Renal

Question 1

The laboratory reports of a client with kidney disease indicated an increase in the blood urea nitrogen (BUN) levels. Which could be the reason behind this condition?

1. Decreased erythropoietin production
2. Decreased gastrointestinal absorption
3. Increased protein intake and breakdown
4. Increased production of nonvolatile acids

Answer 1

3

Option 1:
Decreased erythropoietin production in clients with kidney disease can lead to anemia.
Option 2:
Decreased gastrointestinal absorption in clients with kidney disease can lead to decreased calcium levels.
Option 3:
The BUN levels can increase in clients with kidney disease due to an increased intake of protein and breakdown.
Option 4:
The increased production of nonvolatile acids such as lactic acid and phosphoric acid can lead to metabolic acidosis in clients with kidney disease.

Question 2

A client is undergoing treatment for chronic kidney disease (CKD) with dialysis. During a follow-up visit, the nurse observes from the laboratory tests that the client has developed nephrotoxicity from a prescribed medication. Which drug is responsible for the client’s condition?

1. Demerol
2. Morphine
3. Penicillin
4. Acetaminophen

Answer 2

3

Option 1:
Demerol is a pain medication that should be avoided because it may cause seizures in the client.
Option 2:
Morphine is a pain medication that can be given to a client with CKD and does not cause nephrotoxicity.
Option 3:
Penicillin is an antibiotic that may be nephrotoxic to clients with CKD. The dose or the frequency needs to be adjusted based on the blood serum concentrations.
Option 4:
Acetaminophen is a substitute for NSAIDs that can be used safely in clients with CKD.

Question 3

The nurse reviews the diagnostic test reports of a client and observes that the client has renal cancer that has metastasized to the adrenal gland. Which stage of renal carcinoma is the client in, according to the Robson system of staging?

1. Stage I
2. Stage II
3. Stage III
4. Stage IV

Answer 3

2

Option 1:
Cancer limited to the renal capsule indicates stage 1 renal carcinoma.
Option 2:
A client with perineal fat that is confined to the fascia with adrenal gland metastasis is in stage 2 renal carcinoma.
Option 3:
Cancer relegated to a regional lymph node, a renal vein, and a renal vena cava indicates stage 3 renal carcinoma.
Option 4:
Metastasis to the other sites of the body apart from the renal system indicates stage 4 renal carcinoma.

Question 4

A client is diagnosed with chronic kidney disease that is manifested with hyperkalemia, hypertension, and renal osteodystrophy. The primary health-care provider prescribes a medication to the client. During a follow-up visit, the laboratory reports indicate high levels of potassium in the stools. Which medication is responsible for this report?

1. Albuterol
2. Furosemide
3. Calcium chloride
4. Sodium polystyrene sulfonate

Answer 4

4

Option 1:
Albuterol helps to treat hyperkalemia by assisting in the intracellular movement of potassium.
Option 2:
Furosemide is a loop diuretic that eliminates potassium in the urine. Therefore, high levels of potassium in the urine indicate the efficacy of furosemide.
Option 3:
Calcium chloride treats hyperkalemia by stabilizing the myocardial cell membrane. It is not excreted from the stools.
Option 4:
Sodium polystyrene sulfonate treats hyperkalemia by binding with potassium and facilitates its elimination in the stool. Therefore, a high level of potassium is found in the stools.

Question 5

Which diagnostic test helps to detect metastasis associated with renal cancer?

1. Pyelogram
2. Ultrasound scan
3. Urine cytology testing
4. Radionucleotide isotope scanning

Answer 5

4

Option 1:
A pyelogram helps to detect tumor masses.
Option 2:
An ultrasound scan is used to differentiate solid masses, tumors, and cysts.
Option 3:
Urine cytology testing is used to show neoplastic or atypical cells.
Option 4:
Radionucleotide isotope scanning is used to detect metastasis associated with renal cancer.

Question 6

An RN is teaching a group of clients regarding precautions to help reduce the incidence of urinary tract infections (UTIs). Which statements made by a client indicates a need for further learning? Select all that apply.

1. “I should urinate every 4 to 5 hours.”
2. “I should take bubble bath regularly.”
3. “I should drink eight full glasses of water per day.”
4. “I should drink three 8 oz glasses of unsweetened cranberry juice per day.”
5. “I should report to the physician immediately if I observe cloudy urine.”

Answer 6

1, 2

Option 1:
The nurse should instruct the client to urinate every 3 to 4 hours.
Option 2:
Clients should be instructed to avoid the use of vaginal douches, harsh soaps, and bubble baths because they may increase the risk of UTIs.
Option 3:
Adequate fluid intake decreases the risk of UTIs. The client should be instructed to drink eight full glasses of water daily.
Option 4:
To prevent UTIs, the nurse should recommend that the client drink three 8 oz glasses of unsweetened cranberry juice per day.
Option 5:
The nurse should instruct clients to report signs and symptoms of UTIs, including frequency, change in urine color such as cloudy, fever, and pain while urinating.

Question 7

A client reports frequent fevers, chills, vomiting, and a burning sensation during urination. Urine analysis reports are positive for infection, and the histological examination of renal tissue is negative for inflammation of the renal cells. Which treatment method may reduce the risk of pyelonephritis?

1. Antibiotics
2. Corticosteroids
3. Urinary analgesics
4. Antipyretic drugs

Answer 7

1

Option 1:
The client shows symptoms of frequent urinary tract infections. However, the client does not have inflammation of the renal cells. This may indicate the absence of pyelonephritis. Low-dose antibiotics should be used to treat any infections.
Option 2:
Corticosteroids may be indicated to treat glomerulonephritis to modulate the inflammatory response.
Option 3:
Urinary analgesics are used to relieve symptoms of pyelonephritis. However, it does not reduce the risk of pyelonephritis.
Option 4:
Antipyretic drugs are used to reduce elevated temperatures that may be associated with an infection. However, they may not reduce the risk of infection.

Question 8

Which type of renal replacement therapy is indicated for clients who are acutely ill with chronic kidney disease?

1. Hemodialysis
2. Peritoneal dialysis
3. Intermittent hemodialysis
4. Continuous renal replacement therapies

Answer 8

4

Option 1:
Hemodialysis is not indicated for severely ill clients because the rapid rate of fluid and solute loss pose a risk of hypotension.
Option 2:
Peritoneal dialysis is indicated for clients at home, but not for clients with chronic kidney disease.
Option 3:
Intermittent hemodialysis is another name for hemodialysis.
Option 4:
Clients who are acutely ill and hemodynamically unstable cannot withstand the complications of other types of dialysis. Additionally, continuous renal replacement therapies have an advantage of adjusting the solute and fluid removal hourly. Therefore this dialysis type is preferred for these clients.

Question 9

A client reports lower-back and abdominal pain and a headache. After undergoing an MRI, the client is diagnosed with the early stages of polycystic kidney disease. Which treatment strategy is most beneficial to the client to control the spread of infection?

1. Antibiotics
2. Nephrectomy
3. Non-narcotic medications
4. Angiotensin receptor blockers

Answer 9

1

Option 1:
Polycystic kidney disease is a renal disorder that causes excessive growth of fluid-filled cysts in the kidneys. Antibiotics are prescribed to prevent the spread of infection.
Option 2:
A nephrectomy is a surgical procedure that involves removing the kidneys. This procedure is generally performed in severe conditions.
Option 3:
Nonnarcotic medications are used to manage pain.
Option 4:
Angiotensin receptor blockers, and ACE inhibitors are used to manage hypertension.

Question 10

Which risk factor is associated with adenocarcinoma?

1. Hyperlipidemia
2. Glomerulonephritis
3. Exposure to asbestos
4. Recent strep infection

Answer 10

3

Option 1:
Hyperlipidemia is a common risk factor of chronic kidney disease.
Option 2:
Glomerulonephritis and other polycystic kidney disease are risk factors of chronic kidney disease.
Option 3:
Exposure to asbestos, cadmium, and gasoline are risk factors associated with adenocarcinoma.
Option 4:
Recent strep infection is a risk factor for glomerulonephrirtis.

Question 11

ow is a grade 2 renal trauma described?

1. Superficial lacerations
2. Laceration of the renal artery
3. Hematuria and contusions
4. Renal lacerations above 1 cm in depth

Answer 11

1

Option 1:
The occurrence of superficial lacerations is considered grade 2 according to the renal trauma grading scale.
Option 2:
The laceration of the renal artery is considered grade 5 according to the renal trauma grading scale.
Option 3:
The presence of hematuria and contusions is considered grade 1 according to the renal trauma grading scale.
Option 4:
The presence of lacerations above 1 cm in depth is considered grade 3 according to the renal trauma grading scale.

Question 12

Which stage of renal carcinoma involves the metastasis to other sites of the body according to Robson’s system?

1. Stage I
2. Stage II
3. Stage III
4. Stage IV

Answer 12

4

Option 1:
According to Robson’s system of staging renal carcinoma, stage I is limited to renal capsule.
Option 2:
According to Robson’s system of staging renal carcinoma, stage II involves perirenal fat and the metastasis occurs to the adrenal gland.
Option 3:
According to Robson’s system of staging renal carcinoma, stage III includes the formation of lymph nodes in the renal vein and vena cava.
Option 4:
According to Robson’s system of staging renal carcinoma, stage IV involves the metastasis of the carcinoma to the other parts of the body.

Question 13

Which diagnostic procedure is used to differentiate among solid masses, tumors, and cysts?

1. Ultrasound
2. Urine cytology
3. Radionuclide isotope
4. Intravenous pyelogram

Answer 13

1

Option 1:
An ultrasound is used to differentiate among solid masses, tumors, and cysts.
Option 2:
Urine cytology is used to determine the presence of neoplastic or atypical cells.
Option 3:
Radionuclide isotopes are used in a diagnostic scanning procedure to detect metastasis.
Option 4:
An intravenous pyelogram is used to detect masses.

Question 14

Which is true regarding renal cancer?

1. Metastasis of the tumor is limited to the liver.
2. Benign tumors are more frequent in the kidney.
3. Tumors can be diagnosed only after 50% of metastasis.
4. Tumors reduce the circulation of the renal structures.

Answer 14

4

Option 1:
Metastasis of the tumor occurs in the long bones, lungs, and liver.
Option 2:
Malignant tumors are more frequent than benign tumors.
Option 3:
Tumors can be diagnosed upon 30% of metastasis.
Option 4:
The tumors compress the underlying tissues in the renal structures, which decrease the circulation.

Question 15

Which type of continuous renal replacement therapy involves the slow removal of fluid and solute by diffusion and filtration?

1. Slow continuous ultrafiltration
2. Continuous venovenous hemofiltration
3. Continuous arteriovenous hemofiltration
4. Continuous venovenous hemofiltration with dialysis

Answer 15

4

Option 1:
Slow continuous ultrafiltration involves the slow removal of fluid by filtration.
Option 2:
Continuous venovenous hemofiltration involves the slow removal of fluid and solute by convention and filtration.
Option 3:
Continuous arteriovenous hemofiltration involves the slow removal of fluid and solute by convention and filtration.
Option 4:
Continuous venovenous hemofiltration with dialysis involves the slow removal of fluid and solute with the help of diffusion and filtration.

Question 16

Which phase of an acute kidney injury involves an increase in the creatinine levels?

1. Oliguric phase
2. Diuretic phase
3. Initiating phase
4. Recovery phase

Answer 16

1

Option 1:
An increase in the creatinine levels, blood urea nitrogen levels, electrolyte abnormalities, acidosis, and fluid overload are observed in the oliguric phase.
Option 2:
Increased urination, dehydration, and electrolyte imbalances are observed in the diuretic phase.
Option 3:
Vasoconstriction along with sodium and water retention is observed in the initiating phase.
Option 4:
The restoration of the basement membrane is observed in the recovery phase.

Question 17

A client is on treatment for glomerulonephritis. Which laboratory parameters should be monitored to determine the degree of renal functioning in the client? Select all that apply.

1. Creatinine
2. Blood urea nitrogen
3. Red blood cell count
4. Protein levels in the urine
5. White blood cell count

Answer 17

2

Option 1:
Serum blood urea nitrogen and creatinine are generally measured to determine the degree of renal functioning.
Option 2:
Serum blood urea nitrogen and creatinine are generally measured to determine the degree of renal functioning.
Option 3:
Red blood cell count indicates the extent of damage to the glomerular basement membrane.
Option 4:
Protein levels in the urine can be used to measure the extent of damage to the glomeruli.
Option 5:
Monitoring the white blood cell count helps to determine the extent of infection in glomerulonephritis.

Question 18

The nurse is caring for a client who underwent a radical nephrectomy for renal cancer. Which postoperative assessment made by the nurse is most beneficial to the client? Select all that apply.

1. Monitoring the color of the incision
2. Monitoring for swelling at the incision site
3. Maintaining proper hydration in the client
4. Maintaining the draining tubes parallel to the bed level
5. Monitoring for excessive drainage from the incisions

Answer 18

1, 2, 3

Option 1:
A red-colored incision with purulent drainage indicates infection. Thus, monitoring the color of the incision would be beneficial.
Option 2:
Swelling of the incision site indicates infection. Thus, monitoring for swelling is beneficial.
Option 3:
Adequate hydration is essential to maintain circulating volume.
Option 4:
The draining tubes should be maintained using gravity to reduce the risk of infection by preventing backward flow of the drainage.
Option 5:
Limited drainage indicates an obstruction that has to be cleared to keep the wound clean. Thus, limited drainage needs monitoring.

Question 19

Which laboratory abnormality may lead to a disturbed thought process in a client with end-stage renal disorder?

1. Anemia
2. Uremic toxins
3. Fluid retention
4. Electrolyte imbalances

Answer 19

2

Anemia can cause fatigue in clients with end-stage renal disorder.
Option 2:
Uremic toxins produced during end-stage renal disorder may affect the central nervous system causing a disturbance in thought processes.
Option 3:
Fluid retention can lead to excess fluid volume and edema in clients with end-stage renal disorder.
Option 4:
Electrolytic imbalances may cause dysrhythmias in clients with end-stage renal disorder.

Question 20

A pregnant woman reports fever, chills, urinary frequency, and painful urination. Upon assessment, flank pain and costovertebral tenderness are observed. A histological examination of renal tissue reveals inflammation of the renal cells. Which intervention may be contraindicated in the client?

1. Antipyretics
2. Fluoroquinolones
3. Aminoglycosides
4. Narcotic analgesics

Answer 20

2

The client shows symptoms and signs of pyelonephritis. Antipyretic drugs may help to reduce elevated temperatures associated with an infection caused by pyelonephritis.
Option 2:
Fluoroquinolones are contraindicated in pregnant women due to teratogenicity.
Option 3:
The client shows symptoms and signs of pyelonephritis. Aminoglycoside are typically used in combination with broad spectrum antibiotics to treat pyelonephritis.
Option 4:
Narcotic analgesics may be administered to reduce flank pain associated with pyelonephritis.

Question 21

Which changes may be associated with dialysis procedures?

1. Hypertension
2. Cerebral edema
3. Increased oxygenation
4. Decreased temperature

Answer 21

2

Option 1:
Hypotension may by caused by rapid fluid removal during dialysis.
Option 2:
Because of a rapid shift of fluids and substances during dialysis, a high osmotic gradient may occur in the brain. This results in a shift of fluid into the brain, causing cerebral edema.
Option 3:
Reduced oxygenation may occur with fluid overload or with decreased respiratory effort.
Option 4:
Dialysis can increase the risk of infection through multiple IV lines. Therefore, an increased body temperature may occur during dialysis.