Ch 54 Management of Patients With Kidney Disorders Flashcards
The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem?
A) Hematuria
B) Precipitous decrease in serum creatinine levels
C) Hypotension unresolved by fluid administration
D) Glucosuria
Ans: A
Feedback:
The primary presenting feature of acute glomerulonephritis is hematuria (blood in the
urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Some degree of edema and hypertension is noted in most patients.
The nurse is caring for acutely ill patient. What assessment finding should prompt the nurse to inform the physician that the patient may be exhibiting signs of acute kidney injury (AKI)?
A) The patient is complains of an inability to initiate voiding.
B) The patient’s urine is cloudy with a foul odor.
C) The patient’s average urine output has been 10 mL/hr for several hours.
D) The patient complains of acute flank pain.
Ans: C
Feedback:
Oliguria (
The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The patient has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the patient to take the prescribed phosphorus- binding medication at what time? A) Only when needed B) Daily at bedtime C) First thing in the morning D) With each meal
Ans: D
Feedback:
Both calcium carbonate and calcium acetate are medications that bind with the
phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding medications must be administered with food to be effective.
The nurse is working on the renal transplant unit. To reduce the risk of infection in a patient with a transplanted kidney, it is imperative for the nurse to do what?
A) Wash hands carefully and frequently.
B) Ensure immediate function of the donated kidney. C) Instruct the patient to wear a face mask.
D) Bar visitors from the patient’s room.
Ans: A
Feedback:
The nurse ensures that the patient is protected from exposure to infection by hospital
staff, visitors, and other patients with active infections. Careful handwashing is imperative; face masks may be worn by hospital staff and visitors to reduce the risk for transmitting infectious agents while the patient is receiving high doses of immunosuppressants. Visitors may be limited, but are not normally barred outright. Ensuring kidney function is vital, but does not prevent infection.
The nurse is caring for a patient receiving hemodialysis three times weekly. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse
to be aware of when providing care for this patient?
A) Using a stethoscope for auscultating the fistula is contraindicated.
B) The patient feels best immediately after the dialysis treatment.
C) Taking a BP reading on the affected arm can damage the fistula.
D) The patient should not feel pain during initiation of dialysis.
Ans: C
Feedback:
When blood flow is reduced through the access for any reason (hypotension,
application of BP cuff/tourniquet), the access site can clot. Auscultation of a bruit in the fistula is one way to determine patency. Typically, patients feel fatigued immediately after hemodialysis because of the rapid change in fluid and electrolyte status. Although the area over the fistula may have some decreased sensation, a needle stick is still painful.
A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this
GFR, the nurse interprets that the patient’s chronic kidney disease is at what stage?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Ans: C
Feedback:
Stages of chronic renal failure are based on the GFR. Stage 3 is defined by a GFR in the range of 30 to 59 mL/min/1.73 m2. This is considered a moderate decrease in GFR.
A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason?
A) Hematuria is the most common manifestation of renal trauma and blood losses
may be microscopic, so laboratory analysis is essential.
B) Intake and output calculations are essential and the laboratory will calculate the
precise urine output produced by this patient.
C) A creatinine clearance study may be ordered at a later time and the laboratory
will hold all urine until it is determined if the test will be necessary.
D) There is great concern about electrolyte imbalances and the laboratory will
monitor the urine for changes in potassium and sodium concentrations.
Ans: A
Feedback:
Hematuria is the most common manifestation of renal trauma; its presence after trauma
suggests renal injury. Hematuria may not occur, or it may be detectable only on microscopic examination. All urine should be saved and sent to the laboratory for analysis to detect RBCs and to evaluate the course of bleeding. Measuring intake and output is not a function of the laboratory. The laboratory does not save urine to test creatinine clearance at a later time. The laboratory does not monitor the urine for sodium or potassium concentrations.
A patient admitted with nephrotic syndrome is being cared for on the medical unit.
When writing this patient’s care plan, based on the major clinical manifestation of
nephrotic syndrome, what nursing diagnosis should the nurse include?
A) Constipation related to immobility
B) Risk for injury related to altered thought processes
C) Hyperthermia related to the inflammatory process
D) Excess fluid volume related to generalized edema
Ans: D
Feedback:
The major clinical manifestation of nephrotic syndrome is edema, so the appropriate
nursing diagnosis is ìExcess fluid volume related to generalized edema.î Edema is usually soft, pitting, and commonly occurs around the eyes, in dependent areas, and in the abdomen.
The nurse coming on shift on the medical unit is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing ESKD?
A) A patient with a history of polycystic kidney disease
B) A patient with diabetes mellitus and poorly controlled hypertension
C) A patient who is morbidly obese with a history of vascular disorders
D) A patient with severe chronic obstructive pulmonary disease
Ans: B
Feedback:
Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may cause ESKD. A patient with more than one of these risk factors is at the greatest risk for developing ESKD. Therefore, the patient with diabetes and hypertension is likely at highest risk for ESKD.
The nurse is caring for a patient postoperative day 4 following a kidney transplant.
When assessing for potential signs and symptoms of rejection, what assessment should
the nurse prioritize?
A) Assessment of the quantity of the patient’s urine output
B) Assessment of the patient’s incision
C) Assessment of the patient’s abdominal girth
D) Assessment for flank or abdominal pain
Ans: A
Feedback:
After kidney transplantation, the nurse should perform all of the listed assessments.
However, oliguria is considered to be more suggestive of rejection than changes to the patient’s abdomen or incision.
The nurse is caring for a patient in acute kidney injury. Which of the following complications would most clearly warrant the administration of polystyrene sulfonate (Kayexalate)? A) Hypernatremia B) Hypomagnesemia C) Hyperkalemia D) Hypercalcemia
Ans: C
Feedback:
Hyperkalemia, a common complication of acute kidney injury, is life-threatening if
immediate action is not taken to reverse it. The administration of polystyrene sulfonate reduces serum potassium levels.
Renal failure can have prerenal, renal, or postrenal causes. A patient with acute kidney injury is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it? A) Heart failure B) Glomerulonephritis C) Ureterolithiasis D) Aminoglycoside toxicity
Ans: A
Feedback:
By causing inadequate renal perfusion, heart failure can lead to prerenal failure.
Glomerulonephritis and aminoglycoside toxicity are renal causes, and ureterolithiasis is a postrenal cause.
A 45-year-old man with diabetic nephropathy has ESKD and is starting dialysis. What should the nurse teach the patient about hemodialysis?
A) Hemodialysis is a treatment option that is usually required three times a week.
B) Hemodialysis is a program that will require you to commit to daily treatment.
C) This will require you to have surgery and a catheter will need to be inserted into your abdomen.
D) Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again.
Ans: A
Feedback:
Hemodialysis is the most commonly used method of dialysis. Patients receiving hemodialysis must undergo treatment for the rest of their lives or until they undergo successful kidney transplantation. Treatments usually occur three times a week for at least 3 to 4 hours per treatment.
A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse’s most appropriate action?
A) Inform the physician and assess the patient for signs of infection.
B) Flush the peritoneal catheter with normal saline.
C) Remove the catheter promptly and have the catheter tip cultured.
D) Administer a bolus of IV normal saline as ordered.
Ans: A
Feedback:
Peritonitis is the most common and serious complication of peritoneal dialysis. The first
sign of peritonitis is cloudy dialysate drainage fluid, so prompt reporting to the primary care provider and rapid assessment for other signs of infection are warranted. Administration of an IV bolus is not necessary or appropriate and the physician would determine whether removal of the catheter is required. Flushing the catheter does not address the risk for infection.
The nurse is planning patient teaching for a patient with ESKD who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula?
A) A vein and an artery in your arm will be attached surgically.
B) The arm should be immobilized for 4 to 6 days.
C) One needle will be inserted into the fistula for each dialysis treatment.
D) The fistula can be used 2 days after the surgery for dialysis treatment.
Ans: A
Feedback:
The fistula joins an artery and a vein, either side-to-side or end-to-end. This access will need time, usually 2 to 3 months, to mature before it can be used. The patient is encouraged to perform exercises to increase the size of the affected vessels (e.g., squeezing a rubber ball for forearm fistulas). Two needles will be inserted into the fistula for each dialysis treatment.
A patient with ESKD is scheduled to begin hemodialysis. The nurse is working with the patient to adapt the patient's diet to maximize the therapeutic effect and minimize the risks of complications. The patient's diet should include which of the following modifications? Select all that apply. A) Decreased protein intake B) Decreased sodium intake C) Increased potassium intake D) Fluid restriction E) Vitamin D supplementation
Ans: A, B, D
Feedback:
Restricting dietary protein decreases the accumulation of nitrogenous wastes, reduces uremic symptoms, and may even postpone the initiation of dialysis for a few months. Restriction of fluid is also part of the dietary prescription because fluid accumulation may occur. As well, sodium is usually restricted to 2 to 3 g/day. Potassium intake is usually limited, not increased, and there is no particular need for vitamin D supplementation.
A patient on the critical care unit is postoperative day 1 following kidney transplantation from a living donor. The nurse’s most recent assessments indicate that the patient is producing copious quantities of dilute urine. What is the nurse’s most appropriate response?
A) Assess the patient for further signs or symptoms of rejection.
B) Recognize this as an expected finding.
C) Inform the primary care provider of this finding.
D) Administer exogenous antidiuretic hormone as ordered.
Ans: B
Feedback:
A kidney from a living donor related to the patient usually begins to function immediately after surgery and may produce large quantities of dilute urine. This is not suggestive of rejection and treatment is not warranted. There is no obvious need to report this finding.
A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine level of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders?
A) Monitor the patient’s electrolyte values every hour before the procedure.
B) Preprocedure hydration and administration of acetylcysteine
C) Hemodialysis immediately prior to the CT scan
D) Obtain a creatinine clearance by collecting a 24-hour urine specimen.
Ans: B
Feedback:
Radiocontrast-induced nephropathy is a major cause of hospital-acquired acute kidney
injury. Baseline levels of creatinine greater than 2 mg/dL identify the patient as being high risk. Preprocedure hydration and prescription of acetylcysteine (Mucomyst) the
day prior to the test is effective in prevention. The nurse would not monitor the patient’s electrolytes every hour preprocedure. Nothing in the scenario indicates the need for
hemodialysis. A creatinine clearance is not necessary prior to a CT scan with contrast.
The nurse is caring for a patient with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply.
A) Percuss for pain in the right lower abdominal quadrant.
B) Assess for the presence of peripheral edema.
C) Auscultate the patient’s apical heart rate for dysrhythmias.
D) Assess the patient’s BP.
E) Assess the patient’s orientation and judgment.
Ans: B, D
Feedback:
Most patients with acute glomerular inflammation have some degree of edema and hypertension. Dysrhythmias, RLQ pain, and changes in mental status are not among the most common manifestations of acute glomerular inflammation.
A patient is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the patient develops acute kidney injury. The patient is hemodynamically unstable, but renal replacement therapy is needed to manage the patient’s hypervolemia and hyperkalemia. Which of the following therapies will the patient’s hemodynamic status best tolerate?
A) Hemodialysis
B) Peritoneal dialysis
C) Continuous venovenous hemodialysis (CVVHD) D) Plasmapheresis
Ans: C
Feedback:
CVVHD facilitates the removal of uremic toxins and fluid. The hemodynamic effects of CVVHD are usually mild in comparison to hemodialysis, so CVVHD is best tolerated by an unstable patient. Peritoneal dialysis is not the best choice, as the patient may have sustained abdominal injuries during the accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and electrolyte balance.
A patient has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the patient about what topic? A) Typical diet B) Allergy status C) Psychosocial stressors D) Current medication use
Ans: D
Feedback:
The kidneys are susceptible to the adverse effects of medications because they are repeatedly exposed to substances in the blood. Nephrotoxic medications are a more likely cause of AKI than diet, allergies, or stress.
An 84-year-old woman diagnosed with cancer is admitted to the oncology unit for surgical treatment. The patient has been on chemotherapeutic agents to decrease the tumor size prior to the planned surgery. The nurse caring for the patient is aware that what precipitating factors in this patient may contribute to AKI? Select all that apply. A) Anxiety B) Low BMI C) Age-related physiologic changes D) Chronic systemic disease E) NPO status
Ans: C, D
Feedback:
Changes in kidney function with normal aging increase the susceptibility of elderly patients to kidney dysfunction and renal failure. In addition, the presence of chronic, systemic diseases increases the risk of AKI. Low BMI and anxiety are not risk factors for acute renal disease. NPO status is not a risk, provided adequate parenteral hydration is administered.
A patient is being treated for AKI and the patient daily weights have been ordered. The nurse notes a weight gain of 3 pounds over the past 48 hours. What nursing diagnosis is suggested by this assessment finding?
A) Imbalanced nutrition: More than body requirements
B) Excess fluid volume
C) Sedentary lifestyle
D) Adult failure to thrive
Ans: B
Feedback:
If the patient with AKI gains or does not lose weight, fluid retention should be suspected. Short-term weight gain is not associated with excessive caloric intake or a sedentary lifestyle. Failure to thrive is not associated with weight gain.
A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event?
A) Psychosocial stress
B) Hypersensitivity to an immunization
C) Menarche
D) Streptococcal infection
Ans: D
Feedback:
Postinfectious causes of postinfectious glomerular disease are group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks. Menarche, stress, and hypersensitivity are not typical causes.
