NDEE PRACTICE

A 4-year-old child with nephrotic syndrome has repeated relapses. As the child gets older, what is the most important attribute for the child to develop? 1 A positive body image 2 The ability to test urine 3 Fine muscle coordination 4 Acceptance of possible sterility

1 Children with nephrotic syndrome are treated with immunosuppressive agents, including steroids. During exacerbations they may have a characteristic pale, overweight appearance as a result of edema. Steroid side effects include growth retardation, cataracts, obesity, and hirsutism. Children may become very sensitive about these changes as they grow older. Although the ability to test the urine may be indicated, body image poses a greater concern. Engaging in usual childhood activities between attacks should promote the development of fine muscle coordination. Sterility is not associated with nephrotic syndrome.

The nurse is providing dietary teaching to a client who is receiving hemodialysis. What should the nurse encourage the client to include in the dietary plan? 1 Rice 2 Potatoes 3 Canned salmon 4 Barbecued beef

1 Foods high or moderately high in carbohydrates and low in protein, sodium, and potassium are encouraged for clients on hemodialysis. Potatoes are high in potassium, which is restricted. Canned salmon is high in protein and sodium, which usually are restricted. Barbecued beef is high in protein, sodium, and potassium, which usually are restricted.

A nurse is reviewing the laboratory report of an adolescent child with nephrotic syndrome. What does the nurse expect analysis of the child's urine to reveal? 1 High protein level 2 Low specific gravity 3 Numerous red blood cells 4 Several crystalline particles

1 Protein (albumin) is present in the urine of children with nephrotic syndrome; it is evidence of kidney damage. Proteinuria, combined with oliguria, results in an increased urine specific gravity. Only rarely do red blood cells (RBCs) or RBC casts filter through the glomerular basement membrane. Crystals are not found in the urine of children with nephrotic syndrome.

When receiving hemodialysis, the client may develop hyponatremia. For which clinical findings associated with hyponatremia should the nurse assess the client? Select all that apply. 1 Diarrhea 2 Seizures 3 Chvostek sign 4 Cardiac dysrhythmias 5 Increased temperature

1,2 Sodium is the most abundant cation in the extracellular fluid and functions as part of the sodium/potassium pump. In the presence of a deficit, the client will exhibit confusion, lethargy, diarrhea, and seizures. Spasm of the facial muscles following a tap over the facial nerve (Chvostek sign) indicates hypocalcemia. Cardiac dysrhythmias are associated with increases or decreases in potassium and calcium. An increase in body temperature reflects a possible infection, not an electrolyte imbalance.

Which roommate should the nurse manager assign to a 4-year-old boy who has been admitted to the pediatric unit with nephrotic syndrome? 1 3-year-old boy with impetigo 2 2-year-old boy with pneumonia 3 5-year-old girl with thalassemia 4 4-year-old girl with conjunctivitis

3 A child with nephrotic syndrome is at risk for infection. The child with thalassemia is noninfectious and therefore an appropriate roommate. In addition, the closeness of their ages will encourage preschool socialization. Impetigo, pneumonia, and conjunctivitis are all caused by pathogens; exposure of the child with nephrotic syndrome to infection should be avoided.

What is the most important nursing intervention for a 3-year-old child with a diagnosis of nephrotic syndrome? 1 Regulating diet 2 Encouraging fluids 3 Preventing infection 4 Maintaining bed rest

3 Infection is a constant threat because of a poor general state of nutrition, a tendency toward skin breakdown in edematous areas, corticosteroid therapy, and lowered immunoglobulin levels. Although intake of foods with high nutritional value should be encouraged, this is not the priority. Fluid monitoring is important in determining whether a fluid restriction is indicated. Bed rest may be needed for severe edema, but ambulation is preferred.

A nurse administers sodium polystyrene sulfonate to a client with chronic renal failure. Which finding provides evidence that the intervention is effective? 1 Frequent loose stools 2 Improved mental status 3 Sodium increases to 137 mEq/L (137 mmol/L) 4 Potassium decreases to 4.2 mEq/L (4.2 mmol/L)

4 This resin exchanges sodium ions for potassium in the large intestine to lower the serum potassium level; 4.2 mEq/L (4.2 mmol/L) is in the expected range for potassium. Constipation is a more common side effect. Mental status improvement is not a therapeutic effect of the drug. Sodium retention is an adverse effect; 137 mEq/L (137 mmol/L) is in the expected range for sodium.

A nurse is caring for a toddler with the diagnosis of nephrotic syndrome. What is the best indicator of kidney function in this toddler? 1 Urine output 2 Daily weights 3 Abdominal girth 4 Improved appetite

1 Although it is difficult to obtain an accurate recording of output in a child who is not toilet trained, urine output is a good indicator of kidney function and adequate kidney perfusion. In nephrotic syndrome a large proportion of the child's body weight is composed of retained fluid; the loss of fluid is reflected by a loss of weight. Daily weights are good indicators of fluid balance. Measurements of abdominal circumference are not a good indicator of kidney function. Although increased appetite is a sign of improvement, it is not an indicator of kidney function.

A client who underwent a nephrectomy develops pneumonia after being cared for by a registered nurse (RN) with some duties delegated to a cross-trained technician. Which individuals on the healthcare team may be responsible for the complication? Select all that apply. 1 Registered nurse 2 Patient care associate 3 Cross-trained technician 4 Licensed vocational nurse 5 Unlicensed assistive personne

1, 3 Pneumonia may develop in a client who undergoes a nephrectomy. Because the RN delegates the task of client care to other healthcare team members, he or she is responsible and accountable for postoperative complications in the client. The RN delegates the task of respiratory therapy to the cross-trained technician. Because the cross-trained technician is paired with the RN, he or she is not accountable but is responsible for the postoperative complication. Respiratory therapy may not be delegated to a patient care associate, licensed vocational nurse, or unlicensed assistive personnel.

A client who has been on hemodialysis for several weeks asks the nurse what substances are being removed by the dialysis. Which substance removal should the nurse share with the client? 1 Blood 2 Sodium 3 Glucose 4 Bacteria

2 Sodium is an electrolyte that passes through the semipermeable membrane during hemodialysis. Red blood cells do not pass through the semipermeable membrane during hemodialysis. Glucose does not pass through the semipermeable membrane during hemodialysis. Bacteria do not pass through the semipermeable membrane during hemodialysis.

What is an acute, life-threatening complication for which a nurse should assess a client in the early postoperative period after a radical nephrectomy? 1 Sepsis 2 Hemorrhage 3 Renal failure 4 Paralytic ileus

2 The kidney, an extremely vascular organ, receives a large percentage of the blood flow, and hemorrhage from the operative site can occur. Sepsis and renal failure may occur later in the postoperative period. Paralytic ileus can occur, but it is not life threatening.

A nurse is assessing a school-aged child with a tentative diagnosis of nephrotic syndrome. What clinical finding supports this diagnosis versus a diagnosis of acute glomerulonephritis? 1 Lethargy 2 Anasarca 3 Proteinuria 4 Hypertension

2 The child with nephrotic syndrome has observable edema throughout the body (anasarca); the child with acute glomerulonephritis has edema that is most noticeable around the eyes (periorbital edema). Lethargy and proteinuria each occur with both nephrotic syndrome and acute glomerulonephritis. The blood pressure of a child with nephrotic syndrome is within the expected range; the blood pressure of a child with glomerulonephritis is increased.

A client is to have hemodialysis. What must the nurse do before this treatment? 1 Obtain a urine specimen to evaluate kidney function. 2 Weigh the client to establish a baseline for later comparison. 3 Administer medications that are scheduled to be given within the next hour. 4 Explain that the peritoneum serves as a semipermeable membrane to remove wastes.

2 A baseline weight must be obtained to be able to determine the net fluid loss from dialysis. Obtaining a urine specimen to evaluate kidney function is not necessary; clients with advanced kidney disease may not produce urine. Medications often are delayed until after dialysis to prevent them from being filtered into the dialysate. Explaining that the peritoneum serves as a semipermeable membrane to remove wastes applies to peritoneal dialysis, not hemodialysis.

A nurse is caring for a client with chronic kidney failure. What should the nurse teach the client to limit the intake of to help control uremia associated with end-stage renal disease (ESRD)? 1 Fluid 2 Protein 3 Sodium 4 Potassium

2 The waste products of protein metabolism are the main cause of uremia. The degree of protein restriction is determined by the severity of the disease. Fluid restriction may be necessary to prevent edema, heart failure, or hypertension; fluid intake does not directly influence uremia. Sodium is restricted to control fluid retention, not uremia. Potassium is restricted to prevent hyperkalemia, not uremia.

When assessing a client during peritoneal dialysis, a nurse observes that drainage of the dialysate from the peritoneal cavity has ceased before the required volume has returned. What should the nurse instruct the client to do? 1 Drink a glass of water 2 Turn from side to side 3 Deep breathe and cough 4 Rotate the catheter periodically

2 Turning from side to side will change the position of the catheter, thereby freeing the drainage holes of the tubing, which may be obstructed. Drinking a glass of water and deep breathing and coughing do not influence drainage of dialysate from the peritoneal cavity. The position of the catheter should be changed only by the primary healthcare provider.

A nurse is caring for a client with chronic kidney failure. Which clinical findings should the nurse expect when assessing this client? Select all that apply. 1 Polyuria 2 Lethargy 3 Hypotension 4 Muscle twitching 5 Respiratory acidosis

2, 4 Lethargy results from anemia, buildup of urea, and vitamin deficiencies. Muscle twitching results from excess nitrogenous wastes. Extensive nephron damage causes oliguria, not polyuria. Hypotension does not occur; the blood pressure is within the expected range or elevated as a result of increased total body fluid. Metabolic, not respiratory, acidosis occurs because of the kidneys' inability to excrete hydrogen and regulate sodium and bicarbonate levels.

A client undergoing treatment for a medical condition gave birth to a baby with renal failure as a result of the teratogenic effect of the medications. Which medical condition is the client likely getting treated for? 1 Cancer 2 Epilepsy 3 Hypertension 4 Microbial infection

3 Angiotensin-converting enzyme inhibitors used for treating hypertension may cause renal failure as a teratogenic effect. Treatment of cancer may cause central nervous system malformations. Treatment of epilepsy may cause growth delay. Antimicrobials may cause heart defects.

A 3.5-year-old child hospitalized with nephrotic syndrome. The child has been toilet trained for longer than one year but has been incontinent while in the hospital. The child's parents express concern over this behavior. What is the most therapeutic response by the nurse? 1 "Your child is wetting the bed to get attention. Set limits when this occurs." 2 "The incontinence is caused by the renal disease. It will stop with physical improvement." 3 "This is an expected response to hospitalization. Ignore the regressive behavior and be supportive." 4 "Your child is using this regressive behavior to help cope with hospitalization; just use diapers and say nothing."

3 Regression frequently occurs during and after hospitalization. The child needs support and encouragement from the parents. The child may want more attention due to being sick, but regressing with incontinence is not a likely behavior. Nephrotic syndrome is not associated with neurogenic control of the bladder. Using diapers and saying nothing are both incorrect options because they will shame the child.

A 5-year-old child is brought into the clinic with lethargy, abdominal ascites, and peripheral and periorbital edema. The history indicates ongoing diarrhea and decreased urine output. The child is found to have nephrotic syndrome and started on corticosteroid therapy. What does the nurse inform the parents that they can expect the child to exhibit after a week or two of medication therapy?

Diuresis begins 1 to 3 weeks after the start of corticosteroid therapy in nephrotic syndrome. Other symptoms, such as diarrhea, begin to resolve after the diuresis stage. Risk of infection is one of the nursing concerns with nephrotic syndrome. Enhanced physical growth is not a sign of resolving nephrotic syndrome; growth retardation is seen in long-term corticosteroid therapy.

What should a nurse include in the plan of care for a 9-year-old child with nephrotic syndrome? 1 Providing meticulous skin care 2 Restricting fluids to 4 oz (120 mL) each shift 3 Offering a diet low in carbohydrates and protein 4 Sending blood to the laboratory for typing and crossmatching

Massive edema, typical of nephrotic syndrome, predisposes the child to skin breakdown. The child requires more fluid than 4 oz (120 mL) each shift to maintain hydration. Carbohydrates and proteins are not restricted. Children with nephrotic syndrome usually do not receive blood transfusions.

A 12-year-old boy with nephrotic syndrome is in remission for several months. One day the mother calls the clinic to report that for the past week her child's skin has a pale, muddy appearance; his appetite is poor; and he has been unusually tired after school. In light of the mother's description, what does the nurse suspect?

The anemia associated with renal failureaccounts for the pallor and decreased energy; the decreased appetite and decreased energy are related to the accumulation of toxic wastes. Excessive activity should not cause the signs and symptoms identified by the mother if the child is in remission. An increased temperature will probably be present with an infection; an infection does not cause a muddy pallor. Discontinuing the corticosteroids and diuretics, if prescribed, might result in a recurrence of edema in the steroid-dependent child; it is not a sign of renal failure.

After a nephrectomy a client arrives in the postanesthesia care unit in the supine position. Which action should be employed by the nurse to assess the client for signs of hemorrhage? 1 Turn the client to observe the dressings. 2 Press the client's nail beds to assess capillary refill. 3 Observe the client for hemoptysis when suctioning. 4 Monitor the client's blood pressure for a rapid increase.

1 Because of the anatomic position of the incision, drainage will flow by gravity and accumulate under the client lying in the supine position. Nail beds indicate peripheral perfusion, not early hemorrhage. Respiratory hemorrhage is not common after kidney surgery. The blood pressure decreases and the pulse rate increases with hemorrhage.

A nurse is assessing a client with a diagnosis of kidney failure for clinical indicators of metabolic acidosis. What should the nurse conclude is the reason metabolic acidosis develops with kidney failure? 1 Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate 2 Depressed respiratory rate due to metabolic wastes, causing carbon dioxide retention 3 Inability of the renal tubules to reabsorb water to dilute the acid contents of blood 4 Impaired glomerular filtration, causing retention of sodium and metabolic waste products

1 Bicarbonate buffering is limited, hydrogen ions accumulate, and acidosis results. The rate of respirations increases in metabolic acidosis to compensate for a low pH. The fluid balance does not significantly alter the pH. The retention of sodium ions is related to fluid retention and edema rather than to acidosis.

A low-dose intravenous dopamine hydrochloride infusion drip is prescribed for a client in acute renal failure (ARF). Which method is most appropriate for the nurse to administer this medication to the client? 1 Peripherally inserted central catheter (PICC) line 2 #20 angiocatheter in either antecubital area 3 Large-gauge butterfly needle in hand 4 Femoral line

1 Dopamine hydrochloride is a vesicant, and if it infiltrates into the skin it can cause tissue necrosis. It must be infused through a central line catheter such as a PICC line. An angiocatheter and butterfly needle are not central lines. A femoral line is a central line but is used only in extreme emergencies because of the risk of insertion site infection.

A client is receiving epoetin for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary? 1 "I realize it is important to take this medication because it will cure my anemia." 2 "I know many ways to protect myself from injury because I am at risk for seizures." 3 "I recognize that I may still need blood transfusions if my blood values are very low." 4 "I understand that I will still have to take supplemental iron therapy with this medication."

1 Epoetin will increase a sense of well-being, but it will not cure the underlying medical problem; this misconception needs to be corrected. Seizures are a risk during the first 90 days of therapy, especially if the hematocrit increases more than four points in a 2-week period. A dose adjustment may be necessary. Blood transfusions may still be necessary when the client is severely anemic. Supplemental iron therapy is still necessary when receiving epoetin because the increased red blood cell production still requires iron.

A 3-year-old child is hospitalized with nephrotic syndrome. The child has oliguria and generalized edema. What factor does the nurse identify that will have the greatest effect on the child's adjustment to hospitalization? 1 Lack of parental visits 2 Inability to select a variety of foods 3 Response of peers to the edematous appearance 4 Willingness to participate in cooperative play activities

1 Hospitalization is traumatic to the preschooler because of separation from significant family members. When parents are unable to visit, the nurse should arrange for daily contact with them by other means such as internet webcam technology. Preschoolers are not interested in food; children with nephrotic syndrome often have decreased appetites. Preschoolers are not concerned about attitudes of peers; it is too early in their social development to have this concern. Massive edema results in easy fatigability and a lack of interest in play.

While the nurse is at the bedside of a client in acute renal failure, the client states, "My healthcare provider said that I will be getting some insulin. Do I also have diabetes?" What is the best nursing response? 1 "No, the insulin will help your body handle the increased potassium level." 2 "I suggest that you ask your healthcare provider that question." 3 "You probably had an elevated blood glucose level, so your healthcare provider is being cautious." 4 "No, but insulin will reduce the toxins in your blood by lowering your metabolic rate."

1 Insulin promotes the transfer of potassium into cells, which reduces the circulating blood level of potassium. The response "I suggest that you ask your healthcare provider that question" halts communication and is not supportive. Blood glucose levels usually are not elevated in acute renal failure. Insulin will not lower the metabolic rate.

A child with nephrotic syndrome visits the clinic for follow-up. During the visit the parent states that the child is always tired and has no appetite. The nurse notes that the child has a muddy, pale complexion. What problem does the nurse suspect? 1 Impending renal failure 2 Being too active in school 3 A developing viral infection 4 Refusal of the prescribed medications

1 Poor appetite and decreased energy are associated with the accumulation of toxic waste; anemia accounts for the pallor. Activity does not cause these signs and symptoms. An increased temperature will probably be present, but an infection will not cause a muddy pallor. Discontinuing the corticosteroids and diuretics that are usually prescribed will probably result in recurrence of edema in a steroid-dependent child.

A client is diagnosed with acute kidney failure secondary to dehydration. An intravenous (IV) infusion of 50% glucose with regular insulin is prescribed. What does the nurse recognize as the primary purpose of the IV insulin for this client? 1 Correct hyperkalemia 2 Increase urinary output 3 Prevent respiratory acidosis 4 Increase serum calcium levels

1 The 50% glucose and regular insulin infusion treats the hyperkalemia associated with kidney failure; it moves potassium from the intravascular compartment into the intracellular compartment. Insulin will not increase urinary output. Insulin is not a treatment for respiratory acidosis. Insulin and glucose do not increase serum calcium levels.

To prepare for hemodialysis, a client with end-stage kidney disease is scheduled for surgery, specifically for the creation of an internal arteriovenous fistula in one arm and placement of an external arteriovenous shunt in the other arm. When considering care for these sites, which difference will the nurse consider? 1 The graft is more subject to hemorrhage, clotting, and infection than the fistula is. 2 Blood pressure readings can be taken in the arm with the fistula but not in the one with the shunt. 3 Intravenous (IV) fluids can be administered in the arm with the shunt but not in the one with the fistula. 4 The fistula should be covered with a light dressing, and the shunt should be covered thoroughly with a heavy dressing.

1 The external shunt may come apart with possible hemorrhage; clotting is a potential hazard. Frequent handling increases risk of infection. Blood pressure readings should not be obtained in the extremity that has a shunt or fistula because of the pressure exerted on the circulatory system during the procedure. IVs should not be infused in the extremity with the shunt or the fistula to avoid pressure from the tourniquet and to lessen the chance of phlebitis. The ends of the shunt cannula should be left exposed for rapid reconnection in the event of disruption.

To prepare for hemodialysis, a client with end-stage kidney disease is scheduled for surgery, specifically for the creation of an internal arteriovenous fistula in one arm and placement of an external arteriovenous shunt in the other arm. When considering care for these sites, which difference will the nurse consider? 1 The graft is more subject to hemorrhage, clotting, and infection than the fistula is. 2 Blood pressure readings can be taken in the arm with the fistula but not the one with the shunt. 3 Intravenous (IV) fluids can be administered in the arm with the shunt but not the one with the fistula. 4 The fistula should be covered with a light dressing, and the shunt should be covered thoroughly with a heavy dressing.

1 The external shunt may come apart with possible hemorrhage; clotting is a potential hazard. Frequent handling increases risk of infection. Blood pressure readings should not be obtained in the extremity that has a shunt or fistula because of the pressure exerted on the circulatory system during the procedure. IVs should not be infused in the extremity with the shunt or the fistula to avoid pressure from the tourniquet and to lessen the chance of phlebitis. The ends of the shunt cannula should be left exposed for rapid reconnection in the event of disruption.

A nurse is giving discharge instructions to the parents of an adolescent boy with nephrotic syndrome. What statement by one of the parents about the child's care indicates that more instruction is needed? 1 "Any gain in weight is expected." 2 "We'll give him prednisone with meals." 3 "We'll be sure to test his urine for albumin." 4 "We'll be sure to check his eyelids every morning.

1 Weight gain is not expected when a child with nephrotic syndrome is discharged. Weight gain must be monitored carefully and reported to the primary healthcare provider, because it may be indicative of an accumulation of fluid and an exacerbation of the nephrosis. Steroids are given with food or milk to prevent gastric irritation. Testing the urine for protein helps determine whether kidney function is impaired. The child should be monitored for periorbital edema.

A client who has been receiving hemodialysis for several years is to receive a kidney transplant. What should the nurse share in the client's preoperative teaching plan? Select all that apply. 1 "The kidney may not function immediately." 2 "Precautions are needed to prevent infection." 3 "A urinary catheter will be present postoperatively." 4 "Immunosuppressive medications will be given preoperatively." 5 "The arteriovenous fistula will be used for drawing blood specimens preoperatively."

123 "The kidney may not function immediately." Correct2 "Precautions are needed to prevent infection." Correct3 "A urinary catheter will be present postoperatively."

A 4-year-old child with nephrotic syndrome is admitted to the pediatric unit. What clinical finding does the nurse expect when assessing this child? 1 Severe lethargy 2 Dark, frothy urine 3 Chronic hypertension 4 Flushed, ruddy complexion

2 Dark, frothy urine is characteristic of a child with nephrotic syndrome; large amounts of protein in the urine cause it to take this appearance. The child may be somewhat, not severely, lethargic. Blood pressure is normal or decreased; hypertension is associated with glomerulonephritis. Children with nephrotic syndrome usually have a pale complexion and are not flushed and ruddy in appearance.

A nurse on the pediatric unit is planning recreational activities for a 4-year-old with an exacerbation of nephrotic syndrome. What are the most appropriate activities in light of the child's developmental level and physical status? 1 Riding a tricycle and playing with large blocks 2 Watching cartoon videos and listening to stories 3 Reading animal stories and playing video games 4 Leading a pull toy and playing with a map puzzle

2 Enjoyment of fantasy and listening to stories are quiet, pleasurable pastimes for a 4-year-old. Riding a tricycle requires too much energy, and playing with large blocks is below a 4-year-old child's developmental level. Although preschool children may enjoy video games, they are not expected to be able to read for enjoyment. The pull toy is below a 4-year-old child's developmental level, and a map puzzle is too advanced.

A client receiving hemodialysis has an external shunt for circulatory access. With which life-threatening complication associated with external cannulas should the nurse be most concerned? 1 Infection 2 Hemorrhage 3 Skin breakdown 4 Impaired circulation

2 Exsanguination (hemorrhage) can occur in a matter of minutes if cannulas are dislodged. Infection, skin breakdown, and impaired circulation are not life-threatening situations; preventing hemorrhage takes priority.

An older client who was found unconscious at home was admitted to the hospital with a fractured hip, renal failure, and dehydration. In the 24 hours since admission, the client has received 3 L of intravenous fluid. The client has also developed hyponatremia. Which element would the nurse conclude is the most likely to have contributed to the client developing hyponatremia? 1 Reduced dietary salt intake 2 Intravenous fluid infusion 3 Potassium reabsorption rate 4 Increased glomerular filtration

2 Hemodilution has most likely occurred because 3 L of intravenous fluid will lower the serum sodium level by increasing intravenous fluid and reducing the serum concentration of sodium. A reduced dietary salt intake is not the most likely cause of hyponatremia developing during the first 24 hours of this hospitalization. Changes to the serum potassium reabsorption rate are not likely to have caused hyponatremia in the last 24 hours. A decreased, not increased, glomerular filtration rate occurs with renal failure.

A nurse is caring for a client receiving hemodialysis for chronic kidney disease. The nurse should monitor the client for which complication? 1 Peritonitis 2 Hepatitis B 3 Renal calculi 4 Bladder infection

2 Hepatitis type B [1] [2] is transmitted by blood or blood products. The hemodialysis and routine transfusions needed for a client in end-stage renal failure constitute a high risk for exposure. Peritonitis is a danger for individuals receiving peritoneal dialysis. Renal calculi are not a complication of hemodialysis; they often occur in clients who are confined to prolonged bed rest. Dialysis does not involve the bladder and will not contribute to the development of a bladder infection.

A client is diagnosed with acute tubular necrosis after sustaining a kidney trauma. Which laboratory result should the nurse anticipate while the client is in the oliguric phase? 1 Hypophosphatemia 2 Hyperkalemia 3 Hypomagnesemia 4 Hypernatremia

2 Hyperkalemia is the laboratory result that the nurse should anticipate while the client is in the oliguric phase of acute tubular necrosis (ATN). Hypernatremia, hypophosphatemia, and hypomagnesemia do not occur during this phase. The kidney is unable to reabsorb sodium in the ATN oliguric phase, so serum sodium is lost in the concentrated urine produced. Potassium, magnesium, and phosphorus are retained in the blood as urine levels of these electrolytes diminish. Also, hyperkalemia and metabolic acidosis occur together because the kidneys also cannot excrete hydrogen ions. As hydrogen ions shift into cells to compensate for the rising acidosis, they displace potassium ions out of cells and into serum, which worsens hyperkalemia. Hyperkalemia poses the greatest threat to life because its lethal range is relatively close to its maximum normal range, often indicating a need for dialysis.

The nurse is explaining the physiologic reasons for taking vitamin D and calcium supplements to a client with renal failure. Which statement made by the nurse is appropriate? 1 "There will be a decrease in the inactive forms of vitamin D in your body." 2 "There will be a decrease in the active metabolite of vitamin D in your body." 3 "There will be an increase in the conversion of skin cholesterol into vitamin D." 4 "There will be an increase in the vitamin D associated intestinal absorption of calcium."

2 Renal failure results in decrease in the active metabolite of vitamin D because inactive vitamin D gets activated in the liver followed by the kidneys. Food sources of vitamin D and sunlight contribute to an inactive form of the hormone in the body. Inactive vitamin D will decrease if foods rich in vitamin D are not consumed or exposure to sunlight is reduced. Conversion of skin cholesterol to vitamin D depends on the exposure to sunlight and not renal impairment. In renal failure, there is less active vitamin D and therefore less intestinal absorption of calcium.

A client receiving hemodialysis undergoes surgery to create an arteriovenous fistula. Before discharge, the nurse discusses care at home with the client and his wife. Which statement by the client's wife indicates that further teaching is required? 1 "I must touch the shunt several times a day to feel for the bruit." 2 "I have to take his blood pressure every day in the arm with the fistula." 3 "He will have to be very careful at night not to lie on the arm with the fistula." 4 "We really should check the fistula every day for signs of redness and swelling."

2 Taking the blood pressure in the affected arm may injure the fistula. The presence of a bruit indicates that the circulation is not obstructed by a thrombus. Hemorrhage can occur in a matter of minutes if the cannula is dislodged. Redness and swelling are signs of infection, which is a complication of cannulization.

The nurse is preparing a blood transfusion for a client with renal failure. Why does anemia often complicate renal failure? 1 Increase in blood pressure 2 Decrease in erythropoietin 3 Increase in serum phosphate levels 4 Decrease in serum sodium concentration

2 The hormone erythropoietin, produced by the kidneys, stimulates the bone marrow to produce red blood cells. In renal failure there is a deficiency of erythropoietin that often results in the client developing anemia. Therefore the nurse is instructed to administer blood. In renal failure, increased blood pressure is due to impairment of renal vasodilator factors and is not treated by administration of blood. Phosphate is retained in the body during renal failure, causing binding of calcium leading to done demineralization, not anemia. Increase in urinary sodium concentration and decrease in serum sodium concentration trigger the release of renin from the juxtaglomerular cells.

A nurse is performing peritoneal dialysis for a client. Which action should the nurse take? Incorrect1 Place the client in a side-lying position. Correct2 Warm the dialysate solution slightly before instillation. 3 Infuse the dialysate solution quickly over 5 to 10 minutes. 4 Withhold the routine medications until after the procedure.

2 The infusion should be warmed to body temperature to decrease abdominal discomfort and promote dilation of peritoneal vessels. The side-lying position may restrict fluid inflow and prevent maximum urea clearance; the client should be placed in the semi-Fowler position. The infusion of dialysate solution should take approximately 10 to 20 minutes. Routine medications should not interfere with the infusion of dialysate solution.

The nurse is providing care to a client who has a suspected pelvic fracture as the result of a motor vehicle accident. Which is the priority nursing action? 1 Logrolling for transfers 2 Inspecting the genitalia 3 Preparing for a pelvic examination 4 Administering prescribed pain medication

2 The priority nursing action for this client is to inspect the genitalia for bleeding and obvious injury. The logrolling technique does not need to be implemented when transferring this client. Preparing for a pelvic examination is not an appropriate action. Administering pain prescribed pain medication is an appropriate action but would be done only after inspecting the genitalia for injury.

Monitoring vital signs, particularly the blood pressure and the rate and quality of the pulse, is essential in detecting physiologic adaptations in a preschool child with nephrotic syndrome. Which clinical manifestation should the nurse be able to detect from these vital signs? 1 Heart failure 2 Hypovolemia 3 Pulmonary embolus 4 Increased serum potassium

2 The shift of fluid from the intravascular to the interstitial compartment predisposes the child to hypovolemia; a weak, thready pulse and hypotension are signs of impending shock. Heart failure is usually not a complication of nephrotic syndrome; however, it is a major complication of glomerulonephritis. The development of a pulmonary embolus is not a complication of nephrotic syndrome. Chest pain and dyspnea are signs of a pulmonary embolus. Hypokalemia, not hyperkalemia, occurs. Tubular reabsorption of sodium is increased to replenish the vascular volume; therefore potassium is excreted.

A client with chronic renal failure has been on hemodialysis for 2 years. The client communicates with the nurse in the dialysis unit in an angry, critical manner and is frequently noncompliant with medications and diet. The nurse can best intervene by first considering that the client's behavior is most likely for which reason? 1 An attempt to punish the nursing staff 2 A constructive method of accepting reality 3 A defense against underlying depression and fear 4 An effort to maintain life and to live it as fully as possible

3 Both hostility and noncompliance are forms of anger that are associated with grieving. The client's behavior is not a conscious attempt to hurt others but a way to relieve and reduce anxiety within the self. The client's behavior is a self-destructive method of coping, which can result in death. The client's behavior is an effort to maintain control over a situation that is really controlling the client; it is an unconscious method of coping, and noncompliance may be a form of denial.

A client with chronic renal failure stops responding to the treatment. On examination, the primary healthcare provider determines that the client is terminally ill. What is the best nursing intervention in this situation? 1 Suggest that the family members get a second opinion. 2 Suggest that the family members continue to try different treatments. 3 Encourage the family members to provide pallative care to the client. 4 Inform the family members that the disease is no longer curable and the client will die shortly.

3 Clients who are terminally ill and no longer respond to treatment are in need of palliative care. Palliative care promotes client comfort and provides important interventions to support the client and family at the end of life. There is no need to get a second opinion from another primary healthcare provider, because the client is terminally ill. Continuing to attempt different treatment until of the death of the client may cause more client suffering. It is not advisable to inform the family members that the client will die soon because it may lead to emotional stress. The palliative care team will help prepare the family for the client's death.

A client has end-stage kidney disease and is receiving hemodialysis. During dialysis the client reports nausea and a headache and appears confused. Operating on prescribed protocols, which action will the nurse take? 1 Give an analgesic. 2 Administer an antiemetic. 3 Decrease the rate of exchange. 4 Discontinue the procedure immediately

3 Headache, nausea, and confusion are signs and symptoms of disequilibrium syndrome [1][2], which results from rapid changes in composition of the extracellular fluid; therefore, the rate of exchange should be decreased. Although an analgesic may relieve the headache, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Although administering an antiemetic may relieve the nausea, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Discontinuing the procedure is unnecessary; reducing the rate of exchange should reduce the adaptations of disequilibrium syndrome.

A nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet. What is the rationale for the nurse's instruction? 1 A person's body tends to retain fluid when a salt substitute is included in the diet. 2 Limiting salt substitutes in the diet prevents a buildup of waste products in the blood. 3 Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats. 4 A substance in the salt substitute interferes with the transfer of fluid across capillary membranes, resulting in anasarca.

3 Salt substitutes usually contain potassium, which can lead to hyperkalemia; dysrhythmias are associated with hyperkalemia. Sodium, not salt substitutes, in the diet causes retention of fluid. Salt substitutes do not contain substances that influence blood urea nitrogen (BUN) and creatinine levels; these are the result of protein metabolism. There is no such substance in salt substitutes that interferes with the transfer of fluid across capillary membranes.

A 4-year-old child is being treated for nephrotic syndrome. What assessment finding indicates that the child's condition is improving? 1 The child gains weight. 2 Urine output decreases. 3 Urine specific gravity decreases. 4 The child's hemoglobin and hematocrit increase.

3 Specific gravity of urine measures solids to liquids. When the volume of liquids increases, the specific gravity decreases, indicating that the child is putting out more urine. A specific gravity of 1.0 is water only. Weight gain in a child with nephrotic syndrome indicates an increase in edematous fluid. The child with nephrotic syndrome is oliguric. Decreasing urine output is a negative finding. Hemoglobin and hematocrit are comparisons of solids to liquids in the blood. An increased hematocrit and hemoglobin could indicate dehydration or vascular volume decrease.

A 3-year-old child is admitted to the pediatric unit with a diagnosis of nephrotic syndrome. The child has ascites, oliguria, respirations of 40 breaths/min, and a recent weight gain of 10 lb (4.5 kg). What nursing intervention may help ease the child's respiratory difficulty? 1 Providing six small meals daily 2 Maintaining a well-ventilated room 3 Ensuring bed rest in the low Fowler position 4 Administering oxygen at 2 L/min by way of nasal cannula

3 The low Fowler position decreases pressure on the diaphragm from the abdominal organs and the ascites, thereby increasing respiratory excursion. Frequent feedings may lead to fatigue and quickened respiration, which will further distress the child. Placing the child in a well-ventilated room will not alleviate the cause of the respiratory problem, which is pressure on the diaphragm from the ascites. Oxygen therapy is not necessary; the dyspnea results from pressure on the diaphragm, not lack of oxygen.

An 8-year-old child is admitted to the pediatric unit with nephrotic syndrome. What measures should the nurse expect to include in the plan of care for this child? Select all that apply. 1 Maintaining bed rest 2 Administering antibiotics 3 Providing symptomatic care 4 Eliminating high-sodium foods 5 Monitoring response to steroid

3,4,5 Examples of symptomatic care are treating azotemia with a low-protein diet; encouraging bed rest if there is gross edema; restricting fluids if there is oliguria; and treating infection if it should occur. Foods that are high in sodium are restricted when there is gross edema; although restricting foods that are high in sodium does not lessen the edema, it seems to prevent it from worsening. A steroid is given to children with nephrotic syndrome because of its antiinflammatory properties. It is essential that the nurse monitor the child's response to steroids to determine the medication's effectiveness. Bed rest for children with nephrotic syndrome is generally no longer ordered. When there is gross edema, children usually prefer to remain in bed to conserve energy, but there are no ill effects of ambulating if they wish to do so. Nephrotic syndrome is a noninfectious disorder; however, these children are prone to infection, and if they contract an infection it is treated accordingly.

A 4-year-old child with nephrotic syndrome is being treated with corticosteroid therapy. While evaluating lab values and the intake and output results, the nurse expects to note a decrease in what? 1 Polyuria 2 Hematuria 3 Glycosuria 4 Proteinuria

4 A classic sign of nephrotic syndrome is gross proteinuria; a decrease indicates that treatment has been successful. A child with nephrotic syndrome has gross edema and oliguria; increased urine output is the desired outcome. Children with glomerulonephritis have hematuria; it is not expected in children with nephrotic syndrome. Children with diabetes mellitus have glycosuria; it is not expected in children with nephrotic syndrome.

The nurse is caring for an African American client with renal failure. The client states that the illness is a punishment for sins. Which cultural health belief does the client communicate? 1 Yin/Yang balance 2 Biomedical belief 3 Determinism belief 4 Magicoreligious belief

4 An African American client may have magicoreligious beliefs, which focuses on hexes or supernatural forces that cause illness. Such clients may believe that illness is a punishment for sins. The yin/yang belief system does not consider illness as a punishment. The biomedical belief system maintains that health and illness are related to physical and biochemical processes with disease being a breakdown of the processes. The belief of determinism focuses on outcomes that are externally preordained and cannot be changed.

A client with acute kidney failure is fatigued and becomes lethargic. Upon reviewing the client's medical record, which finding does the nurse determine is the most likely cause of this change in symptoms? 1 Hyperkalemia 2 Hypernatremia 3 A limited fluid intake 4 An increased blood urea nitrogen level

4 An increased blood urea nitrogen level, indicating uremia, is toxic to the central nervous system and causes fatigue and lethargy. Hyperkalemia is associated with muscle weakness, irritability, nausea, and diarrhea. Hypernatremia is associated with firm tissue turgor, oliguria, and agitation. Dehydration can cause fatigue, dry skin and mucous membranes, and rapid pulse and respiratory rates.

The nurse is assessing a pediatric client diagnosed with chronic renal failure exhibiting alterations in growth patterns. When educating the client's parents about the child's growth, which statement is accurate? 1 "Your child's poor growth is most likely caused by sustained alkalosis." 2 "The hypotension associated with your child's diagnosis is causing poor growth." 3 "Your child's poor growth is most likely caused by the carbohydrate restrictions." 4 "Resistance to growth hormone associated with your child's diagnosis is causing poor growth."

4 Poor growth that occurs in children who are diagnosed with chronic renal failure is often due to tissue resistance to growth hormone. Other reasons for poor growth include sustained acidosis, hypertension, and protein restrictions.

The nurse observes a client with kidney failure has increased rate and depth of breathing. Which laboratory parameter does the nurse suspect is associated with this client's condition? 1 Potassium 8 mEq/L 2 Hemoglobin 10 g/dL 3 Phosphorous 7 mg/dL 4 Bicarbonate 15 mEq/L

4 An increased rate and depth of breathing is called Kussmaul respiration and occurs due to metabolic acidosis in clients with kidney disease. Serum bicarbonate level decreases in metabolic acidosis. The normal range of serum bicarbonate is 23-30 mEq/L. Therefore the bicarbonate value of 15 mEq/L is associated with Kussmaul respirations in the client. The normal serum potassium is 3.5-5 mEq/L. Therefore a potassium level of 8 mEq/L indicates hyperkalemia and is associated with changes in cardiac rate and rhythm. The normal range of hemoglobin is 12-16 g/dL in females and 14-18 g/dL in males. Therefore a Hgb of 10 g/dL indicates anemia; this is associated with fatigue, pallor, and shortness of breath. The normal range of serum phosphorous is 3-4.5 mg/dL. Therefore a phosphorous value of 7 mg/dL indicates hyperphosphatemia, which is associated with hypocalcemia and demineralization of bone.

A 3-year-old preschooler has been hospitalized with nephrotic syndrome. What is the best way for the nurse to evaluate fluid retention or loss? 1 Measuring the abdominal girth daily 2 Having the child urinate in a bedpan 3 Testing the child's urine for proteinuria 4 Weighing the child at the same time each day

4 Comparison of daily weights is the most accurate way to assess fluid retention or loss. Having the child urinate in a bedpan is difficult for a child of this age, and the findings will not be accurate. Measuring the abdominal girth daily is way to assess the degree of ascites; it indirectly measures fluid retention. Assessment of urine for protein gives information about the disease process, but not about the amount of fluid retention.

A client is experiencing kidney failure. Which is the most serious complication for which the nurse must monitor a client with kidney failure? 1 Anemia 2 Weight loss 3 Uremic frost 4 Hyperkalemia

4 Decreased glomerular filtration leads to hyperkalemia, which may cause lethal dysrhythmias such as cardiac arrest. Anemia may occur but is not the most serious complication and should be treated in relation to the client's clinical manifestation; erythropoietin and iron supplements usually are used. Weight loss alone is not life threatening. Uremic frost, a layer of urea crystals on the skin, causes itching but it is not the most serious complication.

A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy? 1 "It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration." 2 "It exchanges and cleanses blood by correction of electrolytes and excretion of creatinine." 3 "It decreases the need for immobility because it clears toxins in short and intermittent periods." 4 "It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."

4 Diffusion [1] [2] moves particles from an area of greater concentration to an area of lesser concentration; osmosis moves fluid from an area of lesser to an area of greater concentration of particles, thereby removing waste products into the dialysate, which is then drained from the abdomen. The principle of ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal dialysis uses the peritoneal membrane to indirectly cleanse the blood. Dialysate does not clear toxins in a short time; exchanges may occur four or five times a day.

A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy? 1 "It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration." 2 "It exchanges and cleanses blood by correction of electrolytes and excretion of creatinine." 3 "It decreases the need for immobility, because it clears toxins in short and intermittent periods." 4 "It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."

4 Diffusion [1] [2] moves particles from an area of greater concentration to an area of lesser concentration; osmosis moves fluid from an area of lesser to an area of greater concentration of particles, thereby removing waste products into the dialysate, which is then drained from the abdomen. The principle of ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal dialysis uses the peritoneal membrane to indirectly cleanse the blood. Dialysate does not clear toxins in a short time; exchanges may occur four or five times a day.

The nurse is teaching a client receiving peritoneal dialysis about the reason dialysis solution is warmed before it is instilled into the peritoneal cavity. Which information will the nurse share with the client? 1 Because it forces potassium back into the cells, thereby decreasing serum levels 2 Because it adds extra warmth to the body because metabolic processes are disturbed 3 Because it helps prevent cardiac dysrhythmias by speeding up removal of excess potassium 4 Because it encourages removal of serum urea by preventing constriction of peritoneal blood vessels

4 Encouraging the removal of serum urea by preventing constriction of peritoneal blood vessels promotes vasodilation so that urea, a large-molecular substance, is shifted from the body into the dialyzing solution. Heat does not affect the shift of potassium into the cells. The removal of metabolic wastes is affected in kidney failure, not the metabolic processes. Heating dialysis solution does not affect cardiac dysrhythmias.

A nurse is evaluating a client's understanding of peritoneal dialysis. Which information in the client's response indicates an understanding of the purpose of the procedure? 1 Reestablishing kidney function 2 Cleaning the peritoneal membrane 3 Providing fluid for intracellular spaces 4 Removing toxins in addition to other metabolic wastes

4 Peritoneal dialysis uses the peritoneum as a selectively permeable membrane for diffusion of toxins and wastes from the blood into the dialyzing solution. Peritoneal dialysis acts as a substitute for kidney function; it does not reestablish kidney function. The dialysate does not clean the peritoneal membrane; the semipermeable membrane allows toxins and wastes to pass into the dialysate within the abdominal cavity. Fluid in the abdominal cavity does not enter the intracellular compartment.

A nurse is caring for a client with a diagnosis of chronic kidney failure who has just been told by the primary healthcare provider that hemodialysis is necessary. Which clinical manifestation indicates the need for hemodialysis? 1 Ascites 2 Acidosis 3 Hypertension 4 Hyperkalemia

4 Protein breakdown liberates cellular potassium ions, leading to hyperkalemia, which can cause a cardiac dysrhythmia and standstill. The failure of the kidneys to maintain a balance of potassium is one of the main indications for dialysis. Ascites occurs in liver disease and is not an indication for dialysis. Dialysis is not the usual treatment for acidosis; usually this responds to administration of alkaline drugs. Dialysis is not a treatment for hypertension; this is usually controlled by antihypertensive medication and diet.

A 5-year-old child in renal failure who has undergone creation of an arteriovenous fistula access begins hemodialysis three times a week. The nurse teaches the mother the specific care her child needs. What statement indicates that further teaching is necessary? 1 "I'll offer more drinks in warm weather." 2 "I should call the clinic if he vomits or has diarrhea." 3 "I'll check his pulse at the wrist on each arm every day." 4 "It's OK to take his blood pressure on the arm with the fistula."

4 Taking the blood pressure on the arm with the arteriovenous fistula is contraindicated because the pressure of the inflated cuff may disrupt the integrity of the fistula. Consumption of more fluids is desirable because inadequate fluid intake can result in dehydration and an acid-base imbalance. Calling the clinic is desirable because vomiting or diarrhea may lead to dehydration and an acid-base imbalance. Not only should the pulse be monitored to assess vascular function distal to the arteriovenous fistula, but it should be done on both extremities and the results compared.

A nurse is caring for a client with renal failure. The client wants to go back home but the family members want the client to undergo a kidney transplant. The nurse gives details about the possible threats and benefits of the surgery to the family and informs them that the client wants to stay home. What role does the nurse play here? 1 Educator 2 Manager 3 Caregiver 4 Advocate

4 The nurse in the given scenario plays the role of an advocate by protecting the client's human and legal rights and by providing assistance in asserting these rights. As an educator, the nurse explains concepts and facts about health and the reason for routine care activities, demonstrates procedures, and evaluates the client's progress in learning. As a caregiver, the nurse helps clients to maintain and regain health, manages diseases and symptoms, and attains a maximal level function and independence through the healing process. As a manager, the nurse coordinates the activities of members of the nursing staff in delivering nursing care and has responsibility for personnel, policy, and budgetary issues for a specific nursing unit or agency.

A nurse is caring for a school-aged child with nephrotic syndrome who has massive edema. The nurse teaches the parents about the low-sodium diet that has been ordered. Which food group has the lowest level of sodium compared with the other food groups? Meat Dairy Fresh fruit Fresh vegetables

Fresh fruit has the overall lowest sodium content compared with the other food groups. Meat is higher in sodium than fruit. Dairy products are higher in sodium than fruit is. Fresh vegetables are higher in sodium than fruit is.