Renal System

Question 1

Differentiate between acute renal failure and chronic renal failure.

Answer 1

• Acute renal failure: often reversible, abrupt deterioration of kidney function.
• Chronic renal failure: irreversible, slow deterioration of kidney function characterized by increasing BUN and creatinine. Eventually dialysis is required.

Question 2

During the oliguric phase of renal failure, protein should be severly restricted. What is the rationale for this restriction?

Answer 2

Toxic metabolites that accumulate in the blood (urea, creatinine) are derived mainly from protein catabolism.

Question 3

Identify two nursing interventions for the client on hemodialysis.

Answer 3

1. Do not take BP or perform veinpuncture on the arm with the AV shunt, fistula, or graft,
2. Assess access site for thrill and bruit.

Question 4

What is the highest priority nursing diagnosis for clients in any type of renal failure?

Answer 4

Risk for imbalanced fluid volume.

Question 5

A client in renal failure asks why he is being given antacids. How should the nurse reply?

Answer 5

Calcium and aluminum antacids bind phosphates and help to keep phosphates from being absorbed into the bloodstream, thereby preventing rising phosphate levels; must be taken with meals.

Question 6

List four essential elements of a teaching plan for clients with frequent urinary tract infections.

Answer 6

• Fluid intake 3 L/day
• Good handwashing
• Void every 2-3 hours during waking hours
• Take all prescribed medications
• Wear cotton undergarmets

Question 7

What are the most important nursing interventions for clients with possible renal calculi?

Answer 7

• Straining all urine is the most important intervention.

- Other interventions incle accurate I&O documentation and administering analgesics as needed.

Question 8

What discharge instructions should be given to a client who has had urinary calculi?

Answer 8

• Maintain high fluid intake of 3-4 L/day
• Pursue follow-up care (stones tend to recur)
• Follow prescribed diet based on calculi content
• Avoid supine position

Question 9

Following transurethral resection of the prostate gland (TURP), hematuria should subside by what postoperative day?

Answer 9

The fourth day

Question 10

After the urinary catheter is removed in the TURP client, what are three priority nursing actions?

Answer 10

• Continued strict I&O.
• Continued observations for hematuria.
• Inform client burning and frequency may last for a week.

Question 11

After kidney surgery, what are the primary assessments the nurse should make?

Answer 11

• Respiratory status (breathing is guarded because of pain)
• Circulatory status (the kidney is very vascular and excessive bleeding can occur)
• Pain assessment
• Urinary assessment (most important, assessment of urinary output)