Quiz #6 Urinary Flashcards
A nurse is caring for a school-age child who has acute glomerulonephritis with peripheral edema and is producing 35 mL of urine per hour. The nurse should place the client on which of the following diets?
A. Low-sodium, fluid-restricted.
B. Regular diet, no added salt.
C. Low-protein, low-potassium diet.
D. Low-carbohydrate, low-protein diet.
A. Low-sodium, fluid-restricted.
A low-sodium diet can help reduce fluid retention and swelling. Fluid restriction can also help manage fluid balance and prevent further complications.
A nurse is teaching a client who has chronic kidney disease about the process of continuous ambulatory peritoneal dialysis (CAPD). Which of the following information should the nurse include in the teaching?
A. CAPD filters the client’s blood through an artificial device called a dialyzer.
B. CAPD is the dialysis treatment of choice for clients who have a history of abdominal surgery.
C. CAPD requires the client to follow fewer dietary and fluid restrictions than hemodialysis requires.
D. CAPD requires a rigid schedule of exchange times.
C. CAPD requires the client to follow fewer dietary and fluid restrictions than hemodialysis requires.
Rationale: CAPD’s advantages include fewer dietary and fluid restrictions as compared to hemodialysis.
A nurse is providing teaching to a client who has renal failure and an elevated phosphorus level. The provider instructed the client to take aluminum hydroxide 300 mg PO three times a daily. For which of the following adverse effects should the nurse inform the client?
A. Constipation
B. Metallic taste
C. Headache
D. Muscle spasms
A. Constipation
Rational: Constipation is a common side effect of aluminum-based antacids. The nurse should instruct the client to increase fiber intake and that stool softeners or laxatives may be needed.
** A 5 year old male is admitted with acute glomerulonephritis. On assessment, you note mild edema predominately in the face and tea-colored urine. The patient’s blood pressure is 165/110, heart rate 95, oxygen saturation 98% on room air, and temperature 98.9 ‘F. In your nursing care plan, what nursing interventions will you include in this patient’s plan of care? (SATA)
A. Initiate and maintain a high sodium diet daily.
B. Monitor intake and output hourly.
C. Encourage patient to ambulate every 2 hours while awake.
D. Assess color of urine after every void.
E. Weigh patient every daily on a standing scale.
F. Encourage the patient to consume 4 L of fluid per day.
B, D, E
Patients with acute glomerulonephritis experience proteinuria and hematuria. In addition, they may experience mild edema (mainly in the face/eyes), hypertension, and in severe cases renal failure/oliguria. Therefore, it is very important the nurse monitors intake and output every hour, assesses color of urine, and weighs the patient every day on a standing scale. Option A is wrong because the patient should be consuming a LOW (not high) sodium diet. Option C is wrong because the patient should maintain bed rest until recovered due to experiencing hypertension. Option F is wrong because the patient will be on a fluid restriction…4 L is a lot of fluid to consume. It is generally 2 L or less of fluids per day.
A nurse is assessing a client in the oliguric phase of acute kidney injury. Which of the following findings should the nurse expect?
A. Hypomagnesemia
B. Hyperkalemia
C. Decreased creatinine level
D. Increased glomerular filtration rate (GFR)
B. Hyperkalemia
This choice is correct because hyperkalemia is a common finding in the oliguric phase of acute kidney injury. Hyperkalemia is a condition in which the serum potassium level is higher than normal (more than 5 mEq/L). It may be caused by reduced renal excretion of potassium due to decreased urine output (oliguria). It may cause symptoms such as muscle weakness, paresthesia, bradycardia, or cardiac arrest.
A nurse is developing a plan of care for a client who is to begin receiving peritoneal dialysis. Which of the following interventions should the nurse implement to ensure proper dialysate exchange?
A. Maintain the client in a left lateral position during dialysis.
B. Monitor vital signs every 2 hours during the procedure.
C. Warm the dialysate solution prior to instillation.
D. Place the drainage bag above the level of the client’s abdomen.
C. Warm the dialysate solution prior to instillation.
Warming the dialysate solution prior to instillation is a standard practice in peritoneal dialysis. It helps to promote patient comfort and more efficient exchange of wastes and fluids.
A nurse is reviewing laboratory findings for four client. Which of the following clients has manifestations of acute kidney injury?
A. Hemoglobin 16 g/dL
B. BUN 15 mg/dL
C. Serum potassium 4.5 mEq/L
D. Serum creatinine 6 mg/dL
D. Serum creatinine 6 mg/dL
(This finding is above the expected reference range. The expected reference range for creatinine is 0.5 mg/dL to 1.3 mg/dL depending on the client’s gender and age. An elevated serum creatinine is a manifestation of impaired kidney function, such as with acute kidney injury.)
A nurse is caring for a 44-year-old client who was admitted with an elevated temperature and abdominal pain.
Medical History:
The client reports “not feeling well” for 3 days. The client reports decreased appetite and generalized abdominal pain with nausea. No reports of vomiting or diarrhea. The client has a history of stage IV chronic kidney disease. The client currently completes continuous ambulatory peritoneal dialysis (CAPD) four times per day. Client lives alone and has 4 cats. Other pertinent history includes hypertension, diabetes, and neuropathy. Noncompliant with health care provider visits and follow-up.
A. Creatinine 3.0 mg/dL (0.5 to 1.3 mg/dL)
B. Crackles throughout lungs
C. Nausea
D. Glucose 250 mg/dL
E. Hemoglobin 10 g/dL (12 to 18 g/dL)
F. No dialysis for 24 hr
G. Abdomen rigid with decreased bowel sounds
H. Potassium 7.0 mEq/L (3.5 to 5 mEq/L)
I. WBC count 17,000/mm3
(Normal Finding: 5,000 to 10,000/mm³)
*B. Crackles throughout lungs
F. No dialysis for 24 hr
*G. Abdomen rigid with decreased bowel sounds
*H. Potassium 7.0 mEq/L (3.5 to 5 mEq/L)
*I. WBC count 17,000/mm3
Rationales
B. Crackles throughout lungs
Rational: Clients who have chronic kidney disease are prone to fluid overload. This client has not had dialysis for 24 hr and is showing signs of fluid overload (crackles in lungs and 3+ edema of lower extremities); therefore, this finding requires immediate follow-up.
F. No dialysis for 24 hr.
Rational: Continuous ambulatory peritoneal dialysis (CAPD) is performed by the client with the infusion of exchanges of dialysate into the peritoneal cavity four times per day, seven days a week. With each exchange the dialysate remains in the abdomen for 4 to 8 hr. Since the client has not had dialysis for the last 24 hr, this finding requires immediate follow-up.
G. Abdomen rigid with decreased bowel sounds.
Rational: A rigid abdomen with decreased bowel sounds is indicative of peritonitis; therefore, this finding requires immediate follow-up.
H. Potassium 7.0 mEq/L.
Rational: Elevated potassium levels can lead to life-threatening cardiac dysrhythmias; therefore, this finding requires immediate follow-up.
I. WBC count 17,000/mm3.
Rational: Clients who have chronic kidney disease have altered immunity and are prone to infection. One of the most common complications of peritoneal dialysis is peritonitis. Elevated temperature and increased WBC count is indicative of infection; therefore, this finding requires immediate follow-up.
A nurse is assessing a client who has end-stage kidney disease and is receiving hemodialysis. Which of the following findings should the nurse identify as an indiction that the client is experiencing fluid overload?
The client has a 5 lb weight gain since yesterday.
Rationale: (The nurse should identify that a gain of 2 lb per day is stable. A gain of more than 2 lb per day or 5 lb per week is an indication of fluid overload.)
Chronic glomerulonephritis decreased lab value?
RBC?
A nurse is providing discharge teaching to a client who has a new arteriovenous fistula in the right forearm. Which of the following manifestations should the nurse include in the teaching as a possible indication of venous insufficiency?
A. Cold and numbness distal to the fistula site
B. A raised red rash around the fistula site
C. Pain in the right arm proximal to the fistula site
D. Foul-smelling drainage from the fistula site
A. Cold and numbness distal to the fistula site
Pallor and numbness distal to the fistula site are possible indicators of venous insufficiency and should be immediately reported to the provider.
A nurse is caring for a client who reports to the clinic for laboratory tests. The client has an acute kidney injury caused by acute tubular necrosis and asks why their glomerular filtration rate (GFR) keeps decreasing. Which of the following pathophysiological changes occurring in the kidney should the nurse explain as the cause of the decrease?
A. The glomerular filtration rate decreases because there is injury to the renal tubular cells.
B. The glomerular filtration rate decreases because there is obstruction leading to the filtration system backing up and eventually shutting the kidneys down.
C. The glomerular filtration rate decreases because in?ammatory cells invade the already damaged kidneys.
D. The glomerular filtration rate decreases because there is a reduction of blood flow to the kidneys.
A. The glomerular filtration rate decreases because there is injury to the renal tubular cells.
Acute tubular necrosis (ATN) is a condition where there is damage to the renal tubular cells, which can lead to a decrease in GFR. This is because the tubular cells are responsible for reabsorbing substances from the filtrate back into the blood. When these cells are injured, they cannot function properly, leading to a buildup of waste products and a decrease in GFR.
A nurse is planning care for a client who has acute glomerulonephritis. The nurse should plan to provide which of the following interventions?
A. Weigh the client daily
B. Encourage the client to drink 2 to 3 L of fluid per day.
C. Instruct the client to ambulate every 2 hr.
D. Obtain the client’s serum blood glucose
A. Weigh the client daily
The nurse can monitor fluid retention by weighing the client daily.
A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect?
a.) pH 7.25, HCO3- 19mEq/L, PACO2 30 mm Hg
b.) pH 7.30, HCO3 - 26 mEq/L, PACO2 50 mm Hg
c.) pH 7.50 7.50, HCO3-20 mEq/L, PaCO2 32 mm Hg
d.) pH 7.55, HCO3 - 30 mEq/L, PaCO2 31 mm Hg
a.) pH 7.25, HCO3- 19mEq/L, PACO2 30 mm Hg
A nurse is caring for a client who has end-stage kidney disease (ESKD) & reports having shortness of breath & swelling in his lower extremities. Upon assessment, the nurse notes the client has crackles in his lungs & elevated blood pressure. The nurse should suspect which of the following based on the client’s manifestations?
A.) Hypovolemia
B.) Hypervolemia
C.) Hyperkalemia
D.) Hyponatremia
B.) Hypervolemia
A client who has ESKD experiences excess fluid volume.
