kidney disorders ?s
An instructor is preparing a class on renal cancer for a group of students. Which of the following would the instructor include as a possible risk factor? a) Obesity b) Female gender c) Exposure to sunlight d) Age below 40 years
Obesity Correct Explanation: Risk factors for renal cancer include: age with most renal cancers occurring after age 60, male gender, tobacco use, occupational exposure to industrial chemicals, obesity, unopposed estrogen therapy, polycystic kidney disease, and treatment for renal failure.
Which of the following is a change that occurs in chronic glomerulonephritis? a) Anemia b) Metabolic alkalosis c) Hypokalemia d) Hypophosphatemia
Anemia Correct Explanation: Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic glomerulonephritis.
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek's sign. What deficit does the nurse suspect the patient has? a) Sodium b) Calcium c) Phosphorus d) Magnesium
Calcium Correct Explanation: Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.
Recovery Phase
Characterized by a process of tubular cell repair and regeneration and gradual return of GFR to pre-ARF rates Diuresis may occur as GFR improves Renal function improves rapidly initially (5-25 days) and gradually for up to 1 year
Which of the following is an integumentary manifestation of chronic renal failure? a) Asterixis b) Seizures c) Tremors d) Gray-bronze skin color
Gray-bronze skin color Correct Explanation: Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure
Which of the following is a characteristic of the intrarenal category of acute renal failure? a) Decreased urine sodium b) Decreased creatinine c) Increased BUN d) High specific gravity
Increased BUN Explanation: The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.
Which of the following is the hallmark of the diagnosis of nephrotic syndrome? a) Proteinuria b) Hypokalemia c) Hyponatremia d) Hyperalbuminemia
Proteinuria Correct Explanation: Proteinuria (predominantly albumin) exceeding 3.5 g/day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may also occur. Proteinuria and microscopic hematuria may persist for many months; in fact, 20% of patients have some degree of persistent proteinuria or decreased glomerular filtration rate (GFR) 1 year after presentation
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) Encourage oral fluids. b) Administer furosemide (Lasix) 20 mg I.V. c) Start hemodialysis after a temporary access is obtained. d) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.
Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. Correct Explanation: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. a) Prolonged ST segment b) Tall, peaked T waves c) Multiple spiked P waves d) Shortened QRS complex
Tall, peaked T waves Explanation: Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex
Diagnostic indicators of chronic glomerular nephritis are a urine specific gravity of __________, variable proteinuria, and urinary casts. a) 1.020 b) 1.025 c) 1.03 d) 1.010
The normal urine specific gravity is 1.020 to 1.028. A reduced level of 1.010 is indicative of chronic glomerulonephritis.
Which of the following is the hallmark of the diagnosis of nephrotic syndrome? a) Proteinuria b) Hypokalemia c) Hyponatremia d) Hypoalbuminemia
Which of the following is the hallmark of the diagnosis of nephrotic syndrome? a) Hyponatremia b) Hypokalemia c) Proteinuria d) Hypoalbuminemia
The nurse is administering calcium acetate (PhosLo) to a patient with ESKD. When is the best time for the nurse to administer this medication? a) 2 hours before meals b) At bedtime with 8 ounces of fluid c) With food d) 2 hours after meals
With food Correct Explanation: Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. The nurse administers phosphate binders with food for them to be effective.
A patient diagnosed AKI has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering which of the following? a) Calcium supplements b) Kayexalate c) IV dextrose 50% d) Sorbitol
Kayexalate Correct Explanation: The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract. Sorbitol may be administered in combination with Kayexalate to induce a diarrhea-type effect (it induces water loss in the GI tract). If the patient is hemodynamically unstable (low blood pressure, changes in mental status, dysrhythmia), IV dextrose 50%, insulin, and calcium replacement may be administered to shift potassium back into the cells.
An elderly client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? a) Shows damage to the kidneys b) Reveals causative microorganisms c) If risk for chronic pyelonephritis is likely d) Detects calculi, cysts, or tumors
: Detects calculi, cysts, or tumors Correct Explanation: Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? a) Acute renal failure b) Acute glomerulonephritis c) Chronic renal failure d) Nephrotic syndrome
Acute glomerulonephritis Correct Explanation: Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis
Which of the following is a term used to describe excessive nitrogenous waster in the blood, as seen in acute glomerulonephritis? a) Hematuria b) Azotemia c) Proteinuria d) Bacteremia
Azotemia Correct Explanation: The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood
Diuresis Phase
Begins with the gradual increase in urine production Patient may return to normal urine volume before renal funtion returns to normal Monitor for dehydration during this phase Uremic symptoms may still be present
Initiation Phase
Begins with the initiating event and ends when oliguria occurs May last hours or days Few manifestations - usually not recognized during this phase
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? a) Uses moisturizing creams b) Pats skin dry after bathing c) Keeps nails trimmed short d) Brief, hot daily showers
Brief, hot daily showers Explanation: Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.
Oliguric Phase
Characterized by significant fall in GFR and tubular necrosis May develop oliguria - patients with oliguria have poorer prognosis May be nonoliguric - producing normal amounts of urine, but without filtering properly May present with: edema, hypertension, confusion, disorientation, agitation or lethargy, hyperreflexia, seizures, coma, anorexia, N/V, hypoactive or absent bowel sounds, uremic syndrome
An elderly client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? a) Shows damage to the kidneys b) Reveals causative microorganisms c) If risk for chronic pyelonephritis is likely d) Detects calculi, cysts, or tumor
Detects calculi, cysts, or tumors Explanation: Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine
Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure? a) Ureteral calculus b) Dysrhythmia c) Glomerulonephritis d) Hypovolemia
Glomerulonephritis Correct Explanation: Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
The nurse is caring for a patient in the oliguric phase of AKI. What does the nurse know would be the daily urine output? a) Less than 400 mL b) 1.0 L c) Less than 50 mL d) 1.5 L
Less than 400 mL Correct Explanation: The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The minimum amount of urine needed to rid the body of normal metabolic waste products is 400 mL. In this phase, uremic symptoms first appear and life-threatening conditions such as hyperkalemia develop. (l
Based on her knowledge of the primary cause of ESRD, the nurse knows to assess the most important indicator. What is that indicator? a) Urine protein b) Serum glucose c) Blood pressure d) pH and HCO3
Serum glucose Explanation: The nurse would evaluate serum and urine levels of glucose because diabetes is the primary cause of renal failure.
An expected outcome for the hemodialysis client is: a) The client verbalizes the dwell time for the dialysate. b) The client identifies signs and symptoms of rejection. c) The client explains how to assess the venous access site. d) The client demonstrates how to administer the dialysate by gravity
The client explains how to assess the venous access site. Explanation: Hemodialysis requires the creation of an arterio-venous access site. The absence of a palpable thrill suggests the AV site is blocked or clotted.
The nurse is caring for a patient with ESKD. Which of the following acid-base imbalances is associated with this disorder? a) pH 7.20, PaCO2 36, HCO3 14- b) pH 7.47, PaCO2 45, HCO3 33- c) pH 7.50, PaCO2 29, HCO3 22- d) pH 7.31, PaCO2 48, HCO3 24
pH 7.20, PaCO2 36, HCO3 14- Correct Explanation: Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.
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) removal of the transplanted kidney. c) high-dose I.V. cyclosporine (Sandimmune) therapy. d) intra-abdominal instillation of methylprednisolone sodium succinate (Solu-Medrol).
removal of the transplanted kidney. Explanation: Hyperacute rejection isn't treatable; the only way to stop this reaction is to remove the transplanted organ or tissue. Although cyclosporine is used to treat acute transplant rejection, it doesn't halt hyperacute rejection. Bone marrow transplant isn't effective against hyperacute rejection of a kidney transplant. Methylprednisolone sodium succinate may be given I.V. to treat acute organ rejection, but it's ineffective against hyperacute rejection
Medications giving for acute renal failure
-Medications that are nephrotoxic are removed from treatment regimine and other potentially toxic meds (NSAID's, antibiotics, vasoconstrictors) are avoided -IV fluids and blood volume expanders restore renal perfusion -Dopamine increases cardiac output and dilates vessels of the mesentery and kidneys -Loop diuretics (Lasix) or osmotic diuretics (mannitol) with IV fluids may be given to increase urinary output "wash out" the nephrons to flush nephrotoxins Reduce azotemia and fluid & electrolyte imabalances -ACE inhibitors or other BP meds -Antacids, H2-blockers, or PPI's to prevent GI bleeding -Hyperkalemia (>6.5 mEq/L) must be treated Calcium chloride, insulin and glucose given IV to move K+ from serum into cells -Kayexalate (phosphate-binding exchange resin - exchanges Na for K) may be given po or pr Kayexalate may be given with Sorbitol in induce diarrhea -Amphojel (aluminum hydroxide) binds with phosphates in the GI tract and excretes them within feces -Sodium bicarb to reverse acidosis -Medications that are nephrotoxic are removed from treatment regimine and other potentially toxic meds (NSAID's, antibiotics, vasoconstrictors) are avoided IV fluids and blood volume expanders restore renal perfusion Dopamine increases cardiac output and dilates vessels of the mesentery and kidneys Loop diuretics (Lasix) or osmotic diuretics (mannitol) with IV fluids may be given to increase urinary output "wash out" the nephrons to flush nephrotoxins Reduce azotemia and fluid & electrolyte imabalances ACE inhibitors or other BP meds Antacids, H2-blockers, or PPI's to prevent GI bleeding Hyperkalemia (>6.5 mEq/L) must be treated Calcium chloride, insulin and glucose given IV to move K+ from serum into cells
The nurse is instructing a patient to perform continuous ambulatory peritoneal dialysis correctly at home. Which of the following educational information should the nurse provide to the patient? a) Use an aseptic technique during the procedure. b) Clean the catheter insertion site daily with soap. c) Keep the catheter stabilized to the abdomen, below the belt line. d) Wear a mask while handling any dialysate solutions.
Use an aseptic technique during the procedure. Correct Explanation: The patient should be instructed to use an aseptic technique during the procedure. The patient should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (patients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a patient has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine (Betadine), not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbin
