SG CHAPTER 62: Concepts of Care for Patients with Kidney Disorders

31. What is the nurse's best response when a client with kidney cancer, who had a nephrectomy, asks if the remaining kidney can take over kidney function immediately? A. "Your remaining kidney isn't able to provide adequate function, so other therapies will be necessary." B. "That's a good question. We'll ask your health care provider about it during next rounds." C. "The kidney you have left will provide adequate function, but it may take a few days or weeks." D. "It varies from person to person, but you can expect normal kidney function to return the same day."

✅ C Although overall kidney function decreases after a nephrectomy, the remaining kidney tissue usually works well enough for a healthy life. It may take a few days or weeks for the remaining kidney to assume all kidney functions.

2. What priority question will the nurse be sure to ask a client at risk for acute pyelonephritis? A. "Have you recently been treated for a urinary tract infection?" B. "Are you taking birth control pills as contraception?" C. "Do your have a family history of stroke or myocardial infarction?" D. "Have you ever leaked urine when laughing, jogging, or coughing?"

✅. A Acute pyelonephritis is an active bacterial infection, which results from bacterial infection, with or without obstruction or reflux. An important feature is recent cystitis or treatment for urinary tract infection (UTI).

14. When the nurse reviews laboratory values for a client with chronic glomerulonephritis, and the serum phosphorus level is 5.3 mg/dL, which other change does the nurse expect to see? A. Serum calcium level is low normal or slightly below normal B. Serum potassium level below the normal range C. Elevated serum sodium levels related to dehydration D. Elevated chloride levels related to elevated sodium

✅. A The client's phosphorus level is elevated, so the nurse expects the client's calcium level to below normal, or slightly below normal. This occurs because calcium and phosphorus exist in the blood in a balanced reciprocal relationship. Whenever one electrolyte is elevated, the other is decreased.

26. What does the nurse suspect when assessment reveals a distended bladder and the client reports passing very small amounts of urine today despite a normal fluid intake and feeling the urge to urinate? A. Urethral stricture B. Polycystic kidney disease C. Hydroureter D. Hydronephrosis

✅. A Urethral strictures obstruct urine outflow and may contribute to development of bladder distention, hydroureter, and hydronephrosis.

34. What will the nurse teach a client and family about prevention of kidney and genitourinary trauma? Select all that apply. A. Wear a seat belt. B. Practice safe walking habits. C. Use caution when riding bicycles and motorcycles. D. Wear appropriate protective clothing when participating in contact sports. E. Avoid all contact sports and high-risk activities if you have only one kidney. F. Penetrating trauma is responsible for most kidney injuries.

✅. A, B, C, D, E All of these options are appropriate for the nurse to teach a client and family for prevention of traumatic kidney or genitourinary injuries except option F. The main cause of kidney trauma is blunt injuries.

13. Which symptoms will the nurse expect to find on assessment when a client with chronic glomerulonephritis (GN) develops uremia? Select all that apply. A. Ataxia B. Slurred speech C. Neck vein distention D. Asterixis E. Crackles in lung bases F. Itching

✅. A, B, D, F Uremic symptoms include slurred speech, ataxia, tremors, or asterixis (flapping tremor of the fingers or the inability to maintain a fixed posture with the arms extended and wrists hyperextended). Skin symptoms of uremia include a yellowish color, texture changes, bruises, rashes, or eruptions. Itching and areas of dryness or excoriation from scratching are often present.

10. What results will the nurse expect from a 24-hour urine test for total protein when a client is diagnosed with glomerulonephritis (GN)? A. Protein excretion rate may be increased from 500 mg/24 hr to 3 g/24 hr. B. Protein excretion rate may be decreased from 500 mg/24 hr to 250 mg/24 hr. C. Protein excretion rate will be within normal limits for the client. D. Protein excretion rate will vary from normal to slightly increased.

✅. A When a 24-hour urine collection for total protein is obtained, the nurse expects the protein excretion rate for clients with acute GN to be increased from 500 mg/24 hr to 3 g/24 hr.

18. What is the priority action the nurse will take for a client admi

✅. A The nurse's priority action is to assess the client's fluid volume and hydration status. Assessing the client's hydration status is essential because vascular dehydration is common. If plasma volume is depleted, kidney problems worsen.

22. Which self-care management techniques will the nurse teach a client with polycystic kidney disease (PKD) to prevent constipation? Select all that apply. A. Consume adequate fluid intake of 2 to 3 liters daily. B. Use stool softeners daily. C. Take NSAIDs for discomfort. D. Avoid aspirin-containing drugs. E. Maintain your fiber intake and exercise regularly. F. Increase your dietary protein intake with meals.

✅. A, B, E The nurse teaches the client who has adequate urine output to prevent constipation by maintaining adequate fluid intake (generally 2 to 3 liters daily in food and beverages), maintaining dietary fiber intake, and exercising regularly. The client is advised about the use of stool softeners and bulk agents, including careful use of laxatives, to prevent chronic constipation. Aspirin-containing drugs are avoided to decrease the risk of bleeding, not constipation. NSAIDs are used cautiously because they can reduce kidney blood flow, but do not cause constipation. Protein intake may be limited to slow the development of end-stage kidney disease (ESKD), but is not an action that will reduce constipation.

28. Which client signs and symptoms cause the nurse to suspect the possibility of renovascular disease? Select all that apply. A. Sudden onset of hypertension B. Distended bladder on palpation C. Difficult to control hypertension D. Sustained hyperglycemia E. Elevated serum creatinine F. Decreased glomerular filtration rate

✅. A, C, D, E, F All of these options suggest a diagnosis of renovascular disease except option B, distended bladder. Renovascular disease includes processes affecting the renal arteries that may severely narrow the lumens and greatly reduce blood flow to the kidney tissues.

30. Which postoperative action will the nurse take for a client who had a nephrostomy and a nephrostomy tube is now in place? A. Monitor the amount of drainage in the collection bag. B. Keep the client NPO for at least 6 to 8 hours. C. Irrigate the tube until the return drainage is clear. D. Instruct the client to sleep with the operative side down.

✅. A The nurse monitors the nephrostomy site for leaking urine or blood as well as amount of drainage. Urine drainage may be bloody for the first 12 to 24 hours after the procedure but should gradually clear. If prescribed, the nephrostomy tube can be irrigated with 5 mL sterile saline to check patency and dislodge clots. However, the volume used for this purpose is not intended to irrigate the nephrostomy until urine drainage is clear. Diuresis can occur once the tube is in place.

7. Which information is most important for the nurse to include when teaching a client and family about home care for acute pyelonephritis? Select all that apply. A. Role of nutrition and adequate fluid intake B. Need for a balance between rest and activity C. Signs and symptoms of disease recurrence D. Use of successful coping mechanisms E. Care of a permanent indwelling catheter F. Drug regimen (purpose, timing, frequency, duration, and possible side effects)

✅. A, B, C, D, F All of these options are taught by the nurse to the client and family before discharge except option E. Clients are rarely discharged with a urinary catheter in place, and chronic urinary catheter care is only taught if necessary.

24. For which symptoms or changes will the nurse instruct a client with polycystic kidney disease (PKD) to contact the health care provider immediately? Select all that apply. A. Presence of a foul urine odor B. Going more than 1 day between bowel movements C. Development of a headache that does not go away D. Ge

✅. A, C, E The nurse teaches a client and family to notify the primary health care provider for sudden weight gain, headache that does not go away, and for changes in urine such as a foul odor and new- onset blood in the urine. Missing a bowel movement for 1 day is not enough to establish constipation. Nocturia is characteristic of PKD. Consuming salty foods is a concern because of sodium restrictions, but eating a few small pre

17. Which nursing and collaborative actions are implemented by the nurse when caring for a client with nephrotic syndrome (NS)? Select all that apply. A. Administration of mild diuretics B. Fluid restrictions C. Frequent assessment of hydration status D. Administration of angiotensin-converting enzyme inhibitors E. Collection of urine sample for culture F. Assessment for periorbital swelling

✅. A, C, D, F Angiotensin-converting enzyme inhibitors (ACEIs) can decrease protein loss in the urine and lower blood pressure for clients with NS. Mild diuretics and sodium restriction may be needed to control edema (facial and periorbital) and hypertension. The nurse assesses the client's hydration status because vascular dehydration is common.

25. What is the nurse's priority concern when caring for clients with hydronephrosis or hydroureter? A. Dilute urine B. Dehydration C. Pain with urination D. Obstruction

✅. D Hydronephrosis and hydroureter are problems of urinary elimination with outflow obstruction. Urethral strictures obstruct urine outflow and may contribute to bladder distention, hydroureter, and hydronephrosis. Prompt recognition and treatment are crucial to preventing permanent kidney damage.

20. Which questions will the nurse ask a client suspected of having polycystic kidney disease (PKD)? Select all that apply. A. "Do you have a family history of PKD or kidney disease?" B. "Have you ever had any problems with muscle aches or joint pains?" C. "Do you have any problems with headaches?" D. "Have you had any difficulty with constipation or abdominal discomfort?" E. "Do you have a history of any sexually transmi

✅. A, C, D, F The nurse gathers essential information when taking a client's history. Explore the family history of a client with suspected or actual PKD and ask whether either parent was known to have PKD or whether there is any family history of kidney disease. Important information to obtain includes the age at which the problem was diagnosed in the parent and any related complications. Ask about pain, abdominal discomfort, constipation, changes in urine color or frequency, hypertension, headaches, and a family history of stroke or sudden death.

32. Which therapy does the nurse expect after a client's nephrectomy to prevent an adrenal complication? A. Administration of a potassium supplement B. Prescription for steroid supplement C. Addition of extra calcium to diet D. Estrogen supplements for postmenopausal women

✅. B Adrenal insufficiency is possible as a complication when a kidney and adrenal gland are removed. Although only one adrenal gland may be affected, the remaining gland may not be able to secrete sufficient glucocorticoids immediately after surgery and steroid replacements may be needed.

33. Which assessment findings will the nurse expect to see documented when a client is first admi

✅. B Clients with renal cell carcinoma (RCC) have flank pain, obvious blood in the urine, and a kidney mass that can be palpated. The abdominal mass may be felt with gentle palpation and a renal bruit may be heard on auscultation.

29. What is the nurse's best response when a client with renovascular disease asks why the endovascular procedure, stent placement, is preferable to surgery to correct his or her condition? A. "The procedure will make a bypass route for blood to enter your kidney and does not leave a scar." B. "Stent placement is less risky and requires less time for recovery than does renal artery bypass surgery." C. "A synthetic blood vessel graft is inserted to redirect blood flow from the abdominal aorta into the renal artery." D. "An endovascular procedure is more cost-effective and does not need to be repeated."

✅. B Endovascular techniques are nonsurgical approaches to repair renal artery stenosis. Stent placement with or without balloon angioplasty is an example of an endovascular intervention. These techniques are less risky and require less time for recovery than does renal artery bypass surgery. The procedure does not create a bypass route. Depending on other client factors, the procedure may need to be repeated.

27. Which finding will the nurse associate with an obstruction in the urinary system specifically associated with hydronephrosis? A. Chills and fever B. Flank asymmetry C. Urge incontinence D. Bladder distention

✅. B In hydronephrosis, the kidney enlarges as urine collects in the renal pelvis and kidney tissue. Because the capacity of the renal pelvis is normally 5 to 8 mL, obstruction in the renal pelvis or at the point where the ureter joins the renal pelvis quickly distends the renal pelvis. Since this condition usually affects only one kidney, flank asymmetry is often present due to the enlarged kidney.

15. Which actions will the nurse delegate to the assistive personnel (AP) for appropriate care of a client with acute glomerulonephritis? A. Teaching how to collect a 24-hour urine specimen B. Weighing the client every morning with the same scale C. Assessing for changes in the urine sample D. Evaluating the client's ability to safely get to the bathroom

✅. B The scope of practice for an AP includes assisting with activities of daily living, weighing the client, assisting to the bathroom and other ambulation. The nurse instructs the AP to weigh the client every morning at the same time, wearing the same amount of clothes, and using the same scale. Teaching, assessing, and evaluating are higher level skills performed by the professional RN.

4. Which client will the nurse monitor carefully for highest risk of developing acute pyelonephritis? A. 32-year-old man with diabetes insipidus B. 34-year-old woman with diabetes mellitus in the second trimester of pregnancy C. 75-year-old man who drinks four beers each day D. 78-year-old woman prescribed diuretics for mild heart failure

✅. B The woman in option B has two risk factors for pyelonephritis: diabetes and pregnancy. Pyelonephritis from an ascending infection may follow manipulation of the urinary tract (e.g., placement of a urinary catheter), particularly in clients who have reduced immunity or diabetes. Hormonal changes as well as obstruction caused by the fetus during pregnancy make acute pyelonephritis more common during the second trimester and beginning of the third trimester.

1. Which findings will the nurse assess when a client is experiencing problems with urinary elimination caused by acute pyelonephritis? Select all that apply. A. Hypertension B. Pain and burning with urination C. Client reports back, flank, or loin pain D. Urine is cloudy and has a foul odor E. Client produces large amounts of dilute urine F. Urine sample is dark or smoky colored

✅. B, C, D, F Options B, C, D, and F are manifestations of acute pyelonephritis. See Key features of Acute Pyelonephritis in your text for additional signs and symptoms. Hypertension occurs with chronic pyelonephritis. Urine will be decreased and have characteristics of infections (e.g., turbidity, foul odor), not dilute.

19. Which factors promote long-term adherence to the prescribed antihypertensive drug therapy for a client diagnosed with nephrosclerosis? Select all that apply. A. Monthly reminders B. Once-a-day dosing C. Wri

✅. B, D, E Although many antihypertensive drugs may lower blood pressure, the client's response is important in ensuring long-term adherence to the prescribed therapy. Factors that promote adherence include once-a-day dosing, low cost, and minimal side effects.

16. Which health problem does the nurse suspect when a client with decreased kidney function has increased proteinuria, decreased serum albumin, lipids in blood and urine, increased aPTT and INR, facial edema, and hypertension? A. Glomerulonephritis B. Pyelonephritis C. Nephrotic syndrome D. Chronic kidney failure

✅. C Signs and symptoms of nephrotic syndrome (NS) include sudden onset of: massive proteinuria; hypoalbuminemia; edema (especially facial and periorbital); lipiduria; hyperlipidemia; delayed clo

23. For which minimal risk diagnostic test will the nurse prepare the client with polycystic kidney disease to have as initial screening? A. Kidney-ureter-bladder (KUB) x-rays B. Computed tomography with angiography C. Renal ultrasonography D. Renal needle biopsy

✅. C Ultrasound is the primary method for diagnosing PKD. The size of the kidney is measured by ultrasound as well as cysts within the kidney.

12. When a client with glomerulonephritis has a urine output over the past 24 hours of 1050 mL, how much fluid will the nurse allow the client during the next 24-hour period? A. 1050 to 1150 mL B. 1250 to 1350 mL C. 1450 to 1550 mL D. 1550 to 1650 mL

✅. D For clients with fluid overload, hypertension, and edema, diuretics and sodium and water restrictions are prescribed. The usual fluid allowance is equal to the previous 24-hour urine output plus 500 to 600 mL. In this case the client would be allowed 1050 mL plus 500 to 600 mL which equals 1550 to 1650 mL for the next 24 hours.

8. What priority finding will the nurse assess for when inspecting the hands, face, and eyelids of a client with possible acute glomerulonephritis (GN)? A. Redness B. Rash C. Dryness D. Edema

✅. D The nurse assesses a client's face, eyelids, hands, as well as other areas for edema because this is present in most clients with acute GN.

5. Which client findings cause the nurse to suspect the possibility of chronic pyelonephritis? Select all that apply. A. Sudden onset of massive proteinuria B. Inability to conserve sodium C. Decreased urine-concentrating ability and nocturia D. Abscess formation E. Hypertension F. Hyperkalemia and acidosis

✅B, C, E, F The nurse recognizes manifestations that define chronic pyelonephritis from acute by the following characteristics: hypertension; inability to conserve sodium; decreased urine- concentrating ability, resulting in noct

6. Which condition best indicates to the nurse that a client's fluid intake is sufficient to manage acute pyelonephritis? A. Client estimates an intake of 1.5 liters of water per day. B. Client reports no burning or pain with urination. C. Urine output is clear yellow and dilute. D. Antibiotic treatment was completed exactly as prescribed.

✅C Fluid intake is recommended at 2 L/day, sufficient to result in dilute (pale yellow) urine, unless another health problem requires fluid restriction.

9. What is the nurse's next action after assessing a client with glomerulonephritis (GN) who reports mild shortness of breath and finding crackles in all lung fields, distended neck veins? A. Obtaining a urine sample to check for proteinuria B. Checking for costovertebral angle tenderness or flank pain C. Assessing carefully for additional signs of fluid overload D. Alerting the health care provider about the respiratory symptoms

✅C The nurse assesses for fluid overload and pulmonary edema that may result from fluid and sodium retention occurring with acute GN. He or she asks about any difficulty breathing or shortness of breath. Assessment for crackles in the lung fields, an S3 heart sound (gallop rhythm), and neck vein distention would also be completed. With this information, the nurse would then notify the health care provider of the findings.

1. A nurse is planning care for a client who has prerenal acute kidney injury (AKi) following abdominal aortic aneurysm repair. Urinary output is 60 mL in the past 2 hr, and blood pressure is 92/58 mm Hg. The nurse should expect which of the following interventions? A. Prepare the client for a CT scan with contrast dye. B. Plan to administer nitroprusside. C. Prepare to administer a fluid challenge. d. Plan to position the client in Trendelenburg.

1. A. do not plan for a CT scan. Contrast dye is contraindicated for a client who has possible acute kidney injury. B. Nitroprusside is a rapid‐acting vasodilator used to rapidly reduce blood pressure for clients who have hypertensive crisis. it is contraindicated for clients who have hypotension. C. CORRECT: Plan to administer a fluid challenge for hypovolemia, which is indicated by the client's low urinary output and blood pressure. d. Maintain the client in a supine or modified Trendelenburg position with the head elevated 10 degrees and the lower extremities elevated 20 degrees in order to promote venous return to the heart. NCLEX® Connection: Physiological Adaptation, Fluid and Electrolyte Imbalances

2. A nurse is planning care for a client who has postrenal AKi due to metastatic cancer. The client has a blood creatinine of 5 mg/dL. Which of the following interventions should the nurse include in the plan? (select all that apply.) A. Provide a high‐protein diet. B. Assess the urine for blood. C. Monitor for intermittent anuria. d. Weight the client once per week. e. Provide NsAids for pain.

2. A. CORRECT: Provide a high‐protein diet due to the high rate of protein breakdown that occurs with acute kidney injury. B. CORRECT: Assess urine for blood, stones, and particles indicating an obstruction of the urinary structures that leave the kidney. C. CORRECT: Assess for intermittent anuria due to obstruction or damage to kidneys or urinary structures. d. Weigh the client daily to monitor for fluid retention due to acute kidney injury. e. do not administer NsAids, which are toxic to the nephrons in the kidney. NCLEX® Connection: Physiological Adaptation, Alterations in Body Systems

3. A nurse is planning care for a client who has stage 4 chronic kidney disease. Which of the following actions should the nurse include in the plan of care? (select all that apply.) A. Assess for jugular vein distention. B. Provide frequent mouth rinses. C. Auscultate for a pleural friction rub. d. Provide a high‐sodium diet. e. Monitorfordysrhythmias.

3. A. CORRECT: Assess for jugular vein distention, which can indicate fluid overload and heart failure. B. CORRECT: Provide frequent mouth rinses due to uremic halitosis caused by urea waste in the blood. C. CORRECT: Auscultate for a pleural friction rub related to respiratory failure and pulmonary edema caused by acid base imbalances and fluid retention. d. Monitor blood sodium and reduce the client's dietary sodium intake. e. CORRECT: Monitor for dysrhythmias related to increased blood potassium caused by stage 4 chronic kidney disease. NCLEX® Connection: Physiological Adaptation, Alterations in Body Systems

4. A nurse is reviewing client laboratory data. Which of the following findings is expected for a client who has stage 4 chronic kidney disease? A. Blood urea nitrogen (BUN) 15 mg/dL B. Glomerular filtration rate (GFr) 20 mL/min C. Blood creatinine 1.1 mg/dL d. Blood potassium 5.0 meq/L

4. A. expect the BUN to be above the expected reference range, about 10 to 20 times the BUN finding. B. CORRECT: The GFr is severely decreased to approximately 20 mL/min, which is indicative of stage 4 chronic kidney disease. C. in stage 4 chronic kidney disease, a blood creatinine level can be as high as 15 to 30 mg/dL. d. A client in stage 4 chronic kidney disease would have a blood potassium level greater than 5.0 meq/L. NCLEX® Connection: Reduction of Risk Potential, Laboratory Values

5. A nurse is assessing a client who has prerenal AKi. Which of the following findings should the nurse expect? (select all that apply.) A. reduced BUN B. elevated cardiac enzymes C. reduced urine output d. elevated blood creatinine e. elevated blood calcium

5. A. A manifestation of prerenal AKi is an elevated BUN caused by the retention of nitrogenous wastes in the blood. B. elevated cardiac enzymes is a manifestation of cardiac tissue injury, not AKi. C. CORRECT: A manifestation of prerenal AKi is reduced urine output. d. CORRECT: A manifestation of prerenal AKi is elevated blood creatinine. e. A manifestation of prerenal AKi is reduced calcium level. NCLEX® Connection: Physiological Adaptation,

11. Which interventions will the nurse expect to implement for management of infection as the cause for glomerulonephritis (GN)? Select all that apply. A. Corticosteroids B. Antibiotics C. Cytotoxic drugs D. Personal hygiene E. Fluid restriction F. Handwashing

✅ B, D, F Managing infection as a cause of acute GN begins with appropriate antibiotic therapy. Penicillin, erythromycin, or azithromycin is prescribed for GN caused by streptococcal infection. The nurse stresses personal hygiene and basic infection control principles (e.g., handwashing) to prevent spread of the organism. Clients are taught the importance of completing the entire course of the prescribed antibiotic. Corticosteroids and cytotoxic drugs are used for GN that is not caused by infection. Fluid restriction may be used with the complication of fluid overload.

3. Which laboratory tests would the nurse expect the health care provider to order when a client has acute pyelonephritis? Select all that apply. A. Urine culture for specific infective organism to be treated B. Complete blood count with differential to monitor for increased WBCs C. Urinalysis for bacteria, leucocyte esterase, nitrate, and RBCs D. C-reactive protein and erythrocyte sedimentation rate (ESR) to determine immune response and inflammation E. Blood urea nitrogen (BUN) and serum creatinine levels to monitor for elevation F. Test to determine whether a woman is pregnant

✅A, B, C, D, E, F The nurse expects that all of these laboratory tests will be ordered to determine the presence of acute pyelonephritis.

21. What early sign would the nurse expect when a client is suspected of autosomal dominant polycystic kidney disease (ADPKD)? A. Headache B. Nocturia C. Pruritus D. Facial edema

✅B Nocturia (the need to urinate excessively at night) is an early symptom and occurs because of decreased urine-concentrating ability when a client develops PKD.