Exam 2 - Renal Miscellaneous

*NEPHROTIC SYNDROME* The nurse is preparing a teaching care plan for the client diagnosed with nephrotic syndrome. Which intervention should the nurse include? 1. Stop steroids if a moon face develops. 2. Provide teaching for taking diuretics. 3. Increase the intake of dietary sodium. 4. Report a decrease in daily weight.

1. Steroid therapy should not be stopped abruptly if signs of toxicity occur, such as moon face, because it may result in adrenal insufficiency. *2. Treatment includes diuretics to eliminate dependent edema, usually in the ankles and sacrum. Medication teaching is an appropriate intervention.* 3. Sodium is restricted to prevent fluid retention. 4. A decrease in weight is expected if a diuretic is administered; this indicates the medication is effective.

*KIDNEY TRANSPLANT* The nurse is caring for a client who received a kidney transplant from an unrelated cadaver donor. Which interventions should be included in the plan of care? *Select all that apply* 1. Collect a urine culture every other day. 2. Prepare the client for dialysis three (3) times a week. 3. Monitor urine osmolality studies. 4. Monitor intake and output every shift. 5. Check abdominal dressing every four (4) hours.

*1, 2* *1. Urine cultures are performed frequently because of the bacteria present in the early stages of transplantation.* *2. A cadaver kidney must have undergone acute tubular necrosis and may not function for 2 to 3 weeks, during which time the client may experience anuria, oliguria, and polyuria and require dialysis.* 3. Serum creatinine and BUN levels are monitored, but there is no need to monitor the urine osmolality. 4. Hourly outputs are monitored and compared with the intake of fluids. 5. The dressing is a flank dressing.

*PYELONEPHRITIS* The nurse is caring for a pregnant client diagnosed with acute pyelonephritis. Which scientific rationale supports the client being hospitalized for this condition? 1. The client must be treated aggressively to prevent maternal/fetal complications. 2. The nurse can force the client to drink fluids and avoid nausea and vomiting. 3. The client will be dehydrated and there won't be sufficient blood flow to the baby. 4. Pregnant clients historically are afraid to take the antibiotics as ordered.

*1. A pregnant client diagnosed with a UTI will be admitted for aggressive IV antibiotic therapy. After symptoms subside, the client will be sent home to complete the course of treatment with oral medications.* 2. The nurse cannot "force" a client to drink, and forcing fluids could result in nausea and vomiting, not prevent it. 3. The client may or may not be dehydrated. 4. Pregnant clients have a right to be concerned about taking medications, but most are comfortable taking medications prescribed by the obstetrician.

*NEPHRECTOMY* Which intervention is most important for the nurse to implement for the client with a left nephrectomy? 1. Assess the intravenous fluids for rate and volume. 2. Change surgical dressing every day at the same time. 3. Monitor the client's PT/PTT/INR level daily. 4. Monitor the percentage of each meal eaten.

*1. Assessing the rate and volume of intravenous fluid is the most important intervention for the client who has 1 kidney because an overload of fluids can result in pulmonary edema.* 2. A daily dressing change can be performed at any time and is not the priority intervention. 3. A client who has had surgery should not be receiving any type of anticoagulant therapy, so the nurse should not have to monitor this laboratory data. 4. The nurse assesses the amount of food eaten, but it is not the most important intervention.

*RENAL BIOPSY* The nurse is caring for the client recovering from a percutaneous renal biopsy. Which data indicate the client is complying with client teaching? 1. The client is lying flat in the supine position. 2. The client continues oral fluids restriction while on bedrest. 3. The client use the bedside commode to urinate. 4. The client refuses to ask for any pain medication.

*1. The client needs to lie flat on the back to apply pressure to prevent bleeding.* 2. The client has oral intake withheld prior to the biopsy, not after the client is awake. 3. The client must lie flat on the back, so using a bedside commode is not maintaining bedrest. 4. The client should request pain medication if the client is in pain. This indicates the client is not compliant with the client teaching.

*RENAL TRAUMA* Which problem is most appropriate for the nurse to identify for the client experiencing renal trauma? 1. Infection of the renal tract 2. Ineffective tissue perfusion 3. Alteration in skin integrity 4. Alteration in temperature

1. A potential for infection is appropriate nursing diagnosis, but there is no indication of infection from this question. *2. Bleeding results in an impairment of tissue perfusion. Because of the large amount of blood flow through the renal system, bleeding is a major problem.* 3. Skin integrity is not necessarily an issue in trauma. There is no indication from the question the skin is not intact. 4. An alteration in temperature is not a problem for this client unless infection occurs. This intervention is not indicated at this time.

*PYELONEPHRITIS* The clinic nurse is caring for a client diagnosed with chronic pyelonephritis who is prescribed trimethoprim-sulfamethoxazole (Bactrim), a sulfa antibiotic, twice a day for 90 days. Which statement is the scientific rationale for prescribing this medication? 1. The antibiotic will treat the bladder spasms that accompany a urinary tract infection. 2. If the urine cannot be made bacteria free, the Bactrim will suppress bacterial growth. 3. In three (3) months, the client should be rid of all bacteria in the urinary tract. 4. The HCP is providing the client with enough medication to treat future infections.

1. Antibiotics may indirectly treat bladder spasms if the spasms are caused by an infection, but this is not the reason for prescribing the antibiotic in this manner. *2. Some clients develop a chronic infection and must receive antibiotic therapy as a routine daily medication to suppress the bacterial growth. The prescription will be refilled after the 90 days and continued.* 3. Clients who develop chronic infections may never be free of the bacteria. 4. HCPs do not usually prescribe PRN prescriptions for antibiotics.

*GLOMERULONEPHRITIS* The nurse is preparing a plan of care for the client diagnosed with acute glomerulonephritis. Which statement is an appropriate long-term goal? 1. The client will have a blood pressure within normal limits. 2. The client will show no protein in the urine. 3. The client will maintain normal renal function. 4. The client will have clear lung sounds.

1. Blood pressure within normal limits is a short-term goal. 2. Lack of protein in the urine is a short-term goal. *3. A long-term complication of glomerulonephritis is it can become chronic if unresponsive to treatment, and this can lead to end-stage renal disease. Maintaining renal function is an appropriate long-term goal.* 4. Clear lung sounds indicate the client has been able to process fluids and excrete them from the body. Preventing pulmonary edema is a short-term goal.

*NEPHROTIC SYNDROME* The nurse is caring for a client diagnosed with rule-out nephrotic syndrome. Which intervention should be included in the plan of care? 1. Monitor the urine for bright-red bleeding. 2. Evaluate the calorie count of the 500-mg protein diet. 3. Assess the client's sacrum for dependent edema. 4. Monitor for a high serum albumin level.

1. Hematuria is not a symptom of nephrotic syndrome. 2. A calorie count may be helpful in the treatment of this client, but a calorie count monitors what the name implies - calories. The dietitian can calculate the amount of protein the client consumes, but this is a protein count. *3. The classic sign/symptom of nephrotic syndrome is dependent edema located on the client's sacrum and ankles.* 4. A low serum albumin level is expected for a client diagnosed with nephrotic syndrome.

*GLOMERULONEPHRITIS* The elderly client is diagnosed with chronic glomerulonephritis. Which laboratory value indicates to the nurse the condition has become worse? 1. The blood urea nitrogen is 15 mg/dL. 2. The creatinine level is 1.2 mg/dL. 3. The glomerular filtration rate is 40 mL/min. 4. The 24-hour creatinine clearance is 100 mL/min.

1. Normal blood urea nitrogen levels are 7-18 mg/dL or 8-20 mg/dL for clients older than age 60 years. 2. Normal creatinine levels are 0.6 to 1.2 mg/dL. *3. Glomerular filtration rate (GFR) is approximately 120 mL/min. If the GFR is decreased to 40 mL/min, the kidneys are functioning at about one-third filtration capacity.* 4. Normal creatinine clearance is 85-125 mL/min for males and 75 to 115 mL/min for females.

*NEPHRECTOMY* The nurse is preparing the discharge teaching plan for the male client with a left-sided nephrectomy. Which statement indicates the teaching is effective? 1. "I can't wait to start back to work next week. I really need the money." 2. "I will take my temperature and if it is above 101, I will call my doctor." 3. "I am glad I won't have to keep track of how much I urinate in the day." 4. "I am happy I will be able to eat what I usually eat. I don't like this food."

1. The client recovering from a nephrectomy needs to refrain from strenuous or heavy activities, and norma activities should not be resumed until the client is given permission by the surgeon. *2. The client or family needs to contact the surgeon if the client develops chills, flank pain, decreased urinary output, or fever.* 3. The client needs to be informed of how to monitor the urinary output and which parameters should be reported to the surgeon. 4. The client needs to follow any dietary or fluid restriction the surgeon prescribes.

*RENAL SURGERY* The client is 12 hours postoperative renal surgery. Which data *warrant immediate* intervention by the nurse? 1. The abdomen is soft, nontender, and rounded. 2. Pain is not felt with dorsal flexion of the foot. 3. The urine output is 60mL for the past two (2) hours. 4. The clients trough vancomycin level is 24 mcg/mL.

1. The client who has renal surgery is at risk for paralytic ileus from the manipulation of the colon. A soft, rounded, and nontender abdomen does not require intervention. 2. Pain felt with dorsal flexion of the foot indicates a deep vein thrombosis; therefore, a client who is asymptomatic does not require intervention. 3. The minimum of 30mL/hr does not require intervention by the nurse. *4. The client who has restricted kidney function from surgery should be monitored for damage as a result of the use of aminoglycoside antibiotics, such as vancomycin, which are nephrotoxic. This level is high and warrants notifying the HCP.*

*KIDNEY TRANSPLANT* The client who has had a kidney transplant tells the nurse he has been taking St. John's wort, an herb, for depression. Which action should the nurse take *first*? 1. Praise the client for taking the initiative to treat the depression. 2. Remain nonjudgemental about the client's alternative treatment. 3. Refer the client to a psychologist for counseling for depression. 4. Instruct the client to quit taking the medication immediately.

1. The nurse should investigate any herbs the client is taking, especially if the client has a condition which requires long-term medication, such as antirejection medication. 2. The nurse should remain nonjudgemental but should intervene if the alternative treatment poses a risk to the client. 3. The client may need to be referred for psychological counseling, but it is not the first action the nurse should take. *4. St. John's wort decreases the effects of many medications, including oral contraceptives, antiretrovirals, and transplant immunosuppressant drugs. Rejection of the client's kidney could occur if the client continues to use St. John's wort.*