Renal quiz 1
Which clinical manifestation in a patient with an obstruction in the urinary system is associated specifically with hydronephrosis
Flank asymmetry
The nurse caring for a patient with kidney cell carcinoma, what does the nurse expect to find documented about the patients initial assessment
Flank pain, gross hematuria, palpable kidney mass and renal bruit
The GFR of a patient with acute glomerulonephritis is 50 mL/min. What is the nurses interpretation of this finding
GFR is low, the patient is at risk for fluid overload
The nurse is caring for a patient who had a nephrectomy yesterday. TO manage the patients pain, what is the best plan for analgesia therapy
Give parenteral medications on a schedule
The ER nurse is preparing a patient with kidney trauma for emergency surgery.What is the best task to delegate to the UAP
Go to the blood bank and pick up the units of packed red cells
A patient diagnosed with renal cell carcinoma that has metastasized to the lungs is considered to be in which stage of cancer
IV
After a nephrectomy a patient has a large urine output because of adrenal insufficiency. What does the nurse anticipate the priority intervention for this patient will be
IV fluid replacement because of subsequent hypotension and oliguria
An older adult male patient reports an acute problem with urine retention. The nurse advises the patient to seek medical attention because permanent kidney damage can occur in what time frame
In less than 48 hours
A patient with PKD would exhibit which signs/symptoms
Increased abdominal girth, hypertension, kidney stones
In PKD the effect on the renin angiotensin system in the kidney ends in which result
Increased blood pressure
Kidney tissue changes in chronic glomerulonephritis are caused by which factors
Ischemia, hypertension, fluid and electrolyte imbalance
A patient is very ill and is admitted to the ICU with rapidly progressive glomerulonephritis. The nurse monitors the patient for manifestations of which organ system failure
Kidney
A patient is diagnosed with acute pyelonephritis. What is the priority nursing care for this patient
Managing pain
Which nursing intervention is applicable for a patient with acute glomerulonephritis
Measuring weight daily
A patient is newly admitted with nephrotic syndrome and has proteinuria, edema, hyperlipidemia and hypertension. What is the priority nursing care
Monitor fluid volume from intake and output amounts
A patient is diagnosed with chronic interstitial nephritis. Which nursing action is relevant and specific for this patients medical condition
Monitor for fever
A patient has a family history of autosomal dominant form of PKD and has therefore been advised to monitor for and report symptoms. What is an early symptom of PKD
Nocturia
The nurse reviewing arterial blood gas results of a patient with acute glomerulonephritis. The pH of the sample is 7.35. As acidosis is likely to be present because of hydrogen ion retention and loss of bicarbonate, how does the nurse interpret this data
Normal pH with respiratory compensation
Why may a patient with PKD experience stipation
Polycystic kidneys enlarge and put pressure on the large intestines
The nurse is reviewing a patients lab results. Which lab abnormality in the patient with PKD indicates disease progression
Proteinuria
The nurse is reviewing the lab results for a patient with chronic glomerulonephritis. The serum albumin level is low. What else does the nurse expect to see
Proteinuria
The nurse is reviewing lab results for a patient with suspected kidney problems. Which manifestation is a hallmark for nephrotic syndrome
Proteinuria greater than 3.5 g of protein in 24 hours
The health care provider informs a patient with acute pyelonephritis that abscess formation is common and recommends diagnostic testing to identify the presence of an abscess. Which test does the nurse prepare the patient for
Radionuclide scintillation
A patient is suspected of having PKD. Which diagnostic study has minimal risks and can reveal PKD
Renal sonography
You are supervising a nurse on orientation to the unit who is discharging a patient admitted with kidney stones who underwent lithotripsy. Which statement by the nurse to the patient requires that you intervene
Report any signs of bruising to your physician immediately since this indicates bleeding
A patient with chronic pyelonephritis returns to the clinic for follow up. Which behavior indicates the patient is meeting the expected outcomes to conserve existing kidney function
Reports self administration of antibiotics as prescribed
A patient with PKD reports sharp flank pain followed by blood in the urine. How does the nurse interpret these signs
Ruptured cyst
A nurse is caring for a client with glommerulonephritis. What should the nurse instruct the client to do to prevent recurrent attacks
Seek early treatment for respiratory tract infections
After a nephrectomy one adrenal gland remains. Based on this knowledge, which type of medication replacement therapy does the nurse expect a patient who had a nephrectomy to receive
Steroid
Which patient history factor is considered a causative factor for acute glomerulonephritis
Strep throat 3 weeks ago
A patient is brought to the ER after being involved in a fight in which the patient was kicked and punched repeatedly in the back. What does the nurse include in the initial physcial assessment
Take complete vital signs, check apical and peripheral pulses, inspect both flanks for asymmetryor penetrating injury of the lower chest or back, inspect the abdomen for bruising or penetrating wounds, percuss the abdomen for distention, inspect the urethra for gross bleeding
A patients parent has the autosomal dominant form of polycystic kidney disease. Which abnormal vital sign is the greatest concern for the nurse to follow up with because of the family history of PKD
Temperature of 100.6
The nurse is reviewing the lab results for a patient being evaluated for trouble with passing urine. The urinalysis shows tubular epithelial cells on microscopic examination. How does the nurse interpret this finding
The obstruction is prolonged
A patient has had one kidney removed as a treatment for kidney cancer. The patients spouse asks, does the good kidney take over immediately, I know a person can live with just one kidney. What is the nurses best response
The other kidney will provide adequate function, but this may take days or weeks
A patient returning to the unit after a left radical nephectomy for kidney cell carcinoma is concerned about severe pain on the right side. What does the nurse tell the patient
The pain is likely to be from being positioned on your right side during surgery
A patient reports straining to pass very small amounts of urine today, despite a normal fluid intake, and reports having the urge to urinate. The nurse palpates the bladder and finds that it is distended. How does the nurse interpret these findings
Urethral stricture
After the nurse instructs a patient with PKD on home care, the patient knows to contact the health care provider immediately when what signs/symptoms occur
Weight has increased by 3 pounds in 3 days
A patient with diabetic nephropathy reports having frequent hypoglycemic episodes "so my doctor reduced my insulin which means my diabetes is improving" what is the nurses best response
When kidney function is reduced the insulin is available for a longer time and less of it is needed
An older adult male patient calls the client because he has not passed any urine all day long. What is the nurses best response
You could have an obstruction so you should come back and be checked
The nurse is caring for a patient with nephrotic syndrome. What interventions are included in the plan of care for this patient
administer mild diuretics, assess for edema, administer antihypertensive medications, assess the patients hydration status
A patient with acute glomerulonephritis has edema of the face. The blood pressure is moderately elevated and the patient has gained 2 lbs within the past 24 hours. The patient reports fatigue and refuses to eat. What is the priority nursing care
assess for signs and symptoms of fluid volume overload
What change in diabetic therapy may be needed for a patient who has diabetic nephropathy
decreased insulin dosages
A patient has late stage chronic glomerulonephritis. Which treatment does the nurse discuss and educate the patient about
dialysis or transplantation
The nurse is caring for a patient with kidney cell carcinoma. What symptoms and findings does the nurse expect to see in this patient
erythrocytosis, hypercalcemia, hypertension, hematuria
A patient has sustained a kidney injury. In order to assist the patient to undergo the best diagnostic test to determine the extent of injury, what does the nurse do
give an explanation of computed tomography
The nurse is caring for a postop nephrectomy patient.The nurse notes during the first several hours of the shift a marked and steady downward trend in blood pressure. How does the nurse interpret this finding
internal hemorrhage is possible
The nurse is taking a history on a patient with chronic glomerulonephritis. What is the patient most likely to report
mild edema and hypertension
The nurse is reviewing the lab results for a patient with chronic glomerulonephritis. The phosphorus level is 5.3. What else does the nurse expect to see
serum calcium level below the normal range
A patient with acute glomerulonephritis is required to provide 24 hour urine specimen. What does the nurse expect to see with the specimen
smoky or cola colored urine
A patient with kidney abscess who is receiving antibiotics is ordered an additional treatment by the healthcare provider. The nurse prepares patient education material for which procedure
surgical incision or needle aspiration
A patient is diagnosed with kidney cancer and the health care provider recommends the best therapy. Which treatment does the nurse anticipate teaching the patient about
surgical removal
A patient is admitted for acute glomerulonephritis. In reviewing the patients past medical history which systemic conditions does the nurse suspect may have caused acute glomerulonephritis and will include in the overall treatment plan
systemic lupus erythermatosus and diabetic mephropathy
Which description about the autosomal recessive gene trait of PKD are correct
1.Both parents must carry a mutated allele and both mutated alleles must be inherited 2.Most people with this form of PKD die in early childhood 3. A child has a 1 in 4 chance of inheriting autosomal PKD
Which description about the autosomal dominant gene trait of PKD are correct
1.This is the most common form of PKD 2. Half of people with this form of PKD develop kidney failure by age 50 3. Nearly 100% of people who inherit a PKD gene will develop kidney cysts by age 50
A patient has come to the clinic for follow up of acute pyelonephritis. Which action does the nurse reinforce to the patient
Complete all antibiotic regimens
You are the admitting nurse for a patient with nephrotic syndrome. What assessment finding supports this diagnosis
Edema formation
A patient with PKD usually experiences constipation. What does the nurse recommend
Stool softeners and increased fluids
A 53 year old patient is newly diagnosed with renal artery stenosis. What clinical manifestation does the nurse observe when the patient first seeks health care
Sudden onset of hypertension
A patient reports dull, aching pain and the urinalysis is negative for infection. The nurse identifies that the pain is chronic related to enlarging kidneys compressing abdominal contents. What nursing intervention is best for this patient
Teach methods of relaxation such as deep breathing
The nurse is caring for a patient after a nephrectomy. The nurse notes that the urine flow was 50 ml/hr at the beginning of the shift but several hours later has dropped to 30 ml. What is the nurses priority action
Troubleshoot the drainage system to make sure there are no obstructions
A patient with PKD has nocturia, what does the nurse encourage the patient to do
drink 2 liters of fluid daily
As a charge nurse, you must rearrange room assignments to admit a new patient. Which two patients would be best suited to be roomates
-24 yr old with acute pyelonephritis and severe flank pain -76 yr old with urge incontinence and a UTI
The nurse is giving discharge instructions to a patient who had pyelolithotomy, what topics does the nurse include in the teaching plan
1. Controlling blood pressure 2. Eating properly to promote healing 3. Completing oral antibiotics 4. Monitoring changes in urine output
The nurse is interviewing a patient with suspected PKD. What question does the nurse ask the patient
1. Is there any family history of PKD or kidney disease 2.At what age was your parent diagnosed with PKD 3. Have you had any constipation or abdominal discomfort 4. Have you noticed a change in urine color or frequency 5. Have you had any problems with headaches
Which manifestations are associated with chronic pyelonephritis
1. Obstruction with reflex 2. Structural deformities 3. Neurogenic impairment
The nurse is developing a teaching plan for a patient with PKD. Which topic does the nurse include
1. Teach how to measure and record blood pressure 2. Assist to develop a schedule for self administering drugs 3. Teach to keep blood pressure records 4. Explain the potential side effects of the drugs
You are teaching a patient how best to prevent renal trauma after an injury that required a left nephrectomy, which points would you include in your teaching plan
1. always wear a seatbelt 2. avoid all contact sports 3. Practice safe walking habits 4. use caution when riding a bike
A patient has been informed by the health care provider that treatment will be needed for renal artery stenosis. The nurse prepares to teach about a variety of treatment options. What treatment will the nurse include in the teaching plan
1. hypertension control 2. balloon angioplasty 3. renal artery bypass surgery 4. synthetic blood vessel graft
Which diagnostic test results does the nurse expect to see with acute glomerulonephritis
1. urialysis revealing hematuria 2. urinalysis revealing proteinuria 3.Microscopic red blood cell casts 4. 24 hour for creatine clearance decreased 5. serum albumin levels decreased 6. Antistreptolysin O titers increased
Which patient is at greatest risk for the development of chronic pyelonephritis
36 year old woman with diabetes mellitus who is pregnant
As charge nurse you would assign the nursing care of which patient to an LPN working under the supervision of an RN
48 yr old with cystitis who is taking oral antibiotics
Which type of medication is the best choice to control hypertension in a patient with PKD
ACE inhibitors
The nurse is assessing a patient who reports chills, high fever, and flank pain with urinary urgency and frequency. On physical examination, the patient has costoverterbral angle tenderness, pulse is 110 and respirations are 28. How does the nurse interpret these findings.
Acute pyelonephritis
The nursing diagnosis of constipation related to compression of the intestinal tract has been identified in a patient with polycystic kidney disease. Which nursing care action should you delegate to a newly trained LPN
Administering docusate sodium (colace) 100mg by mouth twice daily
Which ethnic groups are most likely to develop end stage kidney disease related to hypertension
American Indians and hispanic americans
The nurse is caring for a patient with a nephrostomy. The nurse notifies the health care provider about which assessment finding
Amount of drainage decreases and the patient has back pain
Which pain management strategy does the nurse teach a patient who has pain from infected kidney cysts of PKD
Apply dry heat to the abdomen or flank
A patient has chronic glomerulonephritis. In order to assess for uremic symptoms, what does the nurse do
Ask the patient to extend the arms and hyperextend the wrists
The nurse is assessing a patient with glomerulonephritis and notes crackles in the lung fields and neck vein distention. The patient reports mild shortness of breath. Based on these findings what does the nurse do next
Assess for additional signs of fluid overload
A patient with PKD reports a severe headache and is at risk for a berry aneurysm. What is the nurses priority action
Assess for neurologic changes and check vital signs
A patient had a nephrostomy and nephrostomy tube is in place. What is included in the postoperative care of this patient
Assess the amount of drainage in the collection bag
The student nurse is assisting in the postop care of a patient who had a recent nephrectomy. The student demonstrates a reluctance to change the linens because the patient seems so tired. The nurse reminds the student that a priority assessment for the patient is to assess for which factor
Blood on the linens beneath the patient
A patient is diagnosed with hydronephrosis. What is a complication that could result from this condition
Damage to the nephrons
A patient with PKD reports nocturia. What is the nocturia caused by
Decreased urine concentrating ability
The nurse is assessing a patient with possible acute glomerulonephritis. During the inspection of the hands, face and eyelids the nurse is primarily observing for evidence of which factors
Edema
A patient is diagnosed with chronic glomerulonephritis. The patients spouse reports that the patient is irritable, forgetful and has trouble concentrating. Which assessment finding does the nurse expect further examination will reveal
Elevated blood urea nitrogen