Med surg Ch. 67, Care of Patients with Kidney Disorders
The nurse is educating a group of individuals at the community center about methods to prevent kidney trauma. Which statement from a member of the group indicates that further teaching is required?
"I should quit the soccer team so I don't injure my kidneys."
Identify the correct order of the pathophysiologic changes that occur with pyelonephritis.
1.Microbial invasion of the renal pelvis 2.Inflammatory response 3.Formation of fibrosis or scar tissue Correct 4.Decrease in tubular reabsorption and secretion Correct 5.Impairment of kidney function
A nurse is performing an assessment on a patient with early renal cell carcinoma. What manifestation will the nurse most likely find on assessment?
Bruit on auscultation of the kidney
What would be the nursing actions for a patient with kidney trauma? Select all that apply.
Check for hematuria Note the frequency of urination Note if the patient complains of pain and burning on urination
When assessing a patient with acute pyelonephritis, which findings does the nurse anticipate will be present? Select all that apply.
Chills Dysuria Vomiting
Which clinical manifestation in a patient with pyelonephritis indicates that treatment has been effective?
Decreased white blood cells in urine
The nurse is caring for a patient with kidney trauma. The patient has a considerable loss of blood. What intervention should the nurse perform?
Report urethral bleeding prior to urinary catheterization.
The nurse is caring for a patient with acute glomerulonephritis (GN) who has a total urine output of 350 mL in 24 hours. Which intervention would the nurse include in the plan of care?
Teach the patient to limit intake of potassium.
What drug used to treat renal carcinoma blocks a protein that is needed for cell division?
Temsirolimus
What does the nurse teach a patient with polycystic kidney disease about managing the disease?
Report any headache and visual disturbances.
A patient who has recently been diagnosed with renovascular disease asks the nurse, "What is the cause of this disease?" What are the nurse's best responses? Select all that apply.
"A blood clot in your vessels may cause this disease." "A buildup of plaque in your vessels may cause this disease." "The narrowing of your renal vessels may cause this disease."
What instructions will the nurse provide before the patient with suspected renovascular disease undergoes noninvasive diagnostic imaging?
"A radionuclide scan will evaluate your kidney's vessels."
A patient, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which statement by the patient indicates a need for further education about her disease?
"By maintaining a low-salt diet in our house, I can prevent ADPKD in my children."
The school nurse is counseling a teenage student about how to prevent kidney trauma. Which statement by the student indicates a need for further teaching?
"I can't play any type of contact sports because my brother had kidney cancer."
A nurse is caring for a male patient with renal cell carcinoma. What statement made by the patient is consistent with his diagnosis? Select all that apply.
"I feel like my sex drive is decreased." Correct 3 "I look more feminine than I used to." Correct 4 "My blood pressure is high all the time."
A patient with renal cell carcinoma is admitted to the hospital due to severe anemia. What statement will the nurse include in the patient's teaching regarding this condition?
"Kidney cancer decreases red blood cell production, causing anemia."
A patient is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the nurse's best response?
"Take your time. What is bothering you the most?"
What will the nurse teach a patient with diabetes mellitus with nephropathy and the patient's family about this condition?
"The severity of this condition depends on your average blood glucose level."
A patient with stage II renal cell carcinoma asks the nurse, "What does stage II mean?" What is the nurse's best response?
"The tumor is bigger than 2.5 cm but does not involve your lymph nodes."
A nurse is providing discharge instructions to a patient who was admitted and treated for a kidney injury sustained from a fall off of a ladder. What statements will the nurse include in the teaching? Select all that apply.
"Urine leakage is a common complication that may occur after this type of injury." "Report any cloudy, foul-smelling urine to the health care provider immediately." "Delayed bleeding is a common complication that may occur after this type of injury."
During discharge teaching for a patient with kidney disease, what does the nurse teach the patient to do?
"Weigh yourself and take your blood pressure."
What teaching will the nurse provide to a patient who is recovering from an endovascular renal stent placement with balloon angioplasty procedure?
"You should be able to go home tomorrow."
Which hourly urine output amount is considered acceptable for the patient who has just undergone a radical nephrectomy?
30 mL/hr
What amount of urine output is an indicator of adequate perfusion to the remaining kidney after the removal of one of the kidneys?
30-50 mL/hr
The nurse is caring for a patient who has just returned to the surgical unit after a radical nephrectomy. Which assessment information alarms the nurse?
Blood pressure is 98/56 mm Hg; heart rate is 118 beats/min.
A 60-year-old adult patient presents to the emergency department coughing up blood with difficulty breathing. The patient states, "I had the flu a little over a week ago, and I am a type II diabetic." Upon assessment, the nurse notes that the patient is dyspneic and has generalized edema. The patient's vital signs are temperature 99.9°F, pulse 98 bpm, respiration 26 breaths per minute, blood pressure 158/100 mm Hg, and oxygen saturation 88%. Based on the patient's information and assessment findings, what is most likely the primary pathophysiological disease?
Acute glomerulonephritis
The nurse anticipates that a patient who develops hypotension and oliguria post-nephrectomy may need the addition of which element to the regimen?
Addition of a corticosteroid
When caring for a patient with nephrotic syndrome, which intervention should be included in the plan of care?
Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss
What findings indicate end-stage kidney disease (ESKD) for a patient with diabetes mellitus? Select all that apply.
Blood pressure: 150/90 mmHg Glomerular filtration rate (GFR): 10 mL/min/1.73 m 2
The nurse receives a report on a patient with hydronephrosis. Which laboratory study does the nurse monitor?
Blood urea nitrogen (BUN) and creatinine
Which patient assessment finding may indicate adrenal insufficiency following radical nephrectomy?
Altered level of consciousness
What cultural factor increases an American Indian patient's risk for developing end-stage kidney disease (ESKD)?
American Indian patients have greater incidences of hypertension than do other populations.
A nurse is caring for a patient with a degenerative kidney disorder with chronic hypertension. What action by the nurse best promotes the patient's adherence to therapy for the treatment of this disorder?
Assess the patient for knowledge deficit about the disorder.
The nurse is providing postoperative care for a patient who underwent nephrectomy. What actions should the nurse take? Select all that apply.
Assess the urine output every hour. Monitor blood pressure every 4 hours. Inspect the abdomen for distention every shift.
The RN is working with an unlicensed assistive personnel (UAP) in caring for a group of patients. Which action is best for the RN to delegate to the UAP?
Assisting a patient who had a radical nephrectomy 2 days ago to turn in bed
A patient is recovering in the intensive care unit (ICU) after a nephrectomy due to renal cell carcinoma. What nursing intervention best prevents pulmonary complications that may occur after a nephrectomy?
Assisting the patient in using an incentive spirometer
Which action helps prevent kidney trauma in a patient with kidney disease?
Avoiding contact sports
How are the blood creatinine and blood urea nitrogen (BUN) levels related to reduced glomerular filtration rate (GFR) in patients with obstructive kidney disorders?
BUN increases with reduced GFR.
The nurse is caring for a 76-year-old patient on prolonged bedrest related to a history of stroke. Which condition is the patient at risk of developing?
Chronic pyelonephritis
The nurse is caring for a patient with pyelonephritis. What does the nurse teach the patient about preventing end-stage kidney disease?
Complete the drug therapy exactly as indicated.
A nurse is caring for a patient who has sustained trauma to the kidney and urethra. When attempting to insert an indwelling urinary catheter, the nurse notes that the patient's urethral opening is bleeding. What is the nurse's priority action?
Contact the patient's health care provider.
What priority of care will the nurse focus on when caring for a patient with nephrosclerosis? Select all that apply.
Controlling the patient's blood pressure Preserving the patient's kidney function
When assessing a patient with acute glomerulonephritis, which finding causes the nurse to notify the provider?
Crackles throughout the lung fields
A nurse working in triage at the local emergency department assesses a patient who has sustained a kidney injury. What action by the nurse will best assist the health care provider in determining the severity of the patient's injury?
Documenting the mechanism of injury
Which finding is typical of chronic glomerulonephritis?
Dyspnea
A patient presented with symptoms of acute glomerulonephritis. Which sample of urine is likely to be collected for accurate urinalysis?
Early morning sample
Which statements about the relationship between hypertension and kidney disease are accurate? Select all that apply.
Hypertension is the second leading cause of ESKD, with many patients requiring kidney replacement. Renal artery stenosis can lead to sudden onset of hypertension and usually affects patients over 50 years. People of American-Indian and African-American descent have a higher risk of ESKD from uncontrolled hypertension.
What is the paraneoplastic syndrome that is common in patients with renal cell carcinoma?
Erythrocytosis
Which assessment findings does the nurse expect in a patient with kidney cancer? Select all that apply.
Erythrocytosis Hypercalcemia Hepatic dysfunction Increased sedimentation rate
What hormonal deficiency may lead to anemia in patients diagnosed with renal cell carcinoma?
Erythropoietin
A hospitalized patient is 12 hours post nephrostomy. Which clinical manifestations should be assessed for monitoring the complication-like infection? Select all that apply.
Fever Change in urine character
A patient is admitted with uremic symptoms secondary to chronic glomerulonephritis. What does the nurse expect to find in the assessment? Select all that apply.
Flapping tremor of the fingers Itching and dryness of the skin
What is the primary cause of high blood pressure resulting from trauma and injury to the kidney?
Hypertension may result from the activation of the renin-angiotensin-aldosterone system.
A patient is recovering following right radical nephrectomy surgery to address renal cell carcinoma. Which finding is consistent with adrenal insufficiency as a complication of the surgery?
Hyponatremia
What is an early sign of adrenal insufficiency?
Hypotension
A 70-year-old patient reports shortness of breath and a decrease in urine output. What else does the nurse include in the assessment in order to differentiate between congestive heart failure and glomerulonephritis?
Hematuria
What finding reflects a desired outcome in the prevention of end-stage kidney disease (ESKD) in a patient with type 2 diabetes mellitus with microalbuminuria?
Hemoglobin A1C of 6.3%
Which factor is an indicator for a diagnosis of hydronephrosis?
History of urinary stones
What should the nurse expect to find in a patient whose ultrasound shows an obstruction in the upper part of the ureter?
Hydronephrosis
What condition may occur when a patient with nephrosclerosis takes spironolactone?
Hyperkalemia
What manifestation does the nurse expect to assess in a patient with chronic pyelonephritis?
Hyperkalemia
What complication will the nurse observe for in a patient with nephrosclerosis who requires potassium-sparing diuretics? Select all that apply.
Hyperkalemia Fluid volume deficit
Which disorders can lead to nephrosclerosis? Select all that apply.
Hypertension Atherosclerosis Diabetes mellitus
Where is the obstruction located in the kidney for a patient diagnosed with a hydroureter?
Lower part of the ureter
The nurse is preparing a patient diagnosed with hydronephrosis for a nephrostomy. Which laboratory order does the nurse anticipate for the patient prior to the procedure?
INR, PT, PTT
What does the nurse expect to find during the assessment of a patient with polycystic kidney disease (PKD)?
Increased abdominal girth
Which condition may result due to increased renin in a patient with renal cell carcinoma (RCC)?
Increased blood pressure
What clinical manifestations will the nurse expect to find while assessing a patient who has renovascular disease? Select all that apply.
Increased serum creatinine Decreased creatinine clearance High blood pressure that is difficult to control
A patient with hydronephrosis is scheduled for a nephrostomy. What diagnostic test is most important for this patient before the procedure?
International normalized ratio (INR)
The renal echography for a patient indicates hydronephrosis. What does the nurse tell the patient about this condition?
It is caused by an obstruction in the renal pelvis.
The nurse is caring for a patient with stage II renal cell carcinoma (RCC). What is the most accurate statement describing the tumor in the patient's kidney?
It is larger than 2.5 cm in size.
What is the most accurate statement regarding acute glomerulonephritis (GN)?
It may cause edema of the eyelids.
Which statement describing hydronephrosis is correct?
It may occur because of an obstruction caused by kidney stones.
Which type of intravenous fluid would the nurse expect to be administered to a patient who sustained trauma to the kidneys?
Lactated Ringer's
Which assessment findings would lead the nurse to suspect adrenal insufficiency in a patient who underwent a total nephrectomy secondary to renal carcinoma? Select all that apply.
Lethargy and drowsiness Urine output 500 mL/24 hr Blood pressure 88/50 mm Hg
The nurse is reviewing the laboratory results of a patient with altered kidney function. What laboratory findings suggest the onset of nephrotic syndrome? Select all that apply.
Lipiduria Severe proteinuria Increased serum lipid level
Which medication would the nurse expect the health care provider to prescribe for a patient with polycystic kidney disease (PCKD) and persistent high blood pressure in order to achieve blood pressure control and prevent complications?
Lisinopril
The nurse is caring for a patient with acute glomerulonephritis. What instructions does the nurse provide to manage the infection? Select all that apply.
Maintain personal hygiene and handwashing. Restrict potassium and sodium intake in the diet. Consume a fluid intake equal to 24-hour urine output plus 500 mL.
Which goal for a patient with diabetes mellitus will best help prevent diabetic nephropathy?
Maintaining HbA 1C at 7% or less
Which teaching points would be helpful in lowering the risk of end-stage kidney disease when instructing a patient about self-management therapies related to polycystic disease? Select all that apply.
Measuring the blood pressure daily Regular monitoring of bowel movements Getting medical attention in case of hematuria
Which statement about autosomal dominant polycystic kidney disease (ADPKD) is correct?
Men and women have an equal chance of inheriting the disease.
Which signs of uremia would the nurse expect to find when assessing a patient with glomerulonephritis? Select all that apply.
Nausea Vomiting Anorexia
What treatment is preferred for a kidney trauma patient with a grade 5 injury?
Nephrectomy
Which clinical manifestation indicates the inability of the kidneys to concentrate the urine in patients with polycystic kidney disease?
Nocturia
What are the key features of acute pyelonephritis? Select all that apply.
Nocturia Flank pain Abdominal discomfort
What signs/symptoms does the nurse expect to find during the assessment of a patient with polycystic kidney disease (PKD)? Select all that apply.
Nocturia Flank pain Kidney stones
The nurse is caring for a patient with acute pyelonephritis. Which indicator is used to determine adequate fluid intake?
Pale yellow urine
A nurse is caring for a patient with renal cell carcinoma who is admitted to the hospital with a cardiac dysrhythmia due to hypercalcemia. What pathophysiological process is the most likely cause of the patient's hypercalcemia?
Parathyroid hormone is released by the tumor.
After receiving a change-of-shift report on the urology unit, which patient does the nurse assess first?
Patient who was involved in a motor vehicle crash and has hematuria
Which kidney disease would have higher incidence of cerebral aneurysms?
Polycystic kidney disease
When caring for a patient with polycystic kidney disease, which goal is most important?
Preventing progression of the disease
Which staff member should care for a newly admitted patient who is diabetic, has pyelonephritis and prescriptions for intravenous antibiotics, and who needs blood glucose monitoring every 2 hours and insulin administration?
RN who has just completed preoperative teaching for a patient who is scheduled for nephrectomy
When taking the health history of a patient with acute glomerulonephritis, the nurse questions the patient about which related cause of the problem?
Recent respiratory infection
Which findings indicate that a patient is progressing normally 12 hours after a nephrostomy tube is inserted? Select all that apply.
Red-tinged urine Blood pressure of 115/75 mm Hg Minimum urine excretion of 30ml/hr
Which patient action may cause complications if the patient has polycystic kidney disease?
Reducing fluid intake
The nurse is assessing a patient for early signs of renal cell carcinoma (RCC). What finding does the nurse expect in this patient?
Renal bruit on auscultation
Which laboratory parameter indicates impaired kidney function?
Serum creatinine of 3.1 mg/dL
Which are risk factors for renal cell carcinoma? Select all that apply.
Smoking Older age Family history
Which stage of kidney tumor includes extension into the patient's renal vein, lymph nodes, or both?
Stage III
The nurse caring for a patient with suspected chronic pyelonephritis receives the following laboratory results: creatinine 8 mg/dL, BUN 53 mg/dL, serum sodium 138 mEq/L, potassium 5.5 mEq/L, phosphate 6 mg/dL, calcium 8.0 mg/dL. Based on the laboratory results, what conclusion can the nurse make?
The patient's lab work is reflective of decreased kidney function.
The labor and delivery nurse is caring for an obstetric patient who has a newborn with an autosomal-recessive polycystic kidney disease (PKD) trait. What is the nurse's understanding of the future implications for the newborn?
There is a higher incidence of death in childhood from the disease.
Which sign or symptom when assessed in a patient with chronic glomerulonephritis (GN) warrants a call to the health care provider?
Third heart sound (S 3)
Why is cortisol hormonal replacement required for patients with renal cell carcinoma after the surgical removal of one kidney (nephrectomy)?
To manage adrenal insufficiency
When caring for a patient who had a nephrostomy tube inserted 4 hours ago, which is essential for the nurse to report to the health care provider?
Tube that has stopped draining
A patient with a history of diabetes mellitus and cataracts is diagnosed with pyelonephritis. What does the nurse identify as the possible cause of pyelonephritis in the patient?
Use of nonsteroidal anti-inflammatory drugs
A 55-year-old patient who presents to the primary care clinic with a sudden onset of hypertension tells the nurse, "I don't understand why I would have high blood pressure. No one in my family has high blood pressure." What teaching will the nurse most likely provide to the patient?
Ways to decrease the development and progression of atherosclerosis