Exam 3 Renal Disease/Health Disparities Flashcards
A client is admitted to the emergency room with renal calculi and is complaining of moderate to severe flank pain and nausea. The client’s temperature is 100.8 degrees Fahrenheit. The priority nursing goal for this client is:
A. Maintain fluid and electrolyte balance
B. Control nausea
C. Manage pain
D. Prevent urinary tract infection
C. Manage pain
Which of the following should the nurse implement to prepare a client for a KUB (Kidney, Ureter, Bladder) radiography test?
A. Client must be NPO before the examination
B. Enema to be administered prior to the examination
C. Medicate client with furosemide 20 mg IV 30 minutes prior to the examination
D. No special orders are necessary for this examination
D. No special orders are necessary for this examination
Rationale: There are no special orders for this procedure, however, the client must be instructed of the general rule during radiography tests: remove any clothing, jewelry, or objects that may interfere with the test.
A client is receiving digoxin (Lanoxin) 0.25 mg daily. The health care provider has written a new order to give metoprolol (Lopressor) 25 mg B.I.D. In assessing the client prior to administering the medications, which of the following should the nurse report immediately to the health care provider? A. Blood pressure 94/60 mm Hg B. Heart rate 76 bpm C. Urine output 50 ml/hour D. Respiratory rate 16 bpm
A. Blood pressure 94/60 mm Hg
Rationale: Both medications decrease the heart rate. Metoprolol affects blood pressure. Therefore, the heart rate and blood pressure must be within the normal range (HR 60-100; systolic BP over 100) in order to safely administer both medications.
A 33-year-old male client with heart failure has been taking furosemide for the past week. Which of the following assessment cues below may indicate the client is experiencing a negative side effect from the medication? A. Weight gain of 5 pounds B. Edema of the ankles C. Gastric irritability D. Decreased appetite
D. Decreased appetite
Rationale: Furosemide is a loop diuretic that is used for pulmonary edema, edema in heart failure, nephrotic syndrome, and hypertension. Furosemide causes a loss of potassium unless a supplement or a potassium-rich diet is taken. A decrease in appetite is caused by hypokalemia. Signs and symptoms of hypokalemia include anorexia, fatigue, nausea, decreased GI motility, muscle weakness, dysrhythmias, reduced urine osmolality, altered level of consciousness.
A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following of the patient’s medication does not cause urine discoloration? A. Sulfasalazine B. Levodopa C. Phenolphthalein D. Aspirin
D. Aspirin
A 24-year-old female is admitted to the ER due to confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Based on the presenting signs and symptoms, which of the following would you most likely suspect? A. Diverticulosis B. Hypercalcemia C. Hypocalcemia D. Irritable bowel syndrome
B. Hypercalcemia
Rationale: Hypercalcemia can cause polyuria, severe abdominal pain, and confusion.
A nurse is caring for an infant that has recently been diagnosed with a congenital heart defect. Which of the following clinical signs would most likely be present? A. Slow pulse rate B. Weight gain C. Decreased systolic pressure D. Irregular WBC lab values
B. Weight gain
Rationale: Weight gain due to fluid accumulation is associated with heart failure and congenital heart defects. When the heart does not circulate blood normally, the kidneys receive less blood and filter less fluid out of the circulation into the urine. The extra fluid in the circulation builds up in the lungs, the liver, around the eyes, and sometimes in the legs.
Nurse Rose is aware that the statement that best explains why furosemide (Lasix) is administered to treat hypertension is:
A. It dilates peripheral blood vessels.
B. It decreases sympathetic cardio acceleration.
C. It inhibits the angiotensin-converting enzymes.
D. It inhibits the reabsorption of sodium and water in the loop of Henle.
D. It inhibits the reabsorption of sodium and water in the loop of Henle.
Rationale: Furosemide is a loop diuretic that inhibits sodium and water reabsorption in the loop Henle, thereby causing a decrease in blood pressure.
The physician orders lisinopril (Zestril) and furosemide (Lasix) to be administered concomitantly to the client with hypertension. The nurse should: A. Question the order B. Administer the medications C. Administer separately D. Contact the pharmacy
B. Administer the medications
Rationale: Zestril is an ACE inhibitor and is frequently given with a diuretic such as Lasix for hypertension. Studies of hypertension confirm that ACE inhibitors enhance the antihypertensive effects of diuretics, though the interaction appears more additive than synergistic. Combining diuretics with ACE inhibitors appear to be no more effective than combining them with beta blockers.
You have a patient that might have a urinary tract infection (UTI). Which statement by the patient suggests that a UTI is likely?
A. “I pee a lot.”
B. “It burns when I pee.”
C. “I go hours without the urge to pee.”
D. “My pee smells sweet.”
B. “It burns when I pee.”
Rationale: A common symptom of a UTI is dysuria. A patient with a UTI often reports frequent voiding of small amounts and the urgency to void. Symptoms of uncomplicated UTI are pain on urination (dysuria), frequent urination (frequency), inability to start the urine stream (hesitation), sudden onset of the need to urinate (urgency), and blood in the urine (hematuria). Usually, patients with uncomplicated UTI do not have fever, chills, nausea, vomiting, or back pain, which are signs of kidney involvement or upper tract disease/pyelonephritis.
Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium)?
A. If the urine turns orange-red, call the doctor.
B. Take phenazopyridine just before urination to relieve pain.
C. Once painful urination is relieved, discontinue prescribed antibiotics.
D. After painful urination is relieved, stop taking phenazopyridine.
D. After painful urination is relieved, stop taking phenazopyridine.
Rationale: Pyridium is taken to relieve dysuria because it provides an analgesic and anesthetic effect on the urinary tract mucosa. The patient can stop taking it after the dysuria is relieved. Symptomatic treatment with analgesics may be used in patients who present with severe dysuria. Phenazopyridine is a urinary analgesic used in short-term treatment of urinary dysuria or discomfort.
Which patient is at greatest risk for developing a urinary tract infection (UTI)?
A. A 35 y.o. woman with a fractured wrist
B. A 20 y.o. woman with asthma
C. A 50 y.o. postmenopausal woman
D. A 28 y.o. with angina
C. A 50 y.o. postmenopausal woman
Rationale: Women are more prone to UTIs after menopause due to reduced estrogen levels. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli bacteria, which protect against infection. Premenopausal women have large concentrations of lactobacilli in the vagina and prevent the colonization of uropathogens. However, the use of antibiotics can erase this protective effect.
You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining?
A. Check for kinks in the outflow tubing.
B. Raise the drainage bag above the level of the abdomen.
C. Place the patient in a reverse Trendelenburg position.
D. Ask the patient to cough.
A. Check for kinks in the outflow tubing.
Rationale: Tubing problems are a common cause of outflow difficulties, check the tubing for kinks and ensure that all clamps are open. Other measures include having the patient change positions (moving side to side or sitting up), applying gentle pressure over the abdomen, or having a bowel movement. Assess the patency of catheter, noting difficulty in draining. Note the presence of fibrin strings and plugs. Slowing of flow rate and presence of fibrin suggests partial catheter occlusion requiring further evaluation and intervention.
What is the appropriate infusion time for the dialysate in your 38 y.o. patient with chronic renal failure undergoing peritoneal dialysis?
A. 15 minutes
B. 30 minutes
C. 1 hour
D. 2 to 3 hours
A. 15 minutes
Dialysate should be infused quickly. The dialysate should be infused over 15 minutes or less when performing peritoneal dialysis. The fluid exchange takes place over a period ranging from 30 minutes to several hours. Each exchange takes about 30 to 40 minutes. During an exchange, the client can read, talk, watch television, or sleep. With CAPD, the client can keep the solution in the belly for 4 to 6 hours or more. The time that the dialysis solution is in the belly is called the dwell time. Usually, the client changes the solution at least four times a day and sleep with solution in the belly at night
A 30 y.o. female patient is undergoing hemodialysis with an internal arteriovenous fistula in place. What do you do to prevent complications associated with this device?
A. Insert I.V. lines above the fistula.
B. Avoid taking blood pressures in the arm with the fistula.
C. Palpate pulses above the fistula.
D. Report a bruit or thrill over the fistula to the doctor.
B. Avoid taking blood pressures in the arm with the fistula.
Rationale: Don’t take blood pressure readings in the arm with the fistula because the compression could damage the fistula. Do not let anyone put a blood pressure cuff on the access arm. An AV fistula causes extra pressure and extra blood to flow into the vein, making it grow large and strong. The larger vein provides easy, reliable access to blood vessels. Without this kind of access, regular hemodialysis sessions would not be possible.
Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect?
A. Infection
B. Disequilibrium syndrome
C. Air embolism
D. Acute hemolysis
B. Disequilibrium syndrome
Rationale: Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the blood. This can lead to cerebral edema and increased intracranial pressure (ICP). Signs and symptoms include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.
Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps?
A. Increase the rate of dialysis.
B. Infuse normal saline solution.
C. Administer a 5% dextrose solution.
D. Encourage active ROM exercises.
B. Infuse normal saline solution.
Rationale: Treatment includes administering normal saline or hypertonic normal saline solution because muscle cramps can occur when the sodium and water are removed too quickly during dialysis. Saline and/or dextrose solutions, electrolytes, and NaHCO3 may be infused in the venous side of continuous arteriovenous (CAV) hemofilter when high ultrafiltration rates are used for removal of extracellular fluid and toxic solutes. Volume expanders may be required during or following hemodialysis if sudden or marked hypotension occurs.
Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient’s teaching plan?
A. Rub the skin vigorously with a towel.
B. Take frequent baths.
C. Apply alcohol-based emollients to the skin.
D. Keep fingernails short and clean.
D. Keep fingernails short and clean.
Rationale: Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation and breaks in the skin that increase the patient’s risk of infection. Keeping fingernails short and clean helps reduce the risk of infection. Although dialysis has largely eliminated skin problems associated with uremic frost, itching can occur because the skin is an excretory route for waste products such as phosphate crystals (associated with hyperparathyroidism in ESRD).
Which intervention do you plan to include with a patient who has renal calculi?
A. Maintain bed rest
B. Increase dietary purines
C. Restrict fluids
D. Strain all urine
D. Strain all urine
Rationale: All urine should be strained through gauze or a urine strainer to catch stones that are passed. The stones are then analyzed for composition. Strain all urine. Document any stones expelled and sent to the laboratory for analysis. Retrieval of calculi allows identification of the type of stone and influences choice of therapy.
Which drug is indicated for pain related to acute renal calculi?
A. Narcotic analgesics
B. Nonsteroidal anti-inflammatory drugs (NSAIDS)
C. Muscle relaxants
D. Salicylates
A. Narcotic analgesics
Rationale: Narcotic analgesics are usually needed to relieve the severe pain of renal calculi. Narcotic analgesics act at the central nervous system (CNS) mu receptors and are commonly used in the treatment of renal colic. They are inexpensive and proven effective. Disadvantages include sedation, respiratory depression, smooth muscle spasm, and potential for abuse and addiction.
Which of the following causes the majority of UTI’s in hospitalized patients?
A. Lack of fluid intake
B. Inadequate perineal care
C. Invasive procedures
D. Immunosuppression
C. Invasive procedures
Rationale: Invasive procedures such as catheterization can introduce bacteria into the urinary tract. A lack of fluid intake could cause concentration of urine, but wouldn’t necessarily cause infection. A major risk factor for UTI is the use of a catheter. In addition, manipulation of the urethra is also a risk factor. UTI is very common after a kidney transplant; the two triggers include the use of immunosuppressive drugs and vesicoureteral reflux. Other risk factors include the use of antibiotics and diabetes mellitus.
Clinical manifestations of acute glomerulonephritis include which of the following?
A. Chills and flank pain
B. Oliguria and generalized edema
C. Hematuria and proteinuria
D. Dysuria and hypotension
C. Hematuria and proteinuria
Rationale: Hematuria and proteinuria indicate acute glomerulonephritis. These findings result from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis. The most common presenting symptom is gross hematuria as it occurs in 30 to 50% of cases with acute PSGN; patients often describe their urine as smoky, tea-colored, cola-colored, or rusty. The hematuria can be described as postpharyngitic (hematuria seen after weeks of infection).
You expect a patient in the oliguric phase of renal failure to have a 24 hour urine output less than:
A. 200ml
B. 400ml
C. 800ml
D. 1000ml
B. 400ml
Rationale: Oliguria is defined as urine output of less than 400ml/24hours. Renal causes of oliguria arise as a result of tubular damage. As a result of the tubular damage, the kidney loses its normal function i.e., production of urine while excreting the waste metabolites. In addition to this, direct damage to the renal tubules leads to a back leak of filtered uremic metabolites from the tubular lumen into the bloodstream. Hence, in these cases, decreased production of urine leads to oliguria.
The most common early sign of kidney disease is:
A. Sodium retention
B. Elevated BUN level
C. Development of metabolic acidosis
D. Inability to dilute or concentrate urine
B. Elevated BUN level
Rationale: Increased BUN is usually an early indicator of decreased renal function. Although, immediately after a renal insult, blood urea nitrogen (BUN) or creatinine levels may be within the normal range. The only sign of the acute kidney injury may be a decline in urine output. AKI can lead to the accumulation of water, sodium, and other metabolic products. It can also result in several electrolyte disturbances.
A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs, sneezes, or lifts heavy objects?
A. Overflow
B. Reflex
C. Stress
D. Urge
C. Stress
Rationale: Stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-abdominal pressure, such as with coughing or sneezing. Stress incontinence happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on the bladder, causing to leak urine.
A 22 y.o. patient with diabetic nephropathy says, “I have two kidneys and I’m still young. If I stick to my insulin schedule, I don’t have to worry about kidney damage, right?” Which of the following statements is the best response?
A. “You have little to worry about as long as your kidneys keep making urine.”
B. “You should talk to your doctor because statistics show that you’re being unrealistic.”
C. “You would be correct if your diabetes could be managed with insulin.”
D. “Even with insulin, kidney damage is still a concern.”
D. “Even with insulin, kidney damage is still a concern.”
Rationale: Kidney damage is still a concern. Microvascular changes occur in both of the patient’s kidneys as a complication of the diabetes. Diabetic nephropathy is the leading cause of end-stage renal disease. The kidneys continue to produce urine until the end stage. Nephropathy occurs even with insulin management.
A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching?
A. Take cool baths.
B. Avoid tampon use.
C. Avoid sexual activity.
D. Drink 8 to 10 eight-oz glasses of water daily.
D. Drink 8 to 10 eight-oz glasses of water daily.
Rationale: Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps flush the bacteria from the bladder. Encourage increased oral fluid intake (2 to 3 liters a day if no contraindication). Fluid intake facilitates urine production and flushes bacteria from the urinary tract.
Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient?
A. Dysuria, frequency, and urgency
B. Back pain, nausea, and vomiting
C. Hypertension, oliguria, and fatigue
D. Fever, chills, and right upper quadrant pain radiating to the back
C. Hypertension, oliguria, and fatigue
Rationale: Mild to moderate HTN may result from sodium or water retention and inappropriate renin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia. The term “glomerulonephritis” encompasses a subset of renal diseases characterized by immune-mediated damage to the basement membrane, mesangium, or the capillary endothelium, leading to hematuria, proteinuria, and azotemia.
