Chapter 62: Concepts of Care for Patients with Kidney Disorders

Which assessment data would the nurse anticipate in a client with acute pyelonephritis? Select all that apply. A. Urinary frequency B. Dysuria C. Oliguria D. Heart rate 120 beats/min E. Uremia F. Costovertebral angle tenderness

A, B, D, F

Which assessment findings does the nurse expect in a client with kidney cancer? (Select all that apply.) Select all that apply. A. Increased sedimentation rate B. Hepatic dysfunction C. Erythrocytosis D. Hypercalcemia E. Hypokalemia

A, B, C, D

The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment data requires further nursing action? (Select all that apply.) Select all that apply. A. Blood pressure is 98/56 mm Hg. B. Urine output over the past hour was 80 mL. C. Heart rate is 118 beats/min. D. Dressing has a 1-cm area of bleeding. E. Abdominal distention. F. Pain is at a level 4 (on a 0--10 scale).

A, C, E, F

When providing care to a client who has undergone a nephrostomy for hydronephrosis, which observation alerts the nurse to a possible complication? Select all that apply. A. Urine output of 15 mL for the first hour and then diminishing B. Tenderness at the surgical site C. Pink-tinged urine draining from the nephrostomy D. A hematocrit value 3% lower than the preoperative value E. Sudden onset of abdominal pain that worsens after abdominal palpation F. Blood pressure of 180/90 mm Hg that persists despite administration of pain medication

A, D, E, F

What is the appropriate range of urine output for the client who has just undergone a nephrectomy? A. 30 to 50 mL/hr B. 50 to 70 mL/hr C. 23 to 30 mL/hr D. 41 to 60 mL/hr

A. 30 to 50 mL/hr

The nurse is caring for a male client 8 hours after a nephrectomy. Which assessment data point requires immediate nursing intervention? A. Abdominal distention B. Urine output 38 mL in the last hour C. Blood pressure 108/64 mm Hg D. Hemoglobin 14 g/dL

A. Abdominal distention

After receiving change-of-shift report on the urology unit, which client will the nurse assess first? A. Client who was involved in a motor vehicle collision and has hematuria. B. Client with nephrotic syndrome who has gained 2 kg since yesterday. C. Client with glomerulonephritis who has cola-colored urine. D. Client postradical nephrectomy whose temperature is 99.8° F (37.6° C).

A. Client who was involved in a motor vehicle collision and has hematuria.

When assessing a client with acute pyelonephritis, which finding does the nurse anticipate? (Select all that apply.) Select all that apply. A. Oliguria B. Vomiting C. Dysuria D. Chills E. Suprapubic pain

B, C, D

A client, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which client statement indicates to the nurse that the client needs further education? A. "My children have a 50% chance of inheriting the ADPKD gene that causes the disease." B. "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." C. "Even though my children don't have symptoms at the same age I did, they can still have ADPKD." D. "If my children have the ADPKD gene, they will have cysts by the age of 30."

B. "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children."

When assessing a client with acute glomerulonephritis, which question will the nurse ask to determine if the client is following best practices to slow progression of kidney damage? A. "Do you avoid contact sports while you are taking cyclosporine?" B. "How are you evaluating the amount of daily fluid you drink?" C. "Have you contacted anyone from our dialysis support services?" D. "Have you increased your protein intake to promote healing of the damaged nephrons?"

B. "How are you evaluating the amount of daily fluid you drink?"

Which question will the nurse ask the client who has a urinary tract infection to assess the risk for pyelonephritis? A. "What drugs do you take for asthma?" B. "How long have you had diabetes?" C. "How much fluid do you drink daily?" D. "Do you take your antihypertensive drugs at night or in the morning?"

B. "How long have you had diabetes?"

The school nurse is counseling a teenage student about how to prevent kidney trauma. Which student statement indicates a need for further teaching? A. "I always wear pads when playing football." B. "I can't play contact sports since my brother had kidney cancer." C. "I will avoid riding motorcycles." D. "I always wear a seat belt in the car."

B. "I can't play contact sports since my brother had kidney cancer."

The nurse is performing discharge teaching for a client after a nephrectomy for renal cell carcinoma. Which client statement indicates that teaching has been effective? A. "Since renal cell carcinoma usually affects both kidneys, I'll need frequent biopsies." B. "My remaining kidney will provide normal kidney function in a few days or weeks." C. "I need to decrease my fluid intake to prevent stress to my remaining kidney." D. "I'll eventually require some type of renal replacement therapy."

B. "My remaining kidney will provide normal kidney function in a few days or weeks."

The RN is working with assistive personnel (AP) in caring for a group of clients. Which action is best for the RN to delegate to AP? A. Assessing the vital signs of a client who was just admitted with blunt flank trauma and hematuria B. Assisting a client who had a radical nephrectomy 2 days ago to turn in bed C. Palpating for bladder distention on a client recently admitted with a ureteral stricture D. Helping the primary health care provider with a kidney biopsy for a client admitted with acute glomerulonephritis

B. Assisting a client who had a radical nephrectomy 2 days ago to turn in bed

The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor? A. Lipid levels B. Blood urea nitrogen (BUN) and creatinine C. White blood cell (WBC) count D. Hemoglobin and hematocrit (H&H)

B. Blood urea nitrogen (BUN) and creatinine

When assessing a client with acute glomerulonephritis, which assessment finding causes the nurse to notify the primary health care provider? A. Purulent wound on the leg B. Crackles throughout the lung fields C. Cola-colored urine D. History of diabetes

B. Crackles throughout the lung fields

The nurse is reviewing the client's laboratory data prior to a nephrostomy tube insertion. Which data requires the nurse to take action? A. White blood cells in the urine B. INR of 2.1 C. Hematocrit 44% D. Creatinine 0.8 mg/dL

B. INR of 2.1

The nurse is preparing a client for nephrostomy tube insertion. Which factor must be assessed by the nurse before the procedure? A. Blood urea nitrogen (BUN) and creatinine B. Prothrombin time (PT) and international normalized ratio (INR) C. Intake and output (I&O) D. Hemoglobin and hematocrit (H&H)

B. Prothrombin time (PT) and international normalized ratio (INR)

A client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the best nursing response? A. "Why are you hesitant?" B. "You need to tell me so we can determine what is wrong." C. "Take your time. What is bothering you the most?" D. "Don't worry, no one else will know."

C. "Take your time. What is bothering you the most?"

During discharge teaching for a client with kidney disease, what does the nurse teach the client to do? A. "Eat breakfast and go to bed at the same time every day." B. "Drink 2 L of fluid and urinate at the same time every day." C. "Weigh yourself and take your blood pressure." D. "Check your blood sugar and do a urine dipstick test."

C. "Weigh yourself and take your blood pressure."

When caring for a client 24 hours after a nephrectomy, the nurse assesses abdominal distention. Which action will the nurse perform next? A. Insert a nasogastric (NG) tube. B. Notify the surgeon. C. Check vital signs. D. Continue to monitor.

C. Check vital signs.

The nurse is caring for a client with hemorrhage secondary to kidney trauma. Which element does the nurse anticipate will be used for volume expansion? A. Platelet infusions B. 5% dextrose in water C. Normal saline solution D. Fresh-frozen plasma

C. Normal saline solution

For which minimal risk diagnostic test will the nurse prepare the client with polycystic kidney disease to have as initial screening? A. KUB X-ray B. CT with angiography C. Renal ultrasound D. Percutaneous needle biopsy

C. Renal ultrasound

A client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the most appropriate nursing response? A. "The damaged kidneys no longer release a hormone that prevents high blood pressure." B. "The waste products in the blood interfere with mechanisms that control blood pressure." C. "There is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products." D. "Because the kidneys cannot get rid of fluid, blood pressure goes up."

D. "Because the kidneys cannot get rid of fluid, blood pressure goes up."

Which assessment data in a client with chronic glomerulonephritis (GN) warrants the nurse to contact the primary health care provider? A. Itchy skin B. Serum potassium of 5.0 mEq/L (5.0 mmol/L) C. Mild proteinuria D. Third heart sound (S3)

D. Third heart sound (S3)

The nurse is caring a client who had a nephrostomy tube inserted 4 hours ago. Which assessment requires nursing action? A. Small amount of urine leaking around the catheter B. Creatinine of 1.8 mg/dL (160 mcmol/L) C. Dark pink-colored urine D. Tube that has stopped draining

D. Tube that has stopped draining