Iggy Ch. 67

A 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? 1. "Because the kidneys cannot get rid of fluid, blood pressure goes up." 2. "The damaged kidneys no longer release a hormone that prevents high blood pressure." 3. "The waste products in the blood interfere with other mechanisms that control blood pressure." 4. "This is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products."

1. "Because the kidneys cannot get rid of fluid, blood pressure goes up." In chronic kidney disease, fluid levels increase in the circulatory system. The statements asserting that damaged kidneys no longer release a hormone to prevent high blood pressure, waste products in the blood interfere with other mechanisms controlling blood pressure, and high blood pressure is a compensatory mechanism that increases blood flow through the kidneys in attempt excrete waste products are not accurate regarding relationship between chronic kidney disease and high blood pressure.

A 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? 1. "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." 2. "Even though my children don't have symptoms at the same age I did, they can still have ADPKD." 3. "If my children have the ADPKD gene, they will have cysts by the age of 30." 4. "My children have a 50% chance of inheriting the ADPKD gene that causes the disease."

1. "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. Presentation of ADPKD can vary by age of onset, manifestations, and illness severity, even in one family. Almost 100% of those who inherit a PKD gene will develop kidney cysts by age 30. Children of parents who have the autosomal-dominant form of PKD have a 50% chance of inheriting the gene that causes the disease.

The nurse is educating a group of individuals at the community center about methods to prevent kidney trauma. Which statement from a member of the group indicates that further teaching is required? 1. "I should quit the soccer team so I don't injure my kidneys." 2. "I should wear a seatbelt when riding in the car." 3. "It is important to wear protective gear when participating in kick-boxing." 4. "I need to use caution when riding a motorcycle."

1. "I should quit the soccer team so I don't injure my kidneys." It is not necessary to quit sports, but it is recommended to not play contact sports or participate in high-risk activities such as kickboxing if the client has only one kidney. All individuals should wear a seatbelt, wear protective gear when participating in contact sports, and use caution when riding a bicycle or motorcycle.

When caring for a client 24 hours after a nephrectomy, the nurse notes that the client's abdomen is distended. Which action does the nurse perform next? 1. Check vital signs. 2. Notify the surgeon. 3. Continue to monitor. 4. Insert a nasogastric (NG) tube.

1. Check 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. The surgeon should be notified after vital signs are assessed. An NG tube is not indicated for this client.

What signs/symptoms does the nurse expect to find during the assessment of a client with polycystic kidney disease (PKD)? Select all that apply. 1. Flank pain 2. Hypotension 3. Diarrhea 4. Kidney stones 5. Nocturia

1. Flank pain 4. Kidney stones 5. Nocturia The key features of PKD include flank pain, kidney stones, and nocturia. Flank pain may present as a dull ache or as sharp and intermittent discomfort. Dull ache is due to increased kidney size. The client can experience sharp, intermittent pain when a cyst ruptures or due to the presence of kidney stones. Nocturia is the excessive need to urinate at night that occurs due to the decreased ability of the kidney to concentrate urine. The client presents with hypertension (not hypotension) because the kidneys are no longer able to control blood pressure. The client also has constipation, not diarrhea, due to fluid shifts.

The nurse is caring for a client with acute glomerulonephritis. What instructions does the nurse provide to manage the infection? Select all that apply. 1. Maintain personal hygiene and handwashing. 2. Monitor weight every week -- same day, and same time. 3. Restrict potassium and sodium intake in the diet. 4. Consume a fluid intake equal to 24-hour urine output plus 500 mL. 5. Include protein in the diet.

1. Maintain personal hygiene and handwashing. 3. Restrict potassium and sodium intake in the diet. 4. Consume a fluid intake equal to 24-hour urine output plus 500 mL. The client must maintain personal hygiene and practice basic infection control principles such as handwashing to prevent the spread of the organism. Potassium intake is restricted to prevent hyperkalemia. Sodium intake is restricted to prevent edema and hypertension due to fluid overload. The usual fluid allowance is the amount of urine output plus 500 mL to avoid fluid overload. The client must measure weight and blood pressure at the same time each day. Any sudden increase in weight or blood pressure must be reported to the health care provider. Protein intake is restricted to prevent uremia as a result of elevated blood urea nitrogen.

Which statement about autosomal dominant polycystic kidney disease (ADPKD) is correct? 1. Men and women have an equal chance of inheriting the disease. 2. In the dominant form, 100% of the nephrons have cysts. 3. In the recessive form, only a few nephrons have cysts. 4. Both parents of the client have a copy of the mutated allele.

1. Men and women have an equal chance of inheriting the disease. Men and women have an equal chance of inheriting ADPKD because the gene responsible for polycystic kidney disease (PKD) is not located on the sex chromosomes. In the dominant form, only a few nephrons have cysts until the person reaches the age of 30. Half of these people develop chronic kidney disease by the age of 50. In the recessive form of the disease, nearly 100% of nephrons have cysts from birth and most of them die in early childhood. If the client has autosomal recessive PKD, then both parents have a copy of the mutated allele.

The nurse is providing postoperative care for a client who underwent nephrectomy. What actions does the nurse take? Select all that apply. 1. Monitor blood pressure every 4 hours. 2. Inspect the abdomen for distention every shift. 3. Monitor the hemoglobin level every 24 hours. 4. Monitor the respiratory rate every hour. 5. Assess the urine output every hour.

1. Monitor blood pressure every 4 hours. 2. Inspect the abdomen for distention every shift. 5. Assess the urine output every hour. The client's blood pressure should be frequently monitored for hypotension. A decrease in blood pressure is an early sign of hemorrhage and adrenal insufficiency. The client's abdomen should be inspected for distention from bleeding. Urine output is assessed every hour. Large water and sodium losses occur in clients with adrenal insufficiency; this is followed by hypotension. IV replacements of fluids and packed blood cells may be needed. Hemoglobin levels are monitored every 6 to 12 hours. The client's respiratory rate, temperature, and pulse rate are monitored every 4 hours.

When taking the health history of a client with acute glomerulonephritis, the nurse questions the client about which related cause of the problem? 1. Recent respiratory infection 2. Hypertension 3. Unexplained weight loss 4. Neoplastic disease

1. 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. Hypertension is a result of glomerulonephritis, not a cause. Weight gain, not weight loss, is symptomatic of fluid retention in GN. Cancers are not part of the cause of GN.

The nurse is reviewing laboratory results of a client with altered kidney function. What laboratory findings suggest the onset of nephrotic syndrome? Select all that apply. 1. Severe proteinuria 2. Increased serum albumin level 3. Increased serum lipid level 4. Lipiduria 5. Decreased coagulation

1. Severe proteinuria 3. Increased serum lipid level 4. Lipiduria The key feature of nephrotic syndrome is severe proteinuria (more than 3.5 g of protein in 24 hours). Clients may also have high serum lipid levels and fats in the urine (lipiduria) because of changes in liver function. In nephrotic syndrome more protein is lost in the urine due to increased glomerular membrane permeability. This leads to a decrease in serum albumin levels. The client also presents with increased coagulation because of altered liver function.

When caring for a client with nephrotic syndrome, which intervention should be included in the plan of care? 1. Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss. 2. Administering heparin to prevent deep vein thrombosis (DVT). 3. Providing antibiotics to decrease infection. 4. Providing transfusion of clotting factors.

1.Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss. ACE inhibitors can decrease protein loss in the urine. Heparin is administered for DVT, but in nephrotic syndrome it may reduce urine protein and kidney insufficiency. Glomerulonephritis may occur secondary to an infection, but it is an inflammatory process; antibiotics are not indicated for nephrotic syndrome. Clotting factors are not indicated unless bleeding and coagulopathy are present.

The nurse is caring for a client with polycystic kidney disease (PKD). What nursing intervention does the nurse perform to provide comfort from flank pain? 1. Administer aspirin. 2. Administer ciprofloxacin (Cipro) as prescribed. 3. Apply dry heat on the abdomen or flank of the client. 4. Urge the client to drink at least 2 L of fluid daily.

2. Administer ciprofloxacin (Cipro) as prescribed. Application of dry heat to the abdomen or flank will promote comfort when kidney cysts are infected. Pain or discomfort in the cyst could be due to infection, so the nurse may need to administer antibiotic such as ciprofloxacin (Cipro) as prescribed. Aspirin-containing compounds are avoided in PKD to decrease the risk of bleeding. Clients with PKD have nocturia and the urine has low specific gravity; therefore, the client should be urged to drink at least 2 L of fluid daily to prevent dehydration. However, this practice will not provide comfort from flank pain.

Which factor is an indicator for a diagnosis of hydronephrosis? 1. History of nocturia 2. History of urinary stones 3. Recent weight loss 4. Urinary incontinence

2. History of urinary stones Causes of hydronephrosis or hydroureter include tumors, stones, trauma, structural defects, and fibrosis. Nocturia is a key feature of polycystic kidney disease and pyelonephritis, but it is not associated with hydronephrosis. Recent weight loss and urinary incontinence may be factors in renal cell carcinoma, but are not associated with hydronephrosis.

What is the most accurate statement regarding acute glomerulonephritis (GN)? 1. It is more common in women. 2. It may cause edema of the eyelids. 3. It increases serum albumin levels. 4. It often progresses to end-stage kidney disease.

2. It may cause edema of the eyelids. Acute GN often leads to edema of the eyelids due to fluid retention. The disorder is more common in men than in women. It decreases serum albumin levels due to loss of protein in the urine. Clients often recover completely and quickly from acute GN. Rapidly progressive glomerulonephritis (RPGN) (which is different than acute GN) often progresses to end-stage kidney disease.

Which statements about the relationship between hypertension and kidney disease are correct? Select all that apply. 1. Hypertension is the leading cause of end-stage kidney disease (ESKD). 2. People of American-Indian and African-American descent have a higher risk of ESKD from uncontrolled hypertension. 3. Renal artery stenosis can lead to sudden onset of hypertension and usually affects clients over 50 years. 4. Nearly one-third of people with uncontrolled hypertension will develop ESKD and require kidney replacement therapy. 5. Maintain a blood pressure around 160/110 mm Hg to prevent hypertensive renal damage.

2. People of American-Indian and African-American descent have a higher risk of ESKD from uncontrolled hypertension. 3. Renal artery stenosis can lead to sudden onset of hypertension and usually affects clients over 50 years. 4. Nearly one-third of people with uncontrolled hypertension will develop ESKD and require kidney replacement therapy. The risk for ESKD from hypertension is higher among American Indians and African Americans than among Caucasians due to increased lipid levels. Narrowing of the blood vessels of the nephron, or nephrosclerosis, occurs with all types of hypertension. Nearly one-third (about 30%) of clients with ESKD require kidney replacement therapy in the form of dialysis or transplantation. Hypertension is the second leading cause of ESKD while diabetes mellitus is the leading cause. Clients should maintain a blood pressure below 160/110 mm Hg to prevent renal damage from hypertension.

The nurse is assessing a client for early signs of renal cell carcinoma (RCC). What finding does the nurse expect in this client? 1. Sharp intermittent flank pain 2. Renal bruit on auscultation 3. Gynecomastia 4. Bloody urine

2. Renal bruit on auscultation The nurse notes renal bruit on auscultation in the client with RCC. The client often describes the pain in the flank as dull and aching. The pain is more intense if there is bleeding into the tumor or kidney. Gynecomastia and bloody urine are late stages of the disease.

What does the nurse teach a client with polycystic kidney disease about managing the disease? 1. Measure and record temperature every day. 2. Report any headache and visual disturbances. 3. Measure and record body weight every month. 4. Monitor bowel movements to prevent diarrhea.

2. Report any headache and visual disturbances. Clients with polycystic kidney disease are likely to develop berry aneurysms. Therefore, a severe headache with or without neurologic or vision changes must be reported. The client should record his or her temperature only if there is fever. The client must record daily blood pressure and body weight, and the health care provider must be notified of changes in these parameters. The client should maintain adequate fluid intake and increase dietary fiber to avoid constipation.

The nurse is caring for a client with kidney trauma. The client has considerable loss of blood. What intervention does the nurse perform? 1. Take vital signs every 30 minutes. 2. Report urethral bleeding prior to urinary catheterization. 3. Measure and record urine output every 30 minutes. 4. Monitor the client for nausea when fluids are administered.

2. Report urethral bleeding prior to urinary catheterization. The nurse attempts urinary catheterization only if prescribed by the health care provider, especially if the urethral opening is bleeding. Vital signs are monitored every 5 to 15 minutes. Urine output is measured and recorded every hour. Output must be greater than 0.5 mL/Kg/hr. The nurse takes care to administer fluids at the prescribed rate. The client is monitored for shock when fluids are administered.

Which sign or symptom when assessed in a client with chronic glomerulonephritis (GN) warrants a call to the health care provider? 1. Mild proteinuria 2. Third heart sound (S3) 3. Serum potassium of 5.0 mEq/L 4. Itchy skin

2. Third heart sound (S3) S3 indicates fluid overload secondary to failing kidneys; the provider should be notified and instructions obtained. Mild proteinuria is an expected finding in GN. A serum potassium of 5.0 mEq/L reflects a normal value; intervention would be needed for hyperkalemia. Although itchy skin may be present as kidney function declines, it is not a priority over fluid excess.

When assessing a client with acute pyelonephritis, which findings does the nurse anticipate will be present? Select all that apply. 1. Suprapubic pain 2. Vomiting 3. Chills 4. Dysuria 5. Oliguria

2. Vomiting 3. Chills 4. Dysuria Nausea and vomiting are symptoms of acute pyelonephritis. Chills along with fever may also occur, as well as burning (dysuria), urgency, and frequency. Suprapubic pain is indicative of cystitis, not kidney infection (pyelonephritis). Oliguria is related to kidney impairment from severe or long-standing pyelonephritis.

What manifestation does the nurse expect to assess in a client with chronic pyelonephritis? 1. Fevers and chills 2. Nausea and vomiting 3. Hyperkalemia 4. Flank pain

3. Hyperkalemia The client with chronic pyelonephritis has manifestations related to kidney function due to repeated upper urinary tract infections. The client has a tendency to develop hyperkalemia and acidosis. Hyperkalemia occurs when potassium is not secreted and levels exceed 5.4 mEq/L. Acidosis develops from retention of hydrogen ions and loss of bicarbonate. The client with acute pyelonephritis has an active bacterial infection. These clients have fever, chills, nausea, vomiting, and flank pain.

The nurse is caring for a client with stage II renal cell carcinoma (RCC). What is the most accurate statement describing the tumor in the client's kidney? 1. It is within the renal capsule. 2. It has extended beyond Gerota's fascia. 3. It is larger than 2.5 cm in size. 4. It has invaded the renal vein and lymph nodes.

3. It is larger than 2.5 cm in size. In stage II of RCC, the tumor is larger than 2.5 cm. In stage I it is less than 2.5 cm and within the renal capsule. In stage II it extends beyond the renal capsule but not beyond Gerota's fascia. In stage III the tumor invades the renal vein, lymph nodes, or both. In stage IV it invades the organs beyond Gerota's fascia or metastasizes to distant organs.

Which information suggests that a client with diabetes may be in the early stages of kidney damage? 1. Elevation in blood urea nitrogen (BUN) 2. Oliguria 3. Microalbuminuria 4. Painless hematuria

3. Microalbuminuria In the early stages of diabetic nephropathy, microlevels of albumin are first detected in the urine. Progressive kidney damage occurs before dipstick procedures can detect protein in the urine. BUN may change in response to protein and fluid intake. Oliguria is a later finding in kidney disease and may also be present in dehydration. Painless hematuria often occurs with kidney cancer.

Which staff member should care for a newly admitted client who is diabetic, has pyelonephritis and prescriptions for intravenous antibiotics, and who needs blood glucose monitoring every 2 hours and insulin administration? 1. RN whose other assignments include a client receiving chemotherapy for renal cell carcinoma 2. RN who is caring for a client who just returned after having renal artery balloon angioplasty 3. RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy 4. RN who is currently admitting a client with acute hypertension and possible renal artery stenosis

3. RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy The client scheduled for nephrectomy is the most stable client; the RN caring for this client will have time to perform the frequent monitoring and interventions that are needed for the newly admitted client. The client receiving chemotherapy will require frequent monitoring by the RN. The client after angioplasty will require frequent vital sign assessment and observation for hemorrhage and arterial occlusion. The client with acute hypertension will need frequent monitoring and medication administration.

The nurse is performing discharge teaching for a client after a nephrectomy for renal cell carcinoma. Which statement by the client indicates that teaching has been effective? 1. "Because renal cell carcinoma usually affects both kidneys, I'll need to be watched closely." 2. "I'll eventually require some type of renal replacement therapy." 3. "I'll need to decrease my fluid intake to prevent stress to my remaining kidney." 4. "My remaining kidney will provide me with normal kidney function now."

4. "My remaining kidney will provide me with normal kidney function now." After a nephrectomy, the second kidney is expected to eventually provide adequate kidney function, but this may take days or weeks. Renal cell carcinoma typically only affects one kidney. Renal replacement therapy is not the typical treatment for renal cell carcinoma. Fluids should be maintained to flush the remaining kidney.

What is the paraneoplastic syndrome that is common in clients with renal cell carcinoma? 1. Decreased serum calcium level 2. Hypotension 3. Decreased sedimentation rate 4. Erythrocytosis

4. Erythrocytosis Erythrocytosis is a paraneoplastic syndrome common with renal cell carcinoma. It is caused by large amounts of erythropoietin secreted by tumor cells. Parathyroid hormone produced by the tumor cell increases the serum calcium level causing hypercalcemia. The increased level of renin causes hypertension rather than hypotension. Renal cell carcinoma is associated with an increased sedimentation rate.

What does the nurse expect to find during the assessment of a client with polycystic kidney disease (PKD)? 1. Pale yellow urine 2. Hypotension 3. Anuria 4. Increased abdominal girth

4. Increased abdominal girth The client with PKD has increased abdominal girth because the cystic kidneys swell, pushing the abdominal contents forward. The urine is cloudy and foul smelling due to infection or dysuria. It may also be bright red or cola-colored following the rupture of a cyst. The client generally has hypertension related to kidney ischemia from the enlarging cysts. Nocturia or excessive urination in the night is an early manifestation of the disease.

Which goal for a client with diabetes will best help to prevent diabetic nephropathy? 1. Heed the urge to void. 2. Avoid carbohydrates in the diet. 3. Take insulin at the same time every day. 4. Maintain HbA1c

4. Maintain HbA1c Maintaining long-term control of blood glucose will help prevent the progression of diabetic nephropathy. Voiding when the client has the urge prevents the backflow of urine and infection. The diabetic diet is composed of carbohydrates, proteins, and fats. Although taking insulin at the same time each day may indirectly help control blood glucose, it is not the best option.

When caring for a client with hemorrhage secondary to kidney trauma, the nurse provides volume expansion. Which element does the nurse anticipate will be used? 1. Fresh-frozen plasma 2. Platelet infusions 3. 5% dextrose in water 4. Normal saline solution

4. 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. Clotting factors, contained in fresh-frozen plasma, are given for bleeding, not for volume expansion. Platelet infusions are administered for deficiency of platelets. A solution hypotonic to the client's blood, 5% dextrose, is administered for nutrition or hypernatremia, not for volume expansion.

What is the most accurate statement regarding the etiology and genetic risk of polycystic kidney disease (PKD)? 1. Autosomal dominant PKD is rarer than autosomal recessive PKD. 2. PKD can be prevented by adequate control of hypertension. 3. Autosomal dominant PKD-1 (ADPKD-1) is less severe than ADPKD-2. 4. PKD can occur in those with no family history of the disease.

4. PKD can occur in those with no family history of the disease. PKD can occur in those with no family history of the disease if a new mutation occurs. PKD cannot be prevented. Management of hypertension only slows the progression of kidney damage. ADPKD-1 is more common and more severe than ADPKD-2. Autosomal recessive PKD is rare; autosomal dominant PKD is the most common form.

When preparing a client for nephrostomy tube insertion, it is essential for the nurse to monitor which factor before the procedure? 1. Blood urea nitrogen (BUN) and creatinine 2. Hemoglobin and hematocrit (H&H) 3. Intake and output (I&O) 4. Prothrombin time (PT) and International Normalized Ratio (INR)

4. Prothrombin time (PT) and International Normalized Ratio (INR) The procedure will be cancelled or delayed if coagulopathy in the form of prolonged PT/INR exists because dangerous bleeding may result. Nephrostomy tubes are placed to prevent and treat kidney damage; monitoring BUN and creatinine is important, but is not essential before this procedure. H&H is monitored to detect anemia and blood loss; this would not occur before the procedure. This client should be on I&O during the entire hospitalization; it is not necessary only before the procedure, but throughout the admission.

A client with pyelonephritis has been prescribed urinary antiseptic medication. What purpose does this medication serve? 1. Decreases bacterial count 2. Destroys white blood cells 3. Enhances the action of antibiotics 4. Provides comfort

4. Provides comfort Urinary antiseptic drugs such as nitrofurantoin (Macrodantin) are prescribed to provide comfort for clients with pyelonephritis. Antibiotics, not antiseptics, are used to decrease bacterial count and treat pyelonephritis infection; the action of antibiotics is not enhanced with antiseptics. White blood cells, along with antibiotics, fight infection.

The nurse is caring for a client with acute glomerulonephritis (GN) who has a total urine output of 350 mL in 24 hours. What intervention does the nurse include in the plan of care? 1. Encourage a fluid intake of at least 1200 mL in 24 hours. 2. Ensure that the client takes prescribed erythromycin. 3. Plan a diet that ensures a high protein intake. 4. Teach the client to limit intake of potassium.

4. Teach the client to limit intake of potassium. The nurse should teach the client to limit the intake of potassium. A urine output of less than 400 mL/24 hr means the client has oliguria, so potassium intake is restricted to prevent hyperkalemia due to oliguria because clients with oliguria do not have the ability to excrete excess potassium. The usual fluid allowance is 500 to 600 mL above the 24-hour urine output; therefore, the nurse should encourage the client to have a fluid intake of 850 to 950 mL over a period of 24 hours. The nurse should also teach the client the importance of completing the entire course of prescribed antibiotics rather than taking it just until the symptoms last. Oliguria can lead to uremia, so, the nurse may need to restrict the client's intake of protein.