Renal Practice Questions

128. A client was treated for a streptococcal throat infection 2 weeks ago. The client now has been diagnosed with acute poststreptococcal glomerulonephritis. The client asks the nurse how he could have prevented this condition. What should the nurse tell the client? ■ 1. "See your physician for an early diagnosis and treatment of a sore throat." ■ 2. "As long as you do not have a fever, it is suffi cient to gargle daily with an antibacterial mouthwash." ■ 3. "You may continue to utilize the previously prescribed antibiotics until they are gone." ■ 4. "Unscented bar soap may be used in showers."

128. 1. Acute poststreptococcal glomerulonephritis usually follows a streptococcal throat or skin infection by 1 to 2 weeks. Streptococcus-type infections require medical intervention with antibiotics. Antibacterial mouthwashes do not kill streptococci. Previously prescribed antibiotics may not be effective against streptococci, and may also be expired. Bar soap fragrance has no impact on its ability to kill bacteria that reside on skin.

139. A client has nephrotic syndrome. To aid in the resolution of the client's edema, the physician orders 25% albumin. In addition to an absence of edema, the nurse should evaluate the client for which expected outcome? ■ 1. Crackles in the lung bases. ■ 2. Blood pressure elevation. ■ 3. Cerebral edema. ■ 4. Cool skin temperature in lower extremities

139. 2. Albumin is a colloid that remains in the intravascular space, pulling fl uid out of the intracellular and interstitial space. The client with nephrotic syndrome loses excessive amounts of protein, mainly albumin, in the urine. Because fl uid is drawn into the intravascular space, blood pressure will increase. Crackles in the lung bases and cerebral edema are signs of circulatory overload or fl uid volume excess. When edema is present in lower extremities, the skin feels cool to the touch unless an infection is present.

155. Which of the following laboratory fi ndings is present in nephrotic syndrome? ■ 1. Decreased total serum protein. ■ 2. Hypercalcemia. ■ 3. Hyperglycemia. ■ 4. Decreased hematocrit

155. 1. A decreased total serum protein occurs as extensive amounts of protein are excreted from the body through the urine. Clients may develop hypocalcemia. Hyperglycemia is not a fi nding related to nephrotic syndrome. A decreased hematocrit is not a fi nding related to nephrotic

162. 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.

162. 2. 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 fl uid and may gain weight. Hematuria is not a symptom related to nephrotic syndrome

21. The nurse should assess the child with nephrotic syndrome for which of the following? Select all that apply. ■ 1. Normal blood pressure. ■ 2. Generalized edema. ■ 3. Normal serum lipid levels. ■ 4. No red blood cells in the urine. ■ 5. Elevated streptococcal antibody titers.

21. 1, 2, 4. Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia and normal or lower than normal blood pressure. Elevated streptococcal antibody titers are associated with poststreptococcal glomerulonephritis, an immune complex disease.

What is 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.

25. 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, canned peas, canned carrots, corn chips, pickles, and milk are high in sodium

26. 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).

26. 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 fl uid and sodium; the fl uid is reabsorbed, causing fl uid volume excess. The nurse must verify that these symptoms are due to hypertension. Calling the physician before confi rming 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 fi rst the nurse must establish that high blood pressure is the cause of the symptoms. Administering Tylenol for high blood pressure is not recommended.

27. Which of the following questions should the nurse ask fi rst when obtaining a history from the mother of a 10-year-old child with a fever, complaints of not feeling well, 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?"

27. 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 confi rm 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 any recent sore throat would provide additional information to confi rm 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 fi rst.

28. 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.

28. 3. The child with acute poststreptococcal glomerulonephritis experiences a problem with renal function that ultimately affects fl uid balance. Because weight is the best indicator of fl uid balance, obtaining daily weights would be the highest priority.

30. During hospitalization, a 10-year-old child with acute poststreptococcal glomerulonephritis and oliguria asks for food from home. After teaching the mother and child about diet, the nurse determines that the teaching had been effective when the mother brings in which food? ■ 1. Pizza and cola. ■ 2. Hamburger and fries. ■ 3. Ice cream sundae. ■ 4. Strawberries and kiwi.

30. 4. The best choice would be fruits such as strawberries and kiwi because they are low in sodium and potassium. Typically, diet is related to the stage and severity of the disease. In children with uncomplicated disease, a regular diet is offered but sodium is usually restricted. In children with hypertension and edema, moderate restriction of sodium is instituted. Pizza and cola, hamburgers and fries, and ice cream are high in sodium and should be avoided. Children with oliguria usually also have potassium restricted. Therefore, foods such as bananas and oranges would be avoided.

32. 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.

32. 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, fl uids 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.

35. 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.

35. 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.

39. The client's blood urea nitrogen (BUN) concentration is elevated in acute renal failure. What is the likely cause of this fi nding? ■ 1. Fluid retention. ■ 2. Hemolysis of red blood cells. ■ 3. Below-normal metabolic rate. ■ 4. Reduced renal blood fl ow.

39. 4. Urea, an end product of protein metabolism, is excreted by the kidneys. Impairment in renal function caused by reduced renal blood fl ow 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.

36. 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 I.V. access site. ■ 4. Call the admitting physician for orders. ■ 5. Contact the hemodialysis unit.

36. 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 I.V. therapy will become important because fl uids will be administered I.V. in addition to orally. The physician will need to be contacted for further orders; there is no need to contact the hemodialysis unit.

38. A client developed 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 fl ow through the kidneys. ■ 2. An obstruction of urine fl ow from the kidneys. ■ 3. A blood clot formed in the kidneys. ■ 4. Structural damage to the kidney resulting in acute tubular necrosis.

38. 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 kidney resulting from acute tubular necrosis is called intrarenal failure. It is caused by such conditions as hypersensitivity (allergic disorders), renal vessel obstruction, and nephrotoxic agents.

39. 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 watch

39. 2. The child's swollen eyes are caused by fl uid accumulation. Elevating the head of the bed allows gravity to increase the downward fl ow of fl uids 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.

40. 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.

40. 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 specifi c method of action is the exchange of sodium ions for potassium ions. Polystyrene sulfonate does not release hydrogen ions or increase calcium absorption.

41. The toddler with nephrotic syndrome exhibits generalized edema. Which of the following measures should the nurse institute for this child with a nursing diagnosis of 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.

41. 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.

42. 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.

42. 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 specifi c carbohydrates infl uence 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.

43. 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.

43. 1. Gelatin desserts contain little or no potassium and can be served to a client on a potassiumrestricted 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

43. 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.

43. 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 notifi ed if urine output decreases, not increases. In children recovering from nephrotic syndrome, there is no reason to administer acetaminophen daily.

44. 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

44. 1. Pulmonary edema can develop during the oliguric phase of acute renal failure because of decreased urine output and fl uid 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 fl uid retention. Hyperkalemia develops as the kidneys lose the ability to excrete potassium