Chapter 48 - Kidney Disorders

Question 1

The nurse is assessing a client 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

Answer 1

A. Hematuria
Rationale: 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. Glucosuria does not normally accompany glomerulonephritis, and hypertension is much more likely than hypotension.

Question 2

The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform the health care provider that the client may be exhibiting signs of acute kidney injury (AKI)?
A. An inability to initiate voiding for 2 days.
B. The urine is cloudy and has visible sediment with a foul odor.
C. Average urine output has been 10 mL/hr for several hours.
D. Client reports left-sided flank pain.

Answer 2

C. Average urine output has been 10 mL/hr for several hours.
Rationale: Oliguria (<400 mL/day of urine or 0.5 mL/kg an hour over 6 hours) is the most common clinical situation seen in AKI. The client’s inability to void and/or urine hesitancy is typically seen with kidney stones, prostate problems, and/or a urinary tract infection (UTI). Urine that has visible sediment and is cloudy and foul smelling is more suggestive of a UTI. Acute flank pain is sometimes seen in AKI. Generally, flank pain has some connection to a variety of kidney diseases like acute glomerular inflammation and polycystic kidney disease

Question 3

The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time?
A. Only when needed
B. Daily at bedtime
C. First thing in the morning
D. With each meal

Answer 3

D. With each meal
Rationale: 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 given with food to be effective.

Question 4

The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to take what action?
A. Wash hands carefully and frequently.
B. Ensure immediate function of the donated kidney.
C. Instruct the client to wear a face mask.
D. Bar visitors from the client’s room

Answer 4

A. Wash hands carefully and frequently
Rationale: The nurse ensures that the client is protected from exposure to infection by hospital staff, visitors, and other clients 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 client 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

Question 5

The nurse is caring for a client receiving hemodialysis three times weekly. The client has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this client?
A. Using a stethoscope for auscultating the fistula is contraindicated
B. The client feels best immediately after the dialysis treatment
C. Taking a BP reading on the affected arm can damage the fistula
D. The client should not feel pain during initiation of dialysis

Answer 5

C. Taking a BP reading on the affected arm can damage the fistula
Rationale: 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, clients 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

Question 6

A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the client’s chronic kidney disease is at what stage?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4

Answer 6

C. Stage 3
Rationale: Stages of chronic kidney disease 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.

Question 7

An inpatient client with acute kidney injury (AKI) has moderate edema to both legs. What resulting skin conditions would increase the client’s likelihood of skin breakdown? Select all that apply.
A. Atopic dermatitis
B. Pruritus
C. Psoriasis
D. Urticaria
E. Excoriation

Answer 7

B. Pruritus
E. Excoriation
Rationale: The skin may be dry or susceptible to breakdown as a result of edema. Excoriation and itching (pruritus) may result from the deposits of irritating toxins in the client’s tissue due to AKI. Prevention recommendations include bathing in cool water, assisting or encouraging frequent turning and repositioning as well as keeping the skin clean and moisturized. Clients should be instructed to keep nails trimmed to help prevent scratches. Atopic dermatitis or eczema has strong genetic links and is commonly associated with asthma and hay fever. Eczema results in red, dry, and itchy patches of skin. Urticaria or hives are raised, red welts that suddenly appear on the skin and are usually caused by an allergic reaction. Psoriasis is a chronic skin condition characterized by thick red patches or plaques of skin covered with white or silvery scales. Psoriasis is usually linked to an autoimmune response.

Question 8

A client admitted with nephrotic syndrome is being cared for on the medical unit. When writing this client’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

Answer 8

D. Excess fluid volume related to generalized edema
Rationale: The major clinical manifestation of nephrotic syndrome is edema, so the appropriate nursing diagnosis is “Excess fluid volume related to generalized edema.” Edema is usually soft, pitting, and commonly occurs around the eyes, in dependent areas, and in the abdomen.

Question 9

The nurse coming on shift on the medical unit is taking a report on four clients. What client does the nurse know is at the greatest risk of developing ESKD?
A. A client with a history of polycystic kidney disease
B. A client with diabetes mellitus and poorly controlled hypertension
C. A client who is morbidly obese with a history of vascular disorders
D. A client with severe chronic obstructive pulmonary disease

Answer 9

B. A client with diabetes mellitus and poorly controlled hypertension
Rationale: 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 client with more than one of these risk factors is at the greatest risk for developing ESKD. Therefore, the client with diabetes and hypertension is likely at highest risk for ESKD.

Question 10

The nurse is caring for a client 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 client’s urine output
B. Assessment of the client’s incision
C. Assessment of the client’s abdominal girth
D. Assessment for flank or abdominal pain

Answer 10

A. Assessment of the quantity of the client’s urine output
Rationale: 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 client’s abdomen or incision

Question 11

The nurse is caring for a client in acute kidney injury (AKI). Which complication would most clearly warrant the administration of polystyrene sulfonate?
A. Hypernatremia
B. Hypomagnesemia
C. Hyperkalemia
D. Hypercalcemia

Answer 11

C. Hyperkalemia
Rationale: Hyperkalemia (high potassium) is a common complication of AKI. If the client’s potassium is elevated but does not cause ECG (electrocardiography) changes, then polystyrene sulfonate may be administered since it reduces serum potassium levels. It is not recommended for emergency treatment since it takes more than 6 hours to work. Polystyrene sulfonate does not treat low (hypo) magnesium, high sodium (hypernatremia), or high calcium (hypercalcemia).

Question 12

The nurse is caring for a client whose acute kidney injury (AKI) resulted from a prerenal cause. Which condition most likely caused this client’s health problem?
A. Burns
B. Glomerulonephritis
C. Ureterolithiasis
D. Pregnancy

Answer 12

A. Burns
Rationale: AKI has categories that identify causation. These are prerenal, intrarenal, and postrenal. Prerenal AKI results from hypoperfusion of the kidney caused by volume depletion. Common causes are burns, hemorrhage, gastrointestinal losses, sepsis, and shock. Glomerulonephritis and ureterolithiasis (kidney stones) are associated with intrarenal causes. Pregnancy is linked to postrenal AKI (obstructions distal to the kidney).

Question 13

A client with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client 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.”

Answer 13

A. “Hemodialysis is a treatment option that is usually required three times a week.”
Rationale: Hemodialysis is the most commonly used method of dialysis. Clients receiving hemodialysis must undergo treatment for the rest of their lives or until they undergo successful kidney transplantation. Treatment usually occurs three times a week for at least 3 to 4 hours per treatment. Peritoneal dialysis, not hemodialysis, requires placement of a catheter inserted into the abdomen

Question 14

A client with end-stage renal disease 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 health care provider and assess the client 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 prescribed.

Answer 14

A. Inform the health care provider and assess the client for signs of infection.
Rationale: 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 provider and rapid assessment for other signs of infection are warranted. Administration of an IV bolus is not necessary or appropriate and the health care provider would determine whether removal of the catheter is required. Flushing the catheter does not address the risk for infection.

Question 15

The nurse is planning client teaching for a client with end-stage kidney disease who is scheduled for the creation of a fistula. The nurse should teach the client what information 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 5 to 7 days after the surgery for dialysis treatment.”

Answer 15

A. “A vein and an artery in your arm will be attached surgically.”
Rationale: The fistula joins an artery and a vein, either side-to-side or end-to-end. This access will need several weeks to “mature” before it can be used. The client 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.

Question 16

A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client’s diet to maximize the therapeutic effect and minimize the risks of complications. The client’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

Answer 16

A. Decreased protein intake
B. Decreased sodium intake
D. Fluid restriction
Rationale: 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.

Question 17

A client is scheduled for a CT scan of the abdomen with contrast. The client has a baseline creatinine level of 2.3 mg/dL (203 mol/L). In preparing this client for the procedure, the nurse anticipates what orders?
A. Monitor the client’s electrolyte values every hour before the procedure.
B. Provide adequate hydration before the procedure
C. Start hemodialysis immediately prior to the CT scan
D. Obtain a creatinine clearance by collecting a 24-hour urine specimen.

Answer 17

B. Provide adequate hydration before the procedure
Rationale: Radiocontrast-induced nephropathy is a major cause of hospital-acquired acute kidney injury. Baseline levels of creatinine greater than 2 mg/dL (177 mol/L) identify the client as being at high risk. Preprocedure hydration the day prior to the test is effective in prevention. The nurse would not monitor the client’s electrolytes every hour pre-procedure because this would not change the client’s risk factors. To decrease this risk factor, an intervention is needed. Nothing in the scenario indicates the need for hemodialysis. A creatinine clearance is not necessary prior to a CT scan with contrast.

Question 18

A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client’s hypervolemia and hyperkalemia. Which of the following therapies will the client’s hemodynamic status best tolerate?
A. Hemodialysis
B. Peritoneal dialysis
C. Continuous venovenous hemodialysis (CVVHD)
D. Plasmapheresis

Answer 18

C. Continuous venovenous hemodialysis (CVVHD)
Rationale: 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 client. Peritoneal dialysis is not the best choice, as the client may have sustained abdominal injuries during the accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and electrolyte balance.

Question 19

A client 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 client about what priority topic?
A. Typical diet
B. Allergy status
C. Psychosocial stressors
D. Current medication use

Answer 19

D. Current medication use
Rationale: 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.

Question 20

An older adult client diagnosed with cancer is admitted to the oncology unit for surgical treatment. The client has been on chemotherapeutic agents to decrease tumor size prior to the planned surgery. The nurse caring for the client is aware that what precipitating factors in this client may contribute to acute kidney injury (AKI)? Select all that apply.
A. Anxiety and agitation
B. Low body mass index (BMI)
C. Age-related physiologic changes
D. Chronic systemic disease
E. Nothing by mouth (NPO) status

Answer 20

C. Age-related physiologic changes
D. Chronic systemic disease
E. Nothing by mouth (NPO) status
Rationale: Changes in kidney function with normal aging increase the susceptibility of older clients to kidney dysfunction and kidney injury. In addition, the presence of chronic, systemic diseases increases the risk of AKI. This client was on chemotherapeutic agents that frequently cause nausea and vomiting, which contribute to dehydration. Older adult clients taking medications may cause alterations in renal flow and clearance. The client was made NPO prior to surgery, making them more susceptible to AKI even with parenteral fluids. A low BMI and anxiety are not risk factors for acute renal disease.

Question 21

A client is being treated for AKI and the client daily weights have been ordered. The nurse notes a weight gain of 3 pounds (1.4 kg) 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

Answer 21

B. Excess fluid volume
Rationale: If the client 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.

Question 22

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

Answer 22

D. Streptococcal infection
Rationale: 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

Question 23

A client on the medical unit has a documented history of polycystic kidney disease (PKD). What principle should guide the nurse’s care of this client?
A. The disease is self-limiting and cysts usually resolve spontaneously in the fifth or sixth decade of life.
B. The client’s disease is incurable and the nurse’s interventions will be supportive.
C. The client will eventually require surgical removal of his or her renal cysts.
D. The client is likely to respond favorably to lithotripsy treatment of the cysts

Answer 23

B. The client’s disease is incurable and the nurse’s interventions will be supportive.
Rationale: Nursing actions focus on support and symptom control. It is not self-limiting and is not treated surgically or with lithotripsy.

Question 24

The nurse is providing a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants’ risks of renal carcinoma?
A. Avoiding heavy alcohol use
B. Control of sodium intake
C. Smoking cessation
D. Adherence to recommended immunization schedules

Answer 24

C. Smoking cessation
Rationale: Tobacco use is a significant risk factor for renal cancer, surpassing the significance of high alcohol and sodium intake. Immunizations do not address an individual’s risk of renal cancer

Question 25

The nurse performing the health interview of a client with a new onset of periorbital edema has completed a genogram, noting the health history of the client’s siblings, parents, and grandparents. This assessment addresses the client’s risk of what kidney disorder?
A. Nephritic syndrome
B. Acute glomerulonephritis
C. Nephrotic syndrome
D. Polycystic kidney disease (PKD)

Answer 25

D. Polycystic kidney disease (PKD)
Rationale: PKD is a genetic disorder characterized by the growth of numerous cysts in the kidneys. Nephritic syndrome, acute glomerulonephritis, and nephrotic syndrome are not genetic disorders.

Question 26

A client is brought to the renal unit from the PACU status postresection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this client?
A. Increasing oral intake
B. Managing postoperative pain
C. Managing dialysis
D. Increasing mobility

Answer 26

B. Managing postoperative pain
Rationale: The client requires frequent analgesia during the postoperative period and assistance with turning, coughing, use of incentive spirometry, and deep breathing to prevent atelectasis and other pulmonary complications. Increasing oral intake and mobility are not priority nursing actions in the immediate postoperative care of this client. Dialysis is not necessary following kidney surgery.

Question 27

A nurse is caring for a client who is in the diuresis phase of acute kidney injury. The nurse should closely monitor the client for what complication during this phase?
A. Hypokalemia
B. Hypocalcemia
C. Dehydration
D. Acute flank pain

Answer 27

C. Dehydration
Rationale: The diuresis period is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover. The client must be observed closely for dehydration during this phase; if dehydration occurs, the uremic symptoms are likely to increase. Excessive losses of potassium and calcium are not typical during this phase, and diuresis does not normally result in pain.

Question 28

The nurse is caring for a client’s status after a motor vehicle accident. The client has developed AKI. What are the nurse’s roles in caring for this client? Select all that apply.
A. Providing emotional support for the family
B. Monitoring for complications
C. Participating in emergency treatment of fluid and electrolyte imbalances
D. Providing nursing care for primary disorder (trauma)
E. Directing nutritional interventions

Answer 28

A. Providing emotional support for the family
B. Monitoring for complications
C. Participating in emergency treatment of fluid and electrolyte imbalances
D. Providing nursing care for primary disorder (trauma)
Rationale: The nurse has an important role in caring for the client with AKI. The nurse monitors for complications, participates in emergency treatment of fluid and electrolyte imbalances, assesses the client’s progress and response to treatment, and provides physical and emotional support. Additionally, the nurse keeps family members informed about the client’s condition, helps them understand the treatments, and provides psychological support. Although the development of AKI may be the most serious problem, the nurse continues to provide nursing care indicated for the primary disorder (e.g., burns, shock, trauma, obstruction of the urinary tract). The nurse does not direct the client’s nutritional status; the dietitian and the health care provider normally collaborate on directing the client’s nutritional status.

Question 29

A 76-year-old client with ESKD has been told by the health care provider that it is time to consider hemodialysis until a transplant can be found. The client tells the nurse about feeling unsure about undergoing a kidney transplant. What would be an appropriate response for the nurse to make?
A. “The decision is certainly yours to make, but be sure not to make a mistake.”
B. “Kidney transplants in peoples your age are as successful as they are in younger clients.”
C. “I understand your hesitancy to commit to a transplant surgery. Success is relatively rare.”
D. “Have you talked this over with your family?”

Answer 29

B. “Kidney transplants in peoples your age are as successful as they are in younger clients.”
Rationale: Although there is no specific age limitation for renal transplantation, concomitant disorders (e.g., coronary artery disease, peripheral vascular disease) have made it a less common treatment for the older adult. However, the success rate of the surgery is comparable to that for younger clients. The other listed options either belittle the client or give the client misinformation.

Question 30

The nurse has identified the nursing diagnosis of “Risk for Infection” in a client who undergoes peritoneal dialysis. What nursing action best addresses this risk?
A. Maintain aseptic technique when administering dialysate.
B. Wash the skin surrounding the catheter site with soap and water prior to each exchange.
C. Add antibiotics to the dialysate as prescribed.
D. Administer prophylactic antibiotics by mouth or IV as prescribed.

Answer 30

A. Maintain aseptic technique when administering dialysate.
Rationale: Aseptic technique is used to prevent peritonitis and other infectious complications of peritoneal dialysis. It is not necessary to cleanse the skin with soap and water prior to each exchange. Antibiotics may be added to dialysate to treat infection, but they are not used to prevent infection.

Question 31

The nurse is caring for a client who has returned to the postsurgical suite after postanesthetic recovery from a nephrectomy. The nurse’s most recent assessment reveals increased sedation, shortness of breath, hypotension, and low urine output over the last 2 hours. What is the nurse’s best response?
A. Assess the client for signs of bleeding and inform the primary provider.
B. Perform a full neurological assessment and notify the primary care provider.
C. Increase the frequency of taking vital signs, monitor urine output, and notify the provider.
D. Palpate the client’s torso bilaterally for flank pain and notify the primary care provider.

Answer 31

A. Assess the client for signs of bleeding and inform the primary provider
Rationale: Bleeding is a major complication of kidney surgery, and if missed can lead to hypovolemic (decreased volume of circulating blood) and hemorrhagic shock. Bleeding can be suspected when the client experiences fatigue, shortness of breath, and urine output of less than 400 mL within 24 hours. The postoperative client is monitored closely and these findings should be reported to the primary care provider. Ruling out the complication of the life-threatening condition of bleeding is the priority decision for this client. Performing a full neurological assessment will be warranted after the priority complications of surgery are ruled out. Increasing the monitoring of vital signs and urine output are just small parts of assessing the client for bleeding. Palpating the client’s torso for flank pain may increase the client’s pain and does not (in itself) address the most common cause of the client’s signs and symptoms.

Question 32

The critical care nurse is monitoring the client’s urine output and drains following renal surgery. What should the nurse promptly report to the primary care provider?
A. Increased pain on movement
B. Absence of drain output
C. Increased urine output
D. Blood-tinged serosanguineous drain output

Answer 32

B. Absence of drain output
Rationale: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Decreased or absent drainage is promptly reported because it may indicate obstruction that could cause pain, infection, and disruption of the suture lines. Reporting increased pain on movement has nothing to do with the scenario described. Increased urine output and serosanguineous drainage are expected.

Question 33

The nurse is creating an education plan for a client who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan?
A. The importance of increased fluid intake
B. Signs and symptoms of rejection
C. Inspection and care of the incision
D. Techniques for preventing metastasis

Answer 33

C. Inspection and care of the incision
Rationale: The nurse teaches the client to inspect and care for the incision and perform other general postoperative care, including activity and lifting restrictions, driving a vehicle, and pain management. There would be no need to teach the signs or symptoms of rejection as there has been no transplant. Increased fluid intake is not normally recommended and the client has minimal control on the future risk for metastasis

Question 34

A client with end stage renal disease (ESKD) is being treated for a right ankle fracture unrelated to a fall. The client’s lab values show high phosphate levels, low calcium levels, and low vitamin D levels. What is the most likely reason for this client’s fracture?
A. Osteoporosis
B. Codman triangle
C. Hypertrophic osteoarthropathy
D. Renal osteodystrophy

Answer 34

D. Renal osteodystrophy
Rationale: An abnormality seen in ESKD is called renal osteodystrophy or uremic bone disease. It is a disease that involves complex changes in calcium, phosphate, and parathormone balances. Damage seen in ESKD results in an increase in phosphate and a decrease in calcium (reciprocal relationship), which causes increased production from the parathyroid. Clients with ESKD cannot handle these increases, effectively resulting in bone changes and bone disease. All of the other choices can cause fractures but are not typically suspected in a client with ESRD with the presented lab values. Osteoporosis, where bone becomes brittle and fragile, is usually diagnosed with a bone density scan. Codman triangle is a radiologic sign seen commonly on x-rays. It is usually an indication of bone tumors. Hypertrophic osteoarthropathy (HOA) is characterized by abnormal proliferation (growth) of skin and periosteal tissue involving the extremities. Diagnosis is typically from x-rays and physical findings.

Question 35

The nurse is caring for a client who has just returned to the postsurgical unit following renal surgery. When assessing the client’s output from surgical drains, the nurse should physically assess what parameter(s)? Select all that apply.
A. Quantity of output
B. Color of the output
C. Visible characteristics of the output
D. Specific gravity of the output
E. Potential hydrogen (pH) of the output

Answer 35

A. Quantity of output
B. Color of the output
C. Visible characteristics of the output
Rationale: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Decreased or absent drainage from the surgical drains are reported and may indicate obstruction. Specific gravity and pH are not normally assessed at the bedside but are sent to the lab if needed. Those two tests are not part of the recommendations.

Question 36

The nurse is caring for a client after kidney surgery. When assessing for bleeding, what assessment parameter should the nurse evaluate?
A. Oral intake
B. Pain intensity
C. Level of consciousness
D. Radiation of pain

Answer 36

C. Level of consciousness
Rationale: Bleeding is a major complication of kidney surgery. The nurse’s role is to observe for these complications, to report their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision, and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood, and fluid volume and cardiac output. Bleeding is not normally evidenced by changes in pain or oral intake.

Question 37

A nurse is providing education to the family of a client beginning peritoneal dialysis. The family ask questions concerning catheter placement and stabilization. Which information will the nurse provide about the cuffs? Select all that apply.
A. The cuffs are constructed of Dacron polyester material.
B. The cuffs will help stabilize the catheter.
C. The cuffs prevent the dialysate from leaking.
D. The cuffs provide a barrier against microorganisms.
E. The cuffs will absorb the dialysate.

Answer 37

A. The cuffs are constructed of Dacron polyester material.
B. The cuffs will help stabilize the catheter.
C. The cuffs prevent the dialysate from leaking.
D. The cuffs provide a barrier against microorganisms
Rationale: Most catheters used for peritoneal dialysis have two cuffs, which are made of Dacron polyester. The cuffs stabilize the catheter, limit movement, prevent leaks, and provide a barrier against microorganisms. They do not absorb dialysate.

Question 38

A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client’s abdomen is increasing in girth. What is the nurse’s most appropriate action?
A. Advance the catheter 2 to 4 cm further into the peritoneal cavity.
B. Reposition the client to facilitate drainage.
C. Aspirate from the catheter using a 60-mL syringe.
D. Infuse 50 mL of additional dialysate.

Answer 38

B. Reposition the client to facilitate drainage
Rationale: If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the client from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. It would be unsafe to aspirate or to infuse more dialysate.