Renal quizzes MAIN

Creatinine clearance usually: A. approximates glomerular filtration rate (GFR) B. does not change as part of normative aging C. is greater in women compared with men D. increases with hypotension

A. approximates glomerular filtration rate (GFR)

Although the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which is NOT a function of the kidneys? A. excreting protein B. excreting nitrogen waste products C. regulating blood pressure D. stimulating RBC production

A. excreting protein

Which of the following is most likely to be apart of the clinical presentation of an otherwise healthy 27 year old woman with uncomplicated lower urinary tract infection (UTI)? A. urinary frequency B. fever C. suprapubic tenderness D. lower gastrointestinal (GI)upset

A. urinary frequency Signs and Symptoms of Urinary Tract Infections (UTIs) Besides a strong, persistent urge to urinate, common symptoms include: Pain or burning during urination. Passing only small amounts of urine.

Which of the following conditions is characterized by oliguria and hematuria? Acute glomerulonephritis Polycystic kidney disease Cystitis Renal insufficiency

Acute glomerulonephritis

In the kidneys, filtration takes place at the :nephron. calyx. glomerulus .juxtaglomerular apparatus.

glomerulus

GOOD The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching? a) "I should limit foods high in potassium in my diet, such as bananas." b) "I should drink as much as possible to keep my kidneys working." c) "My intake of high sodium foods should be limited." d) "I should limit the amount of protein in my diet."

b) "I should drink as much as possible to keep my kidneys working." Explanation: Dietary management of acute post-streptococcal glomerulonephritis includes restrictions of protein, sodium, potassium, and fluids.

GOOD Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure? a) Dysrhythmia b) Ureteral calculus c) Glomerulonephritis d) Hypovolemia

c) Glomerulonephritis Correct Explanation: Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.

What can patients at risk for renal lithiasis do to prevent the stones in many cases? a. Lead an active lifestyle b. Limit protein and acidic foods in the diet c. Drink enough fluids to produce dilute urine d. Take prophylactic antibiotics to control UTIs

c. Drink enough fluids to produce dilute urine

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? A. Dark coffee colored urine B. Left upper quadrant pain C. Pyuria D. Low blood pressure

A Dark coffee colored urine urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis.

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? A. Donors are selected from compatible living donors. B. Donors must be relatives. C. Donors with hypertension may qualify. D. The client is placed on a transplant list at the local hospital.

A Donors are selected from compatible living donors. Donors do not have to be relatives as long as they are compatible. Potential donors with a history of hypertension, malignant disease, or diabetes are excluded from donation. The client is placed on a national computerized transplant waiting list.

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

A Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.

GOOD A client develops acute renal failure (ARF) after receiving IV therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 mL, the nurse suspects that the client is at risk for: A. cardiac arrhythmia. B. paresthesia. C. dehydration. D. pruritus.

A RENAL FAULURE= increase K= arrythamias As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn't cause paresthesia (sensations of numbness and tingling). Dehydration doesn't occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. In the client with ARF, pruritus results from increased phosphates and isn't associated with hyperkalemia.

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: A. restricting sources of potassium usually found in fresh fruits and vegetables. B. allowing liberal use of sodium. C. limiting iron and folic acid intake. D. eating protein liberally.

A Restrict sources of potassium usually found in fresh fruits and vegetables; hyperkalemia can cause life-threatening changes. Restrict sodium intake as ordered; doing so prevents excess sodium and fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken. Iron and folic acid supplements are needed for RBC production. Epogen stimulates bone marrow to produce RBCs. Restrict protein intake to foods that are complete proteins within prescribed limits. Complete proteins provide positive nitrogen balance for healing and growth.

A client presents to the ED reporting left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The client has also experienced nausea and emesis. The nurse suspects the client is experiencing: A. ureteral stones. B. pyelonephritis. C. cystitis. D. Urethral infection.

A The findings are constant with ureteral stones, edema or stricture, or a blood clot. The other answers do not apply. Key diagnostics in no WBC in urine (no infection) whereas in UTI there is infection,

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? A. Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. B. BUN of 18 mg/dL. C. Serum creatinine of 1.2 mg/dL. D. Glomerular filtration rate (GFR) of 100 mL/min.

A The normal BUN:Cr ratio is less than 15. Prerenal azotemia is caused by hypoperfusion of the kidneys due to a nonrenal cause. Over time, higher than normal blood levels of urea or other nitrogen-containing compounds will develop.

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: A. "As the disease progresses, you will most likely require renal replacement therapy." B. "Dietary changes can reverse the damage that has occurred in your kidneys." C. "Draining of the cysts and antibiotic therapy will cure your disease." D. "Genetic testing will determine the best treatment for your condition."

A There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.

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? A. Hemodialysis B. Peritoneal dialysis C. Continuous arteriovenous hemofiltration (CAVH) D. Continuous venovenous hemofiltration (CVVH)

A Azotemia is a biochemical abnormality, defined as elevation, or buildup of, nitrogenous products (BUN-usually ranging 7 to 21 mg/dL), creatinine in the blood, and other secondary waste products within the body. The client is hemodynamically stable and hemodialysis would be most appropriate. Hemodialysis is used for clients who are acutely ill and require short-term dialysis for days to weeks until kidney function resumes and for clients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) who require long-term or permanent renal replacement therapy. Peritoneal dialysis (PD) may be the treatment of choice for clients with renal failure who are unable or unwilling to undergo hemodialysis or kidney transplantation. CAVH and CVVH are used for client who are hemodynamically unstable.

GOOD A client has a family history of polycystic kidney disease. As the nurse gathers information and completes an assessment related to a polycystic kidney diagnosis, which findings would the nurse expect to find? Select all that apply. A. Hypertension B. Pain from retroperitoneal bleeding C. Normal urinalysis D. renal stones E. Polyuria F. Proteinuria

A. Hypertension B. Pain from retroperitoneal bleeding D. Renal stones E. Polyuria F. Proteinuria Hypertension is present in affected clients at the time of diagnosis. Pain from retroperitoneal bleeding is caused by the size and effects of the cysts. Polyuria can occur. Urinalysis shows mild proteinuria, hematuria, and pyuria. Renal stones are common.

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

A. Serum creatinine increases B. Blood urea nitrogen (BUN) increases C. Creatinine clearance decreases As glomerular filtration decreases, the serum creatinine and BUN levels increase; the creatinine clearance decreases. Potassium and phosphate levels should not be affected by decreased glomerular filtration.

In a diagnosis of a lower urinary tract infection, which structures could be affected? Select all that apply. A. bladder B. urethra C. ureter D. kidney

A. bladder B. urethra The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.

16. The clinical stage of chronic kidney disease called medium failure or stage 3 to 4 disease, A. may be controlled with dietary management. B. requires intervention with dialysis or renal transplantation. C. is associated with a nephron loss of about 50%. D. is successfully managed with diuretic therapy.

A. may be controlled with dietary management. stage 4 PT qualifies for renal transplant

Which rationale explains why patients with chronic kidney disease (CKD) frequently do not receive treatment? a. The patient is not compliant with health care provider instructions. b. The patient does not know the long-term complications of CKD. c. The patient has no symptoms until too many nephrons are destroyed. d. The patient denies that they have any risk factors for acquiring CKD.

Answer: C Dont usually start to have symptoms until stage 4

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

B The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.

Poststreptococcal glomerulonephritis typically occurs how long following a bacterial pharyngitis infection? A. 4 to 6 days B. 1 to 2 weeks C. 3 to 4 weeks D. 2 month

B. 1 to 2 weeks

GOOD Which clinical finding should a nurse look for in a client with chronic renal failure? A. Hypotension B. Uremia C. Metabolic alkalosis D. Polycythemia

B. Uremia Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. A. Hypotension: Hypertension (from fluid overload) C. Metabolic alkalosis: Metabolic acidosis results from the inability to excrete hydrogen ions. D. Polycythemia: Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.

GOOD The major cause of glomerulonephritis is: A. infection of the glomerular capsule secondary to a urinary tract infection. B. immune system damage to glomeruli. C. hydronephrosis from kidney stones. D. Streptococcus infection in the bloodstream that migrates to the glomerulus.

B. immune system damage to glomeruli. glomerulonephritis is not an infection, its damage from inflammation.

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

C Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.

The nurse is caring for a patient in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: A. Hypernatremia. B. Hypokalemia. C. Hyperkalemia. D. Hypercalcemia.

C Hyperkalemia is a common complication of acute renal failure. It is life-threatening if immediate action isn't taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? A. Decreased blood urea nitrogen (BUN) B. Increased serum albumin C. Increased serum creatinine D. Decreased potassium

C In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.

GOOD When describing the functions of the kidney to a client, which of the following would the nurse include? Select all that apply. A. Regulation of white blood cell production B. Synthesis of vitamin K C. Control of water balance D. Secretion of the enzyme renin

C. Control of water balance D. Secretion of the enzyme renin Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins. They also produce the enzyme renin.

The nurse understands that which condition occurs in late chronic kidney disease? Hypokalemia Sodium depletion Decreased urine production Reduced phosphorus excretion

C. Decreased Urine production That's right!RationaleIn the later stages of chronic kidney disease, urine production is decreased. Hyperkalemia, not hypokalemia, occurs. Sodium depletion and reduced phosphorus excretion are common in early chronic kidney disease.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

9. Prerenal failure, regardless of the specific cause, has a single common etiologic factor, which is A. inactivation of the renal autoregulatory mechanisms B. narrowing of afferent arterioles. C. a reduction in renal perfusion. D. a decreased effect of aldosterone and antidiuretic hormones.

C. a reduction in renal perfusion.

A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 mL. Urine output that's less than 50 ml in 24 hours is known as: A. oliguria. B. polyuria. C. anuria. D. hematuria.

C. anuria.

A patient with a 25-year history of diabetes is hospitalized with uncontrolled hypertension. A diagnosis of chronic kidney disease (CKD) is suspected. The nurse identifies that which study is the most accurate indicator of the patient's kidney function? Serum creatinine Serum potassium Blood urea nitrogen (BUN) Calculated glomerular filtration rate (GFR)

Calculated glomerular filtration rate (GFR)

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? A. Elevated urea levels B. Hyperkalemia C. Hypocalcemia D. Elevated white blood cells

Correct answer: B Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: A. nausea and vomiting. B. dyspnea and cyanosis. C. fatigue and weakness. D. thrush and circumoral pallor.

Correct answer: C Explanation: RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF

Objective findings in patients with glomerulonephritis include all of the following except: A. edema B. urinary red blood cell (RBC) casts C. proteinuria D. hypotension

D. hypotension

What causes anemia in people who have end-stage chronic renal disease? Chronic loss of blood in the urine Poor appetite with lack of iron intake Decreased secretion of erythropoietin Increased secretion of aldosterone

Decreased secretion of erythropoietin

The nurse reviews the list of drugs being taken by a patient with chronic kidney disease. The nurse questions which medication? Ibuprofen Calcium acetate Acetaminophen Calcium supplements

IbuprofenIbuprofen, and other nonsteroidal antiinflammatory drugs (NSAIDs), will cause further damage to the kidneys. Chronic kidney disease (CKD) patients should be taking Tylenol as prescribed for pain. CKD patients also could be consuming calcium supplements and PhosLo tablets as prescribed by the health care provider.

Which condition does the nurse suspect in a patient with a glomerular filtration rate (GFR) of 10 mL/minute, a blood urea nitrogen (BUN) level of 23 mg/dL, a potassium level of 4 mEq/L, and a serum bicarbonate level of 20 mEq/L? Uremia Hypertension Dysrhythmias Metabolic acidosis

Uremia A patient with glomerular filtration rate (GFR) of 10 mL/minute has chronic kidney disease (CKD), causing the BUN to rise above the normal BUN level of 6 to 20 mg/dL, which may be a result of uremia. Hypertension may result from hypernatremia in the patient with CKD; there is no sodium level information given. Dysrhythmias may occur in the patient with CKD due to hyperkalemia due to decreased excretion of potassium by the kidneys; however, this patient's potassium level of 4 mEq/L is a normal finding. An inability of the kidneys to excrete ammonia and generate bicarbonates leads to metabolic acidosis, indicated by a serum bicarbonate level lower than 15 mEq/L; the patient's level is greater than 15 mEq/L.

Activation of the renin-angiotensin system stimulates the secretion of: antidiuretic hormone. aldosterone. atrial natriuretic peptides. cortisol.

aldosterone Renin Andolserons, angiotension 1, antiontensin 2, Renin-Angiotensin-Aldosterone System (RAAS)

23. Patients with chronic renal failure usually exhibit A. bradycardia. B. hypokalemia. C. hypocalcemia. D. hematomas.

c

What intervention is appropriate for the patient with stage 4 chronic kidney disease (CKD)? a.Focusing on reduction of risk factors b.Implementing kidney transplantation c.Implementing strategies to slow CKD progression d.Managing complications and preparing for renal replacement

d.Managing complications and preparing for renal replacement

GOOD Individuals with end-stage chronic renal disease are at risk for renal osteodystrophy and spontaneous bone fractures because: excess potassium leaches calcium from bone. erythropoietin secretion is impaired. urea causes demineralization of bone they are deficient in active vitamin D.

.they are deficient in active vitamin D.

The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than ___________ in 24 hours

400 ml

A client is diagnosed with polycystic kidney disease. Which symptom would the nurse most likely assess? A. Hypertension B. Flank pain C. Fever D. Periorbital edema

A Hypertension is often present in clients with polycystic kidney disease at the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and abdominal pain also may be noted based on the size and effects of the cysts. Fever would suggest an infection. Periorbital edema is noted with acute glomerulonephritis.

Which of the following occurs late in chronic glomerulonephritis? A. Peripheral and periorbital edema B. Nosebleed C. Stroke D. Seizure

A Peripheral and periorbital edema with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.

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

A UA WILL SHOW BLOOD AND PROTIEN The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided.

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

Azotemia CorrectExplanation:The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.

GOOD 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? A. Increase fat intake and limit carbohydrates. B. Eliminate fat intake and increase protein intake. C. Increase carbohydrates and limit protein intake. D. Increase protein, carbohydrates, and fat intake.

C Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.

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

C Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.

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? A. 1.5 L B. 1.0 L C. Less than 400 mL D. Less than 50 mL

C The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The minimum amount of urine needed to rid the body of normal metabolic waste products is 400 mL. In this phase, uremic symptoms first appear and life-threatening conditions such as hyperkalemia develop.

GOOD A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? A. "Be sure to eat meat at every meal." B. "Eat plenty of bananas." C. "Increase your carbohydrate intake." D. "Drink plenty of fluids, and use a salt substitute."

C Increase carbs and fats decrease protein, na, HWO, fluids, K and phos A client with CRF requires extra carbohydrates to prevent protein catabolism. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Salt substitutes are high in potassium and should be avoided.

GOOD Which assessment finding is most important in determining nursing care for a client with acute glomerulonephritis? A) Presence of albumin in the urine B) Dark smoky colored urine C) Blurred vision D) Peripheral edema

C) Blurred vision Feedback: Visual disturbances can be indicative of rising blood pressure in a client with acute glomerulonephritis. Severe hypertension needs prompt treatment to prevent convulsions. Presence of albumin (protein) and RBCs in the urine, along with periorbital and peripheral edema, are common symptoms associated with glomerulonephritis.

A 44 year old woman presents with pyelonephritis. The report of her urinalysis is least likely to include: A. WBC casts B. positive nitrites C. 3+ protein D. rare RBCs

C. 3+ protein

When describing the functions of the kidney to a client, which of the following would the nurse include? A. Regulation of white blood cell production B. Synthesis of vitamin K C. Control of water balance D. Secretion of enzymes

C. Control of water balance

The most likely causative organism in community acquired UTI in women during the reproductive years is A. Klebsiella species B. Proteus mirabilit C. Escherichia coli D. Staphylococcus saprophyticus

C. Escherichia coli

During hemodialysis, toxins and wastes in the blood are removed by which of the following? a) Filtration b) Diffusion c) Ultrafiltration d) Osmosis

Diffusion Explanation:The toxins and wastes in the blood are removed by diffusion, in which particles move from an area of higher concentration in the blood to an area of lower concentration into the dialysate.

Which of the following symptoms occurs with both cystitis and pyelonephritis? CVA tenderness Suprapubic pain Dysuria Fever and chills

Dysuria (painful or difficult urination)

Which of the following conditions is known to cause chronic kidney disease? Hypertension Chronic obstructive pulmonary disease Myocarditis Pernicious anemia

Hypertension

a persona has Chronic renal failure, what should they implement in their diet? Phoslo (phosphate binder) Increase vitamin K Increase protien Increase fluids

Phoslo (phosphate binder)

A 44-year-old client is in the hospital unit where you practice nursing. From the results of a series of diagnostic tests, she has been diagnosed with acute glomerulonephritis. What would you expect to find as a result of this condition? a) Polyuria b) Proteinuria c) Pyuria d) No option is correct.

Proteinuria CorrectExplanation:The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided. The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. This answer is incorrect.

GOOD A client with chronic renal failure is experiencing metabolic acidosis. The client most likely requires: a) no treatment b) sodium bicarbonate supplements c) peritoneal dialysis d) hemodialysis

b) sodium bicarbonate supplements to balance out metabolic acidosis Explanation:The metabolic acidosis of chronic renal failure usually produces no symptoms and requires no treatment.

GOOD Glomerulonephritis is characterized by glomerular damage caused by a. growth of microorganisms in the glomeruli. b. release of bacterial substances toxic to the glomeruli. c. accumulation of immune complexes in the glomeruli. d. hemolysis of red blood cells circulating in the glomeruli.

c. accumulation of immune complexes in the glomeruli. Glomerulonephritis is not an infection but rather an antibody-induced injury to the glomerulus, where either autoantibodies against the glomerular basement membrane (GBM) directly damage the tissue or antibodies reacting with nonglomerular antigens are randomly deposited as immune complexes along the GBM. Prior infection by bacteria or viruses may stimulate the antibody production but is not present or active at the time of glomerular damage.

Obstruction of the lower urinary tract in men often is caused by: congenital stricture of a calyx. prostate enlargement. pelvic organ prolapse. urinary tract infection.

prostate enlargement

As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur? A. Hyperphosphatemia B. Hypercalcemia C. Hypokalemia D. Metabolic alkalosis

A Changes include hyperphosphatemia due to its decreased renal excretion, hypocalcemia and decreased vitamin D activation, hyperkalemia due to decreased potassium excretion, and metabolic acidosis from decreased acid secretion by the kidney and inability to regenerate bicarbonate.

GOOD During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication? A. Dehydration B. Hypokalemia C. Oliguria D. Renal calculi

A Dehydration is a complication during the diuresis phase related to elevated urine output and continued symptoms of uremia. The concern with acute kidney injury (AKI) is hyperkalemia. The diuresis phase of AKI is marked by normal or elevated urine output. Oliguria is urine output less than 400 mL in 24 hours and is seen in the oliguria phase. Renal calculi are a possible cause but not a complication of AKI.

GOOD A child is brought into the clinic with symptoms of edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem? A. Sore throat 2 weeks ago B. Red blood cells in the urine C. Elevation of blood pressure D. Protein elevation in the urine

A SREP INFECTION NOT TREATED. DARK COLORED URINE Acute glomerulonephritis usually occurs as a result of bacterial infection such as seen with a beta-hemolytic streptococcal infection or impetigo. Red blood cells and protein found in the urine and elevated blood pressure are symptoms associated with glomerulonephritis.

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 Stage 3 of chronic kidney disease is defined as having a GFR of 30-59 mL/min/1.73 m2

The nurse monitors the client for potential complications during dialysis but recongizes NOT to monitor for A. muscle cramping. B. hypertension. C. dysrhythmias. D. air embolism.

B The nurse should monitor for hypotension, not hypertension, during the treatment related to the removal of fluid. Muscle cramping may occur late in dialysis as fluid and electrolytes rapidly leave the extracellular space. Dysrhythmias may result from electrolyte and pH changes or removal of antiarrhythmic medications. Air embolism is rare, but could occur if air enters the vascular system.

In a diagnosis of an upper urinary tract infection, which structures could be affected? Select all that apply. A. ureter B. kidney C. bladder D. urethra

A, B The upper urinary tract is composed of the kidneys, renal pelves, and ureters.

Enlargement of the prostate causes which of the following to occur? Select all that apply. A. Frequency B. Oliguria C. Anuria D. Obstruction of urine flow E. Polyuria

A, B, C, D Enlargement of the prostate gland causes obstruction of urine flow, resulting in frequency, oliguria, and anuria. Polyuria does not occur.

The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply. A. Secretion of prostaglandins B. Vitamin B production C. Regulation of blood pressure D. Vitamin D synthesis E. Secretion of insulin

A. Secretion of prostaglandins C. Regulation of blood pressure D. Vitamin D synthesis Functions of the kidney include secretion of prostaglandins, regulation of blood pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body does not produce Vitamin B.

A change that occurs during chronic glomerulonephritis is termed A. hypokalemia. B. anemia. C. metabolic alkalosis. D. hypophosphatemia.

B Think kidney failure Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur during chronic glomerulonephritis.

The client with glomerulonephritis is exhibiting gross periorbital edema. Which is the bestnursing intervention to relieve this symptom? A) Administer diuretics. B) Apply warm compresses. C) Elevate the head of the bed. D) Monitor intake and output.

Ans: C Feedback:Periorbital edema can be managed with positioning the client with an HOB elevation. Coolcompresses can be helpful. Diuretics, required as an order by the physician, are used totreat symptoms of edema and hypertension in clients with glomerulonephritis. Monitoringintake and output is an essential nursing measure but not specific to perioribital edemarelief.

The nurse cares for a client diagnosed with chronic glomerulonephritis. The nurse will observe the client for the development of A. hypokalemia. B. anemia. C. metabolic alkalosis. D. hypophosphatemia.

B Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur during chronic glomerulonephritis.

The nurse recognizes which condition as an integumentary manifestation of chronic renal failure? A. Asterixis B. Gray-bronze skin color C. Tremors D. Seizures

B Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.

A patient who complains of a dull, continuous pain in the suprapubic area that occurs with, and at the end of, voiding would most likely be diagnosed with which of the following? A. A kidney stone B. Interstitial cystitis C. Acute pyelonephritis D. Prostatic cancer

B Pain over the suprapubic area is most likely related to the bladder. Pain intensity would increase with fullness. Pain at the end of voiding is one of the symptoms associated with interstitial cystitis. (DYSURIA)

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

B The intrarenal category of acute kidney injury (AKI) encompasses an increased BUN, increased creatinine, a low-normal specific gravity of urine, and increased urine sodium. Intrarenal AKI is the result of actual parenchymal damage to the glomeruli or kidney tubules. Acute tubular necrosis (ATN), AKI in which there is damage to the kidney tubules, is the most common type of intrinsic AKI. Characteristics of ATN are intratubular obstruction, tubular back leak (abnormal reabsorption of filtrate and decreased urine flow through the tubule), vasoconstriction, and changes in glomerular permeability. These processes result in a decrease of GFR, progressive azotemia, and fluid and electrolyte imbalances.

GOOD Which one of the following statements correctly describes a direct end-effect of the renin-angiotensin-aldosterone system? A. Renin promotes the renal excretion of sodium and water in the proximal tubules. B. Aldosterone increases renal reabsorption of water and sodium. C. Angiotensin II causes systemic vasodilation. D. Angiotensin I promotes water excretion by the kidneys without affecting sodium reabsorption.

B. Aldosterone increases renal reabsorption of water and sodium. Angiotensin 2 is a powerful vasoconstrictor

When assessing a client with chronic glomerulonephritis, the nurse notes that the client has generalized edema. The nurse documents this as which of the following? A. Periorbital edema B. Anasarca C. Uremic frost D. Hydronephrosis

B. Anasarca Generalized edema known as anasarca is a common finding with chronic glomerulonephritis. Periorbital edema refers to puffiness around the eyes. Uremic frost is a precipitate that forms on the skin in clients with chronic renal failure. Hydronephrosis refers to a condition involving distention of the renal pelves.

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? A. "I inherited this disorder from one of my parents." B. "The cysts can get quite large in size." C. "As long as I have one normal kidney, I should be fine." D. "If renal failure develops, I may need to consider dialysis."

C Polycystic kidney disease is characterized by the formation of multiple cysts on both kidneys. Polycystic kidney disease is inherited as an autosomal dominant trait. The fluid-filled cysts can cause great enlargement of the kidneys and interfere with kidney function, which can eventually lead to renal failure.

GOOD A chronic renal failure client complains of generalized bone pain and tenderness. Whichassessment finding would alert the nurse to an increased potential for the development ofspontaneous bone fractures? A) Elevated serum creatinine B) Hyperkalemia C) Hyperphosphatemia D) Elevated urea and nitrogen

C) Hyperphosphatemia

Retention of which electrolyte is the most life-threatening effect of renal failure? A. Calcium B. Sodium C. Potassium D. Phosphorous

C. Potassium

A patient has a glomerular filtration rate (GFR) of 50 mL/minute and a serum potassium level of 8 mEq/L. The nurse monitors the patient for which complication? Hypotension Respiratory failure Metabolic acidosis Cardiac dysrhythmias

Cardiac dysrhythmiasThe patient's glomerular filtration rate (GFR) of 50 mL/min is indicative of stage 3 chronic kidney disease, and the patient's serum potassium level of 8 mEq/L indicates hyperkalemia, which may lead to cardiac dysrhythmias. Hypotension and respiratory failure may result from hypermagnesemia. Metabolic acidosis occurs when the patient's bicarbonate levels are lower than 20 mEq/L.

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

Correct answer: C It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

A client requires hemodialysis. Which type of drug should be withheld before this procedure? A. Phosphate binders B. Insulin C. Antibiotics D. Cardiac glycosides

D Cardiac glycosides such as digoxin (Lanoxin) should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digoxin toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.

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? A. Administration of an insulin drip B. Administration of a loop diuretic C. Administration of sodium bicarbonate D. Administration of sodium polystyrene sulfonate [Kayexalate])

D The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.

The nurse is caring for several older clients. Which client would the nurse be especiallyalert for signs and symptoms of pyelonephritis? A) A client with acute renal failure B) A client with a urinary tumor C) A female client with preexisting chronic glomerulonephritis D) A client with urinary obstruction

D) A client with urinary obstruction Feedback: The client with urinary obstruction is at the highest risk of developing pyelonephritis because a urinary obstruction is the most common cause of pyelonephritis in older adults. Acute glomerulonephritis usually occurs in older adults with preexisting chronic glomerulonephritis. Older clients with acute renal failure or urinary tumor are not at high-risk for developing pyelonephritis.

The nurse is caring for a patient with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which of the following nursing actions is contraindicated? a) Obtaining blood samples from the left arm b) Obtaining a blood pressure reading from the right arm c) Palpating the fistula for a "thrill" d) Placing the patient's watch on the left wrist

Obtaining a blood pressure reading from the right armCorrectExplanation:The nurse assesses the vascular access for patency. The bruit, or "thrill," over the venous access site must be evaluated at least every shift. The nurse takes precautions to ensure that the extremity with the vascular access is not used for measuring blood pressure or for obtaining blood specimens; tight dressings, restraints, or jewelry over the vascular access must be avoided as well.

Which of the following conditions is caused by a genetic defect?Acute pyelonephritis Hydroureter Incontinence Polycystic kidney disease

Polycystic kidney disease

The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? (Select all that apply.) a) Red blood cells in the urine b) Proteinuria c) Polyuria d) Hemoglobin of 12.8 g/dL e) White cell casts in the urine

a) Red blood cells in the urine b) Proteinuria e) White cell casts in the urine

13. Acute renal failure produces all of the following characteristic alterations in laboratory values except A. elevated serum creatinine levels .B. azotemia. C. uremia. D. decreased serum potassium levels.

d

A client with acute renal failure progresses through four phases. Which describes the onset phase? A. It is accompanied by reduced blood flow to the nephrons. B. Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. C. The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. D. Normal glomerular filtration and tubular function are restored.

A The onset phase is accompanied by reduced blood flow to the nephrons. In the oliguric phase, fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. During the diuretic phase, excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. During the recovery phase, normal glomerular filtration and tubular function are restored.

The nurse recognizes that a referral for genetic counseling is inappropriate for the client with: A. Alport syndrome B. Polycystic kidney disease C. Renal calculi D. Wilms' tumor

B. Polycystic kidney disease Wilms' tumor, polycystic disease, and Alport are conditions that have a genetic influence. Renal calculi are not influenced by genetic factors.

GOOD The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? A. Wear a mask while handling any dialysate solutions. B. Keep the catheter stabilized to the abdomen, below the belt line. C. Use an aseptic technique during the procedure. D. Clean the catheter insertion site daily with soap.

C RISK INFECTION The client should be instructed to use an aseptic technique during the procedure. The client should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (clients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

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

Correct answer: White blood cell (WBC) count of 20,000/mm3 Explanation: An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

Which classification of urinary tract infection (UTI) is described as infection of the renal parenchyma, renal pelvis, and ureters? a. Upper UTI c. Complicated UTI b. Lower UTI d. Uncomplicated UTI

a. An upper urinary tract infection (UTI) affects the renal

GOOD Which characteristic is more likely with acute pyelonephritis than with a lower UTI? a. Fever b. Dysuria c. Urgency d. Frequency

a. Fever. Systemic manifestations of fever and chills with leukocytosis and nausea and vomiting are more common inpyelonephritis than in a lower UTI. Dysuria, frequency, andurgency can be present with both.

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? a) "Let's wait until after the surgery to discuss your treatment plan." b) "The doctor may decide to delay the use of immunosuppressant drugs." c) "Immunosuppressive drugs guarantee organ success." d) "Even a perfect match does not guarantee organ rejection."

d) "Even a perfect match does not guarantee organ rejection."

GOOD Which test is required for a diagnosis of pyelonephritis? a. Renal biopsy b. Blood culture c. Intravenous pyelogram (IVP) d. Urine for culture and sensitivity

d. A urine specimen specifically obtained for culture and sensitivity is required to diagnose pyelonephritis because it will show pyuria, the specific bacteriuria, and what drug the bacteria is sensitive to for treatment. The renal biopsy is used to diagnose chronic pyelonephritis or cancer. Blood cultures would be done if bacteremia is suspected. Intravenous pyelogram (IVP) would increase renal irritation, but CT urograms may be used to assess for signs of infection in the kidney and complications of pyelonephritis.

26. The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom? A) Azotemia B) Diminished erythropoietin production C) Impaired immunologic response D) Electrolyte imbalances

B) Diminished erythropoietin production

Creatinine is best described as A. a substance produced by the kidney. B. a product related to skeletal muscle metabolism C. produced by the liver and filtered by the kidney D. a by-product of protein metabolism

B. a product related to skeletal muscle metabolism

18. Evidence-based interventions to slow the progression of chronic kidney disease include all of the following except A. blood glucose control for diabetic patients. B. blood pressure control. C. angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blocker (ARB) drugs. D. a sodium-restricted diet.

B. blood pressure control.

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? A. Elevated serum creatinine B. Hyperkalemia C. Hyperphosphatemia D. Elevated urea and nitrogen

C Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.

As the home health nurse reviews medications taken by the client with polycystic kidne ydisease, which medication should be addressed first? A) Lovastin (Mevacor) B) Methylprednisolone (Depo-Medrol) C) Furosemide (Lasix) D) Ibuprofen (Motrin)

D) Ibuprofen (Motrin) Feedback:Nephrotoxic drugs are not administered to clients with renal disease unless no othertherapeutic agent is available. Ibuprofen (Motrin) is a nephrotoxic drug and nephrotoxicmedications, such as nonsteroidal anti-inflammatory drugs and cephalosporin antibiotics,should be avoided in treating clients with polycystic kidney disease. Lovastin (Mevacor)(antihyperlidemic agent) and methylprednisolone (Depo-Medrol) (steroid) are drugspresently being reviewed for slowing the rate of disease progression in clients withpolycystic kidney disease and are not considered nephrotoxic. Furosemide (Lasix) is adiuretic and has no significance in causing renal damage.

A child is brought into the clinic with symptoms of periorbital edema and dark brownrusty urine. Which nursing assessment finding would best assist in determining the causeof this problem? A) Sore throat 2 weeks ago B) Red blood cells in the urine C) Elevation of blood pressure D) Protein elevation in the urine

Ans: AFeedback:Acute glomerulonephritis usually occurs as a result of bacterial infection such as seen witha beta-hemolytic streptococcal infection or impetigo. RBC and protein found in the urineand elevation of blood pressure are symptoms associated with glomerulonephritis.

A client with several calculi in the ureter is scheduled for extracorporeal shock wavelithotripsy (ESWL). Which teaching statement by the nurse best describes the procedure? A) A scope is passed through the urethra to visualize and destroy the stones with alaser. B) After locating the calculi, a small incision is made to remove the stones. C) The stone is identified via fluoroscopy and then shock waves are used to shatter thestones D) Once the calculi are located, a fine wire delivers shock waves to pulverize thestones.

Ans: C Feedback:ESWL is a procedure that uses 800 to 2400 shock waves aimed from outside the bodytoward soft tissues to dense stones. The repetition of the shock waves helps to shatter thestones into smaller particles that can be passed from the urinary tract. No incision isneeded for ESWL therapy. Laser lithotripsy uses a fine wire placement to allow the laserbeam to pulverize the stones.

GOOD 10. All of the following could produce prerenal failure except A. myocardial infarction. B. pyelonephritis. C. septic shock. D. hemorrhage.

B. pyelonephritis. Pre renal is due to decrease blood flow to kidneys

A client diagnosed with acute kidney injury (AKI) has developed congestive heart failure. The client has received 40 mg of intravenous push (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The client's vital signs are stable. Which health care order should the nurse anticipate? A. Lasix 80 mg IVP B. Normal saline bolus of 500 mL C. Chest x-ray D. Mannitol 12.5 g IVP

A Diuretic agents are often used to control fluid volume in clients with acute kidney injury (AKI). The client's urine output indicates an inadequate response to the initial dosage of Lasix and the nurse should anticipate administering Lasix 80 mg IVP. Often in this situation, the initial dosage of Lasix is doubled. The client is experiencing fluid overload, thus, a 500-mL bolus of normal saline bolus would be contraindicated. There is no need to complete a chest x-ray. Mannitol is widely used in the management of cerebral edema and increased intracranial pressure from multiple causes.

The client with acute renal failure progresses through four phases. Which of the following describes the initiation phase? a) Normal glomerular filtration and tubular function are restored. b) The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. c) It is accompanied by reduced blood flow to the nephrons. d) Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications.

c) It is accompanied by reduced blood flow to the nephrons. The initiation phase is accompanied by reduced blood flow to the nephrons. In the oliguric phase, fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. During the diuretic phase, excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. During the recovery phase, normal glomerular filtration and tubular function are restored.

Which of the following nursing actions is most important in caring for the client following lithotripsy? a) Monitor the continuous bladder irrigation. b) Administer allopurinol (Zyloprim). c) Notify the physician of hematuria. d) Strain the urine carefully for stone fragments.

d) Strain the urine carefully for stone fragments. Correct response: Strain the urine carefully for stone fragments.Explanation:The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical anaysis.

A nurse is performing an admission assessment on a client who has severe chronic kidney disease (CKD). Which of the following findings should the nurse expect for this client?a. tachypneab. hypotensionc. exophthalmosd. insomnia

a. tachypneaThe nurse should expect the client who has severe CKD to have tachypnea due to metabolic acidosis