Unit R- Renal Flashcards

Question

The narrowing of preputial opening of foreskin is referred to as what? a. Chordee b. Phimosis c. Epispadias d. Hypospadias

Answer 1

ANS: B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

Answer 2

ANS: C The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a substance that is freely filtered by the glomerulus and secreted by the renal tubule cells. The pH and osmolality are not estimates of glomerular filtration. Although protein in the urine demonstrates abnormal glomerular permeability, it is not a measure of filtration rate.

Answer 3

ANS:A Symptoms of urosepsis include a febrile urinary tract infection coexisting with systemic signs of bacterial illness; blood culture reveals the presence of a urinary pathogen. Proteinuria and edema are symptoms of minimal change nephrotic syndrome. Oliguria and hypertension are symptoms of acute glomerulonephritis. Anemia and thrombocytopenia are symptoms of hemolytic uremic syndrome.

Answer 4

ANS: D An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.

Answer 5

ANS:D The white blood cell (WBC) count in a routine urinalysis should be <1 or 2. Over that amount indicates a urinary tract inflammatory process. The urinalysis specific gravity for children with normal fluid intake is 1.016 to 1.022. When the specific gravity is high, dehydration is indicated. A low specific gravity is seen with excessive fluid intake, distal tubular dysfunction, or insufficient antidiuretic hormone secretion.

Answer 6

ANS: B The immunosuppressant medications are taken indefinitely after a renal transplantation, so they should not be discontinued after 2 weeks. Reporting a fever and observing an incision for redness and swelling are accurate statements. The adolescent is correct in indicating dialysis will not need to be done after the transplantation.

Answer 7

ANS:B Normal serum potassium levels in a school-age child are 3.5 to 5 mEq/L. Sodium polystyrene sulfonate is administered to reduce serum potassium levels. Spironolactone is a potassium-sparing diuretic and should not be used if the serum potassium is elevated. Lactulose is administered to reduce ammonia levels in patients with liver disease. Calcium carbonate may be prescribed as a calcium supplement, but it will not reduce serum potassium levels.

Answer 8

ANS: A, B, C, D The principal feature of acute glomerulonephritis include oliguria, edema, hypertension and circulatory congestion, hematuria, and proteinuria. Bacteriuria is not a principal feature of acute glomerulonephritis.

Answer 9

ANS: A, C, F Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations observed in an infant with a urinary tract infection. Jaundice, swelling of the face, and back pain would not be observed in an infant with a urinary tract infection.

Answer 10

ANS: D, E Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

Answer 11

ANS: A, D, E Moderate sodium restriction and even fluid restriction may be instituted for children with acute glomerulonephritis. Foods with substantial amounts of potassium and sodium are generally restricted during the period of oliguria. Apples, carrot sticks, and strawberries would be items low in sodium and allowed. Bananas are high in potassium and cheese is high in sodium. Those items would be restricted.

Answer 12

ANS: B, C, D, E The disease is suspected on the basis of clinical manifestations that include generalized edema, steadily gaining weight; appearing edematous; and then becoming anorexic, irritable, and less active. The hallmark of this syndrome is proteinuria (higher than 2+ on urine dipstick)

Answer 13

ANS: D Glucose normally is not found in the urine. The normal renal threshold for glucose is about 220 mg/dL (12.2 mmol/L), which means that a person whose blood glucose is less than 220 mg/dL (12.2 mmol/L) will not have glucose in the urine. A positive finding for glucose on urinalysis indicates high blood sugar. The most appropriate action would be to perform a blood glucose assessment. The client needs further evaluation for this abnormal result; therefore, documenting and continuing to monitor are not appropriate. Requesting a 24-hour urine test or reviewing the client’s dietary selections will not assist the nurse to make a clinical decision related to this abnormality.

Answer 14

ANS: B Renin is secreted when special cells in the distal convoluted tubule, called the macula densa, sense changes in blood volume and pressure. When the macula densa cells sense that blood volume, blood pressure, or blood sodium levels are low, renin is secreted. Renin then converts angiotensinogen into angiotensin I. This leads to a series of reactions that cause secretion of the hormone aldosterone. This hormone increases kidney reabsorption of sodium and water, increasing blood pressure, blood volume, and blood sodium levels. Inappropriate or excessive renin secretion is a major cause of persistent hypertension. Renin has no impact on Alzheimer disease, diabetes mellitus, or viral hepatitis.

Answer 15

ANS: C Normal urine osmolality ranges from 300 to 900 mOsm/kg (300 to 900 mmol/kg). This client’s urine is more concentrated, indicating dehydration. The nurse would encourage the client to drink more water. Dehydration can be associated with elevated serum sodium levels. Although a low-sodium diet may be appropriate for this client, this diet change will not have a significant impact on urine osmolality. A diuretic would increase urine output and decrease urine osmolality further. Low serum sodium levels, not elevated serum levels, place the client at risk for seizure activity. These options would further contribute to the client’s dehydration or elevate the osmolality.

Answer 16

ANS: C Erythropoietin is produced in the kidney and is released in response to decreased oxygen tension in the renal blood supply. Erythropoietin stimulates red blood cell production in the bone marrow. Anemia and renal insufficiency are not manifestations of vitamin D deficiency. The kidneys do not play a role in the transportation of red blood cells or any other cells in the blood.

Answer 17

ANS:A Normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Normal creatinine is 0.6 to 1.2 mg/dL (53.0 to 106.1 mcmol/L) (males) or 0.5 to 1.1 mg/dL (44.2 to 97.2 mcmol/L) (females). Creatinine is more specific for kidney function than BUN, because BUN can be affected by several factors (dehydration, high-protein diet, and catabolism). This client’s creatinine is normal, which suggests a nonrenal cause for the elevated BUN. A common cause of increased BUN is dehydration, so the nurse would recommend giving the client more fluids, not placing the client on fluid restrictions. Hemodialysis is not an appropriate treatment for dehydration. The lab results do not indicate an infection; therefore, a urine culture and sensitivity are not appropriate.

Answer 18

ANS: B Older African Americans have a greater age-related decrease in glomerular filtration rate when compared to other racial-ethnic groups. In addition, blood flow decreases and sodium excretion is less effective in older hypertensive African Americans. These changes make this group most at risk for kidney disease.

Answer 19

ANS: D Normal specific gravity for urine is 1.005 to 1.030. A high specific gravity can occur with dehydration, decreased kidney blood flow (often because of dehydration), and presence of antidiuretic hormone. Increasing the client’s fluid intake would be a beneficial intervention. Assessing the creatinine or obtaining a urine culture would not provide data necessary for the nurse to make a clinical decision.

Answer 20

ANS: B Ketone bodies are by-products of incomplete metabolism of fatty acids. Normally, no ketones are present in urine. Ketone bodies are produced when fat sources are used instead of glucose to provide cellular energy. A pH between 4.6 and 8, specific gravity between 1.005 and 1.030, and clear yellow urine are normal findings in a urinalysis.

Answer 21

ANS: C An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of possible internal hemorrhage. AGRchAaDngEeSinLvAiBta.l sCigOnMs (elevated pulse and decreased blood pressure) can indicate that hemorrhage is occurring.

Answer 22

ANS: A The AP should use the female icon for women who have not had a hysterectomy. This allows the scanner to subtract the volume of the uterus from readings. If a woman has had a hysterectomy, the AP should choose the male icon. The AP should explain the procedure to the client, apply gel to the scanning head and clean it after use, and take at least two readings.

Answer 23

ANS: A,B,D | The pH, specific gravity, and glucose are all within normal ranges. The other values are abnormal.

Answer 24

ANS: A,B,E,F Kidneys are very vascular and the client is at risk for bleeding after a biopsy. Therefore, it is essential that the nurse review preprocedure laboratory test results for anemia and coagulation problems.

Answer 25

ANS:A,D The nurse would monitor urine output and contact the primary health care provider if urine output decreases or becomes absent. The nurse would also assess for blood in the client’s urine. The urine may be pink-tinged, but gross bleeding or blood clots should not be present. If bleeding is present, the nurse would urgently contact the primary health care provider. Tolerating oral fluids is a positive outcome and does not need intervention. Metformin would be a concern if the patient received dye; no dye is used in a cystoscopy procedure. The client may experience a burning sensation when urinating after this procedure; this would not require a call to the primary health care provider.

Answer 26

ANS: A,B,E Prior to a percutaneous kidney biopsy, the patient should be NPO for 4 to 6 hours. Coagulation studies should be completed to prevent bleeding after the biopsy. Blood pressure medications should be administered to prevent hypertension before and after the procedure. There is no need to keep the patient on bedrest or assess for blood in the client’s urine prior to the procedure; these interventions should be implemented after a percutaneous kidney biopsy.

Answer 27

ANS: A,B,E,F The nurse should ensure that the client receives adequate fluid intake and has adequate lighting to ambulate safely to the bathroom at night, encourage the client to use the toilet every 2 hours, provide thorough perineal care after each voiding, and assess for urinary retention and urinary tract infections. The nurse would not delegate any teaching to the AP, including bladder training instructions. The AP may participate in bladder training activities, including encouraging and assisting the client to the bathroom at specific times.

Answer 28

ANS: C The classic and most common finding in clients who have bladder cancer is painless and intermittent hematuria that can be with gross or microscopic. Dysuria, frequency, and urgency occur in clients who have bladder infection or obstruction.

Answer 29

ANS: B Low estrogen levels decrease moisture and secretions in the perineal area and cause other tissue changes, predisposing it to the development of infection. Urethritis is most common in postmenopausal women for this reason. Although immune function does decrease with aging and sexually transmitted diseases are a known cause of urethritis, the most likely reason in this patient is low estrogen levels. Personal hygiene usually does not contribute to this disease process.

Answer 30

ANS: C Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many clients think that they have blood in their urine when they see this. In addition, the urine can permanently stain clothing. There are no dietary restrictions or needs while taking this medication.

Answer 31

ANS: A Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence or cystitis. Many people try to manage incontinence by limiting fluids. Alcoholic and caffeinated beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing incontinence

Answer 32

ANS: D The client who has stress incontinence needs to strengthen the muscles of the pelvic floor using Kegel exercises. Catheterizations would not help with incontinence. Incontinence pads may need to be used by this client but that is not the most important thing to teach, and it does not help the client regain more control over his or her bladder.

Answer 33

ANS: B Habit training is undermined by the use of absorbent incontinence briefs or pads. The nurse should reeducate the AP on the technique of habit training. The AP should continue to toilet the client after meals, encourage the client to drink fluids, and record incontinent episodes

Answer 34

ANS: D In patients with overflow incontinence, the voiding reflex arc is not intact. Mechanical pressure, such as that achieved through the Valsalva maneuver (holding the breath and bearing down as if to defecate), can initiate voiding. Stroking the medial aspect of the thigh or providing digital anal stimulation requires the reflex arc to be intact to initiate elimination. Due to the high risk for infection, intermittent catheterization should only be implemented when other interventions are not successful.

Answer 35

ANS: A Dehydration contributes to the precipitation of minerals to form a stone. Although increased intake of calcium causes hypercalcemia and leads to excessive calcium filtered into the urine, if the client is well hydrated, the calcium will be excreted without issues. Dehydration increases the risk for supersatuGraRtioAnDoEfScaLlcAiuBm.CinOtMhe urine, which contributes to stone formation. The nurse would encourage the client to drink more fluids, not decrease calcium intake. Ingestion of aspirin or aspirin-containing products does not cause a stone. Antibiotics neither prevent nor treat a stone.

Answer 36

ANS: D Stones caused by hyperuricmia caused by gout or other reason respond to allopurinol. Phenazopyridine is given to clients with urinary tract infections. Doxycycline is an antibiotic. Tolterodine is an anticholinergic with smooth muscle-relaxant properties.

Answer 37

ANS: B The shock waves from lithotripsy can cause bleeding into the tissues through which the waves pass. Application of ice can reduce the extent and discomfort of the bruising. Although coagulation test results and fresh-frozen plasma are used to assess and treat bleeding disorders, ecchymosis after this procedure is not unusual and does not warrant a higher level of intervention. Changing the client’s position will not decrease bleeding.

Answer 38

ANS: A Smoking is known to be a factoGrRthAaDt gErSeaLtlAyBin.crCeOasMes the risk of bladder cancer. Alcohol use, recreational drug use, and prescription drug use (except medications that contain phenacetin) are not known to markedly increase the risk of developing bladder cancer.

Answer 39

ANS: A The client should use a second form of birth control because antibiotic therapy reduces the effectiveness of estrogen-containing contraceptives. She should not experience increased menstrual bleeding, an irregular heartbeat, or blood in her urine while taking the drug.

Answer 40

ANS: D Functional urinary incontinence occurs as the result of problems not related to the client’s bladder, such as trouble ambulating or difficulty accessing the toilet. One desired outcome is that the client will be able to manage his or her clothing independently. Elastic waistband slacks that are easy to pull down and back up can help the client get on the toilet in time to void. The other instructions do not relate to functional urinary incontinence.

Answer 41

ANS: B Some types of incontinence or other health problems are treated with anticholinergic medications. Anticholinergic siGdRe AefDfeEctSs LinAclBu.deCdOryM mouth, constipation, and urinary retention. The nurse needs to assess the client’s medication list to determine whether the he or she is taking an anticholinergic medication. The other questions are not as helpful to understanding the current situation.

Answer 42

ANS: C The client should try to hold urine consciously until the next scheduled toileting time. Toileting should occur at specific intervals during the training. The interval can be increased once the client becomes comfortable with the interval.

Answer 43

ANS: A There is a strong association between family history and stone formation and recurrence. Nephrolithiasis is associated with many genetic variations; therefore, the nurse should ask whether other family members have also had renal stones. The other questions do not refer to renal calculi but instead are questions that should be asked of a patient with a urinary tract infection.

Answer 44

ANS: C The nurse would accept and acknowledge the client’s concerns, and assist the client to learn techniques that will allow contrGoRl oAfDuEriSnaLryAiBn.coCnOtinMence. The nurse would not diminish the client’s concerns with the use of pads or stating statistics about the occurrence of incontinence.

Answer 45

ANS: A,B,D Fluid intake, estrogen levels, and immune suppression all can increase the chance of recurrent cystitis. Family history is usually insignificant, and cranberry juice, not grapefruit or orange juice, has been found to increase the acidic pH and reduce the risk for bacterial cystitis.

Answer 46

ANS: A,B,C,F Fever and chills may occur in clients who have a UTI if the infection has expanded beyond the bladder into the kidneys. However, these symptoms are not urinary signs and symptoms

Answer 47

ANS: A,D This drug can cause increase blood pressure and, therefore, the client’s blood pressure should be monitored. Mirabegron can increase the effect of warfarin causing bleeding or bruising. The client will need additional coagulation studies to ensure that the INR is within a therapeutic range.

Answer 48

ANS: A,C,D,E,F Drugs, such as diuretics, cause frequent voiding, often in large amounts. Diseases or disorders that limit mobility, such as stroke, arthritis, and Parkinson disease, can prevent an individual from getting to the bathroom in a timely manner. Mental/behavioral problems, such as dementia, impair cognition and the ability to recognize when he or she needs to void.

Answer 49

ANS: A,B,D Stress incontinence is a loss of urine with physical exertion, coughing, sneezing, or exercising. Urge incontinence presents with an abrupt and strong urge to void and usually has a large amount of urine released with each occurrence. Overflow incontinence occurs with bladder distention and results in a constant dribbling of urine. Functional incontinence is the leakage of urine caused by factors other than a disorder of the lower urinary tract. Reflex incontinence results from abnormal detrusor contractions from a neurologic abnormality.

Answer 50

ANS: A,B,C The client should be taught to finish the prescribed antibiotic to ensure that he or she does not get a urinary tract infection. The client should drink at least 3 L of fluid daily to dilute potential stone-forming crystals, prevent dehydration, and promote urine flow. After lithotripsy, the client should expect bruising that may take several weeks to resolve. The client should also experience blood in the urine for several days. The client should report any pain, fever, chills, or difficulty with urination to the primary health care provider as these may signal the beginning of an infection or the formation of another stone.

Answer 51

ANS: A,E Woman can reduce their risk of contracting UTIs by voiding before and after intercourse, not douching or using scented feminine products, and wiping from front to back. If spermicides are currently used, the woman should consider another form of birth control. Loose-fitting cotton underwear is best.

Answer 52

ANS: B Periorbital edema would not be a finding related to PKD and would be investigated further. Flank pain and a distended or enlarged abdomen occur in PKD because the kidneys enlarge and displace other organs. Urine can be bloody or cloudy as a result of cyst rupture or infection.

Answer 53

ANS: C The client who has chronic pyelonephritis has renal damage and therefore has hypertension. The other assessment findings commonly occur in clients with acute pyelonephritis.

Answer 54

ANS: B Clients with PKD often have constipation, which can be managed with increased fiber, exercise, and drinking plenty of water. Laxatives would be used cautiously. Clients with PKD would be on a restricted salt diet, which includes not cooking with salt. White bread has a low-fiber count and would not be included in a high-fiber diet.

Answer 55

ANS: C Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons. Chronically elevated blood glucose levels spill glucose into the urine, changing the pH, and providing a favorable climate for bacterial growth. The neuropathy associated with diabetes reduces bladder tone and reduces the client’s sensation of bladder fullness. Thus, even with large amounts of urine, the client voids less frequently, allowing stasis and overgrowth of microorganisms. Increasing fluid intake (specifically water) and voiding frequently prevent stasis and bacterial overgrowth. Testing urine and using tampons will not help prevent pyelonephritis. A hemoglobin A1C of 9% is too high.

Answer 56

ANS: A Fluid retention is a major feature of acute GN. This weight loss represents fluid loss, indicating that the glomeruli are performing the function of filtration. A urine specific gravity of 1.048 is high. Blood is not usually seen in GN, so this finding would be expected. A blood pressure of 152/88 mm Hg is too high; this may indicate kidney damage or fluid overload.

Answer 57

ANS:B In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and edema formation. If glomerular filtration is normal or near normal, increased protein loss would be matched by increased intake of protein. The client would not need to adjust fat, carbohydrates, or vitamins based on this disorder.

Answer 58

ANS: D The nurse would first fully assess the client for signs of volume depletion and shock, and then notify the primary health care provider. The extensive nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypotension is a clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypotension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Repositioning the patient, measuring specific gravity, and administering pain medication would not provide data necessary to make an appropriate clinical decision, nor are they appropriate interventions at this time.

Answer 59

ANS: D | Beta streptococcus is a bacterium that can cause acute glomerulonephritis, so antibiotic therapy is indicated.

Answer 60

ANS: B The client should not restrict fluids during the day due to increased urination at night. Clients with renal disease may be prescribed fluid restrictions, and would be assessed thoroughly for potential dehydration. Increased nocturnal voiding can be decreased by consuming fluids earlier in the day. Blood pressure control is needed to slow the progression of renal dysfunction. When dietary protein is restricted, refer the client to the registered dietitian nutritionist as needed.

Answer 61

ANS: C Clients may be uncomfortable discussing issues related to elimination and the genitourinary area. The nurse would encourage the client to use language that is familiar to the client. The nurse must assess the client and cannot take the time to stop the discussion or find another nurse to complete the assessment

Answer 62

ANS: B,C,E Clients with PKD experience abdominal distention that manifests as flank pain and increased abdominal girth. Bloody urine is also present with tissue damage secondary to PKD. Clients with PKD often experience constipation, but would not report nocturia or dysuria.

Answer 63

ANS: A,B,D Nephrotic syndrome is caused by glomerular damage and is characterized by proteinuria (protein level higher than 3.5 g/24 hr), hypoalbuminemia, edema, and lipiduria. Fluid overload leading to edema and hypertension is common with nephrotic syndrome; dehydration does not occur. Dysuria is present with cystitis. CVA tenderness is present with inflammatory changes in the kidney.

Answer 64

ANS: B,D,E After a nephrostomy, the nurse would assess the client for complications and urgently notify the primary health care provider if drainage decreases or stops, drainage is cloudy or foul smelling, the nephrostomy site leaks blood or urine, or the client has back pain. Clear drainage is normal. A headache would be an unrelated finding.

Answer 65

ANS:A,B,D A client who has PKD would measure and record his or her blood pressure and weight daily, limit salt intake, and adjust dietary selections to prevent constipation. The client should notify the primary health care provider if urine smells foul or has blood in it, as these are signs of a urinary tract infection or glomerular injury. The client should also notify the provider if visual disturbances are experienced, as this is a sign of a possible berry aneurysm, which is a complication of PKD. Diarrhea and renal stones are not manifestations or complications of PKD; therefore, teaching related to these concepts would be inappropriate.

Answer 66

ANS: A,C,D | The nurse would expect all of these findings except that the urine is usually concentrated with a high specific gravity.

Answer 67

ANS: A,B,C,D,E,F All of these assessment findings commonly occur in clients who have acute pyelonephritis because this health problem is a kidney infection

Answer 68

ANS: B Prerenal causes of AKI are related to a decrease in perfusion, such as in clients who have prolonged dehydration. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney stones are postrenal causes of AKI related to urine flow obstruction.

Answer 69

ANS: A This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood pressure. The nurse can start hydrating the client with a bottle of water first, followed by teaching the patient to drink 2 to 3 L of water each day. An intravenous line may be needed later, after the patient’s degree of dehydration is assessed. An electrocardiogram is not necessary at this time.

Answer 70

ANS: A There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the patient since both the serum creatinine and BUN are elevated, indicating some renal problems. A diet high in protein could be a factor in an increased BUN.

Answer 71

ANS: C This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance are essential. Edema and pain are not usually a problem with fluid loss. There could be changes in the client’s cardiac, respiratory, and mental health status if the electrolyte imbalance is not treated.

Answer 72

ANS: D The nurse would assess that the client could be developing fluid overload and respiratory distress and slow down the normal saline infusion. The calculation of the MAP also reflects perfusion. The insertion of a pulmonary artery catheter would evaluate the client’s hemodynamic status, but this would not be the initial or priority action by the nurse. Vital signs are also important after adjusting the intravenous infusion.

Answer 73

ANS: A The best action by the nurse would be to check the cardiac status with a monitor. High-potassium levels can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but not the best immediate action

Answer 74

ANS: C Contrast media can be nephrotoxic (damaging to the kidneys). Metformin can also be nephrotoxic and the client should not be exposed to two agents. Clients who have diabetes are already at risk for renal damage.

Answer 75

ANS: C Hypotension can be a problem with CVVH if replacement fluid does not provide enough volume to maintain blood pressure. The nurse needs to monitor for ongoing fluid and electrolyte replacement. The sodium level is normal and the potassium level is slightly elevated, which could be normal findings for someone with acute kidney injury. A pulse rate of 88 beats/min is within usual limits.

Answer 76

ANS: B Kussmaul respirations indicate that the client has metabolic acidosis which is a complication of CKD. The client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs to lower serum pH. Hypertension is common in most patients with CKD, and skin itching increases with calcium–phosphate imbalances and elevations of nitrogenous wastes, another common finding in CKD. Uremia from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis.

Answer 77

ANS: C The general principle for fluid restriction for clients is that they may have a daily fluid intake of 500 mL plus the amount of tGheRiAr uDrEinSarLyAoBut.puCt.OIMn this case, 120 mL urinary output plus 500 mL equals 620 mL fluid allowance.

Answer 78

ANS: A The initial action for the nurse is to assess anxiety, coping styles, and the client’s acceptance of the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling hemodialysis appointments may help, and referral to a mental health practitioner and the possibility of peritoneal dialysis are all viable options, assessment of the client’s acceptance of the treatment would come first

Answer 79

ANS: A Furosemide is a loop diuretic that helps reduce fluid overload and hypertension in patients with early stages of CKD. One kilogram of weight equals about 1 L of fluid retained in the client, so daily weights are necessary to monitor the response of the client to the medication. Heart and breath sounds would be assessed if there is fluid retention, as in heart failure. Palpation of the client’s abdomen is not necessary, but the nurse would check for edema. The diet history of the client would be helpful to assess electrolyte replacement since potassium is lost with this diuretic, but this does not assess the effectiveness of the medication.

Answer 80

ANS: A Protein restriction is necessary with CKD due to the buildup of waste products from protein breakdown. The nurse would be concerned with the low albumin level since this indicates that the protein in the diet is not enough for the client’s metabolic needs. The electrolyte values are not related to the protein-restricted diet.

Answer 81

ANS: D Fast-food restaurants usually serve food that is high in sodium. This statement indicates that more teaching needs to occur. The other statements show a correct understanding of the teaching.

Answer 82

ANS: C The absence of adventitious sounds upon auscultation of the lungs indicates a lack of fluid overload and fluid balance in the client’s body. Decreased calcium levels and increased phosphorus levels are common findings with CKD. Edema would indicate a fluid imbalance.

Answer 83

ANS: C The nurse would not use the arm with the AV fistula for intravenous infusion, blood pressure readings, or venipuncture. Compression and infection can result in the loss of the AV fistula. The AV fistula would be monitored by auscultating or palpating the access site. Checking the distal pulse would be an appropriate assessment.

Answer 84

ANS: B An opaque or cloudy effluent is the first sign of peritonitis. A sample of the effluent would need to be sent to the laboratory for culture and sensitivity in order to administer the correct antibiotic. Warming the dialysate in a microwave and flushing the tubing are not safe actions by the nurse. Checking the catheter for obstruction is a viable option but will not treat the peritonitis.

Answer 85

ANS: C Inflow and outflow problems of the dialysate are best controlled by preventing constipation. A daily stool softener is the best option for the client. The drainage bag should be below the level of the abdomen. Flushing the tubing will not help with the flow. A diet high in fiber will also help with a constipation problem.

Answer 86

ANS:D The purpose of giving epoetin alfa to a client with CKD is to manage anemia by stimulating the bone marrow to produce more red blood cells. Therefore, monitoring the client’s hemoglobin, hematocrit, and red blood cell count would indicate if the drug was effective

Answer 87

ANS: A The client with CKD often has a high phosphorus level which tends to lower the calcium level in an inverse relationship, and causes osteodystrophy. To prevent this bone disease, the client needs to take a drug that can bind with phosphorus for elimination via the GI tract. When phosphorus is lowered to within normal limits, normal calcium levels may be restored.

Answer 88

ANS: A,B,C Urine flow obstruction, such as prostate cancer, blood clots in the urinary tract, and kidney stones (ureterolithiasis), causes postrenal AKI. Severe burns would be a prerenal cause. Lupus would be an intrarenal cause for AKI.

Answer 89

ANS: A,C,E The low urine output, sediment, and blood pressure would be reported to the primary health care provider. Postoperatively, the nurse would measure intake and output, check the characteristics of the urine, and report sediment, hematuria, and urine output of less than 0.5 mL/kg/hr for 3 to 4 hours. A urine output of 100 mL is low, but a urine output of 500 mL in 12 hours would be within normal limits. Perfusion to the kidneys is compromised with low blood pressure. The amber odorless urine is normal.

Answer 90

ANS: A,C,E Many clients with AKI are too ill to meet caloric goals and require tube feedings with renal-specific formulas that are lower in sodium, potassium, and phosphorus, and higher in calories than are standard formGulRasA.DESLAB.COM

Answer 91

ANS: B,C,D,E The client who has CKD has fluid overload and electrolyte imbalances, especially hyperkalemia, that can cause hypertension, heart failure, and dysrhythmias. Anemia results because erythropoietin production by the kidneys is decreased.

Answer 92

ANS: B,C,D,E In discharge teaching, the nurse must emphasize that the client needs to have an antibiotic prophylactically before dental procedures to prevent infection. There may be a need for dose reduction in medications if the kidney is not excreting them properly (antacids with magnesium, antibiotics, antidiabetic drugs, insulin, opioids, and anticoagulants).

Answer 93

ANS: A,B,D Hypotension occurs often during hemodialysis treatments as a result of vasodilation from the warmed dialysate. Modest decreases in blood pressure, as is the case with this client, can be maintained with rate adjustment, Trendelenburg positioning, and a fluid bolus. If the blood pressure drops considerably after two boluses and cooling dialysate, the hemodialysis can be stopped and the primary health care provider contacted.

Answer 94

ANS:A,B,D PD is based on exchanges of waste, fluid, and electrolytes in the peritoneal cavity. There is no need for vascular access. Protein is lost in the exchange, which allows for more protein and fluid in the diet. There is flexibility in the time for exchanges, but the treatment takes a longer period of time compared to hemodialysis. There still is risk for infection with PD, especially peritonitis.