Ch 58: Disorders of the Kidneys and Ureters NCLEX Q

A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate?

Donors are selected from compatible living donors.

The nurse is assessing a client suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem?

Hematuria

Which term is used to describe the concentration of urea and other nitrogenous wastes in the blood?

Azotemia

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?

Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL

A client with chronic kidney disease has been hospitalized and is receiving hemodialysis on a scheduled basis. The nurse should include which of the following actions in the plan of care?

Assess for a thrill or bruit over the vascular access site each shift.

The nurse is caring for a client who has returned to the postsurgical suite after postanesthetic recovery from a nephrectomy. The nurse's most recent hourly assessment reveals a significant drop in level of consciousness and BP as well as scant urine output over the past hour. What is the nurse's best response?

Assess the client for signs of bleeding and inform the primary provider.

A female patient undergoes dialysis as a part of treatment for kidney failure. The patient is administered heparin during dialysis to achieve therapeutic levels. Which of the following steps should the nurse take to allow heparin to be metabolized and excreted in the patient?

Avoid administering injections for 2 to 4 hours after heparin administration.

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:

"As the disease progresses, you will most likely require renal replacement therapy."

A 45-year-old man with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis?

"Hemodialysis is a treatment option that is usually required three times a week."

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?

A GFR of 30-59 mL/min/1.73 m2

The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client?

Hemodialysis

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?

Hypovolemic shock caused by hemorrhage

What is a characteristic of the intrarenal category of acute kidney injury (AKI)?

Increased BUN

What is a characteristic of the intrarenal category of acute renal failure?

Increased BUN

The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output?

Less than 400 mL

The nurse is caring for a client after kidney surgery. When assessing for bleeding, what assessment parameter should the nurse evaluate?

Level of consciousness

The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated?

Obtaining a blood pressure reading from the right arm

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI?

Oliguria

Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys?

Oliguria

When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic?

Penicillin

What is a hallmark of the diagnosis of nephrotic syndrome?

Proteinuria

The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? Select all that apply.

Red blood cells in the urine Proteinuria White cell casts in the urine

A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action?

Reposition the patient to facilitate drainage.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?

Risk for infection

As glomerular filtration decreases, which of the following occurs? Select all that apply.

Serum creatinine increases Blood urea nitrogen (BUN) increases Creatinine clearance decreases

The nurse is providing a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants' risks of renal carcinoma?

Smoking cessation

What is used to decrease potassium level seen in acute renal failure?

Sodium polystyrene sulfonate

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.

Tall, peaked T waves

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?

Urine output of 20 ml/hour

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

Urine output of 250 ml/24 hours

The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to do what?

Wash hands carefully and frequently.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?

White blood cell (WBC) count of 20,000/mm3

The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time?

With each meal

The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication?

With food

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level?

dministration of sodium polystyrene sulfonate [Kayexalate])

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:

fatigue and weakness.

The nurse cares for a client who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed:

hyperacute rejection.

A client has been diagnosed with acute glomerulonephritis. This condition causes:

proteinuria.

One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include:

restricting sources of potassium usually found in fresh fruits and vegetables.

A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:

sodium polystyrene sulfonate (Kayexalate)

Tumors of the kidney are almost always cancerous. Renal cell carcinoma is the most common type of kidney cancer in adults. The cause of kidney tumors is unknown; however, certain risk factors are known. What are the known risk factors? Select all that apply.

tobacco use obesity age

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:

water and sodium retention secondary to a severe decrease in the glomerular filtration rate.