Adult Health II Quiz 5: Renal
During the immediate postoperative care of the recipient of a kidney transplant, the nurse expects to a) regulate fluid intake hourly based on urine output b) find urine-tinged drainage on abdominal dressing c) medicate the patient frequently for abdominal flank pain d) remove the urinary catheter to evaluate the ureteral implant
Answer: A Rationale: Fluid and electrolyte balance is critical in the transplant-recipient patient, especially because diuresis often begins soon after surgery. Fluid replacement is adjusted hourly, based on kidney function and output. Urine-tinged drainage on the abdominal dressing may indicate leakage from the ureter implanted into the bladder, and the health care provider should be notified. The donor patient has a flank incision where the kidney was removed,; the recipient patient has an abdominal incision where the kidney was placed in the iliac fossa. The urinary catheter is usually used for 2-3 days to monitor urine output and kidney function.
The nurse evaluates the potency of an AV graft by a) palpating for pulses distal to the graft site b) auscultating for the presence of a bruit at the site c) evaluating the color and temperature of the extremity d) assessing for the presence of numbness and tingling distal to the site
Answer: B Rationale: A patent AV graft creates turbulent blood flow that can be assessed by listening for a bruit or palpated for a thrill as the blood passes through the graft. Assessment of neurovascular status in the extremity distal to the graft site is important to determine that the graft does not impair circulation to the extremity, but the neuromuscular status does not indicate whether the graft is open.
In replying to a patient's questions about the seriousness of her chronic kidney disease (CKD), the nurse knows that the stage of CKD is based on the a) total daily urine output b) glomerular filtration rate c) serum creatinine and urea levels d) degree of altered mental status
Answer: B Rationale: Stages of CKD are based on the glomerular filtration rate (GFR) or the presence of kidney damage over a period of 3 months. No specific markers of urinary output, azotemia, or urine output classify the degree of CKD.
Acute pyelonephritis resulting from an ascending infection from the lower urinary tract occurs most often when a) the kidney is scarred and fibrotic b) the organism is resistant to antibiotics c) there is a preexisting abnormality of the urinary tract d) the patient does not take all of the antibiotics for treatment of a UTI
Answer: C Rationale: Ascending infections from the bladder to the kidney are prevented by normal anatomy and physiology of the urinary tract unless a preexisting condition, such as bladder tumors, prostatic hyperplasia, strictures, or stones, is present. Resistance to antibiotics and failure to take a full prescription of antibiotics for a UTI usually result in relapse or reinfection of the lower urinary tract.
Patients at risk for renal lithiasis can prevent stones in many cases by a) leading an active lifestyle b) limiting protein and acid foods in the diet c) drinking enough fluids to produce a urine output of 2 L/day d) taking prophylactic antibiotics to control UTIs
Answer: C Rationale: Because crystallization of stone constituents can precipitate and unite to form a stone when in supersaturated concentrations, one of the best ways to prevent stones of any type is to keep the urine dilute and flowing, which is an output of about 2 L/day. Sedentary lifestyle is a risk factor for renal stones, but exercise also causes fluid loss and a need for additional fluids. Protein foods high in purine should be restricted only for the small percentage of patients with uric acid stones, and although UTIs contribute to stone formation, prophylactic antibiotics are not indicated.
A nurse teaches the signs of organ rejection to a patient who had a kidney transplant. Which sign would the client have to identify for the nurse to determine that the patient understands the teaching? a) weight loss b) subnormal temperature c) elevated blood pressure d) increased urinary output
Answer: C Rationale: Hypertension is caused by hypervolemia because of the failure of the new kidney.
While caring for a 77-year old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. The clinical manifestations the patient is likely to experience include: a) cloudy urine and fever b) urethral burning and bloody urine c) vague abdominal pain and disorientation d) suprapubic pain and slight decline in body temperature
Answer: C Rationale: The usual classic symptoms of UTI are often absent in older adults, who tend to experience non localized abdominal pain, rather than dysuria and suprapubic pain. They may also experience cognitive impairment characterized by confusion or decreased LOC.
A patient has end-stage kidney disease and is receiving hemodialysis. During dialysis, the client complains of nausea and a headache and appears confused. Operating on standard protocols, the nurse should: a) give an analgesic b) administer an antiemetic c) decrease the rate of exchange d) discontinue the procedure immediately
Answer: C Rationale: These are symptoms of disequilibrium syndrome. which results from rapid changes in composition of the ECF and cerebral edema; the rate of exchange should be decreased.
When admitting a patient with benign prostatic hyperplasia, the most relevant assessment made by the nurse is: a) perineal edema b) urethral discharge c) flank pain radiating to the groin d) distention of the lower abdomen
Answer: D Rationale: Distention of the suprapubic area indicates that the bladder is distended with urine and therefore palpable.
A patient rapidly progressing toward end-stage renal disease asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that contraindications to kidney transplantation include a) hepatitis C infection b) coronary artery disease c) refractory hypertension d) extensive vascular disease
Answer: D Rationale: Extensive vascular disease is a contraindication of renal transplantation, primarily because adequate blood supply is essential to both the health of the new kidney and the circulation of immunosuppressive drugs. Other contraindications include disseminated malignancies, refractory or untreated cardiac disease, chronic respiratory failure, chronic infection, or unresolved psychosocial disorders. CAD may be treated with bypass surgery before transplantation, and transplantation can relieve hypertension. Hepatitis B or C infection is not a contraindication.
While caring for the patient in the oliguric phase of AKI, the nurse monitors the patient for associated collaborative problems, notifying the health care provider when a) urine output is 300 mL/day b) edema occurs in the feet, legs, and sacral area c) the cardiac monitor reveals a depressed T wave and a sagging ST segment d) the patient experiences increasing muscle weakness and abdominal cramping
Answer: D Rationale: Hyperkalemia is a potentially life threatening complication o fAKI in the oliguric phase. Muscle weakness and abdominal cramping are signs of the neuromuscular impairment that occurs with hyperkalemia, in addition to the cardiac conduction abnormalities of a peaked T wave, prolonged PR interval, prolonged QRS interval, and depressed ST segment. Urine output of 300 ml/day is expected during the oliguric phase, as is the development of peripheral edema.
A nurse is obtaining the health history of a patient with a left ureteral calculus who is scheduled for a trans-urethral ureterolithotomy. Which description of pain should the nurse expect the client to report? a) Boring pain in the left flank b) Pain that intensifies on urination c) Dull paint that is constant in the costovertebral angle d) Spasmodic pain on the left side that radiates to the suprapubic area.
Answer: D Rationale: Pain with ureteral stones is caused by spasm ad is excruciating and intermittent; it follows the path of the ureter to the bladder.
If a patient on peritoneal dialysis develops symptoms of severe respiratory difficulty during the infusion of the dialysate solution, the nurse should: a) increase the rate of infusion b) auscultate the lungs for breath sounds c) place the patient in a low Fowler's position d) drain the fluid from the peritoneal cavity
Answer: D Rationale: Pressure from the fluid may cause upward displacement of the diaphragm; draining the solution reduces intra-abdominal pressure, which allows the thoracic cavity to expand on inspiration.
A nurse is assessing a patient who reports frequency and burning when urinating. The nurse performs percussion to determine if there is tenderness that the presence of of an ascending urinary tract infection. Which area should be percussed? a) Tail of Spence b) Suprapubic area c) McBurney's Point d) Costovertebral angle
Answer: D Rationale: The costovertebral angle (angle formed by the lateral and downward curve of the lowest rib and the vertebral column of the spine itself) is percussed to determine if there is tenderness in the area over the kidney; this can be a sign of glomerulonephritis or severe upper urinary tract infection.
Match the following conditions and characteristics with their associated etiologies of acute kidney injury (AKI): (1) prerenal; (2) intrarenal; (3) postrenal - answers may be used more than once. ___a) decreased cardiac output ___b) mechanical outflow obstruction ___c) initial cause of most acute renal failure ___d) prostate cancer ___e) tubular obstruction by myoglobin ___f) hypovolemia ___g) renal stones ___h) nephrotoxic drugs ___i) bladder cancer ___j) renal vascular obstruction ___k) acute glomerulonephritis ___l) anaphylaxis
Answers: a) 1 b) 3 c) 1 d) 3 e) 2 f) 1 g) 3 h) 2 i) 3 j) l k) 2 l) 1
A patient who has been receiving hemodialysis for several years is to receive a kidney transplant. The nurse plans to review the essential information that the patient should know before surgery. Select all that apply. ___a) Precautions needed to prevent infection ___b) Kidney may not function immediately ___c) Urinary catheter will be present postoperatively ___d) Immunosuppressive drugs will be given preoperatively ___e) AV fistula will be used for drawing blood specimens preoperatively
Answers: 1, 2, 3 Rationale: Because kidney infection is a major complication of a kidney transplant, prevention begins with the recognition of the earliest signs and symptoms. The transplanted kidney does not always function immediately; the client should know that dialysis may have to be continued for several weeks. Just prior to a surgery, a urinary catheter is inserted and an antibiotic is instilled into the bladder to decrease the risk of infection.
A home health nurse visits a 40 yo housewife who is receiving hemodialysis. When reviewing the diet with the client, the nurse encourages her to include: a) rice b) potatoes c) canned salmon d) barbecued beef
Answer: A Rationale: Foods high in carbohydrates and low in protein, sodium, and potassium are encouraged for these clients.
After a transurethral vaporization of the prostate, the patient returns to the unit with a urinary retention catheter and a continuous bladder irrigation. What should the nurse do first when the client indicates the need to urinate? a) Assess that the tubing attached to the collection bag is patent. b) Obtain the patient's vital signs before notifying the practitioner. c) Explain that the balloon inflated in the bladder causes this feeling. d) Review the patient's intake and output that was documented in the previous shift.
Answer: A Rationale: The drainage tubing may be obstructed. Retained fluid raises intravesicular pressure, causing discomfort similar to the urge to void.
When teaching a community health class the nurse informs the group that the person at highest risk of developing prostate cancer is: a) 55 yo Black male b) 45 yo white male c) 55 yo Asian male d) 45 yo Hispanic male
Answer: A Rationale: Cancer of the prostate is rare before age 50 but increases with each decade; black men develop cancer of the prostate twice as often and at an earlier age than white men.
Indicate whether the following characteristics are associated with peritoneal dialysis (PD) or hemodialysis (HD). ___a) requires vascular access ___b) increased hyperlipidemia ___c) lowers serum triglycerides ___d) portable system ___e) less cardiovascular stress ___f) more protein loss ___g) intensifies anemia ___h) rapid fluid and creatinine loss ___i) requires fewer dietary restrictions
Answers: a) HD b) PD c) HD d) PD e) PD f) PD g) HD h) HD i) PD