Ch 27 - Pts w/ Renal Disorders
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?
Tenderness over transplant site
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
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?
Wear a mask when performing exchanges.
The exchange of wastes from the blood to the dialysate occurs through the semipermeable membrane by way of osmosis, diffusion, and __________.
ultrafiltration
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?
Acute glomerulonephritis
A 45-year-old man with diabetic nephropathy is now in 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.
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?
Recent history of streptococcal infection
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."
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?
"I should drink as much as possible to keep my kidneys working."
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."
A patient with end-stage renal disease (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?
"Low blood pressure and cramping sometimes occur."
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?
"This type of dialysis will provide more independence."
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse?
"Very few symptoms are associated with renal cancer."
The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number.
4000 **A 1-kg weight gain is equal to 1,000 mL of retained fluid.
Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?
6
The renal diet includes limiting protein. A nurse understands that a client who weighs 198 lb (90 kg) should be limited to the minimum amount of daily protein. What is that amount?
72 grams
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?
Administration of sodium polystyrene sulfonate [Kayexalate])
The nurse is able to identify which condition as uremia?
An excess of urea in the blood
A client has a decreased secretion of erythropoietin from the kidneys due to end-stage kidney disease. The nurse explains that the decrease in erythropoietin will have what effect?
Anemia from the decrease in maturation of red blood cells
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis?
Azotemia
The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find?
Cola-colored urine
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?
Cola-colored urine
A pediatric nurse is providing care for a 7-year-old boy who has been diagnosed with glomerulonephritis. In addition to monitoring this child's blood work closely, what other assessment should prioritized in order to gauge the progression of his disease?
Daily weights
A client who suffered hypovolemic shock during a cardiac incident has developed acute kidney injury. Which is the best nursing rationale for this complication?
Decrease in the blood flow through the kidneys
A patient with chronic renal failure has frequent blood work ordered so that the care team can monitor the progression of his disease. The nurse has noted a consistent downward trend in the patient's levels of hemoglobin, hematocrit, and red blood cells (RBCs). The nurse understands that this is likely attributable to what pathophysiologic phenomenon?
Decreased synthesis and release of erythropoietin
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?
Dehydration
__________ is used to remove fluid and uremic waste products from the body when the kidneys are unable to do so.
Dialysis
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?
Donors are selected from compatible living or deceased donors.
Acute renal failure is a typically irreversible clinical syndrome in which there is an abrupt loss of kidney function and glomerular filtrate rate (GFR) over a period of hours to days. True or False
False
Chronic renal failure is a slow deterioration in renal function that takes places over a couple of weeks. True or False
False
Hypophosphatemia with resulting hypocalcemia develops in renal failure. True or False
False
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure?
Glomerulonephritis
The nurse recognizes which condition as an integumentary manifestation of chronic renal failure?
Gray-bronze skin color
A nursing educator is speaking with a group of new graduates about a patient who has acute glomerulonephritis. The educator should tell the nurses that the patient may exhibit which of the following clinical manifestations?
Hematuria
A college football player is brought to the emergency room by paramedics after a blunt trauma injury received during game. There is a high suspicion that the patient has sustained an injury to his kidneys from being tackled from behind. The emergency room nurse caring for the patient reviews the initial orders written by the health care provider and notes that an order has been written to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important because:
Hematuria is the most common manifestation of renal trauma, and blood losses may be microscopic, so laboratory analysis is essential.
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?
Hyperkalemia
The nurse is caring for a patient in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:
Hyperkalemia
A medical patient has been admitted to the intensive care unit after developing acute renal failure (ARF). The intensive care nurse should anticipate performing interventions to resolve which of the following health problems?
Hyperkalemia and acidosis
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?
Hyperphosphatemia
As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur?
Hyperphosphatemia
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia?
Increase carbohydrates and limit protein intake.
What is a characteristic of the intrarenal category of acute kidney injury (AKI)?
Increased BUN
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?
Renal calculi
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.
Jugular vein distention Crackles Hypertension
__________, a cation-exchange resin, works by exchanging sodium ions for potassium ions in the intestinal tract.
Kayexalate
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?
Keep the dialysis supplies in a clean area, away from children and pets
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?
Less than 400 mL
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important?
Limiting fluid intake
A female patient with a recent diagnosis of end-stage renal disease (ESRD) is scheduled to soon begin hemodialysis. A nephrology nurse has been conducting extensive patient teaching in anticipation of this treatment. What diet should the nurse recommend to minimize her patient's risk of complications and interdialytic weight gain?
Low-protein, low-sodium diet
A client recovering from hepatitis B develops acute nephrotic syndrome. Which treatment will the nurse anticipate being prescribed for this client?
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?
Oliguria
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?
Oliguria
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys?
Oliguria
When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic?
Penicillin
Which of the following occurs late in chronic glomerulonephritis?
Peripheral neuropathy
A patient is scheduled for a computed tomography (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
What is a hallmark of the diagnosis of nephrotic syndrome?
Proteinuria
The nurse earlier infused the prescribed quantity of dialysate into the peritoneal dialysis catheter of an adult patient and has now drained the fluid. Upon examination, the nurse observes that there is significantly less fluid removed than was earlier infused. How should the nurse follow up this observation?
Reposition the patient to facilitate drainage from the peritoneal cavity.
__________ can develop as azotemia worsens.
Seizures
Which of the following would a nurse classify as a prerenal cause of acute renal failure?
Septic shock
Which of the following is the most sensitive indicator of renal function?
Serum creatinine
The laboratory results for a patient with renal failure, accompanied by decreased glomerular filtration, would be evaluated frequently. Which of the following is the most sensitive indicator of renal function?
Serum creatinine of 1.5 mg/dL
What is used to decrease potassium level seen in acute renal failure?
Sodium polystyrene sulfonate
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?
SpO2 at 90% with fine crackles in the lung bases
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?
Start IV fluids with a normal saline solution bolus followed by a maintenance dose.
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.
Tall, peaked T waves
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute kidney injury. Which statement from the nurse best reflects the ability of the kidneys to recover from acute kidney injury?
The kidneys can improve over a period of months.
Mr. Jeung is a 60-year-old man who has been coming to the local dialysis center three times a weeks for the past year. Mr. Jeung is interested in the possibility of beginning home hemodialysis, and his wife is willing and able to assist accordingly. The dialysis nurse knows that the primary goal of performing dialysis in the patient's own home is to maximize:
The patient's independence and quality of life
A leading cause of death among patients undergoing maintenance hemodialysis is atherosclerotic cardiovascular disease. True or False
True
Patients with oliguria and anuria are at high risk for hyperkalemia. True or False
True
Which clinical finding should a nurse look for in a client with chronic renal failure?
Uremia
The nurse is caring for a client with blood loss from esophageal varices. Which assessment finding indicates that the client is exhibiting signs of acute kidney injury (AKI) related to the loss of volume?
Urine output that has been <0.5 mL/kg/hr for several 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?
Use an aseptic technique during the procedure.
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
Inadequate production of erythropoietin by the damaged kidney causes _________.
anemia
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 with chronic kidney disease (CKD) has been receiving erythropoietin injections as prescribed. Which outcome would indicate to the nurse that this medication has been effective?
higher energy levels
The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder?
pH 7.20, PaCO2 36, HCO3 14-
A client has been diagnosed with acute glomerulonephritis. This condition causes:
proteinuria
Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for:
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:
restricting sources of potassium.
A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:
sodium polystyrene sulfonate (Kayexalate)
