Chapter 48: Management of Patients with Kidney Disorders

pruritus

itching

The first indication of disease glomerulonephritis

may be a sudden, severe nosebleed, a stroke, or a seizure.

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?

"As long as I have one normal kidney, I should be fine."

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?

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

The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching?

"I should drink as much as possible to keep my kidneys working."

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

Hypertension

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

Increased BUN

A change that occurs during chronic glomerulonephritis is termed

anemia.

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

removal of the transplanted kidney.

Anasarca

severe generalized edema

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

weight.

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.

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?

"Keep your showers brief, patting your skin dry after showering."

A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse?

"Very few symptoms are associated with renal cancer."

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.

5

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

Acute glomerulonephritis

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?

Administration of sodium polystyrene sulfonate [Kayexalate])

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?

Anasarca

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

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 client requires hemodialysis. Which type of drug should be withheld before this procedure?

Cardiac glycosides

Patient education regarding a fistulae or graft includes which of the following? Select all that apply.

Check daily for thrill and bruit. Avoid compression of the site. No IV or blood pressure taken on extremity with dialysis access. No tight clothing.

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

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

Dehydration

During hemodialysis, toxins and wastes in the blood are removed by which of the following?

Diffusion

Which of the following is the priority issue for the client in the oliguric phase of acute renal failure?

Fluid volume excess

A client, aged 87, undergoes continuous ambulatory peritoneal dialysis (CAPD) for acute renal failure (ARF). Which task would be most important for the nurse to do?

Frequently monitor the client's progress.

The nurse recognizes which condition as an integumentary manifestation of chronic renal failure?

Gray-bronze skin color

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

Hemodialysis

A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)?

Hydrating with saline intravenously before the test

A client with chronic kidney disease becomes confused and reports abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which lab value?

Hyperkalemia

Based on the pathophysiologic changes that occur as renal failure progresses, the nurse identifies the following indicators associated with the disease. Select all that apply.

Hyperkalemia Anemia Hypocalcemia

A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?

Hyperphosphatemia

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?

Inform the physician that catheter may need repositioning.

A patient is postoperative day 3 following the successful transplantation of a kidney. The nurse is aware of the importance of assessing the patient for signs and symptoms of rejection. Consequently, the nurse is constantly monitoring the patient for:

Oliguria and edema

Nursing assessment for the patient receiving peritoneal dialysis would include which of the following to detect the most serious complication of this procedure?

Palpate the abdominal wall for rebound tenderness.

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

Which of the following occurs late in chronic glomerulonephritis?

Peripheral neuropathy

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

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

Septic shock

Which of the following is the most sensitive indicator of renal function?

Serum creatinine

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

Sodium polystyrene sulfonate

Oliguric phase

Sudden drop in urine output results in BUN/creatinine elevations, increase sodium, fluid retention

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

Tenderness over transplant site

A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD?

The client has a history of diverticulitis.

A patient is placed on hemodialysis for the first time. The patient complains of a headache with nausea and begins to vomit, and the nurse observes a decreased level of consciousness. What does the nurse determine has happened?

The patient is experiencing a cerebral fluid shift.

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 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.

Asterixis

aka Liver Flap, a flapping tremor of the hands. When the client extends the arms & hands in front of the body, the hands rapidly flex & extend.

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.

chronic glomerulonephritis

During the diuretic phase,

excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine.

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.

the oliguric phase,

fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications

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

hypertension.

osteodystrophy

is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia

oliguric period

is accompanied by an increase in the serum concentration of wastes such as urea, creatinine, organic acids, and the electrolytes potassium, phosphorous, and magnesium.

The onset phase

is accompanied by reduced blood flow to the nephrons.

The diuretic phase

is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover.

During the recovery phase,

normal glomerular filtration and tubular function are restored.

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 the nurse expect to find? Select all that apply.

Hypertension Pain from retroperitoneal bleeding Polyuria

A client with acute kidney injury progresses through four phases. Which describes the onset phase?

It is accompanied by reduced blood flow to the nephrons.

A client with decreased renal function is to receive a low-protein diet. The client asks the nurse why he needs this type of diet. The nurse would incorporate which reason into the response?

Lessen workload on the kidneys

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

Limiting fluid intake

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

The initiation period

begins with the initial insult and ends when cellular injury and oliguria develops.

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

At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much is this loss equal to?

1.0 lb

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.

Glomerulonephritis is an inflammatory response in the glomerular capillary membrane, and causes disruption of the renal filtration system. Although diagnostic urinalysis can reveal glomerulonephritis, many clients with glomerulonephritis exhibit:

no symptoms.

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

proteinuria

The recovery period

signals the improvement of renal function and energy level and may take 6 to 12 months.

Which phase of acute renal failure signals that glomerular filtration has started to recover?

Diuretic

Decreased calcium, increased potassium, and increased phosphate levels are associated with

ESKD,

transplant rejection

oliguria, edema, fever, increasing blood pressure, weight gain, and swelling or tenderness over the transplanted kidney or graft

The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than ___________mL/kg/hr.

0.5

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? Enter your response as a whole number.

4000

during chronic glomerulonephritis.

Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia

A nurse is caring for a client on bedrest with end-stage kidney disease. What major manifestation of uremia should the nurse expect to decrease with an exercise plan?

Bone demineralization

A client is undergoing peritoneal dialysis as medical treatment for acute renal failure. Before the next instillation, the nurse observes that the client has marked abdominal distention accompanied by pain. Which of the following nursing actions is likely to offer an immediate solution to this problem?

Delay the next dialysis cycle.

Based on her knowledge of the primary cause of end-stage renal disease, the nurse knows to assess the most important indicator. What is that indicator?

Serum glucose

The nurse treats a client with end-stage kidney disease (ESKD). The nurse is concerned that the client is developing renal osteodystrophy. Upon review of the client's laboratory values, it is noted the client has had a calcium level of 11 mg/dL for the past 3 days and the phosphate level is 5.5 mg/dL. The nurse anticipates the administration of which medication?

Sevelamer hydrochloride

A child is brought into the clinic with symptoms of 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

Dialysis disequilibrium

results from cerebral fluid shifts. Signs and symptoms include headache, nausea and vomiting, restlessness, decreased level of consciousness, and seizures. It is rare and more likely to occur in AKI or when BUN levels are very high (exceeding 150 mg/dL).