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A client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the nurse's best response? 1 "Because the kidneys cannot get rid of fluid, blood pressure goes up." 2 "The damaged kidneys no longer release a hormone that prevents high blood pressure." 3 "The waste products in the blood interfere with other mechanisms that control blood pressure." 4 "This is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products."

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The nurse is caring for a client with pyelonephritis. What does the nurse teach the client about preventing end-stage kidney disease? 1 Complete the drug therapy exactly as indicated. 2 Monitor blood glucose levels regularly. 3 Limit fluid intake to 1 L per day. 4 Increase protein intake in the diet.

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When caring for a client 24 hours after a nephrectomy, the nurse notes that the client's abdomen is distended. Which action does the nurse perform next? 1 Check vital signs. 2 Notify the surgeon. 3 Continue to monitor. 4 Insert a nasogastric (NG) tube

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When taking the health history of a client with acute glomerulonephritis, the nurse questions the client about which related cause of the problem? 1 Recent respiratory infection 2 Hypertension 3 Unexplained weight loss 4 Neoplastic disease

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Which statement about autosomal dominant polycystic kidney disease (ADPKD) is correct? 1 Men and women have an equal chance of inheriting the disease. 2 In the dominant form, 100% of the nephrons have cysts. 3 In the recessive form, only a few nephrons have cysts. 4 Both parents of the client have a copy of the mutated allele.

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When caring for a client with nephrotic syndrome, which intervention should be included in the plan of care? 1 Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss. 2 Administering heparin to prevent deep vein thrombosis (DVT). 3 Providing antibiotics to decrease infection. 4 Providing transfusion of clotting factors.

1 ACE inhibitors can decrease protein loss in the urine. Heparin is administered for DVT, but in nephrotic syndrome it may reduce urine protein and kidney insufficiency. Glomerulonephritis may occur secondary to an infection, but it is an inflammatory process; antibiotics are not indicated for nephrotic syndrome. Clotting factors are not indicated unless bleeding and coagulopathy are present.

Which condition may predispose a client to chronic pyelonephritis? 1 Spinal cord injury 2 Cardiomyopathy 3 Hepatic failure 4 Glomerulonephritis

1 Chronic pyelonephritis occurs with spinal cord injury, bladder tumor, prostate enlargement, or urinary tract stones. Weakness of the heart muscle may cause kidney impairment, not an infection. Pyelonephritis may damage the kidney, not the liver. Glomerulonephritis may result from infection, but may not cause infection of the kidney.

Which assessment findings does the nurse expect in a client with kidney cancer? Select all that apply. 1 Erythrocytosis 2 Hypokalemia 3 Hypercalcemia 4 Hepatic dysfunction 5 Increased sedimentation rate

1, 3, 4, 5 Erythrocytosis alternating with anemia and hepatic dysfunction with elevated liver enzymes may occur with kidney cancer. Parathyroid hormone produced by tumor cells can cause hypercalcemia. An elevation in sedimentation rate may occur in paraneoplastic syndromes. Potassium levels are not altered in kidney cancer, but hypercalcemia is present.

10. The nurse is providing postoperative care for a client who underwent nephrectomy. What actions does the nurse take? Select all that apply. 1 Monitor blood pressure every 4 hours. 2 Inspect the abdomen for distention every shift. 3 Monitor the hemoglobin level every 24 hours. 4 Monitor the respiratory rate every hour. 5 Assess the urine output every hour.

1,2,5 The client's blood pressure should be frequently monitored for hypotension. A decrease in blood pressure is an early sign of hemorrhage and adrenal insufficiency. The client's abdomen should be inspected for distention from bleeding. Urine output is assessed every hour. Large water and sodium losses occur in clients with adrenal insufficiency; this is followed by hypotension. IV replacements of fluids and packed blood cells may be needed. Hemoglobin levels are monitored every 6 to 12 hours. The client's respiratory rate, temperature, and pulse rate are monitored every 4 hours.

A client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the nurse's best response? 1 "Don't worry, no one else will know." Correct2 "Take your time. What is bothering you the most?" 3 "Why are you hesitant?" 4 "You need to tell me so we can determine what is wrong."

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A client presents with hydronephrosis due to a kidney stone. Which procedure does the nurse expect the health care provider to prescribe to remove the kidney stone? 1 Nephrostomy 2 Pyelolithotomy 3 Nephrectomy 4 Ureteroplasty

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Which factor is an indicator for a diagnosis of hydronephrosis? 1 History of nocturia 2 History of urinary stones 3 Recent weight loss 4 Urinary incontinence

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Which statement describing hydronephrosis is correct? 1 It is an enlargement of the ureter above the obstruction. 2 It may occur due to obstruction caused by kidney stones. 3 It decreases blood creatinine and blood urea nitrogen levels. 4 It occurs before bladder distension in clients with urethral stricture

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The nurse is caring for a client with polycystic kidney disease (PKD). What nursing intervention does the nurse perform to provide comfort from flank pain? 1 Administer aspirin 2 Administer ciprofloxacin (Cipro) as prescribed. 3 Apply dry heat on the abdomen or flank of the client. 4 Urge the client to drink at least 2 L of fluid daily.

2 Application of dry heat to the abdomen or flank will promote comfort when kidney cysts are infected. Pain or discomfort in the cyst could be due to infection, so the nurse may need to administer antibiotic such as ciprofloxacin (Cipro) as prescribed. Aspirin-containing compounds are avoided in PKD to decrease the risk of bleeding. Clients with PKD have nocturia and the urine has low specific gravity; therefore, the client should be urged to drink at least 2 L of fluid daily to prevent dehydration. However, this practice will not provide comfort from flank pain.

The nurse anticipates that a client who develops hypotension and oliguria post-nephrectomy may need the addition of which element to the regimen? 1 Increase in analgesics 2 Addition of a corticosteroid 3 Administration of a diuretic 4 Course of antibiotic therapy

2 Loss of water and sodium occurs in clients with adrenal insufficiency, which is followed by hypotension and oliguria; corticosteroids may be needed. The nurse should use caution when administering analgesics to a hypotensive client; no indication suggests that pain is present in this client. A diuretic would further contribute to fluid loss and hypotension, potentially worsening kidney function. A few doses of antibiotics are used prophylactically preoperatively and postoperatively; additional therapy is used when evidence of infection exists.

The nurse is assessing a client with diabetic nephropathy. The client has not been taking insulin because blood sugar levels are within acceptable range. What does the nurse tell the client regarding the relationship between diabetes and kidney disease? 1 There is an improvement in diabetes. 2 Insulin is excreted slowly by the kidney. 3 Antidiabetic agents can be stopped gradually. 4 The diabetic diet is effective

2 Normally the kidneys metabolize and excrete insulin. When kidney function is reduced, the insulin is excreted slowly and is available for a longer time. This indicates a rapid progression to end-stage kidney disease. The condition is not an improvement in diabetes but a result of kidney disease. The nurse refers the client to the health care provider for any change in medication. The condition is not influenced by the diabetic diet.

Which sign or symptom when assessed in a client with chronic glomerulonephritis (GN) warrants a call to the health care provider? Incorrect1 Mild proteinuria Correct2 Third heart sound (S3) 3 Serum potassium of 5.0 mEq/L 4 Itchy skin

2 S3 indicates fluid overload secondary to failing kidneys; the provider should be notified and instructions obtained. Mild proteinuria is an expected finding in GN. A serum potassium of 5.0 mEq/L reflects a normal value; intervention would be needed for hyperkalemia. Although itchy skin may be present as kidney function declines, it is not a priority over fluid excess.

The nurse is caring for a client with kidney trauma. The client has considerable loss of blood. What intervention does the nurse perform? 1 Take vital signs every 30 minutes. 2 Report urethral bleeding prior to urinary catheterization. 3 Measure and record urine output every 30 minutes. 4 Monitor the client for nausea when fluids are administered.

2 The nurse attempts urinary catheterization only if prescribed by the health care provider, especially if the urethral opening is bleeding. Vital signs are monitored every 5 to 15 minutes. Urine output is measured and recorded every hour. Output must be greater than 0.5 mL/Kg/hr. The nurse takes care to administer fluids at the prescribed rate. The client is monitored for shock when fluids are administered.

The nurse is assessing a client for early signs of renal cell carcinoma (RCC). What finding does the nurse expect in this client? Incorrect1 Sharp intermittent flank pain Correct2 Renal bruit on auscultation 3 Gynecomastia 4 Bloody urine

2 The nurse notes renal bruit on auscultation in the client with RCC. The client often describes the pain in the flank as dull and aching. The pain is more intense if there is bleeding into the tumor or kidney. Gynecomastia and bloody urine are late stages of the disease.

The renal echography for a client indicates hydronephrosis. What does the nurse tell the client about this condition? 1 It is caused by an obstruction in the lower part of the ureter. 2 It is caused by an obstruction in the renal pelvis. 3 The ureter dilates above the obstruction. 4 The bladder dilates following urethral obstruction.

2 It is caused by an obstruction in the renal pelvis.

When assessing a client with acute pyelonephritis, which findings does the nurse anticipate will be present? Select all that apply. 1 Suprapubic pain 2 Vomiting 3 Chills 4 Dysuria 5 Oliguria

2, 3, 4 Nausea and vomiting are symptoms of acute pyelonephritis. Chills along with fever may also occur, as well as burning (dysuria), urgency, and frequency. Suprapubic pain is indicative of cystitis, not kidney infection (pyelonephritis). Oliguria is related to kidney impairment from severe or long-standing pyelonephritis.

When caring for a client who had a nephrostomy tube inserted 4 hours ago, which is essential for the nurse to report to the health care provider? 1 Dark pink-colored urine 2 Small amount of urine leaking around the catheter 3 Tube that has stopped draining 4 Creatinine of 1.8 mg/dL

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The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor? 1 Hemoglobin and hematocrit (H&H) 2 White blood cell (WBC) count 3 Blood urea nitrogen (BUN) and creatinine 4 Lipid levels

3 BUN and creatinine are kidney function tests. With back pressure on the kidney, glomerular filtration is reduced or absent, resulting in permanent kidney damage. Hydronephrosis results from the backup of urine secondary to obstruction; H&H monitors for anemia and blood loss, while WBC count indicates infection. Elevated lipid levels are associated with nephrotic syndrome, not with obstruction and hydronephrosis.

Which information suggests that a client with diabetes may be in the early stages of kidney damage? 1 Elevation in blood urea nitrogen (BUN) 2 Oliguria 3 Microalbuminuria 4 Painless hematuria

3 In the early stages of diabetic nephropathy, microlevels of albumin are first detected in the urine. Progressive kidney damage occurs before dipstick procedures can detect protein in the urine. BUN may change in response to protein and fluid intake. Oliguria is a later finding in kidney disease and may also be present in dehydration. Painless hematuria often occurs with kidney cancer.

After receiving change-of-shift report on the urology unit, which client does the nurse assess first? 1 Client post-radical nephrectomy whose temperature is 99.8° F (37.6° C) 2 Client with glomerulonephritis who has cola-colored urine 3 Client who was involved in a motor vehicle crash and has hematuria 4 Client with nephrotic syndrome who has gained 2 kg since yesterday

3 kidney trauma

Which staff member should care for a newly admitted client who is diabetic, has pyelonephritis and prescriptions for intravenous antibiotics, and who needs blood glucose monitoring every 2 hours and insulin administration? 1 RN whose other assignments include a client receiving chemotherapy for renal cell carcinoma 2 RN who is caring for a client who just returned after having renal artery balloon angioplasty 3 RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy 4 RN who is currently admitting a client with acute hypertension and possible renal artery stenosis

3 RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy

The nurse is caring for a client who underwent a nephrostomy tube insertion due to a urethral stricture. What assessment findings does the nurse report immediately to the health care provider? Select all that apply. 1 Increase in urinary output into the drainage bag 2 Red-tinged drainage into the collection bag 3 Foul-smelling drainage into the collection bag 4 Leakage of blood from the nephrostomy site 5 Leakage of urine from the nephrostomy site 6 Reports of back pain

3, 4, 5, 6 After nephrostomy, the nurse should notify the provider immediately if there is foul-smelling urine because it can be a manifestation of infection. Any leakage of blood or urine is also reported immediately. Reports of back pain also need immediate attention because the tube may be blocked or dislodged. An increase in urine flow into the drainage bag is a good sign that kidney function is not being compromised due to the obstruction. Red-tinged drainage is common in the first few hours after nephrostomy. It gradually becomes clear and does not require critical rescue. Test-Taking Tip: Calm yourself by closing your eyes, putting down your pencil (or computer mouse), and relaxing. Deep-breathe for a few minutes (or as needed, if you feel especially tense) to relax your body and to relieve tension.

A client is admitted with uremic symptoms secondary to chronic glomerulonephritis. What does the nurse expect to find in the assessment? Select all that apply. 1 Engorgement of the neck veins 2 Presence of an S3 heart sound 3 Flapping tremor of the fingers 4 Itching and dryness of the skin 5 Edema of the foot and ankle

3,4 Flapping tremor of the fingers is a uremic symptom seen in chronic glomerulonephritis. Itching and dryness of the skin may also be due to uremia. Engorgement of the neck veins and presence of an S3 heart sound on auscultation are due to systemic circulatory overload. Circulatory overload may also cause edema of the foot and ankle.

During discharge teaching for a client with kidney disease, what does the nurse teach the client to do? 1 "Drink 2 liters of fluid and urinate at the same time every day." 2 "Eat breakfast and go to bed at the same time every day." 3 "Check your blood sugar and do a urine dipstick test." 4 "Weigh yourself and take your blood pressure."

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The nurse is performing discharge teaching for a client after a nephrectomy for renal cell carcinoma. Which statement by the client indicates that teaching has been effective? 1 "Because renal cell carcinoma usually affects both kidneys, I'll need to be watched closely." 2 "I'll eventually require some type of renal replacement therapy." 3 "I'll need to decrease my fluid intake to prevent stress to my remaining kidney." 4 "My remaining kidney will provide me with normal kidney function now."

4 After a nephrectomy, the second kidney is expected to eventually provide adequate kidney function, but this may take days or weeks. Renal cell carcinoma typically only affects one kidney. Renal replacement therapy is not the typical treatment for renal cell carcinoma. Fluids sh

Which staff member does the charge nurse assign to a client who has benign prostatic hyperplasia and hydronephrosis and needs an indwelling catheter inserted? 1 RN float nurse who has 10 years of experience with pediatric clients 2 LPN/LVN who has worked in the hospital's kidney dialysis unit until recently 3 RN without recent experience who has just completed an RN refresher course 4 LPN/LVN with 5 years of experience in an outpatient urology surgery center

4 Catheterization of a client with an enlarged prostate, a skill within the scope of practice of the LPN/LVN, would be performed frequently in a urology center.The pediatric nurse would have little exposure to prostatic obstruction and adult catheterization. Dialysis clients do not typically have catheters inserted, so the LPN/LVN from the kidney dialysis unit would not be the best staff member to assign to the client. The nurse who has been out of practice for several years is not the best candidate to insert a catheter in a client with an enlarged prostate.

What is the most accurate statement regarding the etiology and genetic risk of polycystic kidney disease (PKD)? Incorrect1 Autosomal dominant PKD is rarer than autosomal recessive PKD. 2 PKD can be prevented by adequate control of hypertension. 3 Autosomal dominant PKD-1 (ADPKD-1) is less severe than ADPKD-2. Correct4 PKD can occur in those with no family history of the disease.

4 PKD can occur in those with no family history of the disease if a new mutation occurs. PKD cannot be prevented. Management of hypertension only slows the progression of kidney damage. ADPKD-1 is more common and more severe than ADPKD-2. Autosomal recessive PKD is rare; autosomal dominant PKD is the most common form.

11. The nurse is caring for a client with acute glomerulonephritis (GN) who has a total urine output of 350 mL in 24 hours. What intervention does the nurse include in the plan of care? 1 Encourage a fluid intake of at least 1200 mL in 24 hours. 2 Ensure that the client takes prescribed erythromycin. 3 Plan a diet that ensures a high protein intake. 4 Teach the client to limit intake of potassium.

4 The nurse should teach the client to limit the intake of potassium. A urine output of less than 400 mL/24 hr means the client has oliguria, so potassium intake is restricted to prevent hyperkalemia due to oliguria because clients with oliguria do not have the ability to excrete excess potassium. The usual fluid allowance is 500 to 600 mL above the 24-hour urine output; therefore, the nurse should encourage the client to have a fluid intake of 850 to 950 mL over a period of 24 hours. The nurse should also teach the client the importance of completing the entire course of prescribed antibiotics rather than taking it just until the symptoms last. Oliguria can lead to uremia, so, the nurse may need to restrict the client's intake of protein.

When preparing a client for nephrostomy tube insertion, it is essential for the nurse to monitor which factor before the procedure? 1 Blood urea nitrogen (BUN) and creatinine 2 Hemoglobin and hematocrit (H&H) 3 Intake and output (I&O) 4 Prothrombin time (PT) and International Normalized Ratio (INR)

4 Prothrombin time (PT) and International Normalized Ratio (INR) r/f bleeding

A client with pyelonephritis has been prescribed urinary antiseptic medication. What purpose does this medication serve? 1 Decreases bacterial count 2 Destroys white blood cells 3 Enhances the action of antibiotics 4 Provides comfort

4 Provides comfort Urinary antiseptic drugs such as nitrofurantoin (Macrodantin) are prescribed to provide comfort for clients with pyelonephritis. Antibiotics, not antiseptics, are used to decrease bacterial count and treat pyelonephritis infection; the action of antibiotics is not enhanced with antiseptics. White blood cells, along with antibiotics, fight infection.

The nurse is caring for a client with stage II renal cell carcinoma (RCC). What is the most accurate statement describing the tumor in the client's kidney? 1 It is within the renal capsule. 2 It has extended beyond Gerota's fascia. 3 It is larger than 2.5 cm in size. 4 It has invaded the renal vein and lymph nodes.

It is larger than 2.5 cm in size In stage II of RCC, the tumor is larger than 2.5 cm. In stage I it is less than 2.5 cm and within the renal capsule. In stage II it extends beyond the renal capsule but not beyond Gerota's fascia. In stage III the tumor invades the renal vein, lymph nodes, or both. In stage IV it invades the organs beyond Gerota's fascia or metastasizes to distant organs.