part 7.2
The nurse is performing discharge teaching for the client after a nephrectomy for renal cell carcinoma. Which statement by the client indicates that teaching has been effective? a. "Because renal cell carcinoma usually affects both kidneys, I'll need to be watched closely." b. "I'll eventually require some type of renal replacement therapy." c. "I'll need to decrease my fluid intake to prevent stress to my remaining kidney." d. "My remaining kidney should provide me with normal kidney function."
d. "My remaining kidney should provide me with normal kidney function." After a nephrectomy, the second kidney is expected to provide adequate kidney function, but this may take days or weeks.
Which of these staff members should be assigned to a client who has benign prostatic hyperplasia and hydronephrosis and needs an indwelling catheter inserted? a. An RN float nurse who has 10 years of experience with pediatric clients b. An LPN/LVN who has worked in the hospital's kidney dialysis unit until recently c. An RN without recent experience who has just completed an RN refresher course d. An LPN/LVN with 5 years of experience in an outpatient urology surgery center
d. An LPN/LVN with 5 years of experience in an outpatient urology surgery center Catheterization of a client with an enlarged prostate, a skill within the scope of practice of the LPN/LVN, would be performed frequently in a urology center.
What does the nurse teach the client to prevent the risk for urinary tract infection (UTI)? a. Limit fluid intake. b. Increase caffeine consumption. c. Limit sugar intake. d. Drink about 3 liters of fluid daily.
d. Drink about 3 liters of fluid daily. Drinking about 3 liters of fluid daily, if another medical problem does not require fluid restriction, helps prevent dehydration and UTIs.
Which goal for the client with diabetes will best help to prevent diabetic nephropathy? a. Heed the urge to void. b. Avoid carbohydrates in the diet. c. Take insulin at the same time every day. d. Maintain HbA1c
d. Maintain HbA1c Maintaining long-term control of blood glucose will help prevent the progression of diabetic nephropathy.
When caring for the client with hemorrhage secondary to kidney trauma, the nurse provides volume expansion. Which of these does the nurse anticipate should be used? a. Fresh-frozen plasma b. Platelet infusions c. 5% dextrose in water d. Normal saline solution
d. Normal saline solution Isotonic solutions and crystalloid solutions are administered for volume expansion; 0.9% sodium chloride (NSS) and 5% dextrose in 0.45% sodium chloride may be used.
The client with pyelonephritis has been prescribed urinary antiseptic medication. What purpose does this medication serve? a. Decreases bacterial count b. Destroys white blood cells c. Enhances the action of antibiotics d. Provides comfort
d. Provides comfort Urinary antiseptic drugs such as nitrofurantoin (Macrodantin) are prescribed to provide comfort for clients with pyelonephritis.
During discharge teaching for the client with kidney disease, what does the nurse teach the client to do? a. Drink 2 liters of fluid and urinate. b. Eat breakfast and go to bed. c. Check blood sugar and do a urine dipstick test. d. Weigh yourself and take your blood pressure.
d. Weigh yourself and take your blood pressure. Regular weight assessment monitors fluid restriction control. Blood pressure control is necessary to reduce cardiovascular complications and slow the progression of kidney dysfunction
The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which of these questions by the nurse to the interdisciplinary health care team will result in reducing client exposure? a. "Should we filter air circulation?" b. "Can we use less radiographic contrast dye?" c. "Should we add low-dose dopamine?" d. "Should we increase IV rates?"
"Can we use less radiographic contrast dye?" Correct: Contrast dye is severely nephrotoxic and other options can be used in its place.
When teaching the client who is to undergo kidney transplant surgery, the nurse includes which of these in the teaching session? a. "Your diseased kidneys will be removed at the same time the transplantation is performed." b. "The new kidney will be placed directly below one of your old kidneys." c. "It is essential for you to wash your hands and avoid people who are ill." d. "You will receive dialysis the day before surgery and for about a week after."
"It is essential for you to wash your hands and avoid people who are ill." Correct: Anti-rejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential.
Discharge teaching has been provided for the client recovering from kidney transplantation. Which information indicates that the client understands the instructions? a. "I can stop my medications when my kidney function return to normal." b. "If my urine output is decreased, I should increase my fluids." c. "The anti-rejection medications will be taken for life." d. "I will drink 8 ounces of water with my medications."
"The anti-rejection medications will be taken for life." Correct: Immune suppressant therapy must be taken for life to prevent organ rejection.
The client is being treated for kidney failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle? a. "All of this is new. What can't you do?" b. "Are you afraid of dying?" c. "How are you doing this morning?" d. "What concerns do you have about your kidney disease?"
"What concerns do you have about your kidney disease?" Correct: This statement is open ended and specific to the client?s concerns.
The client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? a. "I'll talk to the doctor and have your name removed from the waiting list" b. "You sound frustrated with the situation." c. "You're right, the wait is endless for some people." d. "I'm sure you'll get a phone call soon that a kidney is available."
"You sound frustrated with the situation." Correct: This option reflects the feelings the client is having and offers assistance and support.
The client with acute kidney injury is receiving a fluid challenge of 500 mL of normal saline over 1 hour. With a drop factor of 20 drops/mL, how many drops per minute does the nurse infuse?
167 drops/min
What is the appropriate range of urine output for the adult client weighing 110 lbs? _______ to _______ mL/hr
25 to 30 mL/hr Adult urine output expectations are 0.5 to 1 mL/kg/hr.
The nurse should encourage fluids every 2 hours for older adult clients because of a decrease in which factor? A.Antidiuretic hormone (ADH) production B.General metabolism C.Glucose tolerance D.Ovarian production of estrogen
A A decrease in ADH production causes urine to be more dilute, so urine might not concentrate when fluid intake is low. The older adult is at greater risk for dehydration as a result of urine loss. A decrease in general metabolism causes decreased tolerance to cold, decreased appetite, and decreased heart rate and blood pressure; it is not related to fluid intake or hydration. A decrease in glucose tolerance does not affect fluid intake or hydration. A decrease in estrogen production causes a decrease in bone density and is not related to fluid intake and hydration.
The charge nurse on the medical-surgical unit is making client assignments for the shift. Which client is the most appropriate to assign to an LPN/LVN? A.Client with Cushing's syndrome who requires orthostatic vital signs assessments B.Client with diabetes mellitus who was admitted with a blood glucose of 45 mg/dL C.Client with exophthalmos who has many questions about endocrine function D.Client with possible pituitary adenoma who has just arrived on the nursing unit
A An LPN/LVN will be familiar with Cushing's syndrome and the method for assessment of orthostatic vital signs. The client with a blood glucose of 45 mg/dL, the client with questions about endocrine function, and the client with a possible pituitary adenoma all have complex needs that require the experience and scope of practice of an RN.
A client with an endocrine disorder says, "I can't, you know, satisfy my wife anymore." What is the nurse's best response? A."Can you please tell me more?" B."Don't worry. That is normal." C."How does she feel?" D."Should I make an appointment with a counselor?"
A Asking the client to explain his concerns in an open-ended question allows the nurse to explore his feelings more thoroughly. Telling a client that something is "normal" is dismissive; this is new to the client and is a concern for him. The focus of the nurse's response needs to be on the client, not on the wife initially. Referring the client to a counselor is not an appropriate first step; this dismisses the client's concerns and does not allow him to express his frustrations at the moment.
The nurse is teaching a client about maintaining a proper diet to prevent an endocrine disorder. Which food does the nurse suggest after the client indicates a dislike of fish? A.Iodized salt for cooking B.More red meat C.More green vegetables D.Salt substitute for cooking
A Dietary deficiencies in iodide-containing foods may be a cause of an endocrine disorder. For clients who do not eat saltwater fish on a regular basis, teach them to use iodized salt in food preparation. The client should eat a well-balanced diet that includes less animal fat. Eating vegetables contributes to a proper diet; however, this does not prevent an endocrine disorder. Using a salt substitute does not prevent an endocrine disorder; in addition, salt substitutes may contain high levels of potassium, which may lead to electrolyte imbalances.
The nurse is instructing a client who will undergo a suppression test. Which statement by the client indicates that teaching was effective? A."I am being tested to see whether my hormone glands are hyperactive." B."I am being tested to see whether my hormone glands are hypoactive." C."I am being tested to see whether my kidneys work at all." D."I will be given more hormones as a trigger."
A Suppression tests are used when hormone levels are high or in the upper range of normal. Failure of suppression of hormone production during testing indicates hyperfunction. A stimulation test assesses whether hormone glands are hypoactive. The adrenal glands are endocrine glands that are located on the kidneys; a suppression test does not measure kidney function. Hormones are given as a trigger in a stimulation test.
Which gland releases catecholamines? A.Adrenal B.Pancreas C.Parathyroid D.Thyroid
A The adrenal medulla releases catecholamines in response to stimulation of the sympathetic nervous system. The principal hormones of the pancreas are insulin, glucagon, and somatostatin. Parathyroid hormone is the principal hormone of the parathyroid gland. Triiodothyronine (T3), thyroxine (T4), and calcitonin are the principal hormones of the thyroid.
9. Which pulse rate finding in a client taking a drug that stimulates beta1 receptors requires immediate action by the nurse? a.50 beats/min b.95 beats/min c.85 beats/min d.100 beats/min
ANS: A Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions. The nurse expects an increase in heart rate and increased cardiac output. The client with a heart rate of 50 beats/min would be cause for concern because this would indicate that the client was not responding to the medication. The other heart rates are within normal limits but on the higher end and would be considered a therapeutic response to the medication.
The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? a. A client with chronic kidney failure who was just admitted with shortness of breath b. A client with kidney insufficiency who is scheduled to have an arteriovenous (AV) fistula inserted c. A client with azotemia whose blood urea nitrogen and creatinine are increasing d. A client receiving peritoneal dialysis who needs help changing the dialysate bag
A client with chronic kidney failure who was just admitted with shortness of breath Correct: This client's dyspnea may indicate pulmonary edema and should be assessed immediately.
17. The nurse is teaching a client about self-care after menopause. Which teaching topic is the priority? a.Weight-bearing exercise b.Skin care c.Intimacy needs d.Body image changes
ANS: A After menopause, the ovaries produce less estrogen. This leads to decreased bone mass. The client should engage in regular weight-bearing exercise to prevent fractures. The other topics are appropriate but do not take priority over safety needs.
3. A client has a deficiency of aldosterone. Which assessment finding does the nurse correlate with this condition? a.Increased urine output b.Vasoconstriction c.Blood glucose, 98 mg/dL d.Serum sodium, 144 mEq/L
ANS: A Aldosterone, the major mineralocorticoid, maintains extracellular fluid volume. It promotes sodium and water reabsorption and potassium excretion in the kidney tubules. A client with an aldosterone deficiency will have increased urine output. Sodium and potassium levels are normal; in aldosterone deficiency, the client would have hyponatremia and hyperkalemia. Vasoconstriction is not related.
18. The nursing assistant reports that while pouring urine into a 24-hour urine container, some urine splashed the nursing assistant's hand. Which action by the nurse is best? a.Ask the assistant if he or she washed the hands afterward. b.Call the laboratory to see if the container has preservative in it. c.Have the assistant fill out an incident report. d.Send the assistant to Employee Health right away.
ANS: A For safety, the nurse should find out if the assistant washed his or her hands. The nursing assistant should do this for two reasons. First, it is part of Standard Precautions to wash hands after client care. Second, if the container did have preservative in it, this would wash it away. The preservative may be caustic to the skin. The nurse can call the laboratory while the assistant is washing hands if needed. The nursing assistant would then need to fill out an incident or exposure report and may or may not need to go to Employee Health. The nursing assistant also needs further education on Standard Precautions, which include wearing gloves.
15. A client asks why a 24-hour urine collection is necessary to measure excreted hormones instead of a random voided specimen. Which response by the nurse is most accurate? a."We are testing for a hormone secreted on a circadian rhythm." b."The hormone is so dilute in urine, we need a large volume." c."We want to see when the hormone is secreted in both large and small amounts." d."You'd have to be here at a specific time of the day for a random urinalysis."
ANS: A Some hormones are secreted in a pulsatile, or circadian, cycle. When testing for these substances, a collection that occurs over 24 hours will most accurately reflect hormone secretion. The other responses are not accurate.
Which clinical manifestation indicates the need for increased fluids in the client with kidney failure? a. Increased blood urea nitrogen b. Increased creatinine c. Pale urine d. Decreased sodium
Increased blood urea nitrogen Correct: An increase in blood urea nitrogen can be an indication of dehydration, and an increase in fluids is needed.
6. A client is admitted to the hospital with exacerbation of heart failure, which had been stable for several years. Which finding does the nurse associate with the client's current condition? a.Recent prescription for thyroid hormone replacement medication b.Recent onset of menopause c.Patchy areas of depigmentation on the face d.Absence of fish in the diet, but inclusion of the iodized form of table salt
ANS: A Thyroid hormones regulate metabolism. Starting on thyroid replacement therapy can lead to an increase in heart rate and tissue oxygen use, which can lead to an exacerbation of heart failure if the client's heart is not able to meet these increased demands. Menopause and vitiligo (depigmentation of the skin) would not be related. Thyroid function is needed to produce thyroid hormones. The client who does not eat shellfish should use iodized table salt.
11. A client has bilateral patchy areas of skin depigmentation on the arms and the face. Which action by the nurse is best? a.Assess the client's mucous membranes. b.Draw a laboratory specimen for thyroid hormone levels. c.Schedule the client for fasting blood glucose. d.Question the client about sexual functioning.
ANS: A Vitiligo, patchy areas of depigmentation of the skin, is associated with primary hypofunction of the adrenal glands. Other assessment findings in this condition include uneven pigmentation on the mucous membranes. The other assessments are not related to vitiligo.
1. Which are common key features of hormones? (Select all that apply.) a.Hormones may travel long distances to get to their target tissues. b.Continued hormone activity requires continued production and secretion. c.Control of hormone activity is caused by negative feedback mechanisms. d.Most hormones are stored in the target tissue for use later. e.Most hormones cause target tissues to change activities by changing gene activity.
ANS: A, B, C Hormones are secreted by endocrine glands and travel through the body to reach their target tissues. Hormone activity can increase or decrease according to the body's needs, and continued hormone activity requires continued production and secretion. Control is maintained via negative feedback. Hormones are not stored for later use, and they do not alter genetic activity.
2. A client has a hypofunctioning anterior pituitary gland. Which hormones does the nurse expect to be affected by this? (Select all that apply.) a.Thyroid-stimulating hormone b.Vasopressin c.Follicle-stimulating hormone d.Calcitonin e.Growth hormone
ANS: A, C, E Thyroid-stimulating hormone, follicle-stimulating hormone, and growth hormone all are secreted by the anterior pituitary gland. Vasopressin is secreted from the posterior pituitary gland. Calcitonin is secreted from the thyroid gland.
16. An older client is being admitted to the hospital for pneumonia. The client has no other health problems. Which action by the nurse is best? a.Place the client on airborne precautions. b.Offer the client fluids every hour or two. c.Leave the bathroom light on at night. d.Palpate the client's thyroid gland on admission.
ANS: B A normal age-related endocrine change is decreased antidiuretic hormone (ADH) production. This results in a more dilute urine output, which can lead to dehydration. If no contraindications are known, the nurse should offer (or delegate) the client something to drink at least every 2 hours. A client with a simple pneumonia would not need Airborne Precautions. The client may or may not need/want the bathroom light left on at night. Palpating the client's thyroid gland is a part of a comprehensive examination but is not specifically related to this client.
5. A client has a condition of excessive catecholamine release. Which assessment finding does the nurse correlate with this condition? a.Decreased blood pressure b.Increased pulse c.Decreased respiratory rate d.No change in vital signs
ANS: B Catecholamines are responsible for the "fight-or-flight" stress response. Activation of the sympathetic nervous system can be correlated with tachycardia. The other options are not correlated with excessive catecholamine release.
14. A female client with an endocrine problem has hirsutism. Which question or statement by the nurse is most appropriate? a."Do you have the money to pay for treatment?" b."I'm interested in knowing how you feel about yourself." c."Many treatment options are available for this problem." d."What can you do to prevent this from happening?"
ANS: B Hirsutism, excessive hair growth on the face and body, can result from endocrine disorders. This may cause a disruption in body image, especially for female clients. The nurse should gently inquire into the client's body image and self-perception. Asking about the client's financial status sounds judgmental. Simply stating that treatment options are available minimizes the client's concerns. The client is not doing anything to herself to cause the problem, so the last question is inappropriate.
A client is taking a drug that blocks a hormone's receptor site. What is the effect on the client's hormone response? a.Greater hormone metabolism b.Decreased hormone activity c.Increased hormone activity d.Unchanged hormone response
ANS: B Hormones cause activity in the target tissues by binding with their specific cellular receptor sites, thereby changing the activity of the cell. When receptor sites are occupied by other substances that block hormone binding, the cell's response is the same as when the level of the hormone is decreased.
4. A male client reports fluid secretion from his breasts. What does the nurse assess next in this client? a.Posterior pituitary hormones b.Adrenal medulla functioning c.Anterior pituitary hormones d.Parathyroid functioning
ANS: C Breast fluid and milk production are induced by the presence of prolactin, secreted from the anterior pituitary gland. The other hormones do not influence this process.
7. A client has abnormal calcium levels. Which hormone does the nurse anticipate testing for? a.Thyroxine (T4) b.Triiodothyronine (T3) c.Thyrocalcitonin (calcitonin) d.Propylthiouracil (PTU)
ANS: C Parafollicular cells produce thyrocalcitonin (calcitonin [TCT]), which helps regulate serum calcium levels. The other hormones are not related directly to calcium levels.
A client is hospitalized for pituitary function testing. Which nursing action included in the client's plan of care will be most appropriate for the RN to delegate to the LPN/LVN? A.Assess the client for clinical manifestations of hypopituitarism. B.Inject regular insulin for the growth hormone stimulation test. C.Palpate the thyroid gland for size and firmness. D.Teach the client about the adrenocorticotropic hormone stimulation test.
B Injection of insulin is within the LPN/LVN scope of practice. Client assessment for clinical manifestations of hypopituitarism, palpating the thyroid gland, and client education are complex skills requiring training and expertise, and are best performed by an RN.
13. Which client statement indicates the need for clarification regarding the instructions for collecting a 24-hour urine specimen for assessment of endocrine function? a."I will continue to take all my prescribed medicine during the test." b."I will add the preservative to the container at the beginning of the test." c."I will start the collection by saving the first urine of the morning." d."At the end of 24 hours, I will urinate and save that last specimen."
ANS: C The 24-hour urine collection specimen is started when the client first arises and urinates. The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time is noted. The client adds all urine voided after that first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last time and adds this specimen to the collection. The preservative, if used, must be added to the container at the beginning of the collection. Clients can continue to take all their normal medications during a timed urine collection. They should, however, avoid unnecessary medications.
12. A new nurse is palpating a client's thyroid gland. Which action requires intervention from the nurse's mentor? a.The nurse stands behind, instead of in front of, the client. b.The client is asked to swallow while the nurse finds the thyroid gland. c.The nurse palpates the right lobe with his or her left hand. d.The client is placed in a sitting position with the chin tucked down.
ANS: C The client should be in a sitting position with the chin tucked down as the examiner stands behind the client. The nurse feels for the thyroid isthmus while the client swallows and turns the head to the right, and the nurse palpates the right lobe with the right hand. The technique is repeated in the opposite fashion for the left lobe.
2. How does a tropic hormone differ from other hormones? a.Tropic hormones are given to clients who have a hormone deficiency. b.Tropic hormones are exclusively involved in the production of sex hormones. c.Tropic hormones stimulate other endocrine glands to secrete hormones. d.Tropic hormones are not under negative feedback control.
ANS: C The target tissues for tropic hormones are other endocrine glands. The effect of these agents is to stimulate another endocrine gland to secrete its hormone. The other statements are inaccurate.
10. Which situation or condition is likely to result in increased production of thyroid hormones? a.Starvation b.Dehydration c.Adequate sleep d.Cold environmental temperature
ANS: D Cold environmental temperatures stimulate the hypothalamus to secrete thyrotropin-releasing hormone, which in turn stimulates the anterior pituitary gland to secrete thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid gland to secrete thyroid hormones, which, when bound to target tissues, increase the rate of metabolism to maintain body temperature near normal. The other situations would not lead to an increase in thyroid hormone production.
8. Which is the expected clinical manifestation for a client who has excessive production of melanocyte-stimulating hormone? a.Hypoglycemia and hyperkalemia b.Irritability and insomnia c.Increased urine output d.Darkening of the skin
ANS: D Melanocyte-stimulating hormone increases the size of melanocytes in the skin and increases the amount of pigment (melanin) that they produce. The other actions do not occur as the result of excessive melanocyte-stimulating hormone function.
Which finding in the first 24 hours after kidney transplantation requires immediate intervention? a. Abrupt decrease in urine output b. Blood-tinged urine c. Incisional pain d. Increase in urine output
Abrupt decrease in urine output Correct: An abrupt decrease in urine output may indicate complications such as rejection, acute tubular necrosis (ATN), thrombosis, or obstruction.
A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen (BUN) requires 1 liter of normal saline infused over 2 hours. Which staff member should be assigned to care for the client? a. An RN who has floated from pediatrics for this shift b. An LPN/LVN with experience working on the medical unit c. An RN who usually works on the general surgical unit d. A new graduate RN who just finished a 6-week orientation
An RN who usually works on the general surgical unit Correct: The nurse with experience in taking care of surgical clients will be most capable of monitoring this older client receiving rapid fluid infusions, who is at risk for complications such as pulmonary edema and acute kidney failure.
The nurse carefully observes for toxicity of drugs excreted through the kidney. Which of these represents a sign or symptom of digoxin toxicity? a. Serum digoxin level of 1.2 ng/mL b. Polyphagia c. Anorexia d. Serum potassium of 5.0 mEq/L
Anorexia Correct: Anorexia, nausea, and vomiting are symptoms of digoxin toxicity.
When caring for a group of clients, the nurse recognizes that which clients are at risk for acute kidney injury (AKI)? Select all that apply. a. Football player in preseason practice b. Client who underwent contrast dye radiology c. Accident victim recovering from a severe hemorrhage d. Accountant with diabetes e. Client in the intensive care unit on high doses of antibiotics f. Client recovering from gastrointestinal influenza
Answer: Football player in preseason practice; Client who underwent contrast dye radiology; Accident victim recovering from a severe hemorrhage; Client in the intensive care unit on high doses of antibiotics; Client recovering from gastrointestinal influenza Rationale: Urge all people to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis. Contrast media may cause acute renal failure (ARF), especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause acute kidney injury. Certain antibiotics may cause nephrotoxicity. Dehydration reduces kidney blood flow and may cause acute kidney injury.
When caring for the client with a left forearm arteriovenous (AV) fistula created for hemodialysis, the nurse must do which of these? Select all that apply. a. Check brachial pulses daily. b. Auscultate for a bruit each shift. c. Teach the client to palpate for a thrill over the site. d. Elevate the arm above heart level. e. Ensure that no blood pressures are taken in that arm.
Auscultate for a bruit each shift. Correct Teach the client to palpate for a thrill over the site. Correct Ensure that no blood pressures are taken in that arm. A bruit or swishing sound should be present, indicating patency of the fistula. A thrill or buzzing sensation upon palpation should be present, indicating patency of the fistula. No blood pressure, venipuncture, or compression such as lying on the fistula should occur.
The client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? a. Auscultate for pericardial friction rub. b. Assess for crackles. c. Monitor for decreased peripheral pulses. d. Determine whether the client is able to ambulate.
Auscultate for pericardial friction rub. Correct: The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST segment elevation.
Which teaching by the nurse will help the client prevent renal osteodystrophy? a. Low-calcium diet b. Avoiding peas, nuts, and legumes c. Drinking cola beverages only once daily d. Avoiding dairy enriched with vitamin D
Avoiding peas, nuts, and legumes Correct: Kidney failure causes hyperphosphatemia; this client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes.
The client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? a. Avoiding venipuncture and blood pressure measurements in the affected arm b. Discussion on modifications to allow for complete arm rest c. Information on how to assess for bruit d. Information on proper nutrition
Avoiding venipuncture and blood pressure measurements in the affected arm Correct: Compression of vascular access causes decreased blood flow and may cause occlusion; dialysis will not be possible.
The nurse is teaching a client about the correct procedure for a 24-hour urine test for creatinine clearance. Which statement by the client indicates a need for further teaching? A."I should keep the urine container cool in a separate refrigerator or cooler." B."I should not eat any protein when I am collecting urine for this test." C."I won't save the first urine sample." D."To end the collection, I must empty my bladder, adding it to the collection."
B Eating protein does not interfere with collection or testing of the urine sample. Because the specimen must be kept cool, it can be placed in an inexpensive cooler with ice; the client should not keep the specimen container with food or beverages. The timing of the 24-hour collection begins after the initial void. To end a 24-hour urine specimen, emptying the bladder and adding it to the collection is the proper procedure.
To best determine how well a client with diabetes mellitus is controlling blood glucose, which test does the nurse monitor? A.Fasting blood glucose B.Glycosylated hemoglobin (HbA1c) C.Oral glucose tolerance test D.Urine glucose level
B Glycosylated hemoglobin indicates the average blood glucose over several months and is the best indicator of overall blood glucose control. Fasting blood glucose can be used to monitor glucose control, but it is not the best method (although this may be the method that clients are most familiar with). Oral glucose testing and urine glucose levels look at one period of time and are not the best methods to look at overall effectiveness of treatment.
Which statement is true about hormones and their receptor sites? A.Hormone activity is dependent only on the function of the receptor site. B.Hormones need a specific receptor site to work. C.Hormones need to be plasma-bound to activate the receptor site. D.Hormone stores are available for activation until needed.
B In general, each receptor site type is specific for only one hormone. Hormone receptor actions work in a "lock and key" manner, in that only the correct hormone (key) can bind to and activate the receptor site (lock). Hormones travel through the blood to all body areas, but exert their actions only on target tissues. Not all hormones are plasma-bound; for example, thyroid hormones are plasma protein-bound, whereas posterior pituitary hormones are transported by axons. Only certain cells manufacture specific hormones and store the hormones in vesicles.
In type 1 diabetes, insulin injections are necessary to maintain which action between insulin and glucose? A.Glucose intolerance B.Homeostasis C.Insulin intolerance D.Negative feedback
B Insulin injections maintain homeostasis, or normal balance, between insulin and glucose in the client with type 1 diabetes. Type 1 diabetes is a lack of insulin production, not glucose intolerance, and requires frequent doses of insulin. Negative feedback does not occur in type 1 diabetes because of lack of insulin.
The nurse is assessing a client for endocrine dysfunction. Which comment by the client indicates a need for further assessment? A."I am worried about losing my job because of cutbacks." B."I don't have any patience with my kids. I lose my temper faster." C."I don't seem to have any stressors now." D."My weight has been stable these past few years."
B Many endocrine problems can change a client's behavior, personality, and psychological responses; the client stating that he or she has become short-tempered warrants further assessment. Worrying about losing a job is a normal concern but does not give any indication of a need for further assessment. The nurse will need to assess the client's claim that he or she has no stressors at present because the client's response does not provide enough information to make this determination; however, the client's statement about losing patience is the priority. Weight gain or loss may or may not be an indication of an endocrine disorder.
A client has suspected alterations in antidiuretic hormone (ADH) function. Which diagnostic test does the nurse anticipate will be requested for this client? A.Adrenocorticotropic hormone (ACTH) suppression test B.Chest x-ray C.Cranial computed tomography (CT) D.Renal sonography
C ADH is a hormone of the posterior pituitary. Brain abscess, tumor, or subarachnoid hemorrhage could cause alterations in ADH levels. These can be seen on a CT scan of the brain. ACTH triggers the release of cortisol from the adrenal cortex and is not related to ADH. A chest x-ray would not show a pituitary tumor or brain abscess. Even though ADH acts on distal convoluted tubules in the kidneys, a renal sonogram would diagnose the cause of syndrome of inappropriate antidiuretic hormone.
A client is hospitalized with a possible disorder of the adrenal cortex. Which nursing activity is best for the charge nurse to delegate to an experienced nursing assistant? A.Ask about risk factors for adrenocortical problems. B.Assess the client's response to physiologic stressors. C.Check the client's blood glucose levels every 4 hours. D.Teach the client how to do a 24-hour urine collection.
C Blood glucose monitoring is within the nursing assistant's scope of practice if the nursing assistant has received education and evaluation in the skill. Assessing risk factors for adrenocortical problems is not part of a nursing assistant's education. Assessing the client's response to physiologic stressors requires the more complex skill set of licensed nursing staff. Teaching the proper method for a 24-hour urine collection is a multi-step process; this task should not be delegated.
Which negative feedback response is responsible for preventing hypoglycemia during sleep in nondiabetic clients? A.Alpha cells of the pancreas B.Beta cells of the pancreas C.Glucagon release D.Insulin release
C Glucagon is the hormone that binds to receptors on liver cells. This causes the liver cells to convert glycogen to glucose, which keeps blood sugar levels normal during sleep. Alpha cells are responsible for synthesizing and secreting the hormone glucagon. Beta cells are responsible for synthesizing and secreting the hormone insulin. Insulin is the hormone responsible for lowering blood glucose. Insulin improves glucose uptake by the cell.
When caring for the client hoping to receive a kidney transplant, the nurse recognizes that which of these problems will exclude the client from transplantation? a. History of hiatal hernia b. Client with diabetes and HbA1c of 6.8 c. Basal cell carcinoma removed from nose 5 years ago d. Client with tuberculosis
Client with tuberculosis Correct: Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with immune suppressants required to prevent rejection.
To prevent prerenal acute kidney injury, which person is encouraged to increase fluid consumption? a. Construction worker b. Office secretary c. Schoolteacher d. Taxi cab driver
Construction worker Correct: Physical labor and working outdoors, especially in warm weather, cause diaphoresis and place a construction worker at risk for dehydration and prerenal azotemia.
The nurse in the transplantation unit assesses for which of these signs and symptoms of rejection of the transplanted kidney. Select all that apply. a. Blood urea nitrogen (BUN) 21, creatinine 0.9 b. Crackles in lung fields c. Temperature 98.8 d. Blood pressure 164/98 e. +3 edema of lower extremities
Crackles in lung fields orrect Blood pressure 164/98 Correct +3 edema of lower extremities Signs and symptoms of fluid retention are symptoms of transplant rejection. Correct: Increased blood pressure is a symptom of transplant rejection. Correct: Signs and symptoms of fluid retention are symptoms of transplant rejection.
The nurse is reviewing the laboratory test results for a client admitted with a possible pituitary disorder. Which information has the most immediate implication for the client's care? A.Blood glucose 125 mg/dL B.Blood urea nitrogen (BUN) 40 mg/dL C.Serum potassium 5.2 mEq/L D.Serum sodium 110 mEq/L
D The normal range for serum sodium is 135 to 145 mEq/L; a result of 110 mEq/L is considered hyponatremia and is extremely dangerous. The client is at risk for increased intracranial pressure, seizures, and death. The RN must act rapidly because this situation requires immediate intervention. The normal range for fasting blood glucose is 60 to 110 mg/dL; 125 mg/dL is high, but is not considered dangerous. The normal range for BUN is 7 to 20 mg/dL; 40 mg/dL is high. An elevated BUN can be an indication of kidney failure, dehydration, fever, increased protein intake, and shock, so the client should have a creatinine drawn for a more complete picture of kidney function. The normal range for serum potassium is 3.5 to 5.2 mEq/L; 5.2 mEq/L is high normal.
The nurse recognizes that the client with end-stage kidney disease has difficulty adhering to the fluid restriction when which of these is found? a. Blood pressure 118/78 b. Weight loss of 3 lbs during hospitalization c. Dyspnea and anxiety at rest d. Central venous pressure (CVP) of 6 mm Hg
Dyspnea and anxiety at rest Correct: Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse assists the client in correlating symptoms of fluid overload with nonadherence to fluid restriction.
When assisting the client with kidney failure to restrict dietary protein to 40 g/day, the nurse recommends that the client select which of these proteins? a. Eggs b. Ham c. Eggplant d. Macaroni
Eggs Correct: Suggested protein-containing foods are milk, meat, and eggs.
The client is receiving immune suppressive therapy after kidney transplantation. Which measure is most important for the nurse to implement? a. Adherence to therapy b. Handwashing c. Monitoring for low-grade fever d. Strict clean technique
Handwashing Correct: The most important infection control measure is handwashing.
The client with chronic kidney disease presents with bradycardia, prolonged PR interval, and diminished bowel sounds. For which of these should the nurse monitor? a. Hyperchloremia b. Hypomagnesemia c. Hyperkalemia d. Hypercalcemia
Hyperkalemia Correct: Hyperkalemia may be present; electrocardiographic changes and paralytic ileus may develop.
Which of the following represents a positive response to administration of erythropoietin (Epogen, Procrit)? a. Hematocrit of 26.7% b. Potassium within normal range c. Free from spontaneous fractures d. Less fatigue
Less fatigue Correct: Treatment of anemia with erythropoietin will result in increased (H&H) and decreased shortness of breath (SOB) and fatigue.
When administering medications to the client with chronic kidney disease, the nurse recognizes that which of these medications is most effective in slowing the progression of kidney failure? a. Diltiazem (Cardizem) b. Lisinopril (Zestril) c. Clonidine (Catapres) d. Doxazosin (Cardura)
Lisinopril (Zestril) Correct: Angiotensin-converting enzyme (ACE) inhibitors appear to be the most effective drugs to slow the progression of kidney failure.
The nurse teaches the client recovering from acute kidney disease to avoid which of these? a. Nonsteroidal anti-inflammatory drugs b. Angiotensin-converting enzyme (ACE) inhibitors c. Opiates d. Acetaminophen
Nonsteroidal anti-inflammatory drugs Correct: Nonsteroidal anti-inflammatory drugs may be nephrotoxic.
When caring for a client who receives peritoneal dialysis (PD), which of these findings must the nurse report to the provider immediately? a. Pulse oximetry reading of 95% b. Sinus bradycardia, rate of 58 c. Blood pressure of 148/90 d. Temperature of 101.2
Temperature of 101.2 Correct: Peritonitis is the major complication of PD caused by intra-abdominal catheter site contamination; use meticulous aseptic technique when caring for PD equipment.
Which of these interventions is essential for the client in the oliguric phase of acute kidney injury (AKI)? a. Restrict fluids. b. Replace potassium. c. Administer blood transfusions. d. Monitor arterial blood gases (ABGs).
Restrict fluids. Correct: During the oliguric phase of AKI, the client will be at risk for fluid overload; fluid restriction is necessary to limit this problem .
The nurse assists the client with acute kidney injury (AKI) to modify the diet in which way? Select all that apply. a. Restricted protein b. Liberal sodium c. Fluid restriction d. Low potassium e. Low fat
Restricted protein Correct Fluid restriction Correct Low potassium Breakdown of protein leads to azotemia and increased blood urea nitrogen (BUN). Correct: Fluid is restricted during the oliguric stage. Correct: Potassium intoxication may occur; dietary potassium is restricted.
When caring for the client with acute kidney injury and a temporary subclavian hemodialysis catheter, which of these should the nurse report to the provider? a. Crackles at lung bases b. Temperature 100.8 c. +1 ankle edema d. Anorexia
Temperature 100.8 Correct: Infection is a major complication of temporary catheters. Report all symptoms of infection, including fever, to the provider. The catheter may have to be removed.
The client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the nurse's best response? a. "Because the kidneys cannot get rid of fluid, blood pressure goes up." b. "The damaged kidneys no longer release a hormone that prevents high blood pressure." c. "The waste products in the blood interfere with other mechanisms that control blood pressure." d. "This is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products."
a. "Because the kidneys cannot get rid of fluid, blood pressure goes up." In chronic kidney disease, fluid levels increase in the circulatory system.
The client, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which statement by the client indicates a need for further education about her disease? a. "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." b. "Even though my children don't have symptoms at the same age I did, they can still have ADPKD." c. "If my children have the ADPKD gene, they will have cysts by the age of 30." d. "My children have a 50% chance of inheriting the ADPKD gene that causes the disease."
a. "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." There is no way to prevent ADPKD, although early detection and management of hypertension may slow the progression of kidney damage. Limiting salt intake can help control blood pressure.
The school nurse is counseling a teenage student about how to prevent renal trauma. Which statement by the student indicates a need for further teaching? a. "I can't play any type of contact sports because my brother had kidney cancer." b. "I avoid riding motorcycles." c. "I always wear pads when playing football." d. "I always wear a seat belt in the car."
a. "I can't play any type of contact sports because my brother had kidney cancer." Contact sports and high-risk activities should be avoided if a person has only one kidney. A family history of kidney cancer does not prohibit this type of activity.
The nurse is questioning the female client with a urinary tract infection (UTI) about her antibiotic drug regimen. Which statement by the client indicates a need for further instruction? a. "I take my medication only when I have symptoms." b. "I always wipe front to back." c. "I don't use bubble baths and other scented bath products." d. "I try to drink 3 liters of fluid a day."
a. "I take my medication only when I have symptoms." Clients with UTIs must complete all prescribed antibiotic therapy, even when symptoms of infection are absent.
When caring for the client with nephrotic syndrome, which of the following should be included in the plan of care? a. Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss b. Administering heparin to prevent deep vein thrombosis (DVT) c. Providing antibiotics to decrease infection d. Providing transfusion of clotting factors
a. Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss ACE inhibitors can decrease protein loss in the urine.
When preparing a client for nephrostomy tube insertion, it is essential for the nurse to monitor which of these before the procedure? a. BUN and creatinine b. Hemoglobin and hematocrit (H&H) c. Intake and output (I&O) d. Prothrombin time (PT) and international normalized ratio (INR)
a. BUN and creatinine Nephrostomy tubes are placed to prevent and treat kidney damage; this is important but is not essential before the procedure.
The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment information alarms the nurse? a. Blood pressure is 98/56; heart rate is 118. b. Urine output over the past hour was 80 mL. c. Pain is at a level 4 (on a 0 to 10 scale). d. Dressing has a 1-cm area of bleeding.
a. Blood pressure is 98/56; heart rate is 118. Bleeding is a complication of radical nephrectomy; tachycardia and hypotension may indicate impending hypovolemic or hemorrhagic shock. Notify the surgeon immediately and plan to administer fluids, check the complete blood count (CBC), and administer blood if necessary.
When caring for the client 24 hours after a nephrectomy, the nurse notes that the client's abdomen is distended. Which assessment should be made next? a. Check the vital signs. b. Notify the surgeon. c. Continue to monitor. d. Insert a nasogastric (NG) tube
a. Check the vital signs. The client's abdomen may be distended from bleeding. Hemorrhage or adrenal insufficiency causes hypotension, so vital signs should be taken to see if a change in blood pressure has occurred.
Which of the following findings does the nurse expect in the client with kidney cancer? Select all that apply. a. Erythrocytosis b. Hypokalemia c. Hypercalcemia d. Hepatic dysfunction e. Increased sedimentation rate
a. Erythrocytosis c. Hypercalcemia d. Hepatic dysfunction e. Increased sedimentation rate (a) Erythrocytosis alternating with anemia may occur. (c) Parathyroid hormone produced by tumor cells can cause hypercalcemia. (d) Hepatic dysfunction with elevated liver enzymes may occur. (e) Elevation in sedimentation rate may occur in paraneoplastic syndromes. INCORRECT: Potassium levels are not altered in kidney cancer; hypercalcemia is present.
When caring for the client with polycystic kidney disease, the nurse recognizes that which of these goals is most important? a. Preventing progression of the disease b. Performing genetic testing c. Assessing for related causes d. Consulting with the dialysis unit
a. Preventing progression of the disease Preventing complications and progression is the goal.
When taking the health history of a client with acute glomerulonephritis, the nurse questions the client about which related cause of the problem? a. Recent respiratory infection b. Hypertension c. Unexplained weight loss d. Neoplastic disease
a. Recent respiratory infection An infection often occurs before the kidney manifestations of acute glomerulonephritis (GN). The onset of symptoms is about 10 days from the time of infection.
When assessing a client with pyelonephritis, the nurse recognizes that which of these conditions may predispose the client to the problem? a. Spinal cord injury b. Cardiomyopathy c. Hepatic failure{ d. Glomerulonephritis
a. Spinal cord injury Chronic pyelonephritis occurs with spinal cord injury, bladder tumor, prostate enlargement, or urinary tract stones.
Which statement by the client with diabetic nephropathy indicates a need for further education about the disease? a. "Diabetes is the leading cause of kidney failure." b. "I need less insulin, so I am getting better." c. "I may need to reduce my insulin." d. "I must call my provider if the urine dipstick shows protein."
b. "I need less insulin, so I am getting better." When kidney function is reduced, the insulin is available for a longer time and thus less of it is needed. Unfortunately, many clients believe this means that their diabetes is improving.
The client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the nurse's best response? a. "Don't worry, no one else will know." b. "Take your time. What is bothering you the most?" c. "Why are you hesitant?" d. "You need to tell me so we can determine what is wrong."
b. "Take your time. What is bothering you the most?" This statement is patient and understanding and tries to identify the client's problem.
The nurse anticipates that the client who develops hypotension and oliguria post nephrectomy may need addition of which of these to the regimen? a. Increase in analgesics b. Addition of a corticosteroid c. Administration of a diuretic d. A course of antibiotic therapy
b. Addition of a corticosteroid Loss of water and sodium occurs in clients with adrenal insufficiency; this is followed by hypotension and oliguria; corticosteroids may be needed.
The RN is working with a nursing assistant in caring for a group of clients. Which of these actions will be best for the RN to delegate to the nursing assistant? a. Assess the vital signs for a client who was just admitted with blunt flank trauma and hematuria. b. Assist a client who had a radical nephrectomy 2 days ago to turn in bed. c. Help the physician with a kidney biopsy for a client admitted with acute glomerulonephritis. d. Palpate for bladder distention on a client recently admitted with a ureteral stricture.
b. Assist a client who had a radical nephrectomy 2 days ago to turn in bed. The nursing assistant would be working within legal guidelines when assisting a client to turn in bed.
The nurse receives report on a client with hydronephrosis. Which laboratory study should the nurse monitor? a. Hemoglobin and hematocrit (H&H) b. White blood cell (WBC) count c. Blood urea nitrogen and creatinine d. Lipid levels
c. Blood urea nitrogen and creatinine With back pressure on the kidney, glomerular filtration is reduced or absent resulting in permanent kidney damage; BUN and creatinine are kidney function tests.
When assessing the client with acute glomerulonephritis, of which of these findings does the nurse notify the provider? a. Purulent wound on leg b. Crackles throughout the lung fields c. History of diabetes d. Cola-colored urine
b. Crackles throughout the lung fields Crackles indicate fluid overload resulting from kidney damage; shortness of breath (SOB) and dyspnea are typically associated. The provider should be notified.
Which clinical manifestation in the client with pyelonephritis indicates that treatment has been effective? a. Decreased urine output b. Decreased urine white blood cells c. Increased red blood cell count d. Increased urine specific gravity
b. Decreased urine white blood cells A decreased presence of white blood cells indicates the eradication of infection.
Which factor is an indicator for a diagnosis of hydronephrosis? a. History of nocturia b. History of urinary stones c. Recent weight loss d. Urinary incontinence
b. History of urinary stones Causes of hydronephrosis or hydroureter include tumors, stones, trauma, structural defects, and fibrosis.
Which sign or symptom when found in the client with chronic glomerulonephritis warrants a call to the health care provider? a. Mild proteinuria b. Third heart sound c. Serum potassium 5.0 mEq/L d. Itchy skin
b. Third heart sound S3 indicates fluid overload secondary to failing kidney; the physician should be notified and instructions obtained.
When assessing the client with pyelonephritis, which finding does the nurse anticipate will be present? Select all that apply. a. Suprapubic pain b. Vomiting c. Chills d. Dysuria e. Oliguria
b. Vomiting c. Chills d. Dysuria (b) Nausea and vomiting are symptoms of pyelonephritis. (c) Chills along with fever may occur. (d) Burning (dysuria), urgency, and frequency are symptoms of pyelonephritis. INCORRECT: (a) Suprapubic pain is indicative of cystitis, not kidney infection (pyelonephritis). (e) This is related to kidney impairment from severe or long-standing pyelonephritis.
After receiving the change-of-shift report on the urology unit, which of these clients should the nurse assess first? a. A client post radical nephrectomy whose temperature is 99.8° F (37.6° C) b. A client with glomerulonephritis who has cola-colored urine c. A client who was involved in a motor vehicle accident and has hematuria d. A client with nephrotic syndrome who has gained 2 kg since yesterday
c. A client who was involved in a motor vehicle accident and has hematuria The nurse should be aware of the risk for kidney trauma after a motor vehicle accident. The client needs further assessment and evaluation to determine the extent of blood loss and the reason for the hematuria.
A newly admitted client who is diabetic and has pyelonephritis and prescriptions for intravenous antibiotics, blood glucose monitoring every 2 hours, and insulin administration should be cared for by which staff member? a. An RN whose other assignments include a client receiving chemotherapy for renal cell carcinoma b. An RN who is caring for a client who just returned after having renal artery balloon angioplasty c. An RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy d. An RN who is currently admitting a client with acute hypertension and possible renal artery stenosis
c. An RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy This RN is caring for the most stable client and will have time to do the frequent monitoring and interventions that are needed for the newly admitted client.
The nurse is teaching a client with diabetes the importance of preventing kidney damage. Which information suggests that the client may be in early stages of kidney damage? a. Elevation in blood urea nitrogen (BUN) b. Oliguria c. Microalbuminuria d. Painless hematuria
c. Microalbuminuria Microlevels of albumin are first detected in the urine. Progressive kidney damage occurs before dipstick procedures can detect protein in the urine.
When caring for a client who had a nephrostomy tube inserted 4 hours ago, which is essential to report to the physician? a. Dark pink-colored urine b. Small amount of urine leaking around the catheter c. Tube has stopped draining d. Creatinine 1.8
c. Tube has stopped draining Notify the provider when a nephrostomy tube does not drain; it could be obstructed or dislodged.
