Nursing Management: Patients With Renal Disorders
The nurse is caring for a client who underwent a kidney transplant. The client appears anxious and tearful and states, "My body is going to reject the new kidney; I know I'm going to die." What is the best response by the nurse?
"I understand your concerns, let's talk about them."
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse?
"Very few symptoms are associated with renal cancer."
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?
A GFR of 30-59 mL/min/1.73 m2
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?
Acute glomerulonephritis
The nurse is able to identify which condition as uremia?
An excess of urea in the blood
An older adult patient with a number of comorbidities has opted to begin peritoneal dialysis rather than hemodialysis. A nephrology nurse has been coordinating his care from the insertion of the dialysis catheter to the application of his first few dialysis treatments. To closely monitor the patient for complications of this procedure, the nurse should prioritize which of the following assessments?
Assessing the patient for signs and symptoms of infection
Patient education regarding a fistulae or graft includes which of the following? Select all that apply.
Check daily for thrill and bruit. Avoid compression of the site. No IV or blood pressure taken on extremity with dialysis access. No tight clothing.
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 recognizes which condition as an integumentary manifestation of chronic renal failure?
Gray-bronze skin color
A nursing educator is speaking with a group of new graduates about a patient who has acute glomerulonephritis. The educator should tell the nurses that the patient may exhibit which of the following clinical manifestations?
Hematuria
A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values?
Hyperkalemia
The nurse is caring for a patient in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:
Hyperkalemia
A client is diagnosed with polycystic kidney disease. Which symptom would the nurse most likely assess?
Hypertension
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?
Hypovolemic shock caused by hemorrhage
What is a characteristic of the intrarenal category of acute kidney injury (AKI)?
Increased BUN
The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client?
Keep the dialysis supplies in a clean area, away from children and pets
A client diagnosed with acute kidney injury (AKI) has developed congestive heart failure. The client has received 40 mg of intravenous push (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The client's vital signs are stable. Which health care order should the nurse anticipate?
Lasix 80 mg IVP
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys?
Oliguria
A patient is scheduled for a computed tomography (CT) scan of the abdomen with contrast. The patient has a baseline creatinine of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders?
Preprocedure hydration and administration of acetylcysteine
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
Which of the following would a nurse classify as a prerenal cause of acute renal failure?
Septic shock
What is used to decrease potassium level seen in acute renal failure?
Sodium polystyrene sulfonate
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 IV fluids with a normal saline solution bolus followed by a maintenance dose.
A community health nurse is well-aware that the incidence and prevalence of chronic renal failure (CRF) has increased significantly in recent years. In a recent strategic planning meeting, the nurse has proposed health promotion activities to address this problem. Which of the following health promotion campaigns addresses the most common cause of CRF?
Teaching individuals with diabetes to manage their disease
The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse?
Turn the client from side to side.
Which clinical finding should a nurse look for in a client with chronic renal failure?
Uremia
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 instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client?
Use an aseptic technique during the procedure.
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 patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has?
Calcium
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis?
Azotemia
A patient with chronic renal failure has frequent blood work ordered so that the care team can monitor the progression of his disease. The nurse has noted a consistent downward trend in the patient's levels of hemoglobin, hematocrit, and red blood cells (RBCs). The nurse understands that this is likely attributable to what pathophysiologic phenomenon?
Decreased synthesis and release of erythropoietin
A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate?
Donors are selected from compatible living or deceased donors.
One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include:
restricting sources of potassium usually found in fresh fruits and vegetables.
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?
Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL
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 tablets
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.
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure?
Glomerulonephritis
A 58-year-old man has a longstanding diagnosis of poorly controlled type 2 diabetes. As a result of hyperglycemia, the man has developed chronic glomerulonephritis. In light of this new diagnosis, the nurse who is caring for this patient would anticipate that he will exhibit:
Proteinuria
The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client?
Hemodialysis
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
During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication?
Dehydration
The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take?
Hold the medications until after dialysis.
A client with chronic renal failure 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
