Chapter 58: Caring for Clients with Disorders of the Kidneys and Ureters
A client with acute renal failure progresses through four phases. Which describes the onset phase? a. It is accompanied by reduced blood flow to the nephrons. b. Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. c. The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. d. Normal glomerular filtration and tubular function are restored.
a The onset phase is accompanied by reduced blood flow to the nephrons. In the oliguric phase, fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. During the diuretic phase, excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. During the recovery phase, normal glomerular filtration and tubular function are restored.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a. Impaired urinary elimination b. Toileting self-care deficit c. Risk for infection d. Activity intolerance
c The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.
The nurse is providing a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants' risks of renal carcinoma? a. Avoiding heavy alcohol use b. Control of sodium intake c. Smoking cessation d. Adherence to recommended immunization schedules
c Tobacco use is a significant risk factor for renal cancer, surpassing the significance of high alcohol and sodium intake. Immunizations do not address an individual's risk of renal cancer.
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. With food b. 2 hours before meals c. 2 hours after meals d, At bedtime with 8 ounces of fluid
a 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.
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? a. Glomerulonephritis b. Hypovolemia c. Ureteral calculus d. Dysrhythmia
a Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
The nurse performing the health interview of a client with a new onset of periorbital edema has completed a genogram, noting the health history of the client's siblings, parents, and grandparents. This assessment addresses the client's risk of what kidney disorder? a. Nephritic syndrome b. Acute glomerulonephritis c. Nephrotic syndrome d. Polycystic kidney disease (PKD)
d PKD is a genetic disorder characterized by the growth of numerous cysts in the kidneys. Nephritic syndrome, acute glomerulonephritis, and nephrotic syndrome are not genetic disorders.
The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than ___________mL/kg/hr.
0.5
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 mL
Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure? a. Fluid volume excess b. Urinary retention c. Activity intolerance d. Disturbed body image
a The oliguric phase is characterized by fluid retention.
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? a. Avoid administering injections for 2 to 4 hours after heparin administration. b. Provide periods of rest throughout the day and uninterrupted sleep at night. c. Use dialysate solutions after 2 hours. d. Puncture the same site used previously.
a When heparin is administered to a patient during dialysis, it is very important not to administer injections for the next 2 to 4 hours. This restriction allows heparin to be metabolized and excreted. While caring for patients with chronic glomerulonephritis, the nurse should provide periods of rest throughout the day, with uninterrupted sleep at night. When obtaining vascular access, the nurse should avoid puncturing the same site used previously. Using dialysate solutions after 2 hours of dialysis will not allow heparin to be metabolized and excreted.
A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the client's chronic kidney disease is at what stage? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4
c Stages of chronic kidney disease are based on the GFR. Stage 3 is defined by a GFR in the range of 30 to 59 mL/min/1.73 m2. This is considered a moderate decrease in GFR.
Based on the pathophysiologic changes that occur as renal failure progresses, the nurse identifies the following indicators associated with the disease. Select all that apply. a. Hyperkalemia b. Metabolic alkalosis c. Anemia d. Hyperalbuminemia e. Hypocalcemia
a, c, e Hyperkalemia is due to decreased potassium excretion and excessive potassium intake. Metabolic acidosis results from decreased acid secretion by the kidney. A damaged glomerular membrane causes excess protein loss.
What is a characteristic of the intrarenal category of acute kidney injury (AKI)? a. Decreased creatinine b. Increased BUN c. High specific gravity d. Decreased urine sodium
b The intrarenal category of acute kidney injury (AKI) encompasses an increased BUN, increased creatinine, a low-normal specific gravity of urine, and increased urine sodium. Intrarenal AKI is the result of actual parenchymal damage to the glomeruli or kidney tubules. Acute tubular necrosis (ATN), AKI in which there is damage to the kidney tubules, is the most common type of intrinsic AKI. Characteristics of ATN are intratubular obstruction, tubular back leak (abnormal reabsorption of filtrate and decreased urine flow through the tubule), vasoconstriction, and changes in glomerular permeability. These processes result in a decrease of GFR, progressive azotemia, and fluid and electrolyte imbalances.
The nurse is assessing a client suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? a. Hematuria b. Precipitous decrease in serum creatinine levels c. Hypotension unresolved by fluid administration d. Glucosuria
a The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Glucosuria does not normally accompany glomerulonephritis, and hypertension is much more likely than hypotension.
Which clinical finding should a nurse look for in a client with chronic renal failure? a. Hypotension b. Uremia c. Metabolic alkalosis d. Polycythemia
b Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.
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. metabolic alkalosis. d. hypophosphatemia.
b Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur during chronic glomerulonephritis.
A patient is placed on hemodialysis for the first time. The patient complains of a headache with nausea and begins to vomit, and the nurse observes a decreased level of consciousness. What does the nurse determine has happened? a. The dialysis was performed too rapidly. b. The patient is having an allergic reaction to the dialysate. c. The patient is experiencing a cerebral fluid shift. d. Too much fluid was pulled off during dialysis.
c Dialysis disequilibrium results from cerebral fluid shifts. Signs and symptoms include headache, nausea and vomiting, restlessness, decreased level of consciousness, and seizures. It is rare and more likely to occur in AKI or when BUN levels are very high (exceeding 150 mg/dL).
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. Temperature of 99.2° F (37.3° C) d. Urine output of 20 ml/hour
d Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.
A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event? a. Psychosocial stress b. Hypersensitivity to an immunization c. Menarche d. Streptococcal infection
d Postinfectious causes of postinfectious glomerular disease are group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks. Menarche, stress, and hypersensitivity are not typical causes.
A client 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? a. Ensure that the client moves the extremity with the vascular access site as little as possible. b. Change the dressing over the vascular access site at least every 12 hours. c. Utilize the vascular access site for infusion of IV fluids. d. Assess for a thrill or bruit over the vascular access site each shift.
d The bruit, or "thrill," over the venous access site must be evaluated at least every shift. Frequent dressing changes are unnecessary and the client does not normally need to immobilize the site. The site must not be used for purposes other than dialysis.
What is a hallmark of the diagnosis of nephrotic syndrome? a. Hyponatremia b. Proteinuria c. Hyperalbuminemia d. Hypokalemia
b Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.
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. Donors with hypertension may qualify. d. The client is placed on a transplant list at the local hospital.
a Donors are selected from compatible living donors. Donors do not have to be relatives as long as they are compatible. Potential donors with a history of hypertension, malignant disease, or diabetes are excluded from donation. Each local hospital does not have its own transplant list, instead the client will be placed on a national computerized transplant waiting list.
The nurse is caring for a client postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize? a. Assessment of the quantity of the client's urine output b. Assessment of the client's incision c. Assessment of the client's abdominal girth d. Assessment for flank or abdominal pain
a After kidney transplantation, the nurse should perform all of the listed assessments. However, oliguria is considered to be more suggestive of rejection than changes to the client's abdomen or incision.
A client is experiencing a decreasing glomerular filtration. What laboratory values should the nurse expect to follow the change? Select all that apply. a. Serum creatinine increases b. Blood urea nitrogen (BUN) increases c. Creatinine clearance decreases d. Hypokalemia e. Hypophosphatemia
a, b, c As glomerular filtration decreases, the serum creatinine and BUN levels increase; the creatinine clearance decreases. Potassium and phosphate levels should not be affected by decreased glomerular filtration.
The nurse is caring for a client who has just returned to the postsurgical unit following renal surgery. When assessing the client's output from surgical drains, the nurse should assess what parameters? Select all that apply. a. Quantity of output b. Color of the output c. Visible characteristics of the output d. Odor of the output e. pH of the output
a, b, c Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Odor and pH are not normally assessed.
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? a. Blood glucose level of 200 mg/dl b. White blood cell (WBC) count of 20,000/mm3 c. Potassium level of 3.5 mEq/L d. Hematocrit (HCT) of 35%
b An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.
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. Hypovolemic shock caused by hemorrhage c. Paralytic ileus caused by manipulation of the colon during surgery d. Pneumonia caused by shallow breathing because of severe incisional pain
b If bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack.
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. Turn the client from side to side. c. Lower the head of the bed. d. Push the catheter further into the abdomen.
b If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the client from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. Other measures to promote drainage include checking the patency of the catheter by inspecting for kinks, closed clamps, or an air lock.
The nurse coming on shift on the medical unit is taking a report on four clients. What client does the nurse know is at the greatest risk of developing ESKD? a. A client with a history of polycystic kidney disease b. A client with diabetes mellitus and poorly controlled hypertension c. A client who is morbidly obese with a history of vascular disorders d. A client with severe chronic obstructive pulmonary disease
b Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may cause ESKD. A client with more than one of these risk factors is at the greatest risk for developing ESKD. Therefore, the client with diabetes and hypertension is likely at highest risk for ESKD.
A client is brought to the renal unit from the PACU status postresection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this client? a. Increasing oral intake b. Managing postoperative pain c. Managing dialysis d. Increasing mobility
b The client requires frequent analgesia during the postoperative period and assistance with turning, coughing, use of incentive spirometry, and deep breathing to prevent atelectasis and other pulmonary complications. Increasing oral intake and mobility are not priority nursing actions in the immediate postoperative care of this client. Dialysis is not necessary following kidney surgery.
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? a. "Be sure to eat meat at every meal." b. "Eat plenty of bananas." c. "Increase your carbohydrate intake." d. "Drink plenty of fluids, and use a salt substitute."
c A client with CRF requires extra carbohydrates to prevent protein catabolism. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Salt substitutes are high in potassium and should be avoided.
The nurse is caring for a client after kidney surgery. When assessing for bleeding, what assessment parameter should the nurse evaluate? a. Oral intake b. Pain intensity c. Level of consciousness d. Radiation of pain
c Bleeding is a major complication of kidney surgery. The nurse's role is to observe for these complications, to report their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision, and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood, and fluid volume and cardiac output. Bleeding is not normally evidenced by changes in pain or oral intake.
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 a loop diuretic c. Administration of sodium bicarbonate d. Administration of sodium polystyrene sulfonate [Kayexalate])
d 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.
A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client? a. Anemia b. Acidosis c. Hyperkalemia d. Pericarditis
a Anemia develops as a result of inadequate erythropoietin production, the shortened lifespan of RBCs, nutritional deficiencies, and the patient's tendency to bleed, particularly from the GI tract. Erythropoietin, a substance normally produced by the kidneys, stimulates bone marrow to produce RBCs (Murphy, Bennett, & Jenkins, 2010). In ESKD, erythropoietin production decreases and profound anemia results, producing fatigue, angina, and shortness of breath.
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: a. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. b. a decreased serum phosphate level secondary to kidney failure. c. an increased serum calcium level secondary to kidney failure. d. metabolic alkalosis secondary to retention of hydrogen ions.
a The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.
A patient on the critical care unit is postoperative day 1 following kidney transplantation from a living donor. The nurse's most recent assessments indicate that the patient is producing copious quantities of dilute urine. What is the nurse's most appropriate response? a. Assess the patient for further signs or symptoms of rejection. b. Recognize this as an expected finding. c. Inform the primary care provider of this finding. d. Administer exogenous antidiuretic hormone as ordered.
b A kidney from a living donor related to the patient usually begins to function immediately after surgery and may produce large quantities of dilute urine. This is not suggestive of rejection and treatment is not warranted. There is no obvious need to report this finding.
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. Use an aseptic technique during the procedure. d. Clean the catheter insertion site daily with soap.
c The client should be instructed to use an aseptic technique during the procedure. The client should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (clients 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 client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, 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 rubbing.
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. Blood urea nitrogen (BUN) level of 22 mg/dl b. Serum creatinine level of 1.2 mg/dl c. Temperature of 100.2° F (37.8° C) d. Urine output of 250 ml/24 hours
d ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.
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. Acute pyelonephritis b. Osmotic dieresis. c. Dysrhythmias d. Renal calculi
d Postrenal ARF is the result of an obstruction that develops anywhere from the collecting ducts of the kidney to the urethra. This results from ureteral blockage, such as from bilateral renal calculi or benign prostatic hypertrophy (BPH).
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? a. Cola-colored urine b. Left upper quadrant pain c. Pyuria d. Low blood pressure
a Cola-colored urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis.
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. a. Tall, peaked T waves b. Shortened QRS complex c. Multiple spiked P waves d. Prolonged ST segment
a Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.
The nurse has identified the nursing diagnosis of "Risk for Infection" in a client who undergoes peritoneal dialysis. What nursing action best addresses this risk? a. Maintain aseptic technique when administering dialysate. b. Wash the skin surrounding the catheter site with soap and water prior to each exchange. c. Add antibiotics to the dialysate as prescribed. d. Administer prophylactic antibiotics by mouth or IV as prescribed.
a Aseptic technique is used to prevent peritonitis and other infectious complications of peritoneal dialysis. It is not necessary to cleanse the skin with soap and water prior to each exchange. Antibiotics may be added to dialysate to treat infection, but they are not used to prevent infection.
The nurse is caring for a client who has returned to the postsurgical suite after postanesthetic 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? a. Assess the client for signs of bleeding and inform the primary provider. b. Monitor the client's vital signs every 15 minutes for the next hour. c. Reposition the client and reassess vital signs. d. Palpate the client's flanks for pain and inform the primary provider.
a Bleeding may be suspected when the client experiences fatigue and when urine output is less than 30 mL/hr. The care provider must be made aware of this finding promptly. Palpating the client's flanks would cause intense pain that is of no benefit to assessment.
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. Calcium b. Magnesium c. Phosphorus d. Sodium
a 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.
A 45-year-old man with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis? a. "Hemodialysis is a treatment option that is usually required three times a week." b. "Hemodialysis is a program that will require you to commit to daily treatment." c. "This will require you to have surgery and a catheter will need to be inserted into your abdomen." d. "Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again."
a Hemodialysis is the most commonly used method of dialysis. Clients receiving hemodialysis must undergo treatment for the rest of their lives or until they undergo successful kidney transplantation. Treatments usually occur three times a week for at least 3 to 4 hours per treatment.
A client with end-stage renal disease receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action? a. Inform the health care provider and assess the client for signs of infection. b. Flush the peritoneal catheter with normal saline. c. Remove the catheter promptly and have the catheter tip cultured. d. Administer a bolus of IV normal saline as prescribed.
a Peritonitis is the most common and serious complication of peritoneal dialysis. The first sign of peritonitis is cloudy dialysate drainage fluid, so prompt reporting to the primary provider and rapid assessment for other signs of infection are warranted. Administration of an IV bolus is not necessary or appropriate and the physician would determine whether removal of the catheter is required. Flushing the catheter does not address the risk for infection.
A client has been diagnosed with acute glomerulonephritis. This condition causes: a. proteinuria. b. pyuria. c. polyuria. d. No option is correct.
a The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided.
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? a. Azotemia b. Proteinuria c. Hematuria d. Bacteremia
a 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.
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: a. "As the disease progresses, you will most likely require renal replacement therapy." b. "Dietary changes can reverse the damage that has occurred in your kidneys." c. "Draining of the cysts and antibiotic therapy will cure your disease." d. "Genetic testing will determine the best treatment for your condition."
a There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.
The nurse cares for a client who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed: a. acute rejection. b. hyperacute rejection. c. chronic rejection. d. simple rejection.
b After a kidney transplant, rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years. A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized glomerular capillary thrombosis and necrosis. The term "simple" is not used in the categorization of types of rejection of kidney transplants.
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. Butter b. Citrus fruits c. Cooked white rice d. Salad oils
b Foods and fluids containing potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee) are restricted.
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? a. Initiation b. Oliguria c. Diuresis d. Recovery
b The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys, such as urea and creatinine. The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.
The critical care nurse is monitoring the client's urine output and drains following renal surgery. What should the nurse promptly report to the primary provider? a. Increased pain on movement b. Absence of drain output c. Increased urine output d. Blood-tinged serosanguineous drain output
b Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Decreased or absent drainage is promptly reported because it may indicate obstruction that could cause pain, infection, and disruption of the suture lines. Reporting increased pain on movement has nothing to do with the scenario described. Increased urine output and serosanguineous drainage are expected.
The nurse is caring for acutely ill client. What assessment finding should prompt the nurse to inform the physician that the client may be exhibiting signs of acute kidney injury (AKI)? a. The client reports an inability to initiate voiding. b. The client's urine is cloudy with a foul odor. c. The client's average urine output has been 10 mL/hr for several hours. d. The client complains of acute flank pain.
c Oliguria (<500 mL/day of urine) is the most common clinical situation seen in AKI. Flank pain and inability to initiate voiding are not characteristic of AKI. Cloudy, foul-smelling urine is suggestive of a urinary tract infection.
The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated? a. Obtaining blood samples from the left arm b. Palpating the fistula for a "thrill" c. Obtaining a blood pressure reading from the right arm d. Placing the client's watch on the left wrist
c The nurse assesses the vascular access for patency. The bruit, or "thrill," over the venous access site must be evaluated at least every shift. The nurse takes precautions to ensure that the extremity with the vascular access is not used for measuring blood pressure or for obtaining blood specimens; tight dressings, restraints, or jewelry over the vascular access must be avoided as well.
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
c 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.
