Elimination PREP U (NUR 2 TEST 2)

The health care provider is comparing results of a client's recent GFR measurement. Which result would be interpreted as normal? a. 120 to 130 mL/minute b. 100 to 110 mL/minute c. 70 to 115 mL/minute d. 135 to 145 mL/minute

a. The normal GFR, which varies with age, sex, and body size, is approximately 120 to 130 mL/minute/1.73 m2 for normal young healthy adults. A GFR below 60 mL/minute/1.73 m2 represents a loss of one half or more of the level of normal adult kidney function.

The nurse should advise clients taking phenazopyridine (Pyridium) that they may notice a change in urine color. Which color would the nurse identify? a. orange b. blue c. purple d. green

a. The nurse should advise clients taking phenazopyridine that their urine may become discolored and may appear a dark orange to brown color. Phenazopyridine does not cause the urine to become blue, purple, or green.

Which phase of acute renal failure signals that glomerular filtration has started to recover? a. Diuretic b. Oliguric c. Initiation d. Recovery

a. The oliguric period is accompanied by an increase in the serum concentration of wastes such as urea, creatinine, organic acids, and the electrolytes potassium, phosphorous, and magnesium. The initiation period begins with the initial insult and ends when cellular injury and oliguria develops. The diuretic phase is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover. The recovery period signals the improvement of renal function and energy level and may take 6 to 12 months.

The nurse is caring for a client who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the client? a. Limit oral fluid intake for 1 to 2 days. b. Report the presence of fine, sand like particles through the nephrostomy tube. c. Notify the health care provider about cloudy or foul-smelling urine. d. Report any pink-tinged urine within 24 hours after the procedure.

c.

The nurse is planning the care for a client with acute kidney injury (AKI). What should the nurse prioritize in the client's plan of care? Select all that apply. a. Assessing fluid balance b. Monitoring electrolyte levels c. Promoting infection control d. Optimizing pain control e. Protecting from falls

a, b, c The nurse will need to monitor fluid balance carefully as the client can experience both fluid volume excess and deficit in AKI. There are also serious consequences due to electrolyte imbalances, such as cardiac dysrhythmias related to hyperkalemia. Secondary infections are a major cause of death in people with AKI, making infection control another priority. Having AKI on its own does not increase the risk for falls or cause pain in the client.

A client with a recent diagnosis of renal failure requiring hemodialysis is being educated in the dietary management of the disease. Which statement by the client shows an accurate understanding of this component of treatment? Select all that apply. a. "I'll increase the carbohydrates in my diet to provide sufficient energy." b. "I've made a list of high-phosphate foods so that I can try to avoid them." c. "I'm making a point of trying to eat lots of bananas and other food rich in potassium." d. "I don't think I've been drinking enough, so I want to include 8 to 10 glasses of water each day." e. "I'm going to try a high-protein, low-carbohydrate diet."

a, b Persons with chronic kidney disease (CKD) are usually encouraged to limit their dietary phosphorus as a means of preventing secondary hyperparathyroidism, renal osteodystrophy, and hypocalcemia. Excessive protein, potassium, and fluids can be detrimental in individuals whose kidney disease requires hemodialysis. Because protein intake is limited, carbohydrate consumption should increase to meet daily energy requirements.

When caring for the client with kidney failure, the nurse anticipates that which laboratory test abnormalities will be present? Select all that apply. a. Elevated potassium b. Decreased calcium c. Increased creatinine d. Decreased BUN e. Decreased phosphate

a, b, c

As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur? a. Hyperphosphatemia b. Hypercalcemia c. Hypokalemia d. Metabolic alkalosis

a. Changes include hyperphosphatemia due to its decreased renal excretion, hypocalcemia and decreased vitamin D activation, hyperkalemia due to decreased potassium excretion, and metabolic acidosis from decreased acid secretion by the kidney and inability to regenerate bicarbonate.

The nurse is teaching a group of nursing students about the formation of urine in the nephron. Which component does the nurse teach is a component of the nephron? Select all that apply. a. Proximal convoluted tubule b. Loop of Henle c. Distal convoluted tubule d. Collecting tubule e. Renal pelvis

a, b, c, d As stated above, the nephron tubule is divided into four segments: a highly coiled segment called the proximal convoluted tubule, which drains Bowman capsule; a thin, looped structure called the loop of Henle; a distal coiled portion called the distal convoluted tubule; and a collecting tubule, which joins with several tubules to collect the filtrate.

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.

During hemodialysis, toxins and wastes in the blood are removed by which of the following? a. Diffusion b. Osmosis c. Ultrafiltration d. Filtration

a. The toxins and wastes in the blood are removed by diffusion, in which particles move from an area of higher concentration in the blood to an area of lower concentration into the dialysate.

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: a. hematuria. b. weight loss. c. increased urine output. d. increased blood pressure.

b. Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

A nurse is assessing a client with suspected urine retention. Which assessment findings will help to confirm this diagnosis? Select all that apply. a. Severe pain of palpation of the bladder b. Frequency c. Straining when initiating urination d. Feelings of incomplete bladder emptying e. Increased white blood cell count (WBC)

b, c, d Signs of outflow obstruction and urine retention include bladder distension, hesitancy, straining when initiating urination, frequency, small and weak stream, and overflow incontinence and feeling of incomplete bladder emptying. Increased WBC count and elevated temperature would signal infection, which does not have to occur with urinary retention.

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a. Diuresis b.Fever c. Absence of pain d. Weight loss

b. Fever is an indicator of infection or transplant rejection.

The nursing student learns in her anatomy and physiology class that the bladder has how many main components? a. One b. Two c. Three d. Four

b. The bladder consists of 2 main components: the body in which the urine collects and the neck which connects with the urethra.

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? a. Obstruction of the lower urinary tract b. Acute renal failure c. Infection d. Nephrotic syndrome

c. Frequency, urgency, and dysuria are commonly associated with urinary tract infection. Hesitancy and enuresis may indicate an obstruction. Oliguria or anuria and proteinuria might suggest acute renal failure. Nocturia is associated with nephrotic syndrome.

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? a. Pats skin dry after bathing b. Uses moisturizing creams c. Keeps nails trimmed short d. Brief, hot daily showers

d. 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.

A geriatric nurse is performing an assessment of body systems on an 85-year-old client. The nurse should be aware of what age-related change affecting the renal or urinary system? a. Increased ability to concentrate urine b. Increased bladder capacity c. Urinary incontinence d. Decreased glomerular filtration rate

d. Many age-related changes in the renal and urinary systems should be taken into consideration when taking a health history of the older adult. One change includes a decreased glomerular surface area resulting in a decreased glomerular filtration rate. Other changes include the decreased ability to concentrate urine and a decreased bladder capacity. It also should be understood that urinary incontinence is not a normal age-related change, but is common in older adults, especially in women because of the loss of pelvic muscle tone.

The nurse recognizes that which risk factor does NOT predispose a client to the development of kidney stones? a. immobilization b. gout c. hyperparathyroidism d. hypoparathyroidism

d. Hypoparathyroidism is not a risk factor for the development of kidney stones. Immobilization, gout, and hyperparathyroidism are risk factors.

The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse understand that oliguria is said to be present? a. When the urine output is less than 30 mL/h b. When the urine output is about 100 mL/h c. When the urine output is between 300 and 500 mL/h d. When the urine output is between 500 and 1,000 mL/h

a. Oliguria is defined as urine output <0.5 mL/kg/h

The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than ___________mL/kg/hr.

0.5 Oliguria is defined as urine output less than 0.5 mL/kg/hr.

When caring for the client with proteinuria, the nurse recognizes that dysfunction in which structure of the kidney allows protein to leak into the urine? a. Renal pelvis b. Glomerulus c. Calyx d. Collecting tubule

b. Alterations in the structure and function of the glomerular basement membrane are responsible for the leakage of proteins and blood cells into the filtrate that occurs in many forms of glomerular disease.

Retention of which electrolyte is the most life-threatening effect of renal failure? a. Calcium b. Sodium c. Potassium d. Phosphorous

c. Retention of potassium is the most life-threatening effect of renal failure.

The nurse is reviewing the results of a urinalysis on a client with acute pyelonephritis. Which of the following would the nurse most likely expect to find? a. High specific gravity b. Slightly acidic pH c. Absent proteinuria d. Pyuria

d. The chief abnormality noted with the urinalysis is pyuria (combination of bacteria and leukocytes). Specific gravity would be low, pH would be slightly alkaline, and proteinuria would be minimal to mild.

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 teaching a group of nursing students about the major functions of the kidney. What should the nurse include in the discussion? Select all that apply. a. Elimination of water b. Removal of waste products c. Removal of excess electrolytes d. Synthesis of insulin e. Removal of red blood cells

a, b, c The functions of the kidney focus on elimination of water, waste products, excess electrolytes, and unwanted substances from the blood.

A nurse on the renal unit is caring for a client who will soon begin peritoneal dialysis. The family of the client asks for education about the peritoneal dialysis catheter that has been placed in the client's peritoneum. The nurse explains the three sections of the catheter and talks about the two cuffs on the dialysis catheter. What would the nurse explain about the cuffs? Select all that apply. a. The cuffs are made of Dacron polyester. b. The cuffs stabilize the catheter. c. The cuffs prevent the dialysate from leaking. d. The cuffs provide a barrier against microorganisms. e. The cuffs absorb dialysate

a, b, c, d Most of these catheters have two cuffs, which are made of Dacron polyester. The cuffs stabilize the catheter, limit movement, prevent leaks, and provide a barrier against microorganisms. They do not absorb dialysate.

The nurse will monitor which clients at risk for the development of chronic kidney disease (CKD)? Select all that apply. a. Systemic lupus erythematosus b. Polycystic kidney disease c. Glomerulonephritis d. Hyperlipidemia e. Diabetes

a, b, c, e Permanent renal damage can result from systemic lupus erythematosus, polycystic kidney disease, glomerulonephritis, or diabetes. Hypertension also is a frequent cause for CKD. Hyperlipidemia does not cause CKD but may develop in clients with CKD.

A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? a. Kidney b. Ureter c. Bladder d. Urethra

a. The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation.

A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate? a. "Try washing clothes with a strong detergent to ensure that all impurities are gone." b. "When you shower, use really warm water and an antibacterial soap." c. "Keep your showers brief, patting your skin dry after showering." c. "Liberally apply alcohol to the areas of your skin where you itch the most."

c. The client with pruritus needs to keep the skin clean and dry. The client should take brief showers with tepid water, pat the skin dry, use moisturizing lotions or creams, and avoid scratching. In addition, the client should use a mild laundry detergent to wash clothes and an extra rinse cycle to remove all detergent or add 1 tsp vinegar per quart of water to the rinse cycle to remove any detergent residue.

A nurse is caring for a client who has been diagnosed with kidney colic but has yet passed the stone. Which interventions would the nurse emphasize when planning the care for this client? a. Have the client take cool baths. b. Restrict fluid intake. c. Strain the urine. d. Administer acetaminophen every 4 hours for pain.

c. All urine should be strained during an attack in the hope of retrieving the stone for chemical analysis and determination of type. This information, along with a careful history and laboratory tests, provides the basis for long-term preventive measures. The client will require an increase in fluid intake. The client will also require an opioid analgesic to control the pain.

The nurse is caring for a patient with severe pain related to ureteral colic. What medication can the nurse administer with a physician's order that will inhibit the synthesis of prostaglandin E, thereby reducing swelling and facilitating passage of the stone? a. Morphine sulfate b. Aspirin c. Ketoralac (Toradol) d. Meperidine (Demerol)

c. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac (Toradol) are effective in treating renal stone pain because they provide specific pain relief. They also inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone.

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: a. oliguria. b. polyuria. c. anuria. d. hematuria.

c. Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine.

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? a. Keep the AV fistula site dry. b. Keep the AV fistula wrapped in gauze. c. Take the client's blood pressure in the left arm. d. Assess the AV fistula for a bruit and thrill.

d. The nurse needs to assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.

A client who is suspected of having acute renal failure would first be assessed by which blood tests? Select all that apply. a. Blood urea nitrogen b. CBC c. Creatinine d. Phosphorus

a, c Blood tests such as blood urea nitrogen and creatinine provide information about renal function. A complete blood count and phosphorus level would identify other problems.

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following? a. Abnormalities in urine b. Location of discomfort c. Elevated calcium levels d. Structural defects in the kidneys

b. The physical examination of a client with pyelonephritis helps the nurse determine the location of discomfort and signs of fluid retention, such as peripheral edema or shortness of breath. Observing and documenting the characteristics of the client's urine helps the nurse detect abnormalities in the urine. Laboratory blood tests reveal elevated calcium levels, whereas radiography and ultrasonography depict structural defects in the kidneys.

A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure? a. Poor perfusion to the kidneys b. Damage to cells in the adrenal cortex c. Obstruction of the urinary collecting system d. Nephrotoxic injury secondary to use of contrast media

d. Intrinsic renal failure results from damage to the kidney, such as from nephrotoxic injury caused by contrast media, antibiotics, corticosteroids, or bacterial toxins. Poor perfusion to the kidneys may result in prerenal failure. Damage to the epithelial cells of the renal tubules results from nephrotoxic injury, not damage to the adrenal cortex. Obstruction of the urinary collecting system may cause postrenal failure.

Which of the following would a nurse classify as a prerenal cause of acute renal failure? a. Polycystic disease b. Ureteral stricture c. Prostatic hypertrophy d. Septic shock

d. Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias. Ureteral stricture and prostatic hypertrophy would be classified as postrenal causes. Polycystic disease is classified as an intrarenal cause of acute renal failure.

A client has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the client about what topic? a. Typical diet b. Allergy status c. Psychosocial stressors d. Current medication use

d. The kidneys are susceptible to the adverse effects of medications because they are repeatedly exposed to substances in the blood. Nephrotoxic medications are a more likely cause of AKI than diet, allergies, or stress.

The nurse is caring for a client who underwent a kidney transplant. The client appears anxious and tearful and states, "My body is going to reject the new kidney; I know I'm going to die." What is the best response by the nurse? a. "Don't think like that; I'm certain you will be fine." b. "If your body rejects the kidney, you can go back on dialysis; you are not going to die." c. "You've waited years for this transplant, you need to think positively." d. "I understand your concerns, let's talk about them."

d. The nurse must address the client's concerns and encourage the client to express any concerns. The rejection of a transplanted kidney is of great concern to the client, the family, and the health care team for many months. An important nursing function is the assessment of the client's stress and coping. The nurse uses each visit with the client to determine if the client and family are coping effectively and if the client is adhering to the prescribed medication regimen. If indicated or requested, the nurse refers the client for counseling. The other responses are non-therapeutic.

The nurse is conducting discharge teaching for a client who was admitted with a kidney stone. The nurse includes which instruction as a measure to prevent additional kidney stones? a. Increase protein intake. b. Adhere to a low-calcium diet. c. Avoid drinking water before bedtime. d. Avoid drinking tea.

d. The nurse should teach the client to avoid tea and other oxalate-containing foods, such as spinach, strawberries, rhubarb, peanuts, and wheat bran. The client should restrict protein intake to 60 g/day and should drink two glasses of water at bedtime. Low-calcium diets are generally not recommended.

What are appropriate interventions in the care of a client diagnosed with renal calculi? Select all that apply. a. Straining the client's urine b. Addressing the client's pain c. Restricting the client's oral fluid intake d. Keeping track of intake and output e. Inserting a Foley catheter

a, b, d One of the major manifestations of kidney stones is pain. Treatment includes relief of pain. All urine should be strained during an attack in the hope of retrieving the stone for chemical analysis and determination of type. Adequate fluid intake reduces the concentration of stone-forming crystals in the urine and needs to be encouraged. Keeping track of intake and output will help to identify poor output possibly due to obstruction by a calculi. A Foley catheter is not indicated when the client is able to urinate.

A client with chronic kidney disease (CKD) is starting hemodialysis. Which diet will the dialysis nurse likely recommend? a. Diet low in proteins but including eggs and lean meat b. High-calorie diet primarily with carbohydrates c. Low-protein diet with only 15% of protein intake being of high biologic value d. High-protein diet with rich amino acid content

a. A low-protein diet with at least 50% of the proteins that are rich in essential amino acids, such as eggs, lean meat and milk, is recommended for clients with CKD. This will prevent protein malnutrition. The other dietary options would not be optimal for clients on hemodialysis.

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. removal of the transplanted kidney. b. high-dose IV cyclosporine (Sandimmune) therapy. c. bone marrow transplant. d. intra-abdominal instillation of methylprednisolone sodium succinate (Solu-Medrol).

a. 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 IV to treat acute organ rejection, but it's ineffective against hyperacute rejection.

Glomerulonephritis is an inflammatory response in the glomerular capillary membrane, and causes disruption of the renal filtration system. Although diagnostic urinalysis can reveal glomerulonephritis, many clients with glomerulonephritis exhibit: a. no symptoms. b. fever. c. headache. d. polyuria.

a. Many clients with glomerulonephritis have no symptoms. Early symptoms may be so slight that the client does not seek medical attention.

Which client is displaying manifestations of having a kidney stone? a. Acute onset of colicky flank pain radiating to lower abdomen b. Elevation in systemic blood pressure and frequent urination c. A visible abdominal mass and abdominal pain in bilateral lower quadrants d. Increased thirst and urinary output with warm, dry skin

a. One of the major manifestations of kidney stones is pain. Depending on the location, there are two types of pain associated with kidney stones-colic or noncolic. The pain may radiate to the lower abdominal quadrant, bladder area, perineum, or scrotum in men. Stones are not externally visible or palpable. Obstruction by a stone may result in urinary retention and increased fluid volume.

A nurse is caring for a client with end-stage renal failure who has symptoms of anemia. The nurse anticipates administering which intervention to increase red blood cell production? a. Epoetin alfa b. Whole blood c. Oxygen d. Iron

a. Persons with end-stage kidney disease often are anemic because of an inability of the kidneys to produce erythropoietin. This anemia usually is managed by the administration of a recombinant erythropoietin (epoetin alfa) produced through DNA technology to stimulate erythropoiesis.

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 performing palpation of the kidney during assessment of the client on the urology unit. The nurse plans to palpate in which area? a. Upper abdomen, under the costal margins b. Between the 12th thoracic and 3rd lumbar vertebrae c. Lower abdomen in the suprapubic area d. Right costal margin, anterior abdomen

b. The kidneys are paired, bean-shaped organs that lie outside the peritoneal cavity in the back of the upper abdomen, one on each side of the vertebral column at the level of the 12th thoracic to 3rd lumbar vertebrae.

A nurse on a busy medical unit provides care for many clients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which client? a. A client whose diagnosis of chronic kidney disease requires a fluid restriction b. A client who has Alzheimer disease and who is acutely agitated c. A client who is on bed rest following a recent episode of venous thromboembolism d. A client who has decreased mobility following a transmetatarsal amputation

b. Clients who are confused and agitated risk trauma through the removal of an indwelling catheter which has the balloon still inflated. Recent VTE, amputation, and fluid restriction do not directly create a risk for injury or trauma associated with indwelling catheter use.

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? 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 (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). 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.

A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client's hypervolemia and hyperkalemia. Which of the following therapies will the client's hemodynamic status best tolerate? a. Hemodialysis b. Peritoneal dialysis c. Continuous venovenous hemodialysis (CVVHD) d. Plasmapheresis

c. CVVHD facilitates the removal of uremic toxins and fluid. The hemodynamic effects of CVVHD are usually mild in comparison to hemodialysis, so CVVHD is best tolerated by an unstable client. Peritoneal dialysis is not the best choice, as the client may have sustained abdominal injuries during the accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and electrolyte balance.

The nurse is caring for a client with a nursing diagnosis of "Impaired urinary elimination related to discomfort of urinary tract infection." Which medication will provide comfort to this client? a. Fosfomycin b. Sulfamethoxazole c. Nitrofurantoin d. Phenazopyridine

d. Phenazopyridine is prescribed for relief of pain associated with a urinary tract infection. It decreases the burning and urgency related to the disorder. The other medications are all anti-infectives and will ultimately decrease symptoms, but the phenazopyridine will act very quickly.

A client diagnosed with chronic kidney disease (CKD) with GFR < 5 mL/min/1.73 m2 should be monitored for which fluid and electrolyte imbalance? Select all that apply. a. Polyuria b. Hyperkalemia c. Metabolic alkalosis d. Hypocalcemia e. Hyponatremia

a, b, d, e The failing kidneys lose ability to concentrate urine and to reabsorb sodium. Hyperkalemia develops late in CKD, as nephrons can no longer regulate potassium excretion and GFR < 5 mL/min/1.73 m2. Metabolic acidosis occurs when balance between sodium and bicarbonate is lost. Hypocalcemia develops as excretion of phosphate fails and blood levels of phosphate rise.

The nurse will monitor the client with chronic kidney disease (CKD) for which possible cardiovascular changes? Select all that apply. a. Heart failure b. Hypertension c. Hypophosphatemia d. Impaired platelet function e. Pericarditis

a, b, e Hypertension often occurs early in CKD due to several factors, including increased blood volume. Congestive heart failure and pericarditis can occur with more advanced CKD. Hyperphosphatemia develops as kidneys lose ability to excrete phosphate.

A client with chronic kidney disease reports having extreme fatigue, chest pressure when walking and trouble breathing when lying supine in bed. The client's current hemoglobin level is 8.3 g/dL (83 g/L). Which intervention(s) will likely be prescribed for this client during this visit? Select all that apply. a. Increase in iron intake via food and supplementation b. Dietary consult to focus on low phosphate foods and high fiber options c. Injection of an erythropoietin-stimulating agent d. Educational handout on foods to help increase the blood platelet count e. Type and crossmatch for an immediate blood transfusion

a, c Iron and erythropoietin-stimulating agents (ESA) are used to treat anemia and decrease red blood cell (RBC) transfusions and their associated risks. Clients with renal problems do need to watch their phosphate levels; however, it will not help to increase RBC counts. The newest guidelines recommend that restrictive RBC transfusion threshold, in which the transfusion is not indicated until the hemoglobin level is 7 g/dL (70 g/L). It is recommended for hospitalized adult clients who are hemodynamically stable. Lean meats such as fish, chicken and turkey are rich in protein, zinc and vitamin B12; all help increase the blood platelet count, but there is no indication in the laboratory values that this client has a low platelet count.

Which procedure is a nonsurgical method of treatment for renal calculi (kidney stones)? a. Extracorporeal shock wave lithotripsy (ESWL) b. Percutaneous ureterolithotomy c. Percutaneous nephrolithotomy d. Retrograde ureteroscopy

a. ESWL is a nonsurgical treatment that uses sound waves, laser, or dry shock wave energy to break apart the stones. All of the other procedures are surgical in nature.

The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to do what? a. Wash hands carefully and frequently. b. Ensure immediate function of the donated kidney. c. Instruct the client to wear a face mask. d. Bar visitors from the client's room.

a. The nurse ensures that the client is protected from exposure to infection by hospital staff, visitors, and other clients with active infections. Careful handwashing is imperative; face masks may be worn by hospital staff and visitors to reduce the risk for transmitting infectious agents while the client is receiving high doses of immunosuppressants. Visitors may be limited, but are not normally barred outright. Ensuring kidney function is vital, but does not prevent infection.

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 health care provider is reviewing laboratory results of a client. Select the diagnostic test that is considered the best measurement of overall kidney function. a. Glomerular filtration rate (GFR) b. Serum creatinine levels c. Urine albumin levels d. Blood urea nitrogen (BUN)

a. GFR is the best overall measure of kidney function. GFR is usually estimated using the serum creatinine concentration. Creatinine, a by-product of muscle metabolism, is produced at a fairly constant rate, is freely filtered in the glomerulus, and is not reabsorbed in the renal tubules. Essentially all of the creatinine filtered by the kidneys is lost in the urine; therefore, serum creatinine is an indirect measure of GFR. Proteinuria serves as a key adjunctive tool for measuring nephron injury and repair. Urine normally contains small amounts of protein. Blood tests for BUN and creatinine provide information regarding the ability to remove nitrogenous wastes from the blood.

A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? a. "This medication will relieve your pain." b. "This medication should be taken at bedtime." c. "This medication will prevent re-infection." d. "This will kill the organism causing the infection."

a. Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure? a. The kidneys can improve over a period of months. b. Once on dialysis, the need will be permanent. c. Kidney function will improve with transplant. d. Acute renal failure tends to turn to end-stage failure.

a. The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute renal failure can progress to chronic renal failure.\

A client with postrenal acute kidney injury (AKI) exhibits oliguria and edema with laboratory results revealing increased levels of urea, potassium, and creatinine. Based on these data, which phase of AKI is this client most likely experiencing? a. Oliguric phase b. Onset phase c. Recovery phase d. Diuretic phase

a. The oliguric phase of AKI is characterized by marked decrease in glomerular filtration rate (GFR), causing sudden retention of endogenous metabolites, such as urea, potassium, sulfate, and creatinine, that normally are cleared by the kidneys. The urine output is usually lowest at this point. Fluid retention gives rise to edema, water intoxication, and pulmonary congestion. AKI typically progresses through four phases: the onset phase, during which tubular injury is induced; the oliguric phase, during which the GFR falls, nitrogenous wastes accumulate, and urine output decreases; the diuretic phase when the kidneys try to heal and urine output increases; and the recovery phase, where tubular edema resolves and renal function improves. During recovery, there is normalization of fluid and electrolyte balance.

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 whose acute kidney injury has prerenal cause. What most likely caused this client's health problem? a. Heart failure b. Glomerulonephritis c. Ureterolithiasis d. Aminoglycoside toxicity

a. By causing inadequate renal perfusion, heart failure can lead to prerenal failure. Glomerulonephritis and aminoglycoside toxicity are renal causes, and ureterolithiasis is a postrenal cause.

A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the client reviews the initial orders and notes 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? a. Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential. b. Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this client. c. A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary. d. There is great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations.

a. Hematuria is the most common manifestation of kidney trauma; its presence after trauma suggests renal injury. Hematuria may not occur, or it may be detectable only on microscopic examination. All urine should be saved and sent to the laboratory for analysis to detect RBCs and to evaluate the course of bleeding. Measuring intake and output is not a function of the laboratory. The laboratory does not save urine to test creatinine clearance at a later time. The laboratory does not monitor the urine for sodium or potassium concentrations.

A client has a dilated renal pelvis due to obstruction of urine outflow from the kidney. The pressure of filtrate formation is damaging the renal structures. Which condition is most likely? a. Hydronephrosis b. Urinary calculi c. Papillary necrosis d. Prostatic hyperplasia

a. Hydronephrosis refers to urine-filled dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction of urine outflow.

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 with end-stage kidney disease has developed anemia. The nurse teach this client that the reason anemia has developed is: a. the damaged kidney is unable to produce erythropoietin. b. clients with kidney disease must avoid consuming iron. c. medications taken for kidney disease destroy the red blood cells. d. activation of vitamin D cannot occur when kidneys are damaged.

a. Persons with end-stage kidney disease often are anemic because of an inability of the kidneys to produce erythropoietin, the hormone that regulates the differentiation of red blood cells in the bone marrow.

A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? a. Elevated urea levels b. Hyperkalemia c. Hypocalcemia d. Elevated white blood cells

b. Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.

The nurse is caring for a patient recently diagnosed with renal calculi. The nurse should instruct the patient to increase fluid intake to a level where the patient produces at least how much urine each day? a. 1,250 mL b. 2,000 mL c. 2,750 mL d. 3,500 mL

b. Unless contraindicated by renal failure or hydronephrosis, patients with renal stones should drink at least eight 8-ounce glasses of water daily or have IV fluids prescribed to keep the urine dilute. A urine output exceeding 2 L a day is advisable.

A geriatric nurse is caring for several clients. Which alterations in health should the nurse attribute to age-related physiologic changes? a. An 81-year-old man's serum creatinine level has increased sharply since his last blood work. b. A 78-year-old woman's GFR has been steadily declining over several years. c. A 90-year-old woman's blood urea nitrogen (BUN) is rising. d. A dipstick of an 80-year-old man's urine reveals protein is present

b. A gradual decrease in GFR is considered a normal age-related change. Increased creatinine or BUN would warrant follow up, as would the presence of protein in a client's urine.

A client is suspected to have chronic kidney disease (CKD). The nurse will use which glomerular filtration rate (GFR) to aid in this diagnosis? a. 60 mL/min/1.73 m2 or less for 1 month b. 60 mL/min/1.73 m2 or less for 3 months c. 70-90 mL/min/1.73 m2 for 1 month d. 70-90 mL/min/1.73 m2 for 3 months

b. A GFR of 60 ml/min/1.73 m2 or less for 3 months or longer is diagnostic for CKD.

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? a. "The risk of peritonitis is greater with this type of dialysis." b. "This type of dialysis will provide more independence." c. "Peritoneal dialysis will require more work for you." d. "Peritoneal dialysis does not work well for every client."

b. Once a treatment choice has been selected by the client, the nurse should support the client in that decision. Continuous cyclic peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients.

The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document? a. Urinary frequency b. Urinary urgency c. Urinary incontinence d. Urinary stasis

b. The nurse would document urinary urgency. Urinary frequency is urinating more frequently than normal often times due to inadequate emptying of the bladder. Urinary incontinence is the involuntary loss of urine. Urinary stasis is a stoppage or diminution of flow.