Pratt CC Renal
17. Which type of medication is the best choice to control hypertension in a patient with PKD?" A
"a. ACE inhibitors b. Beta blockers c. Calcium channel blockers d. Potassium-sparing diuretics"
20. A patient reports straining to pass very small amounts of urine today, despite a normal fluid intake, and reports having the urge to urinate. The nurse palpates the bladder and finds that it is distended. How does the nurse interpret these findings? A
"a.Urethral stricture b. Hydroureter c.Hydronephrosis d.PKD
80. A patient returning to the unit after a left radical nephrectomy for kidney cell carcinoma is concerned about severe pain on the right side. What does the nurse tell the patient? C
a. "The right kidney was repositioned to take over the function of both kidneys." b. "I'll call your doctor for an order to in- crease your pain medication." c. "The pain is likely to be from being positioned on your right side during surgery." d. "Would you like to talk with someone who had this surgery last year and now is fully recovered?"
70. After a nephrectomy, a patient has a large urine output because of adrenal insufficiency. What does the nurse anticipate the priority interven- tion for this patient will be? C
a. ACE inhibitor to control the hypertension and decrease protein loss in urine b. Straight catheterization or bedside bladder scan to measure residual urine c. IV fluid replacement because of subse- quent hypotension and oliguria d. IV infusion of Temsirolimus to inhibit cell division and prevent metastasis
"A patient reports dull, aching pain and the urinalysis is negative for infection. The nurse identifies that the pain is chronic related to enlarging kidneys compressing abdominal contents. What nursing intervention is best for this patient? C
a. Administer trimethoprim/sulfamethoxa- zole (Bactrim). b. Apply dry heat to the abdomen or flank. c.Teach methods of relaxation such as deep breathing. d.Administer around-the-clock NSAIDs."
10. A patient with PKD reports a severe headache and is at risk for a berry aneurysm. What is the nurse's priority action? C
a. Assess the pain and give a PRN pain medi- cation. b. Reassure the patient that this is an expect- ed aspect of the disease. c. Assess for neurologic changes and check vital signs. d. Monitor for hematuria and decreased urinary output.
66. A patient is diagnosed with chronic interstitial nephritis. Which nursing action is relevant and specific for this patient's medical condition? C
a. Avoid analgesic use. b. Use disposable gloves. c.Monitor for fever. d. Place the patient in isolation.
"Which descriptions about the autosomal reces- sive gene trait of PKD are correct? (Select all that apply.) A,C,E
a. Both parents must carry a mutated allele; and both mutated alleles must be inherited. b.Half of people with this form of PKD develop kidney failure by age 50. c. Most people with this form of PKD die in early childhood. d.One parent must carry a mutated allele that is inherited. e. A child has a 1 in 4 chance of inheriting autosomal PKD.
48. The nurse is assessing a patient with glomeru- lonephritis and notes crackles in the lung fields and neck vein distention. The patient reports mild shortness of breath. Based on these find- ings, what does the nurse do next? C
a. Check for CVA 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.
79. 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?B
a. Chemotherapy b. Surgical removal c.Hormonal therapy d. Radiation therapy
58. A patient with acute glomerulonephritis has edema of the face. The blood pressure is mod- erately 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? D
a. Cluster care to allow rest periods for the patient. b. Obtain a dietary consult to plan an ad- equate nutritional diet. c. Monitor urine output with accurate intake and output amounts. d. Assess for signs and symptoms of fluid volume overload.
65. A patient is newly admitted with nephrotic syndrome and has proteinuria, edema, hyper- lipidemia, and hypertension. What is the pri- ority for nursing care? C
a. Consult the dietitian to provide adequate nutritional intake. b. Prevent urinary tract infection. c. Monitor fluid volume from intake and out- put amounts. d. Provide instruction on a plan of care related to the disease process.
21. A patient is diagnosed with hydronephrosis. What is a complication that could result from this condition? A
a. Damage to the nephrons b. Kidney cancer c.Kidney stone d. Structural defects
16. A patient with PKD has nocturia. What does the nurse encourage the patient to do? A
a. Drink 2 liters of fluid daily. b. Restrict fluid in the evening. c.Only drink 1000 mL/24 hr. d. Take diuretics as ordered.
64. The nurse is reviewing laboratory results for a patient with suspected kidney problems. Which manifestation is a hallmark for ne- phrotic syndrome? B
a. Flank asymmetry b. Proteinuria greater than 3.5 g of protein in 24 hours c. Serum sodium 148 mmol/L d. Serum cholesterol (total) 190 mg/dL patient has late-stage chronic glomerulone"
78. The nurse is caring for a patient with kidney cell carcinoma. What does the nurse expect to find documented about the patient's initial assessment? A
a. Flank pain, gross hematuria, palpable kidney mass, and renal bruit b. Gross hematuria, hypertension, diabetes, and oliguria c. Dysuria, polyuria, dehydration, and pal- pable kidney mass d. Nocturia and urinary retention with dif- ficulty starting stream
74. What change in diabetic therapy may be need- ed for a patient who has diabetic nephropathy? C
a. Fluid restriction b.Decreased activity level c.Decreased insulin dosages d Increased caloric intake
41."A patient with PKD would exhibit which signs/symptoms? (Select all that apply.) B,CD
a. Frequent urination b. Increased abdominal girth c. Hypertension d. Kidney stones e. Diarrhea
49. The GFR of a patient with acute glomerulone- phritis is 50 mL/min. What is the nurse's inter- pretation of this finding? D
a. GFR is normal; therapy is effective. b. GFR is high; the patient is at risk for dehydration. c. GFR is low; the patient is at risk for infection. d. GFR is low; the patient is at risk for fluid overload.
56.The nurse is taking a history on a patient with chronic glomerulonephritis. What is the pa- tient most likely to report? D
a. History of antibiotic allergy b. Intense flank pain c. Malnutrition and weight loss d. Mild edema and hypertension
"12. The nurse is reviewing a patient's laboratory results. Which laboratory abnormality in the patient with PKD indicates disease progression? C
a. Hypercalcemia b. Hypokalemia c. Proteinuria d. Homocysteinuria
81. 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 finding? B
a. Hypertension has been corrected. b. Internal hemorrhage is possible. c. The other kidney is failing. d. This is an expected response to medication.
45. A patient diagnosed with renal cell carcinoma that has metastasized to the lungs is considered to be in which stage of cancer?D
a. I b. II c. III d. IV
11. A patient with PKD reports nocturia. What is the nocturia caused by? C
a. Increased fluid intake in the evening b. Increased hypertension c.Decreased urine concentrating ability d. Detrusor irritability patient with PKD reports sharp flank pain"
44. Kidney tissue changes in chronic glomerulone- phritis are caused by which factors? (Select all that apply.) A,C,E
a. Ischemia b. Fluid overload c. Hypertension d. Elevated body temperature e. Fluid and electrolyte imbalance
73. A patient has been informed by the health care provider that treatment will be needed for re- nal artery stenosis. The nurse prepares to teach about a variety of treatment options. What treatments will the nurse include in the teaching plan? (Select all that apply.) B,C,D,E
a. Kidney transplant b. Hypertension control c. Balloon angioplasty d. Renal artery bypass surgery e. Synthetic blood vessel graft f. Percutaneous ultrasonic pyelolithotomy
13. A patient is suspected of having PKD. Which diagnostic study has minimal risks and can reveal PKD? C
a. Kidneys-ureters-bladder (KUB) x-ray b. Urography c. Renal sonography d. MRI with contrast
51. A patient is diagnosed with chronic glomeru- lonephritis. The patient's spouse reports that the patient is irritable, forgetful, and has trouble concentrating. Which assessment finding does the nurse expect further examination will reveal? B
a. Low oxygen saturation b. Elevated blood urea nitrogen c.High white count with a left shift d.Low blood pressure and bradycardia
82. 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 is the nurse's priority action? C
a. Notify the health care provider for an or- der for an IV fluid bolus. b.Document the finding and continue to monitor for downward trend. c. Troubleshoot the drainage system to make sure there are no obstructions. d.Obtain the patient's weight and compare it to baseline.
54. The nurse is reviewing the laboratory results for a patient with chronic glomerulonephritis. The phosphorus level is 5.3 mg/dL. What else does the nurse expect to see? A
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 electro- lytes"
85. "The ED nurse is preparing a patient with kid- ney trauma for emergency surgery. What is the best task to delegate to the unlicensed assistive personnel (UAP)? C
a. Set the automated blood pressure machine to cycle every 30 minutes. b. Inform the family about surgery and assist them to the surgery waiting area. c. Go to the blood bank and pick up the units of packed red cells. d. Insert a Foley catheter if there is no gross bleeding at the urethra.
69. The student nurse is assisting in the postop- erative care of a patient who had a recent nephrectomy. The student demonstrates a reluctance 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? B
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
15. A patient with PKD usually experiences con- stipation. What does the nurse recommend? A
a. Stool softeners and increased fluids b. Decreased dietary fiber and laxatives c. Laxatives and decreased fluids d. Daily tap water enemas and fiber supple- ments
72. A 53-year-old patient is newly diagnosed with renal artery stenosis. What clinical manifestation does the nurse observe when the patient first seeks health care? A
a. Sudden onset of hypertension b.Urinary frequency and dysuria c.Nausea and vomiting d. Flank pain and hematuria"
71. A patient with a kidney abscess who is receiving antibiotics is ordered an additional treatment by the health care provider. The nurse prepares patient education material for which procedure?A
a. Surgical incision or needle aspiration b. Hemodialysis c. Insertion of a suprapubic catheter d. Cystostomy
77.The nurse is caring for a patient with kidney cell carcinoma. What symptoms and findings does the nurse expect to see in this patient? (Select all that apply.) B,C,F,G
a. Urinary tract infection b. Erythrocytosis c. Hypercalcemia d. Liver dysfunction e. Decreased sedimentation rate f. Hypertension g. Hematuria
68. 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?B
a."Congratulations! You must be follow- ing the diet and lifestyle instructions very carefully." b."When kidney function is reduced, the insulin is available for a longer time and thus less of it is needed." c."You should probably 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 is a complex topic and hard to under- stand."
"The nurse is interviewing a patient with sus- pected PKD. What questions does the nurse ask the patient? (Select all that apply.) A,B,C,D,G
a."Is there any family history of PKD or kidney Disease?" b."At what age was your parent diagnosed with PKD?" c."Have you had any constipation or abdom- inal discomfort?" d. "Have you noticed a change in urine color or frequency?" e."Do you have a history of sexually transmitted disease?" f. "Is there a family history of sudden death from a myocardial infarction?" g."Have you had any problems with headaches?"
75. 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
a."The other kidney will provide adequate function, but this may take days or weeks." b."The other kidney alone isn't able to provide adequate function, so supplemental therapies will be 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."
19. 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? C
a."Try drinking several large glasses of water and waiting a few more hours." b. "Are you having any other symptoms such as flank pain or fever?" c."You could have an obstruction, so you should come in to be checked." d.""I am sorry, but I really can't comment about your problem over the phone.""
"Which patient is at greatest risk for the development of chronic pyelonephritis? C
a.80-year-old woman who takes diuretics for mild heart failure b. 80-year-old man who drinks four cans of beer per day c.36-year-old woman with diabetes mellitus who is pregnant d.36-year-old man with diabetes insipidus
62."A patient with late stage "chronic glomerulonephritis. Which treatment does the nurse discuss and educate the patient about? B
a.Appropriate anti-infective medications b.Dialysis or transplantation c.Radiation therapy d.Immunosuppressive agents
A patient had a nephrostomy and a nephrostomy tube is in place. What is included in the postoperative care of this patient? A
a.Assess the amount of drainage in the collection bag. b.Irrigate the tube to ensure patency. c.Keep the patient NPO for 6 to 8 hours. d.Review the results of the clotting studies.
67. Which ethnic groups are mostly likely to develop end-stage kidney disease related to hypertension? (Select all that apply.) C,E
a.Caucasian Americans b.Asian Americans c.American Indians d.African Americans e.Hispanic Americans
"The nurse is assessing a patient who reports chills, high fever, and flank pain with urinary urgency and frequency. On physical exami- nation, the patient has costovertebral angle (CVA) tenderness, pulse is 110 beats/min, and respirations are 28/min. How does the nurse interpret these findings? B
a.Complicated cystitis b. Acute Pyelonephritis c.Chronic pyelonephritis d. Acute glomerulonephritis
39. The nurse is giving discharge instructions to a patient who had pyelolithotomy. What topics does the nurse include in the teaching plan? (Select all that apply.) A,C,D,E
a.Controlling blood pressure b. Restricting fluids c.Eating properly to promote healing d.Completing oral antibiotics e.Monitoring changes in urine output
57. Which patient history factor is considered a causative factor for acute glomerulonephritis? B
a.Cystitis 6 months ago b.Strep throat 3 weeks ago c. Kidney stones 2 years ago d. Mild hypertension diagnosed 1 year ago
42. In PKD, the effect on the renin-angiotensin system in the kidney ends in which result? B
a.Decreased blood pressure b.Increased blood pressure c.Increased urine output d.Oliguria
50. A patient is very ill and is admitted to the intensive care unit with rapidly progressive glomerulonephritis. The nurse monitors the patient for manifestations of which organ sys- tem failure? D
a.Immune system b. Cardiac c. Liver d. Kidney"
"An older adult male patient reports an acute problem with urine retention. The nurse ad- vises the patient to seek medical attention be- cause permanent kidney damage can occur in what time frame? B
a.In less than 6 hours b. In less than 48 hours c.Within several weeks d.Within several years
83.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 D
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.
55. "The nurse is reviewing arterial blood gas results of a patient with acute glomerulonephri- tis. The pH of the 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
a.Normal pH with respiratory compensation b.Acidosis with failure of respiratory com- pensation c.Alkalosis with failure of metabolic compensation d.Normal pH with metabolic compensation
86. "A patient has sustained a kidney injury. In order to assist the patient to undergo the best diagnostic test to determine the extent of injury, what does the nurse do?C
a.Obtain a clean-catch urine specimen for urinalysis. b.Give an IV fluid bolus before renal arteri-ography. c.Give an explanation of computed tomog- raphy. d.Obtain a blood sample for hemoglobin and hematocrit."
76. After a nephrectomy, one adrenal gland re- mains. Based on this knowledge, which type of medication replacement therapy does the nurse expect a patient who had a nephrectomy to receive? B
a.Potassium b. Steroid c. Calcium d. Estrogen"
52. 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
a.Proteinuria b.Elevated hematocrit c.Very low urine specific gravity d.Low white blood cell count
38. A patient is diagnosed with acute pyelonephritis. What is the priority for nursing care for this patient? C
a.Providing information about the disease process and self-care b. Controlling hypertension c.Managing pain d.Preventing constipation
"A patient's parent has the autosomal domi- nant form of polycystic kidney disease (PKD). Which abnormal vital sign is the greatest con- cern for the nurse to follow up with because of the family history of PKD? B
a.Pulse of 100 beats/min b.Temperature of 100.6° F c.`Blood pressure of 130/84 mm Hg d.Respiratory rate of 22/min"
35. The health care provider informs a patient with acute pyelonephritis that abscess formation is common and recommends diagnostic testing to identify the presence of an abscess. Which test does the nurse prepare the patient for? C
a.Renal arteriography b. Cystourethrogram c.Radionuclide scintillation d. Urodynamic flow studies
59..A patient with acute glomerulonephritis is required to provide a 24-hour urine specimen. What does the nurse expect to see with the specimen? A
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
84. A patient is brought to the emergency department (ED) after being involved in a fight in which the patient was kicked and punched re- peatedly in the back. What does the nurse include in the initial physical assessment? (Select all that apply.)A,B,C,D,F,G
a.Take complete vital signs. b.Check apical and peripheral pulses. c. Inspect both flanks for asymmetry or penetrating injuries of the lower chest or back. d.Inspect the abdomen for bruising or penetrating wounds. e.Deeply palpate the abdomen for signs of rigidity. f. Percuss the abdomen for distention. g.Inspect the urethra for gross bleeding."
14. Which pain management strategy does the nurse teach a patient who has pain from infected kidney cysts of PKD? D
a.Take nothing by mouth. b.Increase the dose of NSAIDs. c.Assume a high-Fowler's position. d.Apply dry heat to the abdomen or flank.
"The nurse is developing a teaching plan for a patient with PKD. Which topics does the nurse include? (Select all that apply.) A,B,D,E
a.Teach how to measure and record blood pressure. b.Assist to develop a schedule for self administering drugs. c. Instruct to take and record weight twice a month. d.Teach to keep blood pressure records. e. Explain the potential side effects of thedrugs. f. Review high-protein, low-fat diet plan."
The nurse is reviewing the laboratory results for a patient being evaluated for trouble with passing urine. The urinalysis shows tubular epithelial cells on microscopic examination. How does the nurse interpret this finding? B
a.The obstruction is resolving. b.The obstruction is prolonged. c.Glomerular filtration rate (GFR) is reduced. d.GFR is adequate.
61. Which diagnostic tests and results does the nurse expect to see with acute glomerulone- phritis? (Select all that apply.) A,B,C,E,G,H
a.Urinalysis revealing hematuria b.Urinalysis revealing proteinuria c.Microscopic red blood cell casts d Normal urine sedimentation assay e.24-hour urine for creatinine clearance decreased f. Serum nitrogen level decreased g.Serum albumin levels decreased h. Antistreptolysin-O titers increased"
The nurse is caring for a patient with a neph- rostomy. The nurse notifies the health care pro- vider about which assessment finding? B
a.Urine drainage is red-tinged 4 hours post- 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.
"18. After the nurse instructs a patient with PKD on home care, the patient knows to contact the health care provider immediately when what sign/symptom occurs? B
a.Urine is blood-tinged. b.Weight has increased by 3 pounds in 3days. c. Two days have passed since the last bowel movement. d. Morning systolic blood pressure has decreased by 5 mm Hg.
A. Associated with acute pyelonephritis b.Common to both acute and chronic pyelonephritis c.Common to neither acute nor chronic pyelonephritis"
A Abscess formation C Alcohol abuse A Active bacterial infection C Decreased urine specific gravity B CVA tenderness/pain B Undergone manipulation of the uri- nary tract"
43. The common problem of hydronephrosis, hydroureter, and urethral stricture in kidney function is ____________.
OBSTRUCTION
"Which descriptions about the autosomal dom- inant gene trait of PKD are correct? (Select all that apply.) B,C,D
a.25% of patients with this form of PKD develop kidney failure by age 30. b. This is the most common form of PKD. c.Half of people with this form of PKD develop kidney failure by age 50. d.Nearly 100% of people who inherit a PKD gene will develop kidney cysts by age 50. e.Most people with this form of PKD die in young adulthood.
46. A patient is admitted for acute glomerulone- phritis. In reviewing the patient's past medical history, which systemic conditions does the nurse suspect may have caused acute glomeru- lonephritis and will include in the overall treatment plan?A
a.Systemic lupus erythematosus and diabetic nephropathy b.Myocardial infarction and atrial fibrillation c.Ischemic stroke and hemiparesis d. Blunt trauma to the kidney with hematuria"
"A followed by blood in the urine. How does the nurse interpret these signs/symptoms? B
a. Infection b. Ruptured cyst c. Increased kidney size d. Ruptured renal artery aneurysm
"Why may a patient with PKD experience con- stipation? A
a. Polycystic kidneys enlarge and put pres- sure on the large intestine. b. Patient becomes dehydrated because the kidneys are dysfunctional. c. Constipation is a side effect from the med- ications given to treat PKD. d. Patients with PKD have special dietary re- strictions that cause constipation."
47."The nurse is assessing a patient with possible acute glomerulonephritis. During the inspec- tion of the hands, face, and eyelids, the nurse is primarily observing for evidence of which factors? B
a. Redness b. Edema c. Rashes d. Dryness
Which manifestations are associated with chronic pyelonephritis? (Select all that apply.) B,D,E
a.Abscess formation b.Obstruction with reflex c.Acute bacterial infection d.Structural deformities e.Neurogenic impairment of voiding"
40. A patient has come to the clinic for follow-up of acute pyelonephritis. Which action does the nurse reinforce to the patient? A
a.Complete all antibiotic regimens. b.Report episodes of nocturia. c.Stop taking the antibiotic when pain is relieved. d.Notify the health care provider of any over-the-counter drug use
63. The nurse is caring for a patient with nephrotic syndrome. What interventions are included in the plan of care for this patient? (Select all that apply.) B,C,D,E
a.Dietary protein must be increased. b.Administer mild diuretics. c.Assess for edema. d. Administer antihypertensive medications. e.Assess the patient's hydration status
36. A patient with chronic pyelonephritis returns to the clinic for follow-up. Which behavior in- dicatesthepatientismeetingtheexpectedout- comes to conserve existing kidney function? C
a.Drinks a liter of fluid every day b.Considers buying a home blood pressure cuff c.Reports self-administration of antibiotics as prescribed d.Takes pain medication on a regular basis"
53. A patient has chronic glomerulonephritis. In order to assess for uremic symptoms, what does the nurse do? B
a.Evaluate the blood urea nitrogen (BUN). b.Ask the patient to extend the arms and hy- perextend the wrists. c.Gently palpate the flank for asymmetry and tenderness. d.Auscultate for the presence of an S3 heart sound.
22. Which clinical manifestation in a patient with an obstruction in the urinary system is associated specifically with a hydronephrosis? A
a.Flank asymmetry b.Chills and fever c. Urge incontinence d.Decreased urine Volume"
"A patient has a family history of autosomal dominant form of PKD and has therefore been advised to monitor for and report symptoms. What is an early symptom of PKD? D
a.Headache b. Pruritus c.Edema d.Nocturia"
60. Which nursing intervention is applicable for a patient with acute glomerulonephritis? D
a.Restricting visitors to adults only b.Using a lift sheet to turn the patient c.Inspecting the vascular access d. Measuring weight daily
Which statement made by a client who has acute pyelonephritis indicates to the nurse correct understanding of the antibiotic therapy? ANS: C Rationale: Antibiotic therapy is most effective when taken for the entire course and not just when symptoms are present. Most antibiotic therapy results in some degree of diarrhea. Although additional drugs may be needed to control this side effect, it is usually unnecessary to stop the drug.
A. "If my temperature is normal for 3 days in a row, the infection is gone and I can stop taking the drug." B. "If my temperature goes above 100° for 2 days, I should take double the dose of the drug." C. "Even if I feel completely well, I should take the drug exactly as prescribed until it is gone." D. "I should notify my prescriber to change the medication if I develop diarrhea while taking this drug."
The wife of a client with severe chronic kidney disease who has a Kussmaul pattern of respiration asks the nurse about giving the client oxygen to ease his respirations. What is the nurse's best response? ANS: D Rationale: The client's respiratory pattern is a compensatory mechanism to help get rid of excess acids. It is not caused by a lack of oxygen. It is possible that the oxygen could slow his respiratory rate somewhat, which would allow him to retain the metabolic acids longer. Oxygen should be applied if his pulse oximetry indicates he is hypoxic. If he is not hypoxic, he should not receive oxygen.
A. "That is a good idea and I will check with the physician right away." B. "The oxygen mask or tube may increase his risk for skin breakdown." C. "He will probably need a high flow of oxygen because he is also anemic." D. "Oxygen will not help his respirations and could make his acidosis worse."
The client with diabetes who also has persistent proteinuria asks what he could do to prevent eventual kidney failure. What is the nurse's best response? ANS: D Rationale: The presence of persistent proteinuria indicates kidney damage has already occurred and is likely to eventually progress to kidney failure. Although kidney failure cannot be prevented, the decline in kidney function can be slowed with tight glycemic control. The severity of diabetic kidney disease is related to the degree of hyperglycemia the client generally experiences. With poor control of hyperglycemia, the complicating problems of atherosclerosis, hypertension, and neuropathy (which promote loss of bladder tone, urinary stasis, and urinary tract infection) are more severe and more likely to cause additional kidney damage sooner.
A. "Wear pads and other protective gear around your lower back when engaging in contact sports." B. "Drink at least 3 L of water daily and avoid carbonated beverages." C. "Limit your intake of proteins to less than 100 g daily." D. "Keep your blood glucose levels in the target range."
What is the most important precaution for the nurse to teach the client with continuing kidney impairment on discharge after treatment for acute kidney injury? ANS: B Rationale: The client with continuing renal impairment after acute kidney injury is at risk for fluid overload. One of the best indicators of fluid overload is rapid weight gain. This client is not at risk for dehydration and is most likely on some degree of fluid restriction. Although clients with kidney impairment are usually asked to avoid alcohol and caffeine, this is not the most important precaution. Even if the client had diabetes, daily checking of the urine for glucose is not generally prescribed.
A. Avoid fluids that contain either alcohol or caffeine. B. Weigh yourself daily and report any rapid weight gain. C. Drink at least 3 liters of fluid daily to prevent dehydration. D. Use a dipstick to check for glucose in your urine at least once daily.
The client admitted to the emergency department 1 hour after a motorcycle crash has all of the following laboratory test results. Which result does the nurse report to the health care provider immediately? ANS: C Rationale: Although the blood glucose and BUN levels are slightly high, the real indicator that puts this client at risk for acute kidney injury and renal failure is the extremely high blood osmolarity indicating severe depletion of the circulating blood volume. (The normal range is 285-295 mOsm/kg.)
A. Blood glucose level of 138 mg/dL B. Blood urea nitrogen of 22 mg/dL C. Blood osmolarity of 330 mOsm D. Serum potassium of 4.9 mEq/L
The client with end-stage kidney disease (ESKD) appears to have pulmonary edema. Which intervention does the nurse perform first? ANS: A Rationale: Raising the head of the bed should be done first because it will provide the client with some immediate relief and slow the progression of pulmonary edema. Applying oxygen also is an appropriate early intervention but will take a bit longer than raising the HOB, especially if the nasal cannula or other equipment is not at the bedside. Measuring oxygen saturation is appropriate but could be done after everything else and before notifying the Rapid Response Team.
A. Raise the head of the bed B. Apply oxygen by nasal cannula C. Notify the Rapid Response Team D. Measure oxygen saturation by pulse oximetry
Which laboratory test result for a client who is about to have a nephrostomy for hydronephrosis does the nurse report immediately to the physician? ANS: D Rationale: Although the sodium and BUN levels are slightly higher than normal, they are within the ranges expected with hydronephrosis. The INR, however, is seriously elevated and indicates a dangerously long clotting time with a greatly increased risk for bleeding. It must be corrected before surgery.
A. Serum sodium 137 mEq/L B. Serum potassium 4.8 mEq/L C. Blood urea nitrogen (BUN) 23 mg/dL D. International normalized ratio (INR) 4.6
A 40-year-old African-American woman is newly diagnosed with mild chronic kidney disease (CKD). She is otherwise very fit and healthy, and no one in her family has CKD. She asks the nurse whether any of the following factors could have caused this problem. Which factor should the nurse indicate may have influenced the development of CKD? ANS: B Rationale: Naproxen is an NSAID that reduces blood flow to the kidney. Prolonged use can lead to kidney damage. Her mother and sister have type 2 diabetes, which increases her risk for that disease but not for chronic kidney disease independent of diabetes.
A. She has followed a vegetarian diet that includes eggs but no dairy products for the past 3 years. B. She has taken 220 mg of naproxen twice daily for 3 years. C. Her mother and older sister have type 2 diabetes. D. She drinks 3 liters of water daily.
When performing an hourly assessment of a client who had a subclavian catheter placed 6 hours ago for continuous arteriovenous hemofiltration with dialysis (CAVHD), the nurse observes these findings. For which finding does the nurse stop the CAVHD? ANS: B Rationale: An increase in pulse oximetry is an indication that CAVHD is effective. The midline tracheal position is normal. The right foot and ankle appearing slightly more edematous than the left foot and ankle is insignificant. Edema formation is seldom bilaterally symmetrical. The drop in blood pressure in 1 hour is very significant and indicates that the client cannot tolerate the rate of CAVHD. He or she is in danger of shock (and impairment of kidney perfusion). CAVHD should be stopped immediately and the client thoroughly assessed for cardiovascular stability.
A. The right foot and ankle appear slightly more edematous than the left foot and ankle. B. Blood pressure has decreased from 148/90 to 90/60. C. Pulse oximetry is increased from 89% to 91%. D. The trachea is in a midline position.
