Ch. 54 Kidney Critical Care Combined

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Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys?

Oliguria Expl: The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys, such as urea and creatinine. The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months. 1577

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

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.

A nurse is caring for an acutely ill patient. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill patient is which of the following? a) Pulse rate b) Weight c) Edema d) Blood pressure

Weight The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. Blood pressure, pulse rate, and edema are not the most accurate indicator of fluid loss or gain.

The most accurate indicator of fluid loss or gain in an acutely ill patient is

weight.

Retention of which electrolyte is the most life-threatening effect of renal failure? a) Potassium b) Calcium c) Phosphorous d) Sodium

A) Potassium Retention of potassium is the most life-threatening effect of renal failure.

A child diagnosed with pyelonephritis has a fever of 104.2. Which antipyretic should the nurse administer?

Acetaminophen

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?

Acute glomerulonephritis

With prostatitis, what foods should be avoided until the inflammation has resolved?

Alcohol Caffeine

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? a) Therapeutic index b) GI absorption rate c) Liver function studies d) Creatinine clearance

D) Creatinine clearance The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

A client who is blind is admitted for treatment of gastroenteritis. Which nursing diagnosis takes highest priority for this client?

Deficient fluid volume

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a) Weight loss b) Fever c) Absence of pain d) Diuresis

b) Fever Fever is an indicator of infection or transplant rejection.

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?

"Increase your carbohydrate intake."

A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). The patient asks the nurse to explain what will be done. What is the nurse's best response?

"Shock waves will break the stones in the kidney to the size of sand grains."

Administration of sodium polystyrene sulfonate (Kayexalate)

A 176-lb client with pyelonephritis has been instructed to drink at least 30 mL of water for each kilogram of body weight. The client prefers to drink bottled water and asks the nurse to calculate the number of 16-oz bottles needed to fulfill the daily intake required. Fill in the blank with the total number of 16-oz bottles of water that should be consumed each day. __________ bottles

Ans: 5 bottles Feedback: Step 1. 2.2 lb : 1 kg :: 176 lb: X kg 176 = 2.2 X 80 kg = X Step 2. Multiply 80 kg by 30 mL = 2400 mL/day Step 3. 30 mL : 1 oz :: 2400 mL : X oz 2400 = 30 X 80 oz = X Step 4.16 oz : 1 bottle :: 80 oz : X bottles 80 = 16 X 5 bottles = X

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: a) "Dietary changes can reverse the damage that has occurred in your kidneys." b) "Draining of the cysts and antibiotic therapy will cure your disease." c) "Genetic testing will determine the best treatment for your condition." d) "As the disease progresses, you will most likely require renal replacement therapy."

"As the disease progresses, you will most likely require renal replacement therapy." There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.

"Even a perfect match does not guarantee organ success."

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 appropriate to warm the dialysate in a microwave." b) "The infusion clamp should be open during infusion." c) "The effluent should be allowed to drain by gravity." d) "It is important to use strict aseptic technique."

"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.

A nurse is interviewing the parents of a child diagnosed with obstructive uropathy. Which statement by the parents would the nurse identify as significant?

"She had surgery to repair a problem with her anus.". Risk factors associated with obstructive uropathy include prune belly syndrome, chromosome abnormalities, anorectal malformations, and ear defects.

Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective?

"Ultrafiltration methods take much longer than hemodialysis.".Ultrafiltration methods (CVVH, CVVHD) are better tolerated by unstable clients as fluid is removed slowly, resulting in mild hemodynamic effects. 1589

A patient has acute kidney injury (AKI) with a negative nitrogen balance. How much weight does the nurse expect the patient to lose?

0.5 kg/day

The critical care nurse is monitoring the patient's urine output and drains following renal surgery. What should the nurse promptly report to the physician?

Absence of drain output

The critical care nurse is monitoring her patient's urine output and drainage from tubes inserted intraoperatively. What would the nurse promptly report to the physician?

Absent drainage

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? a) Acute renal failure b) Chronic renal failure c) Acute glomerulonephritis d) Nephrotic syndrome

Acute glomerulonephritis Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders?

Acute glomerulonephritis- also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure- associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure- may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome- caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

A client, who has suffered with recurrent renal calculi, has learned that the stones were composed of calcium oxalate. In providing dietary education to this client, which food contains the highest levels of oxalate and should be limited? A) Bananas B) Chocolate C) Herbal teas D) Beef

Ans: B Feedback: Because as many as 80% of all renal calculi are composed of calcium oxalate, some believe limiting the amount of oxalate taken in via diet can be helpful. Milk, chocolate, and cocoa are highest in oxalate. Black tea is also high in oxalate. Bananas, herbal tea, and beef are not indicated as high oxalate foods.

A nephrostomy tube is inserted in a client with a large ureteral calculus. Which is the most important consideration in providing nursing care for this client? A) Clamp the tube for no longer than 2 hours at a time. B) Maintain free, continuous urine drainage. C) Leave nephrostomy site open to the air. D) Use only sterile NSS to irrigate the tube.

Ans: B Feedback: Clamping or kinking of the tube will create backup of urine into the renal pelvis, resulting in hydronephrosis and can contribute to renal damage. Always make sure the urine is allowed to flow continuously and freely and do not irrigate. The nephrostomy tube is inserted through a stab wound and enters the kidney. A sterile dressing should be used to prevent pathogen entry.

Which assessment finding is most important in determining nursing care for a client with acute glomerulonephritis? A) Presence of albumin in the urine B) Dark smoky colored urine C) Blurred vision D) Peripheral edema

Ans: C Feedback: Visual disturbances can be indicative of rising blood pressure in a client with acute glomerulonephritis. Severe hypertension needs prompt treatment to prevent convulsions. Presence of albumin (protein) and RBCs in the urine, along with periorbital and peripheral edema, are common symptoms associated with glomerulonephritis.

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

Ans: D Feedback: 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.

As the home health nurse reviews medications taken by the client with polycystic kidney disease, which medication should be addressed first? A) Lovastin (Mevacor) B) Methylprednisolone (Depo-Medrol) C) Furosemide (Lasix) D) Ibuprofen (Motrin)

Ans: D Feedback: Nephrotoxic drugs are not administered to clients with renal disease unless no other therapeutic agent is available. Ibuprofen (Motrin) is a nephrotoxic drug and nephrotoxic medications, such as nonsteroidal anti-inflammatory drugs and cephalosporin antibiotics, should be avoided in treating clients with polycystic kidney disease. Lovastin (Mevacor) (antihyperlidemic agent) and methylprednisolone (Depo-Medrol) (steroid) are drugs presently being reviewed for slowing the rate of disease progression in clients with polycystic kidney disease and are not considered nephrotoxic. Furosemide (Lasix) is a diuretic and has no significance in causing renal damage.

A client has undergone a renal transplant and returns to the healthcare agency for a follow- up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? A) Hypotension B) Weight loss C) Polyuria D) Abdominal pain

Ans: D Feedback: Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.

An elderly client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? A) Shows damage to the kidneys B) If risk for chronic pyelonephritis is likely C) Reveals causative microorganisms D) Detects calculi, cysts, or tumors

Ans: D Feedback: Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.

Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate? a) Give medications that promote fluid retention. b) Limit sodium and water intake. c) Teach client behaviors that decrease urination. d) Assess for dehydration.

B) Limit sodium and water intake Implement prescribed interventions such as limiting sodium and water intake and administering ordered medications that promote fluid elimination. Assessing for dehydration and teaching to decrease urination would not be appropriate interventions.

Patients diagnosed with hypervolemia should avoid sweet or dry food because: a) It obstructs water elimination. b) It can cause dehydration. c) It can lead to weight gain. d) It increases the client's desire to consume fluid.

D) It increases the client's desire to consume fluid The management goal in hypervolemia is to reduce fluid volume. For this reason, fluid is rationed, and the client is advised to take limited amount of fluid when thirsty. Sweet or dry food can increase the client's desire to consume fluid. Sweet or dry food does not obstruct water elimination nor does it cause dehydration. Weight regulation is not part of hypervolemia management except to the extent that it is achieved on account of fluid reduction.

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) "The effluent should be allowed to drain by gravity." b) "It is important to use strict aseptic technique." c) "The infusion clamp should be open during infusion." d) "It is appropriate to warm the dialysate in a microwave."

D) It is appropriate to warm the dialysate in a microwave Explanation: 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.

A nurse is caring for a patient who is in the diuresis phase of AKI. The nurse should closely monitor the patient for what complication during this phase?

Dehydration

A nurse is caring for a renal patient in the dieresis period of ARF. What must the patient be observed closely for during this phase?

Dehydration

In the diuresis period of AKI, the nurse should observe the patient closely for what complication?

Dehydration

Detects calculi, cysts, or tumors. Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions

The nurse coming on shift is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing end-stage renal disease (ESRD)?

Diabetes mellitus with poorly controlled hypertension

A nurse identifies a nursing diagnosis of Risk for Ineffective Breathing Pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? a) Monitor temperature every 4 hours. b) Keep the drainage catheter below the level of insertion. c) Administer isotonic fluid therapy as ordered. d) Encourage use of incentive spirometer every 2 hours.

Encourage use of incentive spirometer every 2 hours. To address the issue of ineffective breathing pattern, encouraging the use of incentive spirometer would be most appropriate to help increase alveolar ventilation. Administering isotonic fluid therapy would be appropriate for issues involving fluid loss such as bleeding or hemorrhage. Keeping the drainage catheter below the level of insertion would be appropriate to reduce the risk of obstruction leading to acute pain. Monitoring the temperature every 4 hours would be appropriate to reduce the client's risk for infection.

The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client?

Keep the dialysis supplies in a clean area, away from children and pets Expl: It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

The nurse is teaching a group of nursing students about acute glomerulonephritis genitourinary conditions. A student asks the about a condition that occurs when there is a decreased volume of urine output. The condition the student is referring to is which of the following?

Oliguria is a subnormal volume of urine.

A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders?

Preprocedure hydration and administration of acetylcysteine

A client is admitted to the hospital with a prerenal disorder, a nonurologic condition that disrupts renal blood flow to the nephrons, affecting their filtering ability. One cause of prerenal acute kidney injury is:

anaphylaxis Expl: Anaphylaxis is a cause of prerenal acute renal failure. Myoglobinuria secondary to burns is a cause of intrarenal acute renal failure. Polycystic disease is a cause of intrarenal acute renal failure. Ureteral stricture is a cause of postrenal acute renal failure. 1577

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes:

confusion, headache, and seizures.

The nurse is caring for a patient with ESKD. Which of the following acid-base imbalances is associated with this disorder? a) pH 7.50, PaCO2 29, HCO3 22- b) pH 7.47, PaCO2 45, HCO3 33- c) pH 7.31, PaCO2 48, HCO3 24- d) pH 7.20, PaCO2 36, HCO3 14-

pH 7.20, PaCO2 36, HCO3 14- Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder?

pH 7.20, PaCO2 36, HCO3 14- Expl: Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.1569

A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include:

periorbital edema.

The objectives of nutrition therapy for chronic kidney disease are to reduce serum nitrogen levels, reduce hypertension and edema, prevent body catabolism, improve renal function, and prevent or delay the onset of complications. Select all of the following which you would teach a client with chronic renal to help them with dietary adherence.

• Most protein should be from animal sources, which in general have a higher biologic value than plant proteins. • Pure sugars and heart-healthy fats are used liberally for calories to spare body and dietary protein.

The nurse is caring for a patient who has just returned to the post-surgical unit following renal surgery. When assessing the patient's output from surgical drains, the nurse should assess what parameters? Select all that apply.

• Quantity of output • Color of the output • Visible characteristics of the output

As glomerular filtration decreases, which of the following occurs? Select all that apply.

• Serum creatinine increases • Blood urea nitrogen (BUN) increases • Creatinine clearance decreases

A client develops acute renal failure (ARF) after receiving IV therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 mL, the nurse suspects that the client is at risk for:

Cardiac arrhythmia

The nurse is caring for a patient in the oliguric phase of AKI. What does the nurse know would be the daily urine output?

Less than 400 mL

The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output?

Less than 400 mL

At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much is this loss equal to? a) 1.0 lb b) 2 lb c) 0.5 lb d) 1.5 lb

1.0 lb The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1-kg (2-lb) weight loss is equal to 1,000 mL.

The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL?

1,000 mL

The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL? a) 1,000 mL b) 750 mL c) 250 mL d) 500 mL

1,000 mL The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1-kg weight gain is equal to 1,000 mL of retained fluid.

A 16-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. What is a cause of postinfectious glomerular disease?

Group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks

Which of the following would be included in the plan of care of someone in Stage 4 renal failure?

Growth hormone injections daily

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) Warm the solution to body temperature. c) Inspect the catheter insertion site for infection. d) Add the prescribed drug to the dialysate.

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 nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? a) Dehydration b) Crackles c) Hypertension d) Hyperkalemia

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

The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following?

Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic glomerulonephritis.

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?

Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL

The nurse is assessing a child diagnosed with nephritic syndrome and observes generalized edema. The nurse documents this as which of the following?

Anasarca refers to generalized edema. Enuresis refers to continued incontinence of urine past the age of toilet training. Hydronephrosis refers to a condition in which the pelvis and calyces of the kidney are dilated. Phimosis refers to a condition in which the foreskin of the penis cannot be retracted.

A patient with chronic kidney disease has been hospitalized and is receiving hemodialysis on a scheduled basis. The nurse should include which of the following actions in the plan of care?

Assess for a thrill or bruit over the vascular access site each shift.

A female client undergoes dialysis as a part of treatment for kidney failure. The client is administered heparin during dialysis to achieve therapeutic levels. Which of the following steps should the nurse take to allow heparin to be metabolized and excreted in the client?

Avoid administering injections for 2 to 4 hours after heparin administration.

Which assessment finding is most important in determining nursing care for a client with acute glomerulonephritis?

Blurred vision. Visual disturbances can be indicative of rising blood pressure in a client with acute glomerulonephritis.

Which is a prodromal symptom of hemolytic uremic syndrome in pediatric patients?

Diarrheal illness

A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. Which of the following would be the best way to prevent this?

Encourage the child to take all the antibiotics if diagnosed with strep throat.

An infant is diagnosed with a urinary tract infection. What would the nurse expect on assessment?

Failure to thrive

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?

Fever

Which of the following is an integumentary manifestation of chronic renal failure?

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.

Which of the following is as integumentary manifestation of chronic renal failure?

Gray-brown skin color

The nurse admits a client from a MVA. Which assessment could indicate possible renal trauma?

Hematuria

The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem?

Hematuria

What s/s could point to renal or bladder cancer?

Hematuria

Which problems identified during prenatal care could represent potential renal problems during childhood?

Hydronephrosis Neural tube defect Oligohydramnios One umbilical artery

As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur?

Hyperphosphatemia

Which assessment is a symptom of nephrosclerosis?

Hypertension

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?

Hypovolemic shock caused by hemorrhage

Acute dialysis is indicated in which situation?

Impending pulmonary edema

The nurse understands acute dialysis is indicated in which of the following situations?

Impending pulmonary edema

A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia?

Increase carbohydrates and limit protein intake.

Which of the following is a characteristic of the intrarenal category of AKI?

Increased BUN

Which of the following is a characteristic of the intrarenal category of acute renal failure? a) Decreased creatinine b) Increased BUN c) Decreased urine sodium d) High specific gravity

Increased BUN The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.

Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure?

Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.

PP Questions: A nephrostomy tube may be inserted for which reason?

Large kidney stone

The client with acute renal failure progresses through four phases. Which of the following describes the initiation phase?

It is accompanied by reduced blood flow to the nephrons. Expl: The initiation phase is accompanied by reduced blood flow to the nephrons. In the oliguric phase, fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. During the diuretic phase, excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. During the recovery phase, normal glomerular filtration and tubular function are restored.

A patient diagnosed AKI has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering which of the following?

Kayexalate

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important?

Limiting fluid intake

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following?

Location of discomfort

A nurse is performing postoperative care on a child with a ureteral stent. Which of the following interventions will help manage tube patency?

Monitor output.

During hemodialysis, excess water is removed from the blood by which of the following?

Osmosis--Excess water is removed from the blood by osmosis, in which water moves from an area of higher solute concentration in the blood toward an area of lower solute concentration into the dialysate

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?

Penicillin

Treatment of metabolic acidosis in chronic renal failure includes:

No treatment

Which assessment finding is common in children diagnosed with nephrotic syndrome?

Periorbital edema

The nurse performing the health interview of a patient with a new onset of periorbital edema has completed a genogram, noting the health history of the patient's siblings, parents, and grandparents. This assessment addresses the patient's risk of what kidney disorder?

Polycystic kidney disease (PKD)

Two weeks after being diagnosed with a streptococcal infection, a client develops fatigue, a low-grade fever, and shortness of breath. The nurse auscultates bilateral crackles and observes jugular vein distention. Urinalysis reveals red and white blood cells and protein. After the physician diagnoses poststreptococcal glomerulonephritis, the client is admitted to the medical-surgical unit. Which immediate action should the nurse take?

Provide a high-protein, fluid-monitored diet.

A persistent painful erection is called....

Praprism

BPH meds

Proscar- liver testing, takes awhile to work, must not be handled by women or children Flomax- increase urine flow in BPH, can cause ortho-hypotension Surgery- TURP

What type of dietary restrictions should a patient with acute glomerulonephritis have?

Protein

A 44-year-old client is in the hospital unit where you practice nursing. From the results of a series of diagnostic tests, she has been diagnosed with acute glomerulonephritis. What would you expect to find as a result of this condition?

Proteinuria

The hallmark sign of nephrotic syndrome is...

Proteinuria

What is a hallmark of the diagnosis of nephrotic syndrome?

Proteinuria

Which of the following is the hallmark of the diagnosis of nephrotic syndrome?

Proteinuria

With a patient with a foley catheter and a nephrostomy tube, how would you record urine output?

Record foley and nephrostomy separate

A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause?

Renal calculi

The educator on your unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patient's teaching what nutritional guidelines would the educator include?

Restrict protein intake to 60 g/d.

The nurse understands that common causes of acute glomerulonephritis in pediatric patients include:

Scarlet fever

Which of the following would a nurse classify as a prerenal cause of acute renal failure?

Septic Shock. Expl: Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias. Ureteral stricture and prostatic hypertrophy would be classified as postrenal causes. Polycystic disease is classified as an intrarenal cause of acute renal failure.

Priapism can also be caused by what other process?

Sickle cell disease

A 40-year-old client has just been diagnosed with acute pyelonephritis. What client education would you offer Mr. McDermott regarding fluids?

Significantly increase fluid intake

A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the patient's chronic kidney disease is at what stage?

Stage 3

The nurse is caring for a patient receiving hemodialysis three times weekly. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient?

Taking a BP reading on the affected arm can damage the fistula.

What is the most common type of cancer among men age 15-35? END PP QUESTIONS

Testicular

You are writing a teaching plan for a patient you are caring for status post resection of a renal tumor. What would you include in that teaching plan?

To inspect and care for the incision

The kidneys can improve over a period of months

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:

There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.

The nurse admits a client post ileal conduit. What is the top priority?

Vital signs

The nurse is working on the renal transplant unit. To reduce the risk of infection in a patient with a transplanted kidney, it is imperative for the nurse to do what?

Wash hands carefully and frequently.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:

Water and sodium retention secondary to a severe decrease in the glomerular filtration rate

Which of the following is the most accurate indicator of fluid loss or gain?

Weight

The nurse is performing double diapering for a male infant with hypospadias who has undergone a surgical repair. The nurse performs the following steps. Place the steps in the order in which the nurse performs them.

When performing double diapering, the nurse cuts a hole or a cross-shaped slit in the front of the smaller diaper and then unfolds both diapers, placing the smaller diaper (with the hole) inside the larger one. Next, the nurse places both diapers under the child and carefully brings the penis (if applicable) and catheter/stent through the hole in the smaller diaper, closing the diaper. Finally, the nurse closes the larger diaper, making sure the tip of the catheter/stent is inside the larger diaper.

The nurse is administering calcium acetate (PhosLo) to a patient with ESKD. When is the best time for the nurse to administer this medication?

With food

A clinical situation in which the increased release of erythropoietin would be expected is: a) hypoexmia b) hypotension c) hyperkalemia d) fluid overload

a) Hypoexmia Erythropoietin is released when the oxygen tension of the renal blood supply is low and stimulates production of red blood cells in the bone marrow. Hypotension causes activation of the renin-angiotensin-aldosterone system, as well as release of ADH. Hyperkalemis stimulates release of aldosterone from the adrenal cortex, and fluid overload does not directly stimulate factors affecting the kidney.

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:

fatigue and weakness

An instructor is preparing a class on renal cancer for a group of students. Which of the following would the instructor include as a possible risk factor?

age with most renal cancers occurring after age 60, male gender, tobacco use, occupational exposure to industrial chemicals, obesity, unopposed estrogen therapy, polycystic kidney disease, and treatment for renal failure.

A client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for:

cardiac arrhythmia.

Which of the following is a characteristic of the intrarenal category of acute renal failure?

increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.

You care for a 3-year-old with hypospadias. After a surgical repair, he has a urethral urinary catheter inserted. You would want to teach his parents that

the catheter insertion site will leave only a minimal scar.

When assessing a client with chronic glomerulonephritis, the nurse notes that the client has generalized edema. The nurse documents this as which of the following? A) Periorbital edema B) Anasarca C) Uremic frost D) Hydronephrosis

Ans: B Feedback: Generalized edema known as anasarca is a common finding with chronic glomerulonephritis. Periorbital edema refers to puffiness around the eyes. Uremic frost is a precipitate that forms on the skin in clients with chronic renal failure. Hydronephrosis refers to a condition involving distention of the renal pelvis.

During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication?

Dehydration Exol: Dehydration is a complication during the diuresis phase related to elevated urine output and continued symptoms of uremia. The concern with acute kidney injury (AKI) is hyperkalemia. The diuresis phase of AKI is marked by normal or elevated urine output. Oliguria is urine output less than 400 mL in 24 hours and is seen in the oliguria phase. Renal calculi are a possible cause but not a complication of AKI

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?

Urine output of 20 ml/hour

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is

"As the disease progresses, you will most likely require renal replacement therapy." Expl: There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail. 1574

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? a) "Let's wait until after the surgery to discuss your treatment plan." b) "Even a perfect match does not guarantee organ rejection." c) "The doctor may decide to delay the use of immunosuppressant drugs." d) "Immunosuppressive drugs guarantee organ success."

"Even a perfect match does not guarantee organ rejection." Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.

A 45-year-old man with diabetic nephropathy has ESKD and is starting dialysis. "What should the nurse teach the patient about hemodialysis?

"Hemodialysis is a treatment option that is usually required three times a week."

A patient with ESRD is scheduled for his first hemodialysis treatment. The patient asks the nurse what common complications may occur from the treatment. What would be the nurse's best reply?

"Hypotension and cramping may occur."

A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate? a) "When you shower, use really warm water and an antibacterial soap." b) "Try washing clothes with a strong detergent to ensure that all impurities are gone." c) "Liberally apply alcohol to the areas of your skin where you itch the most." d) "Keep your showers brief, patting your skin dry after showering."

"Keep your showers brief, patting your skin dry after showering." The client with pruritus needs to keep the skin clean and dry. The client should take brief showers with tepid water, pat the skin dry, use moisturizing lotions or creams, and avoid scratching. In addition, the client should use a mild laundry detergent to wash close and an extra rinse cycle to remove all detergent or add 1 tsp vinegar per quart of water to the rinse cycle to remove any detergent residue.

BPH s/s

hesitancy, decrease in size and force of urine stream, frequency, nocturia; retention- bladder sound will be dull on percussion

An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse?

"This type of dialysis will provide more independence." Expl: Once a treatment choice has been selected by the client, the nurse should support the client in that decision. Continuous cyclic peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients. 1599

What is the normal urine output for the infant/child?

0.5 - 2ml/kg/hr

The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of:

1,500 mL of fluid

1,500 mL of fluid A 1-kg weight gain is equal to 1,000 mL of retained fluid.

A dialysis client is prescribed erythropoietin (Epogen) to treat anemia associated with end-stage renal disease. The client weighs 147 lbs. The order is for Epogen 50 units/kg subcutaneously 3 times per week. The pharmacy supplied Epogen 3000 units/ml. How many milliliters will the nurse administer to the client? Round to the nearest tenth.

1.1 Expl: The client weighs 147 lbs/2.2 lbs per kg = 67.5 kg. Dose to be administered = 67.5 kg x 50 units/kg = 3375 units. 3375 units/3000 units per ml = 1.125 or 1.1 ml Pg. 1582

Nicholas Pendergast, a 57-year-old professional athlete, has a lengthy history of chronic pyelonephritis. He is attending his annual physical exam and has become rather concerned with his potential for renal failure. How many clients with a history of chronic pyelonephritis require dialysis?

10% to 15%

A female client who is diagnosed with calcium oxalate stones is instructed to limit calcium intake. The client is informed that she should consume ____________ mg/ day, or less, of calcium as part of her dietary treatment.

1000

The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? __________________

4,000 Expl: A 1-kg weight gain is equal to 1,000 mL of retained fluid. 4 kg × 1,000 = 4,000. The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. 1568

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).

How many hours do you have to correct testicular torsion in order to save the testis?

6 hours

Lew Wallace, a 57-year-old author, has a history of chronic renal failure and is presenting to his appointment with a physician within an urology group where you practice nursing. Mr. Wallace is in Stage 4 for CRF. What is the approximate level of nephron function loss?

75% - 90%

Lew Wallace, a 57-year-old author, has a history of chronic renal failure and is presenting to his appointment with a physician within a urology group where you practice nursing. Mr. Wallace is in stage 4 for CRF. What is the approximate level of nephron function loss?

75% to 90%

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?

A GFR of 30-59 mL/min/1.73 m^2

The nurse coming on shift on the medical unit is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing ESKD?

A patient with diabetes mellitus and poorly controlled hypertension

The nurse is planning patient teaching for a patient with ESKD who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula?

A vein and an artery in your arm will be attached surgically.

The nurse is planning patient teaching for a patient with end-stage renal disease who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula?

A vein and an artery in your arm will be attached surgically.

A 4-year-old girl with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing her for this procedure, you would want to prepare her to

A voiding cystourethrogram requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed.

A patient with an obstruction of the renal artery causing renal ischemia exhibits HTN. One factor that may contribute to HTN: a) increase renin release b) increased ADH secretion c) decreased aldosterone secretion d) increased synthesis and release of prostaglandins

A) Increase Renin Release Renin is released in resonse to decreased B/P, renal ischemia, eosinophil chemotactic factor (ECF) depletion, and other factors affecting blood suppy to the kidney. It is they catalyst of the renin-angiotensin-aldosterone system, which raises B/P when stimulated. ADH is secreted by the posterior pituitary in response to serum hyperosmolality and low blood volume. Aldosterone is secreted within the renin-angiotensin II, and kidney prostaglandins lower B/P by causing vasodilation.

A 32-year-old flight attendant is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure. The client asks what the angiography will reveal. What is your response, as her nurse? a) Renal circulation b) Urine production c) Kidney function d) Kidney structure

A) Renal circulation A renal angiogram (renal arteriogram) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.

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) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. b) Administer furosemide (Lasix) 20 mg I.V. c) Encourage oral fluids. d) Start hemodialysis after a temporary access is obtained.

A) Start IV fluids with normal saline solution bolus followed by a maintenance dose. Explanation: 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.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a) Urine output of 250 ml/24 hours b) Temperature of 100.2° F (37.8° C) c) Serum creatinine level of 1.2 mg/dl d) Blood urea nitrogen (BUN) level of 22 mg/dl

A) Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

All EXCEPT which patient teaching topic are appropriate to include for a patient with nephrosclerosis?

A. Low cholesterol, low sodium diet B. Smoking cessation C. Control blood glucose **D. Low calcium diet

To determine if ascites is increasing in amount in a child with nephrotic syndrome, which measurements would be most appropriate?

Abdominal circumference

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 a loop diuretic b) Administration of sodium polystyrene sulfonate [Kayexalate]) c) Administration of sodium bicarbonate d) Administration of an insulin drip

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.

Administration of sodium polystyrene sulfonate [Kayexalate]) Expl: 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. 1580

A 32-year-old client has been admitted to the renal unit of the hospital with acute pyelonephritis. She is undergoing parenteral antibiotic treatment. What signs and symptoms would you expect the client to exhibit?

All options are correct.

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?

Anemia

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 patient? a) Anemia b) Acidosis c) Pericarditis d) Hyperkalemia

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.

A child is brought into the clinic with symptoms of periorbital edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem? A) Sore throat 2 weeks ago B) Red blood cells in the urine C) Elevation of blood pressure D) Protein elevation in the urine

Ans: A Feedback: Acute glomerulonephritis usually occurs as a result of bacterial infection such as seen with a beta-hemolytic streptococcal infection or impetigo. RBC and protein found in the urine and elevation of blood pressure are symptoms associated with glomerulonephritis.

A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? A) Decrease in the blood flow through the kidneys B) Obstruction of urine flow from the kidneys C) Blood clot formed in the kidneys interfered with the flow D) Structural damage occurred in the nephrons of the kidneys

Ans: A Feedback: Acute renal failure can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.

The hemodialysis client is scheduled to receive weekly injections of epoetin (Epogen). Which is the most important consideration to be taken by the nurse in the administration of this medication? A) Schedule injection on nondialysis day. B) Administer immediately after dialysis. C) Monitor complete blood count prior to dose. D) Administer with low-dose aspirin to prevent clot formation.

Ans: A Feedback: After dialysis, do not administer injections for 2 to 4 hours to allow time for the metabolism and excretion of heparin (which is administered during dialysis). Serum laboratory tests are performed on a routine basis to identify normal and abnormal findings. Aspirin use is not indicated with Epogen use.

A client with chronic glomerulonephritis has generalized edema. Which response by the nurse best describes why anasarca occurs with this disorder? A) Fluid shifting occurs due to loss of serum protein. B) Albumin levels increase in the blood dragging fluid inside the vessels. C) Increased intake of sodium in the diet results in anasarca. D) Urinary retention promotes the absorption of fluid into tissue spaces.

Ans: A Feedback: Anasarca is caused by the shift of fluid from the intravascular space to interstitial and intracellular locations. The fluid shift results from depletion of protein from the blood (serum) to the urine. Sodium intake should be limited in clients with renal disease. Urinary retention is not indicated with anasarca.

The office nurse is providing information to a client who has experienced recurrent renal calculi. Which of the following jobs would place a client at greatest risk for calculi formation? A) Over-the-road truck driver B) Mining engineer C) Nursing instructor D) Rumba instructor

Ans: A Feedback: Calculi formation is often associated with immobility and/or stasis of urine. Working as an OTR truck driver requires prolonged sitting. Mining engineer, nursing instructors, and rumba dance instructors are less immobile.

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? A) "Even a perfect match does not guarantee organ rejection." B) "Immunosuppressive drugs guarantee organ success." C) "The doctor may decide to delay the use of immunosuppressant drugs." D) "Let's wait until after the surgery to discuss your treatment plan."

Ans: A Feedback: Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.

A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess?

Ans: A Feedback: Hypertension is present in approximately 75% of clients with polycystic kidney disease at the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and abdominal pain also may be noted based on the size and effects of the cysts. Fever would suggest an infection. Periorbital edema is noted with acute glomerulonephritis.

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure? A) The kidneys can improve over a period of months. B) Once on dialysis, the need will be permanent. C) Kidney function will improve with transplant. D) Acute renal failure tends to turn to end-stage failure.

Ans: A Feedback: The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute renal failure can progress to chronic renal failure.

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.

Ans: A Feedback: 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.

26. 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

Ans: B Feedback: 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.

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

Ans: B Feedback: 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.

An investment banker, with chronic renal failure, informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? A) "The risk of peritonitis is greater with this type of dialysis." B) "This type of dialysis will provide more independence." C) "Peritoneal dialysis will require more work for you." D) "Peritoneal dialysis does not work well for every client."

Ans: B Feedback: Once a treatment choice has been selected by the client, the nurse should support the client in that decision. Continuous cyclic peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients.

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."

Ans: B Feedback: 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.

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following? A) Abnormalities in urine B) Location of discomfort C) Elevated calcium levels D) Structural defects in the kidneys

Ans: B Feedback: The physical examination of a client with pyelonephritis helps the nurse determine the location of discomfort and signs of fluid retention, such as peripheral edema or shortness of breath. Observing and documenting the characteristics of the client's urine helps the nurse detect abnormalities in the urine. Laboratory blood tests reveal elevated calcium levels, whereas radiography and ultrasonography depict structural defects in the kidneys.

The nurse evaluates the client as experiencing symptoms of disequilibrium syndrome, following an initial hemodialysis treatment. Which is the best action to be taken by the nurse? A) No action is needed. B) Hold the next scheduled treatment. C) Slow the dialysis process during future treatment. D) Notify the physician and manage the symptoms.

Ans: C Feedback: Disequilibrium syndrome is a neurologic condition believed to be caused by cerebral edema associated with rapid movement of water. The symptoms are self-limiting and disappear within several hours after dialysis but can be prevented by slowing the dialysis process to allow time for gradual equilibrium of water. The nurse should document the symptoms and notify the physician with repeated incidence.

A client with several calculi in the ureter is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which teaching statement by the nurse best describes the procedure? A) A scope is passed through the urethra to visualize and destroy the stones with a laser. B) After locating the calculi, a small incision is made to remove the stones. C) The stone is identified via fluoroscopy and then shock waves are used to shatter the stones. D) Once the calculi are located, a fine wire delivers shock waves to pulverize the stones.

Ans: C Feedback: ESWL is a procedure that uses 800 to 2400 shock waves aimed from outside the body toward soft tissues to dense stones. The repetition of the shock waves helps to shatter the stones into smaller particles that can be passed from the urinary tract. No incision is needed for ESWL therapy. Laser lithotripsy uses a fine wire placement to allow the laser beam to pulverize the stones.

A chronic renal failure client complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? A) Elevated serum creatinine B) Hyperkalemia C) Hyperphosphatemia D) Elevated urea and nitrogen

Ans: C Feedback: Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.

The client with glomerulonephritis is exhibiting gross periorbital edema. Which is the best nursing intervention to relieve this symptom? A) Administer diuretics. B) Apply warm compresses. C) Elevate the head of the bed. D) Monitor intake and output.

Ans: C Feedback: Periorbital edema can be managed with positioning the client with an HOB elevation. Cool compresses can be helpful. Diuretics, required as an order by the physician, are used to treat symptoms of edema and hypertension in clients with glomerulonephritis. Monitoring intake and output is an essential nursing measure but not specific to perioribital edema relief.

A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching? A) "I inherited this disorder from one of my parents." B) "The cysts can get quite large in size." C) "As long as I have one normal kidney, I should be fine." D) "If renal failure develops, I may need to consider dialysis."

Ans: C Feedback: Polycystic kidney disease is characterized by the formation of multiple cysts on both kidneys. Polycystic kidney disease is inherited as an autosomal dominant trait. The fluid- filled cysts can cause great enlargement of the kidneys and interfere with kidney function, which can eventually lead to renal failure.

A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? A) "Squamous cell carcinomas do not present with detectable symptoms." B) "You should have sought treatment earlier." C) "Very few symptoms are associated with renal cancer." D) "Painless gross hematuria is the first symptom in renal cancer."

Ans: C Feedback: Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease. Adenocarcinomas are the most common renal cancer (about 80%), whereas squamous cell renal cancers are rare. It is not therapeutic to place doubt or blame for delayed diagnosis.

A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect? A) Acute glomerulonephritis B) Ureteral stricture C) Urinary calculi D) Renal cell carcinoma

Ans: C Feedback: Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.

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

Ans: C Feedback: The Risk for Ineffective Breathing Pattern is often a challenge in caring for clients post nephrectomy 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.

A client is administered dialysate solution through an abdominal catheter. The nurse notices that the return flow rate is slow, so the nurse advises the client to move to the other side. However, even after changing the client's position, the nurse does not observe an increase in return flow. Which of the following actions should the nurse perform to help accelerate the return flow rate? A) Disconnect the catheter and reapply. B) Loosen the tubing clamp. C) Inform the physician that catheter may need repositioning. D) Stop the process for 5 minutes and resume later.

Ans: C Feedback: The nurse instills dialysate solution and clamps the tubing. If the return flow rate is slow, the nurse asks the client to move from side to side. If this maneuver is unsuccessful, the physician may need to reposition the catheter. The nurse should not tamper with the catheter settings because this may worsen the client's condition or damage the apparatus. Also, stopping the process and resuming it after 5 minutes will not help increase the return flow of the dialysate.

A nurse identifies a nursing diagnosis of Risk for Ineffective Breathing Pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? A) Administer isotonic fluid therapy as ordered. B) Keep the drainage catheter below the level of insertion. C) Encourage use of incentive spirometer every 2 hours. D) Monitor temperature every 4 hours.

Ans: C Feedback: To address the issue of ineffective breathing pattern, encouraging the use of incentive spirometer would be most appropriate to help increase alveolar ventilation. Administering isotonic fluid therapy would be appropriate for issues involving fluid loss such as bleeding or hemorrhage. Keeping the drainage catheter below the level of insertion would be appropriate to reduce the risk of obstruction leading to acute pain. Monitoring the temperature every 4 hours would be appropriate to reduce the client's risk for infection.

Following ureteroscopy, for the removal of ureteral calculus, a stent is temporarily left in place. The client asks what purpose the stent provides. Which is the best response from the nurse? A) "The stent is coated with an antiinfective to promote healing." B) "The stent will catch any debris or blood clots left behind." C) "The stent will provide easier passing of future stones." D) "Inflammation from the stone can block the flow of urine."

Ans: D Feedback: Calculi can traumatize the lining of the ureters, resulting in inflammation and possible obstruction of urine flow. A stent is left behind to allow free-flowing urine until inflammatory process has resolved. Stent are not used for anti-infective properties or to catch debris or clots. Stents are not permanently placed for preventative measures.

The nurse is caring for several older clients. Which client would the nurse be especially alert for signs and symptoms of pyelonephritis? A) A client with acute renal failure B) A client with a urinary tumor C) A female client with preexisting chronic glomerulonephritis D) A client with urinary obstruction

Ans: D Feedback: The client with urinary obstruction is at the highest risk of developing pyelonephritis because a urinary obstruction is the most common cause of pyelonephritis in older adults. Acute glomerulonephritis usually occurs in older adults with preexisting chronic glomerulonephritis. Older clients with acute renal failure or urinary tumor are not at high risk for developing pyelonephritis.

The nurse is caring for a patient who has returned to the postsurgical suite after post-anesthetic recovery from a nephrectomy. The nurse's most recent hourly assessment reveals a significant drop in level of consciousness and BP as well as scant urine output over the past hour. What is the nurse's best response?

Assess the patient for signs of bleeding and inform the physician.

The nurse is caring for a patient postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize?

Assessment of the quantity of the patient's urine output

Which of the following is the leading cause of death among patients undergoing maintenance hemodialysis?

Atherosclerotic cardiovascular disease Expl: A leading cause of death among patients undergoing maintenance hemodialysis is atherosclerotic cardiovascular disease. Heart failure, coronary heart disease and angina pain, stroke, and peripheral vascular insufficiency may occur and may incapacitate the patient. 1601

A female patient undergoes dialysis as a part of treatment for kidney failure. The patient is administered heparin during dialysis to achieve therapeutic levels. Which of the following steps should the nurse take to allow heparin to be metabolized and excreted in the patient?

Avoid administering injections for 2 to 4 hours after heparin administration.

A female client undergoes dialysis as a part of treatment for kidney failure. The client is administered heparin during dialysis, to achieve therapeutic levels. Which of the following steps should the nurse take to allow heparin to be metabolized and excreted in the client?

Avoid administering injections for two to four hours after heparin administration

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis?

Azotemia

Which of the following is a term used to describe excessive nitrogenous waster in the blood, as seen in acute glomerulonephritis?

Azotemia

Which of the following terms is used to describe the concentration of urea and other nitrogenous wastes in the blood?

Azotemia

What is the term for the concentration of urea and other nitrogenous wastes in the blood? a) Proteinuria b) Azotemia c) Uremia d) Hematuria

Azotemia Azotemia is the concentration of urea and other nitrogenous wastes in the blood. Uremia is an excess of urea and other nitrogenous wastes in the blood. Hematuria is blood in the urine. Proteinuria is protein in the urine.

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis

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.

What is an organic cause for erectile dysfunction?

Coronary artery disease

The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition?

Blood urea nitrogen (BUN)-to-creatinine ration (BUN:Cr) >20 Expl: The normal BUN:Cr ratio is less than 15. Prerenal azotemia is caused by hypoperfusion of the kidneys due to a nonrenal cause. Over time, higher than normal blood levels of urea or other nitrogen-containing compounds will develop. 1578

What is a treatment for prostate cancer most commonly used other than surgical removal?

Brachytherapy

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education?

Brief, hot daily showers

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

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.

A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing? a) Hyperglycemia b) Hypercalcemia c) Hyperkalemia d) Hypernatremia

C) Hyperkalemia Administering regular insulin I.V. concomitantly with 50 ml of dextrose 50% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia. This combination doesn't help reverse the effects of hypercalcemia, hypernatremia, or hyperglycemia.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a) Impaired urinary elimination b) Toileting self-care deficit c) Risk for infection d) Activity intolerance

C) Risk for infection Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

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

C) water and sodium retention secondary to a severe decrease in the glomerular filtration rate. Explanation: 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 admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek's sign. What deficit does the nurse suspect the patient has? a) Magnesium b) Calcium c) Sodium d) Phosphorus

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.

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?

Calcium (Hypocalcemia)

When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?

Check for thrill or bruit over the access site.

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a) Absence of pain b) Diuresis c) Fever d) Weight loss

Fever Fever is an indicator of infection or transplant rejection.

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

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 nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium?

Citrus fruits

The nurse is educating a patient who is required to restrict potassium intake. What foods would the nurse suggest the patient eliminate that are rich in potassium?

Citrus fruits

The nurse is educating a patient who is required to restrict potassium intake. What foods would the nurse suggest the patient eliminate that are rich in potassium? a) Salad oils b) Cooked white rice c) Butter d) Citrus fruits

Citrus fruits Foods and fluids containing potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee) are restricted.

When obtaining a urine specimen from a school age child, what method is preferred?

Clean catch specimen

A patient, status post resection of renal tumor, is being discharged home. You are planning discharge for this patient. What would you include in a teaching plan for this patient?

Continuing care

An Investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response

Continuous cyclic peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. Once a treatment choice has been selected by the client, the nurse should support the client in that decision. The risk of peritonitis is greater, and symptoms should be discussed as part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients

A critical care nurse is caring for a trauma patient who has gone into acute renal failure. The critical care nurse knows that he can set up, initiate, maintain, and terminate what system of dialysis for this patient?

Continuous venovenous hemofiltration

The nurse is caring for a patient with chronic glomerulonephritis. What can cause chronic glomerulonephritis?

Repeated episodes of acute nephritic syndrome

The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program? a) Pregnancy b) Diabetes mellitus c) Neuromuscular disorders d) Hypotension

D) Hypotension Hypertension, not hypotension, is a risk factor for kidney disease.

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? a) Decreased blood urea nitrogen (BUN) b) Decreased potassium c) Increased serum albumin d) Increased serum creatinine

D) Increased serum creatinine In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.

Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? a) Increased red blood cell count b) Decreased serum potassium level c) Increased serum calcium level d) Increased serum creatinine level

D) Increased serum creatinine level Explanation: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.

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 sodium level of 135 mEq/L b) Serum potassium level of 4.9 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 Explanation: 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.

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? a) Perform deep-breathing exercises vigorously. b) Avoid carrying heavy items. c) Auscultate the lungs frequently. d) Wear a mask when performing exchanges.

D) Wear a mask when performing exchanges The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.

A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication?

Decrease in the blood flow through the kidneys

A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? a) Blood clot formed in the kidneys interfered with the flow b) Obstruction of urine flow from the kidneys c) Decrease in the blood flow through the kidneys d) Structural damage occurred in the nephrons of the kidneys

Decrease in the blood flow through the kidneys Acute renal failure can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.

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) Hypertension d) Crackles

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

An elderly client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? a) Shows damage to the kidneys b) Detects calculi, cysts, or tumors c) Reveals causative microorganisms d) If risk for chronic pyelonephritis is likely

Detects calculi, cysts, or tumors Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.

The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom?

Diminished erythropoietin production

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) Electrolyte imbalances d) Impaired immunologic response

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.

A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate?

Donors are selected from compatible living donors Expl: Donors are selected from compatible living donors. Donors do not have to be relatives as long as they are compatible. Potential donors with a history of hypertension, malignant disease, or diabetes are excluded from donation. The client is placed on a national computerized transplant waiting list. 1607

A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care?

Encourage use of incentive spirometer every 2 hours

A patient is being treated for AKI and the patient daily weights have been ordered. The nurse notes a weight gain of 3 pounds over the past 48 hours. What nursing diagnosis is suggested by this assessment finding?

Excess fluid volume

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of urinary tract infection. When interviewing the caregivers, which of the following questions would be most important for the nurse to ask?

Gather information about the current illness: when the fever started and its course thus far, signs of pain or discomfort on voiding, recent change in feeding pattern, presence of vomiting or diarrhea, irritability, lethargy, abdominal pain, unusual odor to urine, chronic diaper rash, and signs of febrile convulsions. Toilet training and bathing habits would be of importance, but they are not the most important to ask.

Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure? a) Hypovolemia b) Ureteral calculus c) Dysrhythmia d) Glomerulonephritis

Glomerulonephritis Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.

Which of the following is as integumentary manifestation of chronic renal failure? a) Tremors b) Seizures c) Gray-brown skin color d) Asterixis

Gray-brown skin color Integumentary manifestations of chronic renal failure include a gray-bronze skin color and ecchymosis. Asterixis, tremors, and seizures are neurological manifestations of chronic renal failure.

Renal failure can have prerenal, renal, or postrenal causes. A patient presents with acute renal failure and is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it?

Heart failure

A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason?

Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.

The nurse is caring for a patient following extensive abdominal surgery. The patient develops an infection that is treated with IV gentamicin. After 4 days of treatment, the patient develops oliguria, and laboratory results indicate azotemia. The patient is diagnosed with acute tubular necrosis and transferred to the ICU. The patient is hemodynamically stable. Which of the following dialysis methods would be most appropriate for the patient?

Hemodialysis

A 45-year-old man with diabetic nephropathy has end-stage renal failure and is starting dialysis. He asks for information about hemodialysis. What would the nurse include in the teaching for this patient?

Hemodialysis is a treatment option that is required three times a week.

A patient with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the patient's abdomen is increasing in girth. What is the nurse's most appropriate action?

Reposition the patient to facilitate drainage.

he nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take?

Hold the medications until after dialysis. Expl: Antihypertensive therapy, often part of the regimen of clients on dialysis, is one example when communication, education, and evaluation can make a difference in client outcomes. The client must know when—and when not—to take the medication. For example, if an antihypertensive agent is taken on a dialysis day, hypotension may occur during dialysis, causing dangerously low blood pressure. Many medications that are taken once daily can be held until after dialysis treatment. 1592

Rejection of a transplanted kidney within 24 hours after transplant is termed

Hyperacute rejection

Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for:

Hyperacute rejection isn't treatable; the only way to stop this reaction is to remove the transplanted organ or tissue.

The nurse is caring for a patient who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed which of the following?

Hyperacute. Expl:After a kidney transplant, rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years. A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized glomerular capillary thrombosis and necrosis.

The nurse is caring for a patient in acute kidney injury. Which of the following complications would most clearly warrant the administration of polystyrene sulfonate (Kayexalate)?

Hyperkalemia

The nurse is caring for a patient in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:

Hyperkalemia

Hyperkalemia Expl: 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. 1580

Hyperphosphatemia. Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone.

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? a) Abdominal distention owing to reflex cessation of intestinal peristalsis b) Pneumonia caused by shallow breathing because of severe incisional pain c) Hypovolemic shock caused by hemorrhage d) Paralytic ileus caused by manipulation of the colon during surgery

Hypovolemic shock caused by hemorrhage If bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack.

The nurse is caring for a child admitted with a urinary tract infection. In addition to foul smelling urine, which of the following clinical manifestations would likely have been noted in the child with this diagnosis?

In children, the symptoms or a urinary tract infection may be fever, nausea, vomiting, foul-smelling urine, weight loss, and increased urination. Occasionally there is little or no fever. Vomiting is common, and diarrhea may occur.

While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) in children, one of the parents asks the nurse, "Why would my daughter be more at risk than my son?" Which response by the nurse would be most accurate?

In females, the urethra is shorter, which allows bacteria to enter the bladder. It also is closer in physical proximity to the rectum, leading to possible contamination.

The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is which of the following?

In the cooperative, toilet-trained child, a clean midstream urine may be used successfully to obtain a "clean catch" voided urine. If a culture is needed, the child may be catheterized, but this is usually avoided if possible. A suprapubic aspiration also may be done to obtain a sterile specimen.

A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? a) Eliminate fat intake and increase protein intake. b) Increase protein, carbohydrates, and fat intake. c) Increase carbohydrates and limit protein intake. d) Increase fat intake and limit carbohydrates.

Increase carbohydrates and limit protein intake. Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.

What is a characteristic of the intrarenal category of acute kidney injury (AKI)?

Increased BUN Expl: The intrarenal category of acute kidney injury (AKI) encompasses an increased BUN, increased creatinine, a low-normal specific gravity of urine, and increased urine sodium. Intrarenal AKI is the result of actual parenchymal damage to the glomeruli or kidney tubules. Acute tubular necrosis (ATN), AKI in which there is damage to the kidney tubules, is the most common type of intrinsic AKI. Characteristics of ATN are intratubular obstruction, tubular back leak (abnormal reabsorption of filtrate and decreased urine flow through the tubule), vasoconstriction, and changes in glomerular permeability. These processes result in a decrease of GFR, progressive azotemia, and fluid and electrolyte imbalances.

What is a characteristic of the intrarenal category of acute renal failure?

Increased BUN Expl: The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.

The main problem with acute glomerulonephritis is ....

Inflammation

A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action?

Inform the physician and assess the patient for signs of infection.

Inform the physician that catheter may need repositioning

Which of the following is used to decrease potassium level seen in acute renal failure?

Kayexalate

A patient diagnosed AKI has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering which of the following? a) Calcium supplements b) Kayexalate c) IV dextrose 50% d) Sorbitol

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. Sorbitol may be administered in combination with Kayexalate to induce a diarrhea-type effect (it induces water loss in the GI tract). If the patient is hemodynamically unstable (low blood pressure, changes in mental status, dysrhythmia), IV dextrose 50%, insulin, and calcium replacement may be administered to shift potassium back into the cells.

The nurse is helping a patient to correctly perform peritoneal dialysis at home. The nurse must educate the patient about the procedure. Which educational information should the nurse provide to the patient?

Keep the dialysis supplies in a clean area, away from children and pets

A patient diagnosed with AKI has developed congestive heart failure. The patient has received 40 mg of intravenous pyelogram (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The patient's vital signs are stable. Which of the following health care orders should the nurse anticipate?

Lasix (Furosemide) 80 mg IVP

The nurse is caring for a patient in the oliguric phase of AKI. What does the nurse know would be the daily urine output? a) 1.5 L b) 1.0 L c) Less than 50 mL d) Less than 400 mL

Less than 400 mL The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The minimum amount of urine needed to rid the body of normal metabolic waste products is 400 mL. In this phase, uremic symptoms first appear and life-threatening conditions such as hyperkalemia develop.

The nurse is caring for a patient after kidney surgery. The nurse is aware that bleeding is a major complication of kidney surgery and that if it goes undetected and untreated can result in hypovolemia and hemorrhagic shock in the patient. When assessing for bleeding, what assessment parameter should the nurse evaluate?

Level of consciousness

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? a) Providing pain-relief measures b) Promoting carbohydrate intake c) Encouraging coughing and deep breathing d) Limiting fluid intake

Limiting fluid intake During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following? a) Elevated calcium levels b) Location of discomfort c) Abnormalities in urine d) Structural defects in the kidneys

Location of discomfort The physical examination of a client with pyelonephritis helps the nurse determine the location of discomfort and signs of fluid retention, such as peripheral edema or shortness of breath. Observing and documenting the characteristics of the client's urine helps the nurse detect abnormalities in the urine. Laboratory blood tests reveal elevated calcium levels, whereas radiography and ultrasonography depict structural defects in the kidneys.

The nurse has identified the nursing diagnosis of "risk for infection" in a patient who undergoes peritoneal dialysis. What nursing action best addresses this risk?

Maintain aseptic technique when administering dialysate.

A patient is brought to the renal unit from the PACU status post resection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this patient?

Managing postoperative pain

Mr. Allen was hospitalized for treatment of large renal calculi that were causing obstruction to urine flow. He was taken to surgery for a nephrostomy tube placement. A nephrostomy tube, also called a pyelostomy tube, is a catheter inserted through the skin into the renal pelvis. Select the answer that is true about managing a nephrostomy tube.

Never clamp the nephrostomy tubing.

As an inflammatory response in the glomerular capillary membrane, the renal filtration system is disrupted. Although diagnostic urinalysis can reveal glomerulonephritis, many of those suffering with glomerulonephritis exhibit what symptoms?

No symptoms

An instructor is preparing a class on renal cancer for a group of students. Which of the following would the instructor include as a possible risk factor? a) Age below 40 years b) Female gender c) Obesity d) Exposure to sunlight

Obesity Risk factors for renal cancer include: age with most renal cancers occurring after age 60, male gender, tobacco use, occupational exposure to industrial chemicals, obesity, unopposed estrogen therapy, polycystic kidney disease, and treatment for renal failure.

A client, aged 75, is diagnosed with a renal disease and administered nephrotoxic drugs in normal doses. The nurse is aware that it is important to observe the client closely for any changes in renal status. Which of the following measures may help a nurse determine a change in renal status

Observing the client's urinary output. Explanation: Nephrotoxic drugs are not administered to a client with renal disease unless the client's life is in danger and no other therapeutic agent is of value. Since the client is given nephrotoxic drugs in normal doses, observing the client's urinary output can help the nurse determine a change in the renal status. Observing the client's fluid intake and noting the color of skin and nail beds do not help a nurse determine a change in the renal status. Checking for a thrill or a bruit daily is performed for a client with a vascular access device. 1568

The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated?

Obtaining a blood pressure reading from the right arm

The nurse is caring for a patient with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which of the following nursing actions is contraindicated?

Obtaining a blood pressure reading from the right arm

The nurse is caring for a patient with acute renal injury (AKI). The patient is experiencing an increase in the serum concentration of urea and creatinine. The nurse understands the patient is experiencing which of the following phases of AKI?

Oliguria

You are caring for a patient with acute renal failure. What is the most common clinical manifestation of acute renal failure?

Oliguria

A client has a family history of polycystic kidney disease. As the nurse gathers information and completes an assessment related to a polycystic kidney diagnosis, which findings would be expected? Select all that apply.

• Hypertension • Pain from retroperitoneal bleeding

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase?

Oliguria Expl: During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase. 1577

Nursing assessment for the patient receiving peritoneal dialysis would include which of the following to detect the most serious complication of this procedure? a) Measure fluid drainage to estimate incomplete recovery of fluid. b) Inspect the catheter site for leakage of dialysate. c) Observe for evidence of bleeding. d) Palpate the abdominal wall for rebound tenderness.

Palpate the abdominal wall for rebound tenderness. Peritonitis is the most serious complication of peritoneal dialysis. To detect rebound tenderness, the nurse presses one hand firmly into the abdominal wall and quickly withdraws the hand. Rebound tenderness exists when pain occurs upon removal; this pain is associated with inflammation of the peritoneal cavity.

When assessing the impact of medications on the etiology of ARF, the nurse recognizes which of the following as the drug that is not nephrotoxic? a) Penicillin b) Gentamicin c) Neomycin d) Tobramycin

Penicillin The three nephrotoxic drugs are aminoglycerides.

Which of the following occurs late in chronic glomerulonephritis?

Peripheral neuropathy Expl: Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure. 1572

A 5-year-old child with acute renal failure develops hyperkalemia. Which of the following would the nurse expect to administer?

Polystyrene sulfonate (Kayexalate) is used to decrease potassium levels.

Which of the following is the hallmark of the diagnosis of nephrotic syndrome? a) Hypokalemia b) Hyponatremia c) Proteinuria d) Hypoalbuminemia

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.

A client has been diagnosed with acute glomerulonephritis. This condition causes:

Proteinuria Expl: The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided. 1571

A child is getting a diagnostic work-up for nephrotic syndrome. Which of the following lab results would the nurse expect to see?

Proteinuria, hypoalbuminemia, and hypercholesterolemia are diagnostic of a child with nephritic syndrome. The child will also present symptomatically with a sudden onset of edema. Hematuria is typically seen with glomerulonephritis.

The nurse is reviewing the results of a urinalysis on a client with acute pyelonephritis. Which of the following would the nurse most likely expect to find? a) High specific gravity b) Pyuria c) Absent proteinuria d) Slightly acidic pH

Pyuria The chief abnormality noted with the urinalysis is pyuria (combination of bacteria and leukocytes). Specific gravity would be low, pH would be slightly alkaline, and proteinuria would be minimal to mild.

A 32-year-old client has been admitted to the renal unit with acute pyelonephritis. She is undergoing parenteral antibiotic treatment. As her nurse, what would be a significant aspect of your discharge education?

Recurring infection prevention

A 32-year-old client has pyelonephritis and is undergoing parenteral antibiotic treatment. What will be the effect of the infection on her kidneys?

Renal scarring

One of the roles of the nurse in caring for the clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include teaching which of the following?

Restricting sources of potassium usually found in fresh fruits and vegetables

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?

Risk for infection

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a) Activity intolerance b) Impaired urinary elimination c) Risk for infection d) Toileting self-care deficit

Risk for infection The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

With any process involving scrotal swelling, what nursing intervention can promote comfort?

Scrotal elevation

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) Creatinine clearance of 90 mL/min b) Serum creatinine of 1.5 mg/dL c) Urinary protein level of 150 mg/24h. d) BUN of 20 mg/dLb

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.

A teacher sends a child to see the school nurse for irritability and bruising. Which of the following symptoms would be indicative of hemolytic uremic syndrome?

Signs of hemolytic uremic syndrome include oliguria, irritability, jaundice, bloody diarrhea, purpura, ecchymosis, and pallor 5 to 10 days after a prodromal illness. The child also usually experiences anorexia, slight fevers, and can become lethargic. Symptoms of polyuria, weight gain, high fever, and dysuria are not typically seen with hemolytic uremic syndrome.

What is the action of Phosphodiesterase inhibitors?

Smooth muscle relaxation

What is used to decrease potassium level seen in acute renal failure?

Sodium polystyrene sulfonate

A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:

Sodium polystyrene sulfonate (Kayexalate)

A child is brought into the clinic with symptoms of periorbital edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem

Sore throat 2 weeks ago Expl: Acute glomerulonephritis usually occurs as a result of bacterial infection such as seen with a beta-hemolytic streptococcal infection or impetigo. RBC and protein found in the urine and elevation of blood pressure are symptoms associated with glomerulonephritis. 1570

Following a nephrectomy, which assessment finding is most important in determining nursing care for the client?

SpO2 at 90% with fine crackles in the lung bases

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) SpO2 at 90% with fine crackles in the lung bases c) Blood tinged drainage in Jackson-Pratt drainage tube d) Pain of 3 out of 10, 1 hour after analgesic administration

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.

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) Administer furosemide (Lasix) 20 mg I.V. b) Start hemodialysis after a temporary access is obtained. c) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. d) Encourage oral fluids.

Start I.V. 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.

Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. 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.

A client is admitted with nausea, vomiting, and diarrhea. His BP is 74/30 mmHg. 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?

Start IV fluids with a normal saline solution bolus followed by a maintenance dose

Start IV fluids with a normal saline solution bolus followed by a maintenance dose Expl: 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. Pg. 1557

Which of the following nursing actions is most important in caring for the client following lithotripsy?

Strain the urine carefully for stone fragments.

Which of the following nursing actions is most important in caring for the client following lithotripsy? a) Notify the physician of hematuria. b) Administer allopurinol (Zyloprim). c) Strain the urine carefully for stone fragments. d) Monitor the continuous bladder irrigation.

Strain the urine carefully for stone fragments. The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical anaysis.

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. a) Shortened QRS complex b) Tall, peaked T waves c) Multiple spiked P waves d) Prolonged ST segment

Tall, peaked T waves Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.

Tall, peaked T waves Expl: Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex. 1580

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find?

Tea-colored urine or Cola-colored urine Expl: Tea-colored urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis. 1571

Which nursing intervention should the nurse caring for the client with pyelonephritis implement?

Teach client to increase fluid intake up to 3 liters per day.

Which nursing intervention should the nurse caring for the client with pyelonephritis implement? a) Administer acetaminophen (Tylenol). b) Straight catheterize the client every 4 to 6 hours. c) Restrict fluid intake to 1 liter per day. d) Teach client to increase fluid intake up to 3 liters per day.

Teach client to increase fluid intake up to 3 liters per day. The nurse teaches the client to increase fluid intake to promote renal blood flow and flush bacteria from the urinary tract.

A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection?

Tenderness over transplant site Expl: Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site. 1609

A nurse is providing postoperative care for a 5-year-old who had a hypospadias repair. Which of the following would the nurse expect for postoperative care of this child?

The child is usually hospitalized for under 24 hours with a hypospadias repair. Wheelchair kickball is an appropriate sport since typically the child is not in much pain after the surgery. This will help increase gross motor activity. The tubing should remain unclamped and free from obstruction at all times.

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?

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.

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?

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

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure? a) Once on dialysis, the need will be permanent. b) Kidney function will improve with transplant. c) Acute renal failure tends to turn to end-stage failure. d) The kidneys can improve over a period of months.

The kidneys can improve over a period of months. The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute renal failure can progress to chronic renal failure.

The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse

Turn the client from side to side. Expl: If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the client from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. Other measures to promote drainage include checking the patency of the catheter by inspecting for kinks, closed clamps, or an air lock. 1598

The nurse is performing acute intermittent peritoneal dialysis (PD) on a patient who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. Which of the following is the nurse's best action? a) Lower the head of the bed. b) Turn the patient from side to side. c) Notify the health care provider. d) Push the catheter further into the abdomen.

Turn the patient from side to side. If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the patient from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. Other measures to promote drainage include checking the patency of the catheter by inspecting for kinks, closed clamps, or an air lock.

Which clinical finding should a nurse look for in a client with chronic renal failure?

Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. 1581

A patient presents at the walk-in clinic complaining of edema around the eyes and flank tenderness bilaterally. Acute glomerular inflammation is suspected. What tests would the nurse expect to be ordered to confirm the diagnosis?

Urinalysis

A client comes to the Emergency Department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?

Urinary calculi

Urinary calculi Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.

A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 ml. Urine output that's less than 50 ml in 24 hours is known as:

Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately

Urine output of 20 ml/hour Expl: 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 finding. 1611

Urine output of 250 ml/24 hours

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

Urine output of 250 ml/24 hours

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a) Serum creatinine level of 1.2 mg/dl b) Blood urea nitrogen (BUN) level of 22 mg/dl c) Temperature of 100.2° F (37.8° C) d) Urine output of 250 ml/24 hours

Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

The nurse is instructing a patient to perform continuous ambulatory peritoneal dialysis correctly at home. Which of the following educational information should the nurse provide to the patient?

Use an aseptic technique during the procedure.

The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client?

Use an aseptic technique during the procedure. Expl: The client should be instructed to use an aseptic technique during the procedure. The client should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (clients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing. 1600

Wear a mask when performing exchanges

A nurse cares for an acutely ill client. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill client is:

Weight

A nurse is caring for an acutely ill patient. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill patient is which of the following?

Weight

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?

White blood cell (WBC) count of 20,000/mm3. An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution.

The nurse is administering calcium acetate (PhosLo) to a patient with ESKD. When is the best time for the nurse to administer this medication? a) 2 hours before meals b) At bedtime with 8 ounces of fluid c) With food d) 2 hours after meals

With food Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. The nurse administers phosphate binders with food for them to be effective.

A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?

assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.

The nurse is assessing a child with acute poststreptococcal glomerulonephritis. Which of the following would the nurse expect to assess? Select all answers that apply.

fatigue, lethargy, abdominal pain, hypertension, crackles, and anorexia.

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?

group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV).

The nurse cares for a client who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed:

hyperacute rejection Expl: After a kidney transplant, rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years. A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized glomerular capillary thrombosis and necrosis. The term "simple" is not used in the categorization of types of rejection of kidney transplants. 1609

The nurse monitors the client for potential complications during dialysis but recongizes NOT to monitor for

hypertension

The nurse is caring for a patient with ESKD. Which of the following acid-base imbalances is associated with this disorder?

pH 7.20, PaCO2 36, HCO3 14-. Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid.

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:

restricting sources of potassium usually found in fresh fruits and vegetables. Expl: 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. 1584

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:

weight loss Expl: Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure. 1589

The nurse is caring for a patient with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply.

• Assess for the presence of peripheral edema. • Assess the patient's BP.

The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply.

• Calcium 7.5 mg/dL; hypotension and irritability • Potassium 6.4 mEq/L; dysrhythmias and abdominal distention • Phosphate 5.0 mg/dL; tachycardia and nausea and emesis

A patient with ESKD is scheduled to begin hemodialysis. The nurse is working with the patient to adapt the patient's diet to maximize the therapeutic effect and minimize the risks of complications. The patient's diet should include which of the following modifications? Select all that apply.

• Decreased protein intake • Decreased sodium intake • Fluid restriction

A male client is being cared for after a nephrectomy. Because of the incisional pain and restricted positioning, he frequently suffers from breathing difficulty. Which of the following measures should the nurse include in the care plan to relieve him of the distress? Choose all correct options.

• Help him to breathe deeply and cough every two hours • Provide firm support for the incision when he coughs • Auscultate lung sounds once per shift

Select all of the following which are true about extracorporeal shock wave lithotripsy (ESWL).

• Stones are shattered into smaller particles that are passed from the urinary tract. • ESWL is administered with the client in a water bath or surrounded by a soft cushion while under light anesthesia or sedation.

When caring for a child who has a urinary tract infection, which of the following nursing interventions would be most appropriate. (select all that apply)

• The nurse observes for signs of pain or burning on urination. • The nurse monitors intake and output. • The nurse administers antipyretics as needed.

Ch. 54 Kidney Critical Care Combined

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