Care of Patients with Comprised Multiple Health States: Renal

A client is scheduled for an intravenous pyelogram (IVP). In preparation for the procedure, what should the nurse ask the client?

"Do you have any allergies?"

The nurse is collecting data on a client with a urinary tract infection (UTI). Which statements should the nurse expect the client to make? Select all that apply.

"I need to urinate frequently." "It burns when I urinate." "I need to urinate urgently."

A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which statement, if made by a group member, would indicate understanding of the teaching?

"I should notify the health care provider if urinary urgency, burning, frequency, or difficulty urinating occurs."

A client is scheduled for a creatinine clearance test. The client needs further instruction about preparing for the test after making which statement?

"I will be sure to fast from midnight until the test begins at 8:00 am the following day."

A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address?

"I'm allergic to shellfish."

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?

"Increase your carbohydrate intake."

A graduate nurse is asking for information about chronic renal failure. Which statement by the nurse would be most accurate when providing teaching?

"It is characterized by azotemia, fluid volume excess, and hyperkalemia."

An unlicensed assistive personnel (UAP) tells the nurse, "I think the client is confused. They keep telling me they have to void, but that's not possible because they have a catheter in place that is draining well." What should the nurse tell the UAP?

"The urge to void is usually created by the large catheter, and they may be having some bladder spasms."

A client is admitted to an acute care facility after an episode of status epilepticus. After the client is stabilized, what is the best question for the nurse to ask?

"What medications do you take on a daily basis?"

A client who weighs 207 lb (94.1 kg) is to receive 1.5 mg/kg of gentamicin sulfate intravenously three times each day. How many milligrams of medication should the nurse administer for each dose? Round to the nearest whole number.

141

A nurse receives the assignment of clients for the shift. Following the report, which client should the nurse see first?

a client 3 days after a kidney transplant with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L after dialysis

A registered nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients. Which client's care will the nurse safely delegate to the UAP?

a client diagnosed with renal calculi who is encouraged to ambulate four times daily

A client with diabetes mellitus has had declining renal function over the past several years. Which diet regimen should the nurse recommend to the client on days between dialysis?

a low-protein diet with a prescribed amount of water

The nurse is instructing the unlicensed assistive personnel (UAP) about the correct technique for obtaining a clean-catch urine culture from a female client. Which statement indicates that the UAP has understood the instructions? "I will:

ask the client to clean their labia, void into the toilet, and then into the specimen cup

Aluminum hydroxide gel is prescribed for a client with chronic renal failure to take at home. What is the expected outcome of this drug?

binding phosphate in the intestine

When teaching a client with a urinary tract infection about taking a prescribed antibiotic for 7 days, the nurse should tell the client to report which symptom(s) to the health care provider (HCP)? Select all that apply.

blood in the urine rash fever above 100° F (37.8° C)

A client has nephrotic syndrome. To aid in the resolution of the client's edema, the health care provider prescribes 25% albumin. In addition to an absence of edema, the nurse should evaluate the client for which expected outcome?

blood pressure elevation

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?

blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl

A client comes to the clinic with back pain that has been unrelieved by continuous ibuprofen use over the past several days. Current prescription medications include captopril and hydrochlorothiazide. Which laboratory value should the nurse address?

blood urea nitrogen (BUN) of 26 mg/dL and serum creatinine of 2.35 mg/dL

A client returns to the intensive care unit after coronary artery bypass graft surgery, which was complicated by a prolonged cardiopulmonary bypass and hypotension. After 3 hours in the unit, the client's condition stabilizes. Which assessment finding indicates a potential complication related to this occurrence?

blood urea nitrogen level (BUN) of 40 mg/dL

A client with acute kidney injury has a serum potassium level of 6.5 mEq/L (6.5 mmol/L). The nurse should monitor the client for which potential complication?

cardiac arrest

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:

cardiac arrhythmia.

A client requires hemodialysis. Which type of drug should be withheld before this procedure?

cardiac glycosides

A client with chronic kidney disease (CKD) has a blood urea nitrogen (BUN) of 100 mg/dL, serum creatinine of 6.5 mg/dL, potassium of 6.1 mEq/L, and lethargy. What is the priority nursing assessment?

cardiac rhythm

The nurse is teaching a 20-year-old client about the importance of being vaccinated for human papillomavirus (HPV). The nurse should emphasize that the client is at risk for which health problem?

cervical cancer

The nurse is teaching a client with chronic renal failure who is taking antibiotics about which signs and symptoms of potential nephrotoxicity to report. The nurse should tell the client to report which change(s) in the color of the urine? Select all that apply.

cloudy smoky pink

The nurse teaches the parent of a young child with a peritoneal catheter about the signs and symptoms of peritonitis. The nurse determines that the parent has understood the teaching when they identify which finding as an important sign?

cloudy dialysate drainage return

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis disequilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis disequilibrium syndrome causes:

confusion, headache, and seizures.

A client with acute kidney injury asks the nurse, "Will my kidneys ever function normally again?" What should the nurse tell the client? "You will:

continue to improve over a period of weeks."

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the health care provider base the dosage change?

creatinine clearance

The nurse receives the preoperative blood work report for a client who is scheduled to undergo surgery. Which laboratory finding should the nurse report to the surgeon and anesthesiologist?

creatinine, 2.6 mg/dL (230 µmol/L)

Which abnormal blood value would not be improved by dialysis treatment?

decreased hemoglobin concentration

The nurse is assessing a client with kidney failure. Which finding is concerning?

decreased urine output

A client with type 2 diabetes mellitus who is taking metformin is scheduled for a computed tomography (CT) with contrast of the abdomen tomorrow. Which priority nursing assessment is done before the procedure?

ensuring that the metformin has been withheld for 48 hours prior to the scan

A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl (70mmol/L). The most therapeutic pharmacologic intervention would be to administer

epoetin alfa.

A client with acute renal failure has the following laboratory results. Based on these findings, which of the following should the nurse administer?hemoglobin 9.2 g/dLblood urea nitrogen 22 mg/dLcreatinine 0.7 mg/dLpotassium 4.8 mEq/L

erythropoietin

A client is receiving a blood transfusion, and 1 hour after starting the transfusion the client reports dyspnea and has crackles on lung auscultation. Which medication would be most important for the nurse to give?

furosemide 40 mg I.V.

The client is on a fluid restriction of 500 mL (about 2 cups) per day plus replacement for urine output. Because the client's 24-hour urine output yesterday was 150 mL, the total fluid allotment for the next 24 hours is 650 mL (about 2¾ cups). How should the nurses distribute this fluid over the next 24 hours?

given in small amounts throughout each shift

A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:

hyperkalemia

The nurse is assessing a client who is restless and agitated, has dry mucous membranes, and has intense thirst. The nurse should assess the client further for which electrolyte imbalance?

hypernatremia

A health care provider enters a computer order for a nurse to irrigate a client's nephrostomy tube every 4 hours to maintain patency. The nurse irrigates the tube using sterile technique. After irrigating the tube, the nurse decides that they can safely use the same irrigation set for their 8-hour shift if they cover the set with a paper, sterile drape. This action by the nurse is

inappropriate because irrigation requires strict sterile technique.

The nurse is caring for a client with acute renal failure. Rank in chronological order the phases of acute renal failure. All options must be used.

initial insult oliguric phase diuretic phase recovery phase

To reduce urethral irritation, where should the nurse tape the female client's Foley catheter?

inner thigh

The nurse is caring for a client with chronic renal failure. The nurse should monitor the client for which adverse effects of hypermagnesemia?

lethargy

The nurse is instructing a client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate?

low-protein, low-sodium, low-potassium

A nurse is assessing a client with nephrotic syndrome. The nurse should assess the client for which condition?

massive proteinuria

A client is admitted with fever and flank pain and is diagnosed with pyelonephritis. What is a priority nursing intervention in a client with this disorder?

monitoring laboratory values, especially WBCs

A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure?

nephrotoxic injury secondary to use of contrast media

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis disequilibrium syndrome. Which assessment is the priority?

neurological status

A nurse is obtaining assessment data on a client diagnosed with acute renal failure. Which finding warrants calling the healthcare provider?

peaked T waves on electrocardiogram

A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include:

periorbital edema.

A client with chronic renal failure (CRF) has a hemoglobin of 10.2 g/dl and hematocrit of 40%. Which choice would be a primary assessment?

presence of fatigue and weakness

A client is scheduled for a renal arteriogram. No allergies are recorded in the client's medical record, and the client is unable to provide allergy information. During the arteriogram, the nurse should be alert for which assessment finding that may indicate an allergic reaction to the dye used?

pruritus

A client is in the oliguric phase of acute kidney injury. For which risk should the nurse assess the client?

pulmonary edema

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first?

pulse

A client with renal dysfunction of acute onset comes to the emergency department reporting of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about

recent streptococcal infection.

A nurse is planning to administer a sodium polystyrene sulfonate enema to a client with a potassium level of 6.2 mEq/L. Correct administration and the effects of this enema should include having the client

retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.

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

risk for infection

A nurse is reviewing a client's laboratory test results. Which electrolyte is the major cation controlling a client's extracellular fluid (ECF) osmolality?

sodium

A client receiving total parenteral nutrition is ordered a 24-hour urine test. When initiating a 24-hour urine specimen, the collection time should

start after a known voiding.

The nurse is teaching a client who is receiving hemodialysis how to recognize infection in the shunt. What sign should the nurse tell the client to assess each day?

swelling at the shunt site

Which client will the nurse prioritize to assess first?

the client with ESRD (end-stage renal disease) just admitted the night before

Which clinical finding should a nurse look for in a client with chronic renal failure?

uremia

The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. The nurse should report which finding to the health care provider (HCP)?

urine output: 20 mL per hour

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation?

urine pH of 3.0

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 client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status?

weighing the client daily at the same time each day

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:

weight loss.

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 (0.02 L)

The nurse teaches a client with chronic renal failure when to take aluminum hydroxide gel. Which statement indicates that the client understands the teaching? "I'll take it:

with meals and bedtime snacks."

A client with chronic renal failure is experiencing central nervous system (CNS) changes caused by uremic toxins. Which nursing approach would be most appropriate for addressing these CNS changes?

Assess the client's mental status regularly.

After transurethral resection of the prostate, the nurse notices that the urine draining from the catheter is bright red, has numerous clots, and is viscous. Which nursing action is most appropriate?

Assess vital signs and notify the surgeon.

A client with acute pyelonephritis receives a prescription for co-trimoxazole P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the ordered regimen?

Bacteria are absent on urine culture.

A client has nephropathy. The health care provider (HCP) prescribes a 24-hour urine collection for creatinine clearance. Which action is necessary to ensure proper collection of the specimen?

Collect the urine in a preservative-free container and keep it on ice.

A client diagnosed with chronic renal failure is undergoing hemodialysis. Post dialysis, the client weighs 59 kg. The nurse should teach the client to make which dietary changes?

Control the amount of protein intake to 59 to 70 g/day.

A client receiving total parenteral nutrition (TPN) is ordered to undergo a 24-hour urine test for creatinine clearance. Which actions should the client take to initiate this collection?

Discard the first morning void, then continue the collection for exactly 24 hours.

The nurse finds a container with the client's urine specimen sitting on a counter in the bathroom. The client states that the specimen has been sitting in the bathroom for at least 2 hours. What should the nurse do with the urine specimen?

Discard the urine and obtain a new specimen.

A client has a ureteral catheter in place after renal surgery. What should the nurse do to provide safe care of the ureteral catheter?

Ensure that the catheter is draining freely.

A 39-year-old client has been experiencing intermittent vaginal bleeding for several months. The client's health care provider (HCP) tells the client that they have uterine fibroids and recommends an abdominal hysterectomy. When the client expresses fear about the surgery, what should the nurse do?

Give the client opportunities to express their fears.

A client undergoes extracorporeal shock wave lithotripsy (ESWL) to break up and remove renal calculi. Which nursing measure is appropriate for the postoperative care of this client?

Instruct the client to anticipate hematuria for about 24 hours after the procedure.

Which action would be most appropriate for preventing urinary tract infections in an older adult female client?

Instruct the client to avoid tight-fitting underwear.

Sulfamethoxazole/trimethoprim has been prescribed for a client who has a urinary tract infection. What should the nurse do when administering sulfonamides?

Instruct the client to drink at least eight glasses of water a day.

A client is having peritoneal dialysis. During the exchange, the nurse observes that the solution draining from the client's abdomen is consistently blood-tinged. The client has a permanent peritoneal catheter in place. What clinical judgment should the nurse make about the blood-tinged drainage?

It indicates abdominal blood vessel damage.

Which action has the highest priority in the care of a client with chronic renal failure?

Maintain a low-sodium diet.

Two weeks after being diagnosed with a streptococcal infection, a client develops fatigue, a low-grade fever, and shortness of breath. The nurse auscultates bilateral crackles and observes jugular vein distention. Urinalysis reveals red and white blood cells and protein. After the health care provider diagnoses poststreptococcal glomerulonephritis, the client is admitted to the medical-surgical unit. Which immediate action should the nurse take?

Monitor client blood pressure.

A client who is to receive general anesthesia has a serum potassium level of 5.8 mEq/L (5.8 mmol/L). What action should the nurse take first?

Notify the anesthesiologist.

A client is receiving peritoneal dialysis. What should the nurse assess while the dialysis solution is dwelling in the client's abdomen?

Observe respiratory status.

Prior to administering continuous renal replacement therapy (CRRT) on November 7, the nurse notes that the dialysate is clear and the expiration date is November 6. What is the appropriate action by the nurse?

Obtain new dialysate.

A client with acute kidney failure is placed on fluid restriction of 1000 mL of fluid over a 24-hour period. What is the priority nursing action?

Offer the client proportioned fluids in the day and less during the night.

The nurse is inserting a urinary catheter. Which is the correct order, from first to last, for proper placement of a urinary catheter? All options must be used.

Prepare a sterile field. Lubricate the catheter adequately with a water-soluble lubricant. Insert the catheter far enough into the bladder to prevent trauma to the urethral tissue. Ensure free flow of urine.

The nurse is planning care for a client with a catheter. What action(s) should the nurse take to prevent a catheter-associated urinary tract infection? Select all that apply.

Provide perineal care at least once a day. Maintain a closed drainage system. Encourage the client to drink 101 oz (3000 mL) fluids daily.

During dialysis, a client has disequilibrium syndrome. What should the nurse do first?

Slow the rate of dialysis.

A nurse is about to admit a client to the medical surgical unit directly from the health care provider's office. Upon assessment, the nurse notes that the client has significant periorbital edema. Laboratory values indicate the presence of proteinuria and hypoproteinemia. Which action is the nurse's priority?

Strict intake and output assessment and documentation

A nurse is providing instruction about peritoneal dialysis to a client. Which action warrants immediate action by the nurse?

The client keeps the dialysate cold until ready for use.

When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches the client how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?

The client keeps the drainage bag below the bladder at all times.

An older adult client diagnosed with end-stage renal disease (ESRD) presents with fluid volume excess. Which nursing intervention is the priority?

Assess the client's lung sounds.

A client who had transurethral resection of the prostate has dribbling urine after the Foley catheter is removed on the second postoperative day. The nurse notes that the client had 200 mL of urine output in the last 8 hours with a 1000-mL intake. What should the nurse do first?

Assess for bladder distention.

Which statement best describes the therapeutic action of loop diuretics?

They block sodium reabsorption in the ascending loop and dilate renal vessels.

A client in acute kidney injury has an external cannula inserted in the forearm for hemodialysis. Which nursing measure is appropriate for the care of this client?

Use the unaffected arm for blood pressure measurements.

A client with acute kidney injury is to receive peritoneal dialysis. What should the nurse do to prepare the client for the procedure?

Warm the dialysis solution in the warmer.