Adult Health Chapter 67 and 68 Evolve Questions with some power point info Flashcards
What is the paraneoplastic syndrome that is common in clients with renal cell carcinoma? 1 Decreased serum calcium level 2 Hypotension 3 Decreased sedimentation rate 4 Erythrocytosis
Answer 4.
Erythrocytosis is a paraneoplastic syndrome common with renal cell carcinoma. It is caused by large amounts of erythropoietin secreted by tumor cells. Parathyroid hormone produced by the tumor cell increases the serum calcium level causing hypercalcemia. The increased level of renin causes hypertension rather than hypotension. Renal cell carcinoma is associated with an increased sedimentation rate.
The nurse is caring for a client with pyelonephritis. What does the nurse teach the client about preventing end-stage kidney disease? 1 Complete the drug therapy exactly as indicated. 2 Monitor blood glucose levels regularly. 3 Limit fluid intake to 1 L per day. 4 Increase protein intake in the diet
Answer 1.
The client must be taught the importance of completing antibiotics and other drug therapy exactly as prescribed. Clients have a tendency to discontinue drug therapy as soon as they feel better. This can result in a more resistant form of bacterial infection. Blood pressure (not glucose) levels should be monitored every day; blood pressure control is needed to slow the progression of kidney dysfunction. When kidney impairment decreases concentrating ability, the client is encouraged to drink at least 2 L of fluids every day. Dietary protein is usually restricted.
The nurse is caring for a client with acute pyelonephritis. Which indicator is used to determine adequate fluid intake? A Client reports no pain with urination B Urine dipstick negative for leukocytes C Pale yellow urine D Urine sample negative for bacteria
Answer C
The client with pyelonephritis is recommended to have fluid intake at 2 liters per day, sufficient to result in dilute pale yellow urine, unless there is a contraindication. Urinary antiseptic drugs may be used for comfort but is not an indication of adequate fluid intake. The presence of bacteria or leukocytes in the urine is not directly correlated to fluid intake.
Test-Taking Tip: Avoid selecting answers that state hospital rules or regulations as a reason or rationale for action.
Which condition may predispose a client to chronic pyelonephritis? 1 Spinal cord injury 2 Cardiomyopathy 3 Hepatic failure 4 Glomerulonephritis
Answer 1
Chronic pyelonephritis occurs with spinal cord injury, bladder tumor, prostate enlargement, or urinary tract stones. Weakness of the heart muscle may cause kidney impairment, not an infection. Pyelonephritis may damage the kidney, not the liver. Glomerulonephritis may result from infection, but may not cause infection of the kidney.
When taking the health history of a client with acute glomerulonephritis, the nurse questions the client about which related cause of the problem? 1 Recent respiratory infection 2 Hypertension 3 Unexplained weight loss 4 Neoplastic disease
Answer 1- Recent respiratory infection
An infection often occurs before the kidney manifestations of acute glomerulonephritis (GN). The onset of symptoms is about 10 days from the time of infection. Hypertension is a result of glomerulonephritis, not a cause. Weight gain, not weight loss, is symptomatic of fluid retention in GN. Cancers are not part of the cause of GN.
Test-Taking Tip: After choosing an answer, go back and reread the question stem along with your chosen answer. Does it fit correctly? The choice that grammatically fits the stem and contains the correct information is the best choice.
The nurse is assessing a client for early signs of renal cell carcinoma (RCC). What finding does the nurse expect in this client? 1 Sharp intermittent flank pain 2 Renal bruit on auscultation 3 Gynecomastia 4 Bloody urine
Answer 2- Renal bruit on auscultation
The nurse notes renal bruit on auscultation in the client with RCC. The client often describes the pain in the flank as dull and aching. The pain is more intense if there is bleeding into the tumor or kidney. Gynecomastia and bloody urine are late stages of the disease.
After receiving change-of-shift report on the urology unit, which client does the nurse assess first?
1
Client post–radical nephrectomy whose temperature is 99.8° F (37.6° C)
2
Client with glomerulonephritis who has cola-colored urine
3
Client who was involved in a motor vehicle crash and has hematuria
4
Client with nephrotic syndrome who has gained 2 kg since yesterday
Answer 3- Client who was involved in a motor vehicle crash and has hematuria
The nurse should be aware of the risk for kidney trauma after a motor vehicle crash; this client needs further assessment and evaluation to determine the extent of blood loss and the reason for the hematuria because hemorrhage can be life-threatening. Although slightly elevated, the low-grade fever of the client who is post–radical nephrectomy is not life-threatening in the same way as a trauma victim with bleeding. Cola-colored urine is an expected finding in glomerulonephritis. Because of loss of albumin, fluid shifts and weight gain can be anticipated in a client with nephrotic syndrome.
Study Tip: Identify your problem areas that need attention. Do not waste time on restudying information you know.
The nurse anticipates that a client who develops hypotension and oliguria post-nephrectomy may need the addition of which element to the regimen? 1 Increase in analgesics 2 Addition of a corticosteroid 3 Administration of a diuretic 4 Course of antibiotic therapy
Answer 2- Addition of a corticosteroid
Loss of water and sodium occurs in clients with adrenal insufficiency, which is followed by hypotension and oliguria; corticosteroids may be needed. The nurse should use caution when administering analgesics to a hypotensive client; no indication suggests that pain is present in this client. A diuretic would further contribute to fluid loss and hypotension, potentially worsening kidney function. A few doses of antibiotics are used prophylactically preoperatively and postoperatively; additional therapy is used when evidence of infection exists.
What is the appropriate range of urine output for the client who has just undergone a nephrectomy? 1 23-30 mL/hr 2 30-50 mL/hr 3 41-60 mL/hr 4 50-70 mL/hr
Answer 2- 30-50 ml/hr
Urine output of 30-50 mL/hr or 0.5-1 mL/kg/hr is considered within acceptable range for the client who is post nephrectomy. Output of less than 25 to 30 mL/hr suggests decreased blood flow to the kidney and the onset or worsening of acute kidney injury. A large urine output, followed by hypotension and oliguria, is a sign of hemorrhage and adrenal insufficiency.
Which statement by a client with diabetic nephropathy indicates a need for further education about the disease?
1
“Diabetes is the leading cause of kidney failure.”
2
“I need less insulin, so I am getting better.”
3
“My blood sugar may drop really low at times.”
4
“I must call my provider if the urine dipstick shows protein.”
Answer 2- “I need less insulin, so I am getting better.”
When kidney function is reduced, insulin is available for a longer time and thus less of it is needed. Unfortunately, many clients believe this means that their diabetes is improving. It is true that diabetes mellitus is the leading cause of end-stage kidney disease (ESKD) among Caucasians in the United States. Proteinuria, which may be mild, moderate, or severe, indicates a need for follow-up.
Test-Taking Tip: A psychological technique used to boost your test-taking confidence is to look into a mirror whenever you pass one and say out loud, “I know the material, and I’ll do well on the test.” Try it; many students have found that it works because it reduces “test anxiety.”
The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor? 1 Hemoglobin and hematocrit (H&H) 2 White blood cell (WBC) count 3 Blood urea nitrogen (BUN) and creatinine 4 Lipid levels
Answer 3- BUN and creatinine
BUN and creatinine are kidney function tests. With back pressure on the kidney, glomerular filtration is reduced or absent, resulting in permanent kidney damage. Hydronephrosis results from the backup of urine secondary to obstruction; H&H monitors for anemia and blood loss, while WBC count indicates infection. Elevated lipid levels are associated with nephrotic syndrome, not with obstruction and hydronephrosis.
Study Tip: Remember that intelligence plays a vital role in your ability to learn. However, being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience.
A client with pyelonephritis has been prescribed urinary antiseptic medication. What purpose does this medication serve? 1 Decreases bacterial count 2 Destroys white blood cells 3 Enhances the action of antibiotics 4 Provides comfort
Answer 4- Provides Comfort
Urinary antiseptic drugs such as nitrofurantoin (Macrodantin) are prescribed to provide comfort for clients with pyelonephritis. Antibiotics, not antiseptics, are used to decrease bacterial count and treat pyelonephritis infection; the action of antibiotics is not enhanced with antiseptics. White blood cells, along with antibiotics, fight infection.
During discharge teaching for a client with kidney disease, what does the nurse teach the client to do?
1
“Drink 2 liters of fluid and urinate at the same time every day.”
2
“Eat breakfast and go to bed at the same time every day.”
3
“Check your blood sugar and do a urine dipstick test.”
4
“Weigh yourself and take your blood pressure.”
Answer 4- “Weigh yourself and take your blood pressure.”
Regular weight assessment monitors fluid restriction control, while blood pressure control is necessary to reduce cardiovascular complications and slow the progression of kidney dysfunction. Fluid intake and urination, and breakfast time and bedtime, do not need to be at the same time each day. Clients with diabetes, not kidney disease, should regularly check their blood sugar and perform a urine dipstick test.
The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment information alarms the nurse?
1
Blood pressure is 98/56 mm Hg; heart rate is 118 beats/min.
2
Urine output over the past hour was 80 mL.
3
Pain is at a level 4 (on a 0 to 10 scale).
4
Dressing has a 1-cm area of bleeding.
Answer 1- Blood pressure is 98/56 mmHg; heart rate is 118 beats/ min.
Bleeding is a complication of radical nephrectomy; tachycardia and hypotension may indicate impending hypovolemic or hemorrhagic shock. The surgeon should be notified immediately and fluids should be administered, complete blood count (CBC) should be checked, and blood administered, if necessary. A urine output of 80 mL can be considered normal. The nurse can administer pain medication, but must address hemodynamic instability and possible hemorrhage first. Administering pain medication to a client who has developed shock will exacerbate hypotension. A dressing with a 1-cm area of bleeding is expected postoperatively
A client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include?
1
Avoiding venipuncture and blood pressure measurements in the affected arm
2
Modifications to allow for complete rest of the affected arm
3
How to assess for a bruit in the affected arm
4
How to practice proper nutrition
Answer 1- Avoiding venipuncture and blood pressure measurements in the affected arm.
Compression of vascular access causes decreased blood flow and may cause occlusion; if this occurs, dialysis will not be possible. The arm should be exercised to encourage venous dilation, not rested. The client can palpate for a thrill; a stethoscope is not needed to auscultate the bruit at home. The nurse should take every opportunity to discuss nutrition, even as it relates to wound healing, but loss of the graft or fistula by compression or occlusion must take priority because lifesaving dialysis cannot be performed.
Test-Taking Tip: Read carefully and answer the question asked; pay attention to specific details in the question.
When caring for a client 24 hours after a nephrectomy, the nurse notes that the client's abdomen is distended. Which action does the nurse perform next? 1 Check vital signs. 2 Notify the surgeon. 3 Continue to monitor. 4 Insert a nasogastric (NG) tube.
Answer-1- Check the vital signs
The client’s abdomen may be distended from bleeding; hemorrhage or adrenal insufficiency causes hypotension, so vital signs should be taken to see if a change in blood pressure has occurred. The surgeon should be notified after vital signs are assessed. An NG tube is not indicated for this client.
Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able to get a good night’s sleep the night before your exam. Cramming is not smart, and it is hard work that increases stress while reducing learning. When you cram, your mind is more likely to go blank during a test. When you cram, the information is in your short-term memory so you will need to relearn it before a comprehensive exam. Relearning takes more time. The stress caused by cramming may interfere with your sleep. Your brain needs sleep to function at its best.
Which instruction does the nurse provide to a client with hypertension and diabetes to prevent or delay the onset of chronic kidney disease (CKD)?
1
Test for microalbuminuria every 6 months.
2
Adhere to all drug and diet regimens.
3
Take over-the-counter drugs after checking labels.
4
Take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) if required.
Answer 2- Adhere to all drug and diet regimens
The client with hypertension and diabetes must strictly adhere to drug and diet regimens to prevent blood vessel changes that lead to kidney damage. These medications are not a cure but need to be taken along with changes in lifestyle. The client must test for microalbuminuria every year for early detection of the disease. The client must restrict the use of over-the-counter drugs or NSAIDs as they reduce blood flow to the kidney and their long-term use reduces kidney function.
