kidney disorders-chapter 47, 48 & 49 (evolve, NCLEX prep & notes)

Which is the most life threatening of the fluid and electrolyte changes that occur in the patient with renal disturbances?

Hyperkalemia

_____ is the most life-threatening of the fluid and electrolyte changes that occur in patients with renal disturbances

Hyperkalemia

After a renal biopsy, the client complains of pain at the biopsy site, which radiates to the front of the abdomen. Which would this indicate? A. Bleeding B. Infection C. Renal colic D. Normal, expected pain

A. If pain originates at the biopsy site and begins to radiate to the flank area and around the front of the abdomen, bleeding should be suspected. Hypotension, a decreased hematocrit, and gross or microscopic hematuria should also indicate bleeding.

In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to the maintenance of homeostasis. Which of the following physiological processes are performed by the kidneys? (Select all that apply.) A. Production and secretion of renin B. Hemolysis of old red blood cells (RBCs) C. Activation of vitamin D D. Carbohydrate metabolism E. Erythropoietin production

ANS: A, C, E. In addition to urine formation, the kidneys activate vitamin D to maintain calcium levels, produce erythropoietin to stimulate red blood cell (RBC) production, and produce and release renin to maintain blood pressure. Carbohydrate metabolism and hemolysis of old RBCs are not physiological functions that are performed by the kidneys.

In preparing a patient for intravenous pyelography (IVP), the nurse would expect to A. administer a cathartic or enema. B. assess patient for allergies to penicillin. C. keep the patient NPO for four hours preprocedure. D. advise the patient that a metallic taste may occur during procedure.

ANS: A. Nursing responsibilities in caring for a patient undergoing intravenous pyelography (IVP) include administration of a cathartic or enema to empty the colon of feces and gas. The nurse will also assess the patient for iodine sensitivity, keep the patient NPO for eight hours preprocedure, and advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur.

Eight months after the delivery of her first child, a 31-year-old woman has sought care because of occasional incontinence that she experiences when sneezing or laughing. Which of the following measures should the nurse first recommend in an attempt to resolve the woman's incontinence? A. Kegel exercises B. Use of adult incontinence pads C. Intermittent self-catheterization D. Dietary changes including fluid restriction

ANS: A. Patients who experience stress incontinence frequently benefit from Kegel exercises (pelvic floor muscle exercises). The use of incontinence pads does not resolve the problem and intermittent self-catheterization would be a premature recommendation. Dietary changes are not likely to influence the patient's urinary continence.

Which of the following statements by the nurse regarding continuous ambulatory peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to this procedure? A. "It is essential that you maintain aseptic technique to prevent peritonitis." B. "You will be allowed a more liberal protein diet once you complete CAPD." C. "It is important for you to maintain a daily written record of blood pressure and weight." D. "You will need to continue regular medical and nursing follow-up visits while performing CAPD."

ANS: A. Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of preventing this from occurring. Although the other teaching statements are accurate, they do not have the potential for mortality as does the peritonitis, thus making that nursing action of highest priority.

A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. Which of the following teaching points should the nurse emphasize before the procedure? A. "You might have pink-tinged urine and burning after your cystoscopy." B. "You'll need to refrain from eating or drinking after midnight the day before the test." C. "You'll require a urinary catheter inserted before the cystoscopy and it will be in place for a few days." D. "The morning of the test, the nurse will ask you to drink some water that contains a contrast solution."

ANS: A. Pink-tinged urine, burning, and frequency are common following a cystoscopy. The patient does not need to be NPO prior to the test and a contrast solution is unnecessary. A cystoscopy does not always necessitate catheterization before or after the procedure.

Which of the following nursing diagnoses is a priority in the care of a patient with renal calculi? A. Acute pain B. Deficient fluid volume C. Risk for constipation D. Risk for powerlessness

ANS: A. Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to result from urinary stones, whereas constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.

A patient with a history of end-stage renal disease secondary to diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which of the following assessments should the nurse prioritize before, during, and after his treatment? A. Level of consciousness B. Blood pressure and fluid balance C. Temperature, heart rate, and blood pressure D. Assessment for signs and symptoms of infection

ANS: B. Although all of the assessments are relevant to the care of a patient receiving hemodialysis, the nature of procedure indicates a particular need to monitor patients' blood pressure and fluid balance.

Which of the following assessment findings is a consequence of the oliguric phase of acute kidney injury (AKI)? A. Hypovolemia B. Hyperkalemia C. Hypernatremia D. Thrombocytopenia

ANS: B. In AKI, the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased because of decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.

Which of the following urinalysis results would the nurse recognize as an abnormal finding? A. pH 6.0 B. White blood cells (WBCs) 9/hpf C. Amber yellow colour D. Specific gravity 1.025

ANS: B. Normal white blood cell (WBC) levels in urine are 0-5/hpf, with levels exceeding this indicative of inflammation or urinary tract infection. Amber yellow is normal coloration, whereas a pH of 6.0 is average. Reference ranges for specific gravity are 1.003 to 1.030.

A 70-year-old male patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. The nurse would document which of the following abnormal assessment findings? A. Anuria B. Dysuria C. Oliguria D. Enuresis

ANS: B. Painful and difficult urination is characterized as dysuria. Anuria is an absence of urine production, whereas oliguria is diminished urine production. Enuresis is involuntary nocturnal urination.

Which of the following nursing interventions is appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)? A. Help the patient cope with the rapid progression of the disease. B. Suggest genetic counselling resources for the children of the patient. C. Expect the patient to have polyuria and poor concentration ability of the kidneys. D. Implement appropriate measures for the patient's deafness and blindness in addition to the renal problems.

ANS: B. Polycystic kidney disease (PKD) is one of the most common genetic diseases. The adult form of PKD may range from a relatively mild disease to one that progresses to chronic kidney disease. The progression of PKD is slow, not rapid. Polyuria, deafness, and blindness are not associated with PKD.

The nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based on this diagnosis, the nurse will expect to find which of the following as the "classic triad" of presenting symptoms occurring in patients with renal cancer? A. Fever, chills, flank pain B. Hematuria, flank pain, palpable mass C. Hematuria, proteinuria, palpable mass D. Flank pain, palpable abdominal mass, and proteinuria

ANS: B. There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease.

As a component of the head-to-toe assessment of a patient who has been recently transferred, the nurse is preparing to palpate the patient's kidneys. The nurse should position the patient A. prone. B. supine. C. seated at the edge of the bed. D. standing, facing away from the nurse.

ANS: B. To palpate the right kidney, the patient is positioned supine and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney.

An older adult male patient visits his primary care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for which of the following factors that may dispose him to urinary tract infections (UTIs)? A. High-purine diet B. Sedentary lifestyle C. Benign prostatic hyperplasia (BPH) D. Recent use of broad-spectrum antibiotics

ANS: C. Benign prostatic hyperplasia (BPH) causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to urinary tract infections (UTIs), whereas a diet high in purines is associated with renal calculi.

A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. Which of the following is an expected assessment finding for this patient during this early stage of recovery? A. Hypokalemia B. Hyponatremia C. Large urine output D. Leukocytosis with cloudy urine output

ANS: C. Patients frequently experience diuresis in the hours and days immediately following a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.

When caring for a patient during the oliguric phase of acute kidney injury, which of the following would be an appropriate nursing intervention? A. Weigh patient three times weekly. B. Increase dietary sodium and potassium. C. Provide a low-protein, high-carbohydrate diet. D. Restrict fluids according to previous daily loss.

ANS: D. Patients in the oliguric phase of acute kidney injury will have fluid volume excess with potassium and sodium retention; hence, they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times a week.

The nurse is providing care for a patient who has been admitted to the hospital for the treatment of nephrotic syndrome. Which of the following is a priority nursing assessment in the care of this patient? A. Assessment of pain and level of consciousness B. Assessment of serum calcium and phosphorus levels C. Blood pressure and assessment for orthostatic hypotension D. Daily weights and measurement of the patient's abdominal girth

ANS: D. Peripheral edema is characteristic of nephrotic syndrome, and a key nursing responsibility in the care of patients with the disease is close monitoring of abdominal girth, weights, and extremity size. Pain, level of consciousness, and blood pressure are less important in the care of patients with nephrotic syndrome. Abnormal calcium and phosphorus levels are not commonly associated with the etiology of nephrotic syndrome.

The nurse preparing to administer a dose of calcium acetate (PhosLo) to a patient with chronic kidney disease would interpret that this medication should have a beneficial effect on which of the following laboratory values of the patient? A. Sodium B. Potassium C. Magnesium D. Phosphorus

ANS: D. Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with chronic kidney disease.

The most accurate indicator of fluid loss or gain in an acutely ill patient is which of the following? A. Abdominal girth B. Weight C. Skin turgor D. Level of consciousness

B

The movement of solute (waste products) from an area of higher concentration to an area of lower concentration is: A. Anuria B. Diffusion C. Osmosis D. Ultrafiltration

B

A client with renal sufficiency is admitted with bradycardia secondary to hyperkalemia. In planning care, the PN should consider which nursing diagnosis as the highest priority? A. Fluid volume excess B. Altered cardiac output C. Altered urinary patterns D. Impaired nutrition

B. Bradycardia results in altered cardiac output which will worsen if the hyperkalemia is not resolved. This is the most life-threatening, and therefore, the highest priority of the disgnoses for this client. A and C are also important, but are less of a priority.

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder noted on the client's record should the nurse identify as a risk factor for this disorder? A. Hypoglycemia B. Diabetes Mellitus C. Coronary Artery Disease D. Orthostatic Hypotension

B. Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.

To relieve the symptoms of a lower UTI for which the client is taking prescribed antibiotics, the nurse suggests that the client use the over-the-counter urinary analgesic of phenazopyridine (Pyridium), but should give the client which of the following cautions? A. This preparation contains methylene blue, which turns the urine blue or green B. This preparation must be taken with food to prevent gastrointestinal irritation C. This preparation causes the urine to turn reddish orange and can stain underclothing D. This preparation frequently causes allergic reactions and should be stopped if a rash occurs

C

A client is scheduled for intravenous pyelography (IVP). Which priority nursing action should the nurse take? A. Restrict fluids B. Administer a sedative C. Determine a history of allergies D. Administer an oral preparation of radioplaque dye

C. 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. Checking for allergies is the priority.

The nurse is monitoring an older cliient suspected of having a UTI for signs of infection. Which sign/symptom should occur first? A. fever B. urgency C. confusion D. frequency

C. In an older client, the only symptom of a UTI may be something as vague as increasing mental confusion or frequent unexplained falls.

A client has epididymitis as a complication of a UTI. The nurse is giving the client instructions to prevent a reoccurance. The nurse determines that the client needs further teaching if the client states the intention to do which? A. Drink increased amounts of fluids B. Limit the force of the stream when voiding C. Continue to take antibiotics until all symptoms are gone D. Use condoms to eliminate risk from chlamydia and gonorrhea

C. The antibiotics should be continued for the entire course as ordered by the physician

A client has a history or mild renal insufficiency. Which serum creatinine level should the nurse determine is consistent with this problem? A. 0.6 mg/dL B. 1.1 mg/dL C. 1.9 mg/dL D. 3.5 mg/dL

C. The normal serum creatinine level is 0.6 to 1.3 mg/dL. The client with mild renal insufficiency would have a slightly elevated level, which would be the value of 1.9 mg/dL. Creatinine levels of 3.5 mg/dL may be associated with acute kidney injury or chronic kidney disease

A client with prostatitis resulting from kidney infection has received instructions on management of the condition at home and prevention of reoccurance. Which statement indicates that the client understood the instructions? A. Stop antibiotic therapy when pain subsides B. Exercise as much as possible to stimulate circulation C. Use warm sitz baths and analgesics to increase confort D. Keep fluid intake to a minimum to decrease the need to void

C. Treatment of prostatitis included medication with antibiotics, analgesics and stool softeners. The client is also taught to rest, increase fluid intake and use sitz baths for comfort. Antimicrobial therapy is always continued until the prescription is completely finished.

When admitting a client with acute glomerulonephritis, the nurse inquires about which of the following? A. History of high blood pressure B. Frequency of UTIs C. Recent sore throat and fever D. Family history of kidney disease

C. occurs 5-21 days after a streptococcal throat infection

A patient receiving peritoneal dialysis is complaining of pain with rebound tenderness. The dialysate drainage is cloudy. This is indicative of which acute complication? A. Hernia B. Bleeding C. Leakage D. Peritonitis

D

A client with chronic kidney disease has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now has mental cloudiness, dementia and complaints of bone pain. Which does this data indicate? A. Advancing uremia B. Phosphate overdose C. Folic Acid deficiency D. Aluminum intoxication

D. 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. This condition was formerly known as dialysis dementia. It may be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body, It can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum

A client newly diagnosed with chronic kidney disease has recently begun hemodialysis. Which are signs/symptoms of disequilibrium syndrome? A. Hypertension, tachycardia, and fever B. Hypotension, bradycardia, and hypothermia C. Restlessness, irritability and generalized weakness D. Headache, deteriorating level of consciousness and twitching

D. Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching and possible seizure activity. It is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissues. As a result, water goes into cerebral cells because of the osmotic most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter or at reduced blood flow rates.

The nurse is collecting data on a newly admitted client with a diagnosis of bladder cancer. Which sign/symptom should be noted first? A. Dysuria B. Urgency C. Frequency D. Hematuria

D. Gross, painless hematuria is most frequently the first manifestation of bladder cancer. As the disease progresses, the client may experience dysuria, frequency and urgency.

The nurse determines that sodium polystyrene sulfonate (Kayexalate) has been effective in a client if which laboratory result is noted? A. Serum sodium is 148 mEq/L B. Serum glucose is 110 mg/dL C. Serum chloride is 110 mEq/L D. Serum potassium is 4.9 mEq/L

D. Kayexelate is used to lower potassium levels

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse monitors this client for which signs/symptoms of this disorder? A. edema and purpura of the left arm B. warmth, redness and pain in the left hand C. aching pain, pallor and edema of the left arm D. pallor, diminishing pulse and pain in the left hand

D. arterial steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and diminished pulse distal to the fistula and complains of pain distal to the fistula, which is caused by tissue ischemia. Warmth, redness and pain should more likely characterize a problem with infection.

____ bacteria is responsible for 54.7% of UTIs

E.Coli

TRUE OR FALSE: Upper urinary tract infections, such as pyelonephritis, are more common than lower urinary tract inections

False

TRUE OR FALSE: In acute glomerulonephritis, the kidneys are reduces to as little as 1/5 their normal size

False. In chronic glomerulonephritis, they are reduced to 1/5 their normal size

TRUE OR FALSE: Because of protein loss with continuous peritoneal dialysis, the patient is instructed to eat a high-protein well-balanced diet

True

TRUE OR FALSE: Chronic pyelonephritis is a cause of kidney disease that can result in the need for permanent replacement therapies such as transplantation or dialysis

True

TRUE OR FALSE: More than half of all nursing home residents experience some kind of urinary incontinence

True

TRUE OR FALSE: Successful kidney transplantation eliminated the need for dialysis

True

TRUE OR FALSE: The predominant cause of bladder cancer today is cigarette smoking

True

Pharmocologic therapy in combination with ____ interventions works best for treating urinary incontinence.

behavioural

Coffee, tea, citrus, spices, colas and alcohol are examples of urinary tract ___ and should be avoided in patients with UTIs

irritants

The major clinical manifestations of glumerular injury include _____, hematuria, decreased GFR and alterations in excretion of sodium.

proteinuria

Documenting the patients ___ is a key assessment strategy essential for determining the daily fluid allowance and indicating signs of fluid overload/deficit.

weight