Chapter 48
A client has been diagnosed with acute glomerulonephritis. This condition causes: a. proteinuria. b. polyuria. c. No option is correct. d. pyuria.
proteinuria.
The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching? a. "I should drink as much as possible to keep my kidneys working." b. "My intake of high sodium foods should be limited." c. "I should limit the amount of protein in my diet." d. "I should limit foods high in potassium in my diet, such as bananas."
"I should drink as much as possible to keep my kidneys working."
Rejection of a transplanted kidney within 24 hours after transplant is termed a. chronic rejection. b. simple rejection. c. acute rejection. d. hyperacute rejection.
hyperacute rejection.
The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? a. BUN of 18 mg/dL. b. Serum creatinine of 1.2 mg/dL. c. Glomerular filtration rate (GFR) of 100 mL/min. d. Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.
Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? a. Magnesium b. Phosphorus c. Sodium d. Calcium
Calcium
A client requires hemodialysis. Which type of drug should be withheld before this procedure? a. Phosphate binders b. Insulin c. Cardiac glycosides d. Antibiotics
Cardiac glycosides
The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium? a. Cooked white rice b. Salad oils c. Citrus fruits d. Butter
Citrus fruits
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? a. Cola-colored urine b. Pyuria c. Low blood pressure d. Left upper quadrant pain
Cola-colored urine
A client who suffered hypovolemic shock during a cardiac incident has developed acute kidney injury. Which is the best nursing rationale for this complication? a. Decrease in the blood flow through the kidneys b. Obstruction of urine flow from the kidneys c. Blood clot formed in the kidneys interfered with the flow d. Structural damage occurred in the nephrons of the kidneys
Decrease in the blood flow through the kidneys
During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication? a. Renal calculi b. Hypokalemia c. Oliguria d. Dehydration
Dehydration
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? a. Dehydration b. Hyperkalemia c. Crackles d. Hypertension
Dehydration
A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate? a. Donors are selected from compatible living or deceased donors. b. Donors must be relatives. c. The client is placed on a transplant list at the local hospital. d. Donors with hypertension may qualify.
Donors are selected from compatible living or deceased donors.
A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess? a. Hypertension b. Periorbital edema c. Fever d. Extremity pain
Hypertension
What is a characteristic of the intrarenal category of acute kidney injury (AKI)? a. Decreased urine sodium b. Decreased creatinine c. Increased BUN d. High specific gravity
Increased BUN
The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client? a. SpO2 at 90% with fine crackles in the lung bases b. Blood tinged drainage in Jackson-Pratt drainage tube c. Pain of 3 out of 10, 1 hour after analgesic administration d. Urine output of 35 to 40 mL/hour
SpO2 at 90% with fine crackles in the lung bases
The nurse is caring for a client with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply. a. Assess for the presence of peripheral edema. b. Auscultate the client's apical heart rate for dysrhythmias. c. Percuss for pain in the right lower abdominal quadrant. d. Assess the client's orientation and judgment. e. Assess the client's BP.
a. Assess for the presence of peripheral edema. e. Assess the client's BP.
A client is receiving hemodialysis for acute kidney failure. Which assessment finding(s) indicates to the nurse that the client is experiencing dialysis disequilibrium? Select all that apply. a. Confusion b. Headache c. Nausea d. Vomiting e. Bleeding
a. Confusion b. Headache c. Nausea d. Vomiting
A nurse is assessing a client with acute renal failure. What medications should the nurse identify as a nephrotoxic drug? Select all that apply. a. Gentamycin b. Neomycin c. Penicillin d. Tobramycin e. Ceftriaxone
a. Gentamycin b. Neomycin d. Tobramycin
The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? a. pH 7.47, PaCO2 45, HCO3 33- b. pH 7.20, PaCO2 36, HCO3 14- c. pH 7.31, PaCO2 48, HCO3 24- d. pH 7.50, PaCO2 29, HCO3 22-
pH 7.20, PaCO2 36, HCO3 14-
The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI? a. Initiation b. Oliguria c. Recovery d. Diuresis
Oliguria
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? a. History of hyperparathyroidism b. Recent history of streptococcal infection c. History of osteoporosis d. Previous episode of acute pyelonephritis
Recent history of streptococcal infection
A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause? a. Renal calculi b. Acute pyelonephritis c. Osmotic dieresis. d. Dysrhythmias
Renal calculi
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a. Activity intolerance b. Toileting self-care deficit c. Impaired urinary elimination d. Risk for infection
Risk for infection
Which of the following would a nurse classify as a prerenal cause of acute renal failure? a. Prostatic hypertrophy b. Septic shock c. Ureteral stricture d. Polycystic disease
Septic shock
The nurse is caring for a client who underwent a kidney transplant. The client appears anxious and tearful and states, "My body is going to reject the new kidney; I know I'm going to die." What is the best response by the nurse? a. "Don't think like that; I'm certain you will be fine." b. "You've waited years for this transplant, you need to think positively." c. "If your body rejects the kidney, you can go back on dialysis; you are not going to die." d. "I understand y
"I understand your concerns, let's talk about them."
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? a. "Increase your carbohydrate intake." b. "Eat plenty of bananas." c. "Drink plenty of fluids, and use a salt substitute." d. "Be sure to eat meat at every meal."
"Increase your carbohydrate intake."
An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? a. "Peritoneal dialysis will require more work for you." b. "The risk of peritonitis is greater with this type of dialysis." c. "This type of dialysis will provide more independence." d. "Peritoneal dialysis does not work well for every client."
"This type of dialysis will provide more independence."
The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output? a. 1.5 L b. 1.0 L c. Less than 400 mL d. Less than 50 mL
Less than 400 mL
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? a. Ureteral calculus b. Dysrhythmia c. Glomerulonephritis d. Hypovolemia
Glomerulonephritis
The nurse recognizes which condition as an integumentary manifestation of chronic renal failure? a. Gray-bronze skin color b. Asterixis c. Seizures d. Tremors
Gray-bronze skin color
A client with chronic kidney disease becomes confused and reports abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which lab value? a. Hyperkalemia b. Elevated urea levels c. Hypocalcemia d. Elevated white blood cells
Hyperkalemia
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? a. Start hemodialysis after a temporary access is obtained. b. Encourage oral fluids. c. Administer furosemide (Lasix) 20 mg IV d. Start IV fluids with a normal saline solution bolus followed by a maintenance dose.
Start IV fluids with a normal saline solution bolus followed by a maintenance dose.
The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse? a. Notify the health care provider. b. Push the catheter further into the abdomen. c. Turn the client from side to side. d. Lower the head of the bed.
Turn the client from side to side.
Which clinical finding should a nurse look for in a client with chronic renal failure? a. Hypotension b. Metabolic alkalosis c. Polycythemia d. Uremia
Uremia
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a. Serum potassium level of 4.9 mEq/L b. Serum sodium level of 135 mEq/L c. Urine output of 20 ml/hour d. Temperature of 99.2° F (37.3° C)
Urine output of 20 ml/hour
Which of the following occurs late in chronic glomerulonephritis? a. Peripheral neuropathy b. Seizure c. Nosebleed d. Stroke
Peripheral neuropathy
As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur? a. Hyperphosphatemia b. Hypercalcemia c. Metabolic alkalosis d. Hypokalemia
Hyperphosphatemia
A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching? a. "If renal failure develops, I may need to consider dialysis." b. "I inherited this disorder from one of my parents." c. "The cysts can get quite large in size." d. "As long as I have one normal kidney, I should be fine."
"As long as I have one normal kidney, I should be fine."
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: a. "Genetic testing will determine the best treatment for your condition." b. "As the disease progresses, you will most likely require renal replacement therapy." c. "Dietary changes can reverse the damage that has occurred in your kidneys." d. "Draining of the cysts and antibiotic therapy will cure your disease."
"As the disease progresses, you will most likely require renal replacement therapy."
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? a. "Immunosuppressive drugs guarantee organ success." b. "Even a perfect match does not guarantee organ success." c. "The doctor may decide to delay the use of immunosuppressant drugs." d. "Let's wait until after the surgery to discuss your treatment plan."
"Even a perfect match does not guarantee organ success."
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? a. "You should have sought treatment earlier." b. "Painless gross hematuria is the first symptom in renal cancer." c. "Squamous cell carcinomas do not present with detectable symptoms." d. "Very few symptoms are associated with renal cancer."
"Very few symptoms are associated with renal cancer."
A patient has acute kidney injury (AKI) with a negative nitrogen balance. How much weight does the nurse expect the patient to lose? a. 0.5 kg/day b. 1.0 kg/day c. 1.5 kg/day d. 2.0 kg/day
0.5 kg/day
The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL? a. 500 mL b. 750 mL c. 1,000 mL d. 250 mL
1,000 mL
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? a. Acute glomerulonephritis b. Chronic renal failure c. Nephrotic syndrome d. Acute renal failure
Acute glomerulonephritis
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? a. Administration of an insulin drip b. Administration of sodium polystyrene sulfonate [Kayexalate]) c. Administration of sodium bicarbonate d. Administration of a loop diuretic
Administration of sodium polystyrene sulfonate [Kayexalate])
An athlete is thought to have sustained an injury to a kidney. The ER nurse caring for the client reviews the initial orders written by the primary health care provider and notes an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason? a. There is great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations. b. A cre
Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.
The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client? a. Continuous arteriovenous hemofiltration (CAVH) b. Peritoneal dialysis c. Continuous venovenous hemofiltration (CVVH) d. Hemodialysis
Hemodialysis
A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? a. Elevated serum creatinine b. Hyperphosphatemia c. Hyperkalemia d. Elevated urea and nitrogen
Hyperphosphatemia
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? a. Abdominal distention owing to reflex cessation of intestinal peristalsis b. Paralytic ileus caused by manipulation of the colon during surgery c. Pneumonia caused by shallow breathing because of severe incisional pain d. Hypovolemic shock caused by hemorrhage
Hypovolemic shock caused by hemorrhage
A client with acute kidney injury progresses through four phases. Which describes the onset phase? a. Normal glomerular filtration and tubular function are restored. b. It is accompanied by reduced blood flow to the nephrons. c. The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. d. Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications.
It is accompanied by reduced blood flow to the nephrons.
The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client? a. Wear a mask while handling any dialysate solutions b. Keep the dialysis supplies in a clean area, away from children and pets
Keep the dialysis supplies in a clean area, away from children and pets
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? a. Promoting carbohydrate intake b. Limiting fluid intake c. Encouraging coughing and deep breathing d. Providing pain-relief measures
Limiting fluid intake
A client recovering from hepatitis B develops acute nephrotic syndrome. Which treatment will the nurse anticipate being prescribed for this client? a. Increase in sodium intake b. Vancomycin c. Methylprednisolone d. Low-carbohydrate diet
Methylprednisolone
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? a. Oliguria b. Diuresis c. Acute tubular necrosis d. Restored glomerular function
Oliguria
A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? a. Polyuria b. Weight loss c. Tenderness over transplant site d. Hypotension
Tenderness over transplant site
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a. Serum creatinine level of 1.2 mg/dl b. Blood urea nitrogen (BUN) level of 22 mg/dl c. Temperature of 100.2° F (37.8° C) d. Urine output of 250 ml/24 hours
Urine output of 250 ml/24 hours
The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? a. Wear a mask while handling any dialysate solutions. b. Keep the catheter stabilized to the abdomen, below the belt line. c. Clean the catheter insertion site daily with soap. d. Use an aseptic technique during the procedure.
Use an aseptic technique during the procedure.
A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? a. Avoid carrying heavy items. b. Perform deep-breathing exercises vigorously. c. Wear a mask when performing exchanges. d. Auscultate the lungs frequently.
Wear a mask when performing exchanges.
Which of the following is the most accurate indicator of fluid loss or gain? a. Urine output b. Body temperature c. Caloric intake d. Weight
Weight
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: a. thrush and circumoral pallor. b. nausea and vomiting. c. dyspnea and cyanosis. d. fatigue and weakness.
fatigue and weakness.
The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication? a. 2 hours after meals b. At bedtime with 8 ounces of fluid c. With food d. 2 hours before meals
With food
The nurse cares for a client diagnosed with chronic glomerulonephritis. The nurse will observe the client for the development of a. hypokalemia. b. anemia. c. hypophosphatemia. d. metabolic alkalosis.
anemia.
The nurse is caring for a postoperative client who reports difficulty urinating. The client does not have a urinary catheter in place. Which nursing action(s) are most appropriate at this time? Select all that apply. a. Place a urinary catheter. b. Assist to the bathroom. c. Run water to assist in the let-down reflex. d. Measure urinary output. e. Assist the client to stand.
b. Assist to the bathroom. c. Run water to assist in the let-down reflex. d. Measure urinary output. e. Assist the client to stand.
The nurse is caring for a client with acute kidney injury (AKI) in the oliguric phase. Which is a priority for the nurse to monitor indicating fluid overload? Select all that apply. a. Tenting skin turgor b. Hypertension c. Weight loss d. Jugular vein distention e. Crackles
b. Hypertension d. Jugular vein distention e. Crackles
----Compliance with a renal diet is a difficult lifestyle change for a client on hemodialysis. The nurse should reinforce nutritional information. Which teaching point(s) should be included? Select all that apply. a. Eat a variety of canned vegetables. b. Increase potassium intake. c. Eat foods such as milk, fish, and eggs. d. Restrict fluids based on the previous day's output. e. Consume nonbiologic protein only.
c. Eat foods such as milk, fish, and eggs. d. Restrict fluids based on the previous day's output.
Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for: a. bone marrow transplant. b. intra-abdominal instillation of methylprednisolone sodium succinate (Solu-Medrol). c. high-dose IV cyclosporine (Sandimmune) therapy. d. removal of the transplanted kidney.
removal of the transplanted kidney.
One of the roles of the nurse in caring for clients with chronic kidney disease is to help them learn to minimize and manage potential complications. This would include: a. restricting sources of potassium. b. eating protein liberally. c. allowing liberal use of sodium. d. limiting iron and folic acid intake.
restricting sources of potassium.
A nurse receives her client care assignment. Following the report, she should give priority assessment to the client: a. with pinkish mucus discharge in the appliance bag 2 days after an ileal conduit. b. who is experiencing mild pain from urolithiasis. c. who has a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L 7 days after a kidney transplant. d. who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L.
who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L.