Chapter 67 - Care of Patients with Kidney Disorders

The nurse is caring for a patient with kidney cell carcinoma who manifests paraneoplastic syndromes. What findings does the nurse expect to see in this patient? SATA

Erythrocytosis Hypercalcemia Liver dysfunction HTN

Which clinical manifestation in a patient with an obstruction in the urinary system is associated specifically with a hydronephrosis?

Flank asymmetry

The nurse is caring for a patient with kidney cell carcinoma. What does the nurse expect to find documented about the patient's initial assessment?

Flank pain, gross hematuria, palpable kidney mass, and renal bruit

For a patient with acute glomerulonephritis, a 24-hour urine test was initiated and the glomerular filtration rate (GFR) results are pending. What are the clinical implications of the test results?

GFR is low; the patient is at risk for fluid overload.

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 patient who had a nephrectomy yesterday. To manage the patient's pain, what is the best plan for analgesia therapy?

Give parenteral medications on a schedule.

What are the key features associated with chronic pyelonephritis? SATA

HTN Inability to conserve sodium Decreased urine-concentrating ability, resulting in nocturia Tendency to develop hyperkalemia and acidosis

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 treatments will the nurse include in the teaching plan? SATA

HTN control Balloon angioplasty Renal artery bypass surgery Synthetic blood vessel graft

A patient diagnosed with renal cell carcinoma that has metastasized to the lungs is considered to be in which stage of cancer?

IV (4)

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

In PKD, the effect on the renin-angiotensin system in the kidney has which result?

Increased BP

A patient with PKD would exhibit which signs/symptoms? SATA

Increased abdominal girth HTN Kidney stones

A patient with PKD usually experiences constipation. What does the nurse recommend?

Increased dietary fiber and increased fluids

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 interviewing a patient with suspected PKD. What questions does the nurse ask the patient? SATA

Is there any family history of PKD or kidney disease? Have you had any constipation or abdominal discomfort? Have you noticed a change in urine color or frequency? Have you had any problems with headaches?

A patient is diagnosed with acute pyelonephritis. What is the priority for nursing care for this patient?

Managing pain

A patient is newly admitted with nephrotic syndrome and has proteinuria, edema, hyperlipidemia, and HTN. What is the priority for nursing care?

Monitor fluid volume and the patient's hydration status.

A patient is diagnosed with interstitial nephritis. Which nursing action is relevant and specific for this patient's medical condition?

Monitor for fever.

Which description of the recessive form of PKD is correct?

Most people with this form of PKD die in early childhood.

A patient has a family history of the 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 is reviewing ABG 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

What lab values would the nurse interpret for a patient experiencing problems with urinary elimination as a result of acute pyelonephritis? SATA

Observe complete blood count for elevation of differentials. Observe for elevation of BUN and serum creatinine levels. Observe urinalysis for bacteria, leukocyte esterase, nitrate, or red blood cells.

What is the common problem of hydronephrosis, hydroureter, and urethral stricture in kidney function?

Obstruction

The nurse is taking a history on a patient with chronic glomerulonephritis. What is the patient most likely to report?

Occasional edema and fatigue

Which patient has the greatest risk of developing a kidney abscess?

Patient is diagnosed with acute pyelonephritis

What might the nurse notice if the patient is experiencing problems with urinary elimination as a result of acute pyelonephritis? SATA

Patient reports pain and burning on urination. Patient reports back or flank pain. Urine is cloudy and foul-smelling. Urine may be darker or smoky or have obvious blood in it.

Why may a patient with PKD experience constipation?

Polycystic kidneys enlarge and put pressure on the large intestine.

The nurse is reviewing lab results for a patient with PKD. Which lab abnormality indicates glomeruli involvement?

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 the patient's history, assessment findings, and lab results for a patient with suspected kidney problems. Which manifestation is the main feature of nephrotic syndrome?

Proteinuria greater than 3.5 g of protein in 24 hours

The health care provider advises the patient that diagnostic testing is needed to identify the possible presence of a renal abscess. Which test does the nurse prepare the patient for?

Radionuclide renal scan

A patient is very ill and is admitted to the ICU with rapidly progressing glomerulonephritis. The nurse monitors the patient for manifestations of which organ system failure?

Renal system

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 taking antibiotics as prescribed

The nurse is reviewing the lab results of a patient with chronic glomerulonephritis. The phosphorus level is 5.3 mg/dL. What else does the nurse expect to see?

Serum calcium level below the normal range

A patient with acute glomerulonephritis is required to provide a 24-hour urine specimen. What does the nurse expect to see when looking at the specimen?

Smoky or cola-colored urine

After a nephrectomy, one adrenal gland remains. Based on this knowledge, which type of medication replacement therapy does the nurse expect if the remaining adrenal gland function is insufficient?

Steroid

Which patient history factor is considered causative for acute glomerulonephritis?

Strep throat 3 weeks ago

A 53-year-old patient is newly diagnosed with renal artery stenosis. What clinical manifestation is the nurse most likely to observe when the patient first seeks health care?

Sudden onset of HTN

A patient is admitted for acute glomerulonephritis. In reviewing the patient's past medical history, which systemic conditions does the nurse suspect may have caused acute glomerulonephritis and will include in the overall plan of care?

Systemic lupus erythematosus and diabetic nephropathy

A patient is brought to the ED 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 physical assessment?

Take complete vital signs. Check apical and peripheral pulses. Inspect both flanks for asymmetry or penetrating injuries of the lower chest or back. Inspect the abdomen for bruising or penetrating wounds. Inspect the urethra for gross bleeding.

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 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. Which condition is most likely to be associated with these findings?

Urethral stricture

Which diagnostic tests and results does the nurse expect to see with acute glomerulonephritis? SATA

Urinalysis revealing hematuria Urinalysis revealing proteinuria Microscopic red blood cell casts

After the nurse instructs a patient with PKD on home care, the patient knows to contact the health care provider immediately when what sign/symptom occurs?

Weight has increased by 3 pounds in 2 days.

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 ED 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.

Kidney tissue changes in chronic glomerulonephritis are caused by which factors? SATA

Ischemia HTN Infection

Which nursing intervention is applicable for a patient with acute glomerulonephritis?

Measuring weight daily

A patient is suspected of having PKD. Which diagnostic study has minimal risks and can reveal PKD?

Renal sonography

A patient with PKD reports sharp flank pain followed by blood in the urine. How does the nurse interpret these signs/symptoms?

Ruptured cyst

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

The nurse is developing a teaching plan for a patient with PKD. Which topics does the nurse include? SATA

Teach how to measure and record blood pressure. Assist to develop a schedule for self-administering drugs. Explain the potential side effects of the drugs.

A patient with a history of PKD reports dull, aching flank pain and the urinalysis is negative for infection. The health care provider tells the nurse that the pain is chronic and related to enlarging kidneys compressing abdominal contents. What nursing intervention is best for this patient?

Teach methods of relaxation such as deep- breathing.

A patient is newly diagnosed with type 2 DM. Which screening recommendation does the nurse give to the patient regarding the early detection of diabetic kidney disease?

Urine should be tested annually for protein and microalbuminuria.

A patient has a late-stage chronic glomerulonephritis. Which educational brochure would be the most appropriate to prepare for the patient?

"Important Points to Know about Dialysis"

A patient has had one kidney removed as a treatment for kidney cancer. The patient's spouse asks, "Does the good kidney take over immediately? I know a person can live with just one kidney." What is the nurse's 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 nephrectomy for kidney cell carcinoma reports having some soreness on the right side. What does the nurse tell the patient?

"The soreness is likely to be from being positioned on your right side during surgery."

The off-going nurse is giving shift report to the oncoming nurse about the care of a patient who had a nephrostomy tube placed 3 days ago and it is to remain in place until the urinary obstruction is resolved. What is the most important point to clearly communicate about the urine drainage?

"Urine is draining only into the collection bag, not the bladder; therefore the minimum expected drainage is 30 mL/hour."

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 nurse's best response?

"When kidney function is reduced, the insulin is available for a longer time and thus less of it is needed."

An older adult male patient calls the clinic because he has "not passed any urine all day long." What is the nurse's best response?

"You could have an obstruction, so you should come in to be checked."

Which patient has the greatest risk for developing chronic pyelonephritis?

36-year-old woman with DM who is pregnant

Which description of the autosomal-dominant form of PKD is correct?

50% of people with this form of PKD develop kidney disease by age 50.

Which data set indicates that the patient with DM is achieving the goals of care to prevent the development of microalbuminuria and delay the progression to end-stage kidney disease?

A1C <7%, BP is 125/75 mm Hg, LDL cholesterol is 90 mg/dL

For the patient with PKD, which antihypertensive med may be used because it helps control the cell growth aspects of PKD and reduce microalbuminuria?

ACE inhibitors

Which factor/manifestation is primarily associated with acute pyelonephritis?

Active bacterial infection

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 costovertebral angle (CVA) tenderness, pulse is 110 bpm, and respirations are 28/min. How does the nurse interpret these findings?

Acute pyelonephritis

The nurse is caring for a patient with nephrotic syndrome. What interventions are included in the plan of care for this patient? SATA

Administer mild diuretics. Assess for edema. Administer antihypertensive medications.

The health care provider tells the nurse that the patient with PKD has salt wasting. Which intervention is the nurse likely to use related to nutrition therapy?

Advise that a low-sodium diet is not currently necessary.

Which ethnic groups are mostly likely to develop end-stage kidney disease related to HTN? SATA

American Indians African 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 nurse's priority action?

Assess for neurologic changes and check vital signs.

A patient with acute glomerulonephritis has edema of the face. The BP is moderately elevated and the patient has gained 2 pounds within the past 24 hours. The patient reports fatigue and refuses to eat. What is the priority for nursing care?

Assess for s/s of fluid volume overload.

A patient had a nephrostomy and a nephrostomy tube is in place. What is included in the postop 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 move the patient to change the linens because "the patient seems so tired." The nurse reminds the student that a priority assessment for this patient is to assess for which factor?

Blood on the linens beneath the patient

A 22yo patient comes to the clinic for a wellness check-up. History reveals that the patient's parent has the autosomal-dominant form of polycystic kidney disease (PKD). Which vital sign suggests that the patient should be evaluated for PKD?

Blood pressure of 136/88 mm Hg

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 would the nurse do first?

Check the drainage system for kinks or obstructions to flow.

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.

The health care team is using a collaborative and interdisciplinary approach to design a treatment plan for a patient with PKD. What is the top priority?

Controlling HTN

What change in diabetic therapy may be needed for a patient who has diabetic nephropathy?

Decreased insulin dosages

A patient with PKD has nocturia. What does the nurse encourage the patient to do?

Drink at least 2 liters of fluid daily.

The nurse is assessing a patient with possible acute glomerulonephritis. During the inspection of the hands, face, and eyelids, what is the nurse primarily observing for?

Edema

A patient is diagnosed with chronic glomerulonephritis. The patient's spouse reports that the patient is irritable, forgetful, and has trouble concentrating. Which assessment finding does the nurse expect on further examination?

Elevated BUN