Prep U CH 48: Management of Patients with Kidney Disorders

A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection?

Tenderness over transplant site

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 history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?

Acute glomerulonephritis

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?

Recent history of streptococcal infection

An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse?

"This type of dialysis will provide more independence."

The nurse is caring for a client 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 client to exhibit? Select all that apply. - Magnesium 1.5 mg/dL; mood changes and insomnia - Calcium 7.5 mg/dL; hypotension and irritability - Chloride 90 mEq/L; irritability and seizures - Potassium 6.4 mEq/L; dysrhythmias and abdominal distention - Phosphate 5.0 mg/dL; tachycardia and nausea and emesis

- Calcium 7.5 mg/dL; hypotension and irritability - Potassium 6.4 mEq/L; dysrhythmias and abdominal distention - Phosphate 5.0 mg/dL; tachycardia and nausea and emesis

A nurse is assessing a client with acute renal failure. What medications should the nurse identify as a nephrotoxic drug? Select all that apply. - Penicillin - Gentamycin - Tobramycin - Neomycin - Ceftriaxone

- Gentamycin - Tobramycin - Neomycin

The nurse is caring for a client with acute kidney injury (AKI) in the oliguric phase. Which is a priority for the nurse to monitor indicating fluid overload? Select all that apply. - Jugular vein distention - Tenting skin turgor - Crackles - Weight loss - Hypertension

- Jugular Vein Distention - Crackles - Hypertension

The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, which action(s) will the nurse take? Select all that apply. - Wash hands carefully and frequently - Assess vital signs frequently - Instruct staff to always wear a mask - Perform skin hygiene - Perform oral care

- Wash hands carefully and frequently - Perform skin hygiene - Perform oral care

The nurse weighs a client daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg client over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of:

1,500 mL of fluid

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

4000 mL

A client has stage 3 chronic kidney failure. What would the nurse expect the client's glomerular filtration rate (GFR) to be?

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

The nurse is able to identify which condition as uremia?

An excess of urea in the blood

A client with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client?

Anemia

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

Azotemia

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?

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

The client with chronic renal failure reports intense itching. Which assessment finding would indicate the need for further nursing education?

Brief, hot daily showers Hot water removes more oils from the skin and can increase dryness and itching.

A client admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the client has?

Calcium

Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted.

Citrus fruits

When caring for the client with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?

Cola-colored urine

During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication?

Dehydration

During hemodialysis, toxins and wastes in the blood are removed by which of the following?

Diffusion

A client has been diagnosed with postrenal failure. The nurse reviews the client's electronic health record and notes a possible cause. What is the possible cause?

Renal Calculi

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.

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?

Fever

Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure?

Glomerulonephritis

An athlete is thought to have sustained an injury to a kidney. The ER nurse caring for the client reviews the initial orders written by the primary health care provider and notes an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason?

Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.

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

A client with chronic kidney disease becomes confused and reports abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which lab value?

Hyperkalemia

A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?

Hyperphosphatemia

The nurse is caring for a client after kidney surgery. What major danger should the nurse closely monitor for?

Hypovolemic shock caused by hemorrhage

What is a characteristic of the intrarenal category of acute renal failure?

Increased BUN

The nurse is caring for a client in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output?

Less than 400 mL

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder?

Metabolic acidosis

A client recovering from hepatitis B develops acute nephrotic syndrome. Which treatment will the nurse anticipate being prescribed for this client?

Methylprednisolone

The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated?

Obtaining a blood pressure reading from the right arm

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?

Oliguria

Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys?

Oliguria

What occurs late in chronic glomerulonephritis?

Peripheral neuropathy

What is polycystic kidney disease?

Polycystic kidney disease is an inherited disease characterized by the formation of multiple cysts on both kidneys. The fluid-filled cysts can cause great enlargement of the kidneys and interfere with kidney function, which can eventually lead to renal failure.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?

Risk for infection

Which of the following would a nurse classify as a prerenal cause of acute renal failure?

Septic shock

A client is admitted with nausea, vomiting, and diarrhea. Their blood pressure on admission is 74/30 mm Hg. The client is oliguric and their blood urea nitrogen (BUN) and creatinine levels are elevated. The health care provider will most likely write an order for which treatment?

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

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?

The kidneys can improve over a period of months.

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?

Turn the client from side to side.

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)?

Urine output of 250 ml/24 hours

The nurse is caring for a client with blood loss from esophageal varices. Which assessment finding indicates that the client is exhibiting signs of acute kidney injury (AKI) related to the loss of volume?

Urine output that has been <0.5 mL/kg/hr for several hours

The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client?

Use an aseptic technique during the procedure.

A client has doubts about performing peritoneal dialysis at home. They inform the nurse about their existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?

Wear a mask when performing exchanges.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?

White blood cell (WBC) count of 20,000/mm3

The nurse is administering calcium acetate (PhosLo) to a client with end-stage renal disease. When is the best time for the nurse to administer this medication?

With food

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:

fatigue and weakness.

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

proteinuria.

Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for:

removal of the transplanted kidney.

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:

restricting sources of potassium.