Chapter 54 PrepU
A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess? Extremity pain Periorbital edema Fever Hypertension
HTN Hypertension is present in approximately 75% of clients with polycystic kidney disease at the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and abdominal pain also may be noted based on the size and effects of the cysts. Fever would suggest an infection. Periorbital edema is noted with acute glomerulonephritis.
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? "The doctor may decide to delay the use of immunosuppressant drugs." "Even a perfect match does not guarantee organ success." "Let's wait until after the surgery to discuss your treatment plan." "Immunosuppressive drugs guarantee organ success."
"Even a perfect match does not guarantee organ success." A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse?
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan? Assess the AV fistula for a bruit and thrill. Keep the AV fistula wrapped in gauze. Keep the AV fistula site dry. Take the client's blood pressure in the left arm.
Assess the AV fistula for a bruit and thrill.
A client is experiencing a decreasing glomerular filtration. What laboratory values should the nurse expect to follow the change? Select all that apply. Blood urea nitrogen (BUN) increases Serum creatinine increases Creatinine clearance decreases Hypophosphatemia Hypokalemia
Blood urea nitrogen (BUN) increases Serum creatinine increases Creatinine clearance decreases
Based on the pathophysiologic changes that occur as renal failure progresses, the nurse identifies the following indicators associated with the disease. Select all that apply. Hypocalcemia Hyperalbuminemia Metabolic alkalosis Anemia Hyperkalemia
Hyperkalemia Anemia Hypocalcemia Hyperkalemia is due to decreased potassium excretion and excessive potassium intake. Metabolic acidosis results from decreased acid secretion by the kidney. A damaged glomerular membrane causes excess protein loss.
Nursing assessment for the patient receiving peritoneal dialysis would include which of the following to detect the most serious complication of this procedure? Inspect the catheter site for leakage of dialysate. Measure fluid drainage to estimate incomplete recovery of fluid. Palpate the abdominal wall for rebound tenderness. Observe for evidence of bleeding.
Palpate the abdominal wall for rebound tenderness. Peritonitis is the most serious complication of peritoneal dialysis. To detect rebound tenderness, the nurse presses one hand firmly into the abdominal wall and quickly withdraws the hand. Rebound tenderness exists when pain occurs upon removal; this pain is associated with inflammation of the peritoneal cavity.
A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? Tenderness over transplant site Hypotension Polyuria Weight loss
Tenderness over transplant site Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.
A client is admitted to the hospital with a prerenal disorder, a nonurologic condition that disrupts renal blood flow to the nephrons, affecting their filtering ability. One cause of prerenal acute kidney injury is: anaphylaxis polycystic disease ureteral stricture myoglobinuria secondary to burns
anaphylaxis Anaphylaxis is a cause of prerenal acute renal failure. Myoglobinuria secondary to burns is a cause of intrarenal acute renal failure. Polycystic disease is a cause of intrarenal acute renal failure. Ureteral stricture is a cause of postrenal acute renal failure.
Which assessment finding is most important in determining the severity of client's acute glomerulonephritis? Dark smoky colored urine Peripheral edema Presence of albumin in the urine Blurred vision
Blurred vision Visual disturbances can be indicative of rising blood pressure in a client with acute glomerulonephritis. Severe hypertension needs prompt treatment to prevent convulsions. Presence of albumin (protein) and RBCs in the urine, along with periorbital and peripheral edema, are common symptoms associated with glomerulonephritis.
A client has a family history of polycystic kidney disease. As the nurse gathers information and completes an assessment related to a polycystic kidney diagnosis, which findings would the nurse expect to find? Select all that apply. Hypertension Normal urinalysis No renal stones Polyuria Pain from retroperitoneal bleeding
Hypertension Pain from retroperitoneal bleeding Polyuria Hypertension is present in affected clients at the time of diagnosis. Pain from retroperitoneal bleeding is caused by the size and effects of the cysts. Polyuria can occur. Urinalysis shows mild proteinuria, hematuria, and pyuria. Renal stones are common.
A client develops acute renal failure (ARF) after receiving IV therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 mL, the nurse suspects that the client is at risk for: paresthesia. dehydration. pruritus. cardiac arrhythmia.
cardiac arrhythmia. As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn't cause paresthesia (sensations of numbness and tingling). Dehydration doesn't occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. In the client with ARF, pruritus results from increased phosphates and isn't associated with hyperkalemia.
During hemodialysis, toxins and wastes in the blood are removed by which of the following? Ultrafiltration Osmosis Filtration Diffusion
diffusion The toxins and wastes in the blood are removed by diffusion, in which particles move from an area of higher concentration in the blood to an area of lower concentration into the dialysate.
The nurse monitors the client for potential complications during dialysis but recognizes NOT to monitor for air embolism. muscle cramping. dysrhythmias. hypertension.
hypertension. The nurse should monitor for hypotension, not hypertension, during the treatment related to the removal of fluid. Muscle cramping may occur late in dialysis as fluid and electrolytes rapidly leave the extracellular space. Dysrhythmias may result from electrolyte and pH changes or removal of antiarrhythmic medications. Air embolism is rare, but could occur if air enters the vascular system
A client's renal failure has become chronic. Which signs and symptoms are associated with chronic renal failure? Select all that apply. muscle cramps lethargy bleeding of the oral mucous membranes enhanced cognition
muscle cramps lethargy bleeding of the oral mucous membranes Lethargy, muscle cramps, and bleeding of the oral mucous membranes are some of the signs and symptoms of chronic renal failure. With chronic renal failure, mental processes progressively slow as electrolyte imbalances become marked and nitrogenous wastes accumulate.
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? "Be sure to eat meat at every meal." "Eat plenty of bananas." "Increase your carbohydrate intake." "Drink plenty of fluids, and use a salt substitute."
"Increase your carbohydrate intake." A client with CRF requires extra carbohydrates to prevent protein catabolism. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Salt substitutes are high in potassium and should be avoided.
A nurse is caring for a client on bedrest with end-stage kidney disease. What major manifestation of uremia should the nurse expect to decrease with an exercise plan? A decreased serum phosphorus level Bone demineralization Increased secretion of parathormone Hyperparathyroidism
Bone demineralization Uremic bone disease, often called renal osteodystrophy, develops from the complex changes in calcium, phosphate, and parathormone balance. Clients on bedrest with end-stage kidney disease will have increased bone demineralization. Bone disease will cause a retention of phosphorus, low serum calcium levels, abnormal vitamin D metabolism, and elevated aluminum levels. Hypoparathyroidism and decreased secretion of the parathormone will occur with the client on bedrest.
The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply. Potassium 6.4 mEq/L; dysrhythmias and abdominal distention Phosphate 5.0 mg/dL; tachycardia and nausea and emesis Chloride 90 mEq/L; irritability and seizures Magnesium 1.5 mg/dL; mood changes and insomnia Calcium 7.5 mg/dL; hypotension and irritability
Calcium 7.5 mg/dL; hypotension and irritability Potassium 6.4 mEq/L; dysrhythmias and abdominal distention Phosphate 5.0 mg/dL; tachycardia and nausea and emesis Decreased calcium, increased potassium, and increased phosphate levels are associated with ESKD, along with the signs and symptoms associated with these serum values. Decreased magnesium and chloride levels are not associated with ESKD.
Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure? Activity intolerance Disturbed body image Urinary retention Fluid volume excess
Fluid volume excess The oliguric phase is characterized by fluid retention.
A client is being cared for after a nephrectomy. Because of the incisional pain and restricted positioning, the client frequently suffers from breathing difficulty. Which measures should the nurse include in the care plan to relieve this distress? Select all that apply. Have client walk around the room as much as possible. Provide firm support for the incision when the client coughs. Help the client to breathe deeply and cough every 2 hours. Administer antibiotic therapy as prescribed.
Help the client to breathe deeply and cough every 2 hours. Provide firm support for the incision when the client coughs.
A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure? Obstruction of the urinary collecting system Nephrotoxic injury secondary to use of contrast media Poor perfusion to the kidneys Damage to cells in the adrenal cortex
Nephrotoxic injury secondary to use of contrast media Intrinsic renal failure results from damage to the kidney, such as from nephrotoxic injury caused by contrast media, antibiotics, corticosteroids, or bacterial toxins. Poor perfusion to the kidneys may result in prerenal failure. Damage to the epithelial cells of the renal tubules results from nephrotoxic injury, not damage to the adrenal cortex. Obstruction of the urinary collecting system may cause postrenal failure.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? Risk for infection Activity intolerance Impaired urinary elimination Toileting self-care deficit
Risk for infection The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.
Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for: bone marrow transplant. intra-abdominal instillation of methylprednisolone sodium succinate (Solu-Medrol). high-dose IV cyclosporine (Sandimmune) therapy. removal of the transplanted kidney.
removal of the transplanted kidney. Hyperacute rejection isn't treatable; the only way to stop this reaction is to remove the transplanted organ or tissue. Although cyclosporine is used to treat acute transplant rejection, it doesn't halt hyperacute rejection. Bone marrow transplant isn't effective against hyperacute rejection of a kidney transplant. Methylprednisolone sodium succinate may be given IV to treat acute organ rejection, but it's ineffective against hyperacute rejection.
A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD? The client has a history of severe anemia during hemodialysis. The client has a history of diverticulitis. The client is on the kidney transplant waiting list. The client is blind in his right eye.
The client has a history of diverticulitis. A history of diverticulitis contraindicates CAPD because CAPD has been associated with the rupture of diverticulum. A history of severe anemia while on hemodialysis or being on the transplant waiting list doesn't contraindicate CAPD. The client who's blind or partially blind can still learn to perform CAPD.
The laboratory results for a patient with renal failure, accompanied by decreased glomerular filtration, would be evaluated frequently. Which of the following is the most sensitive indicator of renal function? Urinary protein level of 150 mg/24h. Creatinine clearance of 90 mL/min BUN of 20 mg/dLb Serum creatinine of 1.5 mg/dL
Serum creatinine of 1.5 mg/dL As glomerular filtration decreases, the serum creatinine and BUN levels increase and the creatinine clearance decreases. Serum creatinine is the more sensitive indicator of renal function because of its constant production in the body. The BUN is affected not only by renal disease but also by protein intake in the diet, tissue catabolism, fluid intake, parenteral nutrition, and medications such as corticosteroids.
The nurse treats a client with end-stage kidney disease (ESKD). The nurse is concerned that the client is developing renal osteodystrophy. Upon review of the client's laboratory values, it is noted the client has had a calcium level of 11 mg/dL for the past 3 days and the phosphate level is 5.5 mg/dL. The nurse anticipates the administration of which medication? Calcium acetate Calcium carbonate Sevelamer hydrochloride Mylanta
Sevelamer hydrochloride Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the gastrointestinal tract. Binders such as calcium carbonate or calcium acetate are prescribed, but there is a risk of hypercalcemia. If calcium is high or the calcium-phosphorus product exceeds 55 mg/dL, a polymeric phosphate binder such as sevelamer hydrochloride may be prescribed. This medication binds dietary phosphorus in the intestinal tract; one to four tablets should be administered with food to be effective. Magnesium-based antacids are avoided to prevent magnesium toxicity.
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: "Dietary changes can reverse the damage that has occurred in your kidneys." "As the disease progresses, you will most likely require renal replacement therapy." "Draining of the cysts and antibiotic therapy will cure your disease." "Genetic testing will determine the best treatment for your condition."
"As the disease progresses, you will most likely require renal replacement therapy." There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.
As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur? Hypercalcemia Hyperphosphatemia Hypokalemia Metabolic alkalosis
Hyperphosphatemia Changes include hyperphosphatemia due to its decreased renal excretion, hypocalcemia and decreased vitamin D activation, hyperkalemia due to decreased potassium excretion, and metabolic acidosis from decreased acid secretion by the kidney and inability to regenerate bicarbonate.
A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause? Dysrhythmias Renal calculi Acute pyelonephritis Osmotic dieresis.
Renal calculi Postrenal ARF is the result of an obstruction that develops anywhere from the collecting ducts of the kidney to the urethra. This results from ureteral blockage, such as from bilateral renal calculi or benign prostatic hypertrophy (BPH).
A child is brought into the clinic with symptoms of edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem? Protein elevation in the urine Sore throat 2 weeks ago Elevation of blood pressure Red blood cells in the urine
Sore throat 2 weeks ago Acute glomerulonephritis usually occurs as a result of bacterial infection such as seen with a beta-hemolytic streptococcal infection or impetigo. Red blood cells and protein found in the urine and elevated blood pressure are symptoms associated with glomerulonephritis.
A patient is placed on hemodialysis for the first time. The patient complains of a headache with nausea and begins to vomit, and the nurse observes a decreased level of consciousness. What does the nurse determine has happened? The patient is experiencing a cerebral fluid shift. Too much fluid was pulled off during dialysis. The dialysis was performed too rapidly. The patient is having an allergic reaction to the dialysate.
The patient is experiencing a cerebral fluid shift. Dialysis disequilibrium results from cerebral fluid shifts. Signs and symptoms include headache, nausea and vomiting, restlessness, decreased level of consciousness, and seizures. It is rare and more likely to occur in AKI or when BUN levels are very high (exceeding 150 mg/dL).
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: allowing liberal use of sodium. limiting iron and folic acid intake. eating protein liberally. restricting sources of potassium.
restricting sources of potassium. The nurse will teach the client to restrict sources of potassium, such as fresh fruits and vegetables, because hyperkalemia can cause life-threatening changes. The client will restrict sodium intake as ordered; doing so prevents fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken; iron and folic acid supplements are needed for red blood cell (RBC) production, and Epogen stimulates the bone marrow to produce RBCs. The client will restrict protein intake to foods that are complete proteins within prescribed limits; complete proteins provide positive nitrogen balance for healing and growth.
A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: weight loss. increased urine output. increased blood pressure. hematuria.
weight loss. Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.
