med surge chapter 58 disorders of the kidneys and ureters

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. __________ bottles

5 Bottles

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? A) "Even a perfect match does not guarantee organ rejection." B) "Immunosuppressive drugs guarantee organ success." C) "The doctor may decide to delay the use of immunosuppressant drugs." D) "Let's wait until after the surgery to discuss your treatment plan."

A) "Even a perfect match does not guarantee organ rejection."

When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? A) Check for thrill or bruit over the access site. B) Inspect the catheter insertion site for infection. C) Add the prescribed drug to the dialysate. D) Warm the solution to body temperature.

A) Check for thrill or bruit over the access site.

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

A) Hypertension

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? A) Periorbital edema B) Anasarca C) Uremic frost D) Hydronephrosis

B) Anasarca

A nephrostomy tube is inserted in a client with a large ureteral calculus. Which is the most important consideration in providing nursing care for this client? A) Clamp the tube for no longer than 2 hours at a time. B) Maintain free, continuous urine drainage. C) Leave nephrostomy site open to the air. D) Use only sterile NSS to irrigate the tube.

B) Maintain free, continuous urine drainage.

The nurse evaluates the client as experiencing symptoms of disequilibrium syndrome, following an initial hemodialysis treatment. Which is the best action to be taken by the nurse? A) No action is needed. B) Hold the next scheduled treatment. C) Slow the dialysis process during future treatment. D) Notify the physician and manage the symptoms.

C) Slow the dialysis process during future treatment.

Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? A) Urine output of 35 to 40 mL/hour B) Pain of 3 out of 10, 1 hour after analgesic administration C) SpO2 at 90% with fine crackles in the lung bases D) Blood-tinged drainage in Jackson-Pratt drainage tube

C) SpO2 at 90% with fine crackles in the lung bases

Following ureteroscopy, for the removal of ureteral calculus, a stent is temporarily left in place. The client asks what purpose the stent provides. Which is the best response from the nurse? A) "The stent is coated with an anti-infective to promote healing." B) "The stent will catch any debris or blood clots left behind." C) "The stent will provide easier passing of future stones." D) "Inflammation from the stone can block the flow of urine."

D) "Inflammation from the stone can block the flow of 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? A) Decrease in the blood flow through the kidneys B) Obstruction of urine flow from the kidneys C) Blood clot formed in the kidneys interfered with the flow D) Structural damage occurred in the nephrons of the kidneys

A) Decrease in the blood flow through the kidneys

A client with chronic glomerulonephritis has generalized edema. Which response by the nurse best describes why anasarca occurs with this disorder? A) Fluid shifting occurs due to loss of serum protein. B) Albumin levels increase in the blood dragging fluid inside the vessels. C) Increased intake of sodium in the diet results in anasarca. D) Urinary retention promotes the absorption of fluid into tissue spaces.

A) Fluid shifting occurs due to loss of serum protein.

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? A) "It is important to use strict aseptic technique." B) "It is appropriate to warm the dialysate in a microwave." C) "The infusion clamp should be open during infusion." D) "The effluent should be allowed to drain by gravity."

B) "It is appropriate to warm the dialysate in a microwave."

The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom? A) Azotemia B) Diminished erythropoietin production C) Impaired immunologic response D) Electrolyte imbalances

B) Diminished erythropoietin production

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? A) Elevated urea levels B) Hyperkalemia C) Hypocalcemia D) Elevated white blood cells

B) Hyperkalemia

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

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

A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? A) "Squamous cell carcinomas do not present with detectable symptoms." B) "You should have sought treatment earlier." C) "Very few symptoms are associated with renal cancer." D) "Painless gross hematuria is the first symptom in renal cancer."

C) "Very few symptoms are associated with renal cancer."

Which assessment finding is most important in determining nursing care for a client with acute glomerulonephritis? A) Presence of albumin in the urine B) Dark smoky colored urine C) Blurred vision D) Peripheral edema

C) Blurred vision

The office nurse is providing information to a client who has experienced recurrent renal calculi. Which of the following jobs would place a client at greatest risk for calculi formation? A) Over-the-road truck driver B) Mining engineer C) Nursing instructor D) Rumba instructor

A) Over-the-road truck driver

A child is brought into the clinic with symptoms of periorbital edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem? A) Sore throat 2 weeks ago B) Red blood cells in the urine C) Elevation of blood pressure D) Protein elevation in the urine

A) Sore throat 2 weeks ago

An elderly client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? A) Shows damage to the kidneys B) If risk for chronic pyelonephritis is likely C) Reveals causative microorganisms D) Detects calculi, cysts, or tumors

D) Detects calculi, cysts, or tumors

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? A) Pats skin dry after bathing B) Uses moisturizing creams C) Keeps nails trimmed short D) Brief, hot daily showers

D) Brief, hot daily showers

As the home health nurse reviews medications taken by the client with polycystic kidney disease, which medication should be addressed first? A) Lovastatin B) Methylprednisolone C) Furosemide D) Ibuprofen

D) Ibuprofen

The hemodialysis client is scheduled to receive weekly injections of epoetin. Which is the most important consideration to be taken by the nurse in the administration of this medication? A) Schedule injection on non-dialysis day. B) Administer immediately after dialysis. C) Monitor complete blood count prior to dose. D) Administer with low-dose aspirin to prevent clot formation.

A) Schedule injection on non-dialysis day.

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following? A) Abnormalities in urine B) Location of discomfort C) Elevated calcium levels D)Structural defects in the kidneys

B) Location of discomfort

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? A) Hypotension B) Weight loss C) Polyuria D) Abdominal pain

D) Abdominal pain

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

A) The kidneys can improve over a period of months.

The client with glomerulonephritis is exhibiting gross periorbital edema. Which is the best nursing intervention to relieve this symptom? A) Administer diuretics. B) Apply warm compresses. C) Elevate the head of the bed. D) Monitor intake and output.

C) Elevate the head of the bed.

A chronic renal failure client 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? A) Elevated serum creatinine B) Hyperkalemia C) Hyperphosphatemia D) Elevated urea and nitrogen

C) 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? A) Disconnect the catheter and reapply. B) Loosen the tubing clamp. C) Inform the physician that catheter may need repositioning. D) Stop the process for 5 minutes and resume later.

C) Inform the physician that catheter may need repositioning.

A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect? A) Acute glomerulonephritis B) Ureteral stricture C) Urinary calculi D) Renal cell carcinoma

C) Urinary calculi

A client with several calculi in the ureter is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which teaching statement by the nurse best describes the procedure? A) A scope is passed through the urethra to visualize and destroy the stones with a laser. B) After locating the calculi, a small incision is made to remove the stones. C) The stone is identified via fluoroscopy and then shock waves are used to shatter the stones. D) Once the calculi are located, a fine wire delivers shock waves to pulverize the stones.

C) The stone is identified via fluoroscopy and then shock waves are used to shatter the stones.

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? A) "The risk of peritonitis is greater with this type of dialysis." B) "This type of dialysis will provide more independence." C) "Peritoneal dialysis will require more work for you." D) "Peritoneal dialysis does not work well for every client."

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

The nurse is caring for several older clients. Which client would the nurse be especially alert for signs and symptoms of pyelonephritis? A) A client with acute renal failure B) A client with a urinary tumor C) A female client with preexisting chronic glomerulonephritis D) A client with urinary obstruction

D) A client with urinary obstruction