NCLEX 6th Ed Renal/GU

A nurse has taught the client with polycystic kidney disease about management of the disorder and prevention and recognition of complications. The nurse should determine that the client understands the instructions if the client states that which sign/symptom is not a cause for concern? A. Burning on urination B. A temperature of 100.6° F C. New-onset shortness of breath D. A blood pressure of 105/68 mm Hg

D. A blood pressure of 105/68 mm Hg The client with polycystic kidney disease should report any signs/symptoms of urinary tract infection (options 1 and 2) so that treatment may begin promptly. Lowered blood pressure is not a complication of polycystic kidney disease, and it is an expected effect of antihypertensive therapy. The client would be concerned about increases in blood pressure because control of hypertension is essential. The client may experience heart failure as a result of hypertension, and thus any symptoms of heart failure, such as shortness of breath, are also a concern.

A client with chronic kidney disease (CKD) takes aluminum hydroxide gel (ALternaGEL) as a phosphate binder. On the basis of this information, the nurse determines that the client is most at risk for which problem? A. Constipation B. Dehydration C. Inability to tolerate activity D. Impaired physical mobility

A. Constipation The client with CKD is almost certain to have a problem with constipation as a result of factors such as fluid restriction, fatigue that limits exercise, and dietary restrictions. In addition, phosphate-binding antacids such as aluminum hydroxide gel cause constipation as a side effect. The other problems listed are unrelated to the information in the question.

A client who is performing peritoneal dialysis at home calls the clinic and reports that the outflow from the dialysis catheter seems to be decreasing in amount. The clinic nurse should ask which question first? A. "Have you had any diarrhea?" B. "Have you been constipated recently?" C. "Have you had any abdominal discomfort?" D. "Have you had an increased amount of flatulence?"

B. "Have you been constipated recently?" Reduced outflow from the dialysis catheter may be caused by the catheter position, infection, or constipation. Constipation may contribute to a reduced outflow because peristalsis seems to aid in drainage. Options 1, 3, and 4 are unrelated to the causes of reduced outflow from the dialysis catheter.

A client with renal cell carcinoma of the left kidney is scheduled for nephrectomy. The right kidney appears normal at this time. The client is anxious about whether dialysis will ultimately be a necessity. The nurse should plan to use which information in discussions with the client to alleviate anxiety? A. There is a strong likelihood that the client will need dialysis within 5 to 10 years. B. There is absolutely no chance of needing dialysis because of the nature of the surgery. C. One kidney is adequate to meet the needs of the body so long as it has normal function. D. Dialysis could become likely, but it depends on how well the client complies with fluid restriction after surgery.

C. One kidney is adequate to meet the needs of the body so long as it has normal function. Fears about having only one functioning kidney are common in clients who must undergo nephrectomy for renal cancer. These clients need emotional support and reassurance that the remaining kidney should be able to fully meet the body's metabolic needs, so long as it has normal function. Therefore the remaining options are incorrect.

A nurse is caring for a client whose urine output was 25 mL for two consecutive hours. The nurse plans care, knowing that which client-related factor would increase the amount of blood flow to the kidneys? A. Physiological stress B. Release of norepinephrine C. Release of low levels of dopamine D. Sympathetic nervous system stimulation

C. Release of low levels of dopamine The release of low levels of dopamine exerts a vasodilating effect on the renal arteries, increasing urinary output. The other options cause renal vasoconstriction.

A client diagnosed with polycystic kidney disease has been taught about the treatment plan for this disease. The nurse should determine that the client needs additional teaching if the client states that which is included in the treatment plan? A. Genetic counseling B. Sodium restriction C. Increased water intake D. Antihypertensive medications

B. Sodium restriction Individuals with polycystic kidney disease seem to waste rather than retain sodium. Unless the client has problems with uncontrolled hypertension, they need increased sodium and water intake. Antihypertensive medications are prescribed to control hypertension. Genetic counseling is advisable because of the hereditary nature of the disease.

The client with a crush injury to the leg has a highly positive urine myoglobin level. The nurse should assess this client carefully for signs and symptoms of which problem? A. Brain attack B. Respiratory failure C. Myocardial infarction D. Acute tubular necrosis

D. Acute tubular necrosis The normal urine myoglobin level is negative. After extensive muscle destruction or damage, myoglobin is released into the bloodstream, where it is cleared from the body by the kidneys. When a large amount of myoglobin is being cleared from the body, there is a risk of the renal tubules being clogged with myoglobin, causing acute tubular necrosis. This is one form of acute kidney injury. The remaining options are unrelated to a positive myoglobin level.

The nurse instructs a client about continuous ambulatory peritoneal dialysis (CAPD). Which statement, if made by the client, indicates an accurate understanding of CAPD? A. "No machinery is involved, and I can pursue my usual activities." B. "A cycling machine is used, so the risk for infection is minimized." C. "The drainage system can be used once during the day and a cycling machine for three cycles at night." D. "A portable hemodialysis machine is used so that I will be able to ambulate during the treatment."

A. "No machinery is involved, and I can pursue my usual activities." CAPD closely approximates normal renal function, and the client will need to infuse and drain the dialysis solution several times a day. No machinery is used, and CAPD is a manual procedure.

At the beginning of the work shift, a nurse is assessing a client who has returned from the postanesthesia care unit after transurethral resection of the prostate (TURP). The nurse should assess for which color in the urinary drainage tubing that indicates proper irrigation and adequate functioning of the device? A. Pale pink B. Dark pink C. Bright red D. Red with clots

A. Pale pink If the bladder irrigation solution is infusing at a sufficient rate, the urinary drainage will be pale pink. A dark pink color (sometimes referred to as punch-colored) indicates that the speed of the irrigation should be increased. Bright red bleeding and red urine with clots should be reported to the surgeon because either finding could indicate complications.

A client with benign prostatic hyperplasia undergoes a transurethral resection of the prostate. Postoperatively the client is receiving continuous bladder irrigations. The nurse assesses the client for manifestations of transurethral resection syndrome. Which assessment data would indicate the onset of this syndrome? A. Tachycardia and diarrhea B. Bradycardia and confusion C. Increased urinary output and anemia D. Decreased urinary output and bladder spasms

B. Bradycardia and confusion Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure, such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.

The nurse checks the serum myoglobin level for a client with a crush injury to the right lower leg because the client is at risk for developing which type of acute kidney injury? A. Prerenal B. Intrarenal C. Postrenal D. Extrarenal

B. Intrarenal Serum myoglobin levels increase in crush injuries when large amounts of myoglobin and hemoglobin are released from damaged muscle and blood cells. The accumulation may cause acute tubular necrosis, an intrarenal cause of renal failure. Prerenal causes are conditions that interfere with the perfusion of blood to the kidney. Postrenal causes include conditions that cause urinary obstruction distal to the kidney. The cause and the type of renal failure may determine the interventions used in treatment.

A nurse measures the cardiac output of a client and finds it to be 6 L/min. Which amount should the nurse calculate is the amount of blood circulating to the kidneys? A. 100 to 300 mL/min B. 500 to 1000 mL/min C. 1200 to 1500 mL/min D. 2000 to 2500 mL/min

C. 1200 to 1500 mL/min The kidneys normally receive about 20% to 25% of the cardiac output when the client is at rest. If the cardiac output is 6 L/min, then the kidneys receive 1.2 to 1.5 L/min, which is equal to 1200 to 1500 mL/min.

A client is being discharged to home while recovering from acute kidney injury (AKI). A reduction in which substance indicates to the nurse that the client understands the dietary teaching? A. Fats B. Vitamins C. Potassium D. Carbohydrates

C. Potassium The excretion of potassium and maintenance of potassium balance are normal functions of the kidneys. In the client with acute kidney injury or chronic kidney disease, potassium intake must be restricted as much as possible (to 60 to 70 mEq/day). The primary mechanism of potassium removal during AKI is dialysis. Vitamins, carbohydrates, and fats are not normally restricted in the client with AKI unless a secondary health problem warrants the need to do so. The amount of fluid permitted is generally calculated to be equal to the urine volume plus the insensible loss volume of 500 mL.

A client with end-stage renal disease (ESRD) has the problem of ineffective coping. Which nursing intervention would be potentially unsafe in working with this client? A. Assess the client and family's coping patterns. B. Explore the meaning of the illness with the client. C. Set limits on mood swings and expressions of hostility. D. Give the client information when the client is ready to listen.

C. Set limits on mood swings and expressions of hostility. Clients with ESRD are likely to experience mood swings or express hostility, anger, and depression, among other responses. The nurse should acknowledge the client's feelings, allow the client to express those feelings, and be supportive. Options 1, 2, and 4 are helpful and appropriate interventions for the client.

A nurse is reviewing the assessment findings for a client with a diagnosis of nephrotic syndrome. Which would the nurse expect to note in this client? A. Decreased serum lipids B. Signs of fluid volume deficit C. Decreased protein in the urine D. Decreased serum albumin levels

D. Decreased serum albumin levels Nephrotic syndrome describes a variety of signs and symptoms that accompany any condition that markedly impairs filtration by glomerular capillary membranes and results in increased permeability to protein. Hallmark signs and symptoms of this syndrome include increased serum lipids, edema, increased excretion of protein in the urine, and decreased serum albumin levels.

A nurse has provided dietary instructions to a client with renal calculi who must learn about the foods that yield an alkaline residue in the urine. The nurse determines that the client has properly understood the information presented when the client chooses which selections from a diet menu? A. Spinach salad, milk, and a banana B. Chicken, potatoes, and cranberries C. Peanut butter sandwich, milk, and prunes D. Linguini with shrimp, tossed salad, and a plum

B. Chicken, potatoes, and cranberries In some client situations, the health care provider may prescribe a diet that consists of foods that yield either an alkaline or an acid residue in the urine. In an alkaline residue diet, all fruits are allowed except cranberries, blueberries, prunes, and plums. Options, 2, 3 and 4 represent an acid residue diet.

The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, would indicate an adequate understanding of the treatment plan for this client? A. Prevent fluid overload. B. Prevent loss of electrolytes. C. Promote the excretion of wastes. D. Reduce the urine specific gravity.

B. Prevent loss of electrolytes. In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring. Options 1, 3, and 4 are not the primary concerns in this phase of acute kidney injury.

A client passes a urinary stone, and laboratory analysis of the stone indicates that it is composed of calcium oxalate. On the basis of this analysis, which option should the nurse specifically include in the dietary instructions? A. Increase intake of dairy products. B. Avoid citrus fruits and citrus juices. C. Avoid green, leafy vegetables such as spinach. D. Increase intake of meat, fish, plums, and cranberries.

C. Avoid green, leafy vegetables such as spinach. Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.

The nurse tests the urine of a client with acute kidney injury (AKI) with a multitest reagent strip. The strip tests highly positive for proteinuria. The nurse plans care, knowing that this result is consistent with which type of AKI? A. Prerenal B. Postrenal C. Intrinsic D. Atypical

C. Intrinsic With intrinsic failure, there is a fixed specific gravity and the urine tests positive for proteinuria. In prerenal failure, the specific gravity is high and there is very little or no proteinuria. In postrenal failure, there is a fixed specific gravity and little or no proteinuria. There is no disorder known as atypical renal failure.

The nurse is reviewing the medication record of a client diagnosed with chronic kidney disease (CKD). The nurse notes that the client is receiving aluminum hydroxide (ALternaGEL). The nurse plans care, knowing that which is the purpose of this medication? A. Prevents ulcers. B. Prevents constipation. C. Promotes the elimination of potassium from the body. D. Combines with phosphorus and helps eliminate phosphates from the body.

D. Combines with phosphorus and helps eliminate phosphates from the body. Aluminum hydroxide binds with phosphate in the intestines for excretion in the feces, thus lowering phosphorus levels. It can cause constipation, and it does not promote the elimination of potassium. It may be used in the treatment of hyperacidity associated with gastric ulcers, but this is not the purpose of its use in the client with renal failure.

A client with a chronic kidney disease who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). When should the nurse plan to administer this medication? A. During dialysis B. Just before dialysis C. The day after dialysis D. On return from dialysis

D. On return from dialysis Antihypertensive medications such as enalapril (Vasotec) are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting an entire day to resume the medication. This would lead to ineffective control of the blood pressure.

A client undergoing hemodialysis is at risk for bleeding from the heparin used during the hemodialysis treatment. The nurse assesses for this occurrence by periodically checking the results of which laboratory test? A. Bleeding time B. Thrombin time C. Prothrombin time (PT) D. Partial thromboplastin time (PTT)

D. Partial thromboplastin time (PTT) Heparin is the anticoagulant used most often during hemodialysis. The hemodialysis nurse monitors the extent of anticoagulation by checking the PTT, which is the appropriate measure of heparin effect. Thrombin and bleeding times are not used to measure the effect of heparin therapy, although they are useful in the diagnosis of other clotting abnormalities. The PT is one test used to monitor the effect of warfarin (Coumadin) therapy

A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. The nurse should assess the client for which expected manifestation of AKI? A. Bradycardia B. Hypertension C. Decreased cardiac output D. Decreased central venous pressure

B. Hypertension AKI caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of AKI commonly manifests with hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for any form of renal failure.

The nurse is receiving a client from the postanesthesia care unit who has had percutaneous nephrolithotomy for calculi in the renal pelvis. The nurse anticipates that the client's care will most likely involve monitoring which device? A. Ureteral stent B. Suprapubic tube C. Nephrostomy tube D. Jackson Pratt drain

C. Nephrostomy tube A nephrostomy tube is put in place after percutaneous nephrolithotomy for calculi in the renal pelvis. The client also may have a Foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect elimination of the calculus fragments.

A client being discharged home after renal transplantation has a risk for infection related to immunosuppressive medication therapy. The nurse determines that the client needs further instruction on measures to prevent and control infection if the client states that it is necessary to take which action? A. Take an oral temperature daily. B. Use good hand washing technique. C. Take all scheduled medications exactly as prescribed. D. Monitor urine character and output at least 1 day each week.

D. Monitor urine character and output at least 1 day each week. The client receiving immunosuppressive medication therapy must learn and use infection-control methods for use at home. The client self-monitors urine output and its characteristics on a daily basis. The client must learn proper hand washing technique and should take the temperature daily to detect early infection. This is especially important because the client also takes corticosteroids, which mask signs and symptoms of infection. All medications should be taken exactly as prescribed.

The nurse is analyzing the post-hemodialysis laboratory test results for a client with chronic kidney disease. The nurse interprets that the dialysis is having an expected but nontherapeutic effect if which value is decreased? A. Potassium B. Creatinine C. Phosphorus D. Red blood cell (RBC) count

D. Red blood cell (RBC) count Hemodialysis typically lowers the amounts of fluid, sodium, potassium, urea nitrogen, creatinine, uric acid, magnesium, and phosphate levels in the blood. Hemodialysis also worsens anemia because RBCs are lost during dialysis from blood sampling and anticoagulation and from residual blood left in the dialyzer. Although all of these results are expected, only the lowered RBC count is nontherapeutic and worsens the anemia already caused by the disease process.

The nurse provides discharge instructions to a client after a prostatectomy. What is the priority discharge instruction for this client? A. Avoid driving a car for at least 1 week. B. Increase fluid intake to at least 2.5 L/day. C. Avoid lifting any objects greater than 30 pounds. D. Contact the health care provider (HCP) if small clots are noticed in the urine.

B. Increase fluid intake to at least 2.5 L/day. A daily intake of 2.5 L of fluid should be maintained to limit clot formation and prevent infection. Driving a car and sitting for long periods are restricted for at least 3 weeks. The client should be instructed to avoid lifting objects heavier than 20 pounds for at least 6 weeks. Passing small pieces of tissue or blood clots in the urine for up to 2 weeks after surgery is expected and does not necessitate contacting the HCP.

A nurse is providing instructions to a client who is scheduled for cystoscopy and possible biopsy and will be receiving general anesthesia. Which instruction should the nurse provide to the client? A. The procedure will take about 4 hours. B. Intravenous fluids may be started on the day of the procedure. C. Preprocedure sedatives are never administered with general anesthesia. D. A full liquid breakfast only may be allowed on the day of the procedure.

B. Intravenous fluids may be started on the day of the procedure. Client preparation for cystoscopy and possible biopsy includes informing the client that intravenous fluids will be started the day of the procedure to ensure adequate hydration and flow of urine. The procedure will take approximately 30 minutes to 1 hour. An informed consent is obtained from the client, and preprocedure sedatives are administered as prescribed. If a general anesthetic is to be used, the client is told that fasting is necessary after midnight before the procedure.

A client is experiencing the syndrome of inappropriate antidiuretic hormone (ADH) secretion. When explaining this disorder to the client and family, the nurse recalls that ADH works to reabsorb water in which parts of the nephron? A. The glomerulus and calices B. The loop of Henle and the distal tubule C. The distal tubule and the collecting duct D. The proximal tubule and the loop of Henle

C. The distal tubule and the collecting duct The distal tubule and the collecting duct of the nephron require the presence of ADH for water reabsorption. The hormone increases the permeability of the membranes to allow water to flow more easily along the concentration gradient. The glomerulus filters but does not reabsorb. The calices are responsible for collecting the urine. The proximal tubule and the loop of Henle reabsorb water without the assistance of ADH.

Before providing care for a client in the late stages of chronic kidney disease (CKD), the nurse should review the results of which most relevant laboratory study? A. Urinalysis, hematocrit, hemoglobin B. Culture and sensitivity testing, serum sodium C. Urine specific gravity, intravenous pyelogram D. Fasting blood glucose, serum potassium, serum calcium

D. Fasting blood glucose, serum potassium, serum calcium Because of the potentially life-threatening outcomes associated with hyperglycemia, hyperkalemia, and hypocalcemia, they are the most relevant to nursing management of the client with CKD. The diagnostic tests in the remaining options may be helpful in diagnosing CKD or in monitoring treatment but are not the most relevant. Additionally, decreased hematocrit and hemoglobin occur in CKD because of the decreased level of erythropoietin. However, a decrease in hematocrit and hemoglobin may be reflective of various health alterations.

A client has chronic kidney disease (CKD) that does yet not require dialysis. Which comment to the nurse, if made by the client, indicates the need for further teaching? A. "I will reduce the sodium in my diet, and I can use salt substitutes to spice my food." B. "The amount of fluid I can have every day depends on the amount of urine I put out." C. "I will weigh myself on my bathroom scale every morning right after I have urinated." D. "I should report a gain in weight, trouble with my breathing, or increased leg swelling."

A. "I will reduce the sodium in my diet, and I can use salt substitutes to spice my food." CKD is a condition in which the kidneys have progressive problems in their ability to clear nitrogenous waste products and control fluid and electrolyte balance within the body. Conservative treatment of CKD slows progression of the disease and includes reducing the protein, sodium, potassium, and phosphorus in the diet and controlling the blood pressure. It is important to reduce the sodium in the diet. Salt substitutes usually are potassium-based and should not be used by a client with CKD because of the risk of hyperkalemia. The client should alter the fluid intake in relation to urine output. Obtaining a daily weight is an important measurement that indicates fluid volume. The client should also monitor for signs and symptoms of fluid overload, which could include an increase in weight, edema, and fluid collection in the lungs.

The nurse is working on a medical-surgical nursing unit and is caring for several clients with chronic kidney disease. The nurse interprets that which client is best suited for peritoneal dialysis as a treatment option? A. A client with severe heart failure B. A client with a history of ruptured diverticula C. A client with a history of herniated lumbar disk D. A client with a history of three previous abdominal surgeries

A. A client with severe heart failure Peritoneal dialysis may be the treatment option of choice for clients with severe cardiovascular disease. Severe cardiac disease can be worsened by the rapid shifts in fluid, electrolytes, urea, and glucose that occur with hemodialysis. For the same reason, peritoneal dialysis may be indicated for the client with diabetes mellitus. Contraindications to peritoneal dialysis include diseases of the abdomen such as ruptured diverticula or malignancies; extensive abdominal surgeries; history of peritonitis; obesity; and a history of back problems, which could be aggravated by the fluid weight of the dialysate. Severe disease of the vascular system also may be a relative contraindication.

The nurse is assessing the renal function of a client at risk for acute kidney injury. After noting the amount of urine output and urine characteristics, the nurse proceeds to assess which as the best indirect indicator of renal status? A. Blood pressure B. Apical heart rate C. Jugular vein distention D. Level of consciousness

A. Blood pressure The kidneys normally receive 20% to 25% of the cardiac output, even under conditions of rest. For kidney function to be optimal, adequate renal perfusion is necessary. Perfusion can best be estimated by the blood pressure, which is an indirect reflection of the adequacy of cardiac output. The heart rate affects the cardiac output but can be altered by factors unrelated to kidney function. Jugular vein distention and level of consciousness are unrelated items.

Which findings noted in a client on continuous ambulatory peritoneal dialysis (CAPD) should be reported to the health care provider (HCP)? A. Cloudy yellow dialysate output B. Client refusal to take the stool softener C. Previous evening's dwell time of 8 hours D. Peritoneal catheter site is not red, and the skin has grown around the cuff

A. Cloudy yellow dialysate output CAPD is a form of peritoneal dialysis in which exchanges are completed four or five times daily. Peritonitis is a major complication of this type of dialysis. Peritonitis can be recognized by cloudy dialysate outflow, fever, abdominal guarding (board-like abdomen), abdominal pain, pain on inflow, malaise, nausea, and vomiting. The client has the right to refuse medications, but it also is important for the nurse to explain the importance of medications to the client. Typically the dwell time during the night is for the entire time that the client sleeps, which could be around 7 to 9 hours. The peritoneal site should have intact skin. The skin grows around the peritoneal catheter cuff, and this prevents tunnel (around catheter) infections.

A client has been diagnosed with pyelonephritis. The nurse interprets that which health problem has placed the client at risk for this disorder? A. Diabetes mellitus B. Orthostatic hypotension C. Coronary artery disease D. Intravenous (IV) contrast medium

A. Diabetes mellitus Pyelonephritis is most commonly caused by entry of bacteria, obstruction, or reflux. Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, overuse of analgesics, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.

A client with uric acid calculi is placed on a low-purine diet. The nurse instructs the client to restrict the intake of which food? A. Fish B. Plum juice C. Fruit juice D. Cranberries

A. Fish Clients who form uric acid calculi should be placed on a low-purine diet. Their intake of fish and meats (especially organ meats) should be restricted. Dietary modifications also may help adjust urinary pH so that stone formation is inhibited. Depending on health care provider prescription, the urine may be alkalinized by increasing the intake of bicarbonates or acidified by drinking cranberry, plum, or prune juice.

A nurse is performing an assessment on a client with acute kidney injury who is in the oliguric phase. During this phase, the nurse understands that which manifestations are associated findings? Select all that apply. A. Increased serum creatinine level B. A low and fixed specific gravity C. Increased blood urea nitrogen (BUN) level D. Urine osmolarity of approximately 300 mOsm/L E. A urine output of 600 to 800 mL in a 24-hour period

A. Increased serum creatinine level B. A low and fixed specific gravity C. Increased blood urea nitrogen (BUN) level D. Urine osmolarity of approximately 300 mOsm/L During the oliguric phase of acute kidney injury, serum creatinine levels increase by approximately 1 mg/dL per day, and the BUN level increases by approximately 20 mg/dL per day. The specific gravity of the urine is low and fixed, and the urine osmolarity approaches that of the client's serum level, or about 300 mOsm/L. Urine output is less than 100 mL in a 24-hour period.

A nurse is developing a plan of care for a client with a diagnosis of nephrotic syndrome whose glomerular filtration rate (GFR) is normal. Which interventions should be appropriate components of the care plan? Select all that apply. A. Monitor daily weight. B. Maintain sodium restrictions. C. Maintain a diet low in protein. D. Monitor intake and output (I&O). E. Maintain bed rest when edema is severe.

A. Monitor daily weight. B. Maintain sodium restrictions. D. Monitor intake and output (I&O). E. Maintain bed rest when edema is severe. Controlling edema is a critical aspect of therapeutic management of nephrotic syndrome. If the GFR is normal, dietary intake of proteins is needed to restore normal plasma oncotic pressure and thereby decrease edema. Daily measurement of weight and abdominal girth, and careful monitoring of intake and output will determine whether weight loss is caused by diuresis or protein loss. Dietary modifications may include salt restriction and fluid restriction and are based on the client's symptoms. Bed rest is prescribed to promote diuresis when edema is severe.

A nurse is reviewing the urinalysis results for a client with glomerulonephritis. Which findings would the nurse expect to note? Select all that apply. A. Proteinuria B. Hematuria C. Positive ketones D. A low specific gravity E. A dark and smoky appearance of the urine

A. Proteinuria B. Hematuria E. A dark and smoky appearance of the urine In the client with glomerulonephritis, characteristic findings in the urinalysis report are gross proteinuria and hematuria. The specific gravity is elevated, and the urine may appear dark and smoky. Positive ketones are not associated with this condition but may indicate a secondary problem.

A client is diagnosed with epididymitis. The nurse checks the health care provider's prescriptions and expects that which options will be prescribed? Select all that apply. A. Sitz bath B. Antibiotics C. Scrotal elevation D. Use of a heating pad E. Bed rest with bathroom privileges

A. Sitz bath B. Antibiotics C. Scrotal elevation E. Bed rest with bathroom privileges Common interventions used in the treatment of epididymitis include bed rest with bathroom privileges, elevation of the scrotum, ice packs, sitz baths, analgesics, and antibiotics. A heating pad would not be used because direct application of heat would enhance blood flow to the area, thereby increasing the swelling.

A nurse is caring for a client who has just returned from having a cystoscopy. The nurse should recognize which as an abnormal assessment finding for this client? A. The client reports bright red urine. B. The client reports pink-tinged urine. C. The client reports having urinary frequency. D. The client complains of burning when urinating.

A. The client reports bright red urine. The main purpose of a cystoscopy is to inspect the interior of the bladder with a tubular lighted scope (cystoscope). Pink-tinged urine is a normal finding after this procedure, but bright red urine indicates hemorrhaging and is not a normal finding.

A client is about to begin hemodialysis. Which measure(s) should the nurse employ in the care of the client? Select all that apply. A. Using sterile technique for needle insertion B. Using standard precautions in the care of the client C. Giving the client a mask to wear during connection to the machine D. Wearing full protective clothing such as goggles, mask, gloves, and apron E. Covering the connection site with a bath blanket to enhance extremity warmth

A. Using sterile technique for needle insertion B. Using standard precautions in the care of the client C. Giving the client a mask to wear during connection to the machine D. Wearing full protective clothing such as goggles, mask, gloves, and apron Infection is a major concern with hemodialysis. For that reason, the use of sterile technique and the application of a face mask for both nurse and client are extremely important. It also is imperative that standard precautions be followed, which includes the use of goggles, mask, gloves, and an apron. The connection site should not be covered; it should be visible so that the nurse can assess for bleeding, ischemia, and infection at the site during the hemodialysis procedure.

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, would the nurse identify as a risk factor for this disorder? A. Hypoglycemia B. Diabetes mellitus C. Coronary artery disease D. Orthostatic hypotension

B. Diabetes mellitus Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and presence of an indwelling urinary catheter or frequent catheterization. The conditions noted in options 1, 3, and 4 are not associated risk factors.

A client is experiencing a decrease in renal perfusion. The nurse plans care, knowing that the client could benefit from greater endogenous production of which substance that dilates the renal arteries? A. Serotonin B. Dopamine C. Epinephrine D. Norepinephrine

B. Dopamine Dopaminergic receptors are found in the renal blood vessels and in the nerves. When stimulated, they dilate renal arteries and help modulate release of the neurotransmitter, dopamine. Renal artery dilation helps to improve urine output by increasing blood flow through the kidneys. Serotonin is a local hormone that is released from platelets after an injury; it constricts arterioles but dilates capillaries. Epinephrine and norepinephrine affect the beta receptors in the body.

A client with glomerulonephritis has developed acute kidney injury (AKI) as a complication. The nurse would expect to note which abnormal finding documented on the client's medical record? A. Bradycardia B. Hypertension C. Decreased cardiac output D. Decreased central venous pressure

B. Hypertension AKI caused by glomerulonephritis is classified as an intrinsic or intrarenal cause of renal failure. It is commonly manifested by hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from a prerenal cause is characterized by decreased blood pressure, tachycardia, decreased cardiac output, and decreased central venous pressure. Bradycardia is not part of the clinical picture for any form of kidney failure.

The nurse is caring for a client with acute kidney injury (AKI). When performing an assessment, the nurse would expect to note which breathing pattern? A. Apnea B. Kussmaul's respirations C. Decreased respirations D. Cheyne-Stokes respirations

B. Kussmaul's respirations Clinical manifestations associated with AKI occur as a result of metabolic acidosis. The nurse would expect to note Kussmaul's respirations as a result of the metabolic acidosis because the bodily response is to exhale excess carbon dioxide. The breathing patterns noted in options 1, 3, and 4 are not characteristic of AKI.

The nurse has provided instructions to a client with a urinary tract infection regarding foods and fluids to consume that will acidify the urine. Which fluids should the nurse include in the client's teaching plan that will aid in acidifying the urine? Select all that apply. A. Milk B. Prune juice C. Apricot juice D. Cranberry juice E. Carbonated drinks

B. Prune juice C. Apricot juice D. Cranberry juice Acidification of the urine inhibits multiplication of bacteria. Fluids that acidify the urine include prune, apricot, cranberry, and plum juice. Carbonated drinks should be avoided because they increase urine alkalinity. Two glasses of milk a day can make the urine more alkaline, which could aid in the development of kidney stones.

A cystectomy is performed for a client with a diagnosis of bladder cancer, and a Kock pouch is created for urinary diversion. In preparing a discharge teaching plan for the client, the nurse should include which instruction in the plan? A. Dietary restrictions B. Technique of catheterization C. External pouch and application care D. Proper administration of prophylactic antibiotics

B. Technique of catheterization Kock's pouch is a continent internal ileal reservoir. The nurse instructs the client about the technique of catheterization. Dietary restrictions are not required. There is no external pouch. Antibiotics are not required unless an infection is present; also, antibiotics are prescribed by the health care provider.

The nurse is caring for a client just after ureterolithotomy and is monitoring the drainage from the ureteral catheter hourly. Suddenly, the catheter stops draining. The nurse assesses the client and determines that which is the least likely cause of the problem? A. Blood clots B. Ureteral edema C. Chemical sediment D. Catheter displacement

B. Ureteral edema After ureterolithotomy, a ureteral catheter is put in place. Urine flows freely through it for the first 2 to 3 days. As ureteral edema diminishes, urine leaks around the ureteral catheter and drains directly into the bladder. At this point drainage through the ureteral catheter diminishes. Immediately after surgery, absence of drainage usually is caused by blockage from blood clots, mucous shreds, chemical sediment, or catheter displacement.

The registered nurse is instructing a new nursing graduate about hemodialysis. Which statement, if made by the new nursing graduate, would indicate an understanding of the procedure for hemodialysis? Select all that apply. A. "Sterile dialysate must be used." B. "Dialysate contains metabolic waste products." C. "Heparin sodium is administered during dialysis." D. "Dialysis cleanses the blood of accumulated waste products." E. "Warming the dialysate increases the efficiency of diffusion."

C. "Heparin sodium is administered during dialysis." D. "Dialysis cleanses the blood of accumulated waste products." E. "Warming the dialysate increases the efficiency of diffusion." Heparin sodium is used during dialysis, and it inhibits the tendency of blood to clot when it comes in contact with foreign substances. Option 4 is the purpose of dialysis. The dialysate is warmed to approximately 100° F to increase the efficiency of diffusion and to prevent a decrease in the client's blood temperature. Dialysate is made from clear water and chemicals and is free from any metabolic waste products or medications. Bacteria and other microorganisms are too large to pass through the membrane; therefore the dialysate does not need to be sterile.

A nurse instructor is evaluating a nursing student for knowledge regarding care of a client with acute kidney injury. Which statement by the student demonstrates the need for further education about the diuretic phase of acute kidney injury? A. "The increase in urine output indicates the return of some renal function." B. "The diuretic phase develops about 14 days after the initial insult and lasts about 10 days." C. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." D. "The blood urea nitrogen (BUN) and creatinine levels will continue to rise during the first few days of diuresis."

C. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." The diuretic phase of acute kidney injury is characterized by an increase in urine output of more than 1000 mL in a 24 hour period. This increase in urine output indicates the return of some renal function; however, BUN and creatinine levels continue to rise during the first few days of diuresis. The diuretic phase develops about 14 days after the initial insult and lasts about 10 days.

The nurse is planning a teaching session with a client who has chronic kidney disease (CKD) about managing the condition between dialysis treatments. The nurse should plan to include the instruction that weight gain between dialysis treatments should be ideally no more than what value? A. 5 to 6 kg B. 2 to 4 kg C. 1 to 1.5 kg D. 0.5 to 1.0 kg

C. 1 to 1.5 kg Limiting weight gain to 1 to 1.5 kg between dialysis treatments helps prevent the hypotension that occurs with the removal of large volumes of fluid during dialysis. The nurse instructs the client in how to manage daily fluid allotment to assist the client in staying within a low fluid intake range to prevent excess weight gain. Options 1, 2, and 4 are incorrect.

A client with chronic kidney disease (CKD) is about to begin hemodialysis therapy. The client asks the nurse about the frequency and scheduling of hemodialysis treatments. The nurse's response is based on an understanding that which represents the typical schedule? A. 5 hours of treatment 2 days per week B. 2 hours of treatment 6 days per week C. 3 to 4 hours of treatment 3 days per week D. 2 to 3 hours of treatment 5 days per week

C. 3 to 4 hours of treatment 3 days per week The typical schedule for hemodialysis is 3 to 4 hours of treatment 3 days per week. Individual adjustments are made according to variables such as the size of the client, type of dialyzer, rate of blood flow, personal client preferences, and other factors.

A client who is to have a cystectomy with creation of an ileal conduit asks the nurse why the bowel needs to be cleansed before surgery if the bladder is being removed. The nurse would give the best response using which piece of information? A. All clients undergo bowel preparation with major surgery. B. This will decrease the chance of postoperative paralytic ileus. C. A portion of the bowel will be used to create the conduit for urinary diversion. D. This will reduce the chance that the surgeon will nick the bowel during surgery.

C. A portion of the bowel will be used to create the conduit for urinary diversion. The client scheduled for surgical creation of either an ileal conduit or a reservoir undergoes bowel preparation the night before the procedure. Preparation can include intake of copious clear liquids, laxatives, enemas, and antibiotics, depending on health care provider preference. This is done primarily to prevent infection because a loop of bowel will be used to create the urinary diversion.

Which client is most at risk for developing a Candida urinary tract infection (UTI)? A. An obese woman B. A man with diabetes insipidus C. A young woman on antibiotic therapy D. A male paraplegic on intermittent catheterization

C. A young woman on antibiotic therapy Candida infections, which are fungal infections, develop in persons who are on long-term antibiotic therapy because an alteration of normal flora occurs. These infections also are commonly seen in clients with blood dyscrasias, diabetes mellitus, cancer, or immunosuppression and in those with a drug addiction.

The nurse is teaching a client with nephrotic syndrome about managing the disorder. What should the nurse instruct the client to adjust upward or downward according to the amount of edema present? A. Salt intake B. Water intake C. Activity level D. Use of diuretics

C. Activity level The client is taught to adjust the activity level according to the amount of edema. As edema decreases, activity can increase. Correspondingly, as edema increases, the client should increase rest periods and limit activity. Bed rest is recommended during periods of severe edema. The client with nephrotic syndrome usually has a standard limit set on sodium intake. Fluids are not restricted unless the client also is hyponatremic. Diuretics are prescribed on a specific schedule, and doses are not titrated according to the level of edema.

A client who is performing peritoneal dialysis calls the nurse at the renal unit and reports the presence of severe abdominal pain and diarrhea. The client also informs the nurse that the peritoneal dialysis returns are brown-tinged in color. Which would the nurse suspect? A. Infection B. An intact catheter C. Bowel perforation D. Bladder perforation

C. Bowel perforation Complications of a peritoneal catheter include infection, perforation of the bowel or bladder, and bleeding. Brown-tinged returns suggest bowel perforation, which usually is accompanied by severe abdominal pain and diarrhea. Cloudy or opaque returns suggest possible infection. Urine-colored returns suggest possible bladder perforation. Option 2 is unrelated to the information provided in the question.

In performing a physical assessment of a client with chronic kidney disease (CKD), which finding should the nurse anticipate to note? A. Glycosuria B. Polyphagia C. Crackles auscultated in lungs D. Blood pressure 98/58 mm Hg

C. Crackles auscultated in lungs Chronic kidney disease is a condition in which the kidneys have progressive problems in clearing nitrogenous waste products and controlling fluid and electrolyte balance within the body. Cardiovascular symptoms of heart failure and hypertension are caused by the fluid volume overload resulting from the kidney's inability to excrete water. Signs and symptoms of heart failure include jugular venous distention, S3 heart sound, pedal edema, increased weight, shortness of breath, and crackles auscultated in the lungs. The typical signs and symptoms of CKD include proteinuria or hematuria, not glycosuria. The nurse would observe anorexia and nausea in this client, not polyphagia.

A client undergoing hemodialysis begins to experience muscle cramping. What corrective action should the hemodialysis nurse caring for the client take? A. Administer hypotonic saline. B. Increase the ultrafiltration rate. C. Decrease the ultrafiltration rate. D. Administer magnesium sulfate.

C. Decrease the ultrafiltration rate. Muscle cramps during hemodialysis result either from too-rapid removal of water and sodium or neuromuscular hypersensitivity. The nurse corrects this situation by either slowing down the ultrafiltration rate on the hemodialyzer or administering hypertonic or isotonic normal saline. Magnesium sulfate is not prescribed to correct this occurrence.

A client has been diagnosed with polycystic kidney disease. On assessment of the client, the nurse will observe for which as the most common manifestation of this disorder? A. Headache B. Hypotension C. Flank pain and hematuria D. Complaints of low pelvic pain

C. Flank pain and hematuria The most common findings with polycystic kidney disease are hematuria and flank or lumbar pain that is either colicky in nature or dull and aching. Other common findings include proteinuria, calculi, uremia, and palpable kidney masses. Hypertension is another common finding and may be associated with cardiomegaly and heart failure. The client may complain of a headache, but this is not a specific assessment finding in polycystic kidney disease.

A nurse is reviewing the list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse should base the response on knowing that which is the action of the glucose in the solution? A. Decreases the risk of peritonitis B. Prevents disequilibrium syndrome C. Increases osmotic pressure to produce ultrafiltration D. Prevents excess glucose from being removed from the client

C. Increases osmotic pressure to produce ultrafiltration Increasing the glucose concentration makes the solution more hypertonic. The more hypertonic the solution, the higher the osmotic pressure for ultrafiltration and thus the greater the amount of fluid removed from the client during an exchange. The remaining options do not identify the purpose of the glucose.

A nurse is preparing a plan of care for a client with chronic kidney disease and uremia. The nurse is developing interventions to assist in promoting an increased dietary intake while at the same time maintaining necessary dietary restrictions. Which action should the nurse include in the plan of care? A. Increase the amount of protein in the diet. B. Increase the amount of potassium in the daily diet. C. Maintain a diet high in calories with frequent snacks. D. Encourage the client to eat a large breakfast and smaller meals later in the day.

C. Maintain a diet high in calories with frequent snacks. Uremia usually is accompanied by nausea, anorexia, and an unpleasant taste in the mouth. Most clients experience more nausea and vomiting in the morning. Therefore to maintain optimal nutrition, it is best for these clients to eat a diet that is high in calories with frequent snacks and a light breakfast in the morning and larger meals later in the day. Dietary management usually is aimed at restricting protein, sodium, and potassium.

A health care provider writes prescriptions for a client with chronic kidney disease (CKD). Which prescription should the nurse question? A. Insert a saline lock. B. Obtain a daily weight. C. Provide a high-protein diet. D. Administer a calcium supplement with each meal.

C. Provide a high-protein diet. When a client experiences CKD, the blood urea nitrogen (BUN) and serum creatinine levels rise. The client also experiences increased potassium, increased phosphates, and decreased calcium. BUN and creatinine are the by-products of protein metabolism, so monitoring of protein intake is important, with care taken to include proteins of high biological value. Clients with CKD will have protein restricted early in the disease to preserve kidney function. In end-stage disease, protein is restricted according to the client's weight, the type of dialysis, and protein loss. With CKD, the nurse is concerned about fluid volume overload and accumulation of waste products. Because of the kidney's inability to excrete fluid, it is important for the nurse to prevent as well as assess for early signs of fluid volume excess. Infusing an intravenous (IV) solution into a client with CKD significantly increases the risk for overload. If an IV access is needed, it usually involves only a saline lock. Obtaining the client's daily weight is one of the most important assessment tools for evaluating changes in fluid volume. The kidneys also are responsible for removing waste products. The client also receives phosphate binders, calcium supplements, and vitamin D to prevent bone demineralization (osteodystrophy) from chronically elevated phosphate levels.

A client is scheduled for surgical creation of an internal arteriovenous (AV) fistula on the following day. The client says to the nurse, "I'll be so happy when the fistula is made tomorrow. This means I can have that other hemodialysis catheter pulled right out." Which interpretation should the nurse make based on the client's statement? A. The client has an accurate understanding of the procedure and aftercare. B. The client does not realize how painful removal of the dialysis catheter will be. C. The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use. D. The client is not aware that the alternative access site is left in place prophylactically for 2 months.

C. The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use. An AV fistula is the internal creation of an arterial-to-venous anastomosis. This causes engorgement of the vein, allowing both the artery and the vein to be easily cannulated for hemodialysis. Fistulas take 1 to 2 weeks to mature (engorgement) or develop before they can be used for dialysis, so the current method of access must remain in place to be used during that time period.

The nurse has administered a dose of meperidine hydrochloride (Demerol), 100 mg, to a client with renal colic as treatment for pain. The nurse carefully monitors this client for which side effect of this medication? A. Bradycardia B. Hypertension C. Urinary retention D. Increased respirations

C. Urinary retention Meperidine hydrochloride is an opioid analgesic. Side effects of meperidine hydrochloride include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

An ambulatory care nurse is providing instructions to a client after a cystoscopy. Which statement by the client indicates a need for further instruction? A. "I should increase my fluid intake." B. "I can apply heat to my lower abdomen." C. "I may have some burning on urination for the next few days." D. "If I notice any pink-tinged urine, I should contact the health care provider."

D. "If I notice any pink-tinged urine, I should contact the health care provider." The client is instructed that pink-tinged urine and burning on urination are expected for 1 to 2 days after the procedure. Increased fluid intake is encouraged. Application of heat to the lower abdomen, administration of mild analgesics, and the use of sitz baths may relieve discomfort. The client also is advised to avoid alcoholic beverages for 2 days after the test.

The nurse is giving general instructions to a client receiving hemodialysis. Which statement would be most appropriate for the nurse to include? A. "It is acceptable to eat whatever you want on the day before hemodialysis." B. "It is acceptable to exceed the fluid restriction on the day before hemodialysis." C. "Medications should be double-dosed on the morning of hemodialysis because of potential loss." D. "Several types of medications should be withheld on the day of dialysis until after the procedure."

D. "Several types of medications should be withheld on the day of dialysis until after the procedure." Many medications are dialyzable, which means that they are extracted from the bloodstream during dialysis. Therefore many medications may be withheld on the day of dialysis until after the procedure. It is not typical for medications to be double-dosed, because there is no way to be certain how much of each medication is cleared by dialysis. Clients receiving hemodialysis are not routinely taught that it is acceptable to disregard dietary and fluid restrictions.

A client with chronic kidney disease (CKD) has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now presents with mental cloudiness, dementia, and complaints of bone pain. The nurse determines that these assessment data are compatible with which condition? A. Advancing uremia B. Phosphate overdose C. Folic acid deficiency D. Aluminum intoxication

D. Aluminum intoxication Aluminum intoxication can occur when there is accumulation of aluminum, an ingredient in many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. It can be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body. It can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum. The data in the question are not specifically associated with the other conditions noted in the options.

A client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. Which intervention is the priority nursing action? A. Check the shunt for the presence of bruit and thrill. B. Observe the site once as time permits during the shift. C. Check the results of the prothrombin time as they are determined. D. Ensure that small clamps are attached to the arteriovenous shunt dressing.

D. Ensure that small clamps are attached to the arteriovenous shunt dressing. An external arteriovenous shunt is a less common form of access site but carries a risk for bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also should be assessed at least every 4 hours. Check the shunt for the presence of bruit and thrill relates to patency of the shunt. Although checking the results of the prothrombin time is important, it is not the priority nursing action.

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? A. Hypertension, tachycardia, and fever B. Hypotension, bradycardia, and hypothermia C. Restlessness, irritability, and generalized weakness D. Headache, deteriorating level of consciousness, and twitching

D. Headache, deteriorating level of consciousness, and twitching Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

The nurse is monitoring the fluid balance of an assigned client. The nurse determines that the client has proper fluid balance if which 24-hour intake and output totals are noted? A. Intake 1500 mL, output 800 mL B. Intake 3000 mL, output 2000 mL C. Intake 2400 mL, output 2900 mL D. Intake 1800 mL, output 1750 mL

D. Intake 1800 mL, output 1750 mL For the client taking a normal diet, the normal fluid intake is approximately 1200 to 1800 mL of measurable fluids per day. The client's output in the same period should be about the same and does not include insensible losses, which are extra. Insensible losses are offset by the fluid in solid foods, which also is not measured.

A client with an arteriovenous fistula in the left arm and who is undergoing hemodialysis is at risk for infection. Which should the nurse formulate as the best outcome goal for this client problem? A. The client washes hands at least once per day. B. The client's temperature remains lower than 101° F. C. The client avoids blood pressure (BP) measurement in the left arm. D. The client's white blood cell (WBC) count remains within normal limits.

D. The client's white blood cell (WBC) count remains within normal limits. General indicators that the client is not experiencing infection include a temperature and WBC count within normal limits. The client also should use proper hand washing technique as a general preventive measure. Hand washing once per day is insufficient. It is true that the client should avoid BP measurement in the affected arm; however, this would relate more closely to the problem of risk for injury.

The spouse of a client with acute kidney injury secondary to heart failure asks the nurse how a heart problem can affect the kidneys. The nurse should base a response using what fact about the kidneys? A. The kidneys get fatigued from having to filter too much fluid. B. The kidneys can react adversely to moderate doses of furosemide (Lasix). C. The kidneys will shut down easily if serum levels of digoxin (Lanoxin) are high. D. The kidneys generally require and receive about 20% to 25% of the resting cardiac output.

D. The kidneys generally require and receive about 20% to 25% of the resting cardiac output. Heart failure is referred to as a prerenal cause of acute kidney injury because heart failure results in decreased blood flow to the kidneys. The kidneys normally receive about 20% to 25% of the cardiac output and require adequate perfusion to function properly. With a significant or prolonged decrease in blood supply, the kidneys can fail. Options 1 and 3 are incorrect. As for option 2, large doses of furosemide resulting in severe dehydration may lead to decreased kidney perfusion, but moderate doses of furosemide do not cause prerenal acute kidney injury, and furosemide may be used to treat acute kidney injury.

A client with renal cancer is to undergo preoperative renal artery embolization. What should the nurse tell the client regarding the primary benefit of this procedure? A. This will reduce the time needed for surgery by at least half because it provides hemostasis. B. This will cause the tumor to become tougher and easier to resect in surgery with the scalpel. C. This will prevent the risk of pulmonary embolism by occluding the renal artery and its branches. D. This will decrease the size of the tumor because its blood supply will be removed after placement of an absorbable gelatin sponge.

D. This will decrease the size of the tumor because its blood supply will be removed after placement of an absorbable gelatin sponge. Renal artery embolization may be done instead of radiation therapy to shrink the kidney tumor by cutting off its blood supply and impairing its overall vascularity. A secondary benefit is that it reduces the risk of hemorrhage during surgery. This procedure can be accomplished in a number of ways, including placement of an absorbable gelatin sponge (Gelfoam), a balloon, a metal coil, or any of various other substances.