Exam 4 AH1 Ch70

In planning care for a client with renal cell carcinoma, the nurse monitors for which electrolyte imbalance? a. Hyponatremia b. Hypernatremia c. Hypocalcemia d. Hypercalcemia

ANS: D Renal cell carcinoma tissues frequently produce ectopic hormones, including parathyroid hormone. Increased production of parathyroid hormone leads to decreased renal excretion of calcium and increased serum calcium concentration. The other electrolyte abnormalities typically do not occur.

A client presents to the emergency department with severe dehydration and is ordered to receive 3 L of fluid over 6 hours. The nurse sets the intravenous pump at a rate of ______ mL/hr.

500

The nurse completes which assessment in a client with acute glomerulonephritis and periorbital edema? a. Auscultating breath sounds b. Checking blood glucose levels c. Measuring deep tendon reflexes d. Testing urine for protein

ANS: A Acute glomerular nephritis can cause sodium and water retention. When clients have edema, they may also have circulatory overload with pulmonary edema. The other assessments would not be related to this client's condition

In assessing a client recently diagnosed with acute glomerulonephritis, the nurse asks which question to determine potential contributing factors? a. "Are you sexually active?" b. "Do you have pain or burning on urination?" c. "Has anyone in your family had chronic kidney problems?" d. "Have you had a cold or sore throat within the last 2 weeks?"

ANS: D The most common cause of acute glomerulonephritis is the presence of a systemic infection (often a skin or respiratory infection) resulting in the formation of antigen-antibody complexes, which precipitate in the kidney tissues. The other questions would not assess for contributing causes.

A client has nephrotic syndrome. Which finding shows that therapy is effective? a. Serum albumin level, 2.8 g/dL b. Serum albumin level, 4 g/dL c. Urine protein level, 3.7 g/24 hr d. Potassium, 4.2 mEq/L

ANS: B The main diagnostic findings in nephrotic syndrome are severe proteinuria, low serum albumin, high serum lipids, and fat in the urine. A serum albumin of 4 g/dL is within the normal range, showing that therapy is working. An albumin level of 2.8 g/dL is low, and proteinuria of 3.7 g/24 hr is high, showing that the disease is not yet controlled. Potassium is not affected.

A client who had kidney trauma required a nephrectomy. What does the nurse teach the client about this condition? a. "You need to avoid participating in contact sports like football." b. "You probably will end up on dialysis a few years from now." c. "You need medication to control your high blood pressure from the injury." d. "You will always be required to restrict your salt and fluid intake."

ANS: A Clients with one kidney need to avoid contact sports because the kidneys are easily injured. The client will not end up on dialysis, have new hypertension, or be required to restrict salt and fluids because of the nephrectomy.

Which clinical manifestation indicates to the nurse that a client with glomerulonephritis (GN) is responding as expected to the prescribed treatment? a. The client has lost 11 pounds in the past 10 days. b. The client's urine specific gravity is 1.048. c. No blood is observed in the client's urine. d. The client's blood pressure is 152/88 mm Hg.

ANS: A Fluid retention is a major feature of glomerular nephritis. This weight loss represents fluid loss, indicating that the glomeruli are performing the function of filtration. The urine specific gravity is high. Blood is not usually seen in GN, so this finding would be expected. The client's blood pressure is too high; this may indicate kidney damage or fluid overload.

The nurse monitors for which clinical manifestations in a client with nephrotic syndrome? (Select all that apply.) a. Proteinuria, >3.5 g/24 hr b. Hypoalbuminemia c. Dehydration d. Lipiduria e. Dysuria f. Costovertebral angle (CVA) tenderness

ANS: A, B, D Nephrotic syndrome is caused by glomerular damage and is characterized by proteinuria (protein level higher than 3.5 g/24 hr), hypoalbuminemia, edema, and lipiduria. CVA tenderness is present with inflammatory changes in the kidney. Dysuria is present with cystitis.

The visiting nurse has many clients who are African American. Which intervention is most important for the nurse to accomplish when seeing these clients? a. Weigh the clients and compare their weights. b. Assess the clients' blood pressure. c. Observe the clients for any signs of abuse. d. Ask the clients about their medications.

ANS: B All interventions are important for the visiting nurse to accomplish. However, African Americans have a high rate of hypertension leading to end-stage renal disease. Each encounter that the nurse has with an African-American client provides a chance to detect hypertension and treat it. If the client is already on antihypertensive medication, assessing blood pressure monitors therapy.

Which statement by a client with hypertension secondary to renal disease indicates the need for further teaching? a. "I can prevent more damage to my kidneys by managing my blood pressure." b. "If I have increased urination at night, I need to drink less fluid during the day." c. "I need to see the dietitian to discuss limiting my protein intake." d. "It is important that I take my antihypertensive medications as directed."

ANS: B Blood pressure control is needed to slow the progression of renal dysfunction. The client should not restrict fluids to prevent dehydration. Increased nocturnal voiding can be decreased by consuming the same amount of fluid earlier in the day. When dietary protein is restricted, refer the client to the registered dietitian as needed.

A client with polycystic kidney disease (PKD) has received extensive teaching in the clinic. Which statement by the client indicates that an important goal related to nutrition is being met? a. "I take a laxative every night before going to bed." b. "I have a soft bowel movement every morning." c. "Food tastes so much better since I can use salt again." d. "The white bread I am eating does not cause gas."

ANS: B Clients with PKD often have constipation, which can be managed with increased fiber, exercise, and drinking plenty of water. A soft bowel movement on a regular basis indicates that the client is preventing constipation. Laxatives should be used cautiously, and the need for their use indicates that the goal of preventing constipation via nutritional means is not being met. Clients with PKD should be on a restricted salt diet. White bread has a low fiber count and would not be included in a high-fiber diet.

A client is in the emergency department after experiencing kidney trauma. The abdomen is tender and distended, and blood is visible at the urinary meatus. Which action by the nurse is most appropriate? a. Assess vital signs and abdominal pain every 5 to 15 minutes. b. Consult with the provider before inserting a catheter. c. Monitor the client's IV rate and prepare to give blood. d. Assist with obtaining informed consent for surgery if needed.

ANS: B Clients with blood at the urinary meatus should not have a urinary catheter inserted via the urethra before additional diagnostic studies are done. The urethra could be torn. The nurse should question the provider about the need for a catheter; if one is needed, the provider can insert a suprapubic catheter. The other options are appropriate interventions.

A client with polycystic kidney disease and hypertension is prescribed a diuretic for blood pressure control. Which statement by the client indicates the need for further teaching regarding these orders? a. "I will weigh myself every day at the same time." b. "I will drink only 1 liter of fluid each day." c. "I will avoid aspirin and aspirin-containing drugs." d. "I will avoid nonsteroidal anti-inflammatory drugs."

ANS: B Diuretics for blood pressure control can lead to fluid volume depletion and can decrease blood flow to the kidney, further decreasing renal function. The client should be instructed to drink at least 2500 mL/24 hr. NSAIDs should be used cautiously because they can reduce kidney blood flow. Aspirin products increase the risk for bleeding and should be avoided.

On assessment of a client with polycystic kidney disease (PKD), which finding is of greatest concern to the nurse? a. Flank pain b. Periorbital edema c. Bloody and cloudy urine d. Enlarged abdomen

ANS: B Flank pain and a distended or enlarged abdomen occur in PKD because the kidneys enlarge and displace other organs. Urine can be bloody or cloudy owing to cyst rupture or infection. Periorbital edema would not be a finding related to PKD and should be investigated further.

A client with diabetes is hospitalized with recurrent pyelonephritis. The provider orders IV gentamicin (Garamycin) before culture results come back. Which action by the nurse is best? a. Monitor the client's blood sugar before and after each dose. b. Consult with the pharmacist about the antibiotic selection. c. Monitor the client's daily blood urea nitrogen and creatinine levels. d. Check the client's most recent hemoglobin A1c result.

ANS: B Gentamycin is an aminoglycoside antibiotic and has nephrotoxic properties. People with diabetes are always at risk for diabetes-related kidney disease, and such agents should be avoided in this population. The nurse should consult the pharmacist for a list of antibiotics acceptable for empiric therapy for this client. Blood glucose does not need to be monitored more frequently when a client with diabetes receives antibiotics. Checking laboratory work is always an important nursing function, but client safety takes priority.

A client has nephrotic syndrome and a normal glomerular filtration. Which dietary selection shows that the client understands nutritional therapy for this condition? a. Decreased intake of protein b. Increased intake of protein c. Decreased intake of carbohydrates d. Increased intake of carbohydrates

ANS: B In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and edema formation. If glomerular filtration is normal or near-normal, increased protein loss should be matched by increased intake of protein.

In interviewing a client with a family history of polycystic kidney disease (PKD), the nurse assesses for which clinical manifestations most carefully? (Select all that apply.) a. Nocturia b. Flank pain c. Diarrhea d. Dysuria e. Bloody urine f. Increased abdominal girth

ANS: B, E, F Flank pain and abdominal girth size are related to distention, and bloody urine is seen with tissue damage secondary to the PKD. The client may also have constipation.

A middle-aged client with diabetes mellitus is being treated for the third episode of acute pyelonephritis in the past year and asks what can be done to help prevent these infections. Which is the nurse's best response? a. "Test your urine daily for the presence of ketone bodies and proteins." b. "Use tampons rather than sanitary napkins during your menstrual period." c. "Drink more water and empty your bladder every 2 to 3 hours during the day." d. "Keep your hemoglobin A1c under 9% by keeping your blood sugar controlled."

ANS: C Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons. Chronically elevated blood glucose levels spill glucose into the urine, changing the pH and providing a favorable climate for bacterial growth. The neuropathy associated with diabetes reduces bladder tone and reduces the client's sensation of bladder fullness. Thus, even with large amounts of urine, the client voids less frequently, allowing stasis and overgrowth of microorganisms. Increasing fluid intake (specifically water) and voiding frequently prevent stasis and bacterial overgrowth. Testing urine and wearing tampons will not help prevent pyelonephritis. A hemoglobin A1c of 9% is too high.

A client is hospitalized with a urinary tract infection (UTI). Which clinical manifestation alerts the nurse to the possibility of a complication from the UTI? a. Burning on urination b. Cloudy, dark urine c. Fever and chills d. Hematuria

ANS: C Lower urinary tract infections are rarely associated with systemic symptoms of fever and chills. A client with a UTI who develops fever and chills should be assessed for the development of pyelonephritis. The other options can be seen with UTI.

An older client is hospitalized with suspected heart failure. After 2 days of treatment, the client is not improving. Which laboratory value does the nurse report to the provider? a. Potassium, 3.7 mEq/L b. Sodium, 144 mEq/L c. Glomerular filtration rate, 55 mL/min d. Creatinine, 0.9 mg/dL

ANS: C The client's GFR is extremely low; this can correspond with kidney disorders, including acute glomerulonephritis (GN). Because of pulmonary and cardiac congestion that accompanies acute GN, the condition can be mistaken for heart failure, especially in the older adult. The nurse should report this laboratory value so the client can undergo additional diagnostic studies. The other laboratory values are normal.

A client with autosomal dominant polycystic kidney disease (ADPKD) asks whether his children could develop this disease. Which is the nurse's best response? a. "No genetic link is known, so your children are not at increased risk." b. "The disease is sex linked, so only your sons could be affected." c. "Both you and your wife must have the disease for your children to develop it." d. "Each of your children has a 50% risk of having ADPKD."

ANS: D ADPKD is transmitted as an autosomal dominant trait and therefore is not gender specific. Children whose parents have the autosomal dominant form of PKD have a 50% chance of inheriting the gene that causes the disease.

A client has a large renal calculus. Which assessment finding may indicate the development of a complication? a. Blood pressure of 178/94 mmHg b. Urine output of 5600 mL/24 hr c. Client reports of pain on urination d. Asymmetric, tender flank area

ANS: D Hydronephrosis, indicated by an asymmetric flank with tenderness, is commonly caused by obstruction such as a renal calculus. As the kidney continues to make urine, the volume of urine backs up into the kidney, increasing pressure, and the kidney is enlarged as a result. An asymmetric tender flank would be one manifestation of this condition. Polyuria, dysuria, and hypertension are not complications associated with renal calculi.

A client with glomerulonephritis has a glomerular filtration rate (GFR) of 40 mL/min, as measured by a 24-hour creatinine clearance. Which is the nurse's interpretation of this finding? a. Excessive GFR, client at risk for dehydration b. Excessive GFR, client at risk for fluid overload c. Reduced GFR, client at risk for dehydration d. Reduced GFR, client at risk for fluid overload

ANS: D The GFR refers to the initial amount of urine that the kidneys filter from the blood. In the healthy adult, the normal GFR ranges between 100 and 120 mL/min, most of which is reabsorbed in the kidney tubules. A GFR of 40 mL/min is drastically reduced, with the client experiencing fluid retention and risks for hypertension and pulmonary edema as a result of excess vascular fluid.

A client returned to the nursing unit after having a nephrostomy performed. Over the next 6 hours, drainage in the tube has gone from 40 mL/hr to 12 mL over the last hour. Which intervention by the nurse is most appropriate? a. Document the finding in the client's record. b. Evaluate the tube as working in the hand-off report. c. Clamp the tube in preparation for removing it. d. Assess the client's abdomen and vital signs.

ANS: D The nephrostomy tube should continue to have a consistent amount of drainage. If the drainage slows or stops, it may be obstructed. The nurse must notify the provider, but first should carefully assess the client's abdomen for pain and distention and check vital signs so that this information can be reported too. The other interventions are not appropriate.

In assessing a client 6 hours after a radical nephrectomy for renal cell carcinoma, the nurse notes that the client's blood pressure has decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for this past hour. Which is the nurse's best action? a. Position the client so that the remaining kidney is not dependent. b. Measure the specific gravity of the client's urine. c. Document the findings in the client's record. d. Assess the pulse rate and quality, and then notify the provider.

ANS: D The nurse should fully assess the client for signs of volume depletion and shock, then should notify the provider. The radical nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypotension is a clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypotension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Documentation is critical but is not the priority at this time. The other two options would not be helpful interventions.