MS Ch 54: Kidney Function
A nurse is caring for an acutely ill patient. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill patient is which of the following? a) Pulse rate b) Blood pressure c) Weight d) Edema
c) Weight Explanation: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. Blood pressure, pulse rate, and edema are not the most accurate indicator of fluid loss or gain.
Which of the following is a term used to describe excessive nitrogenous waster in the blood, as seen in acute glomerulonephritis? a) Azotemia b) Proteinuria c) Bacteremia d) Hematuria
a) Azotemia Explanation: The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.
The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? a) Peripheral neuropathy b) Hypotension c) Cola-colored urine d) Hyperalbuminemia
c) Cola-colored urine Explanation: Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.
Patient education regarding a fistulae or graft includes which of the following? Select all that apply. a) Cleanse site b.i.d. b) No tight clothing. c) Avoid compression of the site. d) Check daily for thrill and bruit. e) No IV or blood pressure taken on extremity with dialysis access.
• Check daily for thrill and bruit. • Avoid compression of the site. • No IV or blood pressure taken on extremity with dialysis access. • No tight clothing. Explanation: The nurse teaches the patient with fistulae or grafts to check daily for a thrill and bruit. Further teaching includes avoiding compression of the site; not permitting blood to be drawn, an IV to be inserted, or blood pressure to be taken on the extremity with the dialysis access; not to wear tight clothing, carry bags or pocketbooks on that side, and not lie on or sleep on the area. The site is not cleansed unless it is being accessed for hemodialysis.
Which of the following is as integumentary manifestation of chronic renal failure? a) Gray-brown skin color b) Tremors c) Asterixis d) Seizures
a) Gray-brown skin color Explanation: Integumentary manifestations of chronic renal failure include a gray-bronze skin color and ecchymosis. Asterixis, tremors, and seizures are neurological manifestations of chronic renal failure.
Mr. Billings is being seen as a client in the urology practice. He has a family history of polycystic kidney disease. Of the following assessment findings, which would you expect to find as you gather information and complete an assessment related to a polycystic kidney diagnosis? Select all that apply. a) Pain from retroperitoneal bleeding b) No renal stones c) Normal urinalysis d) Hypertension
• Hypertension • Pain from retroperitoneal bleeding Explanation: Hypertension is present in approximately 75% of affected clients at the time of diagnosis. Pain from retroperitoneal bleeding is caused by the size and effects of the cysts. Urinalysis shows mild proteinuria, hematuria, and pyuria. Renal stones are common.
Which of the following nursing actions is most important in caring for the client following lithotripsy? a) Strain the urine carefully for stone fragments. b) Administer allopurinol (Zyloprim). c) Monitor the continuous bladder irrigation. d) Notify the physician of hematuria.
a) Strain the urine carefully for stone fragments. Explanation: The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical analysis.
In the diuresis period of AKI, the nurse should observe the patient closely for what complication? a) Oliguria b) Dehydration c) Hypokalemia d) Renal calculi
b) Dehydration Explanation: Dehydration is a complication during the diuresis phase related to elevated urine output and continued symptoms of uremia. The concern with AKI is hyperkalemia. The diuresis phase of AKI is marked by normal or elevated urine output. Oliguria is urine output less than 400 mL in 24 hours and is seen in the oliguria phase. Renal calculi are a possible cause but not complication of AKI.
The nurse is caring for a patient following extensive abdominal surgery. The patient develops an infection that is treated with IV gentamicin. After 4 days of treatment, the patient develops oliguria, and laboratory results indicate azotemia. The patient is diagnosed with acute tubular necrosis and transferred to the ICU. The patient is hemodynamically stable. Which of the following dialysis methods would be most appropriate for the patient? a) Peritoneal dialysis b) Hemodialysis c) Continuous arteriovenous hemofiltration (CAVH) d) Continuous venovenous hemofiltration (CVVH)
b) Hemodialysis Explanation: The patient is hemodynamically stable and hemodialysis would be most appropriate. Hemodialysis is used for patients who are acutely ill and require short-term dialysis for days to weeks until kidney function resumes and for patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) who require long-term or permanent renal replacement therapy. Peritoneal dialysis (PD) may be the treatment of choice for patients with renal failure who are unable or unwilling to undergo hemodialysis or kidney transplantation. CAVH and CVVH are used for patients who are hemodynamically unstable.
A 44-year-old client is in the hospital unit where you practice nursing. From the results of a series of diagnostic tests, she has been diagnosed with acute glomerulonephritis. What would you expect to find as a result of this condition? a) Pyuria b) Proteinuria c) No option is correct. d) Polyuria
b) Proteinuria Explanation: The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided. The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. This answer is incorrect.
Which phase of acute renal failure signals that glomerular filtration has started to recover? a) Recovery b) Initiation c) Diuretic d) Oliguric
c) Diuretic Explanation: 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 client with acute renal failure progresses through four phases. Which of the following describes the initiation phase? a) Normal glomerular filtration and tubular function are restored. b) The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. c) Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. d) It is accompanied by reduced blood flow to the nephrons.
d) It is accompanied by reduced blood flow to the nephrons. Explanation: The initiation 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.
The nurse is helping a patient to correctly perform peritoneal dialysis at home. The nurse must educate the patient about the procedure. Which educational information should the nurse provide to the patient? a) Keep the dialysis supplies in a clean area, away from children and pets b) Clean the catheter insertion site daily with soap c) Keep the catheter stabilized to the abdomen, below the belt line d) Wear a mask while handling any dialysate solutions
a) Keep the dialysis supplies in a clean area, away from children and pets Explanation: It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a patient has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine (Betadine), not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.
The nurse is instructing a patient to perform continuous ambulatory peritoneal dialysis correctly at home. Which of the following educational information should the nurse provide to the patient? a) Wear a mask while handling any dialysate solutions. b) Clean the catheter insertion site daily with soap. c) Keep the catheter stabilized to the abdomen, below the belt line. d) Use an aseptic technique during the procedure.
d) Use an aseptic technique during the procedure. Explanation: The patient should be instructed to use an aseptic technique during the procedure. The patient should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (patients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a patient has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine (Betadine), not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: a) "As the disease progresses, you will most likely require renal replacement therapy." b) "Genetic testing will determine the best treatment for your condition." c) "Dietary changes can reverse the damage that has occurred in your kidneys." d) "Draining of the cysts and antibiotic therapy will cure your disease."
a) "As the disease progresses, you will most likely require renal replacement therapy." Explanation: There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.
Which of the following occurs late in chronic glomerulonephritis? a) Peripheral neuropathy b) Nosebleed c) Stroke d) Seizure
a) Peripheral neuropathy Explanation: Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? a) Recovery b) Diuresis c) Oliguria d) Initiation
c) Oliguria Explanation: The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys, such as urea and creatinine. 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 history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? a) Chronic renal failure b) Acute renal failure c) Nephrotic syndrome d) Acute glomerulonephritis
d) Acute glomerulonephritis Explanation: Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.