Med Surg 3 Kidney Stuff

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: a) "As the disease progresses, you will most likely require renal replacement therapy." b) "Draining of the cysts and antibiotic therapy will cure your disease." c) "Dietary changes can reverse the damage that has occurred in your kidneys." d) "Genetic testing will determine the best treatment for your condition."

"As the disease progresses, you will most likely require renal replacement therapy." Explanation: 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 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? a) "Let's wait until after the surgery to discuss your treatment plan." b) "The doctor may decide to delay the use of immunosuppressant drugs." c) "Immunosuppressive drugs guarantee organ success." d) "Even a perfect match does not guarantee organ rejection."

"Even a perfect match does not guarantee organ rejection." Explanation: 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.

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? a) "It is appropriate to warm the dialysate in a microwave." b) "The infusion clamp should be open during infusion." c) "The effluent should be allowed to drain by gravity." d) "It is important to use strict aseptic technique."

"It is appropriate to warm the dialysate in a microwave." Explanation: 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.

Isotonic solutions have which of the following properties?

*

What types of fluids are used to treat edema?

*

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?

1,000 mL

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? a. A GFR of 90 mL/min/1.73 m2 b. A GFR of 30-59 mL/min/1.73 m2 c. A GFR of 120 mL/min/1.73 m2 d. A GFR of 85 mL/min/1.73 m2

A GFR of 30-59 mL/min/1.73 m2

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? a) BUN of 18 mg/dL. b) Glomerular filtration rate (GFR) of 100 mL/min. c) Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. d) Serum creatinine of 1.2 mg/dL.

Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20 Explanation: 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.

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a) Fever b) Diuresis c) Weight loss d) Absence of pain

Fever Explanation: Fever is an indicator of infection or transplant rejection.

Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure? a) Hypovolemia b) Ureteral calculus c) Dysrhythmia d) Glomerulonephritis

Glomerulonephritis Explanation: Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? a) Hypovolemic shock caused by hemorrhage b) Abdominal distention owing to reflex cessation of intestinal peristalsis c) Paralytic ileus caused by manipulation of the colon during surgery d) Pneumonia caused by shallow breathing because of severe incisional pain

Hypovolemic shock caused by hemorrhage Explanation: 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.

Which of the following is a characteristic of the intrarenal category of acute renal failure? a) Decreased creatinine b) High specific gravity c) Increased BUN d) Decreased urine sodium

Increased BUN Explanation: The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.

**What is a characteristic of the intrarenal category of acute kidney injury (AKI)?

Increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.

A client, aged 75, is diagnosed with a renal disease and administered nephrotoxic drugs in normal doses. The nurse is aware that it is important to observe the client closely for any changes in renal status. Which of the following measures may help a nurse determine a change in renal status? A. Observing the client's urinary output. B. Observing the client's fluid intake. C. Checking for a thrill or a bruit daily. D. Observing the skin color and nail beds.

Observing the client's urinary output. Explanation: Nephrotoxic drugs are not administered to a client with renal disease unless the client's life is in danger and no other therapeutic agent is of value. Since the client is given nephrotoxic drugs in normal doses, observing the client's urinary output can help the nurse determine a change in the renal status. Observing the client's fluid intake and noting the color of skin and nail beds do not help a nurse determine a change in the renal status. Checking for a thrill or a bruit daily is performed for a client with a vascular access device.

What is a hallmark of the diagnosis of nephrotic syndrome?

Proteinuria Explanation: Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? a) Recent history of streptococcal infection b) History of osteoporosis c) Previous episode of acute pyelonephritis d) History of hyperparathyroidism

Recent history of streptococcal infection Explanation: 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.

Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? a) Blood tinged drainage in Jackson-Pratt drainage tube b) Urine output of 35 to 40 mL/hour c) SpO2 at 90% with fine crackles in the lung bases d) Pain of 3 out of 10, 1 hour after analgesic administration

SpO2 at 90% with fine crackles in the lung bases Explanation: (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.)

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia: A. Tall, peaked T waves B. Multiple spiked P waves C. Prolonged ST segment D. Shortened QRS complex

Tall, peaked T waves Explanation: Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.

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? A. The kidneys can improve over a period of months. B. Kidney function will improve with transplant. C. Once on dialysis, the need will be permanent. D. Acute renal failure tends to turn to end-stage failure.

The kidneys can improve over a period of months. Explanation: 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.

A nurse is planning to delegate tasks to a a licensed practical nurse (LPN). Which of the following entities is important for the nurse to understand when delegating tasks to the LPN?

The state Nurse Practice Act

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a) Serum sodium level of 135 mEq/L b) Serum potassium level of 4.9 mEq/L c) Temperature of 99.2° F (37.3° C) d) Urine output of 20 ml/hour

Urine output of 20 ml/hour Explanation: 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. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a) Urine output of 250 ml/24 hours b) Temperature of 100.2° F (37.8° C) c) Serum creatinine level of 1.2 mg/dl d) Blood urea nitrogen (BUN) level of 22 mg/dl

Urine output of 250 ml/24 hours Explanation: 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.

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. Explanation: 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.

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? a) Avoid carrying heavy items b) Auscultate the lungs frequently c) Perform deep-breathing exercises vigorously d) Wear a mask when performing exchanges.

Wear a mask when performing exchanges Explanation: 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 most accurate indicator of fluid loss or gain in an acutely ill patient is _________.

Weight

Acute dialysis is indicated during which situation? a. impending pulmonary edema b. hypokalemia c. metabolic alkalosis d. dehydration

impending pulmonary edema Explanation: Acute dialysis is indicated when there is a high and increasing level of serum potassium, fluid overload, or impending pulmonary edema, or increasing acidosis.

A client has been diagnosed with acute glomerulonephritis. This condition causes:

proteinuria

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 Explanation: The kidneys secrete erythropoietin, which is a substance that promotes the maturation of red blood cells.

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis?

Azotemia Explanation: 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.

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? a) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. b) Administer furosemide (Lasix) 20 mg I.V. c) Encourage oral fluids. d) Start hemodialysis after a temporary access is obtained

A) Start IV fluids with normal saline solution bolus followed by a maintenance dose. Explanation: 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 patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek's sign. What deficit does the nurse suspect the patient has?

Calcium

In the treatment of shock, which vasoactive drug results in reduced preload and afterload, reducing the oxygen demand of the heart?

Correct response: Nitroprusside Explanation: A disadvantage of nitroprusside is that it causes hypotension. Dopamine and epinephrine improve contractility, increase stroke volume, and increase cardiac output. Methoxamine increases blood pressure by vasoconstriction.