NURS 309 Quiz 11 Acute Renal 2
A patient is very ill and is admitted to the intensive care unit with rapidly progressing glomerulonephritis. The nurse monitors for manifestations of which prognosis? A. End-stage kidney disease B. Gradual improvement after IV fluids C. Stroke due to malignant hypertension D. Full recovery if aggressively treated
A. End-stage kidney disease
Which clinical manifestation in a patient with an obstruction in the urinary system is associated specifically with a hydronephrosis? A. Flank asymmetry B. Chills and fever C. Urge incontinence D. Bladder distension
A. Flank asymmetry
A patient with polycystic kidney disease reports nocturia and cloudy urine. What does the nurse encourage the patient to do? A. Drink at least 2 liters of fluid daily B. Restrict fluids to decrease urination C. Drink 1000 mL early in the morning D. Add a pinch of salt to water in the evenings
A. Drink at least 2 liters of fluid daily
The nurse is interviewing a patient with suspected polycystic kidney disease (PKD). What questions does the nurse ask the patient? SATA A. "Is there any family history of PKD or kidney disease?" B. "Do you have a history of sexually transmitted disease?" C. "Have you had any constipation or abdominal discomfort?" D. "Have you noticed a change in urine color or frequency?" E. "Have you had any problems with headaches?" F. "Have you had any problems with muscle aches or joint pain?"
A. "Is there any family history of PKD or kidney disease?" C. "Have you had any constipation or abdominal discomfort?" D. "Have you noticed a change in urine color or frequency?" E. "Have you had any problems with headaches?"
A patient has had one kidney removed as a treatment for kidney cancer. The patient's spouse asks, "Does the good kidney take over immediately? I know a person can live with just one kidney." What is the nurse's best response? A. "The other kidney will provide adequate function, but this may take days or weeks" B. "The other kidney isn't able to provide adequate function, so other therapies are needed" C. "That's a good question. Remember to ask your doctor next time he or she comes in" D. "It varies a lot, but within a few days we expect everything to normalize"
A. "The other kidney will provide adequate function, but this may take days or weeks"
The off-going nurse is giving shift report to the oncoming nurse about the care of a patient who had a nephrostomy tube placed 12 hours ago. What is the most important point to clearly communicate about the urine drainage? A. "Urine is draining only into the collection bag, not the bladder; therefore the amount of drainage must be assessed hourly for the first 24 hours" B. "The intake and urinary output have been monitored hourly and the patient has not shown signs/symptoms of dehydration" C. "The surgeon placed ureteral tubes so all of the urine will pass through the bladder; therefore perform hourly bladder scans to measure residual" D. "The nephrostomy site has not been leaking any blood or urine and you should continue to monitor the site for leakage"
A. "Urine is draining only into the collection bag, not the bladder; therefore the amount of drainage must be assessed hourly for the first 24 hours"
The nurse is teaching a patient how best to prevent renal trauma after an injury that required a left nephrectomy. Which points would the nurse include in the teaching plan? SATA A. Always wear a seat belt B. Avoid contact sports C. Practice safe walking habits D. Wear protective clothing if you participate in contact sports E. Use caution when riding a bicycle F. Always avoid use of drugs that may damage the kidney
A. Always wear a seat belt B. Avoid contact sports C. Practice safe walking habits E. Use caution when riding a bicycle
For a patient with polycystic kidney disease (PKD), which type of antihypertensive medication may be used because it helps control the cell growth aspects of PKD and reduce microalbuminaria? A. Angiotensin-converting enzyme inhibitors B. Beta-blockers C. Calcium channel blockers D. Vasodilators
A. Angiotensin-converting enzyme inhibitors
A patient had a nephrostomy and a nephrostomy tube is in place. What is included in the postoperative care of this patient? A. Assess the amount of drainage in the collection bag B. Irrigate the tube until the return drainage is clear C. Keep the patient NPO for 6 to 8 hours D. Instruct to sleep with operative side downward
A. Assess the amount of drainage in the collection bag
The nurse is providing care for a patient after a kidney biopsy. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? SATA A. Check vital signs every 4 hours for 24 hours B. Remind the patient about strict bed rest for 2 to 6 hours C. Reposition the patient by log-rolling with supporting backroll D. Measure and record urine output E. Assess the dressing site for bleeding and checking complete blood count results F. Teach the patient to resume normal activities after 24 hours if there is no bleeding
A. Check vital signs every 4 hours for 24 hours B. Remind the patient about strict bed rest for 2 to 6 hours C. Reposition the patient by log-rolling with supporting backroll D. Measure and record urine output
A patient has come to the clinic for follow up of acute pyelonephritis. Which action does the nurse reinforce to the patient? A. Complete all antibiotic regimens B. Report episodes of nocturia C. Wash hands to prevent spreading infection D. Avoid taking any over-the-counter drugs
A. Complete all antibiotic regimens
What laboratory values would the nurse observe in a patient experiencing problems with urinary elimination as a result of acute pyelonephritis? SATA A. Complete blood count for evaluation of differentials B. Blood urea nitrogen and serum creatinine levels for evaluation C. Electrolyte deficiencies, such as hypokalemia and hyponatremia D. Urine culture to identify specific organisms causing infection E. Urinalysis for bacteria, leukocyte esterase, nitrate, or red blood cells F. C-reactive protein and erythrocyte sedimentation rate for immune response
A. Complete blood count for evaluation of differentials B. Blood urea nitrogen and serum creatinine levels for evaluation D. Urine culture to identify specific organisms causing infection E. Urinalysis for bacteria, leukocyte esterase, nitrate, or red blood cells F. C-reactive protein and erythrocyte sedimentation rate for immune response
The health care team is using a collaborative and interdisciplinary approach to design a treatment plan for a patient with polycystic kidney disease. What is the top priority? A. Controlling hypertension B. Preventing rupture of cysts C. Providing genetic counseling D. Identifying community resources
A. Controlling hypertension
A patient is diagnosed with hydronephrosis. What is the primary complication that could result from this condition? A. Damage to blood vessels and kidney tubules B. Kidney stones disease with retained stones C. Hypertension and diabetic nephropathy D. Pyelonephritis with vesicoureteral reflux
A. Damage to blood vessels and kidney tubules
The nurse is caring for a patient with kidney cell carcinoma. What does the nurse expect to find documented about this patient's initial assessment? A. Flank pain, gross hematuria, palpable kidney mass, and renal bruit B. Gross hematuria, hypertension, diabetes, and oliguria C. Dysuria, polyuria, dehydration, and palpable kidney mass D. Nocturia and urinary retention with difficulty starting stream
A. Flank pain, gross hematuria, palpable kidney mass, and renal bruit
Which diagnostic test result does the nurse expect to see with acute glomerulonephritis? SATA A. Hematuria B. Proteinuria C. Microscopic red blood cell casts in urine D. Serum albumin level decreased E. Serum potassium decreased F. Serum phosphorus decreased
A. Hematuria B. Proteinuria C. Microscopic red blood cell casts in urine D. Serum albumin level decreased
The health care provider informs the nurse that the patient has acute pyelonephritis that appears to have been caused by a bacterial infection in the blood. For this patient, what is the priority concept? A. Immunity B. Elimination C. Fluid and electrolyte imbalance D. Cellular regulation
A. Immunity
A patient with polycystic kidney disease usually experiences constipation. What does the nurse recommend? A. Increased dietary fiber and increased fluids B. Drinking water until constipation resolves C. Daily laxatives and increased exercise D. Tap-water enemas and fiber supplements
A. Increased dietary fiber and increased fluids
The nurse is developing a teaching plan for a patient with polycystic kidney disease. Which topics does the nurse include? SATA A. Instruct how to measure and record blood pressure B. Assist to develop a schedule for self-administering drugs C. Teach about daily weights, same time of day, and same amount of clothing D. Review the potential side effects of the drugs E. Explain high-protein, low-fat diet plan F. Teach to take pulse before and after taking medications
A. Instruct how to measure and record blood pressure B. Assist to develop a schedule for self-administering drugs C. Teach about daily weights, same time of day, and same amount of clothing D. Review the potential side effects of the drugs
The nurse is reviewing arterial blood gas results of a patient with acute glomerulonephritis. The pH sample is 7.35. As acidosis is likely to be present because of hydrogen ion retention and loss of bicarbonate, how does the nurse interpret this data? A. Normal pH with respiratory compensation B. Acidosis with failure of respiratory compensation C. Alkalosis with failure of metabolic compensation D. Normal pH with metabolic compensation
A. Normal pH with respiratory compensation
A patient is diagnosed with nephrosclerosis. Which factors would promote long-term adherence to the prescribed antihypertensive medication therapy? SATA A. Once-a-day dosing B. Annual reminders C. Minimal side effects D. Eliminating dietary restrictions E. Low cost F. Drug brochures
A. Once-a-day dosing C. Minimal side effects E. Low cost
Which patient has the greatest risk for developing chronic pyelonephritis? A. Patient is bedridden and has prostate enlargement with reflux B. Patient has hematuria and dysuria related to a urinary tract infection C. Patient had a nephrectomy secondary to severe kidney trauma D. Patient reports limiting fluids in the evening to control nocturia
A. Patient is bedridden and has prostate enlargement with reflux
Which patient has the greatest risk for developing a kidney abscess? A. Patient is diagnosed with acute pyelonephritis B. Patient has flank asymmetry related to hydronephrosis C. Patient developed a urinary tract infection secondary to a urinary catheter D. Patient is diagnosed with hypertension and nephrosclerosis
A. Patient is diagnosed with acute pyelonephritis
Why may a patient with polycystic kidney disease (PKD) experience constipation? A. Polycystic kidneys enlarge and put pressure on the large intestine B. Patient becomes dehydrated because the kidneys are dysfunctional C. Constipation is a side effect from the medications given to treat PKD D. Patients with PKD have special dietary restrictions that cause constipation
A. Polycystic kidneys enlarge and put pressure on the large intestine
The nurse is reviewing the laboratory results for a patient with chronic glomerulonephritis. The serum albumin level is low. What else does the nurse expect to see? A. Proteinuria B. Elevated hematocrit C. High specific gravity D. Low white blood cell count
A. Proteinuria
The nurse is reviewing the laboratory results of a patient with chronic glomerulonephritis. The phosphorous level is 5.3 mg/dL. What else does the nurse except to see? A. Serum calcium level below the normal range B. Serum potassium level below the normal range C. Falsely elevated serum sodium level D. Elevated serum levels for all other electrolytes
A. Serum calcium level below the normal range
A patient with acute glomerulonephritis is required to provided a 24-hour urine specimen. What does the nurse expect to see when looking at the specimen? A. Smoky or cola-colored urine B. Clear and very dilute urine C. Urine that is full of pus and very thick D. Bright orange-colored urine
A. Smoky or cola-colored urine
A 53-year-old patient is newly diagnosed with renal artery stenosis. Which clinical manifestation is the nurse most likely to observe when the patient first seeks health care? A. Sudden onset of hypertension B. Urinary frequency and dysuria C. Nausea and vomiting D. Flank pain and hematuria
A. Sudden onset of hypertension
The nurse is reviewing the medical history of a patient who was admitted for acute glomerulonephritis. Which systemic conditions may have caused acute glomerulonephritis and should be included in the overall plan of care? A. Systemic lupus erythematosus and diabetic glomerulopathy B. Myocardial infarction and atrial fibrillation C. Ischemic stroke and hemiparesis D. Blunt trauma to the kidney with hematuria
A. Systemic lupus erythematosus and diabetic glomerulopathy
A patient is brought to the ER because he was in a fight and was repeatedly kicked and punched in the back. What does the nurse include in the initial physical assessment? SATA A. Take complete vital signs B. Check apical pulse and peripheral pulses C. Inspect flanks for bruising, asymmetry, or penetrating injuries D. Inspect abdomen, chest, and lower back for bruising or penetrating wounds E. Deeply palpate the abdomen for signs of rigidity F. Inspect the urethra for gross bleeding
A. Take complete vital signs B. Check apical pulse and peripheral pulses C. Inspect flanks for bruising, asymmetry, or penetrating injuries D. Inspect abdomen, chest, and lower back for bruising or penetrating wounds F. Inspect the urethra for gross bleeding
A patient reports straining to pass very small amounts of urine today, despite normal fluid intake, and reports having the urge to urinate. The nurse palpates the bladder and finds that it is distended. Which condition is most likely to be associated with these findings? A. Urethral stricture B. Hydroureter C. Hydronephrosis D. Polycystic kidney disease
A. Urethral stricture
The nurse is caring for a patient with risk for kidney disease for whom a urinalysis has been ordered. What time would the nurse instruct the unlicensed assistive personnel is best to collect this sample? A. With first morning void B. Before any meal C. At bedtime D. Immediately
A. With first morning void
A patient has late-stage chronic glomerulonephritis. Which educational brochure would be the most appropriate to prepare for the patient? A. "How to Take Your Anti-Infective Medications" B. "Important Points to Know about Dialysis" C. "What Are the Side Effects of Radiation Therapy?" D. "Precautions to Take During Immunosuppressive Therapy"
B. "Important Points to Know about Dialysis"
A patient with diabetic nephropathy reports having frequent hypoglycemic episodes "so my doctor reduced my insulin, which means my diabetes is improving." What is the nurse's best response? A. "Congratulations! That's great news. You must be carefully following the diet and lifestyle recommendations." B. "When kidney function is reduced, the insulin is available for a longer time and thus less of it is needed" C. "You should talk to your doctor again. You have been diagnosed with nephropathy and that changes the situation" D. "Let me get you a brochure about the relationship of diabetes and kidney disease. It can be hard to understand"
B. "When kidney function is reduced, the insulin is available for a longer time and thus less of it is needed"
Which manifestation is primarily associated with acute pyelonephritis? A. Obstruction caused by hydroureter B. Active bacterial infection C. Increased urinary retention D. Peripheral and facial edema
B. Active bacterial infection
Insertion of an indwelling urinary catheter increases the patient's risk for developing what type of kidney disorder? A. Polycystic kidney disease B. Acute pyelonephritis C. Renal stenosis D. Nephrosclerosis
B. Acute pyelonephritis
The nurse is assessing a patient who reports chills, high fever, and flank pain with urinary urgency and frequency. On physical examination, the patient has costovertebral angle tenderness, pulse is 110 beats/min, and respirations are 28/min. How does the nurse interpret these findings? A. Complicated cystitis B. Acute pyelonephritis C. Chronic pyelonephritis D. Acute glomerulonephritis
B. Acute pyelonephritis
The nurse is caring for a patient with nephrotic syndrome. What interventions are included in the plan of care for this patient? SATA A. Fluids should be restricted B. Administer mild diuretics C. Assess for edema D. Administer antihypertensive medications E. Assess for dysuria F. Assess hydration status
B. Administer mild diuretics C. Assess for edema D. Administer antihypertensive medications F. Assess hydration status
The nurse caring for a patient with a nephrostomy. The nurse notifies the health care provider about which assessment finding? A. Urine drainage is red-tinged 4 hours after surgery B. Amount of drainage decreases and the patient has back pain C. There is a small steady drainage for the first 4 hours postsurgery D. The nephrostomy site looks dry and intact
B. Amount of drainage decreases and the patient has back pain
Which patient history factor is considered causative for acute glomerulonephritis? A. Urinary incontinence for 6 months B. Strep throat 3 weeks ago C. Kidney stones 2 years ago D. Mild hypertension diagnosed 1 year ago
B. Strep throat 3 weeks ago
A patient has chronic glomerulonephritis . In order to assess for uremic symptoms, what does the nurse do? A. Evaluate the blood urea nitrogen B. Ask the patient to extend the arms and hyperextend the wrists C. Gently palpate the flank for asymmetry and tenderness D. Auscultate for the presence of an S3 heart sound
B. Ask the patient to extend the arms and hyperextend the wrists
The student nurse is assisting in the postoperative care of a patient who had a recent nephrectomy. The student demonstrates a reluctance to move the patient to change the linens because "the patient seems so tired." The nurse reminds the student that a priority assessment for this patient is to assess for which factor? A. Skin breakdown on the patient's back B. Blood on the linens beneath the patient C. Urinary incontinence and moisture D. The patient's ability to move self in bed
B. Blood on the linens beneath the patient
The nurse is assessing a patient with possible acute glomerulonephritis. During the inspection of the hands, face, and eyelids, what is the nurse primarily observing for? A. Redness B. Edema C. Rashes D. Dryness
B. Edema
A patient is diagnosed with chronic glomerulonephritis. The patient's spouse reports that the patient is irritable, forgetful, and has trouble concentrating. Which assessment finding does the nurse expect on further examination? A. Increased respiratory rate B. Elevated blood urea nitrogen C. Hypokalemia D. Low blood pressure
B. Elevated blood urea nitrogen
The nurse is caring for a patient with kidney cell carcinoma who manifests paraneoplastic syndromes. What findings does the nurse expect to see in this patient? SATA A. Urinary tract infection B. Erthrocytosis C. Hypercalcemia D. Liver dysfunction E. Decreased sedimentation rate F. Hypertension
B. Erthrocytosis C. Hypercalcemia D. Liver dysfunction F. Hypertension
What are the key features associated with chronic pyelonephritis? SATA A. Abscess formation B. Hypertension C. Inability to conserve sodium D. Decreased urine-concentrating ability resulting in nocturia E. Tendency to develop hyperkalemia and acidosis F. Sudden onset of massive proteinuria
B. Hypertension C. Inability to conserve sodium D. Decreased urine-concentrating ability resulting in nocturia E. Tendency to develop hyperkalemia and acidosis
An older adult male patient reports an acute problem with urine retention. The nurse advices the patient to seek medical attention because permanent kidney damage can occur in what time frame? A. In less than 6 hours B. In less than 48 hours C. Within several weeks D. Within several years
B. In less than 48 hours
A patient with polycystic kidney disease would exhibit which signs/symptoms? SATA A. Frequent urination B. Increased abdominal girth C. Hypertension D. Kidney stones E. Diarrhea F. Bloody or cloudy urine
B. Increased abdominal girth C. Hypertension D. Kidney stones F. Bloody or cloudy urine
In polycystic kidney disease, the effect on the renin-angiotensin system in the kidney has which results? A. Adrenal insufficiency B. Increased blood pressure C. Increased urine output D. Oliguria
B. Increased blood pressure
The nurse is caring for a postoperative nephrectomy patient. The nurse notes during the first several hours of the shift, a marked and steady downward trend in blood pressure. How does the nurse interpret this findings? A. Hypertension has been corrected B. Internal hemorrhage is possible C. The other kidney is failing D. Fluids are shifting into the interstitial space
B. Internal hemorrhage is possible
Under what circumstances would it be appropriate for the nurse to seek an order for catheter replacement if the health care provider fails to order it? A. Family requests a long-term catheter to prevent urinary incontinence for a confused relative B. Patient has had current catheter for two weeks and new antibiotics were just ordered C. Patient has an existing catheter but exterior of closed system becomes soiled D. Nurse notices a large amount of dark amber urine in the drainage bag
B. Patient has had current catheter for two weeks and new antibiotics were just ordered
What might the nurse notice if the patient is experiencing problems with urinary elimination as a result of acute pyelonephritis? SATA A. Patient urinates large amounts of dilute urine B. Patient reports pain and burning on urination C. Patient reports back or flank pain D. Urine is cloudy and foul smelling E. Urine may be darker or smoky or have obvious blood in it F. Patient reports nocturia
B. Patient reports pain and burning on urination C. Patient reports back or flank pain D. Urine is cloudy and foul smelling E. Urine may be darker or smoky or have obvious blood in it F. Patient reports nocturia
The nurse is reviewing the lab values for a patient with risk for urinary problems. Which finding is of most concern to the nurse? A. Blood urea nitrogen (BUN) of 10 mg/mL B. Presence of glucose and protein in urine C. Serum creatinine of 0.6 mg/dL D. Urinary pH of 8
B. Presence of glucose and protein in urine
The nurse is reviewing the patient's history assessment findings, and laboratory results for a patient with suspected kidney problems. Which manifestation is the main feature of nephrotic syndrome? A. Abrupt onset of flank symmetry B. Proteinuria greater than 3.5 g in 24 hours C. Serum sodium greater than 148 mmol/L D. Serum cholesterol (total) 190 mg/dL
B. Proteinuria greater than 3.5 g in 24 hours
A patient with polycystic kidney disease reports sharp flank pain followed by blood in the urine. How does the nurse interpret these signs/symptoms? A. Infection of the cyst B. Ruptured cyst C. Ruptured berry aneurysm D. Increased kidney size
B. Ruptured cyst
After a nephrectomy, one adrenal gland remains. Based on this knowledge, which type of medication replacement therapy does the nurse expect if the remaining adrenal gland function is insufficient? A. Potassium B. Steroid C. Calcium D. Estrogen
B. Steroid
A patient is diagnosed with kidney cancer and the health care provider recommends the best therapy. Which treatment does the nurse anticipate teaching the patient about? A. Chemotherapy B. Surgical removal C. Hormonal therapy D. Radiation therapy
B. Surgical removal
The nurse is reviewing the laboratory results for a patient being evaluated for difficulties with passing urine. The urinalysis shows tubular epithelial cells on microscopic examination. How does the nurse interpret this finding? A. Blood chemistries should be evaluated B. The obstruction is prolonged C. The patient has a urinary tract infection D. Glomerular filtration rate is reduced
B. The obstruction is prolonged
After the nurse instructs a patient with polycystic kidney disease on home care, the patient knows to contact the health care provider immediately when what sign/symptom occur? A. Urine is a clear, pale yellow color B. Weight has increased by 5 pounds in 2 days C. Two days have passed since the lat bowel movement D. Morning systolic blood pressure has decreased by 5 mm Hg
B. Weight has increased by 5 pounds in 2 days
A patient returning to the unit after a left radical nephrectomy for kidney cell carcinoma reports having some soreness on the right side. What does the nurse tell the patient? A. "The right kidney was repositioned to take over the function of both kidneys" B. "I'll call your doctor for an order to increase your pain medication" C. "The soreness is likely to be from being positioned on your right side during surgery" D. "You are having referred pain. It's expected, but you can take mild pain medication"
C. "The soreness is likely to be from being positioned on your right side during surgery"
An older adult male patient calls the clinic because he has "not passed any urine all day long." What is the nurse's best response? A. "Try drinking several large glasses of water and waiting a few more hours" B. "If you develop flank pain or fever, then you should probably come in" C. "You could have an obstruction, so you should come in and get checked" D. "I am sorry, but I really can't comment about your problem over the phone"
C. "You could have an obstruction, so you should come in and get checked"
The health care provider writes an order, to give the patient fluid allowance equal to the 24-hour urine output plus 500 to 600 mL. Urine output was 60 mL at 0800; 260 mL at 1200; 200 mL at 1600; 280 mL at 2000; 100 mL at 0000; 100 mL at 0400; and 50 mL at 0700. How much fluids can the patient have over the next 24 hours? A. 500 to 600 mL B. 1050 to 1060 mL C. 1550 to 1650 mL D. 2500 to 2600 mL
C. 1550 to 1650 mL
Which patient has the greatest risk for developing acute pyelonephritis? A. 80-year-old woman who takes diuretics for mild heart failure B. 80-year-old man who drinks four cans of beer a day C. 36-year-old woman with diabetes mellitus who is pregnant D. 36-year-old man with diabetes insipidus
C. 36-year-old woman with diabetes mellitus who is pregnant
For which patient is the nurse most concerned about the risk for developing kidney disease? A. A 25-year-old patient who developed a urinary tract infection (UTI) during pregnancy B. A 55-year-old patient with a history of kidney stones C. A 63-year-old patient with type 2 diabetes D. A 79-year-old patient with stress urinary incontinence
C. A 63-year-old patient with type 2 diabetes
Which ethnic or cultural groups are most likely to develop end-stage kidney disease related to hypertension? SATA A. Caucasian Americans B. Jewish Americans C. American Indians D. African Americans E. Hispanic Americans F. Bisexual Americans
C. American Indians D. African Americans
The nurse is assessing a patient with glomerulonephritis and notes crackles in the lung fields and neck vein distension. The patient reports milds shortness of breath. Based on these findings, what does the nurse do next? A. Check for costovertebral angle tenderness or flank pain B. Obtain a urine sample to check for proteinuria C. Assess for additional signs of fluid overload D. Alert the health care provider about the respiratory symptoms
C. Assess for additional signs of fluid overload
A patient with polycystic kidney disease is at risk for a berry aneurysm and reports a severe headache. What is the nurse's priority action? A. Assess the pain and give a PRN pain medication B. Reassure that this is an expected symptom of the disease C. Assess for neurological changes and check vital signs D. Monitor for hematuria and decreased urinary output
C. Assess for neurological changes and check vital signs
A 22-year-old patient comes to the clinic for a wellness check-up. History reveals that the patient's parent has the autosomal-dominant form of polycystic kidney disease (PKD). Which vital sign suggests that the patient should be evaluated for PKD? A. Pulse of 95 beats/min B. Temperature of 100.6 C. Blood pressure of 136/88 mm Hg D. Respiratory rate of 26/min
C. Blood pressure of 136/88 mm Hg
The nurse is caring for a patient after a nephrectomy. The nurse notes that the urine flow was 50 mL/hr at the beginning of the shift but several hours later has dropped to 30 mL. What would the nurse do first? A. Notify the health care provider for an order for an IV fluid bolus B. Document the finding and continue to monitor for downward trend C. Check the drainage system for kinks or obstructions to flow D. Obtain the patient's weight and compare it to baseline
C. Check the drainage system for kinks or obstructions to flow
What are the key features of renovascular disease? SATA A. Sodium wasting B. Flank pain C. Decreased glomerular filtration rate D. Elevated serum creatinine E. Poorly controlled diabetes or sustained hyperglycemia F. Significant, difficult-to-control high blood pressure
C. Decreased glomerular filtration rate D. Elevated serum creatinine E. Poorly controlled diabetes or sustained hyperglycemia F. Significant, difficult-to-control high blood pressure
What change in diabetic therapy may be needed for a patient who has diabetic nephropathy? A. Fluid restriction B. Decreased activity level C. Decreased insulin dosage D. Increased caloric intake
C. Decreased insulin dosage
A patient with polycystic kidney disease reports nocturia. What is the nocturia caused by? A. Increased fluid intake in the evening B. Increased hypertension C. Decreased urine-concentrating ability D. Detrusor irritability
C. Decreased urine-concentrating ability
After a nephrectomy, a patient has a large urine output because of adrenal insufficiency. What does the nurse anticipate the priority intervention for this patient will be? A. Angiotensin-converting enzyme inhibitor to control hypertension and decrease protein loss in urine B. Straight catheterization or bedside bladder scan to measure residual urine C. IV fluid replacement because of subsequent hypotension and oliguria D. IV infusion of temsirolimus, to inhibit cell division and cell cycle progression
C. IV fluid replacement because of subsequent hypotension and oliguria
A patient is newly admitted with nephrotic syndrome and has proteinuria, edema, hyperlipidemia, and hypertension. What is the priority for nursing care? A. Consult the dietitian to provide adequate nutritional intake B. Prevent kidney and urinary tract infection C. Monitor fluid volume and the patient's hydration status D. Prepare the patient for a renal biopsy
C. Monitor fluid volume and the patient's hydration status
A patient is admitted to the medical-surgical unit for acute pyelonephritis. What is the priority concept to consider in the immediate nursing care of this patient? A. Oxygenation B. Acid-base balance C. Pain D. Cellular regulation
C. Pain
The nurse is caring for a patient with risk for incomplete bladder emptying. Which noninvasive finding best supports this problem? A. Patient is able to void additional 100 mL after nurse massages over the bladder B. Patient voids additional 350 mL with insertion of an intermittent catheter C. Patient has post-void residual 275 mL documented by bedside bladder scanner D. Patient has constant dribbling between voiding
C. Patient has post-void residual 275 mL documented by bedside bladder scanner
The ER is preparing a patient with kidney trauma for emergency surgery. What is the best task to delegate to an unlicensed assistive personnel? A. Set the automated blood pressure machine to cycle every 2 hours B. Inform the family about surgery and assist them to the surgery waiting area C. Pick up the units of packed red blood cells from the blood bank D. Insert a urinary catheter if there is no gross bleeding at the urethra
C. Pick up the units of packed red blood cells from the blood bank
The patient sustained traumatic injury and needs the best diagnostic test to determine the extend of injury to the kidney. What does the nurse do? A. Obtain a clean-catch urine specimen for urinalysis B. Give an IV fluid bolus before renal arteriography C. Pick up the units of packed red blood cells from the blood bank D. Obtain a blood sample for hemoglobin and hematocrit
C. Pick up the units of packed red blood cells from the blood bank
The healthcare provider advises the patient that diagnostic testing is needed to identify the possible presence of a renal abscess. Which test does the nurse prepare the patient for? A. Renal arteriography B. Cystourethrogram C. Renal scan D. Urodynamic flow studies
C. Renal scan
A patient is suspected of having polycystic kidney disease (PKD). Which diagnostic study has minimal risks and is used to provide initial screening for PDK? A. Kidneys-ureters-bladder xray B. Computed tomography with angiography C. Renal ultrasonography D. Renal biopsy
C. Renal ultrasonography
A patient with chronic pyelonephritis returns to the clinic for follow up. Which behavior indicates the patient is performing the self-care measures to conserve existing kidney function? A. Drinks a liter of fluid every day B. Considers buying a home blood pressure cuff C. Reports taking antibiotics as prescribed D. Takes pain medications on a regular basis
C. Reports taking antibiotics as prescribed
A patient with a history of polycystic kidney disease reports dull, aching flank pain and the urinalysis is negative for infection. The health care provider tells the nurse that the pain is chronic and related to enlarging kidneys compressing abdominal contents. What nursing intervention is best for this patient? A. Administer an angiotensin-converting enzyme inhibitor such as lisinopril B. Apply cool compresses to the abdomen or flank C. Teach methods of relaxation such as deep-breathing D. Administer around-the-clock non-steroidal anti-inflammatory drugs
C. Teach methods of relaxation such as deep-breathing
The nurse is interviewing and assessing a patient who has the signs/symptoms of acute glomerulonephritis. Which disorder is most likely to mimic similar signs/symptoms? A. Acute flare up of rheumatoid arthritis B. Metastasis of renal carcinoma to distal sites C. Urinary obstruction due to hydroureter D. Acute exacerbation of heart failure
D. Acute exacerbation of heart failure
The patient problem of constipation related to compression of the intestinal tract has been identified in a patient with polycystic kidney disease. Which action should the nurse assign to a newly-trained LPN/LVN? A. Instructing the patient about foods that are high in fiber B. Teaching the patient about foods that assist in promoting bowel regularity C. Assessing the patient for previous bowel problems and bowel routine D. Administering docusate sodium 100 mg by mouth twice a day
D. Administering docusate sodium 100 mg by mouth twice a day
The health care provider tells the nurse that the patient with polycystic kidney disease has salt wasting. Which intervention is the nurse likely to use related to nutrition therapy? A. Talk to the patient about seasonings that are alternatives to salt B. Help the patient select a lunch tray with low-sodium items C. Obtain an order for fluid restriction to prevent loss of sodium during urination D. Advise that a low-sodium diet is not currently necessary
D. Advise that a low-sodium diet is not currently necessary
Which pain management strategy does the nurse teach a patient with polycystic kidney disease who has chronic pain related to the kidney cysts? A. Rest and sleep in a prone position B. Increase dosage of non-steroidal anti-inflammatory C. Gently rub or massage the flank area D. Apply dry heat to the abdomen or flank
D. Apply dry heat to the abdomen or flank
A patient with acute glomerulonephritis has edema of the face. The blood pressure is moderately elevated and the patient has gained 2 pounds within the past 24 hours. The patient reports fatigue and refuses to eat. What is the priority for nursing care? A. Cluster care to allow rest periods for the patient B. Obtain a dietary consult to plan an adequate nutritional diet C. Monitor urine output with accurate intake and output amounts D. Assess for signs and symptoms of fluid volume overload
D. Assess for signs and symptoms of fluid volume overload
For a patient with acute glomerulonephritis, a 24-hour urine test was initiated and the glomerular filtration rate (GFR) results are pending. What is the correct clinical implication of GFR results? A. GFR is normal; therapy can be discontinued B. GFR is low; the patient is at risk for retention C. GFR is high; the patient is at risk for infection D. GFR is low; the patient is at risk for fluid overload
D. GFR is low; the patient is at risk for fluid overload
The nurse is caring for a patient who had a nephrectomy yesterday. To manage the patient's pain, what is the best plan for analgesia therapy? A. Limit narcotics because of respiratory depression B. Give an oral analgesic when the patient can eat C. Alternate parenteral and oral medications D. Give parenteral medications on a schedule
D. Give parenteral medications on a schedule
A patient has renal cell carcinoma that has metastasized to the lungs. What stage is the cancer? A. I B. II C. III D. IV
D. IV
Which nursing intervention is applicable for a patient with acute glomerulonephritis? A. Restricting visitors who have infections B. Assessing the incision site C. Inspecting the vascular access D. Measuring weight daily
D. Measuring weight daily
A patient has a family history of the autosomal-dominant form of the polycystic kidney disease (PKD) and has been advised to monitor for and report symptoms. What is an early symptom of PKD? A. Headache B. Pruritus C. Edema D. Nocturia
D. Nocturia
What is the main concern for patients who have hydronephrosis, hydroureter, or urethral stricture? A. Dilute urine B. Pain on urination C. Dehydration D. Obstruction
D. Obstruction
The nurse is taking a history on a patient with chronic glomerulonephritis. What is the patient most likely to report? A. History of antibiotic allergy B. Intense flank pain C. Poor appetite and weight loss D. Occasional edema and fatigue
D. Occasional edema and fatigue
A nurse is caring for a client with glomerulonephritis. What should the nurse instruct the client to do to prevent recurrent attacks? A. Take showers instead of tub baths B. Continue the same restrictions on fluid intake C. Avoid situations that involve physical activity D. Seek early treatment for respiratory tract infections
D. Seek early treatment for respiratory tract infections
The nurse has delegated collection of a urinalysis specimen to an experienced unlicensed assistive personnel (UAP). For which action must the nurse intervene? A. The UAP provides the patient with a specimen cup B. The UAP reminds the patient of the need for the specimen C. The UAP assists the patient to the bathroom D. The UAP allows the specimen to sit for more than 1 hour
D. The UAP allows the specimen to sit for more than 1 hour
