STUDY prep u renal

The nurse is caring for a patient postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize?

Assessment of the quantity of the patient's urine output

A female client undergoes dialysis as a part of treatment for kidney failure. The client is administered heparin during dialysis to achieve therapeutic levels. Which of the following steps should the nurse take to allow heparin to be metabolized and excreted in the client?

Avoid administering injections for 2 to 4 hours after heparin administration.

A female patient undergoes dialysis as a part of treatment for kidney failure. The patient is administered heparin during dialysis to achieve therapeutic levels. Which of the following steps should the nurse take to allow heparin to be metabolized and excreted in the patient?

Avoid administering injections for 2 to 4 hours after heparin administration.

A female client undergoes dialysis as a part of treatment for kidney failure. The client is administered heparin during dialysis, to achieve therapeutic levels. Which of the following steps should the nurse take to allow heparin to be metabolized and excreted in the client?

Avoid administering injections for two to four hours after heparin administration

Which of the following terms is used to describe the concentration of urea and other nitrogenous wastes in the blood?

Azotemia

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?

Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl

Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure?

Glomerulonephritis

Which of the following is an integumentary manifestation of chronic renal failure?

Gray-bronze skin color

Which of the following is as integumentary manifestation of chronic renal failure?

Gray-brown skin color

A 16-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. What is a cause of postinfectious glomerular disease?

Group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks

The nurse is caring for a patient following extensive abdominal surgery. The patient develops an infection that is treated with IV gentamicin. After 4 days of treatment, the patient develops oliguria, and laboratory results indicate azotemia. The patient is diagnosed with acute tubular necrosis and transferred to the ICU. The patient is hemodynamically stable. Which of the following dialysis methods would be most appropriate for the patient?

Hemodialysis

A 45-year-old man with diabetic nephropathy has end-stage renal failure and is starting dialysis. He asks for information about hemodialysis. What would the nurse include in the teaching for this patient?

Hemodialysis is a treatment option that is required three times a week.

The nurse is caring for a patient in acute kidney injury. Which of the following complications would most clearly warrant the administration of polystyrene sulfonate (Kayexalate)?

Hyperkalemia

The nurse understands acute dialysis is indicated in which of the following situations?

Impending pulmonary edema

Which of the following is a characteristic of the intrarenal category of AKI?

Increased BUN

Which of the following is a characteristic of the intrarenal category of acute renal failure?

Increased BUN

A patient diagnosed with AKI has developed congestive heart failure. The patient has received 40 mg of intravenous pyelogram (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The patient's vital signs are stable. Which of the following health care orders should the nurse anticipate?

Lasix (Furosemide) 80 mg IVP

The nurse is caring for a patient after kidney surgery. The nurse is aware that bleeding is a major complication of kidney surgery and that if it goes undetected and untreated can result in hypovolemia and hemorrhagic shock in the patient. When assessing for bleeding, what assessment parameter should the nurse evaluate?

Level of consciousness

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important?

Limiting fluid intake

The nurse is caring for a patient with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which of the following nursing actions is contraindicated?

Obtaining a blood pressure reading from the right arm

The nurse is caring for a patient with acute renal injury (AKI). The patient is experiencing an increase in the serum concentration of urea and creatinine. The nurse understands the patient is experiencing which of the following phases of AKI?

Oliguria

Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys?

Oliguria

The nurse performing the health interview of a patient with a new onset of periorbital edema has completed a genogram, noting the health history of the patient's siblings, parents, and grandparents. This assessment addresses the patient's risk of what kidney disorder?

Polycystic kidney disease (PKD)

A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders?

Preprocedure hydration and administration of acetylcysteine

A 44-year-old client is in the hospital unit where you practice nursing. From the results of a series of diagnostic tests, she has been diagnosed with acute glomerulonephritis. What would you expect to find as a result of this condition?

Proteinuria

Which of the following is the hallmark of the diagnosis of nephrotic syndrome?

Proteinuria

A 32-year-old client has pyelonephritis and is undergoing parenteral antibiotic treatment. What will be the effect of the infection on her kidneys?

Renal scarring

The nurse is caring for a patient with chronic glomerulonephritis. What can cause chronic glomerulonephritis?

Repeated episodes of acute nephritic syndrome

A patient with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the patient's abdomen is increasing in girth. What is the nurse's most appropriate action?

Reposition the patient to facilitate drainage.

The educator on your unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patient's teaching what nutritional guidelines would the educator include?

Restrict protein intake to 60 g/d.

One of the roles of the nurse in caring for the clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include teaching which of the following?

Restricting sources of potassium usually found in fresh fruits and vegetables

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?

Risk for infection

A 40-year-old client has just been diagnosed with acute pyelonephritis. What client education would you offer Mr. McDermott regarding fluids?

Significantly increase fluid intake

A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the patient's chronic kidney disease is at what stage?

Stage 3

Which of the following nursing actions is most important in caring for the client following lithotripsy?

Strain the urine carefully for stone fragments.

A patient presents at the walk-in clinic complaining of edema around the eyes and flank tenderness bilaterally. Acute glomerular inflammation is suspected. What tests would the nurse expect to be ordered to confirm the diagnosis?

Urinalysis

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?

Urine output of 20 ml/hour

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

Urine output of 250 ml/24 hours

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?

"Increase your carbohydrate intake."

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:

"As the disease progresses, you will most likely require renal replacement therapy."

A 45-year-old man with diabetic nephropathy has ESKD and is starting dialysis. "What should the nurse teach the patient about hemodialysis?

"Hemodialysis is a treatment option that is usually required three times a week."

A patient with ESRD is scheduled for his first hemodialysis treatment. The patient asks the nurse what common complications may occur from the treatment. What would be the nurse's best reply?

"Hypotension and cramping may occur."

A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). The patient asks the nurse to explain what will be done. What is the nurse's best response?

"Shock waves will break the stones in the kidney to the size of sand grains."

Nicholas Pendergast, a 57-year-old professional athlete, has a lengthy history of chronic pyelonephritis. He is attending his annual physical exam and has become rather concerned with his potential for renal failure. How many clients with a history of chronic pyelonephritis require dialysis?

10% to 15%

A female client who is diagnosed with calcium oxalate stones is instructed to limit calcium intake. The client is informed that she should consume ____________ mg/ day, or less, of calcium as part of her dietary treatment.

1000

Lew Wallace, a 57-year-old author, has a history of chronic renal failure and is presenting to his appointment with a physician within an urology group where you practice nursing. Mr. Wallace is in Stage 4 for CRF. What is the approximate level of nephron function loss?

75% - 90%

Lew Wallace, a 57-year-old author, has a history of chronic renal failure and is presenting to his appointment with a physician within a urology group where you practice nursing. Mr. Wallace is in stage 4 for CRF. What is the approximate level of nephron function loss?

75% to 90%

The nurse coming on shift on the medical unit is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing ESKD?

A patient with diabetes mellitus and poorly controlled hypertension

The nurse is planning patient teaching for a patient with ESKD who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula?

A vein and an artery in your arm will be attached surgically.

The nurse is planning patient teaching for a patient with end-stage renal disease who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula?

A vein and an artery in your arm will be attached surgically.

The critical care nurse is monitoring the patient's urine output and drains following renal surgery. What should the nurse promptly report to the physician?

Absence of drain output

The critical care nurse is monitoring her patient's urine output and drainage from tubes inserted intraoperatively. What would the nurse promptly report to the physician?

Absent drainage

A 32-year-old client has been admitted to the renal unit of the hospital with acute pyelonephritis. She is undergoing parenteral antibiotic treatment. What signs and symptoms would you expect the client to exhibit?

All options are correct.

A patient with chronic kidney disease has been hospitalized and is receiving hemodialysis on a scheduled basis. The nurse should include which of the following actions in the plan of care?

Assess for a thrill or bruit over the vascular access site each shift.

A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?

Assess the AV fistula for a bruit and thrill.

The nurse is caring for a patient who has returned to the postsurgical suite after post-anesthetic recovery from a nephrectomy. The nurse's most recent hourly assessment reveals a significant drop in level of consciousness and BP as well as scant urine output over the past hour. What is the nurse's best response?

Assess the patient for signs of bleeding and inform the physician.

A patient, status post resection of renal tumor, is being discharged home. You are planning discharge for this patient. What would you include in a teaching plan for this patient?

Continuing care

A critical care nurse is caring for a trauma patient who has gone into acute renal failure. The critical care nurse knows that he can set up, initiate, maintain, and terminate what system of dialysis for this patient?

Continuous venovenous hemofiltration

A nurse is caring for a patient who is in the diuresis phase of AKI. The nurse should closely monitor the patient for what complication during this phase?

Dehydration

A nurse is caring for a renal patient in the dieresis period of ARF. What must the patient be observed closely for during this phase?

Dehydration

In the diuresis period of AKI, the nurse should observe the patient closely for what complication?

Dehydration

The nurse coming on shift is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing end-stage renal disease (ESRD)?

Diabetes mellitus with poorly controlled hypertension

Ms. Linden is in end-stage chronic renal failure and is being added to the transplant list. You are explaining to her how donors are found for clients needing kidneys. You would be accurate in telling her which of the following?

Donors are selected from compatible living donors.

A patient is being treated for AKI and the patient daily weights have been ordered. The nurse notes a weight gain of 3 pounds over the past 48 hours. What nursing diagnosis is suggested by this assessment finding?

Excess fluid volume

Renal failure can have prerenal, renal, or postrenal causes. A patient presents with acute renal failure and is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it?

Heart failure

The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem?

Hematuria

A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that 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?

Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.

Acute dialysis is indicated in which situation?

Impending pulmonary edema

A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action?

Inform the physician and assess the patient for signs of infection.

Which of the following is used to decrease potassium level seen in acute renal failure?

Kayexalate

The nurse is helping a patient to correctly perform peritoneal dialysis at home. The nurse must educate the patient about the procedure. Which educational information should the nurse provide to the patient?

Keep the dialysis supplies in a clean area, away from children and pets

The nurse has identified the nursing diagnosis of "risk for infection" in a patient who undergoes peritoneal dialysis. What nursing action best addresses this risk?

Maintain aseptic technique when administering dialysate.

A patient is brought to the renal unit from the PACU status post resection of a renal tumor. What would be a priority nursing action in the care of this patient?

Management of postoperative pain

A patient is brought to the renal unit from the PACU status post resection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this patient?

Managing postoperative pain

Mr. Allen was hospitalized for treatment of large renal calculi that were causing obstruction to urine flow. He was taken to surgery for a nephrostomy tube placement. A nephrostomy tube, also called a pyelostomy tube, is a catheter inserted through the skin into the renal pelvis. Select the answer that is true about managing a nephrostomy tube.

Never clamp the nephrostomy tubing.

As an inflammatory response in the glomerular capillary membrane, the renal filtration system is disrupted. Although diagnostic urinalysis can reveal glomerulonephritis, many of those suffering with glomerulonephritis exhibit what symptoms?

No symptoms

You are caring for a patient with acute renal failure. What is the most common clinical manifestation of acute renal failure?

Oliguria

Two weeks after being diagnosed with a streptococcal infection, a client develops fatigue, a low-grade fever, and shortness of breath. The nurse auscultates bilateral crackles and observes jugular vein distention. Urinalysis reveals red and white blood cells and protein. After the physician diagnoses poststreptococcal glomerulonephritis, the client is admitted to the medical-surgical unit. Which immediate action should the nurse take?

Provide a high-protein, fluid-monitored diet.

A 32-year-old client has been admitted to the renal unit with acute pyelonephritis. She is undergoing parenteral antibiotic treatment. As her nurse, what would be a significant aspect of your discharge education?

Recurring infection prevention

The nurse is caring for a patient receiving hemodialysis three times weekly. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient?

Taking a BP reading on the affected arm can damage the fistula.

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?

Tea-colored urine

You are writing a teaching plan for a patient you are caring for status post resection of a renal tumor. What would you include in that teaching plan?

To inspect and care for the incision

Which clinical finding should a nurse look for in a client with chronic renal failure?

Uremia

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?

Use an aseptic technique during the procedure.

The nurse is working on the renal transplant unit. To reduce the risk of infection in a patient with a transplanted kidney, it is imperative for the nurse to do what?

Wash hands carefully and frequently.

A nurse is caring for an acutely ill patient. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill patient is which of the following?

Weight

Which of the following is the most accurate indicator of fluid loss or gain?

Weight

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?

White blood cell (WBC) count of 20,000/mm3

A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 ml. Urine output that's less than 50 ml in 24 hours is known as:

anuria.

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes:

confusion, headache, and seizures.

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:

fatigue and weakness.

A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include:

periorbital edema.

The most accurate indicator of fluid loss or gain in an acutely ill patient is

weight.

A patient with ESKD is scheduled to begin hemodialysis. The nurse is working with the patient to adapt the patient's diet to maximize the therapeutic effect and minimize the risks of complications. The patient's diet should include which of the following modifications? Select all that apply.

• Decreased protein intake • Decreased sodium intake • Fluid restriction

Mr. Billings is being seen as a client in the urology practice. He has a family history of polycystic kidney disease. Of the following assessment findings, which would you expect to find as you gather information and complete an assessment related to a polycystic kidney diagnosis? Select all that apply.

• Hypertension • Pain from retroperitoneal bleeding

The objectives of nutrition therapy for chronic kidney disease are to reduce serum nitrogen levels, reduce hypertension and edema, prevent body catabolism, improve renal function, and prevent or delay the onset of complications. Select all of the following which you would teach a client with chronic renal to help them with dietary adherence.

• Most protein should be from animal sources, which in general have a higher biologic value than plant proteins. • Pure sugars and heart-healthy fats are used liberally for calories to spare body and dietary protein.

The nurse is caring for a patient who has just returned to the post-surgical unit following renal surgery. When assessing the patient's output from surgical drains, the nurse should assess what parameters? Select all that apply.

• Quantity of output • Color of the output • Visible characteristics of the output