Nurs 107 PrepU Chap 48 Management of Patients with Kidney Disorders

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? pH 7.50, PaCO2 29, HCO3 22- pH 7.31, PaCO2 48, HCO3 24- pH 7.20, PaCO2 36, HCO3 14- pH 7.47, PaCO2 45, HCO3 33-

pH 7.20, PaCO2 36, HCO3 14-

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? "It is important to use strict aseptic technique." "The infusion clamp should be open during infusion." "The effluent should be allowed to drain by gravity." "It is appropriate to warm the dialysate in a microwave."

"It is appropriate to warm the dialysate in a microwave."

A patient 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 Pericarditis Acidosis Hyperkalemia

Anemia

A nurse is caring for a client on bedrest with end-stage kidney disease. What major manifestation of uremia should the nurse expect to decrease with an exercise plan? Bone demineralization A decreased serum phosphorus level Hyperparathyroidism Increased secretion of parathormone

Bone demineralization

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? Hypovolemic shock caused by hemorrhage Paralytic ileus caused by manipulation of the colon during surgery Abdominal distention owing to reflex cessation of intestinal peristalsis Pneumonia caused by shallow breathing because of severe incisional pain

Hypovolemic shock caused by hemorrhage

The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output? Less than 50 mL Less than 400 mL 1.5 L 1.0 L

Less than 400 mL

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? Acute tubular necrosis Restored glomerular function Oliguria Diuresis

Oliguria

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? History of hyperparathyroidism Recent history of streptococcal infection History of osteoporosis Previous episode of acute pyelonephritis

Recent history of streptococcal infection

The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication? 2 hours after meals 2 hours before meals With food At bedtime with 8 ounces of fluid

With food

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 Weight loss Hypotension Polyuria

Tenderness over transplant site

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

Calcium

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? Dehydration Hypertension Crackles Hyperkalemia

Dehydration

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? A GFR of 85 mL/min/1.73 m2 A GFR of 90 mL/min/1.73 m2 A GFR of 30-59 mL/min/1.73 m2 A GFR of 120 mL/min/1.73 m2

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

The nurse cares for a client who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed: hyperacute rejection. simple rejection. acute rejection. chronic rejection.

hyperacute rejection.

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? Administration of an insulin drip Administration of a loop diuretic Administration of sodium bicarbonate Administration of sodium polystyrene sulfonate [Kayexalate])

Administration of sodium polystyrene sulfonate [Kayexalate])

Which of the following would a nurse classify as a prerenal cause of acute renal failure? Prostatic hypertrophy Polycystic disease Ureteral stricture Septic shock

Septic shock

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

Azotemia

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? Pyuria Cola-colored urine Low blood pressure Left upper quadrant pain

Cola-colored urine

Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? Ureteral calculus Hypovolemia Glomerulonephritis Dysrhythmia

Glomerulonephritis

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? Fever Weight loss Diuresis Absence of pain

Fever

Which of the following occurs late in chronic glomerulonephritis? Peripheral neuropathy Seizure Stroke Nosebleed

Peripheral neuropathy

A client recovering from hepatitis B develops acute nephrotic syndrome. Which treatment will the nurse anticipate being prescribed for this client? Vancomycin Methylprednisolone Increase in sodium intake Low-carbohydrate diet

Methylprednisolone

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? Brief, hot daily showers Pats skin dry after bathing Uses moisturizing creams Keeps nails trimmed short

Brief, hot daily showers

Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted. Citrus fruits Salad oils Butter White rice

Citrus fruits

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: thrush and circumoral pallor. nausea and vomiting. fatigue and weakness. dyspnea and cyanosis.

fatigue and weakness.

A client has been diagnosed with acute glomerulonephritis. This condition causes: No option is correct. pyuria. polyuria. proteinuria.

proteinuria.

A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? "Very few symptoms are associated with renal cancer." "Squamous cell carcinomas do not present with detectable symptoms." "Painless gross hematuria is the first symptom in renal cancer." "You should have sought treatment earlier."

"Very few symptoms are associated with renal cancer."

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? Cola-colored urine Hypotension Hyperalbuminemia Peripheral neuropathy

Cola-colored urine

What is a hallmark of the diagnosis of nephrotic syndrome? Hyperalbuminemia Hypokalemia Hyponatremia Proteinuria

Proteinuria

One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: limiting iron and folic acid intake. restricting sources of potassium. eating protein liberally. allowing liberal use of sodium.

restricting sources of potassium.

The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: 500 mL of fluid 1,500 mL of fluid 2,000 mL of fluid 1,000 mL of fluid

1,500 mL of fluid

Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? Pain of 3 out of 10, 1 hour after analgesic administration Blood tinged drainage in Jackson-Pratt drainage tube Urine output of 35 to 40 mL/hour SpO2 at 90% with fine crackles in the lung bases

SpO2 at 90% with fine crackles in the lung bases

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? Increased pH with decreased hydrogen ions Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75% Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL Increased serum levels of potassium, magnesium, and calcium

Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL

A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? Eliminate fat intake and increase protein intake. Increase carbohydrates and limit protein intake. Increase protein, carbohydrates, and fat intake. Increase fat intake and limit carbohydrates.

Increase carbohydrates and limit protein intake.

What is a characteristic of the intrarenal category of acute renal failure? Increased BUN Decreased urine sodium Decreased creatinine High specific gravity

Increased BUN

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? Encourage oral fluids. Administer furosemide (Lasix) 20 mg IV Start hemodialysis after a temporary access is obtained. Start IV fluids with a normal saline solution bolus followed by a maintenance dose.

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

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? Urine output of 20 ml/hour Serum potassium level of 4.9 mEq/L Serum sodium level of 135 mEq/L Temperature of 99.2° F (37.3° C)

Urine output of 20 ml/hour

When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic? Penicillin Gentamicin Tobramycin Neomycin

Penicillin

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)? Temperature of 100.2° F (37.8° C) Serum creatinine level of 1.2 mg/dl Blood urea nitrogen (BUN) level of 22 mg/dl Urine output of 250 ml/24 hours

Urine output of 250 ml/24 hours

A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? Elevated urea and nitrogen Hyperphosphatemia Elevated serum creatinine Hyperkalemia

Hyperphosphatemia

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? Blood glucose level of 200 mg/dl Potassium level of 3.5 mEq/L Hematocrit (HCT) of 35% White blood cell (WBC) count of 20,000/mm3

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

The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client? Clean the catheter insertion site daily with soap Keep the dialysis supplies in a clean area, away from children and pets Keep the catheter stabilized to the abdomen, below the belt line Wear a mask while handling any dialysate solutions

Keep the dialysis supplies in a clean area, away from children and pets

A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching? "As long as I have one normal kidney, I should be fine." "If renal failure develops, I may need to consider dialysis." "I inherited this disorder from one of my parents." "The cysts can get quite large in size."

"As long as I have one normal kidney, I should be fine."

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: "Genetic testing will determine the best treatment for your condition." "Draining of the cysts and antibiotic therapy will cure your disease." "As the disease progresses, you will most likely require renal replacement therapy." "Dietary changes can reverse the damage that has occurred in your kidneys."

"As the disease progresses, you will most likely require renal replacement therapy."

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? "Let's wait until after the surgery to discuss your treatment plan." "Immunosuppressive drugs guarantee organ success." "The doctor may decide to delay the use of immunosuppressant drugs." "Even a perfect match does not guarantee organ success."

"Even a perfect match does not guarantee organ success."

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." "Peritoneal dialysis will require more work for you." "The risk of peritonitis is greater with this type of dialysis." "Peritoneal dialysis does not work well for every client."

"This type of dialysis will provide more independence."

A client with chronic kidney disease (CKD) has been receiving erythropoietin injections as prescribed. Which outcome would indicate to the nurse that this medication has been effective? Bowel movements solid and formed Blood pressure within normal limits Absence of pallor Absence of a paradoxical pulse

Absence of pallor

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? Monitor temperature every 4 hours. Administer isotonic fluid therapy as ordered. Keep the drainage catheter below the level of insertion. Encourage use of incentive spirometer every 2 hours.

Encourage use of incentive spirometer every 2 hours.

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? Peritoneal dialysis Continuous arteriovenous hemofiltration (CAVH) Hemodialysis Continuous venovenous hemofiltration (CVVH)

Hemodialysis

The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take? Check with the dialysis nurse about the medications. Administer the medications as ordered. Hold the medications until after dialysis. Ask if the client wants to take the medications.

Hold the medications until after dialysis.

A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? Hypocalcemia Hyperkalemia Elevated urea levels Elevated white blood cells

Hyperkalemia

What is a characteristic of the intrarenal category of acute renal failure? High specific gravity Decreased creatinine Decreased urine sodium Increased BUN

Increased BUN

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? Encouraging coughing and deep breathing Providing pain-relief measures Limiting fluid intake Promoting carbohydrate intake

Limiting fluid intake

Compliance to a renal diet is a difficult lifestyle change for a patient on hemodialysis. The nurse should reinforce nutritional information. Which of the following teaching points should be included? Select all that apply. Limit protein to 1.6 g/kg/day. Restrict fluid to daily urinary output plus 500 to 800 mL. Eat foods such as milk, fish, and eggs. Increase potassium to prevent cardiac problems. Restrict sodium to 2,000 to 3,000 mg daily.

Restrict fluid to daily urinary output plus 500 to 800 mL. Eat foods such as milk, fish, and eggs. Restrict sodium to 2,000 to 3,000 mg daily.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? Risk for infection Activity intolerance Impaired urinary elimination Toileting self-care deficit

Risk for infection

The nurse treats a client with end-stage kidney disease (ESKD). The nurse is concerned that the client is developing renal osteodystrophy. Upon review of the client's laboratory values, it is noted the client has had a calcium level of 11 mg/dL for the past 3 days and the phosphate level is 5.5 mg/dL. The nurse anticipates the administration of which medication? Sevelamer hydrochloride Mylanta Calcium carbonate Calcium acetate

Sevelamer hydrochloride

A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD? The client has a history of diverticulitis. The client is blind in his right eye. The client has a history of severe anemia during hemodialysis. The client is on the kidney transplant waiting list.

The client has a history of diverticulitis.

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure? The kidneys can improve over a period of months. Kidney function will improve with transplant. Acute renal failure tends to turn to end-stage failure. Once on dialysis, the need will be permanent.

The kidneys can improve over a period of months.

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? Auscultate the lungs frequently. Avoid carrying heavy items. Perform deep-breathing exercises vigorously. Wear a mask when performing exchanges.

Wear a mask when performing exchanges.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: a decreased serum phosphate level secondary to kidney failure. metabolic alkalosis secondary to retention of hydrogen ions. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. an increased serum calcium level secondary to kidney failure.

water and sodium retention secondary to a severe decrease in the glomerular filtration rate.