 1 hour after analgesic administration SpO2 at 90% with fine crackles in the lung bases Blood tinged drainage in Jackson-Pratt drainage tube
SpO2 at 90% with fine crackles in the lung bases The Risk for Ineffective Breathing Pattern is often a challenge in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output is monitored to maintain a urine output of greater than 30 mL/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.
Which of the following occurs late in chronic glomerulonephritis? Peripheral neuropathy Nosebleed Seizure Stroke
Peripheral neuropathy Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: "As the disease progresses, you will most likely require renal replacement therapy." "Dietary changes can reverse the damage that has occurred in your kidneys." "Draining of the cysts and antibiotic therapy will cure your disease." "Genetic testing will determine the best treatment for your condition."
"As the disease progresses, you will most likely require renal replacement therapy." There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.
A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? Encourage use of incentive spirometer every 2 hours. Monitor temperature every 4 hours. Keep the drainage catheter below the level of insertion. Administer isotonic fluid therapy as ordered.
Encourage use of incentive spirometer every 2 hours. To address the issue of ineffective breathing pattern, encouraging the use of incentive spirometer would be most appropriate to help increase alveolar ventilation. Administering isotonic fluid therapy would be appropriate for issues involving fluid loss such as bleeding or hemorrhage. Keeping the drainage catheter below the level of insertion would be appropriate to reduce the risk of obstruction leading to acute pain. Monitoring the temperature every 4 hours would be appropriate to reduce the client's risk for infection.
The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated? Obtaining blood samples from the left arm Palpating the fistula for a "thrill" Obtaining a blood pressure reading from the right arm Placing the client's watch on the left wrist
Obtaining a blood pressure reading from the right arm The nurse assesses the vascular access for patency. The bruit, or "thrill," over the venous access site must be evaluated at least every shift. The nurse takes precautions to ensure that the extremity with the vascular access is not used for measuring blood pressure or for obtaining blood specimens; tight dressings, restraints, or jewelry over the vascular access must be avoided as well.
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? Diuresis Oliguria Restored glomerular function Acute tubular necrosis
Oliguria During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? "Immunosuppressive drugs guarantee organ success." "Let's wait until after the surgery to discuss your treatment plan." "The doctor may decide to delay the use of immunosuppressant drugs." "Even a perfect match does not guarantee organ success."
"Even a perfect match does not guarantee organ success." Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.
A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching? "I inherited this disorder from one of my parents." "The cysts can get quite large in size." "As long as I have one normal kidney, I should be fine." "If renal failure develops, I may need to consider dialysis."
"As long as I have one normal kidney, I should be fine." Polycystic kidney disease is characterized by the formation of multiple cysts on both kidneys. Polycystic kidney disease is inherited as an autosomal dominant trait. The fluid-filled cysts can cause great enlargement of the kidneys and interfere with kidney function, which can eventually lead to renal failure.
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? "It is important to use strict aseptic technique." "It is appropriate to warm the dialysate in a microwave." "The infusion clamp should be open during infusion." "The effluent should be allowed to drain by gravity."
"It is appropriate to warm the dialysate in a microwave." The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? "Painless gross hematuria is the first symptom in renal cancer." "Squamous cell carcinomas do not present with detectable symptoms." "You should have sought treatment earlier." "Very few symptoms are associated with renal cancer."
"Very few symptoms are associated with renal cancer." Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease. Adenocarcinomas are the most common renal cancer (about 80%),whereas squamous cell renal cancers are rare. It is not therapeutic to place doubt or blame for delayed diagnosis.
The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: 500 mL of fluid 1,000 mL of fluid 1,500 mL of fluid 2,000 mL of fluid
1,500 mL of fluid A 1-kg weight gain is equal to 1,000 mL of retained fluid.
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? Administration of an insulin drip Administration of a loop diuretic Administration of sodium bicarbonate Administration of sodium polystyrene sulfonate [Kayexalate])
Administration of sodium polystyrene sulfonate [Kayexalate]) The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
When assessing a client with chronic glomerulonephritis, the nurse notes that the client has generalized edema. The nurse documents this as which of the following? Periorbital edema Anasarca Uremic frost Hydronephrosis
Anasarca Generalized edema known as anasarca is a common finding with chronic glomerulonephritis. Periorbital edema refers to puffiness around the eyes. Uremic frost is a precipitate that forms on the skin in clients with chronic renal failure. Hydronephrosis refers to a condition involving distention of the renal pelvis.
A client has a decreased secretion of erythropoietin from the kidneys due to end-stage kidney disease. What outcome will the decrease in erythropoietin have? Anemia from the decrease in maturation of red blood cells Decrease in blood sugar levels due to alteration in insulin levels Increase in blood sugar levels due to alteration in insulin levels Development of male sex characteristics
Anemia from the decrease in maturation of red blood cells The kidneys secrete erythropoietin, which is a substance that promotes the maturation of red blood cells.
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? Increased pH with decreased hydrogen ions Increased serum levels of potassium, magnesium, and calcium Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75%
Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl. A BUN level of 100 mg/dl and a serum creatinine of 6.5 mg/dl are abnormally elevated results, reflecting CRF and the kidneys' decreased ability to remove nonprotein nitrogen waste from the blood. CRF causes decreased pH and increased hydrogen ions — not vice versa. CRF also increases serum levels of potassium, magnesium, and phosphorous, and decreases serum levels of calcium. A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls within the normal range of 60% to 75%.
The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? Serum creatinine of 1.2 mg/dL. BUN of 18 mg/dL. Glomerular filtration rate (GFR) of 100 mL/min. Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.
Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. The normal BUN:Cr ratio is less than 15. Prerenal azotemia is caused by hypoperfusion of the kidneys due to a nonrenal cause. Over time, higher than normal blood levels of urea or other nitrogen-containing compounds will develop.
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? Pats skin dry after bathing Uses moisturizing creams Keeps nails trimmed short Brief, hot daily showers
Brief, hot daily showers Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.
Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure? Dysrhythmia Ureteral calculus Glomerulonephritis Hypovolemia
Glomerulonephritis Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
The nurse recognizes which condition as an integumentary manifestation of chronic renal failure? Asterixis Gray-bronze skin color Tremors Seizures
Gray-bronze skin color Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.
The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client? Hemodialysis Peritoneal dialysis Continuous arteriovenous hemofiltration (CAVH) Continuous venovenous hemofiltration (CVVH)
Hemodialysis The client is hemodynamically stable and hemodialysis would be most appropriate. Hemodialysis is used for clients who are acutely ill and require short-term dialysis for days to weeks until kidney function resumes and for clients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) who require long-term or permanent renal replacement therapy. Peritoneal dialysis (PD) may be the treatment of choice for clients with renal failure who are unable or unwilling to undergo hemodialysis or kidney transplantation. CAVH and CVVH are used for client who are hemodynamically unstable.
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? Abdominal distention owing to reflex cessation of intestinal peristalsis Hypovolemic shock caused by hemorrhage Paralytic ileus caused by manipulation of the colon during surgery Pneumonia caused by shallow breathing because of severe incisional pain
Hypovolemic shock caused by hemorrhage If bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack.
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? Increase fat intake and limit carbohydrates. Eliminate fat intake and increase protein intake. Increase carbohydrates and limit protein intake. Increase protein, carbohydrates, and fat intake.
Increase carbohydrates and limit protein intake. Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? Oliguria Initiation Recovery Diuresis
Oliguria The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys, such as urea and creatinine. The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.
A patient is postoperative day 3 following the successful transplantation of a kidney. The nurse is aware of the importance of assessing the patient for signs and symptoms of rejection. Consequently, the nurse is constantly monitoring the patient for: Decreased level of consciousness and pruritus Oliguria and edema Pain and hematuria Weight loss and lethargy
Oliguria and edema After kidney transplantation, the nurse assesses the patient for signs and symptoms of transplant rejection: oliguria, edema, fever, increasing blood pressure, weight gain, and swelling or tenderness over the transplanted kidney or graft. The other given assessment findings are not directly suggestive or organ rejection.
A nurse who provides care in a high-acuity medical setting is aware of the high incidence and morbidity of acute renal failure (ARF). To reduce patients' risks of developing ARF during their stay in hospital, it is imperative that: Standard precautions be adhered to rigorously Patients be encouraged to ambulate as soon as they are able Patients' medication regimens be monitored closely Tube feeding or parenteral nutrition be initiated for patients who cannot eat
Patients' medication regimens be monitored closely Medications are frequently implicated in cases of hospital-acquired ARF. Malnutrition, lack of infection control, and inactivity are not directly causative of ARF.
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? History of hyperparathyroidism History of osteoporosis Recent history of streptococcal infection Previous episode of acute pyelonephritis
Recent history of streptococcal infection Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? Previous episode of acute pyelonephritis History of hyperparathyroidism Recent history of streptococcal infection History of osteoporosis
Recent history of streptococcal infection Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.
The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? Select all that apply. White cell casts in the urine Red blood cells in the urine Proteinuria Polyuria Hemoglobin of 12.8 g/dL
Red blood cells in the urine Proteinuria White cell casts in the urine The primary presenting features of an acute glomerular inflammation are hematuria, edema, azotemia (an abnormal concentration of nitrogenous wastes in the blood), and proteinuria (excess protein in the urine) (Porth & Matfin, 2009). The urine may appear cola colored because of red blood cells (RBCs) and protein plugs or casts; RBC casts indicate glomerular injury.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? Impaired urinary elimination Toileting self-care deficit Risk for infection Activity intolerance
Risk for infection The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? Encourage oral fluids. Administer furosemide (Lasix) 20 mg IV Start hemodialysis after a temporary access is obtained. Start IV fluids with a normal saline solution bolus followed by a maintenance dose.
Start IV fluids with a normal saline solution bolus followed by a maintenance dose. The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? Serum potassium level of 4.9 mEq/L Serum sodium level of 135 mEq/L Temperature of 99.2° F (37.3° C) Urine output of 20 ml/hour
Urine output of 20 ml/hour Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? Blood urea nitrogen (BUN) level of 22 mg/dl Serum creatinine level of 1.2 mg/dl Temperature of 100.2° F (37.8° C) Urine output of 250 ml/24 hours
Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.
Which of the following is the most accurate indicator of fluid loss or gain? Weight Urine output Caloric intake Body temperature
Weight The most accurate indicator of fluid loss or gain in an acutely ill patient is weight, as accurate intake and output and assessment of insensible losses may be difficult. Urine output, caloric intake, and body temperature would not be the most reliable indicator of fluid loss or gain.
The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication? With food 2 hours after meals 2 hours before meals At bedtime with 8 ounces of fluid
With food Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. The nurse administers phosphate binders with food for them to be effective.
A client's renal failure has become chronic. Which signs and symptoms are associated with chronic renal failure? Select all that apply. lethargy muscle cramps bleeding of the oral mucous membranes enhanced cognition
lethargy muscle cramps bleeding of the oral mucous membranes Lethargy, muscle cramps, and bleeding of the oral mucous membranes are some of the signs and symptoms of chronic renal failure. With chronic renal failure, mental processes progressively slow as electrolyte imbalances become marked and nitrogenous wastes accumulate.
One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: restricting sources of potassium usually found in fresh fruits and vegetables. allowing liberal use of sodium. limiting iron and folic acid intake. eating protein liberally.
restricting sources of potassium usually found in fresh fruits and vegetables. Restrict sources of potassium usually found in fresh fruits and vegetables; hyperkalemia can cause life-threatening changes. Restrict sodium intake as ordered; doing so prevents excess sodium and fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken. Iron and folic acid supplements are needed for RBC production. Epogen stimulates bone marrow to produce RBCs. Restrict protein intake to foods that are complete proteins within prescribed limits. Complete proteins provide positive nitrogen balance for healing and growth.
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: water and sodium retention secondary to a severe decrease in the glomerular filtration rate. a decreased serum phosphate level secondary to kidney failure. an increased serum calcium level secondary to kidney failure. metabolic alkalosis secondary to retention of hydrogen ions.
water and sodium retention secondary to a severe decrease in the glomerular filtration rate. The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.
