Med Surg. Chapter 54

The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching?

"I should drink as much as possible to keep my kidneys working."

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find?

Cola-colored urine

A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication?

Decrease in the blood flow through the kidneys

The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom?

Diminished erythropoietin production

Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure?

Glomerulonephritis

A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)?

Hydrating with saline intravenously before the test

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

Hypovolemic shock caused by hemorrhage

The nurse understands acute dialysis is indicated in which of the following situations?

Impending pulmonary edema

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?

Increase carbohydrates and limit protein intake.

Which of the following is used to decrease potassium level seen in acute renal failure?

Kayexalate

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important?

Limiting fluid intake

A client is being treated for renal calculi and suspected hydronephrosis. Therefore, the nurse should maintain a record of the kidney's function. Which of the following measures can the nurse take to help achieve the objective?

Monitor the client's intake and output.

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?

Nephrotoxic injury secondary to use of contrast media

The nurse is caring for a patient with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which of the following nursing actions is contraindicated?

Obtaining a blood pressure reading from the right arm

Which nursing intervention should the nurse caring for the client with pyelonephritis implement?

Teach client to increase fluid intake up to 3 liters per day.

Which clinical finding should a nurse look for in a client with chronic renal failure?

Uremia

A nurse is caring for an acutely ill patient. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill patient is which of the following?

Weight

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

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.

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.

A male client who is admitted with the diagnosis of urinary calculi complains of excruciating pain. The pain is suspected to be caused by increased pressure in the renal pelvis. Which measure would be most appropriate to provide pain relief?

Encourage frequent ambulation.

A nurse identifies a nursing diagnosis of Risk for Ineffective Breathing Pattern related to incision pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care?

Encourage use of incentive spirometer every 2 hours.

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?

"It is appropriate to warm the dial sate in a microwave."

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?

Penicillin

Which of the following occurs late in chronic glomerulonephritis?

Peripheral neuropathy

The nurse is instructing a patient to perform continuous ambulatory peritoneal dialysis correctly at home. Which of the following educational information should the nurse provide to the patient?

Use an aseptic technique during the procedure.

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.

Rejection of a transplanted kidney within 24 hours after transplant is termed

hyperacute rejection.

Dietary modification is part of nutritional therapy for the management of acute renal failure. Which of the following foods should be restricted for the patient with this disorder?

orange juice

The nurse is caring for a patient with ESKD. Which of the following acid-base imbalances is associated with this disorder?

pH 7.20, PaCO2 36, HCO3 14-

The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL?

1,000 mL

The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of:

1,500 mL of fluid

At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much is this loss equal to?

1.0 lb

A dialysis client is prescribed erythropoietin (Epogen) to treat anemia associated with end-stage renal disease. The client weighs 147 lbs. The order is for Epogen 50 units/kg subcutaneously 3 times per week. The pharmacy supplied Epogen 3000 units/ml. How many milliliters will the nurse administer to the client? Round to the nearest tenth.

1.1

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders?

Acute glomerulonephritis

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.

What is the term for the concentration of urea and other nitrogenous wastes in the blood?

Azotemia

Which of the following is a term used to describe excessive nitrogenous waster in the blood, as seen in acute glomerulonephritis?

Azotemia

The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition?

Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.

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?

Calcium

When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?

Check for thrill or bruit over the access site.

Which of the following is a characteristic of the intrarenal category of acute renal failure?

Increased BUN

Following a nephrectomy, which assessment finding is most important in determining nursing care for the client?

SpO2 at 90% with fine crackles in the lung bases

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?

Wear a mask when performing exchanges.

A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this patient?

Anemia

Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted.

Citrus fruits

Based on her knowledge of the primary cause of ESRD, the nurse knows to assess the most important indicator. What is that indicator?

Serum glucose

A client comes to the Emergency Department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?

Urinary calculi

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

The nurse is helping a patient to correctly perform peritoneal dialysis at home. The nurse must educate the patient about the procedure. Which educational information should the nurse provide to the patient?

Keep the dialysis supplies in a clean area, away from children and pets

Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for:

removal of the transplanted kidney.

Mr. Billings is being seen as a client in the urology practice. He has a family history of polycystic kidney disease. Of the following assessment findings, which would you expect to find as you gather information and complete an assessment related to a polycystic kidney diagnosis? Select all that apply.

• Pain from retroperitoneal bleeding • Hypertension

The nurse is caring for a female patient who underwent a kidney transplant. The patient appears anxious and tearful and states "My body is going to reject the new kidney; I know I'm going to die." Which of the following is the best response by the nurse?

"I understand your concerns, let's talk about them."

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?

"Increase your carbohydrate intake."

Which of the following is as integumentary manifestation of chronic renal failure?

Gray-brown skin color

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?

Detects calculi, cysts, or tumors

A 44-year-old client is in the hospital unit where you practice nursing. From the results of a series of diagnostic tests, she has been diagnosed with acute glomerulonephritis. What would you expect to find as a result of this condition?

Proteinuria

Which of the following is the hallmark of the diagnosis of nephrotic syndrome?

Proteinuria

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?

Recent history of streptococcal infection

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

Risk for infection

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?

Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.

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

Tall, peaked T waves

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?

Tea-colored urine

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."

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?

Citrus fruits

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?

Dehydration

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?

Fever

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure?

The kidneys can improve over a period of months.

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)?

Urine output of 250 ml/24 hours

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?

"Even a perfect match does not guarantee organ rejection."

Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?

6

Which of the following is an integumentary manifestation of chronic renal failure?

Gray-bronze skin color

A chronic renal failure client complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?

Hyperphosphatemia

As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur?

Hyperphosphatemia

An instructor is preparing a class on renal cancer for a group of students. Which of the following would the instructor include as a possible risk factor?

Obesity

Which of the following nursing actions is most important in caring for the client following lithotripsy?

Strain the urine carefully for stone fragments.

The nurse is performing acute intermittent peritoneal dialysis (PD) on a patient who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. Which of the following is the nurse's best action?

Turn the patient from side to side.

The nurse is administering calcium acetate (PhosLo) to a patient with ESKD. When is the best time for the nurse to administer this medication?

With food

A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 ml. Urine output that's less than 50 ml in 24 hours is known as:

anuria.