Prectice Questions NDEE RENAL ADAPTIVE QUESTIONS N3
The nurse is providing care to a client who has a suspected pelvic fracture as the result of a motor vehicle accident. Which is the priority nursing action? 1-Logrolling for transfers 2-Inspecting the genitalia 3-Preparing for a pelvic examination 4-Administering prescribed pain medication
2-Inspecting the genitalia The priority nursing action for this client is to inspect the genitalia for bleeding and obvious injury. The logrolling technique does not need to be implemented when transferring this client
A client has glomerulonephritis. To prevent future attacks of glomerulonephritis, the nurse planning discharge teaching includes which instruction? 1-"Restrict fluid intake." 2-"Take showers instead of bubble baths." 3-"Avoid situations that involve physical activity." 4-"Seek early treatment for respiratory infections."
4-"Seek early treatment for respiratory infections."
The nurse observes a client with kidney failure has increased rate and depth of breathing. Which laboratory parameter does the nurse suspect is associated with this client's condition? 1-Potassium 8 mEq/L 2-Hemoglobin 10 g/dL 3-Phosphorous 7 mg/dL 4-Bicarbonate 15 mEq/
4-Bicarbonate 15 mEq/
A client with chronic kidney disease is receiving ferrous sulfate (Feosol). The nurse should monitor the client for which common side effect associated with this medication? Diarrhea. Weakness. Headache. Constipation
Constipation
A client newly diagnosed with chronic kidney disease has recently begun hemodialysis. Which are signs/symptoms of disequilibrium syndrome? Hypertension, tachycardia, and fever. Hypotension, bradycardia, and hypothermia. Restlessness, irritability, and generalized weakness. Headache, deteriorating level of consciousness, and twitching.
Headache, deteriorating level of consciousness, and twitching. Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea and vomiting, twitching, and possible seizure activity.
A client with chronic kidney disease is on a restricted protein diet and is taught about high-biologic-value protein foods. An understanding of the rationale for this diet is demonstrated when the client states that high-biologic-value protein foods are: Needed to promote weight gain. Necessary to prevent muscle wasting. Used to increase urea blood products. Responsible for controlling hypertension.
Necessary to prevent muscle wasting. High-biologic-value (HBV) protein contains essential amino acids needed by the body for tissue building and repair; HBV proteins limit the extent of nitrogenous wastes.
The urinary output of a 9-year-old child with acute glomerulonephritis decreases to 250 mL/24 hr. A diet low in sodium and potassium is prescribed. What should the nurse encourage the child to have for lunch? 1-Baked chicken, green beans, and lemonade 2-Cream of tomato soup, salami sandwich, and cola 3-Grilled cheese sandwich, sliced tomatoes, and milk 4-Peanut butter and jelly sandwich, celery, and orangeade
1-Baked chicken, green beans, and lemonade
When receiving hemodialysis, the client may develop hyponatremia. For which clinical findings associated with hyponatremia should the nurse assess the client? Select all that apply. 1-Diarrhea 2-Seizures 3-Chvostek sign 4-Cardiac dysrhythmias 5-Increased temperature
1-Diarrhea 2-Seizures
A 5-year-old child is brought into the clinic with lethargy, abdominal ascites, and peripheral and periorbital edema. The history indicates ongoing diarrhea and decreased urine output. The child is found to have nephrotic syndrome and started on corticosteroid therapy. What does the nurse inform the parents that they can expect the child to exhibit after a week or two of medication therapy? 1-Diuresis 2-Formed stools 3-No signs of infection 4-Enhanced physical growth
1-Diuresis
A child is admitted with a diagnosis of acute poststreptococcal glomerulonephritis. While performing a physical assessment and reviewing the child's laboratory reports, what clinical findings does the nurse expect? Select all that apply. 1-Hematuria 2-Proteinuria 3-Periorbital edema 4-Increased specific gravity 5-Mildly elevated blood pressure
1-Hematuria 2-Proteinuria 3-Periorbital edema 4-Increased specific gravity 5-Mildly elevated blood pressure
What should a nurse include in the plan of care for a 9-year-old child with nephrotic syndrome? 1-Providing meticulous skin care 2-Restricting fluids to 4 oz (120 mL) each shift 3-Offering a diet low in carbohydrates and protein 4-Sending blood to the laboratory for typing and crossmatching
1-Providing meticulous skin care Massive edema, typical of nephrotic syndrome, predisposes the child to skin breakdown.
A school-aged child is admitted to the pediatric unit with hypertensive acute glomerulonephritis. In addition to hydralazine, what medication does the nurse anticipate will be prescribed initially? 1-Digoxin 2-Furosemide 3-Alprazolam 4-Phenytoin
2-Furosemide Furosemide is a loop diuretic that is recommended for the treatment of acute glomerulonephritis; it promotes the excretion of fluid and thus limits fluid retention. Digoxin is not used because there is no cardiac involvement.
A client receiving hemodialysis has an external shunt for circulatory access. With which life-threatening complication associated with external cannulas should the nurse be most concerned? 1-Infection 2-Hemorrhage 3-Skin breakdown 4-Impaired circulation
2-Hemorrhage
What is an acute, life-threatening complication for which a nurse should assess a client in the early postoperative period after a radical nephrectomy? 1-Sepsis 2-Hemorrhage 3-Renal failure 4-Paralytic ileus
2-Hemorrhage
A nurse is caring for a client receiving hemodialysis for chronic kidney disease. The nurse should monitor the client for which complication? 1-Peritonitis 2-Hepatitis B 3-Renal calculi 4-Bladder infection
2-Hepatitis B Hepatitis type B [1] [2] is transmitted by blood or blood products. The hemodialysis and routine transfusions needed for a client in end-stage renal failure constitute a high risk for exposure.
Monitoring vital signs, particularly the blood pressure and the rate and quality of the pulse, is essential in detecting physiologic adaptations in a preschool child with nephrotic syndrome. Which clinical manifestation should the nurse be able to detect from these vital signs? 1-Heart failure 2-Hypovolemia 3-Pulmonary embolus 4-Increased serum potassium
2-Hypovolemia
The nurse is providing postoperative care to a kidney transplant recipient. What is the nurse's first priority during this period? 1-Teaching signs of rejection to the client 2-Maintaining fluid and electrolyte balance 3-Providing emotional support to the recipient 4-Advising the client to have frequent blood testing
2-Maintaining fluid and electrolyte balance
A client develops acute glomerulonephritis after a recent streptococcal infection. The nurse should expect to find which clinical manifestation during the health history and physical examination? 1-Nocturia 2-Periorbital edema 3-Increased appetite 4-Recent weight loss
2-Periorbital edema
A client in end-stage kidney disease is receiving peritoneal dialysis. What should the nurse do when caring for this client? 1-Maintain the client in the supine position during the entire procedure. 2-Position the client from side to side if fluid is not draining adequately. 3-Remove the cannula at the end of the procedure, applying a dry, sterile dressing. 4-Notify the primary healthcare provider if there is a deficit of 100 mL in the drainage return
2-Position the client from side to side if fluid is not draining adequately.
A nurse is caring for a client with chronic kidney failure. What should the nurse teach the client to limit the intake of to help control uremia associated with end-stage renal disease (ESRD)? 1-Fluid 2-Protein 3-Sodium 4-Potassium
2-Protein
A healthcare team is caring for a client who underwent kidney transplantation. Which task is most suitable to be delegated to a licensed practical nurse (LPN) to provide effective client care? Select all that apply. 1-Emptying urinary drainage bag 2-Recording vital signs 3-Assessing of urine output 4-Placing the urinary catheter 5-Administering intravenous fluids
2-Recording vital signs 4-Placing the urinary catheter
A nurse is caring for a client who had a kidney transplant. Which test is most important for the nurse to monitor to determine whether a client's newly transplanted kidney is working effectively? 1-Renal scan 2-Serum creatinine 3-24-hour urine output 4-White blood cell (WBC) count
2-Serum creatinine
A client who has been on hemodialysis for several weeks asks the nurse what substances are being removed by the dialysis. Which substance removal should the nurse share with the client? 1-Blood 2-Sodium 3-Glucose 4-Bacteria
2-Sodium
A client who had a kidney transplant develops leukopenia 3 weeks after surgery. What does the nurse conclude is the most probable cause of the leukopenia? 1-Bacterial infection 2-High creatinine levels 3-Rejection of the kidney 4-Antirejection medications
4-Antirejection medications
During the infusion of dialysate during peritoneal dialysis, the client exhibits symptoms of severe respiratory difficulty. What should the nurse do? 1-Slow the rate of the client's infusion 2-Place the client in a low-Fowler position 3-Auscultate the client's lungs for breath sounds 4-Drain the fluid from the client's peritoneal cavity
4-Drain the fluid from the client's peritoneal cavity
The nurse is caring for an African American client with renal failure. The client states that the illness is a punishment for sins. Which cultural health belief does the client communicate? 1-Yin/Yang balance 2-Biomedical belief 3-Determinism belief 4-Magicoreligious belief
4-Magicoreligious belief
A client has end-stage kidney disease and is admitted for a kidney transplant. Which information should the nurse share when teaching about the donor? 1-Must have the same blood type 2-Must be a member of the same family 3-Must be approximately the same body size 4-Must have matching leukocyte antigen complexes
4-Must have matching leukocyte antigen complexes
A 4-year-old child with nephrotic syndrome is being treated with corticosteroid therapy. While evaluating lab values and the intake and output results, the nurse expects to note a decrease in what? 1-Polyuria 2-Hematuria 3-Glycosuria 4-Proteinuria
4-Proteinuria
The nurse is caring for a client who has been diagnosed with glomerulonephritis. Which initial urinary finding supports this diagnosis? 1-Anuria 2-Dysuria 3-Polyuria 4-Proteinuria
4-Proteinuria
Which roommate should the nurse manager assign to a 4-year-old boy who was admitted to the pediatric unit with nephrotic syndrome? 3-year-old boy with impetigo. 2-year-old boy with pneumonia. 5-year-old girl with thalassemia. 4-year-old girl with conjunctivitis.
5-year-old girl with thalassemia. A child with nephrotic syndrome is at risk for infection. The child with thalassemia is noninfectious and therefore is an appropriate roommate. In addition, the closeness of age will provide for preschool socialization.
A client with end-stage kidney disease is receiving continuous ambulatory peritoneal dialysis. The nurse should monitor the client for which peritoneal dialysis complications? Select all that apply. 1-Pruritus 2-Oliguria 3-Tachycardia 4-Cloudy outflow 5-Abdominal pain
3-Tachycardia 4-Cloudy outflow 5-Abdominal pain
A nurse is caring for a client with end-stage renal disease who has a mature arteriovenous (AV) fistula. What nursing care should be included in the client's plan of care? Select all that apply. Auscultate for a bruit. Palpate the site to identify a thrill. Irrigate with saline to maintain patency. Avoid drawing blood from the affected extremity. Keep the fistula clamped until ready to perform dialysis.
Auscultate for a bruit. Palpate the site to identify a thrill. Avoid drawing blood from the affected extremity.
A nurse is reviewing the laboratory report of an adolescent child with nephrotic syndrome. What does the nurse expect analysis of the child's urine to reveal? 1-High protein level 2-Low specific gravity 3-Numerous red blood cells 4-Several crystalline particles
1-High protein level
A nurse on the pediatric unit is admitting an adolescent child with acute glomerulonephritis (AGN). What is the priority nursing intervention? 1-Assessing the child for dysuria 2-Inspecting the child for jaundice 3-Monitoring the child for hypertension 4-Testing the child's vomitus for occult blood
3-Monitoring the child for hypertension
A nurse is assessing a school-aged child who has been admitted to the pediatric unit with a diagnosis of acute glomerulonephritis. What clinical finding does the nurse expect? 1-Polyuria 2-Dehydration 3-Periorbital edema 4-Decreased blood pressure
3-Periorbital edema
What is the most important nursing intervention for a 3-year-old child with a diagnosis of nephrotic syndrome? 1-Regulating diet 2-Encouraging fluids 3-Preventing infection 4-Maintaining bed res
3-Preventing infection
A client with uremic syndrome has the potential to develop many complications. Which complication should the nurse anticipate? Hypotension. Hypokalemia. Flapping hand tremors. Elevated hematocrit values.
Flapping hand tremors. An elevation in uremic waste products causes irritation of the nerves, resulting in flapping hand tremors (asterixis, "liver flap").
What should a nurse include in the plan of care for a client with nephrotic syndrome? Providing meticulous skin care. Restricting fluids to four ounces each shift. Offering a diet low in carbohydrates and protein. Sending blood to the laboratory for typing and crossmatching.
Providing meticulous skin care. The massive edema, typical of nephrotic syndrome, predisposes the client to skin breakdown.
The nurse is assigned to care for a child who is suspected of having glomerulonephritis. The nurse reviews the child's record and notes that which finding is associated with the diagnosis of glomerulonephritis? Hypotension. Red-brown urine. Low urinary specific gravity. A low blood urea nitrogen (BUN) level.
Low urinary specific gravity. Gross hematuria resulting in dark, smoky, cola-colored or red-brown urine is a classic symptom of glomerulonephritis, and hypertension is also common. A mid- to high urinary specific gravity is associated with glomerulonephritis. BUN levels may be elevated.
A 6-year-old child is hospitalized with nephrotic syndrome. The mother asks the nurse what she may bring for her child to play with during the hospitalization. In light of the child's age, what should the nurse suggest? Select all that apply. 1-Checkers 2-Wooden puzzles 3-Paper and crayons 4-Simple card games 5-CDs and a CD player
1-Checkers 3-Paper and crayons 4-Simple card games
The nurse is providing dietary teaching to a client who is receiving hemodialysis. What should the nurse encourage the client to include in the dietary plan? 1-Rice 2-Potatoes 3-Canned salmon 4-Barbecued beef
1-Rice
A nurse teaches the signs of organ rejection to a client who had a kidney transplant. What should the nurse include in the education? 1-Weight loss 2-Subnormal temperature 3-Elevated blood pressure 4-Increased urinary output
3-Elevated blood pressure Hypertension is a clinical manifestation of kidney transplant. Weight gain, not loss, occurs with a rejection of the kidney because of fluid retention.
A client undergoing treatment for a medical condition gave birth to a baby with renal failure as a result of the teratogenic effect of the medications. Which medical condition is the client likely getting treated for? 1-Cancer 2-Epilepsy 3-Hypertension 4-Microbial infection
3-Hypertension
A client who has been receiving hemodialysis for several years is to receive a kidney transplant. What should the nurse share in the client's preoperative teaching plan? Select all that apply. 1-"The kidney may not function immediately." 2-"Precautions are needed to prevent infection." 3-"A urinary catheter will be present postoperatively." 4-"Immunosuppressive medications will be given preoperatively." 5-"The arteriovenous fistula will be used for drawing blood specimens preoperatively.
1-"The kidney may not function immediately." 2-"Precautions are needed to prevent infection." 3-"A urinary catheter will be present postoperatively."
A 6-year-old child treated for acute glomerulonephritis has improved and is soon to be discharged. What should the nurse plan to offer the parents in preparation for the discharge? 1-Samples of no-salt-added diets for the child to continue at home 2-Suggestions about activities to keep the child mobile for longer periods 3-Instructions about when the child should return for a workup for a kidney transplant 4-Phone numbers to reach the nurse on the unit so the parents may call if there are any questions
1-Samples of no-salt-added diets for the child to continue at home
A nurse is caring for a toddler with the diagnosis of nephrotic syndrome. What is the best indicator of kidney function in this toddler? 1-Urine output 2-Daily weights 3-Abdominal girth 4-Improved appetite
1-Urine output
A 9-year-old child is found to have acute glomerulonephritis after a recent infection. What microorganism should the nurse suspect as the cause of the child's current health problem? 1-Haemophilus 2-Streptococcus 3-Pseudomonas 4-Staphylococcus
2-Streptococcus Acute glomerulonephritis, an immune complex disease, is a reaction that occurs as a sequela of streptococcal infection; it is known as acute poststreptococcal glomerulonephritis.
A nurse is performing peritoneal dialysis for a client. Which action should the nurse take? 1-Place the client in a side-lying position. 2-Warm the dialysate solution slightly before instillation. 3-Infuse the dialysate solution quickly over 5 to 10 minutes. 4-Withhold the routine medications until after the procedure.
2-Warm the dialysate solution slightly before instillation.
A nurse is caring for an 8-year-old child with acute poststreptococcal glomerulonephritis (APSGN). What medications does the nurse expect the practitioner to prescribe? Select all that apply. 1-Penicillin 2-Morphine 3-Furosemide 4-Labetalol 5-Phenobarbital
3-Furosemide 4-Labetalol
An 8-year-old child is admitted to the pediatric unit with nephrotic syndrome. What measures should the nurse expect to include in the plan of care for this child? Select all that apply. 1-Maintaining bed rest 2-Administering antibiotics 3-Providing symptomatic care 4-Eliminating high-sodium foods 5-Monitoring response to steroids
3-Providing symptomatic care 4-Eliminating high-sodium foods 5-Monitoring response to steroids
A nurse is caring for a client with a diagnosis of chronic kidney failure who has just been told by the primary healthcare provider that hemodialysis is necessary. Which clinical manifestation indicates the need for hemodialysis? 1-Ascites 2-Acidosis 3-Hypertension 4-Hyperkalemia
4-Hyperkalemia
f a client undergoing peritoneal dialysis develops symptoms of severe respiratory difficulty during the infusion of the dialysate, the nurse should: Slow the rate of the client's infusion. Place the client in a low Fowler's position. Auscultate the client's lungs for breath sounds. Drain the fluid from the client's peritoneal cavity.
Drain the fluid from the client's peritoneal cavity. Pressure from the dialysate may cause upward displacement of the diaphragm; the dialysate should be drained from the peritoneal cavity.
Which of the following clinical findings should the nurse expect to find during the assessment of a child with acute glomerulonephritis (AGN)? Select all that apply. 1-Flank pain 2-Periorbital edema 3-Intermittent fever 4-Increased urine volume 5-Decreased joint mobility
1-Flank pain 2-Periorbital edema
A client with acute kidney failure is fatigued and becomes lethargic. Upon reviewing the client's medical record, which finding does the nurse determine is the most likely cause of this change in symptoms? 1-Hyperkalemia 2-Hypernatremia 3-A limited fluid intake 4-An increased blood urea nitrogen level
4-An increased blood urea nitrogen level An increased blood urea nitrogen level, indicating uremia, is toxic to the central nervous system and causes fatigue and lethargy.
The nurse is caring for a client who is receiving azathioprine, cyclosporine, and prednisone before receiving a kidney transplant. What does the nurse identify as the purpose of these drugs? 1-Stimulate leukocytosis 2-Provide passive immunity 3-Prevent iatrogenic infection 4-Reduce antibody production
4-Reduce antibody production
A 4-year-old child with nephrotic syndrome is admitted to the pediatric unit. What clinical finding does the nurse expect when assessing this child? 1-Severe lethargy 2-Dark, frothy urine 3-Chronic hypertension 4-Flushed, ruddy complexion
2-Dark, frothy urine
Which medications prescribed to a client after a kidney transplant surgery may require the client to visit a dentist? Select all that apply. 1-Sirolimus 2-Everolimus 3-Prednisone 4-Cyclosporine 5-Prednisolone
2-Everolimus 4-Cyclosporine
A nurse is providing dietary instructions to a client who is being treated with continuous ambulatory peritoneal dialysis (CAPD) for chronic glomerulonephritis. Which should the nurse include when discussing what the client needs? 1-Low-calorie foods 2-High-quality protein 3-Increased fluid intake 4-Foods rich in potassium
2-High-quality protein
A healthcare provider prescribes steroid therapy for a 4-year-old child who has nephrotic syndrome. What goal of this treatment does the nurse explain to the child's parents? 1-Prevents infection 2-Stimulates diuresis 3-Provides hemopoiesis 4-Reduces blood pressure
2-Stimulates diuresis
Which roommate should the nurse manager assign to a 4-year-old boy who has been admitted to the pediatric unit with nephrotic syndrome? 1-3-year-old boy with impetigo 2-2-year-old boy with pneumonia 3-5-year-old girl with thalassemia 4-4-year-old girl with conjunctivitis
3-5-year-old girl with thalassemia
A 6-year-old boy is hospitalized with an exacerbation of nephrotic syndrome. The mother asks the nurse what she should bring for her son to play with during the hospitalization. What should the nurse suggest? 1-Plastic bat, cloth ball, and a hula hoop 2-Stuffed animals, large puzzles, and blocks 3-Checkers, simple card games, and crayons 4-Children's magazines, a model plane kit, and laptop computer
3-Checkers, simple card games, and crayons School-aged children enjoy competition, have manipulative skills, and are creative. A bat, ball, and hula hoop require too much expenditure of energy for a child in the acute phase of nephrotic syndrome
A nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet. What is the rationale for the nurse's instruction? 1-A person's body tends to retain fluid when a salt substitute is included in the diet. 2-Limiting salt substitutes in the diet prevents a buildup of waste products in the blood. 3-Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats. 4-A substance in the salt substitute interferes with the transfer of fluid across capillary membranes, resulting in anasarca
3-Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats.
A 3-year-old child is hospitalized with nephrotic syndrome. The child has oliguria and generalized edema. What factor does the nurse identify that will have the greatest effect on the child's adjustment to hospitalization? Lack of parental visits. Inability to select a variety of foods. Response of peers to the edematous appearance. Willingness to participate in cooperative play activities.
Lack of parental visits.
A client is diagnosed with acute kidney failure secondary to dehydration. An intravenous (IV) infusion of 50% glucose with regular insulin is prescribed. What does the nurse recognize as the primary purpose of the IV insulin for this client? 1-Correct hyperkalemia 2-Increase urinary output 3-Prevent respiratory acidosis 4-Increase serum calcium levels
1-Correct hyperkalemia
The laboratory results of a client with a pulmonary hemorrhage and glomerulonephritis reveal the presence of IgG antibodies. Which type of hypersensitivity reaction should a nurse suspect? 1-Cytotoxic reaction 2-Immediate reaction 3-Immune-complex reaction 4-Delayed hypersensitivity reaction
1-Cytotoxic reaction
A low-dose intravenous dopamine hydrochloride infusion drip is prescribed for a client in acute renal failure (ARF). Which method is most appropriate for the nurse to administer this medication to the client? 1-Peripherally inserted central catheter (PICC) line 2-#20 angiocatheter in either antecubital area 3-Large-gauge butterfly needle in hand 4-Femoral line
1-Peripherally inserted central catheter (PICC) line
A nurse is obtaining the health history of a 5-year-old child who has been admitted to the child health unit with acute glomerulonephritis. What does the nurse expect the child's mother to report? 1-The child had a sore throat a few weeks ago. 2-The child has just recovered from the measles. 3-The child's father has a family history of urinary tract infections. 4-The child's immunizations were administered at the start of school.
1-The child had a sore throat a few weeks ago.
After a nephrectomy a client arrives in the postanesthesia care unit in the supine position. Which action should be employed by the nurse to assess the client for signs of hemorrhage? 1-Turn the client to observe the dressings. 2-Press the client's nail beds to assess capillary refill. 3-Observe the client for hemoptysis when suctioning. 4-Monitor the client's blood pressure for a rapid increase
1-Turn the client to observe the dressings.
A client is to have hemodialysis. What must the nurse do before this treatment? 1-Obtain a urine specimen to evaluate kidney function. 2-Weigh the client to establish a baseline for later comparison. 3-Administer medications that are scheduled to be given within the next hour. 4-Explain that the peritoneum serves as a semipermeable membrane to remove wastes
2-Weigh the client to establish a baseline for later comparison.
A 3.5-year-old child hospitalized with nephrotic syndrome. The child has been toilet trained for longer than one year but has been incontinent while in the hospital. The child's parents express concern over this behavior. What is the most therapeutic response by the nurse? 1-"Your child is wetting the bed to get attention. Set limits when this occurs." 2-"The incontinence is caused by the renal disease. It will stop with physical improvement." 3-"This is an expected response to hospitalization. Ignore the regressive behavior and be supportive." 4-"Your child is using this regressive behavior to help cope with hospitalization; just use diapers and say nothing."
3-"This is an expected response to hospitalization. Ignore the regressive behavior and be supportive."
Which clinical findings indicate to the nurse that a 6-year-old child has nephrotic syndrome (NS) rather than acute glomerulonephritis (AGN)? Select all that apply. 1-Lethargic and appears unwell 2-Gross hematuria 3-Generalized edema 4-Massive proteinuria 5-Unchanged blood pressure
3-Generalized edema 4-Massive proteinuria 5-Unchanged blood pressure
A 6-year-old child is admitted to the pediatric unit with a diagnosis of nephrotic syndrome. What should the plan of care include during the acute phase? 1-Offering a low-protein diet 2-Encouraging fluids every hour 3-Promoting frequent position changes 4-Providing time for active play periods
3-Promoting frequent position changes
A nurse on the pediatric unit is planning recreational activities for a 4-year-old with an exacerbation of nephrotic syndrome. What are the most appropriate activities in light of the child's developmental level and physical status? 1-Riding a tricycle and playing with large blocks 2-Watching cartoon videos and listening to stories 3-Reading animal stories and playing video games 4-Leading a pull toy and playing with a map puzzle
2-Watching cartoon videos and listening to stories
A client is experiencing kidney failure. Which is the most serious complication for which the nurse must monitor a client with kidney failure? 1-Anemia 2-Weight loss 3-Uremic frost 4-Hyperkalemia
4-Hyperkalemia
A 4-year-old child with nephrotic syndrome has repeated relapses. As the child gets older, what is the most important attribute for the child to develop? 1-A positive body image 2-The ability to test urine 3-Fine muscle coordination 4-Acceptance of possible sterility
1-A positive body image
A nurse is assessing a 10-year-old child admitted to the pediatric unit with acute poststreptococcal glomerulonephritis (APSGN). What specific signs and symptoms does the nurse expect? Select all that apply. 1-Anorexia 2-Glycosuria 3-Hypotension 4-Periorbital edema 5-Increased creatinine level
1-Anorexia 4-Periorbital edema 5-Increased creatinine level
A nurse is caring for a toddler with the diagnosis of nephrotic syndrome. What is the best indicator of fluid balance in this toddler? Daily weights. Urinary output. Abdominal girth. Improved appetite.
Daily weights. In nephrotic syndrome a large proportion of the child's body weight is composed of retained fluid; the loss of fluid is reflected by a loss of weight.
A client is diagnosed as having kidney failure. During the oliguric phase the nurse should assess the client for: Hyperkalemia Hypocalcemia Hypernatremia Hypoproteinemia
Hyperkalemia The kidneys retain potassium during the oliguric phase of kidney failure; an elevated potassium level is one of the main indicators of the need for dialysis.
A client with nephrotic syndrome is in remission for several months and calls the clinic to report that for the past week skin has a muddy pale appearance, appetite is poor, and has been unusually tired. Based on description, what does the nurse suspect? Impending renal failure. Excessive activity at school. Development of a viral infection. Nonadherence to the medication protocol.
Impending renal failure.
A 9-year-old child with chronic kidney disease is undergoing peritoneal dialysis. For which associated complication should the nurse monitor the child? 1-Petechiae 2-Abdominal bruit 3-Cloudy return dialysate 4-Increased blood glucose level
3-Cloudy return dialysate The returned dialysate should be clear; cloudy return dialysate solution is indicative of infection.
A nurse administers sodium polystyrene sulfonate to a client with chronic renal failure. Which finding provides evidence that the intervention is effective? 1-Frequent loose stools 2-Improved mental status 3-Sodium increases to 137 mEq/L (137 mmol/L) 4-Potassium decreases to 4.2 mEq/L (4.2 mmol/L)
4-Potassium decreases to 4.2 mEq/L (4.2 mmol/L)
A client has a kidney transplant. The nurse should monitor for which assessment findings associated with rejection of the transplant? Select all that apply. 1-Fever 2-Oliguria 3-Jaundice 4-Polydipsia 5-Weight gain
1-Fever 2-Oliguria 5-Weight gain
A child with nephrotic syndrome visits the clinic for follow-up. During the visit the parent states that the child is always tired and has no appetite. The nurse notes that the child has a muddy, pale complexion. What problem does the nurse suspect? 1-Impending renal failure 2-Being too active in school 3-A developing viral infection 4-Refusal of the prescribed medications
1-Impending renal failure
A nurse is assessing a school-aged child with a tentative diagnosis of nephrotic syndrome. What clinical finding supports this diagnosis versus a diagnosis of acute glomerulonephritis? 1-Lethargy 2-Anasarca 3-Proteinuria 4-Hypertension
2-Anasarca The child with nephrotic syndrome has observable edema throughout the body (anasarca); the child with acute glomerulonephritis has edema that is most noticeable around the eyes (periorbital edema).
What is the most appropriate assessment with which to detect the development of complications associated with acute glomerulonephritis (AGN) in a school-aged child? 1-Assessing the joints for stiffness daily 2-Measuring the pH of each urine specimen 3-Checking the blood pressure every 4 hours 4-Testing the urine from each voiding for glucose
3-Checking the blood pressure every 4 hours
A nurse is caring for a client with end-stage kidney disease who is about to receive a transplant. When the client returns from the postanesthesia care unit after a kidney transplant, how often should the nurse measure the client's urinary output? 1-1 hour 2-2 hours 3-15 minutes 4-30 minutes
1-1 hour Hourly output is critical in assessing kidney function; decreasing urinary output is a sign of rejection. Every 2 hours is too infrequent for monitoring output immediately after a kidney transplant; it is essential to monitor output more frequently to evaluate whether the new kidney is working or being rejected. It is not necessary to monitor every 15 or 30 minutes.
A nurse is assessing a client with a diagnosis of kidney failure for clinical indicators of metabolic acidosis. What should the nurse conclude is the reason metabolic acidosis develops with kidney failure? 1-Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate 2-Depressed respiratory rate due to metabolic wastes, causing carbon dioxide retention 3-Inability of the renal tubules to reabsorb water to dilute the acid contents of blood 4-Impaired glomerular filtration, causing retention of sodium and metabolic waste products
1-Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate
What should nursing care for a child admitted with acute glomerulonephritis be directed toward? 1-Enforcing bed rest 2-Promoting diuresis 3-Encouraging fluids 4-Removing dietary salt
2-Promoting diuresis
A 6-year-old child is in the acute phase of nephrotic syndrome. The mother asks the nurse about play activities for her child. What should the nurse suggest? Select all that apply. 1-Hula hoop 2-Video games 3-Large puzzles 4-Stuffed animal 5-Children's books
2-Video games 5-Children's books Age-appropriate video games do not require excessive energy to play and will help a 6-year-old child avoid boredom. Children's books are appropriate for 6-year-old children because at this age they are beginning to read. Also, the parents may read to the child. This activity does not require energy. Playing with a hula hoop requires energy that a child in the acute phase of nephrotic syndrome does not have. Large puzzles are more appropriate for toddlers, who are developing fine motor skills. A stuffed animal is more appropriate for an infant or toddler. It is a passive toy that will not be stimulating for a 6-year-old child.
A client has end-stage kidney disease and is receiving hemodialysis. During dialysis the client reports nausea and a headache and appears confused. Operating on prescribed protocols, which action will the nurse take? 1-Give an analgesic. 2-Administer an antiemetic. 3-Decrease the rate of exchange. 4-Discontinue the procedure immediately
3-Decrease the rate of exchange.
The nurse is teaching a client receiving peritoneal dialysis about the reason dialysis solution is warmed before it is instilled into the peritoneal cavity. Which information will the nurse share with the client? 1-Because it forces potassium back into the cells, thereby decreasing serum levels 2-Because it adds extra warmth to the body because metabolic processes are disturbed 3-Because it helps prevent cardiac dysrhythmias by speeding up removal of excess potassium 4-Because it encourages removal of serum urea by preventing constriction of peritoneal blood vessels
4-Because it encourages removal of serum urea by preventing constriction of peritoneal blood vessels
A nurse teaches a client who is scheduled for a kidney transplant about the need for immunosuppressive medications. The nurse determines that the client understands the teaching when the client states that medications must be taken for what period of time? 1-"For the rest of my life." 2-"Until the surgery is over." 3-"Until the surgery heals." 4-"During the intraoperative period."
1-"For the rest of my life."
A client who is receiving peritoneal dialysis reports severe respiratory difficulty. What immediate action should the nurse implement? 1-Auscultate the lungs. 2-Obtain arterial blood gases. 3-Notify the healthcare provider. 4-Apply pressure to the abdomen
1-Auscultate the lungs.
Before discharging a 9-year-old child who is being treated for acute poststreptococcal glomerulonephritis (APSGN), what information should the nurse plan to give the parents? 1-How to obtain the vital signs daily 2-Date on which to return to prepare for renal dialysis 3-Instructions about which high-sodium foods to avoid 4-List of activities that will encourage the child to remain active
3-Instructions about which high-sodium foods to avoid
If a client on peritoneal dialysis develops symptoms of severe respiratory difficulty during the infusion of the dialysate solution, what should the nurse do? 1-Increase the rate of infusion. 2-Auscultate the lungs for breath sounds. 3-Place the client in a low-Fowler position. 4-Drain the fluid from the peritoneal cavity
4-Drain the fluid from the peritoneal cavity
A client with end-stage kidney disease says to the nurse, "I heard that it is inevitable that I will need a kidney transplant. If so, which one of my kidneys will be removed?" Which is the best response by the nurse? 1-"Neither of your kidneys will be removed unless they are infected." 2-"The kidney that is the most diseased is removed and replaced with a new one." 3-"It is up to the primary healthcare provider as to which kidney is replaced with a new one." 4-"Your right kidney will be removed, because it has a longer renal vein, making transplantation easier."
1-"Neither of your kidneys will be removed unless they are infected." The recipient's own kidneys are not removed unless a chronic infection is present. The primary healthcare provider will not decide which kidney is replaced, the most diseased kidney will not be removed, and the right kidney will stay because the kidneys are left in place; the new kidney is placed in the right lower quadrant.
A nurse is caring for a client who recently had a kidney transplant. Which priority assessment finding requires follow up by the nurse? 1-Fever 2-Hematuria 3-Moon facies 4-Yellow sclera
1-Fever
A 12-year-old boy with nephrotic syndrome is in remission for several months. One day the mother calls the clinic to report that for the past week her child's skin has a pale, muddy appearance; his appetite is poor; and he has been unusually tired after school. In light of the mother's description, what does the nurse suspect? 1-Impending renal failure 2-Excessive activity at school 3-Development of a viral infection 4-Nonadherence to the medication protocol
1-Impending renal failure
To prepare for hemodialysis, a client with end-stage kidney disease is scheduled for surgery, specifically for the creation of an internal arteriovenous fistula in one arm and placement of an external arteriovenous shunt in the other arm. When considering care for these sites, which difference will the nurse consider? 1-The graft is more subject to hemorrhage, clotting, and infection than the fistula is. 2-Blood pressure readings can be taken in the arm with the fistula but not in the one with the shunt. 3-Intravenous (IV) fluids can be administered in the arm with the shunt but not in the one with the fistula. 4-The fistula should be covered with a light dressing, and the shunt should be covered thoroughly with a heavy dressing
1-The graft is more subject to hemorrhage, clotting, and infection than the fistula is.
A 3-year-old child with nephrotic syndrome has been receiving prednisone for 1 week. The nurse reviews the child's progress record and determines that the medication has been effective. What information supports this conclusion? Select all that apply. 1-Weight loss 2-Lower blood pH 3-Decreased lethargy 4-Increased urine output 5-Decreased blood pressure
1-Weight loss 3-Decreased lethargy 4-Increased urine output
A client with acute kidney injury is to receive peritoneal dialysis and asks why the procedure is necessary. Which is the nurse's best response? 1-"It prevents the development of serious heart problems." 2-"It helps perform some of the work usually done by the kidneys." 3-"It will keep your kidneys from getting worse and may 'restart' your kidneys to perform better than before." 4-"It speeds recovery because the kidneys are not responding to regulating hormones.
2-"It helps perform some of the work usually done by the kidneys."
A client is waiting for a kidney transplant. What explanation should the nurse include when teaching the client about the transplant? 1-"Production of urine will be delayed after surgery." 2-"You will require immunosuppressive drugs daily for the rest of your life." 3-"Symptoms of rejection include a decrease in temperature and blood pressure." 4-"You will need to modify your program of work and recreation, including sports."
2-"You will require immunosuppressive drugs daily for the rest of your life."
The nurse is monitoring a client who is receiving peritoneal dialysis. After the dialysate has infused, the client reports severe respiratory difficulty. Which immediate action should the nurse take? 1-Weigh the client 2-Auscultate breath sounds 3-Obtain arterial blood gases 4-Turn the client on the right side
2-Auscultate breath sounds Lung sounds should be auscultated for signs of fluid overload. Weighing the client will not correct the problem. It is not necessary to turn the client to the side.
A client is recovering from a kidney transplant. Which medications should the nurse expect to be prescribed for this client's maintenance therapy? Select all that apply. 1-Basiliximab 2-Azathioprine 3-Prednisone 4-Cyclosporine Antithymocyte globulin-equine
2-Azathioprine 3-Prednisone 4-Cyclosporine Antithymocyte globulin-equine
A client is diagnosed with acute tubular necrosis after sustaining a kidney trauma. Which laboratory result should the nurse anticipate while the client is in the oliguric phase? 1-Hypophosphatemia 2-Hyperkalemia 3-Hypomagnesemia 4-Hypernatremia
2-Hyperkalemia Hyperkalemia is the laboratory result that the nurse should anticipate while the client is in the oliguric phase of acute tubular necrosis (ATN).
An older client who was found unconscious at home was admitted to the hospital with a fractured hip, renal failure, and dehydration. In the 24 hours since admission, the client has received 3 L of intravenous fluid. The client has also developed hyponatremia. Which element would the nurse conclude is the most likely to have contributed to the client developing hyponatremia? 1-Reduced dietary salt intake 2-Intravenous fluid infusion 3-Potassium reabsorption rate 4-Increased glomerular filtration
2-Intravenous fluid infusion
A nurse is caring for a 6-year-old child who is admitted to the pediatric unit with recently diagnosed nephrotic syndrome. The parents ask the nurse why their child is retaining so much fluid. What should the nurse consider before telling the parents about the changes in body fluid distribution in language that they can understand? 1-Loss of sodium and water through an impaired basement membrane of the glomerulus results in hypovolemia. 2-Loss of body protein reduces oncotic pressure, and fluid moves from the intravascular to the interstitial space. 3-Hyperproteinemia results in increased oncotic pressure, and fluid moves from the intravascular to interstitial space. 4-Basement membranes of the glomeruli become selectively impermeable to water, and fluid is retained in the tissues
2-Loss of body protein reduces oncotic pressure, and fluid moves from the intravascular to the interstitial space.
During the postoperative period after surgery for a kidney transplant, the client's creatinine level is 3.1 mg/dL (260 mcmol/L). What should the nurse do first in response to this laboratory result? 1-Notify the primary healthcare provider. 2-Obtain current blood test results. 3-Assess for decreased urine output. 4-Check the intravenous (IV) infusion
3-Assess for decreased urine output. The expected serum creatinine range is 0.7 to 1.4 mg /dL (62 to 124 mcmol/L). The nurse should obtain additional information that may indicate acute rejection; therefore, the nurse must first assess for decreased urine output and changes in vital sign
A 3-year-old child is admitted to the pediatric unit with a diagnosis of nephrotic syndrome. The child has ascites, oliguria, respirations of 40 breaths/min, and a recent weight gain of 10 lb (4.5 kg). What nursing intervention may help ease the child's respiratory difficulty? 1-Providing six small meals daily 2-Maintaining a well-ventilated room 3-Ensuring bed rest in the low Fowler position 4-Administering oxygen at 2 L/min by way of nasal cannula
3-Ensuring bed rest in the low Fowler position
A nurse is caring for a school-aged child with nephrotic syndrome who has massive edema. The nurse teaches the parents about the low-sodium diet that has been ordered. Which food group has the lowest level of sodium compared with the other food groups? 1-Meat 2-Dairy 3-Fresh fruit 4-Fresh vegetables
3-Fresh fruit Fresh fruit has the overall lowest sodium content compared with the other food groups. Meat is higher in sodium than fruit. Dairy products are higher in sodium than fruit is. Fresh vegetables are higher in sodium than fruit is.
A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy? 1-"It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration." 2-"It exchanges and cleanses blood by correction of electrolytes and excretion of creatinine." 3-"It decreases the need for immobility, because it clears toxins in short and intermittent periods." 4-"It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."
4-"It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."
A 5-year-old child in renal failure who has undergone creation of an arteriovenous fistula access begins hemodialysis three times a week. The nurse teaches the mother the specific care her child needs. What statement indicates that further teaching is necessary? 1-"I'll offer more drinks in warm weather." 2-"I should call the clinic if he vomits or has diarrhea." 3-"I'll check his pulse at the wrist on each arm every day." 4-"It's OK to take his blood pressure on the arm with the fistula."
4-"It's OK to take his blood pressure on the arm with the fistula."
The nurse is assessing a pediatric client diagnosed with chronic renal failure exhibiting alterations in growth patterns. When educating the client's parents about the child's growth, which statement is accurate? 1-"Your child's poor growth is most likely caused by sustained alkalosis." 2-"The hypotension associated with your child's diagnosis is causing poor growth." 3-"Your child's poor growth is most likely caused by the carbohydrate restrictions." 4-"Resistance to growth hormone associated with your child's diagnosis is causing poor growth."
4-"Resistance to growth hormone associated with your child's diagnosis is causing poor growth."
The parents of a child with acute poststreptococcal glomerulonephritis tell the nurse they are concerned about activity restrictions after discharge. Which level of activity following discharge would the nurse provide teaching about? 1-Activity must be limited for 1 month. 2-The child should not play active games. 3-The child must remain in bed for 2 weeks. 4-Activity is permitted alternating with rest
4-Activity is permitted alternating with rest
The parents of a 7-year-old child who has acute glomerulonephritis (AGN) are fearful that their other child may contract the illness. What should the nurse explain to them about the disorder? 1-The cause of acute glomerulonephritis is unknown, so it is difficult to know how to prevent it. 2-Acute glomerulonephritis is inherited as a sex-linked recessive trait that usually occurs only in males. 3-The cause of acute glomerulonephritis is the formation of a clot in the renal tubules resulting from a systemic infection. 4-Acute glomerulonephritis is caused by an antigen-antibody response that is usually associated with Streptococcus infection.
4-Acute glomerulonephritis is caused by an antigen-antibody response that is usually associated with Streptococcus infection.
A client who is to begin continuous ambulatory peritoneal dialysis asks the nurse what this entails. What information should the nurse include when answering the client's question? 1-Hemodialysis and peritoneal dialysis will be done together. 2-Peritoneal dialysis is performed in an ambulatory care clinic. 3-About a quarter of a liter of dialysate is maintained in the peritoneal cavity. 4-Constant contact is maintained between the dialysate and the peritoneal membrane
4-Constant contact is maintained between the dialysate and the peritoneal membrane
A nurse is caring for a client with end-stage kidney disease after a kidney transplant. Which finding indicates the transplant is successful? 1-Increased specific gravity 2-Correction of hypotension 3-Elevated serum potassium 4-Decreasing serum creatinine
4-Decreasing serum creatinine
A nurse is giving discharge instructions to the parents of a boy with nephrotic syndrome. What parental statement about their child's care indicates that more instructions are needed? "Any gain in weight is expected." "Prednisone will be given with meals." "We plan to test his urine for albumin." "We will check his eyelids every morning."
"Any gain in weight is expected." Weight gain is not expected when a child with nephrotic syndrome is discharged. Weight gain must be monitored carefully and reported to the practitioner because it can be indicative of an accumulation of fluid and an exacerbation of the nephrosis.
While the nurse is at the bedside of a client in acute renal failure, the client states, "My doctor said that I will be getting some insulin. Do I also have diabetes?" The response that best demonstrates an understanding of the use of insulin in acute renal failure is: "No, the insulin will help your body handle the increased potassium level." "Why don't you ask that question when the doctor comes to see you today." "You probably had an elevated blood glucose level, so your doctor is being cautious." "No, but insulin will reduce the toxins in your blood by lowering your metabolic rate."
"No, the insulin will help your body handle the increased potassium level." Insulin promotes the transfer of potassium into cells, which reduces the circulating blood level of potassium.
An 80-year-old female is admitted to the hospital because of complications associated with severe dehydration. The client's daughter asks the nurse how her mother could have become dehydrated because she is alert and able to care for herself. The nurse's best response is: "The body's fluid needs decrease with age because of tissue changes." "Access to fluid may be insufficient to meet the daily needs of the older adult." "Memory declines with age, and the older adult may forget to ingest adequate amounts of fluid." "The thirst reflex diminishes with age, and therefore the recognition of the need for fluid is decreased."
"The thirst reflex diminishes with age, and therefore the recognition of the need for fluid is decreased." For reasons that are still unclear, the thirst reflex diminishes with age, and this may lead to a concomitant decline in fluid intake.
Which of the following patient statements needs to be explored further regarding kidney function? (Select all that apply.) "These are the only shoes I could wear today." "I had to use three pillows to sleep last night." "I have this funny metallic taste in my mouth." "I have been drinking 8 glasses of water each day." "I have been taking ibuprofen twice a day for the past month."
"These are the only shoes I could wear today." "I had to use three pillows to sleep last night." "I have this funny metallic taste in my mouth." "I have been taking ibuprofen twice a day for the past month." Answer A implies swelling in the feet. Answer B implies paroxysmal nocturnal dyspnea. Answer C could be related to uremia. Nonsteroidal antiinflammatory drugs such as ibuprofen can lead to renal impairment. Drinking 8 or more glasses of water per day is a preventive measure for kidney disease.
How should the nurse expect the urine of a child with acute glomerulonephritis with hematuria to appear? 1-Cola-colored 2-Orange 3-Bright red 4-Straw-colored
1-Cola-colored
A preschooler is admitted with a diagnosis of acute glomerulonephritis. The child's history reveals a 5-lb (2.3 kg) weight gain in 1 week and periorbital edema. How can the nurse obtain the most accurate information on the status of the child's edema? 1-Weighing daily 2-Observing body changes 3-Measuring intake and output 4-Monitoring electrolyte values
1-Weighing daily
A nurse is caring for a client with chronic kidney failure. Which clinical findings should the nurse expect when assessing this client? Select all that apply. 1-Polyuria 2-lethargy 3-Hypotension 4-Muscle twitching 5-Respiratory acidosis
2-lethargy 4-Muscle twitching
Severe hypertension develops in a child with acute glomerulonephritis. What medication does the nurse anticipate that the healthcare provider will prescribe? 1-Digoxin 2-Diazepam 3-Captopril 4-Phenytoin
3-Captopril
A 4-year-old child is being treated for nephrotic syndrome. What assessment finding indicates that the child's condition is improving? 1-The child gains weight. 2-Urine output decreases. 3-Urine specific gravity decreases. 4-The child's hemoglobin and hematocrit increase
3-Urine specific gravity decreases.
A 7-year-old child must remain quietly in bed while undergoing peritoneal dialysis. What activity is most appropriate for the nurse to plan for this child? 1-Learning to play chess 2-Constructing a model airplane 3-Working multiple-piece puzzles with another child 4-Using a large sponge ball to play catch with a roommate
3-Working multiple-piece puzzles with another child
A 3-year-old preschooler has been hospitalized with nephrotic syndrome. What is the best way for the nurse to evaluate fluid retention or loss? 1-Measuring the abdominal girth daily 2-Having the child urinate in a bedpan 3-Testing the child's urine for proteinuria 4-Weighing the child at the same time each day
4-Weighing the child at the same time each day
In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to the maintenance of homeostasis. Which physiologic processes are performed by the kidneys? Select all that apply. A. Production and secretion of renin B. Activation of vitamin D C. Carbohydrate metabolism D. Erythropoietin production E. Hemolysis of old red blood cells (RBCs)
A. Production and secretion of renin B. Activation of vitamin D D. Erythropoietin production
A client with chronic kidney disease has been on dialysis for 2 years. The client is receiving combination of medications for the disease, including aluminum hydroxide. The client now has mental cloudiness, dementia, and complaints of bone pain. Which does this data indicate? Advancing uremia. Phosphate overdose. Folic acid deficiency. Aluminum intoxication.
Aluminum intoxication. Aluminum intoxication may 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.
Which of the following is characteristic of acute kidney injury? Most always reversible with low mortality rates. An abrupt decline in kidney function with a rise in serum creatinine. Mechanical obstruction of urinary outflow is the most common cause. Cardiovascular disease is the most common cause of death.
An abrupt decline in kidney function with a rise in serum creatinine. Acute kidney injury (AKI) is a rapid reduction in kidney function resulting in failure to maintain waste ELIMINATION, FLUID AND ELECTROLYTE BALANCE, and ACID-BASE BALANCE
A client has been receiving hemodialysis for several months. The nurse considers that bleeding into the GI tract is of particular significance to a client with chronic kidney disease because: Hypovolemia can compromise kidney function. Blood is digested thereby increasing the kidneys' protein load. Clotting problems in kidney disease make diagnosis of the bleeding site difficult. Usual signs of blood loss will not be manifested in the client with kidney failure.
Blood is digested thereby increasing the kidneys' protein load.
The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse should take which actions? Select all that apply. Contact the health care provider (HCP). Check the level of the drainage bag. Reposition the client to his or her side. Place the client in good body alignment. Check the peritoneal dialysis system for kinks. Increase the flow rate of the peritoneal dialysis solution.
Check the level of the drainage bag. Reposition the client to his or her side. Place the client in good body alignment. Check the peritoneal dialysis system for kinks.
A 4-year-old child with nephrotic syndrome is admitted to the pediatric unit. What clinical finding does the nurse expect when assessing this child? Severe lethargy. Dark, frothy urine. Chronic hypertension. Flushed, ruddy complexion.
Dark, frothy urine. Dark, frothy urine is characteristic of a child with nephrotic syndrome; large amounts of protein in the urine cause it to have a dark, frothy appearance.
A client has end-stage kidney disease and is receiving hemodialysis. During dialysis the client complains of nausea and a headache and appears confused. Operating on standing protocols, the nurse should: Give an analgesic. Administer an antiemetic. Decrease the rate of exchange. Discontinue the procedure immediately.
Decrease the rate of exchange.
A client is scheduled for intravenous pyelography (IVP). Which priority nursing action should the nurse take? Restrict fluids. Administer a sedative. Determine a history of allergies. Administer an oral preparation of radiopaque dye.
Determine a history of allergies. An iodine-based dye may be used during the IVP and can cause allergic reactions such as itching, hives, rash, tight feeling in the throat, shortness of breath, and bronchospasm.
The nurse is reviewing the client's record and notes that the health care provider has documented that the client has a renal disorder. Which laboratory results would indicate a decrease in renal function? Select all that apply. Elevated serum creatinine level. Elevated thrombocyte cell count. Decreased red blood cell (RBC) count. Decreased white blood cell (WBC) count. Elevated blood urea nitrogen (BUN) level.
Elevated serum creatinine level. Decreased red blood cell (RBC) count. Elevated blood urea nitrogen (BUN) level. BUN testing is a frequently used laboratory test to determine renal function. The BUN and serum creatinine levels start to rise when the glomerular filtration rate falls below 40% to 60%. A decreased RBC count may be noted if erythropoietic function by the kidney is impaired. An increased WBC is most likely to be noted in renal disease. Thrombocyte cell counts do not indicate decreased renal function.
A client is admitted with a diagnosis of nephrotic syndrome. The client has ascites, oliguria, respirations of 40 per minute, and a recent weight gain of 10 pounds. What nursing intervention may help lessen the client's respiratory difficulty? Providing 6 small meals daily. Maintaining a well-ventilated room. Ensuring bed rest in the low-Fowler position. Administering oxygen at 2 L per minute by mask.
Ensuring bed rest in the low-Fowler position. The low-Fowler position decreases pressure on the diaphragm from the abdominal organs and the ascites, thereby increasing respiratory excursion.
Monitoring vital signs, particularly the blood pressure and the rate and quality of the pulse, is essential to detect physiological adaptations in a child with nephrotic syndrome. Which clinical manifestation should the nurse detect based on these vital signs? Heart failure Hypovolemia Pulmonary embolus Increased serum potassium
Hypovolemia The shift of fluid from the intravascular to the interstitial compartment predisposes to hypovolemia; a weak, thready pulse and hypotension are signs of impending shock.
The nurse is caring for a client with acute renal failure. The most serious complication for this client is: Anemia. Infection. Weight loss. Platelet dysfunction.
Infection. Infection is responsible for one third of the traumatic or surgically induced deaths of clients with acute renal failure, as well as for medically induced acute renal failure.
An older adult client is admitted to the hospital with a diagnosis of chronic kidney disease. The nurse reviews the client's medical record and completes a physical assessment. Which clinical finding is a priority to be communicated to the practitioner? Sodium level. Potassium level. Creatinine results. Elevated blood pressure.
Potassium level. The potassium is increased outside the expected range for an adult, which places the client at risk for a cardiac dysrhythmia; the increased potassium level must be treated immediately because elevated levels can be lethal.
What is one of the most important role of the nurse in relation to acute poststreptococcal glomerulonephritis? Promote early diagnosis and treatment of sore throats and skin lesions. Encourage patients to request antibiotic therapy for all upper respiratory infections. Teach patients with acute post-streptococcal glomerulonephritis (APSGN) that long-term prophylactic antibiotic therapy is necessary to prevent recurrence. Monitor patients for respiratory symptoms that indicate that the disease is affecting the alveolar basement membrane.
Promote early diagnosis and treatment of sore throats and skin lesions.
A client is admitted with a diagnosis of nephrotic syndrome. What should the plan of care include during the acute phase? Offering a low-protein diet. Encouraging fluids every hour. Promoting frequent position changes. Providing time for active play periods.
Promoting frequent position changes. Severe edema is usually present, and changes of position are necessary to prevent skin breakdown.
A client with end-stage kidney disease is receiving continuous ambulatory peritoneal dialysis. The nurse is monitoring the client for manifestations of complications associated with peritoneal dialysis. Select all that apply. Pruritus. Oliguria. Tachycardia. Cloudy outflow. Abdominal pain.
Tachycardia. Cloudy outflow. Abdominal pain. Tachycardia can be caused by peritonitis, a complication of peritoneal dialysis; the heart rate increases to meet the metabolic demands associated with infection. Cloudy or opaque dialysate outflow (effluent) is the earliest sign of peritonitis; it is caused by the constituents associated with an infectious process. Abdominal pain is associated with peritonitis, a complication of peritoneal dialysis; pain results from peritoneal inflammation, abdominal distention, and involuntary muscle spasms
The client develop a seizure shortly after hemodialysis. Which nursing actions should the nurse implement? Select all that apply. Time the seizure. Restrain the child. Stay with the child. Insert an oral airway. Place the child in a supine position. Loosen clothing around the child's neck.
Time the seizure. Stay with the child. Loosen clothing around the child's neck.
The home health care nurse is teaching about peritoneal dialysis to a client who has just started the procedure. The client is informed that if drainage of dialysate from the peritoneal cavity ceases before the required amount has drained out, the client should: Drink a glass of water. Turn from side to side. Deep breathe and cough. Periodically rotate and reposition the catheter.
Turn from side to side. Turning from side to side will change the position of the catheter, thereby freeing the drainage holes, which may be obstructed.
A client with acute kidney failure states, "Why am I twitching and my fingers and toes tingling?" The nurse should respond, "This is caused by: acidosis." calcium depletion." potassium retention." sodium chloride depletion."
calcium depletion."
The most reliable and accurate estimate of glomerular filtration and therefore of kidney function is:
creatinine clearance
A trauma patient arrives at the critical care unit after an assault. Upon assessment, the nurse identifies Grey-Turner sign. This is indicative of potential trauma sustained to the: kidney. liver. bladder. spleen.
kidney. Visual inspection related to the kidneys focuses on the patient's flank and abdomen. Kidney trauma is suspected if a purplish discoloration is present on the flank (Grey-Turner sign) or near the posterior 11th or 12th ribs.
The patient in renal failure has experienced a severe hypotensive event, and the ratio of BUN to creatinine is 15:1. The nurse is aware that this is an example of: prerenal failure. intrarenal failure. postrenal failure. chronic renal failure.
prerenal failure.
A nurse is evaluating a client's understanding of peritoneal dialysis. Which information in the client's response indicates an understanding of the purpose of the procedure? 1-Reestablishing kidney function 2-Cleaning the peritoneal membrane 3-Providing fluid for intracellular spaces 4-Removing toxins in addition to other metabolic wastes
4-Removing toxins in addition to other metabolic wastes
When preparing discharge teaching for a client who had a kidney transplant, in addition to a corticosteroid, the nurse expects what other medications to be prescribed to prevent kidney rejection? 1-Furosemide and sirolimus 2-Cefazolin and methotrexate 3-Methylprednisolone and phenytoin 4-Tacrolimus and mycophenolate mofeti
4-Tacrolimus and mycophenolate mofeti Standard triple therapy includes a corticosteroid prednisone (methylprednisolone), an antimetabolite (mycophenolate), and a calcineurin inhibitor (tacrolimus and cyclosporine).
Which of the following immunologic mechanisms are involved in glomerulonephritis? Tubular blocking by precipitates of bacteria and antibody reactions. Deposition of immune complexes and complement in glomerular basement membrane (GBM). Thickening of the GBM from autoimmune microangiopathic changes. Destruction of glomeruli by proteolytic enzymes contained in the GBM.
Deposition of immune complexes and complement in glomerular basement membrane (GBM). Glomerulonephritis is an immunologic inflammatory process affecting the renal glomeruli, resulting from two different types of antibody-induced injury. In the first type, an unknown mechanism stimulates the development of autoantibodies specific for antigens within the glomerular basement membrane.
Hypertension develops in a school-aged child with acute glomerulonephritis. What medication does the nurse anticipate that the healthcare provider will prescribe? 1-Digoxin 2-Furosemide 3-Diazepam 4-Phenytoin
2-Furosemide
A nurse is giving discharge instructions to the parents of an adolescent boy with nephrotic syndrome. What statement by one of the parents about the child's care indicates that more instruction is needed? 1-"Any gain in weight is expected." 2-"We'll give him prednisone with meals." 3-"We'll be sure to test his urine for albumin." 4-"We'll be sure to check his eyelids every morning
1-"Any gain in weight is expected."
A client is receiving epoetin for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary? 1-"I realize it is important to take this medication because it will cure my anemia." 2-"I know many ways to protect myself from injury because I am at risk for seizures." 3-"I recognize that I may still need blood transfusions if my blood values are very low." 4-"I understand that I will still have to take supplemental iron therapy with this medication."
1-"I realize it is important to take this medication because it will cure my anemia."
While the nurse is at the bedside of a client in acute renal failure, the client states, "My healthcare provider said that I will be getting some insulin. Do I also have diabetes?" What is the best nursing response? 1-"No, the insulin will help your body handle the increased potassium level." 2-"I suggest that you ask your healthcare provider that question." 3-"You probably had an elevated blood glucose level, so your healthcare provider is being cautious." 4-"No, but insulin will reduce the toxins in your blood by lowering your metabolic rate.
1-"No, the insulin will help your body handle the increased potassium level."
The nurse is preparing a blood transfusion for a client with renal failure. Why does anemia often complicate renal failure? 1-Increase in blood pressure 2-Decrease in erythropoietin 3-Increase in serum phosphate levels 4-Decrease in serum sodium concentration
2-Decrease in erythropoietin The hormone erythropoietin, produced by the kidneys, stimulates the bone marrow to produce red blood cells. In renal failure there is a deficiency of erythropoietin that often results in the client developing anemia.
he nurse is explaining the physiologic reasons for taking vitamin D and calcium supplements to a client with renal failure. Which statement made by the nurse is appropriate? 1-"There will be a decrease in the inactive forms of vitamin D in your body." 2-"There will be a decrease in the active metabolite of vitamin D in your body." 3-"There will be an increase in the conversion of skin cholesterol into vitamin D." 4-"There will be an increase in the vitamin D associated intestinal absorption of calcium."
2-"There will be a decrease in the active metabolite of vitamin D in your body."
During an 8-hour shift a client drinks two 6-ounce cups of tea and vomits 125 mL of fluid. Intravenous fluids absorbed equaled the urinary output. What is the client's fluid balance during this 8-hour period? 125 mL 235 mL 360 mL 485 mL
235 mL 235 mL is the correct calculation. The client's intake was 360 mL (6 oz × 30 mL = 360 mL) and the loss was 125 mL of fluid; 360 mL - 125 mL = 235 mL.
A 3.5-year-old child hospitalized with nephrotic syndrome. The child has been toilet trained for longer than one year but has been incontinent while in the hospital. The child's parents express concern over this behavior. What is the most therapeutic response by the nurse? 1-"Your child is wetting the bed to get attention. Set limits when this occurs." 2-"The incontinence is caused by the renal disease. It will stop with physical improvement." 3-"This is an expected response to hospitalization. Ignore the regressive behavior and be supportive." 4-"Your child is using this regressive behavior to help cope with hospitalization; just use diapers and say nothing."
3-"This is an expected response to hospitalization. Ignore the regressive behavior and be supportive."
A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy? 1-"It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration." 2-"It exchanges and cleanses blood by correction of electrolytes and excretion of creatinine." 3-"It decreases the need for immobility because it clears toxins in short and intermittent periods." 4-"It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion.
4-"It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion.
On assessment, the nurse notes that a client with glomerulonephritis has developed crackles in the lung bases bilaterally. Vital signs: BP 150/100, PR 110, RR 24, O2 sat 97%. What should the nurse do? Select all that apply. Assess for complications such as fluid overload. Notify the health care provider (HCP). Elevate head of bed and insert foley catheter. Advise the client to get more rest. Notify dietician to reduce caloric intake.
Assess for complications such as fluid overload. Notify the health care provider (HCP