NU310: (prepU: management of patients with kidney disorders)

A change that occurs during chronic glomerulonephritis is termed A) hypophosphatemia. B) metabolic alkalosis. C) hypokalemia. D) anemia.

D) anemia.

The nurse cares for a client who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed: A) simple rejection. B) acute rejection. C) chronic rejection. D) hyperacute rejection.

D) hyperacute rejection.

A client recovering from hepatitis B develops acute nephrotic syndrome. Which treatment will the nurse anticipate being prescribed for this client? A) Methylprednisolone B) Increase in sodium intake C) Vancomycin D) Low-carbohydrate diet

A) Methylprednisolone

The nurse is able to identify which condition as uremia? A) An excess of protein in the urine B) An excess of urea in the blood C) An excess of protein in the blood D) An excess of blood in the urine

B) An excess of urea in the blood

A nurse is caring for a client on bedrest with end-stage kidney disease. What major manifestation of uremia should the nurse expect to decrease with an exercise plan? A) Hyperparathyroidism B) Bone demineralization C) Increased secretion of parathormone D) A decreased serum phosphorus level

B) Bone demineralization

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute kidney injury. Which statement from the nurse best reflects the ability of the kidneys to recover from acute kidney injury? A) Acute kidney injury tends to turn to end-stage failure. B) The kidneys can improve over a period of months. C) Once on dialysis, the need will be permanent. D) Kidney function will improve with transplant.

B) The kidneys can improve over a period of months.

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)? A) Serum creatinine level of 1.2 mg/dl B) Urine output of 250 ml/24 hours C) Temperature of 100.2° F (37.8° C) D) Blood urea nitrogen (BUN) level of 22 mg/dl

B) Urine output of 250 ml/24 hours

What is a hallmark of the diagnosis of nephrotic syndrome? A) Hyperalbuminemia B) Hyponatremia C) Proteinuria D) Hypokalemia

C) Proteinuria

Which of the following would a nurse classify as a prerenal cause of acute renal failure? A) Prostatic hypertrophy B) Ureteral structure C) Septic shock D) Polycystic disease

C) Septic shock

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: A) 2,000 mL of fluid B) 500 mL of fluid C) 1,000 mL of fluid D) 1,500 mL of fluid

D) 1,500 mL of fluid

Nursing assessment for the patient receiving peritoneal dialysis would include which of the following to detect the most serious complication of this procedure? A) Observe for evidence of bleeding. B) Inspect the catheter site for leakage of dialysate. C) Measure fluid drainage to estimate incomplete recovery of fluid. D) Palpate the abdominal wall for rebound tenderness.

D) Palpate the abdominal wall for rebound tenderness.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? A) Risk for infection B) Impaired urinary elimination C) Activity intolerance D) Toileting self-care deficit

A) Risk for infection

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? A) Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75% B) Increased serum levels of potassium, magnesium, and calcium C) Increased pH with decreased hydrogen ions D) Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL

D) Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL

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? A) Monitor temperature every 4 hours. B) Administer isotonic fluid therapy as ordered. C) Keep the drainage catheter below the level of insertion. D) Encourage use of incentive spirometer every 2 hours.

D) Encourage use of incentive spirometer every 2 hours.

A client with chronic kidney disease weighs 209 lbs (95 kg) and is prescribed 1.2 grams of protein per kg per day. Which amount of protein will the client ingest per day?

114

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

D) "As the disease progresses, you will most likely require renal replacement therapy."

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) Paralytic ileus caused by manipulation of the colon during surgery C) Pneumonia caused by shallow breathing because of severe incisional pain D) Abdominal distention owing to reflex cessation of intestinal peristalsis

A) Hypovolemic shock caused by hemorrhage

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 skin color and nail beds. C) Observing the client's fluid intake. D) Checking for a thrill or a bruit daily.

A) Observing the client's urinary output.

One of the roles of the nurse in caring for clients with chronic kidney disease is to help them learn to minimize and manage potential complications. This would include: A) restricting sources of potassium. B) eating protein liberally. C) limiting iron and folic acid intake. D) allowing liberal use of sodium.

A) restricting sources of potassium.

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? A) Crackles B) Dehydration C) Hyperkalemia D) Hypertension

B) Dehydration

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 30-59 mL/min/1.73 m2 B) A GFR of 90 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) A GFR of 30-59 mL/min/1.73 m2

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? A) Butter B) Citrus fruits C) Salad oils D) Cooked white rice

B) Citrus fruits

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? A) Diuresis B) Fever C) Weight loss D) Absence of pain

B) Fever

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) "Immunosuppressive drugs guarantee organ success." B) "The doctor may decide to delay the use of immunosuppressant drugs." C) "Let's wait until after the surgery to discuss your treatment plan." D) "Even a perfect match does not guarantee organ success."

D) "Even a perfect match does not guarantee organ success."

A client with acute kidney injury progresses through four phases. Which describes the onset phase? A) Normal glomerular filtration and tubular function are restored. B) Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. C) The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. D) It is accompanied by reduced blood flow to the nephrons.

D) It is accompanied by reduced blood flow to the nephrons.

The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client? A) Pain of 3 out of 10, 1 hour after analgesic administration B) Urine output of 35 to 40 mL/hour C) Blood tinged drainage in Jackson-Pratt drainage tube D) SpO2 at 90% with fine crackles in the lung bases

D) SpO2 at 90% with fine crackles in the lung bases

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) "It is important to use strict aseptic technique." D) "The effluent should be allowed to drain by gravity."

A) "It is appropriate to warm the dialysate in a microwave."

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? A) pH 7.47, PaCO2 45, HCO3 33- B) pH 7.50, PaCO2 29, HCO3 22- C) pH 7.20, PaCO2 36, HCO3 14- D) pH 7.31, PaCO2 48, HCO3 24-

C) pH 7.20, PaCO2 36, HCO3 14-

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? A) Bacteremia B) Proteinuria C) Hematuria D) Azotemia

D) Azotemia

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? A) Pats skin dry after bathing B) Brief, hot daily showers C) Keeps nails trimmed short D) Uses moisturizing creams

B) Brief, hot daily showers

Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure? A) Activity intolerance B) Fluid volume excess C) Urinary retention D) Disturbed body image

B) Fluid volume excess

When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic? A) Neomycin B) Penicillin C) Gentamicin D) Tobramycin

B) Penicillin

What is used to decrease potassium level seen in acute renal failure? A) Sorbitol B) Sodium polystyrene sulfonate C) Calcium supplements D) IV dextrose 50%

B) Sodium polystyrene sulfonate

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

B) Tall, peaked T waves

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? A) Chronic renal failure B) Acute renal failure C) Acute glomerulonephritis D) Nephrotic syndrome

C) Acute glomerulonephritis

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) Serum creatinine of 1.2 mg/dL. C) Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. D) Glomerular filtration rate (GFR) of 100 mL/min.

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

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? A) Low blood pressure B) Left upper quadrant pain C) Cola-colored urine D) Pyuria

C) Cola-colored urine

A client who suffered hypovolemic shock during a cardiac incident has developed acute kidney injury. Which is the best nursing rationale for this complication? A) Blood clot formed in the kidneys interfered with the flow B) Structural damage occurred in the nephrons of the kidneys C) Decrease in the blood flow through the kidneys D) Obstruction of urine flow from the kidneys

C) Decrease in the blood flow through the kidneys

Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? A) Dysrhythmia B) Hypovolemia C) Glomerulonephritis D) Ureteral calculus

C) Glomerulonephritis

What is a characteristic of the intrarenal category of acute kidney injury (AKI)? A) Decreased urine sodium B) High specific gravity C) Increased BUN D) Decreased creatinine

C) Increased BUN

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) History of hyperparathyroidism B) Previous episode of acute pyelonephritis C) Recent history of streptococcal infection D) History of osteoporosis

C) Recent history of streptococcal 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? A) Encourage oral fluids. B) Administer furosemide (Lasix) 20 mg IV C) Start IV fluids with a normal saline solution bolus followed by a maintenance dose. D) Start hemodialysis after a temporary access is obtained.

C) Start IV fluids with a normal saline solution bolus followed by a maintenance dose.

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 potassium level of 4.9 mEq/L B) Serum sodium level of 135 mEq/L C) Urine output of 20 ml/hour D) Temperature of 99.2° F (37.3° C)

C) Urine output of 20 ml/hour

The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number.

4000

The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply. A) Potassium 6.4 mEq/L; dysrhythmias and abdominal distention B) Calcium 7.5 mg/dL; hypotension and irritability C) Magnesium 1.5 mg/dL; mood changes and insomnia D) Chloride 90 mEq/L; irritability and seizures D) Phosphate 5.0 mg/dL; tachycardia and nausea and emesis

A, B and D

A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)? A) Performing the test without contrast B) Administering Garamycin (gentamicin) prophylactically C) Administering sodium bicarbonate after the procedure D) Hydrating with saline intravenously before the test

D) Hydrating with saline intravenously before the test