Honan, Chapter 27: Nursing Management: Patients With Renal Disorders
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.
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis?
Azotemia
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?
Hyperphosphatemia
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse?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."
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."
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
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
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])
The nurse is able to identify which condition as uremia?
An excess of urea in the blood
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 ratio (BUN:Cr) >20.
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
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
A client requires hemodialysis. Which type of drug should be withheld before this procedure?
Cardiac glycosides
Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted.
Citrus fruits
The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find?
Cola-colored urine
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?
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?
Decrease in the blood flow through the kidneys
A 58-year-old man has a longstanding diagnosis of poorly controlled type 2 diabetes. As a result of hyperglycemia, the man has developed chronic glomerulonephritis. In light of this new diagnosis, the nurse who is caring for this patient would anticipate that he will exhibit:
Proteinuria
During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication?
Dehydration
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?
Dehydration
A nurse is assessing a client with acute renal failure. What medications should the nurse identify as a nephrotoxic drug? Select all that apply.
Gentamycin Tobramycin Neomycin
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure?
Glomerulonephritis
A nursing educator is speaking with a group of new graduates about a patient who has acute glomerulonephritis. The educator should tell the nurses that the patient may exhibit which of the following clinical manifestations?
Hematuria
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.
What is a characteristic of the intrarenal category of acute kidney injury (AKI)?
Increased BUN
What is a characteristic of the intrarenal category of acute renal failure?
Increased BUN
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure?
Increased serum creatinine level
What is a hallmark of the diagnosis of nephrotic syndrome?
Proteinuria
A female patient with a recent diagnosis of end-stage renal disease (ESRD) is scheduled to soon begin hemodialysis. A nephrology nurse has been conducting extensive patient teaching in anticipation of this treatment. What diet should the nurse recommend to minimize her patient's risk of complications and interdialytic weight gain?
Low-protein, low-sodium diet
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
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?
Recent history of streptococcal infection
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
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
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 community health nurse is well-aware that the incidence and prevalence of chronic renal failure (CRF) has increased significantly in recent years. In a recent strategic planning meeting, the nurse has proposed health promotion activities to address this problem. Which of the following health promotion campaigns addresses the most common cause of CRF?
Teaching individuals with diabetes to manage their disease
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
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.
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
Which of the following is the most accurate indicator of fluid loss or gain?
Weight
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
A change that occurs during chronic glomerulonephritis is termed
anemia.
Rejection of a transplanted kidney within 24 hours after transplant is termed
hyperacute rejection.
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.
The nurse monitors the client for potential complications during dialysis but recognizes NOT to monitor for
hypertension.
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.
