Renal Prep-U
A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate? a) "Try washing clothes with a strong detergent to ensure that all impurities are gone." b) "Keep your showers brief, patting your skin dry after showering." c) "Liberally apply alcohol to the areas of your skin where you itch the most." d) "When you shower, use really warm water and an antibacterial soap."
"Keep your showers brief, patting your skin dry after showering." Explanation: The client with pruritus needs to keep the skin clean and dry. The client should take brief showers with tepid water, pat the skin dry, use moisturizing lotions or creams, and avoid scratching. In addition, the client should use a mild laundry detergent to wash close and an extra rinse cycle to remove all detergent or add 1 tsp vinegar per quart of water to the rinse cycle to remove any detergent residue
The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following? a) Hypophosphatemia b) Metabolic alkalosis c) Hypokalemia d) Anemia
Anemia Explanation: Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic glomerulonephritis.
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? a) Brief, hot daily showers b) Keeps nails trimmed short c) Pats skin dry after bathing d) Uses moisturizing creams
Brief, hot daily showers Explanation: Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek's sign. What deficit does the nurse suspect the patient has? a) Magnesium b) Calcium c) Phosphorus d) Sodium
Calcium Explanation: Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes
The nurse is educating a patient who is required to restrict potassium intake. What foods would the nurse suggest the patient eliminate that are rich in potassium? a) Butter b) Salad oils c) Cooked white rice d) Citrus fruits
Citrus fruits Explanation: Foods and fluids containing potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee) are restricted.
A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? a) Decrease in the blood flow through the kidneys b) Blood clot formed in the kidneys interfered with the flow c) Obstruction of urine flow from the kidneys d) Structural damage occurred in the nephrons of the kidneys
Decrease in the blood flow through the kidneys Explanation: Acute renal failure can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.
An elderly client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? a) Shows damage to the kidneys b) Reveals causative microorganisms c) Detects calculi, cysts, or tumors d) If risk for chronic pyelonephritis is likely
Detects calculi, cysts, or tumors Explanation: Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.
Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure? a) Ureteral calculus b) Dysrhythmia c) Glomerulonephritis d) Hypovolemia
Glomerulonephritis Explanation: Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
Which of the following is an integumentary manifestation of chronic renal failure? a) Gray-bronze skin color b) Seizures c) Tremors d) Asterixis
Gray-bronze skin color Explanation: Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? a) Increase protein, carbohydrates, and fat intake. b) Increase fat intake and limit carbohydrates. c) Increase carbohydrates and limit protein intake. d) Eliminate fat intake and increase protein intake.
Increase carbohydrates and limit protein intake. Explanation: Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? a) Increased serum creatinine level b) Decreased serum potassium level c) Increased red blood cell count d) Increased serum calcium level
Increased serum creatinine level Explanation: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.
A patient diagnosed AKI has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering which of the following? a) Calcium supplements b) Sorbitol c) IV dextrose 50% d) Kayexalate
Kayexalate Explanation: The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract. Sorbitol may be administered in combination with Kayexalate to induce a diarrhea-type effect (it induces water loss in the GI tract). If the patient is hemodynamically unstable (low blood pressure, changes in mental status, dysrhythmia), IV dextrose 50%, insulin, and calcium replacement may be administered to shift potassium back into the cells.
When assessing the impact of medications on the etiology of ARF, the nurse recognizes which of the following as the drug that is not nephrotoxic? a) Neomycin b) Penicillin c) Gentamicin d) Tobramycin
Penicillin Explanation: The three nephrotoxic drugs are aminoglycerides.
Which of the following would a nurse classify as a prerenal cause of acute renal failure? a) Septic shock b) Ureteral stricture c) Prostatic hypertrophy d) Polycystic disease
Septic shock Explanation: Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias. Ureteral stricture and prostatic hypertrophy would be classified as postrenal causes. Polycystic disease is classified as an intrarenal cause of acute renal failure.
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. a) Prolonged ST segment b) Shortened QRS complex c) Tall, peaked T waves d) Multiple spiked P waves
Tall, peaked T waves Explanation: Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a) Serum potassium level of 4.9 mEq/L b) Urine output of 20 ml/hour c) Serum sodium level of 135 mEq/L d) Temperature of 99.2° F (37.3° C)
Urine output of 20 ml/hour Explanation: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a) Blood urea nitrogen (BUN) level of 22 mg/dl b) Urine output of 250 ml/24 hours c) Temperature of 100.2° F (37.8° C) d) Serum creatinine level of 1.2 mg/dl
Urine output of 250 ml/24 hours Explanation: ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.
A nurse receives her client care assignment. Following the report, she should give priority assessment to the client: a) with pinkish mucus discharge in the appliance bag 2 days after an ileal conduit. b) who has a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L 7 days after a kidney transplant. c) who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L. d) who is experiencing mild pain from urolithiasis.
who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L. Explanation: A sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L in a client immediately following dialysis should be the priority assessment. Pinkish mucus discharge in the appliance bag is a normal finding for a client who's had an ileal conduit, as are a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L in a client who's had a kidney transplant. Although the nurse should further assess mild pain from urolithiasis, this is an expected finding and not a priority in relation to the client with abnormal sodium and potassium levels
Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? a) SpO2 at 90% with fine crackles in the lung bases b) Pain of 3 out of 10, 1 hour after analgesic administration c) Blood tinged drainage in Jackson-Pratt drainage tube d) Urine output of 35 to 40 mL/hour
SpO2 at 90% with fine crackles in the lung bases Explanation: The Risk for Ineffective Breathing Pattern is often a challenge in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output is monitored to maintain a urine output of greater than 30 mL/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period
