Renal Adaptive Quizzing
A client with a history of chronic kidney disease is hospitalized. Which assessment findings will alert the nurse to kidney insufficiency? A. Facial flushing B. Edema and pruritis C. Dribbling after voiding and dysuria D. Diminished force and caliber of stream
B. Edema and pruritis The accumulation of metabolic wastes in the blood ( uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease.
A nurse is caring for a client who reports urinary problems, and the healthcare provider prescribes a cholinergic medication. Which urinary problem will this medication correct? A. Urinary frequency due to bladder spasticity B. Urinary retention due to bladder atony C. Pain due to urinary tract calculi D. Urinary urgency due to urinary tract infection
B. Urinary retention due to bladder atony Cholinergics intensify and prolong the action of acetylcholine, which increases tone in the genitourinary tract, preventing urinary retention. Anticholinergics are prescribed for frequency and urgency associated with a spastic bladder. Cholinergics will not prevent renal calculi. Urinary tract infections are a secondary gain because cholinergics help prevent urinary retention that can lead to urinary tract infection, but this is not the primary purpose for administering a cholinergic.
A client is to have hemodialysis. What must the nurse do before this treatment? A. Obtain a urine specimen to evaluate kidney function B. Weigh the client to establish a baseline for later comparison C. Administer medications that are scheduled to be given within the next hour D. Explain that the peritoneum serves as a semipermeable membrane to remove wastes
B. Weigh the client to establish a baseline for later comparison A baseline weight must be obtained to be able to determine the net fluid loss from dialysis. Obtaining a urine specimen to evaluate kidney function is not necessary; clients with advanced kidney disease may not produce urine. Medications often are delayed until after dialysis to prevent them from being filtered into the dialysate. Explaining that the peritoneum serves as a semipermeable membrane to remove wastes applies to peritoneal dialysis, not hemodialysis.
While reviewing the urinalysis reports of an elderly client, the nurse finds white blood cells (WBCs) in the urine. Which condition might the client have? A. Pyelonephritis B. Kidney trauma C. Kidney infection D. Acute tubular nephrosis
C. Kidney infection The presence of white blood cells (WBCs) in the urine is indicates a kidney or urinary tract infection. The presence of red blood cells (RBCs) in the urine indicates pyelonephritis, kidney trauma, or acute tubular necrosis.
The nurse is caring for a client who has been diagnosed with glomerulonephritis. Which initial urinary finding supports this diagnosis? A. Anuria B. Dysuria C. Polyuria D. Proteinuria
D. Proteinuria Protein in the urine (proteinuria) and hematuria (blood in the urine) are classic manifestations of the onset of glomerulonephritis because of the increased permeability of the vascular bed in the kidneys. Suppression of urine formation (anuria) is not an initial manifestation of glomerulonephritis; oliguria may be present. Pain or burning on urination (dysuria) is indicative of cystitis, not glomerulonephritis. Excessive urination (polyuria) does not occur as an initial change with glomerulonephritis; polyuria and nocturia may occur later with chronic glomerulonephritis, when the renal structures are destroyed.
What is the most important test the nurse should check to determine whether a transplanted kidney is functioning? A. WBC count B. Renal ultrasound C. Serum creatinine level D. 24-hour urinary output
C. Serum creatinine level Serum creatinine concentration measures the kidney's ability to excrete metabolic wastes. Creatinine, a nitrogenous product of protein breakdown, is increased with renal insufficiency. WBC count does not measure kidney function; white blood cells usually are depressed because of immunosuppressive therapy to prevent rejection. WBC count is more valuable for assessing structure than function. Although 24-hour urinary output should be considered, it is not as definitive as the serum creatinine level.
Nitrofurantoin 0.1 g is prescribed for a client with a urinary tract infection. Each tablet contains 50 mg. How many tablets will the nurse administer?
2 tablets
Trimethoprim-sulfamethoxazole is prescribed for a client with cystitis. When teaching about the medication, what does the nurse instruct the client to do? A. Drink 8 to 10 glasses of water daily B. Drink two glasses of orange juice daily C. Take the medication with meals D. Take the medication until symptoms subside
A. Drink 8 to 10 glasses of water daily A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine). Orange juice produces an alkaline ash, which results in an alkaline urine that supports the growth of bacteria. Trimethoprim-sulfamethoxazole should be taken 1 hour before meals for maximum absorption. A prescribed course of antibiotics must be completed to eliminate the infection, which can exist on a subclinical level after symptoms subside.
When admitting a client with benign prostatic hyperplasia, which assessment made by the nurse is most relevant? A. Perineal edema B. Urethral discharge C. Flank pain radiating to the groin D. Distension of the lower abdomen
D. Distension of the lower abdomen Distention of the suprapubic area indicates that the bladder is distended with urine and therefore palpable. Perineal edema is not related to urinary retention and benign prostatic hyperplasia. Urethral discharge may be related to sexually transmitted infections. Radiating flank pain may indicate renal calculi.
A client is admitted to the hospital with severe flank pain, nausea, and hematuria caused by a ureteral calculus. What should be the nurse's initial intervention? A. Strain all urine output B. Increase oral fluid intake C. Obtain a urine specimen for culture D. Administer the prescribed analgesic
D. Administer the prescribed analgesic Pain of renal colic may be excruciating; unless relief is obtained, the client will be unable to cooperate with other therapy. Urine can be saved and strained after the client's priority needs are met. Increasing fluid intake may or may not be helpful. If the stone is large the fluid can build up, leading to hydronephrosis; however, if the stone is small, fluids may help flush the stone. Although a culture generally is prescribed, this is not the priority when a client has severe pain.
A client arrives at a health clinic reporting hematuria, frequency, urgency, and pain on urination. Which diagnosis will the nurse most likely observe written in the client's medical record? A. Chronic glomerulonephritis B. Nephrotic syndrome C. Pyelonephritis D. Cystitis
D. Cystitis Cystitis is an inflammation of the bladder that causes frequency and urgency of urination, pain on micturition, and hematuria. Chronic glomerulonephritis is a disease of the kidney that is associated with manifestations of systemic circulatory overload. Nephrotic syndrome is a condition of increased glomerular permeability characterized by severe proteinuria. Pyelonephritis is a diffuse, pyogenic infection of the pelvis and parenchyma of the kidney that causes flank pain, chills, fever, and weakness.
A client with kidney dysfunction reports anorexia, itching, nausea, vomiting, and muscle cramps. Which renal complication do these symptoms indicate? A. Uremia B. Nephritis C. Nephrosis D. Renal colic
A. Uremia Uremia is a condition caused by a buildup of nitrogenous waste products due to kidney impairment. It is characterized by anorexia, itching, nausea, vomiting, and muscle cramps. Nephritis is characterized by kidney inflammation. Nephrosis is a degenerative process in the kidney. Renal colic is characterized by pain that radiates into the groin, scrotum or labia, and perineal area.
A client with acute kidney injury is to receive peritoneal dialysis and asks why the procedure is necessary. Which is the nurse's best response? A. "It prevents the development of serious heart problems." B. "It helps perform some of the work usually done by the kidneys." C. "It will keep your kidneys from getting worse and may 'restart' your kidneys to perform better than before." D. "It speeds recovery because the kidneys are not responding to regulating hormones."
B. "It helps perform some of the work usually done by the kidneys." Dialysis removes chemicals, wastes, and fluids usually removed from the body by the kidneys. The mention of heart problems is a threatening response and may cause increased fear or anxiety. Stating that peritoneal dialysis, "removes toxic chemicals from the body so you will not get worse," is threatening and can cause an increase in anxiety. Dialysis helps maintain fluid and electrolytes; the nephrons are damaged in acute kidney injury, so it may or may not speed recovery.
A nurse is caring for a client receiving hemodialysis for chronic kidney disease. The nurse should monitor the client for which complication? A. Peritonitis B. Hepatitis B C. Renal calculi D. Bladder infection
B. Hepatitis B Hepatitis B is transmitted by blood or blood products. The hemodialysis and routine transfusions needed for a client in end-stage renal failure constitute a high risk for exposure. Peritonitis is a danger for individuals receiving peritoneal dialysis. Renal calculi are not a complication of hemodialysis; they often occur in clients who are confined to prolonged bed rest. Dialysis does not involve the bladder and will not contribute to the development of a bladder infection.
A nurse is caring for a client with a ureteral calculus. Which are the most important nursing actions? Select all that apply. A. Limiting fluid intake at night B. Monitoring intake and output C. Straining the urine at each voiding D. Recording the client's blood pressure E. Administering the prescribed analgesic
B. Monitoring intake and output C. Straining the urine at each voiding E. Administering the prescribed analgesic A urinary calculus may obstruct urine flow, which will be reflected in a decreased output; obstruction may result in hydronephrosis. Urine is strained to determine whether any calculi or calcium gravel is passed. Reduction of pain is a priority. A calculus obstructing a ureter causes flank pain that extends toward the abdomen, scrotum and testes, or vulva; the pain begins suddenly and is severe (renal colic). Fluids should be encouraged to promote dilute urine and facilitate passage of the calculi. Recording the blood pressure is not critical.
A client develops acute glomerulonephritis after a recent streptococcal infection. The nurse should expect to find which clinical manifestation during the health history and physical examination? A. Nocturia B. Periorbital edema C. Increased appetite D. Recent weight loss
B. Periorbital edema Periorbital edema occurs because of the retention of fluid. The client will experience oliguria, not nocturia. The client will develop anorexia related to elevated toxic substances in the blood. The client will have a weight gain because of the retention of fluid.
A client with chronic kidney disease is receiving medication to manage anemia. Which primary goal should the nurse include in the care plan from this information? A. Prevention of uremic frost B. Prevention of chronic fatigue C. Prevention of tubular necrosis D. Prevention of dependent edema
B. Prevention of chronic fatigue Kidney failure results in impaired erythropoietin production, which causes anemia and chronic fatigue; treating the anemia will help in managing the fatigue. Uremic frost results because urea compounds and other waste products of metabolism that are not excreted by the kidneys are brought to the skin by small superficial capillaries and are excreted and deposited on the skin. Tubular necrosis is a pathologic condition of the kidneys that can lead to kidney failure. The anemia and dependent edema associated with kidney failure are not interrelated.
A nurse is caring for a client with end-stage renal disease. Which clinical indicators of end-stage renal disease should the nurse expect? Select all that apply. A. Polyuria B. Jaundice C. Azotemia D. Hypertension E. Polycythemia
C. Azotemia and D. Hypertension Azotemia is an increase in nitrogenous waste, particularly urea, in the blood; this is common in end-stage renal disease. Hypertension occurs as a result of fluid and sodium overload and dysfunction of the rennin-angiotensin-aldosterone system. Excessive nephron damage in end-stage renal disease causes oliguria, not polyuria; excessive urination is common in early kidney insufficiency from an inability to concentrate urine. Jaundice is common with biliary obstruction, not end-stage renal disease. Anemia, not polycythemia, occurs because of decreased erythropoietin, decreased red blood cell (RBC) production, and decreased RBC survival time.
A nurse is notified that the latest potassium level for a client in acute kidney injury is 6.2 mEq (6.2 mmol/L). Which action should the nurse take first? A. Alert the cardiac arrest team B. Call the laboratory to repeat the test C. Take vital signs and notify the primary healthcare provider D. Obtain an electrocardiogram (ECG) strip and obtain an antiarrhythmic medication
C. Take vital signs and notify the primary healthcare provider Vital signs monitor the cardiopulmonary status; the primary healthcare provider must treat this hyperkalemia to prevent cardiac dysrhythmias. The cardiac arrest team responds to a cardiac arrest; there is no sign of arrest in this client. A repeat laboratory test will take time and probably reaffirm the original results; the client needs medical attention. Although obtaining an ECG strip is appropriate, obtaining an antiarrhythmic is premature; vital signs and medical attention is needed first.
A 5-year-old child in renal failure who has undergone creation of an arteriovenous fistula access begins hemodialysis three times a week. The nurse teaches the mother the specific care her child needs. What statement indicates that further teaching is necessary? A. "I'll offer more drinks in warm weather." B. "I should call the clinic if he vomits or has diarrhea." C. "I'll check his pulse at the wrist on each arm every day." D. "It's OK to take his blood pressure on the arm with the fistula."
D. "It's OK to take his blood pressure on the arm with the fistula." Taking the blood pressure on the arm with the arteriovenous fistula is contraindicated because the pressure of the inflated cuff may disrupt the integrity of the fistula. Consumption of more fluids is desirable because inadequate fluid intake can result in dehydration and an acid-base imbalance. Calling the clinic is desirable because vomiting or diarrhea may lead to dehydration and an acid-base imbalance. Not only should the pulse be monitored to assess vascular function distal to the arteriovenous fistula, but it should be done on both extremities and the results compared.
A healthcare provider prescribes furosemide for a client with hypervolemia. The nurse recalls that furosemide exerts its effects in what part of the renal system? A. Distal tubule B. Collecting duct C. Glomerulus of the nephron D. Loop of Henle
D. Loop of Henle Furosemide acts in the ascending limb of the loop of Henle in the kidney. Thiazides act in the distal tubule in the kidney. Potassium-sparing diuretics act in the collecting duct in the kidney. Plasma expanders, not diuretics, act in the glomerulus of the nephron in the kidney.
A nurse is caring for a client with diabetes who is scheduled for a radiographic study requiring contrast. Which should the nurse expect the health care provider to prescribe? A. Acetylcysteine before the test B. Renal-friendly contrast medium for the test C. Forced diuresis with mannitol after the test D. Hydration with dextrose and water throughout the test
A. Acetylcysteine before the test Acetylcysteine is an antioxidant that scavenges oxygen free radicals, which are released when contrast medium causes cell death to renal tubular tissue; it also induces slight vasodilation. Contrast that is renal friendly does not exist. Mannitol is not necessary. Saline alone provides better protection of the kidneys from contrast-induced nephropathy. Hydration with saline, not dextrose and water, affords some protection from kidney damage caused by contrast media; dextrose will increase the glucose level in an individual with diabetes and thus is contraindicated.
Which statement regarding erythropoietin is true? A. Erythropoietin is released by the pancreas B. An erythropoietin deficiency causes diabetes C. An erythropoietin deficiency is associated with renal failure D. Erythropoietin is released only when there is adequate blood flow
C. An erythropoietin deficiency is associated with renal failure Erythropoietin is produced by the kidneys; its deficiency occurs in renal failure. Erythropoietin is released by the kidneys, not the pancreas. Erythropoietin deficiency causes anemia. Erythropoietin is secreted in response to hypoxia, which results in decreased oxygenated blood flow to the tissues.
How should the nurse expect the urine of a child with acute glomerulonephritis with hematuria to appear? A. Cola-colored B. Orange C. Bright red D. Straw-colored
A. Cola-colored Cola-colored urine indicates the presence of large numbers of red blood cells. Orange-colored urine usually is associated with certain foods or medications. Red indicates frank bleeding that is associated with urinary tract trauma, not glomerulonephritis. Straw-colored urine is the color of dilute urine; it is an expected finding in a healthy child.
The nurse is caring for a client with ureteral colic. To prevent the development of renal calculi in the future, which strategy should be included in the client's plan of care? A. Instructing the client to drink at least 3 L of fluid daily B. Interventions to decrease the serum creatinine level C. A urinary output goal of 2000 mL per 24 hours D. Excluding milk products from the diet
A. Instructing the client to drink at least 3 L of fluid daily Increasing fluid intake dilutes the urine, and crystals are less likely to coalesce and form calculi. An elevated serum creatinine has no relationship to the formation of renal calculi. Calcium restriction is necessary only if calculi have a calcium phosphate basis. Producing only 2000 mL of urine per 24 hours is inadequate.
The nurse is explaining the physiologic reasons for taking vitamin D and calcium supplements to a client with renal failure. Which statement made by the nurse is appropriate? A. "There will be a decrease in the inactive forms of vitamin D in your body." B. "There will be a decrease in the active metabolite of vitamin D in your body." C. "There will be an increase in the conversion of skin cholesterol into vitamin D." D. "There will be an increase in the vitamin D associated intestinal absorption of calcium."
B. "There will be a decrease in the active metabolite of vitamin D in your body." Renal failure results in decrease in the active metabolite of vitamin D because inactive vitamin D gets activated in the liver followed by the kidneys. Food sources of vitamin D and sunlight contribute to an inactive form of the hormone in the body. Inactive vitamin D will decrease if foods rich in vitamin D are not consumed or exposure to sunlight is reduced. Conversion of skin cholesterol to vitamin D depends on the exposure to sunlight and not renal impairment. In renal failure, there is less active vitamin D and therefore less intestinal absorption of calcium.
An 85-year-old client has a three-day history of nausea, vomiting, and diarrhea. The client develops weakness and confusion and is admitted to the hospital. To best monitor the client's rehydration status, what should the nurse assess? A. Skin turgor B. Daily weight C. Urinary output D. Mucous membranes
B. Daily weight A continuous increase in serial weight determinations indicates a movement toward correction in the dehydration; 1 L of fluid weighs 2.2 pounds (1 kilogram). The skin in older adults has less fluid and subcutaneous fat than in younger adults, which results in a subjective and inaccurate assessment of rehydration. In older adults there can be a decrease in renal blood flow and tubular function; therefore, urinary output does not provide an accurate assessment of rehydration therapy. The mucous membranes in older adults are drier than in younger adults because of the decrease in salivary secretions and therefore do not provide an accurate assessment of rehydration therapy.
Which retrograde procedure involves the examination of the ureters and the renal pelvises? A. Cystogram B. Pyelogram C. Urethrogram D. Voiding cystourethrogram
B. Pyelogram A pyelogram is a retrograde examination of the ureters and the pelvis of both kidneys. A cystogram is a retrograde examination of the bladder. An urethrogram is a retrograde examination of the urethra. A voiding cystourethrogram is used to determine whether urine is flowing backward into the urethra.
After reviewing the urinalysis reports of a group of clients, a nurse suspects a client to have kidney disease. Which client's findings support the nurse's suspicion? Client A: Serum creatinine 1.1 mg/dL Client B: BUN 18 mg/dL Client C: Serum creatinine 2.5 mg/dL Client D: BUN 20 mg/dL
Client C: Serum creatinine 2.5 mg/dL The normal range of serum creatinine lies between 0.6 and 1.2 mg/dL. The serum creatinine concentration of client C is 2.5 mg/dL, which is greater than the normal value, and indicates renal impairment. Therefore the laboratory findings of client C support the nurse's suspicion. A serum creatinine concentration of 1.1 mg/dL in client A is a normal finding. The normal range of blood urea nitrogen (BUN) is 10 to 20 mg/dL; therefore, the urinalysis reports for clients B and D are normal.
A client with limited mobility is being discharged. To prevent urinary stasis and formation of renal calculi, what should the nurse instruct the client to do? A. Increase oral fluid intake to 2 to 3 L/day B. Maintain bedrest after discharge C. Limit fluid intake to 1 L/day D. Void at least every hour
A. Increase oral fluid intake to 2 to 3 L/day Increasing oral fluid intake to 2 to 3 L/day, if not contraindicated, will dilute urine and promote urine flow, thus preventing stasis and complications such as renal calculi. Bed rest and limited fluid intake may lead to urinary stasis and increase risk for the formation of renal calculi. Voiding at least every hour has no effect on urinary stasis and renal calculi.
A client with chronic renal failure has been on hemodialysis for 2 years. The client communicates with the nurse in the dialysis unit in an angry, critical manner and is frequently noncompliant with medications and diet. The nurse can best intervene by first considering that the client's behavior is most likely for which reason? A. An attempt to punish the nursing staff B. A constructive method of accepting reality C. A defense against underlying depression and fear D. An effort to maintain life and to live it as fully as possible
C. A defense against underlying depression and fear Both hostility and noncompliance are forms of anger that are associated with grieving. The client's behavior is not a conscious attempt to hurt others but a way to relieve and reduce anxiety within the self. The client's behavior is a self-destructive method of coping, which can result in death. The client's behavior is an effort to maintain control over a situation that is really controlling the client; it is an unconscious method of coping, and noncompliance may be a form of denial.
A nurse is reviewing the laboratory reports of a client with a diagnosis of end-stage renal disease. Which test result should the nurse anticipate? A. Arterial pH of 7.5 B. Hematocrit of 54% C. Potassium of 6.3 mEq/L D. Creatinine of 1.2 mg/dL
C. Potassium of 6.3 mEq/L Clients with end-stage renal disease have impaired potassium excretion, so the nurse should anticipate a potassium level more than the expected range of 3.5 to 5 mEq/L (3.5 to 5 mmol/L). Clients with end-stage renal disease usually have a serum pH that is less than 7.35 because of metabolic acidosis. A pH of 7.5 that exceeds the expected range of 7.35 to 7.45 is not anticipated because this is alkalosis. Clients with end-stage renal disease have decreased erythropoietin, which leads to decreased red blood cell production and hematocrit; a hematocrit of 54% exceeds the expected range, which is 39% to 50% for males and 35% to 47% for females; therefore, it is not anticipated. Clients with end-stage renal disease have a decreased ability to eliminate nitrogenous wastes, which leads to increased creatinine levels; a creatinine level of 1.2 mg/dL (106 mcmol/L) is within the expected range of 0.7 to 1.4 mg /dL (62 to 124 mcmol/L) and therefore is not anticipated.
A client reports urinary frequency and burning. To determine whether there is tenderness that indicates the presence of an ascending urinary tract infection, the nurse should palpate which area? A. Tail of Spence B. Suprapubic area C. McBurney point D. Costovertebral angle
D. Costovertebral angle The costovertebral angle (the angle formed by the lateral and downward curve of the lowest rib and the vertebral column of the spine itself) is percussed to determine whether there is tenderness in the area over the kidney; this can be a sign of glomerulonephritis or severe upper urinary tract infection. The tail of Spence extends from the upper outer quadrant of the breast to the axillary area; this is the most common site for tumors associated with cancer of the breast. The suprapubic area is above the symphysis pubis; it is palpated and percussed to assess for bladder distention. McBurney's point is 1 to 2 inches (2.5 to 5 cm) above the anterosuperior spine of the ileum on a line between the ileum and umbilicus; external pressure produces tenderness with acute appendicitis, not a kidney infection.
Which drug prescribed to a client with a urinary tract infection (UTI) turns urine reddish-orange in color? A. Amoxicillin B. Ciprofloxacin C. Nitrofurantoin D. Phenazopyridine
D. Phenazopyridine Phenazopyridine is a topical anesthetic that is used to treat pain or burning sensation associated with urination. It also imparts a characteristic orange or red color to urine. Amoxicillin is a penicillin form that could cause pseudomembranous colitis as a complication; it is not associated with reddish-orange colored urine. Ciprofloxacin is a quinolone antibiotic used for treating UTIs and can cause serious cardiac dysrhythmias and sunburns. It is not, however, responsible for reddish-orange colored urine. Nitrofurantoin is an antimicrobial medication prescribed for UTIs. This drug may affect the kidneys but is not associated with reddish-orange colored urine.
The nurse is preparing a client who is on metformin therapy and is scheduled to undergo renal computed tomography with contrast dye. What does the nurse anticipate the primary healthcare provider to inform the client regarding the procedure? A. "Discontinue metformin 1 day prior to procedure." B. "Discontinue metformin a half-day prior to procedure." C. "Discontinue metformin 3 days following the procedure." D. "Discontinue metformin 7 days following the procedure."
A. "Discontinue metformin 1 day prior to procedure." Metformin can react with the iodinated contrast dye that is given for a renal computed tomography (CT) and cause lactic acidosis. Therefore the nurse anticipates an instruction that the client should discontinue the metformin 1 day before the procedure. Stopping the metformin a half-day before the renal CT may not reduce the risk of lactic acidosis. The client is advised to discontinue the metformin for at least 48 hours after the procedure. It is not necessary to discontinue metformin for 3 to 7 days after a renal CT with contrast media.
A client is receiving epoetin for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary? A. "I realize it is important to take this medication because it will cure my anemia." B. "I know many ways to protect myself from injury because I am at risk for seizures." C. "I recognize that I may still need blood transfusions if my blood values are very low." D. "I understand that I will still have to take supplemental iron therapy with this medication."
A. "I realize it is important to take this medication because it will cure my anemia." Epoetin will increase a sense of well-being, but it will not cure the underlying medical problem; this misconception needs to be corrected. Seizures are a risk during the first 90 days of therapy, especially if the hematocrit increases more than four points in a 2-week period. A dose adjustment may be necessary. Blood transfusions may still be necessary when the client is severely anemic. Supplemental iron therapy is still necessary when receiving epoetin because the increased red blood cell production still requires iron.
A client with kidney dysfunction is about to undergo renal testing using a contrast medium. Which nursing interventions should be conducted before the procedure to ensure the client's safety? Select all that apply. A. Assessing the client for a history of cirrhosis B. Asking the client if he or she has a known shellfish allergy C. Assessing the client for a history of lactic acidosis D. Assessing the client's hydration status by checking blood pressure and respiratory rate E. Asking the client to discontinue metformin 12 hours before the procedure
A. Assessing the client for a history of cirrhosis B. Asking the client if he or she has a known shellfish allergy D. Assessing the client's hydration status by checking blood pressure and respiratory rate While interviewing a client who is about to undergo kidney procedure using a contrast medium, the nurse should assess for a history of cirrhosis. Clients with cirrhosis have an increased chance of developing kidney failure after the procedure. The nurse should confirm any known shellfish allergies because contrast dye administered during the study may cause nephrotoxicity. It is not necessary to check the client for a history of lactic acidosis when ensuring the client's safety for renal testing. If the client had lactic acidosis currently, then this would be a significant factor when ensuring the client's safety for renal testing. The nurse should also assess the client's hydration status by checking blood pressure and respiratory rate. The nurse should ask the client to discontinue metformin 24 hours before the procedure to prevent lactic acidosis.
A nurse is caring for a client with end-stage renal disease who has a mature arteriovenous (AV) fistula. Which nursing care should be included in the client's plan of care? Select all that apply. A. Auscultate for a bruit B. Palpate the site to identify a thrill C. Irrigate with saline to maintain patency D. Avoid drawing blood from the affected extremity E. Keep the fistula clamped until ready to perform dialysis
A. Auscultate for a bruit B. Palpate the site to identify a thrill D. Avoid drawing blood from the affected extremity The presence of a bruit indicates patency of the AV fistula. The presence of a vibration or thrill indicates patency of the AV fistula. Drawing blood is avoided to prevent damage to the AV fistula. An AV fistula is internal and is not irrigated. The AV fistula is under the skin and is not clamped.
A nurse teaches a client with calcium-based renal calculi about foods that can be eaten on a low-calcium diet. The nurse concludes that the teaching is effective when the client selects which food items from the menu? Select all that apply. A. Baked chicken B. Chocolate pudding C. Salmon loaf with cheese sauce D. Roast beef with mashed potato E. Vanilla ice cream with chocolate syrup
A. Baked chicken D. Roast beef with mashed potato Baked chicken is relatively low in calcium. Roast beef and mashed potato have moderate amounts of calcium. Pudding is made with milk and is high in calcium. Cheese is high in calcium. Ice cream is made with milk and is high in calcium.
A nurse is caring for a client with acute kidney injury. Which findings should the nurse anticipate when reviewing the laboratory report of the client's blood level of calcium, potassium, and creatinine? Select all that apply. A. Calcium 7.6 mg/dL B. Calcium 10.5 mg/dL C. Potassium 6.0 mEq/L D. Potassium 3.5 mEq/L E. Creatinine 3.2 mg/dL F. Creatinine 1.1 mg/dL
A. Calcium 7.6 mg/dL C. Potassium 6.0 mEq/L E. Creatinine 3.2 mg/dL A client with acute kidney injury will have a low calcium level, a high potassium level, and an elevated creatinine level.
A client who is 5 feet, 8 inches tall (173 cm) and weighs 220 lb (99.8 kg) is admitted to the hospital with ureteral colic, blood in the urine, and a blood pressure of 150/90 mm Hg. Which is the priority objective of nursing care for this client? A. Decrease pain B. Decrease weight C. Decrease hematuria D. Decrease hypertension
A. Decrease pain Sharp, severe pain (renal colic) radiating toward the genitalia and thigh is associated with ureteral distention and must be relieved. Weight loss is a long-term goal; reducing pain is the priority. Although the hematuria will be addressed, pain reduction is the priority. Although the client's hypertension will be addressed, pain reduction is the priority.
A client is transferred to the post-anesthesia care unit after undergoing a pyelolithotomy. The client's urinary output is 50 mL/hr. What should the nurse do? A. Record the output as an expected finding B. Encourage the client to drink oral fluids C. Milk the client's nephrostomy tube D. Notify the primary healthcare provider
A. Record the output as an expected finding An output of 50 mL/hr is adequate; when urine output drops below 20 to 30 mL/hr, it may indicate renal failure, and the primary healthcare provider should be notified. Encouraging the client to drink oral fluids is contraindicated; the client probably still will be under the influence of anesthesia, and the gag reflex may be depressed. Milking the client's nephrostomy tube is unnecessary because the output is adequate.
A 24-hour urine test is prescribed for a client who has a tentative diagnosis of pheochromocytoma. What should the nurse do first? A. Start the time of the test after discarding the first voiding B. Discard the last voiding in the 24-hour time period for the test C. Insert a urinary retention catheter to promote the collection of urine D. Strain the urine following each voiding before adding the urine to the container
A. Start the time of the test after discarding the first voiding The first voiding is discarded because that urine was in the bladder before the test began and should not be included. The last voiding should be placed in the specimen container because the urine was produced during the 24-hour time frame of the test. Discarding the last void in the 24-hour time period for the test is not necessary; voided specimens are acceptable. Straining the urine following each voiding before adding the urine to the container is not necessary; this is done for clients with renal calculi.
The nurse is preparing a blood transfusion for a client with renal failure. Why does anemia often complicate renal failure? A. Increase in blood pressure B. Decrease in erythropoietin C. Increase in serum phosphate levels D. Decrease in serum sodium concentration
B. Decrease in erythropoietin The hormone erythropoietin, produced by the kidneys, stimulates the bone marrow to produce red blood cells. In renal failure there is a deficiency of erythropoietin that often results in the client developing anemia. Therefore the nurse is instructed to administer blood. In renal failure, increased blood pressure is due to impairment of renal vasodilator factors and is not treated by administration of blood. Phosphate is retained in the body during renal failure, causing binding of calcium leading to done demineralization, not anemia. Increase in urinary sodium concentration and decrease in serum sodium concentration trigger the release of renin from the juxtaglomerular cells.
The primary healthcare provider prescribed a diagnostic study with contrast medium for an older adult who has an endocrine disorder. Which assessment result should the nurse check before the study? A. Urinary pH B. Serum creatinine C. Urinary creatinine D. Creatinine clearance
B. Serum creatinine If a contrast medium is used in older adults with an elevated serum creatinine, it may cause renal failure. Thus, the nurse should assess the client's renal function prior to the diagnostic by checking the serum creatinine to assess for renal failure. Urinary pH may not help a nurse assess the client's risk of renal failure. Urinary creatinine helps to assess the degree of renal failure but usually takes 24 hours and is not routinely done before contrast medium tests. Creatinine clearance helps to assess the glomerular filtration rate.
After reviewing the laboratory reports, the nurse anticipates that the client has renal impairment. Which test reports support the nurse's concern? Select all that apply. A. Serum albumin 4.7 g/dL B. Serum creatinine 2.0 mg/dL C. Serum potassium 5.9 mEq/L D. Serum cholesterol 120 mg/dL E. Blood urea nitrogen 32 mg/dL
B. Serum creatinine 2.0 mg/dL C. Serum potassium 5.9 mEq/L E. Blood urea nitrogen 32 mg/dL Renal impairment is marked by increased serum creatinine concentration, blood urea nitrogen, and potassium ion concentration levels. The normal serum creatinine concentration lies between 0.5 and 1.5 mg/dL (44.2-132.6 µmol/L). A serum creatinine value of 2.0 mg/dL (176.8 µmol/L) indicates renal impairment. The normal concentration of potassium ions in serum ranges from 3.5 to 5 mEq/L (3.5-5 mmol/L). A potassium ion concentration of 5.9 mEq/L(5.9 mmol/L) indicates kidney dysfunction. The normal value of blood urea nitrogen (BUN) lies between 7 and 20 mg/dL (2.45-7.14 mmol/L). A BUN value of 32 mg/dL (11.424 mmol/L) indicates renal impairment. The normal range of serum albumin concentration lies between 3.5 to 5.5 g/dL (5.075-7.975 µmol/L). A cholesterol value less than 200 mg/dL (5.18 mmol/L) is normal.
While reviewing the medical reports in an acute care setting, the nurse finds that the client is at risk for kidney damage and requests the healthcare provider to increase the intravenous fluid rate as a priority nursing intervention. Which finding supports the nurse's conclusion? A. Pulse pressure is 40 mmHg B. Urinary output is 25 mL/hour C. Systolic blood pressure is 120 mmHg D. Blood osmolality is 280 milliosmoles per kg
B. Urinary output is 25 mL/hour The urine output should be at least 30 ml per hour. Less than 30 ml per hour indicates the need for notifying the healthcare provider because low urine output indicates volume depletion that may result in renal damage. Pulse pressure of 40 mm Hg is a normal finding. Systolic blood pressure of 120 mm Hg is a normal finding. Blood osmolality of 280 milliosmoles per kg is a normal finding.
The registered nurse is preparing to assess a client's renal system. Which statement by the nurse indicates effective technique? A. "I must first palpate the client if a tumor is suspected." B. "I must first listen for normal pulse at the client's wrist region." C. "I must first auscultate the client and then proceed to percussion and palpation." D. "I must first examine tender abdominal areas and then proceed to nontender areas."
C. "I must first auscultate the client and then proceed to percussion and palpation." Palpation and percussion can cause an increase in normal bowel sounds and hide abdominal vascular sounds. Therefore it is wise to perform auscultation prior to percussion and palpation during clinical assessment of the renal system. Palpation should be avoided if a client is suspected of having a tumor because it could harm the client. It is more important as part of clinical assessment of the renal system to listen for bruit by auscultating over the renal artery. Bruit indicates renal artery stenosis. The nontender areas should be examined prior to tender areas to avoid confusion regarding radiating pain from the tender area being percussed.
A client is admitted with metabolic acidosis. The nurse considers that two body systems interact with the bicarbonate buffer system to preserve healthy body fluid pH. What two body systems should the nurse assess for compensatory changes? A. Skeletal and nervous B. Circulatory and urinary C. Respiratory and urinary D. Muscular and endocrine
C. Respiratory and urinary Increased respirations blow off carbon dioxide (CO 2), which decreases the hydrogen ion concentration and the pH increases (less acidity). Decreased respirations result in CO 2 buildup, which increases hydrogen ion concentration and the pH falls (more acidity). The kidneys either conserve or excrete bicarbonate and hydrogen ions, which helps to adjust the body's pH. The buffering capacity of the renal system is greater than that of the pulmonary system, but the pulmonary system is quicker to respond. Skeletal and nervous systems do not maintain the pH, nor do muscular and endocrine systems. Although the circulatory system carries fluids and electrolytes to the kidneys, it does not interact with the urinary system to regulate plasma pH.
A client has undergone pelvic surgery and the nurse removes the catheter in a week according to instructions. In the follow up within several hours, which finding in the client indicates a need for reinsertion of catheter? A. Anuria B. Polyuria C. Retention D. Incontinence
C. Retention The inability of the client to urinate in spite of the bladder being filled with urine is called retention. Generally clients who have undergone pelvic surgery and have the catheter removed experience urinary retention. The catheter should be reinserted if the client is unable to void. Anuria is the drastic decrease in urine output to less than 100 mL in a day and is a sign of end-stage kidney disease or acute kidney injury. Polyuria is anticipated in a client who is diagnosed with diabetes mellitus or insipidus, and the client eliminates large volumes of urine at a time. Incontinence or the loss of ability over voluntarily control of urination is a sign of conditions such as neurogenic bladder or bladder infection.
