Chapter 58: Caring for Clients with Disorders of the Kidneys and Ureters

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? 250 mL 500 mL 750 mL 1,000 mL

1,000mL

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? Cola-colored urine Left upper quadrant pain Pyuria Low blood pressure

Cola-colored urine

The nurse is providing a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants' risks of renal carcinoma? Avoiding heavy alcohol use Control of sodium intake Smoking cessation Adherence to recommended immunization schedules

Smoking cessation

The nurse coming on shift on the medical unit is taking a report on four clients. What client does the nurse know is at the greatest risk of developing ESKD? A client with a history of polycystic kidney disease A client with diabetes mellitus and poorly controlled hypertension A client who is morbidly obese with a history of vascular disorders A client with severe chronic obstructive pulmonary disease

A client with diabetes mellitus and poorly controlled hypertension

A 45-year-old man with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis? "Hemodialysis is a treatment option that is usually required three times a week." "Hemodialysis is a program that will require you to commit to daily treatment." "This will require you to have surgery and a catheter will need to be inserted into your abdomen." "Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again."

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

The nurse is planning client teaching for a client with end-stage kidney disease who is scheduled for the creation of a fistula. The nurse should teach the client what information about the fistula? "A vein and an artery in your arm will be attached surgically." "The arm should be immobilized for 4 to 6 days." "One needle will be inserted into the fistula for each dialysis treatment." "The fistula can be used 5 to 7 days after the surgery for dialysis treatment."

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

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." "Dietary changes can reverse the damage that has occurred in your kidneys." "Draining of the cysts and antibiotic therapy will cure your disease." "Genetic testing will determine the best treatment for your condition."

"As the disease progresses, you will most likely require renal replacement therapy."

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 90 mL/min/1.73 m2 A GFR of 30-59 mL/min/1.73 m2 A GFR of 120 mL/min/1.73 m2 A GFR of 85 mL/min/1.73 m2

A GFR of 30-59 mL/min/1.73 m2

The critical care nurse is monitoring the client's urine output and drains following renal surgery. What should the nurse promptly report to the primary provider? Increased pain on movement Absence of drain output Increased urine output Blood-tinged serosanguineous drain output

Absence of drain output

A client undergoes dialysis as a part of treatment for kidney failure, and is administered heparin during dialysis to achieve therapeutic levels. Which step 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. Provide periods of rest throughout the day and uninterrupted sleep at night. Use dialysate solutions after 2 hours. Puncture the same site used previously.

Avoid administering injections for 2 t 4 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 Proteinuria Hematuria Bacteremia

Azotemia

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

Dehydration

Which phase of acute renal failure signals that glomerular filtration has started to recover? Diuretic Oliguric Initiation Recovery

Diuretic

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 or deceased donors. Donors must be relatives. Donors with hypertension may qualify. The client is placed on a transplant list at the local hospital.

Donors are selected from compatible living or deceased donors.

A client admitted with nephrotic syndrome is being cared for on the medical unit. When writing this client's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include? Constipation related to immobility Risk for injury related to altered thought processes Hyperthermia related to the inflammatory process Excess fluid volume related to generalized edema

Excess fluid volume related to generalized edema

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

Glomerulonephritis

Which clinical finding should a nurse look for in a client with chronic renal failure? Hypotension Uremia Metabolic alkalosis Polycythemia

Uremia

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

Urine output of 20 ml/h

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

Limiting fluid intake

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 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.

A client 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? Ensure that the client moves the extremity with the vascular access site as little as possible. Change the dressing over the vascular access site at least every 12 hours. Utilize the vascular access site for infusion of IV fluids. Assess for a thrill or bruit over the vascular access site each shift.

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

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

Administration of sodium polystyrene sulfonate (Kayexalate)

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 Acidosis Hyperkalemia Pericarditis

Anemia

The nurse is caring for a client who has returned to the postsurgical suite after postanesthetic 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 client for signs of bleeding and inform the primary provider. Monitor the client's vital signs every 15 minutes for the next hour. Reposition the client and reassess vital signs. Palpate the client's flanks for pain and inform the primary provider.

Assess the client for signs of bleeding and inform the primary provider.

The nurse is caring for a client 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 client's urine output Assessment of the client's incision Assessment of the client's abdominal girth Assessment for flank or abdominal pain

Assessment of the quantity of the client's urine output

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. Provide periods of rest throughout the day and uninterrupted sleep at night. Use dialysate solutions after 2 hours. Puncture the same site used previously.

Avoid administering injections 2 to 4 hours after heparin administration

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? Increased pH with decreased hydrogen ions Increased serum levels of potassium, magnesium, and calcium Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75%

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

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: acute rejection. hyperacute rejection. chronic rejection. simple rejection.

Hyperacute rejection

The nurse is caring for a client in acute kidney injury. Which of the following complications would most clearly warrant the administration of polystyrene sulfonate? Hypernatremia Hypomagnesemia Hyperkalemia Hypercalcemia

Hyperkalemia

What is a hallmark of the diagnosis of nephrotic syndrome? Hyponatremia Proteinuria Hyperalbuminemia Hypokalemia

Proteinuria

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: nausea and vomiting. dyspnea and cyanosis. fatigue and weakness. thrush and circumoral pallor.

Fatigue and weakness

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

Gray-bronze skin color

The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? Select all that apply. Red blood cells in the urine Polyuria Proteinuria White blood cell casts in the urine Hemoglobin of 12.8 g/dL

Red blood cells in the urine Proteinuria

A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the client's chronic kidney disease is at what stage? Stage 1 Stage 2 Stage 3 Stage 4

Stage 3

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)? Blood urea nitrogen (BUN) level of 22 mg/dl Serum creatinine level of 1.2 mg/dl Temperature of 100.2° F (37.8° C) Urine output of 250 ml/24 hours

Urine output of 250 ml/24 hours

A client's renal failure has become chronic. Which signs and symptoms are associated with chronic renal failure? Select all that apply. lethargy muscle cramps bleeding of the oral mucous membranes enhanced cognition

lethargy muscle cramps bleeding of the oral mucous membranes

A client has been diagnosed with acute glomerulonephritis. This condition causes: proteinuria. pyuria. polyuria. No option is correct.

proteinuria.

Tumors of the kidney are almost always cancerous. Renal cell carcinoma is the most common type of kidney cancer in adults. The cause of kidney tumors is unknown; however, certain risk factors are known. What are the known risk factors? Select all that apply. tobacco use obesity age alcohol use

tobacco use obesity age

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. allowing liberal use of sodium. limiting iron and folic acid intake. eating protein liberally.

Restricting sources of potassium

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

Risk for infection

The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to do what? Wash hands carefully and frequently. Ensure immediate function of the donated kidney. Instruct the client to wear a face mask. Bar visitors from the client's room.

Wash hands carefully and frequently

What is a characteristic of the intrarenal category of acute kidney injury (AKI)? Decreased creatinine Increased BUN High specific gravity Decreased urine sodium

Increased BUN

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? Blood glucose level of 200 mg/dl White blood cell (WBC) count of 20,000/mm3 Potassium level of 3.5 mEq/L Hematocrit (HCT) of 35%

White blood cell (WBC) count of 20,000/mm3

The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time? Only when needed Daily at bedtime First thing in the morning With each meal

With each meal

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

With food

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? Acute pyelonephritis Osmotic dieresis. Dysrhythmias Renal calculi

Renal calculi

A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action? Advance the catheter 2 to 4 cm further into the peritoneal cavity. Reposition the client to facilitate drainage. Aspirate from the catheter using a 60-mL syringe. Infuse 50 mL of additional dialysate.

Reposition the client to facilitate drainage

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

Tall, peaked T waves

The nurse is caring for acutely ill client. What assessment finding should prompt the nurse to inform the physician that the client may be exhibiting signs of acute kidney injury (AKI)? The client reports an inability to initiate voiding. The client's urine is cloudy with a foul odor. The client's average urine output has been 10 mL/hr for several hours. The client complains of acute flank pain.

The client's average urine output has been 10 mL/hr for several hours

A client with end-stage renal disease 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 health care provider and assess the client for signs of infection. Flush the peritoneal catheter with normal saline. Remove the catheter promptly and have the catheter tip cultured. Administer a bolus of IV normal saline as prescribed.

Inform the health care provider and assess the client for signs of 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? Wear a mask while handling any dialysate solutions Keep the catheter stabilized to the abdomen, below the belt line Keep the dialysis supplies in a clean area, away from children and pets Clean the catheter insertion site daily with soap

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

A client diagnosed with acute kidney injury (AKI) has developed congestive heart failure. The client has received 40 mg of intravenous push (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The client's vital signs are stable. Which health care order should the nurse anticipate? Lasix 80 mg IVP Normal saline bolus of 500 mL Chest x-ray Mannitol 12.5 g IVP

Lasix 80 mg IVP

The nurse is caring for a client after kidney surgery. When assessing for bleeding, what assessment parameter should the nurse evaluate? Oral intake Pain intensity Level of consciousness Radiation of pain

Level of consciousness

The nurse has identified the nursing diagnosis of "Risk for Infection" in a client who undergoes peritoneal dialysis. What nursing action best addresses this risk? Maintain aseptic technique when administering dialysate. Wash the skin surrounding the catheter site with soap and water prior to each exchange. Add antibiotics to the dialysate as prescribed. Administer prophylactic antibiotics by mouth or IV as prescribed.

Maintain aseptic technique when administering dialysate.

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. Inspect the catheter site for leakage of dialysate. Observe for evidence of bleeding. Measure fluid drainage to estimate incomplete recovery of fluid. TAKE ANOTHER QUIZ

Palpate the abdominal wall for rebound tenderness

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? 1.5 L 1.0 L Less than 400 mL Less than 50 mL

Less than 400 ml

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI? Initiation Oliguria Diuresis Recovery

Oliguria

The nurse is assessing a client suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? Hematuria Precipitous decrease in serum creatinine levels Hypotension unresolved by fluid administration Glucosuria

Hematuria

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 Peritoneal dialysis Continuous arteriovenous hemofiltration (CAVH) Continuous venovenous hemofiltration (CVVH)

Hemodialysis

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

Hypovolemic shock caused by hemorrhage

A client is brought to the renal unit from the PACU status postresection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this client? Increasing oral intake Managing postoperative pain Managing dialysis Increasing mobility

Managing postoperative pain

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. What would the nurse teach a client with chronic kidney disease to assist with dietary adherence. Select all that apply. 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. Restrict protein intake to plant proteins because they are easier for the body to process. Restrict all sugars as the excess calories may be harmful to the kidneys.

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.

A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure? Poor perfusion to the kidneys Damage to cells in the adrenal cortex Obstruction of the urinary collecting system Nephrotoxic injury secondary to use of contrast media

Nephrotoxic injury secondary to use of contrast media

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

Oliguria

A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the client reviews the initial orders and notes 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. Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this client. A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary. There is great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations.

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

A nurse on the renal unit is caring for a client who will soon begin peritoneal dialysis. The family of the client asks for education about the peritoneal dialysis catheter that has been placed in the client's peritoneum. The nurse explains the three sections of the catheter and talks about the two cuffs on the dialysis catheter. What would the nurse explain about the cuffs? Select all that apply. The cuffs are made of Dacron polyester. The cuffs stabilize the catheter. The cuffs prevent the dialysate from leaking. The cuffs provide a barrier against microorganisms. The cuffs absorb dialysate

The cuffs are made of Dacron polyester. The cuffs stabilize the catheter. The cuffs prevent the dialysate from leaking. The cuffs provide a barrier against microorganisms.