Prepu - Chapter 54: Management of Patients With Kidney Disorders

An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? "This type of dialysis will provide more independence." "The risk of peritonitis is greater with this type of dialysis." "Peritoneal dialysis will require more work for you." "Peritoneal dialysis does not work well for every client."

"This type of dialysis will provide more independence."

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

The nurse is able to identify which condition as uremia? An excess of blood in the urine An excess of urea in the blood An excess of protein in the blood An excess of protein in the urine

An excess of urea in the blood

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 client? Acidosis Pericarditis Hyperkalemia Anemia

Anemia

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? Brief, hot daily showers Uses moisturizing creams Pats skin dry after bathing Keeps nails trimmed short

Brief, hot daily showers

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? Fever Absence of pain Weight loss Diuresis

Fever

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? Pneumonia caused by shallow breathing because of severe incisional pain Abdominal distention owing to reflex cessation of intestinal peristalsis Paralytic ileus caused by manipulation of the colon during surgery Hypovolemic shock caused by hemorrhage SUBMIT ANSWER Exit quiz

Hypovolemic shock caused by hemorrhage

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 protein, carbohydrates, and fat intake. Increase fat intake and limit carbohydrates. Eliminate fat intake and increase protein intake. Increase carbohydrates and limit protein intake.

Increase carbohydrates and limit protein intake.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? Temperature of 100.2° F (37.8° C) Urine output of 250 ml/24 hours Blood urea nitrogen (BUN) level of 22 mg/dl Serum creatinine level of 1.2 mg/dl

Urine output of 250 ml/24 hours

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? Perform deep-breathing exercises vigorously. Auscultate the lungs frequently. Wear a mask when performing exchanges. Avoid carrying heavy items.

Wear a mask when performing exchanges.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? Hematocrit (HCT) of 35% Potassium level of 3.5 mEq/L Blood glucose level of 200 mg/dl White blood cell (WBC) count of 20,000/mm3

White blood cell (WBC) count of 20,000/mm3

The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication? With food 2 hours after meals At bedtime with 8 ounces of fluid 2 hours before meals SUBMIT ANSWER

With food

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. Tall, peaked T waves Prolonged ST segment Shortened QRS complex Multiple spiked P waves

Tall, peaked T waves

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

Dehydration

The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than ___________mL/kg/hr.

0.5

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? Hematuria Bacteremia Azotemia Proteinuria

Azotemia

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? Continuous arteriovenous hemofiltration (CAVH) Hemodialysis Continuous venovenous hemofiltration (CVVH) Peritoneal dialysis

Hemodialysis

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 Elevated urea and nitrogen Elevated serum creatinine Hyperkalemia

Hyperphosphatemia

The nurse cares for a client who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed: acute rejection. simple rejection. chronic rejection. hyperacute rejection.

hyperacute rejection.

Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? Glomerulonephritis Dysrhythmia Ureteral calculus Hypovolemia

Glomerulonephritis

Patient education regarding a fistulae or graft includes which of the following? Select all that apply. Check daily for thrill and bruit. Cleanse site b.i.d. No IV or blood pressure taken on extremity with dialysis access. Avoid compression of the site. No tight clothing.

Check daily for thrill and bruit. No IV or blood pressure taken on extremity with dialysis access. Avoid compression of the site. No tight clothing.

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? Restored glomerular function Acute tubular necrosis Diuresis Oliguria

Oliguria

A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? "Squamous cell carcinomas do not present with detectable symptoms." "You should have sought treatment earlier." "Painless gross hematuria is the first symptom in renal cancer." "Very few symptoms are associated with renal cancer."

"Very few symptoms are associated with renal cancer."

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? Cola-colored urine Pyuria Left upper quadrant pain Low blood pressure

Cola-colored urine

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 Elevated urea levels Elevated white blood cells Hypocalcemia

Hyperkalemia

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. dyspnea and cyanosis. nausea and vomiting. thrush and circumoral pallor.

fatigue and weakness.

A client has been diagnosed with acute glomerulonephritis. This condition causes: polyuria. No option is correct. proteinuria. pyuria.

proteinuria

A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching? "The cysts can get quite large in size." "I inherited this disorder from one of my parents." "If renal failure develops, I may need to consider dialysis." "As long as I have one normal kidney, I should be fine."

"As long as I have one normal kidney, I should be fine."

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 GFR of 90 mL/min/1.73 m2 A GFR of 120 mL/min/1.73 m2 A GFR of 85 mL/min/1.73 m2

A GFR of 30-59 mL/min/1.73 m2

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? Administration of an insulin drip Administration of a loop diuretic Administration of sodium bicarbonate Administration of sodium polystyrene sulfonate [Kayexalate])

Administration of sodium polystyrene sulfonate [Kayexalate])

A client is experiencing a decreasing glomerular filtration. What laboratory values should the nurse expect to follow the change? Select all that apply. Hypokalemia Blood urea nitrogen (BUN) increases Creatinine clearance decreases Hypophosphatemia Serum creatinine increases

Blood urea nitrogen (BUN) increases Creatinine clearance decreases Serum creatinine increases

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. Serum creatinine of 1.2 mg/dL. BUN of 18 mg/dL. Glomerular filtration rate (GFR) of 100 mL/min.

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

Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted. White rice Citrus fruits Salad oils Butter

Citrus fruits

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? Hyperalbuminemia Peripheral neuropathy Hypotension Cola-colored urine

Cola-colored urine

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. Donors must be relatives. The client is placed on a transplant list at the local hospital. Donors with hypertension may qualify.

Donors are selected from compatible living or deceased donors.

What is a characteristic of the intrarenal category of acute kidney injury (AKI)? Decreased creatinine Decreased urine sodium High specific gravity Increased BUN

Increased BUN

What is a characteristic of the intrarenal category of acute renal failure? Decreased creatinine Decreased urine sodium High specific gravity Increased BUN

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 catheter stabilized to the abdomen, below the belt line Wear a mask while handling any dialysate solutions Keep the dialysis supplies in a clean area, away from children and pets Clean the catheter insertion site daily with soap

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

The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output? Less than 400 mL Less than 50 mL 1.5 L 1.0 L

Less than 400 mL

What is a hallmark of the diagnosis of nephrotic syndrome? Proteinuria Hypokalemia Hyperalbuminemia Hyponatremia

Proteinuria

Which of the following occurs late in chronic glomerulonephritis? Peripheral neuropathy Nosebleed Seizure Stroke

Peripheral neuropathy

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? History of osteoporosis Previous episode of acute pyelonephritis Recent history of streptococcal infection History of hyperparathyroidism

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? Activity intolerance Risk for infection Toileting self-care deficit Impaired urinary elimination

Risk for infection

Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? Blood tinged drainage in Jackson-Pratt drainage tube SpO2 at 90% with fine crackles in the lung bases Pain of 3 out of 10, 1 hour after analgesic administration Urine output of 35 to 40 mL/hour

SpO2 at 90% with fine crackles in the lung bases

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. Encourage oral fluids. Administer furosemide (Lasix) 20 mg IV Start hemodialysis after a temporary access is obtained.

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

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. Kidney function will improve with transplant. Acute renal failure tends to turn to end-stage failure. Once on dialysis, the need will be permanent.

The kidneys can improve over a period of months.

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 Temperature of 99.2° F (37.3° C) Serum sodium level of 135 mEq/L Serum potassium level of 4.9 mEq/L

Urine output of 20 ml/hour

The nurse monitors the client for potential complications during dialysis but recognizes NOT to monitor for muscle cramping. dysrhythmias. hypertension. air embolism.

hypertension

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? pH 7.50, PaCO2 29, HCO3 22- pH 7.47, PaCO2 45, HCO3 33- pH 7.20, PaCO2 36, HCO3 14- pH 7.31, PaCO2 48, HCO3 24-

pH 7.20, PaCO2 36, HCO3 14-

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. eating protein liberally. limiting iron and folic acid intake. allowing liberal use of sodium.

restricting sources of potassium.