Med Surg II - Chapter 67 - Care of Patients with Kidney Disorders

What cultural factor increases an American Indian patient's risk for developing end-stage kidney disease (ESKD)? 1 American Indian patients do not respond to conventional medicine as do other populations. 2 American Indian patients have greater incidences of hypertension than do other populations. 3 American Indian patients do not respond to changes in electrolyte levels as do other populations. 4 American Indian patients have greater incidences of genetic alterations of the kidney than do other populations.

2 American Indian patients have greater incidences of hypertension than do other populations. Hypertension is more common in African American and American Indian patients than in other populations. This increases the risk for developing ESKD. American Indian patients do not respond differently to conventional medicine or to changes in electrolyte levels than other populations. American Indian patients do not have greater incidences of genetic alterations of the kidney than other populations.

Which action helps prevent kidney trauma in a patient with kidney disease? 1 Avoiding contact sports 2 Eating a protein-rich diet 3 Avoiding the use of seat belts 4 Including adequate salt in the diet

1 Avoiding contact sports Contact sports may cause trauma to the kidney. Salt may increase hypertension and water retention, but not the risk of kidney trauma. The use of seat belts will help prevent jerky movements and reduces the risk of kidney trauma. A high-protein diet will aggravate a kidney injury because of the buildup of metabolic wastes in the body; therefore, the nurse would not instruct the patient to eat a protein-rich diet.

What would be the nursing actions for a patient with kidney trauma? Select all that apply. 1 Check for hematuria 2 Note the frequency of urination 3 Encourage the intake of excess fluid 4 Include foods that are high in calcium content in patient's diet 5 Note if the patient complains of pain and burning on urination

1 Check for hematuria 2 Note the frequency of urination 5 Note if the patient complains of pain and burning on urination Hematuria, a decrease or increase in frequency of urination, and a burning sensation or pain while urinating are indicators of deteriorating kidney functions. Excess fluid intake may cause fluid overload resulting in hypertension. Therefore, normal fluid intake is recommended. A high calcium diet may result in the formation of kidney stones.

Which disorders can lead to nephrosclerosis? Select all that apply. 1 Hypertension 2 Nephrolithiasis 3 Atherosclerosis 4 Hydronephrosis 5 Diabetes mellitus

1 Hypertension 3 Atherosclerosis 5 Diabetes mellitus Nephrosclerosis is a degenerative disorder that is caused by thickening of the blood vessels that supply the kidney, as well as those in the nephron. This is caused by hypertension, atherosclerosis, and diabetes mellitus and can lead to renal failure. Kidney stones, or nephrolithiasis, and hydronephrosis do not cause vascular changes within the kidney.

Which patient action may cause complications if the patient has polycystic kidney disease? 1 Reducing fluid intake 2 Maintaining healthy weight 3 Performing regular exercise 4 Adhering to a sodium-restricted diet

1 Reducing fluid intake Polycystic kidney disease is an inherited disorder in which fluid-filled cysts develop in the nephrons. Reduced fluid intake may lead to dehydration which can worsen kidney function. Regular exercise helps the patient relieve stress, which may cause high blood pressure; it does not cause complications for patients with polycystic kidney disease. Maintenance of a healthy weight helps in managing blood sugar levels and lowers the risk of kidney disease. A sodium-restricted diet is important to control blood pressure levels; it does not cause complications for patients with polycystic kidney disease.

Which laboratory parameter indicates impaired kidney function? 1 Serum creatinine of 3.1 mg/dL 2 Serum calcium of 13.5 mg/dL 3 Serum bicarbonate of 28 mEq/L 4 Blood urea nitrogen (BUN) of 9 mg/dL

1 Serum creatinine of 3.1 mg/dL When kidney function is impaired, the kidneys are unable to excrete metabolic wastes, which leads to an increase in serum creatinine. A normal serum creatinine is 0.6 to 1.2 mg/dL. A creatinine of 3.1 mg/dL is over 2 times the normal range. A serum calcium level of 13.5 mg/dL is elevated, whereas serum calcium levels are relatively low in patients with impaired kidney function. Patients with impaired kidney function generally show a decrease in serum bicarbonate levels related to metabolic acidosis. A bicarbonate level of 28 mEq/L is at the high end of normal. Patients with impaired kidney function normally have an increase in BUN levels; a BUN level of 9 mg/dL is within the normal range.

What is the nurse's priority when caring for a patient with polycystic kidney disease (PKD)? 1 Monitoring fluid balance 2 Controlling hypertension 3 Maintaining electrolyte balance 4 Monitoring for ruptured aneurysms

2 Controlling hypertension The nurse's priority when caring for a patient with PKD is control of hypertension. Proper treatment can interrupt the process of hypertension that leads to further kidney damage, as well as avoid complications such as stroke from the hypertension. Fluid and electrolyte balance are affected by renal damage. The priority goal is to prevent damage by controlling the hypertension. Patients with PKD have a higher incidence of aneurysms, but this is a lower priority than monitoring blood pressure.

Which finding is typical of chronic glomerulonephritis? 1 Polyuria 2 Dyspnea 3 Malnutrition 4 Hypotension

2 Dyspnea An expected finding for the patient diagnosed with chronic glomerulonephritis includes dyspnea, which occurs due to fluid overload and decreased urine output. Polyuria is not associated with chronic glomerulonephritis; however, nocturia and dysuria are common assessment findings. Hypertension is an expected finding in the patient with chronic glomerulonephritis. Malnutrition is not associated with chronic glomerulonephritis.

What hormonal deficiency may lead to anemia in patients diagnosed with renal cell carcinoma? 1 Renin 2 Erythropoietin 3 Parathyroid hormone 4 Human chorionic gonadotropin

2 Erythropoietin The kidneys produce erythropoietin, which acts on the bone marrow to stimulate the production of mature red blood cells. In renal cell carcinoma, tumor cells destroy the renal cells that produce erythropoietin; this action results in anemia. Renin, parathyroid hormone, and human chorionic gonadotropin do not cause anemia. Renin causes increase in the blood pressure. Parathyroid hormone produced by tumor cells can cause hypercalcemia. Human chorionic gonadotropin causes decreased libido and changes in secondary sex features.

What condition may occur when a patient with nephrosclerosis takes spironolactone? 1 Hypokalemia 2 Hyperkalemia 3 Hyponatremia 4 Hyperuricemia

2 Hyperkalemia Spironolactone is a potassium-sparing diuretic. So, if used alone or in combination with other diuretics, spironolactone causes hyperkalemia or an increase in serum potassium levels. Hypokalemia (decrease in serum potassium), hyponatremia (decrease in serum sodium), and hyperuricemia (increase in serum uric acid) may occur with the use of thiazide diuretics.

The nurse is caring for a patient with stage II renal cell carcinoma (RCC). What is the most accurate statement describing the tumor in the patient's kidney? 1 It is within the renal capsule. 2 It is larger than 2.5 cm in size. 3 It has extended beyond Gerota's fascia. 4 It has invaded the renal vein and lymph nodes.

2 It is larger than 2.5 cm in size. In stage II of RCC, the tumor is larger than 2.5 cm. In stage I it is less than 2.5 cm and within the renal capsule. In stage II it extends beyond the renal capsule but not beyond Gerota's fascia. In stage III the tumor invades the renal vein, lymph nodes, or both. In stage IV it invades the organs beyond Gerota's fascia or metastasizes to distant organs.

Which clinical manifestation indicates the inability of the kidneys to concentrate the urine in patients with polycystic kidney disease? 1 Oliguria 2 Nocturia 3 Hematuria 4 Proteinuria

2 Nocturia Nocturia is frequent urination at night because the kidneys are unable to concentrate the urine. Oliguria is the diminished production and excretion of urine due to decreased renal blood flow. Hematuria is the presence of blood in the urine due to tissue damage. Proteinuria is the excretion of proteins in the urine due to increased permeability of proteins through the glomerular capillary wall.

What signs/symptoms does the nurse expect to find during the assessment of a patient with polycystic kidney disease (PKD)? Select all that apply. 1 Diarrhea 2 Nocturia 3 Flank pain 4 Hypotension 5 Kidney stones

2 Nocturia 3 Flank pain 5 Kidney stones The key features of polycystic kidney disease (PKD) include flank pain, kidney stones, and nocturia. Flank pain may present as a dull ache or as sharp and intermittent discomfort. Dull ache is due to increased kidney size. The patient can experience sharp, intermittent pain when a cyst ruptures or because of the presence of kidney stones. Nocturia is the excessive need to urinate at night that occurs because of the decreased ability of the kidney to concentrate urine. The patient presents with hypertension (not hypotension) because the kidneys are no longer able to control blood pressure. The patient also has constipation, not diarrhea, because of fluid shifts.

What is the most accurate statement regarding the etiology and genetic risk of polycystic kidney disease (PKD)? 1 PKD can be prevented by adequate control of hypertension. 2 PKD can occur in those with no family history of the disease. 3 Autosomal dominant PKD is rarer than autosomal recessive PKD. 4 Autosomal dominant PKD-1 (ADPKD-1) is less severe than ADPKD-2.

2 PKD can occur in those with no family history of the disease. PKD can occur in those with no family history of the disease if a new mutation occurs. PKD cannot be prevented. Management of hypertension only slows the progression of kidney damage. ADPKD-1 is more common and more severe than ADPKD-2. Autosomal recessive PKD is rare; autosomal dominant PKD is the most common form.

A patient presents with hydronephrosis because of a kidney stone. Which procedure does the nurse expect the health care provider to prescribe to remove the kidney stone? 1 Nephrostomy 2 Pyelolithotomy 3 Nephrectomy 4 Ureteroplasty

2 Pyelolithotomy A pyelolithotomy procedure is done to remove the stone from the kidney. Nephrostomy is performed when a stricture causes hydronephrosis and cannot be treated by urological methods; it diverts the urine to the outside and prevents further damage to the kidney. Nephrectomy is the process of surgically removing the kidney. Ureteroplasty is the repair or revision of the ureter; it is done for patients with poor ureteric valve closure or dilated ureters.

Which hourly urine output amount is considered acceptable for the patient who has just undergone a radical nephrectomy? 1 10 mL/hr 2 20 mL/hr 3 30 mL/hr 4 90 mL/hr

3 30 mL/hr Urine output of at least 30 mL/hr or 0.5 to 1 mL/kg/hr is considered acceptable for the patient who is status post radical nephrectomy. Output of less than 30 mL/hr suggests decreased blood flow to the kidney and the potential for acute kidney injury. A large hourly urine output, followed by hypotension and oliguria, is a sign of hemorrhage and adrenal insufficiency.

A nurse working in triage at the local emergency department assesses a patient who has sustained a kidney injury. What action by the nurse will best assist the health care provider in determining the severity of the patient's injury? 1 Determining the patient's pain level 2 Checking the patient's urine for blood 3 Documenting the mechanism of injury 4 Assessing the appearance of the flank area

3 Documenting the mechanism of injury Documenting the patient's mechanism of injury can help the provider determine the severity of the patient's injury. While determining the patient's pain level, checking the patient's urine for blood, and assessing the appearance of the flank area are all appropriate interventions for this patient, these interventions do not best assist the health care provider in determining the severity of the patient's injury.

Which type of kidney disorder may occur in the patient diagnosed with systemic lupus erythematosus (SLE)? 1 Pyelonephritis 2 Nephrosclerosis 3 Glomerular disease 4 Renovascular disease

3 Glomerular disease In SLE, the immune system produces antibodies against the healthy cells. These auto-antibodies lead to inflammation of the glomeruli resulting in glomerular disease. Pyelonephritis is a bacterial infection in the kidneys and renal pelvis. Nephrosclerosis is the thickening of nephron blood vessels and is due to uncontrolled hypertension and diabetes mellitus. Renovascular disease affects the renal artery by narrowing the lumen and reduces blood flow to the kidneys.

Which statements about the relationship between hypertension and kidney disease are accurate? Select all that apply. 1 Hypertension is the leading cause of end-stage kidney disease (ESKD). 2 Maintain a maximum blood pressure of 160/110 mm Hg to prevent hypertensive renal damage. 3 Hypertension is the second leading cause of ESKD, with many patients requiring kidney replacement. 4 Renal artery stenosis can lead to sudden onset of hypertension and usually affects patients over 50 years. 5 People of American-Indian and African-American descent have a higher risk of ESKD from uncontrolled hypertension.

3 Hypertension is the second leading cause of ESKD, with many patients requiring kidney replacement. 4 Renal artery stenosis can lead to sudden onset of hypertension and usually affects patients over 50 years. 5 People of American-Indian and African-American descent have a higher risk of ESKD from uncontrolled hypertension. Statistical analysis of the population indicates that hypertension is the second leading cause of ESKD, with many patients requiring dialysis or kidney transplantation. Narrowing of the renal artery, as in renal artery stenosis, can cause sudden-onset hypertension in older adults, and may lead to kidney disease. The risk for ESKD from hypertension is higher among American Indians and African Americans than among Caucasians because of increased lipid levels. Hypertension is the second leading cause of ESKD, while diabetes mellitus is the leading cause. Patients should maintain a blood pressure below 160/110 mm Hg to prevent renal damage from hypertension.

What is an early sign of adrenal insufficiency? 1 Flank pain 2 Proteinuria 3 Hypotension 4 Water retention

3 Hypotension A decrease in blood pressure or hypotension is the first sign indicating hemorrhage and adrenal insufficiency. Patients with renal cell carcinoma or urinary tract infections will have flank pain, but flank pain is not a sign of adrenal insufficiency. Proteinuria is a characteristic feature of nephropathy, but it is not associated with adrenal insufficiency. Adrenal insufficiency will cause a loss of water and sodium in the urine, not water retention.

Which statement describing hydronephrosis is correct? 1 It is an enlargement of the ureter above the obstruction. 2 It decreases blood creatinine and blood urea nitrogen levels. 3 It may occur because of an obstruction caused by kidney stones. 4 It occurs before bladder distension in patients with urethral stricture.

3 It may occur because of an obstruction caused by kidney stones. Hydronephrosis occurs because of an obstruction to the flow of urine and may occur as a result of kidney stones. Hydronephrosis is an enlargement of the renal pelvis that leads to a reduction in the glomerular filtration rate. This increases blood creatinine and blood urea nitrogen levels. Urethral strictures cause bladder distension, not hydronephrosis.

Which complication of polycystic kidney disease (PKD) may result in high blood pressure? 1 Kidney calculi 2 Kidney abscess 3 Kidney ischemia 4 Necrosis of the kidney

3 Kidney ischemia Enlargement of cysts in the kidneys compress the blood vessels, resulting in kidney ischemia. Kidney ischemia activates the rennin-angiotensin system, resulting in high blood pressure in patients with PKD. Kidney calculi are the formation of stones in the kidneys obstructing urinary excretion. A kidney abscess is the collection of the pus formed by tissue debris during an infection. Necrosis of the kidney refers to the death of renal tissue.

Where is the obstruction located in the kidney for a patient diagnosed with a hydroureter? 1 Throughout the ureter 2 Upper part of the ureter 3 Lower part of the ureter 4 The ureter is not obstructed; it is dilated.

3 Lower part of the ureter The obstruction is located in the lower part of the ureter in a patient diagnosed with a hydroureter. With hydroureter, the obstruction is not throughout the ureter. For a diagnosis of hydronephrosis, the obstruction is located in the upper part of the ureter. The ureter is not dilated with hydroureter.

What treatment is preferred for a kidney trauma patient with a grade 5 injury? 1 Drug therapy 2 Fluid therapy 3 Nephrectomy 4 Angiographic embolization

3 Nephrectomy An avulsion of renal blood vessels and a completely shattered kidney are observed in a grade 5 kidney injury. A nephrectomy is the appropriate treatment. Drug therapy, fluid therapy, and angiographic embolization are not preferred to treat a grade 5 kidney trauma.

The nurse is assessing a patient for early signs of renal cell carcinoma (RCC). What finding does the nurse expect in this patient? 1 Bloody urine 2 Gynecomastia 3 Renal bruit on auscultation 4 Sharp, intermittent flank pain

3 Renal bruit on auscultation The nurse notes renal bruit on auscultation in the patient with renal cell carcinoma (RCC). The patient often describes the pain in the flank as dull and aching. The pain is more intense if there is bleeding into the tumor or kidney. Gynecomastia and bloody urine are late stages of the disease.

Which condition may predispose a patient to chronic pyelonephritis? 1 Hepatic failure 2 Cardiomyopathy 3 Spinal cord injury 4 Glomerulonephritis

3 Spinal cord injury Chronic pyelonephritis occurs with spinal cord injury, bladder tumor, prostate enlargement, or urinary tract stones. Weakness of the heart muscle may cause kidney impairment, not an infection. Pyelonephritis may damage the kidney, not the liver. Glomerulonephritis may result from infection, but does not cause infection of the kidney.

Which stage of kidney tumor includes extension into the patient's renal vein, lymph nodes, or both? 1 Stage I 2 Stage II 3 Stage III 4 Stage IV

3 Stage III A stage III tumor may extend to the renal vein and lymph nodes. A stage I kidney tumor would be smaller than 2.5 cm. A patient with stage II tumor will have a tumor larger than 2.5 cm but no involvement of the lymph node and renal vein. A stage IV kidney tumor will metastasize and invade adjacent organs.

What drug used to treat renal carcinoma blocks a protein that is needed for cell division? 1 Sorafenib 2 Interleukin-2 3 Temsirolimus 4 Interferon alpha

3 Temsirolimus Temsirolimus inhibits tumor cell division by blocking a metabolism protein necessary for mitosis. Sorafenib is a multikinase inhibitor that prevents the growth of blood vessels in tumor cells. Interleukin-2 is a biological response modifier and does not act by blocking proteins required for cell division. Interferon alpha is a cytokine that enhances the phagocytic activity of macrophages.

Why is cortisol hormonal replacement required for patients with renal cell carcinoma after the surgical removal of one kidney (nephrectomy)? 1 To manage pain 2 To prevent infections 3 To manage adrenal insufficiency 4 To improve function of second kidney

3 To manage adrenal insufficiency A nephrectomy involves the removal of the adrenal gland. Adrenal insufficiency will occur because of decreased cortisol hormone production. Therefore, these patients will require cortisol therapy. Pain is managed by opioid analgesics. Infections are prevented by the use of antibiotics. Cortisol doesn't have an effect on improving the function of the second kidney.

Which patient assessment finding may indicate adrenal insufficiency following radical nephrectomy? 1 Patient report of back pain 2 Metallic taste in the mouth 3 Bleeding at the surgical site 4 Altered level of consciousness

4 Altered level of consciousness Symptoms of adrenal insufficiency can include altered level of consciousness, as well as water depletion and hypotension. Complaints of back pain may be a result of positioning during surgery, not adrenal insufficiency. A metallic taste in the mouth is caused by the use of antibiotics, not adrenal insufficiency. Bleeding at the surgical site is caused by damage to blood vessels, not adrenal insufficiency.

What is the drug of choice for hypertension in a patient diagnosed with polycystic kidney disease (PKD)? 1 Diuretics 2 Beta-blockers 3 Calcium channel blockers 4 Angiotensin-converting enzyme inhibitors

4 Angiotensin-converting enzyme inhibitors Angiotensin-converting enzyme inhibitors (ACE inhibitors) act by controlling cell growth in PKD and changing renal hemodynamics through the reduction of angiotensin-II production. Diuretics increase urinary protein excretion, resulting in worsening kidney function. Beta-blockers and calcium channel blockers may retard the progression of renal impairment but to a lesser extent compared to ACE inhibitors.

What is the primary cause of high blood pressure resulting from trauma and injury to the kidney? 1 Hypertension may result from a blood clot caused by the injury. 2 Hypertension may result from too much fluid being administered. 3 Hypertension may result from a decrease in the level of antidiuretic hormone. 4 Hypertension may result from the activation of the renin-angiotensin-aldosterone system.

4 Hypertension may result from the activation of the renin-angiotensin-aldosterone system. Traumatic kidney injury can also cause hypertension from changes in perfusion and activation of the renin-angiotensin-aldosterone system. While hypertension may result from a blood clot or fluid overload, these are not the primary causes of hypertension associated with trauma to the kidney. Hypertension typically occurs with an increased, not decreased, level of antidiuretic hormone and is not associated with trauma to the kidney.

What does the nurse expect to find during the assessment of a patient with polycystic kidney disease (PKD)? 1 Anuria 2 Hypotension 3 Pale yellow urine 4 Increased abdominal girth

4 Increased abdominal girth The patient with polycystic kidney disease (PKD) has increased abdominal girth because the cystic kidneys swell, pushing the abdominal contents forward. The urine is cloudy and foul smelling because of infection or dysuria. It may also be bright red or cola-colored following the rupture of a cyst. The patient generally has hypertension related to kidney ischemia from the enlarging cysts. Nocturia or excessive urination in the night is an early manifestation of the disease.

Which condition may result due to increased renin in a patient with renal cell carcinoma (RCC)? 1 Decreased libido 2 Decreased hemoglobin 3 Increased calcium levels 4 Increased blood pressure

4 Increased blood pressure Increased blood pressure (hypertension) is associated with an increase in renin. Decreased libido is due to increased human chorionic gonadotropin hormone. Decreased hemoglobin occurs because of decreased erythropoietin production. Increased parathyroid hormone levels results in high calcium levels.

Which kidney disease would have higher incidence of cerebral aneurysms? 1 Pyelonephritis 2 Acute kidney injury 3 Glomerulonephritis 4 Polycystic kidney disease

4 Polycystic kidney disease Cerebral aneurysm is the outpouching and thinning of artery wall in the brain. This condition is caused by inherited genes and hypertension due to polycystic kidney disease. The incidence of cerebral aneurysm is not found with pyelonephritis, acute kidney injury, and glomerulonephritis because these kidney disorders are not inherited.

Which procedure is preferred for the removal of a large stone from the kidney pelvis? 1 Nephrostomy 2 Ureteroplasty 3 Nephrectomy 4 Pyelolithotomy

4 Pyelolithotomy Pyelolithotomy is the procedure used to remove larger stones from the renal pelvis. Nephrostomy allows urine to be drained by a tube surgically inserted through the skin into the kidneys. Ureteroplasty is the surgical reconstruction of the ureters. Nephrectomy is a surgical procedure to remove the kidney or a part of a kidney.

A patient with a history of diabetes mellitus and cataracts is diagnosed with pyelonephritis. What does the nurse identify as the possible cause of pyelonephritis in the patient? 1 Use of antibiotics 2 Use of antihypertensive drugs 3 Use of oral hypoglycemic drugs 4 Use of nonsteroidal anti-inflammatory drugs

4 Use of nonsteroidal anti-inflammatory drugs Prolonged and extensive use of nonsteroidal anti-inflammatory drugs may lead to necrosis and reflux of urine, resulting in pyelonephritis. Use of antibiotics and oral hypoglycemic drugs do not lead to pyelonephritis. Antihypertensive drugs are used to lower blood pressure levels in patients with kidney disease; they are not associated with pyelonephritis.

Which signs of uremia would the nurse expect to find when assessing a patient with glomerulonephritis? Select all that apply. 1 Nausea 2 Vomiting 3 Anorexia 4 Hypotension 5 Hypothermia

Nausea 2 Vomiting 3 Anorexia Uremia is the buildup of nitrogenous waste products in the bloodstream due to poorly functioning kidneys. The symptoms include nausea, vomiting, and anorexia. The patient would be hypertensive from fluid volume buildup. Due to the immune response, the patient would have a fever, not hypothermia.