Renal
. The dialysis solution is warmed before use in peritoneal dialysis primarily to: 1. Encourage the removal of serum urea. 2. Force potassium back into the cells. 3. Add extra warmth to the body. 4. Promote abdominal muscle relaxation
1. The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance. Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations, but this is a secondary reason for warming the solution. The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.
During dialysis, the nurse observes that the flow of dialysate stops before all the solution has drained out. The nurse should: 1. Have the client sit in a chair. 2. Turn the client from side to side. 3. Reposition the peritoneal catheter. 4. Have the client walk.
2. Fluid return with peritoneal dialysis is accomplished by gravity flow. Actions that enhance gravity flow include turning the client from side to side, raising the head of the bed, and gently massaging the abdomen. The client is usually confined to a recumbent position during the dialysis. The nurse should not attempt to reposition the catheter.
The nurse judges that the mother understands the diet restrictions for her child with chronic renal failure who is receiving peritoneal dialysis when she reports providing a diet involving which of the following? 1. Sodium and water restrictions. 2. High protein and carbohydrates. 3. High potassium and iron. 4. Protein and phosphorous restrictions.
2. High protein and carbohydrates.
A nurse is assessing a client with nephrotic syndrome. The nurse should assess the client for which condition? 1. Hematuria. 2. Massive proteinuria. 3. Increased serum albumin level. 4. Weight loss.
2. Massive proteinuria. Nephrotic syndrome is characterized by massive proteinuria caused by increased glomerular membrane permeability. Other symptoms include peripheral edema, hyperlipidemia, and hypoalbuminemia. Because of the edema, clients retain fluid and may gain weight. Hematuria is not a symptom related to nephrotic syndrome.
A 15-year-old has been diagnosed with acute glomerulonephritis and has been in the hospital for 1 day. Which of the following findings requires immediate action? 1. Large amount of generalized edema. 2. Urine specific gravity of 1.030. 3. Large amount of albumin in the urine. 4. 24-hour output of 1,500 mL.
. 2. An adolescent with acute glomerulonephritis has a high urine specific gravity related to oliguria caused by inflammation of the glomeruli. The client will have periorbital edema, but not the generalized edema that occurs in nephrotic syndrome. In glomerulonephritis, there is some albumin in the urine, but there are large amounts of red blood cells, giving the urine a brown color. The urine in glomerulonephritis is scanty, averaging about 400 mL in 24 hours, which leads to fluid volume excess and hypertension.
The nurse is discussing concerns about sexual activity with a client with chronic renal failure. Which one of the following strategies would be most useful? 1. Help the client to accept that sexual activity will be decreased. 2. Suggest using alternative forms of sexual expression and intimacy. 3. Tell the client to plan rest periods after sexual activity. 4. Suggest that the client avoid sexual activity to prevent embarrassment
. 2. Altered sexual functioning commonly occurs in chronic renal failure and can stress marriages and relationships. Altered sexual functioning can be caused by decreased hormone levels, anemia, peripheral neuropathy, or medication. The client should not decrease or avoid sexual activity but instead should modify it. The client should rest before sexual activity.
. The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which of the following diets would be most appropriate? 1. High-carbohydrate, high-protein. 2. High-calcium, high-potassium, high-protein. 3. Low-protein, low-sodium, low-potassium. 4. Low-protein, high-potassium.
. 3. Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high-carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day.
When developing the discharge teaching plan for a child with chronic renal failure and the family, the nurse should emphasize restriction of which of the following nutrients? 1. Ascorbic acid. 2. Calcium. 3. Magnesium. 4. Phosphorus..
4. Phosphorus..
A client developed cardiogenic shock after a severe myocardial infarction and has now developed acute renal failure. The client's family asks the nurse why the client has developed acute renal failure. The nurse should base the response on the knowledge that there was: 1. A decrease in the blood flow through the kidneys. 2. An obstruction of urine flow from the kidneys. 3. A blood clot formed in the kidneys. 4. Structural damage to the kidney resulting in acute tubular necrosis
. 1. There are three categories of acute renal failure: prerenal, intrarenal, and postrenal. Causes of prerenal failure occur outside the kidney and include poor perfusion and decreased circulating volume resulting from such factors as trauma, septic shock, impaired cardiac function, and dehydration. In this case of severe myocardial infarction, there was a decrease in perfusion of the kidneys caused by impaired cardiac function. An obstruction within the urinary tract, such as from kidney stones, tumors, or benign prostatic hypertrophy, is called postrenal failure. Structural damage to the kidneyresulting from acute tubular necrosis is called intrarenal failure. It is caused by such conditions as hypersensitivity (allergic disorders), renal vessel obstruction, and nephrotoxic agents.
During the client's dialysis, the nurse observes that the solution draining from the abdomen is consistently blood-tinged. The client has a permanent peritoneal catheter in place. The nurse should interpret that the bleeding: 1. Is expected with a permanent peritoneal catheter. 2. Indicates abdominal blood vessel damage. 3. Can indicate kidney damage. 4. Is caused by too-rapid infusion of the dialysate
. 2. Because the client has a permanent catheter in place, blood-tinged drainage should not occur. Persistent blood-tinged drainage could indicate damage to the abdominal vessels, and the physician should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too-rapid infusion of the dialysate can cause pain, not blood-tinged drainage.
. A 10-year-old with glomerulonephritis reports a headache and blurred vision. The nurse should immediately: 1. Put the client to bed. 2. Obtain the child's blood pressure. 3. Notify the physician. 4. Administer acetaminophen (Tylenol).
. 2. Hypertension occurs with acute glomerulonephritis. The symptoms of headache and blurred vision may indicate an elevated blood pressure. Hypertension in acute glomerulonephritis occurs due to the inability of the kidneys to remove fluid and sodium; the fluid is reabsorbed, causing fluid volume excess. The nurse must verify that these symptoms are due to hypertension. Calling the physician before confirming the cause of the symptoms would not assist the physician in his treatment. Putting the client to bed may help treat an elevated blood pressure, but first the nurse must establish that high blood pressure is the cause of the symptoms. Administering Tylenol for high blood pressure is not recommended.
When developing the plan of care for a school-age child with acute poststreptococcal glomerulonephritis who has a fluid restriction of 1,000 mL/day, which of the following fluids should the nurse consider as most appropriate for the client's condition and effective for preventing excessive thirst? 1. Diet cola. 2. Ice chips. 3. Lemonade. 4. Tap water
. 2. The most appropriate and effective choice would be ice chips, because they help moisten the mouth and lips while keeping fluid intake low. However, ice chips must still be counted as intake with the fluid restriction. Sweet beverages, such as diet cola or lemonade, commonly increase thirst. Tap water effectively relieves thirst but does not help keep fluid intake low.
After completion of peritoneal dialysis, the nurse should assess the client for which of the following? 1. Hematuria. 2. Weight loss. 3. Hypertension. 4. Increased urine output.
. 2. Weight loss is expected because of the removal of fluid. The client's weight before and after dialysis is one measure of the effectiveness of treatment. Blood pressure usually decreases because of the removal of fluid. Hematuria would not occur after completion of peritoneal dialysis. Dialysis only minimally affects the damaged kidneys' ability to manufacture urine.
When developing the discharge plan for a school-age child diagnosed with acute poststreptococcal glomerulonephritis, which instruction should the nurse plan to discuss? 1. Restricting dietary protein 2. Monitoring pulse rate and rhythm. 3. Preventing respiratory infections. 4. Restricting foods high in potassium
. 3. Children recovering from glomerulonephritis need to avoid exposure to all types of infections. Glomerulonephritis is caused by group A beta-hemolytic streptococcus, a common cause of sore throat. As the child recovers, he or she may be susceptible to a recurrence if exposed to the organism again. During convalescence from glomerulonephritis, fluid and dietary restrictions are no longer indicated because the kidneys are now functioning normally. There is no need for the parents to assess the child's vital signs.
Which of the following questions should the nurse ask first when obtaining a history from the mother of a 10-year-old child with a fever, malaise, and swelling around the eyes? 1. "Has the child had a sore throat recently?" 2. "Is the child playing with friends as usual?" 3. "Does the child urinate as much as usual?" 4. "Is the urine pale in color?"
.3 Most likely, the nurse suspects that the child is exhibiting signs and symptoms of glomerulonephritis, such as periorbital edema and fever. Other signs and symptoms include loss of appetite, dark-colored urine, pallor, headaches, and abdominal pain. To confirm this suspicion, the nurse would ask about the child's urinary elimination patterns. Typically the child with glomerulonephritis experiences a decrease in urine output. Asking about anyrecent sore throat would provide additional information to confirm the suspicion of glomerulonephritis, because the most common type is acute poststreptococcal glomerulonephritis, which follows a strep throat by 10 to 14 days. Frequently, the children have only mild cold symptoms and do not realize they have a streptococcal infection. Asking whether the child plays with friends as usual is important and gives the nurse information about how the child feels in general. However, this is a general question that would be appropriate to ask later on in the history. Although asking the mother about the color of the child's urine is important, the nurse needs to determine whether there is any change in the child's urinary output first.
The nurse is determining which teaching approaches for the clientwith chronic renal failure and uremia would be most appropriate. The nurse should: 1. Provide all needed teaching in one extended session. 2. Validate the client's understanding of the material frequently. 3. Conduct a one-on-one session with the client. 4. Use videotapes to reinforce the material as needed.
. 2. Uremia can cause decreased alertness, so the nurse needs to validate the client's comprehension frequently. Because the client's ability to concentrate is limited, short lessons are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videotapes because clients may not beable to maintain alertness during the viewing of the videotape.
. The client in acute renal failure has an external cannula inserted in the forearm for hemodialysis. Which of the following nursing measures is appropriate for the care of this client? 1. Use the unaffected arm for blood pressure measurements. 2. Draw blood from the cannula for routine laboratory work. 3. Percuss the cannula for bruits each shift. 4. Inject heparin into the cannula each shift.
1. The unaffected arm should be used for blood pressure measurement. The external cannula must be handled carefully and protected from damage and disruption. In addition, a tourniquet or clamps should be kept at the bedside because dislodgment of the cannula would cause arterial hemorrhage. The arm with the cannula is not used for blood pressure measurement, IV therapy, or venipuncture. Patency is assessed by auscultating for bruits every shift. Heparin is not injected into the cannula to maintain patency. Because it is part of the general circulation, the cannula cannot be heparinized.
A child with nephrosis is taking prednisone. The nurse should teach the caregivers to report which of the following adverse effects? Select all that apply. 1. Increased urinary output. 2. Hematemesis. 3. Respiratory infection. 4. Bleeding gums. 5. Vision problems.
2, 3. Adverse effects of steroid therapy include edema of the face and trunk, increased susceptibility to infection, gastric and intestinal mucosal bleeding, sodium and water retention, and hypertension. Urinary output is decreased due to the retention of sodium. Bleeding gums do not result from steroids. Steroid therapy does not cause vision problems.
hich of the following nursing interventions should be included in the client's plan of care during dialysis therapy? 1. Limit the client's visitors. 2. Monitor the client's blood pressure. 3. Pad the side rails of the bed. 4. Keep the client on nothing-by-mouth (NPO) status.
2. Because hypotension is a complication associated with peritoneal dialysis, the nurse records intake and output, monitors vital signs, and observes the client's behavior. The nurse also encourages visiting and other diversional activities. A client on peritoneal dialysis does not need to be placed in a bed with padded side rails or kept on NPO status.
During dialysis, the client has disequilibrium syndrome. The nurse should first: 1. Administer oxygen per nasal cannula. 2. Slow the rate of dialysis. 3. Reassure the client that the symptoms are normal. 4. Place the client in Trendelenburg's position.
2. If disequilibrium syndrome occurs during dialysis, the most appropriate intervention is to slow the rate of dialysis. The syndrome is believed to result from too-rapid removal of urea and excess electrolytes from the blood; this causes transient cerebral edema, which produces the symptoms. Administration of oxygen and position changes do not affect the symptoms. It would not be appropriate to reassure the client that the symptoms are normal.
A school-age client admitted to the hospital because of decreased urine output and periorbital edema is diagnosed with acute poststreptococcal glomerulonephritis. Which of the following actions should receive the highest priority? 1. Assessing vital signs every 4 hours. 2. Monitoring intake and output every 12 hours. 3. Obtaining daily weight measurements. 4. Obtaining serum electrolyte levels daily
3. The child with acute poststreptococcal glomerulonephritis experiences a problem with renal function that ultimately affects fluid balance. Because weight is the best indicator of fluid balance, obtaining daily weights would be the highest priority
Which of the following statements by the mother of a toddler diagnosed with nephrotic syndrome indicates that the mother has understood the nurse's teaching about this disease? 1. "My child really likes chips and bologna. I guess we'll have to find something else." 2. "We'll have to encourage lots of liquids. Did you say about 4 L everyday?" 3. "We worry about the surgery. Do you think we should do direct donation of blood?" 4. "We understand the need for antibiotics. I just wish the antibiotics could be given by mouth."
1. Children with nephrotic syndrome usually require sodium restriction. Because potato chips and bologna are high in sodium, the mother's statement about finding something else reflects understanding of this need. Although fluid intake is not restricted in children with nephrotic syndrome, 4 L is an excessive amount for a toddler. The typical fluid requirement for a toddler is 115 mL/kg. Surgical intervention and antibiotic therapy are not parts of the treatment plan for nephrotic syndrome.
Which of the following assessments would be most appropriate for the nurse to make while the dialysis solution is dwelling within the client's abdomen? 1. Assess for urticaria. 2. Observe respiratory status. 3. Check capillary refill time. 4. Monitor electrolyte status.
2. During dwell time, the dialysis solution is allowed to remain in the peritoneal cavity for the time prescribed by the physician (usually 20 to 45 minutes). During this time, the nurse should monitor the client's respiratory status because the pressure of the dialysis solution on the diaphragm can create respiratory distress. The dialysis solution would not cause urticaria or affect circulation to the fingers. The client's laboratory values are obtained before beginning treatment and are monitored every 4 to 8 hours during the treatment, not just during the dwell time.
The mother of a toddler with nephrotic syndrome asks the nurse what can be done about the child's swollen eyes. Which measure should the nurse suggest? 1. Applying cool compresses to the child's eyes. 2. Elevating the head of the child's bed. 3. Applying eye drops every 8 hours. 4. Limiting the child's television watching
2. The child's swollen eyes are caused by fluid accumulation. Elevating the head of the bed allows gravity to increase the downward flow of fluids in the body, away from the face. Applying cool compresses or eye drops, or limiting television, may be comforting but will not relieve the swelling.
The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel (Amphojel). Which of the following statements would indicate that the client understands the teaching? 1. "I'll take it every 4 hours around the clock." 2. "I'll take it between meals and at bedtime." 3. "I'll take it when I have an upset stomach." 4. "I'll take it with meals and bedtime snacks."
4. Aluminum hydroxide gel (Amphojel) is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not administered to treat an upset stomach caused by hyperacidity in clients with chronic renal failure and therefore is not prescribed between meals.
. Which of the following diet plans would be appropriate for the nurse to discuss with the family of a child with acute renal failure? 1. High carbohydrate and protein. 2. High fat and carbohydrate. 3. Low fat and protein. 4. Low in carbohydrate and fat.
. 2. The child with acute renal failure needs extra calories to reduce tissue catabolism, metabolic acidosis, and uremia. Using a high-fat and carbohydrate diet helps to supply the necessary extra calories. If the child is able to tolerate oral foods, concentrated food sources that are high in carbohydrate and fat but low in protein, potassium, and sodium may be provided.
Which of the following is the most common initial manifestation of acute renal failure? 1. Dysuria. 2. Anuria. 3. Hematuria. 4. Oliguria
. 4. Oliguria is the most common initial symptom of acute renal failure. Anuria is rarely the initial symptom. Dysuria and hematuria are not associated with acute renal failure.
The mother of a child with chronic renal failure who is receiving peritoneal dialysis at home asks the nurse what she can do if both inflow and drain times are increased. Which of the following instructions would be most appropriate for the nurse to include when responding to the mother? 1. Assess the child for constipation. 2. Decrease the amount of dialysate infused for each dwell. 3. Incorporate the increased inflow and drain times into the dialysis schedule. 4. Monitor the child for shoulder pain during inflow and drain times.
1. Accumulation of hard stool in the bowel can cause the distended intestine to block the holes of the catheter. Consequently, the dialysate cannot flow freely through the catheter. Decreasing the dialysate infusion may make the dialysis less effective. Altering fluid, electrolyte, and waste product removal can cause fluid and electrolyte imbalance and increased levels of blood urea nitrogen and creatinine. Incorporating the increased times into the dialysis may make the dialysis less effective because fewer cycles can be scheduled. Shoulder pain, which may occur occasionally, can be caused by air in the peritoneal space and diaphragmatic irritation. However, it is unrelated to inflow and drain times
A client with acute renal failure has an increase in the serum potassium level. The nurse should monitor the client for: 1. Cardiac arrest. 2. Pulmonary edema. 3. Circulatory collapse. 4. Hemorrhage.
1. Hyperkalemia places the client at risk for serious cardiac arrhythmias and cardiac arrest. Therefore, the nurse should carefully monitor the client for cardiac arrhythmias and be prepared to treat cardiac arrest when caring for a client with hyperkalemia. Increased potassium levels do not result in pulmonary edema, circulatory collapse, or hemorrhage.
In the oliguric phase of acute renal failure, the nurse should assess the client for: 1. Pulmonary edema. 2. Metabolic alkalosis. 3. Hypotension. 4. Hypokalemia
1. Pulmonary edema can develop during the oliguric phase of acute renal failure because of decreased urine output and fluid retention. Metabolic acidosis develops because the kidneys cannot excrete hydrogen ions, and bicarbonate is used to buffer the hydrogen. Hypertension may develop as a result of fluid retention. Hyperkalemia develops as the kidneys lose the ability to excrete potassium.
Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the expected outcome of giving this drug? 1. Relieving the pain of gastric hyperacidity. 2. Preventing Curling's stress ulcers. 3. Binding phosphate in the intestine. 4. Reversing metabolic acidosis.
3. A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body's calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Antacids will not prevent Curling's stress ulcers and do not affect metabolic acidosis.
The nurse is planning care with the parents of a child who requires continuous peritoneal dialysis. Which finding should be discussed with the physician? 1.The family lives a long distance from the medical facility. 2. The child attends a large public school. 3. The child reports having a previous surgery for a ruptured appendix. 4. The family feels the child cannot self-regulate to wake at night and change bags.
3. A client who has had a ruptured appendix may have peritoneal scarring that may alter the effectiveness of treatment. Living a long distance from a medical facility is typically a reason to select peritoneal dialysis. Attending a large school is not a problem, but the school nurse needs to be included as part of the health care team. Typically the treatment schedule can be planned to allow for uninterrupted sleep at night.
A parent of a child with acute poststreptococcal glomerularnephritis (APSGN) asks how a strep infection caused their child to have a kidney problem. What is the nurse's best response? 1. "The streptococcal infection spread through the bloodstream to your child's kidneys." 2. "Your child made excessive antibodies to fight the infection that are now attacking the kidneys." 3. "By-products of immune complexes that fought the infection are depositing in the kidneys." 4. "The strep infection weakened your child's immune system, making him susceptible to a secondary infection."
3. APSGN is an immune complex disease. Large antigen-antibody complexes are formed that deposit in the glomerular capillary loops leading to obstruction. APSGN is considered an autoimmune disorder, not an infection. Antibodies do not attack the kidneys in this disorder.
The client asks about diet changes when using continuous ambulatory peritoneal dialysis (CAPD). Which of the following would be the nurse's best response? 1. "Diet restrictions are more rigid with CAPD because standard peritoneal dialysis is a more effective technique." . "Diet restrictions are the same for both CAPD and standard peritoneal dialysis." 3. "Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant." 4. "Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because CAPD works more quickly."
3. Dietary restrictions with CAPD are fewer than those with standard peritoneal dialysis because dialysis is constant, not intermittent. The constant slow diffusion of CAPD helps prevent accumulation of toxins and allows for a more liberal diet. CAPD does not work more quickly, but more consistently. Both types of peritoneal dialysis are effective.
A client undergoing long-term peritoneal dialysis at home is currently experiencing a reduced outflow from the dialysis catheter. To determine if the catheter is obstructed, the nurse should inquire whether the client has: 1. Diarrhea. 2. Vomiting. 3. Flatulence. 4. Constipation.
4. Constipation may contribute to reduced urine outflow in part because peristalsis facilitates drainage outflow. For this reason, bisacodyl suppositories can be used prophylactically, even without a history of constipation. Diarrhea, vomiting, and flatulence typically do not cause decreased outflow in a peritoneal dialysis catheter.
After emphasizing to an adolescent with renal failure the importance of maintaining a positive self-concept, which of the following behaviors by the adolescent should the nurse identify as an indicator that the plan is working? 1. Reports of headaches, abdominal pain, and nausea. 2. Insistence on making diet choices even if the foods chosen are restricted. 3. Verbalization of plans to quit all after-school activities when returning home. 4. Demonstration of desire to do the dressing changes and take care of the medications.
4. Demonstration of desire to do the dressing changes and manage medications implies compliance with the medical regimen and acceptance of the condition, thereby indicating a positive self-image. Diffuse somatic symptoms could indicate anxiety or problems with coping, with a negative effect on self-concept. Insistence on choosing restricted foods implies that the adolescent has not accepted the diagnosis and is noncompliant, possibly indicating a negative self-concept. Social withdrawal from activities may indicate depression, possibly negatively affecting the self-concept.
. The toddler with nephrotic syndrome exhibits generalized edema. Which of the following measures should the nurse institute for this child with impaired skin integrity related to edema? 1. Ambulate every shift while awake. 2. Apply lotion on opposing skin surfaces. 3. Apply powder to skinfolds. 4. Separate opposing skin surfaces with soft cloth.
4. Placing soft cloth between opposing skin surfaces absorbs moisture and keeps the area dry, thus preventing any further breakdown. The child with nephrotic syndrome and severe edema is usually maintained on bed rest. Therefore, ambulation is not appropriate. Applying lotion or powder to edematous surfaces that touch increases moisture and can lead to maceration, causing further breakdown.
. A client is to receive peritoneal dialysis. To prepare for the procedure, the nurse should: 1. Assess the dialysis access for a bruit and thrill. 2. Insert an indwelling urinary catheter and drain all urine from the bladder. 3. Ask the client to turn toward the left side. 4. Warm the solution in the warmer.
4. Warm the solution in the warmer.
. The nurse assesses the child with chronic renal failure who is receiving peritoneal dialysis for edema. Which finding is expected for this child? 1. Absence of pulmonary crackles. 2. Increased dialysate outflow. 3. Normal blood pressure. 4. Pallor.
4. With edema, pallor can occur owing to hemodilution as intestinal fluid moves to the vascular space. The child would exhibit pulmonary crackles secondary to pulmonary congestion and edema. Dialysate outflow would decrease, not increase, as the body attempts to conserve fluid. The child's blood pressure would be increased because of excessive fluid volume.
. A client has been admitted with acute renal failure. What should the nurse do? Select all that apply. 1. Elevate the head of the bed 30 to 45 degrees. 2. Take vital signs. 3. Establish an IV access site. 4. Call the admitting physician for prescriptions. 5. Contact the hemodialysis unit
. 1, 2, 3, 4. Elevation of the head of the bed will promote ease of breathing. Respiratory manifestations of acute renal failure include shortness of breath, orthopnea, crackles, and the potential for pulmonary edema. Therefore, priority is placed on facilitation of respiration. The nurse should assess the vital signs because the pulse and respirations will be elevated. Establishing a site for IV therapy will become important because fluids will be administered IV in addition to orally. The physician will need to be contacted for further prescriptions; there is no need to contact the hemodialysis unit.
. After teaching the mother of a young child with a peritoneal catheter about the signs and symptoms of peritonitis, the nurse determines that the mother has understood the teaching when she identifies which of the following as an important sign? 1. Cloudy dialysate drainage return .2. Distended abdomen. 3. Shortness of breath. 4. Weight gain of 3 lb (1.36 kg) in 2 days.
. 1. Normally, dialysate drainage return should be clear. With peritonitis, large numbers of bacteria, white blood cells, and fibrin cause the dialysate to appear cloudy. Abdominal distention is unrelated to peritonitis. However, it might suggest an obstruction. Weight gain and shortness of breath are associated with fluid excess, not infection.
. While performing daily peritoneal dialysis and catheter exit site care with the mother of a child with chronic renal failure, which of the following would be an important step to emphasize to the mother? 1. Applying an occlusive dressing after cleaning the site. 2. Changing the dressing when the peritoneal space is dry. 3. Examining the site for signs of infection while cleaning the area. 4. Pulling on the catheter to hold taut while cleaning the skin.
3. Examining the site for signs of infection while cleaning the area.
The nurse determines that interventions for decreasing fluid retention have been effective when the child with nephrotic syndrome demonstrates evidence of which of the following? 1. Decreased abdominal girth. 2. Increased caloric intake. 3. Increased respiratory rate. 4. Decreased heart rate.
. 1. Fluid accumulates in the abdomen and interstitial spaces owing to hydrostatic pressure changes. Increased abdominal fluid is evidenced by an increase in abdominal girth. Therefore, decreased abdominal girth is a sign of reduced fluid in the third spaces and tissues. When fluid accumulates in the abdomen and interstitial spaces, the child does not feel hungry and does not eat well. Although increased caloric intake may indicate decreased intestinal edema, it is not the best and most accurate indicator of fluid retention. Increased respiratory rate may be an indication of increasing fluid in the abdomen (ascites) causing pressure on the diaphragm. Heart rate usually stays in the normal range even with excessive fluid volume.
The client receives heparin while receiving hemodialysis. The nurse explains the rationale supporting anticoagulation by making which of the following statements? 1. "Regional anticoagulation is achieved by putting heparin in the dialysis machine and protamine sulfate, which reverses the anticoagulation, in the client." 2. "You will receive warfarin sodium (Coumadin) to maintain anticoagulation between treatments." 3. "Heparin does not enter the body, so there is no risk of bleeding." 4. "Clotting time is seriously prolonged for several hours after each treatment."
. 1. Regional anticoagulation can be achieved by infusing heparin in the dialyzer and protamine sulfate, its antagonist, in the client. Warfarin sodium (Coumadin) is not used in dialysis treatment. There is some risk of bleeding; however, clotting time is monitored carefully. The client's clotting time will not be seriously affected, although some rebound effect may occur.
A 10-year-old child hospitalized with acute poststreptococcal glomerulonephritis during the acute stage has elevated blood pressure and low urine output for 14 hours. The nurse should next: 1. Assess the child's neurologic status. 2. Encourage the child to drink more water. 3. Advise the child to eat a low-sodium breakfast. 4. Help the client to ambulate in the hallway.
. 1. The nurse should assess the child's neurologic status, because hypertensive encephalopathy is a major potential complication of the acute phase of glomerulonephritis. Seizure precautions also should be instituted. Hypertensive encephalopathy can result in transient loss of vision, hemiparesis, disorientation, and grand mal seizures. Encouraging the child to drink more water is inappropriate because the child has had a low urine output for 14 hours. Typically, in this situation, fluids would be restricted. Although a low-sodium diet is encouraged, it is not the priority action at this time. Initially, bed rest, not ambulation, is advocated during the acute phase of glomerulonephritis.
The client who is in acute renal failure has an elevated blood ureanitrogen (BUN). What is the likely cause of this finding? 1. Fluid retention. 2. Hemolysis of red blood cells. 3. Below-normal metabolic rate. 4. Reduced renal blood flow.
. 4. Urea, an end product of protein metabolism, is excreted by the kidneys. Impairment in renal function caused by reduced renal blood flow results in an increase in the plasma urea level. Fluid retention, hemolysis of red blood cells, and lowered metabolic rate do not cause an elevated BUN value
A client is receiving continuous ambulatory peritoneal dialysis (CAPD). The nurse should assess the client for which of the following signs of peritoneal infection? 1. Cloudy dialysate fluid. 2. Swelling in the legs . 3. Poor drainage of the dialysate fluid. 4. Redness at the catheter insertion site.
. Cloudy drainage indicates bacterial activity in the peritoneum. Other signs and symptoms of infection are fever, hyperactive bowel sounds, and abdominal pain. Swollen legs may indicate heart failure. Poor drainage of dialysate fluid is probably the result of a kinked catheter. Redness at the insertion site indicates local infection, not peritonitis. However, a local infection that is left untreated can progress to the peritoneum.
The nurse teaches the client how to recognize infection in the shunt by telling the client to assess the shunt each day for: 1. Absence of a bruit. 2. Sluggish capillary refill time. 3. Coolness of the involved extremity. 4. Swelling at the shunt site.
. 4. Signs and symptoms of an external access shunt infection include redness, tenderness, swelling, and drainage from around the shunt site. The absence of a bruit indicates closing of the shunt. Sluggish capillary refill time and coolness of the extremity indicate decreased blood flow to the extremity.
During the first hemodialysis treatment, the client develops a headache, confusion, and nausea. The nurse should assess the client further for: 1. Disequilibrium syndrome. 2. Myocardial infarction. 3. Air embolism. 4. Peritonitis.
. 1. Common symptoms of disequilibrium syndrome include headache, nausea and vomiting, confusion, and even seizures. Disequilibrium syndrome typically occurs near the end or after the completion of hemodialysis treatment. It is the result of rapid changes in solute composition and osmolality of the extracellular fluid. These symptoms are not related to cardiac function, air embolism, or peritonitis.
A client with chronic renal failure who receives hemodialysis three times a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? Select all that apply. 1. Drink fluids before eating solid foods. 2. Have limited amounts of fluids only when thirsty. 3. Limit activity. 4. Keep all dialysis appointments. 5. Eat smaller, more frequent meals.
. 2, 4, 5. To manage nausea, the nurse can advise the client to drink limited amounts of fluid only when thirsty, eat food before drinking fluids to alleviate dry mouth, encourage strict follow-up for blood work, dialysis, and health care provider visits. Smaller, more frequent meals may help to reduce nausea and facilitate medication taking. The client should be as active as possible to avoid immobilization because it increases bone demineralization. The client should also maintain the dialysis schedule because the dialysis will remove wastes that can contribute to nausea.
Which of the following meals would be most appropriate for a 15- year-old with glomerulonephritis with severe hypertension? 1. Egg noodles, hamburger, canned peas, milk. 2. Baked ham, baked potato, pear, canned carrots, milk. 3. Baked chicken, rice, beans, orange juice. 4. Hot dog on a bun, corn chips, pickle, cookie, milk.
. 3. The best selection of food would include no added salt or salty food. Because sodium cannot be excreted due to the oliguria and to avoid increasing the hypertension, a low-salt diet is recommended. Most canned foods have sodium added as a preservative. Hamburger, ham, hot dogs,
The client performs self peritoneal dialysis. What should the nurse teach the client about preventing peritonitis? Select all that apply. 1. Broad-spectrum antibiotics may be administered to prevent infection. 2. Antibiotics may be added to the dialysate to treat peritonitis. 3. Clean technique is permissible for prevention of peritonitis. 4. Peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort. 5. Peritonitis is the most common and serious complication of peritoneal dialysis.
1, 2, 4, 5. Broad-spectrum antibiotics may be administered to prevent infection when a peritoneal catheter is inserted for peritoneal dialysis. Ifperitonitis is present, antibiotics may be added to the dialysate. Aseptic technique is imperative. Peritonitis, the most common and serious complication of peritoneal dialysis, is characterized by cloudy dialysate drainage, diffuse abdominal pain, and rebound tenderness.
The client with acute renal failure asks the nurse for a snack. Because the client's potassium level is elevated, which of the following snacks is most appropriate? 1. A gelatin dessert. 2. Yogurt. 3. An orange. 4. Peanuts.
1. Gelatin desserts contain little or no potassium and can be served toa client on a potassium-restricted diet. Foods high in potassium include bran and whole grains; most dried, raw, and frozen fruits and vegetables; most milk and milk products; chocolate, nuts, raisins, coconut, and strong brewed coffee.
The nurse is planning interventions for a school-aged child in need of diversional activity. Which of the following activities should the nurse expect to include? 1. Playing a card game with someone the same age. 2. Putting together a puzzle with mother. 3. Playing video games with a 4-year-old. 4. Watching a movie with a younger brother.
1. Generally, school-age children enjoy activities with their peers first, then family members, and lastly younger children. School-age children like to be busy but also to accomplish something. This helps to meet their task of industry versus inferiority, feeling good about what they are able to accomplish.
. The client with chronic renal failure takes magnesium hydroxide (milk of magnesia) at home for constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because: 1. Milk of magnesia can cause magnesium intoxication. 2. Milk of magnesia is too harsh on the bowel. 3. Metamucil is more palatable. 4. Milk of magnesia is high in sodium.
1. Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems. Milk of magnesia is harsher than Metamucil, but magnesium toxicity is a more serious problem. A client may find both milk of magnesia and Metamucil unpalatable. Milk of magnesia is not high in sodium.
. The toddler with nephrotic syndrome responds to treatment and is ready to go home. When helping the family plan for home care, which of the following instructions should the nurse include in the teaching? 1. Administer pain medication as needed. 2. Keep the child away from others with an infection. 3. Notify the physician if there is an increase in the child's urine output. 4. Administer acetaminophen (Tylenol) daily.
. 2. A child recovering from nephrotic syndrome should be protected from infection. Therefore, the nurse would teach the parents to keep the child away from others with an infection. Because pain is not associated with this disorder, pain medication typically is not needed. The physician should be notified if urine output decreases, not increases. In children recovering from nephrotic syndrome, there is no reason to administer acetaminophen daily.
. A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. The intended outcome of this diet is to: 1. Act as a diuretic. 2. Reduce demands on the liver. 3. Help maintain urine acidity. 4. Prevent the development of ketosis
. 4. High-carbohydrate foods meet the body's caloric needs during acute renal failure. Protein is limited because its breakdown may result in accumulation of toxic waste products. The main goal of nutritional therapy in acute renal failure is to decrease protein catabolism. Protein catabolism causes increased levels of urea, phosphate, and potassium. Carbohydrates provide energy and decrease the need for protein breakdown. They do not have a diuretic effect. Some specific carbohydrates influence urine pH, but this is not the reason for encouraging a high-carbohydrate, low-protein diet. There is no need to reduce demands on the liver through dietary manipulation in acute renal failure.
The client's serum potassium level is elevated in acute renal failure, and the nurse administers sodium polystyrene sulfonate (Kayexalate). This drug acts to: 1. Increase potassium excretion from the colon. 2. Release hydrogen ions for sodium ions. 3. Increase calcium absorption in the colon. 4. Exchange sodium for potassium ions in the colon.
. 4. Polystyrene sulfonate, a cation-exchange resin, causes the body to excrete potassium through the gastrointestinal tract. In the intestines, particularly the colon, the sodium of the resin is partially replaced by potassium. The potassium is then eliminated when the resin is eliminated with feces. Although the result is to increase potassium excretion, the specific method of action is the exchange of sodium ions for potassium ions. Polystyrene sulfonate does not release hydrogen ions or increase calcium absorption
A toddler diagnosed with nephrotic syndrome has a fluid volume excess related to fluid accumulation in the tissues. Which measure should the nurse anticipate including in the child's plan of care? 1. Limiting visitors to 2 to 3 hours a day. 2. Maintaining strict bed rest. 3. Testing urine specific gravity every shift. 4. Weighing the child before breakfast.
. 4. The best indicator of fluid balance is weight. Therefore, daily weight measurements help determine fluid losses and gains. Although limiting visitors to 2 to 3 hours per day or maintaining strict bed rest would help to ensure that the child gets adequate rest, this is unrelated to the child's fluid balance. In nephrotic syndrome, urine is tested for protein, not specific gravity.
A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it: 1. Is relatively low in cost. 2. Allows the client to be more independent. 3. Is faster and more efficient than standard peritoneal dialysis. 4. Has fewer potential complications than standard peritoneal dialysis
2. The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers, health care personnel, and machines for life sustaining treatment. This independence is a valuable outcome for some people. CAPD is costly and must be done daily. Adverse effects and complications are similar to those of standard peritoneal dialysis. Peritoneal dialysis usually takes less time but cannot be done at home.
. A client with chronic renal failure is receiving hemodialysis three times a week. In order to protect the fistula the nurse should: 1. Take the blood pressure in the arm with the fistula. 2. Report the loss of a thrill or bruit on the arm with the fistula. 3. Auscultate for a thrill and palpate for a bruit on the arm with the fistula. 4. Start a second IV in the arm with the fistula.
3. The nurse must always palpate for a thrill and auscultate for a bruit in the arm with the fistula and promptly report the absence of either/or a thrill or bruit to the health care provider as it indicates an occlusion. No procedures such as IV access, blood pressure measurements, or blood draws are done on an arm with a fistula as they could damage the fistula.
. Which of the following abnormal blood values would not be improved by dialysis treatment? 1. Elevated serum creatinine level. 2. Hyperkalemia. 3. Decreased hemoglobin concentration. 4. Hypernatremia.
. 3. Dialysis has no effect on anemia. Because some red blood cells are injured during the procedure, dialysis aggravates a low hemoglobin concentration. Dialysis will clear metabolic waste products from the body and correct electrolyte imbalances.
An adolescent with chronic renal failure is scheduled to go home with a peritoneal dialysis catheter in place. When developing the discharge teaching plan for the client and the family focusing on psychosocial needs, which of the following areas should be a top priority to include? 1. Advantages of limiting social activities and contacts for the first few months. 2. Not disclosing information about the peritoneal dialysis to people outside the family. 3. Possible effect on body image of the presence of an abdominal catheter. 4. Importance of relying on parents to do the dialysis and dressing changes.
. 3. For an adolescent, body image is a major concern. The presence of an abdominal catheter can greatly affect the client's body image. The adolescent needs opportunities to discuss feelings about altered body image due to the catheter. Adolescents need to be with their peers and to maintain social activities and contacts in order to meet the developmental tasks for this age group. The adolescent client may choose to confide in friends for both psychological health and physical safety. Because peers are most important to adolescents, they will confide in their peers before confiding in family members. Another major developmental need of the adolescent is achieving independence. Relying on the parents would interfere with the adolescent's ability to do so.
. During a home visit, the public health nurse assesses the peritoneal catheter exit site of a child with chronic renal failure. Which of the following findings should lead the nurse to determine a client has an infection? 1. Dialysate leakage. 2. Granulation tissue. 3. Increased time for drainage. 4. Tissue swelling.
. 4. Tissue swelling, pain, redness, and exudate indicate infection. Dialysate leakage is associated with improper catheter function, incomplete healing at the insertion site, or excessive instillation of dialysate. Granulation tissue indicates healing around the exit site, not infection. Increased time for drainage may indicate that the tube is kinked, suggesting an obstruction.
The client with acute renal failure is recovering and asks the nurse, "Will my kidneys ever function normally again?" The nurse's response is based on knowledge that the client's renal status will most likely: 1. Continue to improve over a period of weeks. 2. Result in the need for permanent hemodialysis. 3. Improve only if the client receives a renal transplant. 4. Result in end-stage renal failure.
1. The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. The client should be taught how to recognize the signs and symptoms of decreasing renal function and to notify the physician if such problems occur. In a client who is recovering from acute renal failure, there is no need for renal transplantation or permanent hemodialysis. Chronic renal failure develops before end-stage renal failure.
