Prepu Ch.53, 54 KIDNEY (Medsurg book)

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? A. Dehydration B. Hyperkalemia C. Crackles D. Hypertension

A. Dehydration The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.

Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?

6 The nurse will administer 2 tablets per dose (800 mg/400 mg per tablet). The client receives a total of 3 doses per day or 6 tablets (2 tablets per dose x 3 doses).

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? A. "It is important to use strict aseptic technique." B. "It is appropriate to warm the dialysate in a microwave." C. "The infusion clamp should be open during infusion." D. "The effluent should be allowed to drain by gravity."

B. "It is appropriate to warm the dialysate in a microwave." The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.

What is a hallmark of the diagnosis of nephrotic syndrome? A. Hyponatremia B. Proteinuria C. Hypoalbuminemia D. Hypokalemia

B. Proteinuria Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.

The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document? A. Urinary frequency B. Urinary urgency C. Urinary incontinence D. Urinary stasis

B. Urinary urgency The nurse would document urinary urgency. Urinary frequency is urinating more frequently than normal often times due to inadequate emptying of the bladder. Urinary incontinence is the involuntary loss of urine. Urinary stasis is a stoppage or diminution of flow.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? A. Serum potassium level of 4.9 mEq/L B. Serum sodium level of 135 mEq/L C. Temperature of 99.2° F (37.3° C) D. Urine output of 20 ml/hour

D. urine output of 20 ml/hour Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.

The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? A. "I will feel a warm sensation as the dye is injected." B. "I should remove all jewelry before the test." C. "I should let the staff know if I feel claustrophobic." D. "I will need to drink all of the dye as quickly as possible."

A. "I will feel a warm sensation as the dye is injected." A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected.

A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client? A. Anemia B. Acidosis C. Hyperkalemia D. Pericarditis

A. Anemia Anemia develops as a result of inadequate erythropoietin production, the shortened lifespan of RBCs, nutritional deficiencies, and the patient's tendency to bleed, particularly from the GI tract. Erythropoietin, a substance normally produced by the kidneys, stimulates bone marrow to produce RBCs (Murphy, Bennett, & Jenkins, 2010). In ESKD, erythropoietin production decreases and profound anemia results, producing fatigue, angina, and shortness of breath.

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? A. Azotemia B. Proteinuria C. Hematuria D. Bacteremia

A. Azotemia 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.

One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: A. restricting sources of potassium usually found in fresh fruits and vegetables. B. allowing liberal use of sodium. C. limiting iron and folic acid intake. D. eating protein liberally

A. restricting sources of potassium usually found in fresh fruits and vegetables. Restrict sources of potassium usually found in fresh fruits and vegetables; hyperkalemia can cause life-threatening changes. Restrict sodium intake as ordered; doing so prevents excess sodium and fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken. Iron and folic acid supplements are needed for RBC production. Epogen stimulates bone marrow to produce RBCs. Restrict protein intake to foods that are complete proteins within prescribed limits. Complete proteins provide positive nitrogen balance for healing and growth.

The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom? A. Azotemia B. Diminished erythropoietin production C. Impaired immunologic response D. Electrolyte imbalances

B. Diminished erythropoietin production Erythropoietin is a hormone produced in the kidneys, and this production is inadequate in chronic renal failure, which results in anemia. Azotemia, impaired immune response, and electrolyte imbalance are associated with chronic renal failure but not indicated with anemia.

The nurse recognizes which condition as an integumentary manifestation of chronic renal failure? A. Asterixis B. Gray-bronze skin color C. Tremors D. Seizures

B. Gray-bronze skin color Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.

A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? A. Elevated urea levels B. Hyperkalemia C. Hypocalcemia D. Elevated white blood cells

B. Hyperkalemia Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? A. "Be sure to eat meat at every meal." B. "Eat plenty of bananas." C. "Increase your carbohydrate intake." D. "Drink plenty of fluids, and use a salt substitute."

C. "Increase your carbohydrate intake." A client with CRF requires extra carbohydrates to prevent protein catabolism. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Salt substitutes are high in potassium and should be avoided.

A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client? A. "An x-ray will be done to view your kidneys, ureters, and bladder." B. "A contrast medium will be used to help see the structures better." C. "You don't need to do any fasting before this noninvasive test." D. "You'll have a pressure dressing on your groin after the test."

C. "You don't need to do any fasting before this noninvasive test." Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. It is not invasive, does not require the injection of a radiopaque dye, and does not require fasting or bowel preparation. An x-ray of the abdomen to view the kidneys, ureters, and bladder is called a KUB. A contrast medium is used for computed tomography of the abdomen and pelvis. A pressure dressing is applied to the groin after a renal arteriogram.

The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, the nurse recalls that several substances are filtered from the blood by the glomerulus and these substances are then excreted in the urine. The nurse identifies the presence of which substances in the urine as abnormal findings? A. Potassium and sodium B. Bicarbonate and urea C. Glucose and protein D. Creatinine and chloride

C. Glucose and protein The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that it is not excreted in the urine.

Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? A. Urine output of 35 to 40 mL/hour B. Pain of 3 out of 10, 1 hour after analgesic administration C. SpO2 at 90% with fine crackles in the lung bases D. Blood tinged drainage in Jackson-Pratt drainage tube

C. SpO2 at 90% with fine crackles in the lung bases The Risk for Ineffective Breathing Pattern is often a challenge in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output is monitored to maintain a urine output of greater than 30 mL/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? A. Administration of an insulin drip B. Administration of a loop diuretic C. Administration of sodium bicarbonate D. Administration of sodium polystyrene sulfonate [Kayexalate])

D. Administration of sodium polystyrene sulfonate [Kayexalate]) The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? A. Pats skin dry after bathing B. Uses moisturizing creams C. Keeps nails trimmed short D. Brief, hot daily showers

D. Brief, hot daily showers Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.

When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic? A. Penicillin B. Gentamicin C. Tobramycin D. Neomycin

A. Penicillin The three nephrotoxic drugs are aminoglycerides.

The laboratory results for a patient with renal failure, accompanied by decreased glomerular filtration, would be evaluated frequently. Which of the following is the most sensitive indicator of renal function? A. Serum creatinine of 1.5 mg/dL B. BUN of 20 mg/dLb C. Creatinine clearance of 90 mL/min D. Urinary protein level of 150 mg/24h.

A. Serum creatinine of 1.5 mg/dL As glomerular filtration decreases, the serum creatinine and BUN levels increase and the creatinine clearance decreases. Serum creatinine is the more sensitive indicator of renal function because of its constant production in the body. The BUN is affected not only by renal disease but also by protein intake in the diet, tissue catabolism, fluid intake, parenteral nutrition, and medications such as corticosteroids.

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? A. Azotemia B. Proteinuria C. Hematuria D. Bacteremia

A. azotemia 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.

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? A. Obstruction of the lower urinary tract B. Acute renal failure C. Infection D. Nephrotic syndrome

C. Infection Frequency, urgency, and dysuria are commonly associated with urinary tract infection. Hesitancy and enuresis may indicate an obstruction. Oliguria or anuria and proteinuria might suggest acute renal failure. Nocturia is associated with nephrotic syndrome.

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? A. Encourage oral fluids. B. Administer furosemide (Lasix) 20 mg IV C. Start hemodialysis after a temporary access is obtained. D. Start IV fluids with a normal saline solution bolus followed by a maintenance dose.

D. Start IV fluids with a normal saline solution bolus followed by a maintenance dose. The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.

Following a renal biopsy, a client reports severe pain in the back, the arms, and the shoulders. Which intervention should be offered by the nurse? A. Assess the patient's back and shoulder areas for signs of internal bleeding. B. Distract the client's attention from the pain. C. Provide analgesics to the client. D. Enable the client to sit up and ambulate.

A. Assess the patient's back and shoulder areas for signs of internal bleeding. After a renal biopsy, the client should be on bed rest. The nurse observes the urine for signs of hematuria. It is important to assess the dressing frequently for signs of bleeding, monitor vital signs, and evaluate the type and severity of pain. Severe pain in the back, shoulder, or abdomen may indicate bleeding. In such a case, the nurse should notify the physician about these signs and symptoms. The nurse should also assess the client for difficulty voiding and encourage adequate fluid intake.

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? A. Calcium B. Magnesium C. Phosphorus D. Sodium

A. Calcium Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.

When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? A. Check for thrill or bruit over the access site. B. Inspect the catheter insertion site for infection. C. Add the prescribed drug to the dialysate. D. Warm the solution to body temperature.

A. Check for thrill or bruit over the access site. When preparing a client for hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency. Inspecting the catheter insertion site for infection, adding the prescribed drug to the dialysate, and warming the solution to body temperature would be necessary when preparing a client for peritoneal dialysis.

The health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator? A. Creatinine clearance level B. Uric acid level C. Blood urea nitrogen (BUN) D. BUN to creatinine ratio

A. Creatinine clearance level The creatinine clearance measures the volume of blood cleared of endogenous creatinine in 1 minute. This serves as a measure of the glomerular filtration rate. Therefore the creatinine clearance test is a sensitive indicator of renal disease progression.

An appropriate nursing intervention for the client following a nuclear scan of the kidney is to: A. Encourage high fluid intake. B. Strain all urine for 48 hours. C. Apply moist heat to the flank area. D. Monitor for hematuria.

A. Encourage high fluid intake. A nuclear scan of the kidney involves the IV administration of a radioisotope. Fluid intake is encouraged to flush the urinary tract to promote excretion of the isotope. Monitoring for hematuria, applying heat, and straining urine do not address the potential renal complications associated with the radioisotope.

What is used to decrease potassium level seen in acute renal failure? A. Sodium polystyrene sulfonate (Kayexalate) B. Sorbitol C. IV dextrose 50% D. Calcium supplements

A. Sodium polystyrene sulfonate (Kayexalate) The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.

A client is having a blood urea nitrogen (BUN) test. BUN level is: A. increased in renal disease and urinary obstruction. B. decreased in nephrotic syndrome. C. decreased in renal disease and urinary obstruction. D. unchanged in renal disease.

A. increased in renal disease and urinary obstruction.

The nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration? A. phenazopyridine hydrochloride B. Infection C. Phenytoin D. Metronidazole

A. phenazopyridine hydrochloride Orange to amber-colored urine is caused by concentrated urine due to dehydration, fever, bile, excess bilirubin or carotene, and the medications phenazopyridium hydrochloride and nitrofurantoin. Infection would cause yellow to milky white urine. Phenytoin would cause the urine to become pink to red. Metronidazole would cause the urine to become brown to black.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: A. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. B. a decreased serum phosphate level secondary to kidney failure. C. an increased serum calcium level secondary to kidney failure. D. metabolic alkalosis secondary to retention of hydrogen ions.

A. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? A. A GFR of 90 mL/min/1.73 m2. B. A GFR of 30-59 mL/min/1.73 m2 C. A GFR of 120 mL/min/1.73 m2 D. A GFR of 85 mL/min/1.73 m2

B. A GFR of 30-59 mL/min/1.73 m2 Stage 3 of chronic kidney disease is defined as having a GFR of 30-59 mL/min/1.73 m2