Hinkle Chapter 54: Management of Patients With Kidney Disorder

During hemodialysis, toxins and wastes in the blood are removed by which of the following? Filtration Ultrafiltration Osmosis Diffusion SUBMIT ANSWER

Diffusion

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? "The cysts can get quite large in size." "If renal failure develops, I may need to consider dialysis." "As long as I have one normal kidney, I should be fine." "I inherited this disorder from one of my parents."

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

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

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

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." "Painless gross hematuria is the first symptom in renal cancer." "Squamous cell carcinomas do not present with detectable symptoms." "You should have sought treatment earlier." SUBMIT ANSWER

"Very few symptoms are associated with renal cancer."

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 500 mL 750 mL 250 mL SUBMIT ANSWER

1,000 mL

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: 2,000 mL of fluid 1,500 mL of fluid 1,000 mL of fluid 500 mL of fluid

1,500 mL of fluid

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

Administration of sodium polystyrene sulfonate [Kayexalate])

The nurse is able to identify which condition as uremia? An excess of blood in the urine An excess of protein in the blood An excess of urea in the blood An excess of protein in the urine

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

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 Pericarditis Acidosis Hyperkalemia

Anemia

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

Azotemia

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? Hypotension Peripheral neuropathy Cola-colored urine Hyperalbuminemia

Cola-colored urine

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

Decrease in the blood flow through the kidneys

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

Donors are selected from compatible living or deceased donors.

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

Fever

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

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.

What is used to decrease potassium level seen in acute renal failure? IV dextrose 50% Calcium supplements Sodium polystyrene sulfonate Sorbitol

Sodium polystyrene sulfonate

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

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

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? At bedtime with 8 ounces of fluid With food 2 hours after meals 2 hours before meals

With food

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. dyspnea and cyanosis. nausea and vomiting. thrush and circumoral pallor.

fatigue and weakness.

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? Hyperkalemia Elevated urea levels Hypocalcemia Elevated white blood cells

Hyperkalemia

A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess? Extremity pain Hypertension Fever Periorbital edema

Hypertension

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

Less than 400 mL

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 Diuresis Acute tubular necrosis Restored glomerular function

Oliguria 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.

Which of the following is the most sensitive indicator of renal function? Potassium Creatinine clearance Serum creatinine Blood urea nitrogen (BUN) SUBMIT ANSWER

Serum creatinine

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? pH 7.31, PaCO2 48, HCO3 24- pH 7.47, PaCO2 45, HCO3 33- pH 7.50, PaCO2 29, HCO3 22- pH 7.20, PaCO2 36, HCO3 14-

pH 7.20, PaCO2 36, HCO3 14-

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? Sodium Magnesium Phosphorus Calcium

Calcium

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? Acute renal failure tends to turn to end-stage failure. Kidney function will improve with transplant. Once on dialysis, the need will be permanent. The kidneys can improve over a period of months.

The kidneys can improve over a period of months.

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

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

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

Increased BUN

A client with chronic renal failure 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? Elevated serum creatinine Hyperphosphatemia Hyperkalemia Elevated urea and nitrogen

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. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.

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

Glomerulonephritis

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

Glomerulonephritis

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? "Eat plenty of bananas." "Drink plenty of fluids, and use a salt substitute." "Increase your carbohydrate intake." "Be sure to eat meat at every meal."

"Increase your carbohydrate intake."

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 1.5 lb 2 lb 0.5 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 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? Peritoneal dialysis Hemodialysis Continuous arteriovenous hemofiltration (CAVH) Continuous venovenous hemofiltration (CVVH)

Hemodialysis

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 No renal stones Polyuria Normal urinalysis

Hypertension Pain from retroperitoneal bleeding Polyuria

Which of the following occurs late in chronic glomerulonephritis? Seizure Nosebleed Peripheral neuropathy Stroke

Peripheral neuropathy

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

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

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

Tall, peaked T waves

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. metabolic alkalosis secondary to retention of hydrogen ions. a decreased serum phosphate level secondary to kidney failure. an increased serum calcium level secondary to kidney failure.

water and sodium retention secondary to a severe decrease in the glomerular filtration rate. 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 nurse receives her client care assignment. Following the report, she should give priority assessment to the client: who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L. who has a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L 7 days after a kidney transplant. who is experiencing mild pain from urolithiasis. with pinkish mucus discharge in the appliance bag 2 days after an ileal conduit.

who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L.

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." "Peritoneal dialysis does not work well for every client." "The risk of peritonitis is greater with this type of dialysis." "Peritoneal dialysis will require more work for you."

"This type of dialysis will provide more independence.""This type of dialysis will provide more independence."

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? Glomerular filtration rate (GFR) of 100 mL/min. Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. Serum creatinine of 1.2 mg/dL. BUN of 18 mg/dL. SUBMIT ANSWER

Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.

Which assessment finding is most important in determining the severity of client's acute glomerulonephritis? Peripheral edema Blurred vision Dark smoky colored urine Presence of albumin in the urine

Blurred vision

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? Hypovolemic shock caused by hemorrhage Abdominal distention owing to reflex cessation of intestinal peristalsis 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

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

Dehydration

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

Glomerulonephritis

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

Urine output of 20 ml/hour

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

Donors are selected from compatible living or deceased donors.

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: allowing liberal use of sodium. limiting iron and folic acid intake. eating protein liberally. restricting sources of potassium.

restricting sources of potassium. The nurse will teach the client to restrict sources of potassium, such as fresh fruits and vegetables, because hyperkalemia can cause life-threatening changes. The client will restrict sodium intake as ordered; doing so prevents fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken; iron and folic acid supplements are needed for red blood cell (RBC) production, and Epogen stimulates the bone marrow to produce RBCs. The client will restrict protein intake to foods that are complete proteins within prescribed limits; complete proteins provide positive nitrogen balance for healing and growth.