Nurse 225: Ch. 30

A nurse is caring for a client with postrenal acute kidney injury. The nurse is caring for which client? Aclient with blood loss A client with hypovolemia A client with an obstruction A client with nephron damage

A client with an obstruction -Postrenal failure is due to urinary tract obstruction. Nephron damage is characteristic of intrarenal failure. Prerenal failure is usually caused by hypoperfusion of the kidney owing to decreased systemic blood volume (hypovolemia), usually from blood loss.

Which clients have increased serum calcium and therefore an increased risk of renal stone formation? Select all that apply. A client with acidic urine A client with hypocalcemia A client with hyperparathyroidism A client with prolonged immobilization A client with increased intestinal absorption of calcium

A client with hyperparathyroidism, A client with prolonged immobilization, A client with increased intestinal absorption of calcium -Hyperparathyroidism and increased intestinal absorption of calcium increase serum calcium levels, and immobilization causes bone demineralization, increasing serum levels and increasing the risk of renal stone formation. Alkaline urine, not acidic, is associated with calcium stones. Hypocalcemia is decreased calcium; increased calcium is associated with increased risk of renal stones.

Which client is most at risk for developing chronic kidney disease? A client with myocarditis A client with hypertension A client with pernicious anemia A client with chronic obstructive pulmonary disease

A client with hypertension -Hypertension is a major cause of chronic kidney disease, because organs can be damaged without obvious signs and symptoms. Myocarditis, pernicious anemia, and chronic obstructive pulmonary disease do not cause chronic kidney disease.

Which male client is most predisposed to an obstruction of the lower urinary tract? A client with pelvic organ prolapse A client with prostate enlargement A client with urinary tract infection A client with congenital stricture of a calyx

A client with prostate enlargement -Anatomic causes of resistance to urine flow include urethral stricture, prostatic enlargement in men, and pelvic organ prolapse in women. A urinary tract infection does not lead to an obstruction of the lower urinary tract; however, a urinary tract obstruction can lead to a urinary tract infection. A congenital stricture of a calyx could lead to upper urinary tract obstruction, not lower.

Which information indicates the nurse needs more instruction about the classifications of acute kidney injury? A type of classification is prerenal acute kidney injury. A type of classification is postrenal acute kidney injury. A type of classification is intrarenal acute kidney injury. A type of classification is ultrarenal acute kidney injury

A type of classification is ultrarenal acute kidney injury -The nurse needs more instruction because ultrarenal is not a classification. Acute kidney injury is classified as prerenal, intrarenal, or postrenal, depending on the cause of the injury.

While planning care for a client in chronic renal failure, what should the nurse consider about the client's calcium level? Calcium will be abnormally high due to acidosis. Calcium will be abnormally low in the blood serum. Calcium will be abnormally high in the blood serum. Calcium will be absorbed in larger amounts from the gastrointestinal tract.

Calcium will be abnormally low in the blood serum. -Low serum calcium results from decreased absorption from the gastrointestinal tract. Hypocalcemia develops in chronic renal failure, not high levels. Acidosis also contributes to a negative calcium balance.

A nurse is teaching about the possible causes of acute kidney injury. Which information should the nurse include? Select all that apply. Correct1 Cardiac failure Correct2 Neurogenic bladder Correct3 Renal artery occlusion Correct4 Childbirth complications 5 Chronic glomerulonephritis

Cardiac failure, Neurogenic bladder, Renal artery occlusion, Childbirth complications -Cardiac failure, neurogenic bladder, renal artery occlusion, and childbirth complications are possible causes of acute kidney injury. Chronic glomerulonephritis is most often associated with chronic kidney disease.

A nurse is teaching an adult community group about the predisposing factors associated with pyelonephritis. Which factors should the nurse include? Select all that apply. Pregnancy Viral infection Catheterization Neurogenic bladder Urinary obstruction

Catheterization, Neurogenic bladder, Urinary obstruction, Pregnancy -Predisposing factors of pyelonephritis include urinary obstruction, neurogenic bladder, instrumentation (e.g., catheterization), and pregnancy. Viral infection is not known to be a predisposing factor of pyelonephritis; bacterial infections can be a common cause.

Which information from the client indicates teaching by the nurse was successful for identifying one major modifiable risk factor for bladder cancer? Age Race Gender Cigarette smoking

Cigarette smoking -Smoking is a modifiable risk factor. The risk of primary bladder cancer is greater among people who smoke or are exposed to metabolites of aniline dyes or other aromatic amines. Age, race, and gender are nonmodifiable risk factors.

A nurse is assessing a client with acute kidney injury. Which assessment findings are characteristic of this condition? Select all that apply. Paresthesia Crystals in the urine Increased serum calcium Decreased glomerular filtration Accumulation of nitrogenous waste products in the blood

Decreased glomerular filtration, Accumulation of nitrogenous waste products in the blood -Acute kidney injury is a sudden decline in kidney function, with a decrease in glomerular filtration and accumulation of nitrogenous waste products in the blood, as demonstrated by an elevation in plasma creatinine and blood urea nitrogen (BUN) levels. Increased serum calcium is not characteristic of acute kidney injury; increased creatinine and BUN are. Crystals in the urine are not characteristic of acute kidney injury. Paresthesia is not characteristic of renal failure; increased creatinine and BUN are.

A nurse monitors a client with end-stage chronic renal disease for anemia. What is the best rationale for the nurse's action? Chronic loss of blood in the urine Increased secretion of aldosterone Poor appetite with lack of iron intake Decreased secretion of erythropoietin

Decreased secretion of erythropoietin -Inadequate production of erythropoietin decreases red blood cell production, and uremia decreases red blood cell life span. As a result, anemia develops. Hematuria is not a characteristic of end-stage chronic renal disease. Aldosterone levels do not contribute to anemia. Iron deficiency does not cause the anemia in end-stage chronic renal disease. Poor appetite and lack of iron intake may occur in this client, but they are not the best reason for the nurse's action.

A client missed two dialysis sessions. Which assessment findings will the nurse most likely observe when the client attends the next dialysis session? Select all that apply. Sallow skin color from retained urochrome Possible cardiac dysrhythmias due to hyperkalemia Positive Chvostek and Trousseau signs due to hypomagnesemia Deep rapid breathing due to a compensatory mechanism for metabolic acidosis Fatigue due to progressive accumulation of uremic toxins and low red blood cells

Deep rapid breathing due to a compensatory mechanism for metabolic acidosis, Fatigue due to progressive accumulation of uremic toxins and low red blood cells, Sallow skin color from retained urochrome, Possible cardiac dysrhythmias due to hyperkalemia -A person who needs dialysis and has missed two sessions will have fatigue due to progressive accumulation of uremic toxins and low red blood cells. Deep rapid breathing occurs due to a compensatory mechanism for metabolic acidosis. Possible cardiac dysrhythmias may occur due to hyperkalemia. Sallow skin color results from retained urochrome. Positive Chvostek and Trousseau signs are due to calcium, not magnesium.

A client has end-stage chronic renal disease. The nurse monitors the client for renal osteodystrophy and spontaneous bone fractures. What is the rationale for the nurse's actions? Erythropoietin secretion is impaired. Deficiency of active vitamin D occurs. Urea causes demineralization of bone. Excess potassium leaches calcium from bone.

Deficiency of active vitamin D occurs. -Vitamin D, required for calcium absorption in the digestive tract, is activated in the kidneys. With chronic renal failure, vitamin D is not activated and calcium is not deposited in the bones. Erythropoietin does not influence bone mineralization; it affects red blood cells. Urea does not cause renal osteodystrophy; it causes azotemia. Hyperkalemia does not influence bone mineralization but does affect cardiac functioning.

What pathophysiologic changes does the nurse expect in a client that has upper urinary tract obstruction within 7 days? Select all that apply. Increased urinary stasis Tubulointerstitial fibrosis Reduced size of the medulla Increased metabolic acidosis Dilation of the upper urinary tract

Dilation of the upper urinary tract, Tubulointerstitial fibrosis, Increased urinary stasis -If an upper urinary tract obstruction is not resolved within 7 days, increased urinary stasis, tubulointerstitial fibrosis, and dilation of the upper urinary tract occur. If the obstruction has still not been resolved after 28 days, the medulla decreases in size and metabolic acidosis occurs

A nurse is caring for a client with cystitis and a client with pyelonephritis. Which assessment finding will be typical of both clients? Dysuria Fever and chills Suprapubic pain Costovertebral angle tenderness

Dysuria -Dysuria, or painful urination, is present with both disorders. Fever and chills do not usually occur with cystitis. Costovertebral angle tenderness occurs only with pyelonephritis, because the kidneys are located at the costovertebral angle. Suprapubic pain occurs only with cystitis, because the bladder is located just behind the pubic bone.

A client with chronic kidney disease has anemia. While planning care, the nurse should consider whether there is a deficiency of which hormone? Aldosterone Angiotensin I Parathyroid Erythropoietin

Erythropoietin -Erythropoietin is responsible for stimulating marrow to make red blood cells. In chronic kidney disease, there are insufficient quantities of this substance. Aldosterone is not involved in red blood cell production but rather regulates the balance of salt and water in the body. Angiotensin I is not involved in red blood cell production but rather in the regulation of blood volume and systemic vascular resistance. Parathyroid hormone is not involved in red blood cell production but rather in the control of blood and bone calcium.

Which term should the nurse use to describe the consequence of an upper urinary tract obstruction in one of a client's ureters? Anuria Hydronephrosis Dilation of the urethra Kidney stone formation

Hydronephrosis -Dilation of the urinary tract occurs proximal to the obstruction. In this case, the proximal ureter and renal pelvis would enlarge, causing hydronephrosis. Urine production will continue to occur if one ureter is blocked, so anuria would not occur. Dilation of the urinary tract occurs proximal to the obstruction, so the urethra would not be dilated. Kidney stones are causes, rather than consequences, of an upper urinary tract obstruction.

A client is in end-stage chronic renal disease. Which life-threatening assessment finding will cause the nurse to notify the primary healthcare provider immediately? Azotemia Hypertension Hyperkalemia Increased creatinine

Hyperkalemia - With the onset of oliguria, total body potassium can increase to life-threatening levels and must be controlled by dialysis. Although azotemia, hypertension, and increased creatinine are consequences of end-stage chronic renal disease, they usually are not acutely life-threatening like potassium.

A client has renal colic originating from the proximal ureters. What type of pain will the nurse find upon assessment? In the flank and radiates to the groin In the back and radiates retroperitoneally In the abdomen and radiates to the chest In the right side and radiates to the left side

In the flank and radiates to the groin -Renal colic, described as moderate to severe pain, often originating in the flank and radiating to the groin, usually indicates obstruction of the renal pelvis or proximal ureter. Pain in the abdomen that radiates to the bladder, as well as pain in the back that radiates retroperitoneally, usually indicates lower urinary tract symptoms. Colic pain does not move from the right to the left side or to the chest.

A client has end-stage chronic renal disease. Which laboratory result will the nurse expect to see on the chart? Metabolic alkalosis Decreased serum sodium Increased serum creatinine Decreased blood urea nitrogen

Increased serum creatinine -End-stage chronic renal disease causes increased serum creatinine and blood urea nitrogen because the dysfunctional kidneys are not able to excrete these metabolic waste products. Metabolic acidosis, not alkalosis, is common with end-stage chronic renal disease. Hyponatremia can occur in the early stages, but ultimately the kidney loses its ability to regulate sodium and water balance. Both sodium and water are retained, leading to an increase in serum sodium. Chronic renal failure causes increased blood urea nitrogen.

A client has renal stones. While planning care for this client, the nurse should remember which most common physiologic abnormality for hypercalciuria? Decreased oxalate in the diet Excretion of excessive uric acid Intestinal hyperabsorption of dietary calcium Hypoparathyroidism with prolonged immobility

Intestinal hyperabsorption of dietary calcium -Hypercalciuria is usually attributable to intestinal hyperabsorption of dietary calcium. Hyperparathyroidism, not hypoparathyroidism, and bone demineralization associated with prolonged immobilization are also known to cause hypercalciuria. Although oxalate in the diet influences the risk of calcium stones, primary hyperoxaluria is a rare, inherited disorder. Uric acid stones, not calcium stones, occur in persons who excrete excessive uric acid in the urine.

A client has chronic kidney failure and develops Kussmaul respirations. The nurse suspects the client is experiencing which condition? Anemia Dehydration Metabolic acidosis Chronic hyperlipidemia

Metabolic acidosis -Pulmonary edema and metabolic acidosis can cause Kussmaul respirations. Fluid overload (not dehydration), leading to pulmonary edema, causes Kussmaul respirations. Anemia does not cause Kussmaul respirations but does result from chronic kidney failure due to reduced erythropoietin secretion. Chronic hyperlipidemia may contribute to chronic renal disease, but it does not cause Kussmaul respirations.

A client has just developed acute kidney injury. Which assessment finding is common in the early stages? Oliguria Diuresis Hematuria Proteinuria

Oliguria -Oliguria begins within 1 day after a hypotensive event and lasts 1 to 3 weeks, but it may regress in several hours or extend for several weeks, depending on the duration of ischemia or the severity of injury or obstruction. Diuresis occurs in later stages of healing. Hematuria can occur with glomerulonephritis. Proteinuria occurs with nephrotic syndrome.

A nurse is teaching about a common cause of prerenal acute kidney injury. Which information should the nurse include in the teaching session? One cause is prostatic hypertrophy. One cause is neurogenic bladder. One cause is an allograft rejection. One cause is inadequate cardiac output.

One cause is inadequate cardiac output. -Poor perfusion can result from renal vasoconstriction, hypotension, hypovolemia, hemorrhage, or inadequate cardiac output. A decreased cardiac output causes decreased renal perfusion and decreased glomerular filtration rate. An allograft rejection may cause intrarenal acute kidney injury, whereas neurogenic bladder and prostatic hypertrophy may cause postrenal acute kidney injury.

A client who reports abdominal and flank pain has been diagnosed with bacteria in the urine. What is the appropriate term for involvement of the upper urinary tract that is likely to cause such symptoms? Cystitis Pyelonephritis Bladder tumor Nephrotic syndrome

Pyelonephritis -Pyelonephritis indicates involvement of the upper tracts. Cystitis is inflammation of the bladder. Nephrotic syndrome is the excretion of 3.5 g or more of protein in the urine per day and is characteristic of glomerular injury. Gross painless hematuria is the archetypal clinical manifestation of bladder cancer, not bacterial infection.

A client has a locally invasive malignant bladder tumor. Which treatment options should the nurse consider while planning care for this client? Select all that apply. Endoscopy Nephrectomy Radical cystectomy Adjuvant chemotherapy Transurethral resection

Radical cystectomy, Adjuvant chemotherapy -Radical cystectomy with urinary diversion and adjuvant chemotherapy is required for locally invasive tumors. Endoscopy is a diagnostic procedure (or a component of treatment in endoscopic surgery); it is not a treatment by itself. Nephrectomy is the removal of a kidney and is not indicated for bladder tumors. Transurethral resection or laser ablation, combined with intravesical chemotherapy or immunotherapy, is effective for superficial tumors.

The nurse is caring for a client experiencing acute kidney injury (AKI). The chart notes that the client's urine output is increasing significantly and that the serum creatinine level has decreased and normalized. The client is in which phase of AKI? Recovery Initiation Remediation Maintenance

Recovery -The recovery phase is the interval when kidney injury is repaired and normal renal function is reestablished. Diuresis (output is increasing significantly) is common during this phase, with a decline in serum creatinine and urea concentrations and an increase in creatinine clearance. Initiation is the time that the kidney injury is evolving. Maintenance occurs once the damaging incident is over and may last several weeks to months. During maintenance the urine output is the lowest and serum creatinine and blood urea nitrogen levels both increase. There is no remediation phase.

A nurse is teaching an adult class about the major risk factor for developing bladder cancer. Which information should the nurse include? Smoking Bacteriuria Urethral obstruction Exposure to coal dust

Smoking -The risk of primary bladder cancer is greater among people who smoke or are exposed to metabolites of aniline dyes or other aromatic amines. Bacteriuria and urethral obstruction are not major risk factors for developing bladder cancer. Exposure to coal dust is not a major risk factor for developing bladder cancer; coal dust can lead to respiratory problems.

A client has a hydroureter. How should the nurse interpret this finding? The client has excessive urine flow through one of the ureters. The client has dilation of one of the ureters due to obstruction and urine backup. The client has a congenital defect where one ureter is larger than the other. The client has a structural anomaly where all urine is diverted through only one ureter.

The client has dilation of one of the ureters due to obstruction and urine backup. -Dilation of the ureter is referred to as hydroureter (accumulation of urine in the ureter) from an obstruction in the upper urinary tract. A hydroureter does not cause excessive urine flow but a backup of urine. A hydroureter is not a congenital defect but occurs from an obstruction. A hydroureter does not cause urine to be diverted through only one ureter but causes a backup of urine and dilation.

A client has acute tubular necrosis. A coworker says, "I've been taking care of this client for over 2 weeks. After my days off, I come back and find that the client has mild diuresis. I'm really worried by this change, but no one else is. What's going on?" How should the nurse respond? It's good you noticed this change. It could be something serious that was not caught while you were away. You had better measure the blood sugar. The client may have developed diabetes, and what you see may be osmotic diuresis from glucose in the urine. Given that the client was oliguric for so long, this is probably rebound polyuria. As long as the blood pressure is stable and there is no hypovolemia, you should not worry. The renal tubules are recovering, so the client is making more urine, but the kidney is not able to concentrate urine well because it is not fully recovered.

The renal tubules are recovering, so the client is making more urine, but the kidney is not able to concentrate urine well because it is not fully recovered. -The coworker should have recognized the diuretic phase of acute tubular necrosis. The diuresis is part of acute tubular necrosis and is not a problem in itself; it is not an osmotic diuresis such as occurs in diabetes mellitus. The client does not have rebound polyuria

A client was severely injured in a motor vehicle accident and lost a lot of blood. When the emergency personnel extracted the client from the wreckage, the blood pressure was 40/undetectable. Now the client is in the hospital with acute kidney injury as well as multiple broken bones and lacerations. "What is this 'prerenal' business that I keep hearing about?" says the client's spouse. What is the nurse's best response? Acute kidney injury is a new term for what people used to call acute renal failure. This injury did not start in the kidney itself, but rather in the blood flow to the kidney. The kidney injury is only the beginning of the problems that are expected, so the staff is being vigilant. The primary healthcare providers are not sure what caused the acute kidney injury, but they are working toward a complete recovery.

This injury did not start in the kidney itself, but rather in the blood flow to the kidney. -The problem that triggers prerenal acute kidney injury occurs before the blood circulates to the kidney. Hypovolemia is a common cause of prerenal acute kidney injury. Acute kidney injury is a new term for what people used to call acute renal failure, but this does not answer the question. The staff's efforts with regard to the prerenal kidney injury are not driven by foreboding of worsening health. The staff is aware of what caused the kidney injury; it was caused by the hypoperfusion.

A nurse is planning management goals for a client with acute kidney injury. Which goals should the nurse include? Select all that apply. Treating infections Maintaining nutrition Correcting fluid disturbances Monitoring the kidney transplant Remembering that drug excretion is impaired

Treating infections, Maintaining nutrition, Correcting fluid disturbances, Remembering that drug excretion is impaired -The four main management principles of acute kidney injury are correcting fluid and electrolyte disturbances, treating infections, maintaining nutrition, and remembering that excretion of drugs or their metabolites is impaired. Kidney transplant is used in the management of chronic kidney disease.

History -Myocardial infarction 4 years previously -two episodes of kidney stones in past 2 years -nephrotic syndrome in childhood Health Habits -walks 2 miles daily -eats oatmeal and orange juice for breakfast -refuses to eat green leafy or orange vegetables Physical Examination -vital signs within normal limits -old appendectomy scar on abdomen -dry skin on the face and hand but not elsewhere A nurse is assessing a client at an annual examination. Which assessment finding does the nurse recognize as a reason to teach the client to drink enough water every day to produce dilute urine? Eats oatmeal and orange juice for breakfast Two episodes of kidney stones in past 2 years Refuses to eat green leafy or orange vegetables Dry skin on the face and hands but not elsewhere

Two episodes of kidney stones in past 2 years -Reducing the concentration of stone-forming substances by increasing urine flow rate with high fluid intake is an important measure for kidney stones. Eating oatmeal and orange juice for breakfast is a useful health habit that does not require increased water intake. Increasing water intake will not compensate for not eating vegetables. Dry skin on the face and hands but not elsewhere may reflect weather exposure during walking and does not require increased water intake.

Which term should the nurse use to describe the accumulation of nitrogenous wastes in a client with chronic kidney disease? Uremia Anuria Oliguria Hematuria

Uremia -Uremia and azotemia are terms for the accumulation of nitrogenous wastes. Anuria is the absence of urine. Oliguria is insufficient urine output (30 ml/hour or less). Hematuria is blood in the urine.

Phys Exam -Uremic skin residue -Pruritus -Pallor skin tone Lab Results -Blood urea nitrogen and creatinine increased -arterial blood pH decreased -serum potassium increased Intake and Output -Oral Intake: 1000 ml -Sodium- restricted diet -Urine: 50 ml in 24 hrs -A nurse is caring for a client who has end-stage kidney disease and needs dialysis. Which assessment finding does the nurse recognize as indicative of frost? Pallor skin tone Uremic skin residues Serum potassium increased Arterial blood pH decreased

Uremic skin residues -Hyperparathyroidism and uremic skin residues (known as uremic frost) are associated with inflammation, irritation, and pruritus, with scratching, excoriation, and increased risk for infection. Increased serum potassium is hyperkalemia, not frost. Arterial blood pH decrease is metabolic acidosis, not frost. Pallor skin tone is associated with anemia, not frost.

A nurse is assessing a client with acute cystitis. Which assessment findings are typical for this client? Select all that apply. Dysuria Colic pain Urinary stones Urinary urgency Urinary frequency Pain in the suprapubic area

Urinary urgency, Urinary frequency, Pain in the suprapubic area, Dysuria -Most clients with acute cystitis experience dysuria, urinary frequency and urgency, and pain in the suprapubic area or lower back, or both. Colic pain usually occurs with urinary stones, not with acute cystitis. Stones are not typical of acute cystitis.

A client has urinary calculi. While planning care, the nurse considers which most important factor in the formation of renal calculi? Urine pH Urine sodium levels Serum lactate levels Temperature of the urine

Urine pH -The temperature and pH of the urine influence the risk of precipitation and calculus formation, and pH is most important. Urine sodium levels and serum lactate levels do not have a major influence on formation of renal calculi.