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A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about:
A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction.
he nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel. Which statement indicates that the client understands the teaching?
Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks.
ileal conduit complications
Dusky appearance of the stoma • Stoma protrusion from the skin • Sharp abdominal pain with rigidity
The nurse instructs the client who is taking gentamicin to monitor renal function. The nurse determines that the client needs additional instruction when he makes which statement?
I should call if I have a fever
A child with cystic fibrosis is receiving gentamicin. Which nursing action is most important?
Monitoring intake and output is the most important nursing action when administering an aminoglycoside, such as gentamicin, because a decrease in output is an early sign of renal damage.
The nurse is assessing a client who has benign prostatic hypertrophy (BPH). The nurse should ask the client if he has:
The symptoms of BPH are related to obstruction as a result of an enlarged prostate. Difficulty in starting the urinary stream is a common symptom, along with dribbling, hesitancy, and urinary retention.
allopurinol and s/s
Treats gout and kidney stones that are caused by high levels of uric acid nausea bone marrow depression rash
Polycystic kidney disease
is a lifelong genetic disorder. A no-added salt diet is indicated to delay hypertension. Cysts may develop in other organs such as the liver. Pain manifests as the kidney disease progresses. NSAIDs may be used to treat this pain.
A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 ml. Urine output that's less than 50 ml in 24 hours is known as:
urine output of less than 50ml/hr is anuria
When caring for a client with acute renal failure, the nurse should assess the client carefully for which of the following?
• Hyperkalemia. • Metabolic acidosis. • Hypermagnesemia
The nurse is caring for a child with acute glomerulonephritis and is meeting with the family to discuss discharge instructions. Which of the following are important teaching points for the nurse to review with the child's family?
• Monitor fluid intake and output. • Report any signs of infection. • Restrict the intake of sodium.
A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes:
confusion, h/a and seizures
The nurse is caring for a client with chronic renal failure. The nurse should monitor the client for which adverse effects of hypermagnesemia?
Early signs and symptoms of hypermagnesemia include drowsiness, lethargy, nausea, and vomiting. tremors are associated with hypomagnesmia
Allopurinol is prescribed for a client who has chronic gout. Which comment indicates that the client understands how to take the allopurinol?
"I should drink plenty of fluids when taking allopurinol." t is important that the client force fluids to 3,000 mL/day to avoid the development of renal calculi when taking allopurinol. Allopurinol must be taken consistently to be effective in the treatment of gout. The drug should be taken after meals to avoid gastrointestinal distress.
The nurse is preparing a client for a cardiac catheterization. Which of the following client statements would the nurse need to report to the healthcare provider immediately?
"I took my metformin this morning."
The parents of a 7-year-old child with glomerulonephritis ask what they can do to ensure that their other children do not develop the disease. The nurse should respond with which statement?
"If your child has strepococcal infection, complete the course of antibiotics."
A graduate nurse is asking for information about chronic renal failure. Which of the following statements by the nurse would be most accurate when providing teaching?
"It is characterized by azotemia, fluid volume excess, and hyperkalemia." When chronic renal failure occurs, the body is unable to eliminate the wastes, resulting in azotemia. In addition, the kidneys are not able to eliminate the body fluids, resulting in fluid volume overload. There is also a rise in potassium levels resulting in hyperkalemia. The most common cause of chronic renal failure is diabetes.
The nurse in an outpatient clinic is conducting a follow-up assessment on a child who had a severe streptococcal infection 1 week ago. The client is doing better, and the nurse is providing teaching to the parents about continuing to monitor the client for possible complications of the infection. Which information is most important for the nurse to discuss with the parents?
"Return immediately if acute flank or mid-abdominal pain occurs." Explanation: Acute glomerulonephritis is a major complication of streptococcal infections in children. The onset is often marked by a sudden occurrence of acute flank or mid-abdominal pain. The child may show signs of fluid retention, such as weight gain and edema. Hypertension also commonly occurs.
A client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for:
As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia.
A nurse is developing a teaching plan for a child with acute poststreptococcal glomerulonephritis. What is the most important point to address in this plan?
Because poststreptococcal glomerulonephritis may cause severe, life-threatening hypertension, it is most important for the nurse to teach the parents how to monitor the child's blood pressure
Which statement by the parent of a toddler diagnosed with nephrotic syndrome indicates that the parent has understood the nurse's teaching about this disease?
Children with nephrotic syndrome usually require sodium restriction. Because potato chips and bologna are high in sodium, the mother's statement about finding something else reflects understanding of this need.
Which condition may contribute to hyperparathyroidism?
Chronic renal failure Because failing kidneys can't convert vitamin D, the serum calcium level declines.
A child has been prescribed a 3-day treatment of gentamicin sulfate. Which of the following manifestations would indicate that the child is developing toxicity?
Decreased renal output
The nurse is planning care for a client who has returned to the medical-surgical unit following repair of an aortic aneurysm. The nurse first should assess the client for:
Following surgical repair of an aortic aneurysm, there is a potential for an alteration in renal perfusion, manifested by decreased urine output. The altered renal perfusion may be related to renal artery embolism, prolonged hypotension, or prolonged aortic cross-clamping during surgery. Electrolyte imbalance and anxiety do not present imminent risk for this client; signs of wound infection are generally not evident immediately following surgery, but the nurse should monitor the incision on an ongoing basis
The nurse is caring for a client on the urinary unit. When providing report to the next shift, it is noted that the client has osteopenia and history of renal calculi. Which of the following disorders would the nurse suspect?
Hyperparathyroidism is characterized by osteopenia and renal calculi secondary to overproduction of parathyroid hormone. The hallmark symptom of hypoparathyroidism is tetany from hypocalcemia. Hypopituitarism presents with extreme weight loss and atrophy of all endocrine glands. Symptoms of hypothyroidism include hair loss, weight gain, and cold intolerance
hypocalcemia and hyperphosphatemia
Hypocalcemia is a calcium deficit that causes nerve fiber irritability and repetitive muscle spasms. Signs and symptoms of hypocalcemia include Trousseau's sign, cardiac arrhythmias, diarrhea, increased clotting times, anxiety, and irritability. The calcium-phosphorus imbalance leads to brittle bones and pathologic fractures.
which of the following is a serious adverse effect of ibuprofen in the elderly?
Impaired renal function.
Why is renal failure common in aortic aneurism
Renal failure commonly occurs if clamping time is prolonged, cutting off the blood supply to the kidneys.
What are important nursing care measures for a client with diabetes who is admitted with end-stage renal failure?
Restrict sodium and potassium and restrict fluids as ordered.
A client with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid-base balance?
Returning bicarbonate to the body's circulation The kidney performs two major functions to assist in acid-base balance. The first is to reabsorb and return to the body's circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine.
An adolescent is admitted with a diagnosis of nephrotic syndrome. Which signs or symptoms would the nurse expect to see with this syndrome? Select all that apply.
The four classic signs and symptoms of early stage nephrotic syndrome are hypercholesterolemia, hypoproteinemia, proteinuria, and periorbital edema.
Which of the following compensatory actions by the body would occur if a client were in respiratory acidosis?
The compensatory mechanism for respiratory acidosis is the renal system. In respiratory acidosis, the kidneys will conserve HCO3- in an attempt to correct the acidosis. Excretion of HCO3- would exacerbate the body's acidosis. The lungs cannot compensate for a problem that arises in the respiratory system.
A medical nurse educator is reviewing a client's recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis?
The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. In respiratory and metabolic alkalosis, the kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance.
A client with chronic renal failure is receiving hemodialysis three times a week. To protect the fistula the nurse should
The nurse must always auscultate for a bruit and palpate for a thrill in the arm with the fistula and promptly report the absence of either a thrill or bruit to the health care provider (HCP) as it indicates an occlusion. The client should not have a pressure dressing on the shunt and should avoid wearing tight clothing or carrying heavy items such as purse over the area of the shunt to avoid restricting blood flow in the shunt. No procedures such as IV access, blood pressure measurements, or blood draws are done on an arm with a fistula as they could damage the fistula.
A client returns to an intensive care unit after coronary artery bypass graft surgery, which was complicated by prolonged cardiopulmonary bypass and hypotension. After 3 hours in the unit, the client's condition stabilizes. However, the urine output has decreased despite adequate filling pressures. The nurse expects the physician to add which drug, at which flow rate, to the client's regimen?
This client is at high risk for acute prerenal failure secondary to decreased renal perfusion during surgery. To dilate the renal arteries and help prevent renal shutdown, the physician is likely to order dopamine at a low flow rate (2 to 5 mcg/kg/minute).
A client has experienced excessive losses of bicarbonate and has subsequently developed an acid-base imbalance. How will this lost bicarbonate be replaced?
To replace any lost bicarbonate, the renal tubular cells generate new bicarbonate through a variety of chemical reactions. This newly generated bicarbonate is then reabsorbed by the tubules and returned to the body.
signs and symptoms of glomerulonephritis
eriorbital edema and fever. Other signs and symptoms include loss of appetite, dark-colored urine, pallor, headaches, and abdominal pain. To confirm this suspicion, the nurse would ask about the child's urinary elimination patterns. Typically the child with glomerulonephritis experiences a decrease in urine output. Asking about any recent sore throat would provide additional information to confirm the suspicion of glomerulonephritis, because the most common type is acute poststreptococcal glomerulonephritis, which follows a strep throat by 10 to 14 days. Frequently, the children have only mild cold symptoms and do not realize they have a streptococcal infection.
Which meal would be most appropriate for a 15-year-old with glomerulonephritis with severe hypertension?
baked chicken, rice, beans, orange juice The best selection of food would include no added salt or salty food. Because sodium cannot be excreted due to the oliguria and to avoid increasing the hypertension, a low-salt diet is recommended.
sodium polystyrene sulfonate
causes the body to excrete potassium through the gastrointestinal tract
When teaching a client with chronic renal failure who is taking antibiotics about signs and symptoms of potential nephrotoxicity to report, the nurse should encourage the client to promptly report which changes in the color of the urine?
cloudy smoky and pink
low purine diet foods for renal calculi
milk, all fruits, tomatoes, cereals, and corn.
The parent of a child with chronic renal failure who is receiving peritoneal dialysis at home asks the nurse what she can do if both inflow and drain times are increased. Which instructions would be most appropriate for the nurse to include when responding to the parent?
monitor the child for constipation
A 10-year-old child diagnosed with acute glomerulonephritis is admitted to the pediatric unit. The nurse should ensure that which action is a part of the child's care?
obtaining vital signs every 4 hours and obtaining daily weight (hypertension)
When obtaining the nursing history of a client who has diabetes mellitus, the nurse should assess the client for which of the following early symptom of renal insufficiency?
polyuria first, than oliguria
The nurse judges that the mother understands the diet restrictions for her child with chronic renal failure who is receiving peritoneal dialysis when she reports providing a diet involving which components?
protein and phosphorous restrictions
