Question 1

A male client undergoes nephrectomy and is admitted for postoperative care. However, during postoperative care, he suffers from a severe internal hemorrhage. The internal hemorrhage is stopped, and the client is allowed to rest. Which of the following interventions should the nurse provide to manage and minimize hemorrhage effectively?

Accepted Answer

Monitoring vital signs every 1 to 4 hours will enable the nurse to detect signs of hemorrhage early and take timely action to manage and minimize it effectively. Encouraging the client to breathe deeply and cough every 2 hours, auscultating the lungs every 4 to 5 hours, and using two hands to support the incision during coughing are important interventions for postoperative care but may not be as critical in managing and minimizing hemorrhage.

Question 2

A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess?

Accepted Answer

Hypertension is a common complication of polycystic kidney disease.

Question 3

A client is prescribed an antispasmodic agent to help relieve bladder spasms associated with pyelonephritis. Which of the following would the nurse expect the physician to order?

Accepted Answer

Antispasmodic agents such as oxybutynin chloride are commonly prescribed to relieve bladder spasms associated with pyelonephritis. Ciprofloxacin, trimethoprim-sulfamethoxazole, and gentamycin are antibiotics which may be prescribed to treat pyelonephritis, but they do not have antispasmodic properties.

Question 4

A client is administered dialysate solution through an abdominal catheter. The nurse notices that the return flow rate is slow, so the nurse advises the client to move to the other side. However, even after changing the client's position, the nurse does not observe an increase in return flow. Which of the following actions should the nurse perform to help accelerate the return flow rate?

Accepted Answer

If changing the client's position does not work, the catheter may be positioned improperly and should be repositioned by the physician. Disconnecting and reapplying the catheter is unnecessary unless there is a problem with the insertion site. Loosening the tubing clamp may allow air to enter the tubing and cause further complications. Stopping the process for 5 minutes and resuming later would not help with the slow return flow rate.

Question 5

A client, aged 75, is diagnosed with a renal disease and administered nephrotoxic drugs in normal doses. The nurse is aware that it is important to observe the client closely for any changes in renal status. Which of the following measures may help a nurse determine a change in renal status?

Accepted Answer

Observing the client's urinary output is the most appropriate measure for determining changes in renal status, as it provides information on kidney function and any potential issues with urine production or elimination. Monitoring fluid intake can be helpful in managing fluid balance, but it does not provide direct information on renal status. Checking for a thrill or a bruit may be important in assessing vascular access sites, but it is not directly related to renal function. Observing skin color and nail beds can provide information on overall health status, but does not specifically address changes in renal function.

Question 6

A client, aged 87, undergoes continuous ambulatory peritoneal dialysis (CAPD) for acute renal failure (ARF). Which task would be most important for the nurse to do?

Accepted Answer

Since the client is undergoing CAPD for ARF, it is crucial for the nurse to frequently monitor their progress to ensure that the treatment is effective and complications are prevented. Monitoring for hypoglycemia and hyperglycemia, ensuring a proper diet, and noting color changes in the eyes, teeth, and nails may be important but not as critical as monitoring the client's progress.

Question 7

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?

Accepted Answer

Wearing a mask during exchanges can help prevent the spread of infection and protect the client from inhaling any pathogens that may be present in the surrounding environment. It is not necessary to perform deep-breathing exercises or auscultate the lungs frequently during peritoneal dialysis, and avoiding heavy lifting may be recommended for other reasons unrelated to the upper respiratory infection.

Question 8

A client comes to the Emergency Department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?

Accepted Answer

The sudden onset of severe flank pain that radiates to the suprapubic region and even to the tip of the penis is a classic presentation of urinary calculi, also known as kidney stones. The pain may come in waves as the stone moves through the urinary tract. Acute glomerulonephritis is an inflammation of the kidney's glomeruli and typically presents with symptoms such as hematuria (blood in urine), proteinuria (excessive protein in urine), and swelling in the extremities. Ureteral stricture is a narrowing of the ureter, which can cause obstruction of urine flow and may present with symptoms such as pain during urination and frequent urination. Renal cell carcinoma is a type of kidney cancer that typically presents with symptoms such as blood in urine, flank pain, and weight loss. However, it is not typically associated with pain that radiates to the suprapubic region or the tip of the penis.

Question 9

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following?

Accepted Answer

Acute pyelonephritis is a type of kidney infection, and during a physical examination, the nurse can help determine the location of discomfort, which is relevant to diagnosing and managing the condition. Abnormalities in urine, elevated calcium levels, and structural defects in the kidneys are typically identified through laboratory tests and imaging studies, not through a physical examination.

Question 10

An instructor is preparing a class on renal cancer for a group of students. Which of the following would the instructor include as a possible risk factor?

Accepted Answer

Obesity has been identified as a possible risk factor for renal cancer. Age over 40 years, male gender, and exposure to certain chemicals (such as asbestos and cadmium) are also known risk factors, while exposure to sunlight is not.

Question 11

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?

Accepted Answer

Glomerulonephritis is commonly caused by an immune response triggered by previous infections, particularly with streptococcus bacteria. Therefore, a recent history of streptococcal infection is significant in establishing a client's risk for developing glomerulonephritis. Previous episodes of pyelonephritis, hyperparathyroidism, and osteoporosis are not directly related to the development of glomerulonephritis.

Question 12

The nurse is reviewing the results of a urinalysis on a client with acute pyelonephritis. Which of the following would the nurse most likely expect to find?

Accepted Answer

Pyelonephritis is an infection of the kidney and is typically characterized by the presence of white blood cells (pyuria) in the urine, indicating inflammation and infection. High specific gravity and slightly acidic pH can also be present with pyelonephritis, but proteinuria is often present as well, indicating that the infection has affected the kidneys' ability to filter properly. Therefore, A, B, and C are not the best choices.

Question 13

After teaching a group of students about urolithiasis, the instructor determines that additional teaching is needed when the students identify which of the following as a possible risk factor?

Accepted Answer

The answer of After teaching a group of students about...

Question 14

A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care?

Accepted Answer

Encouraging the use of an incentive spirometer every 2 hours would help maintain adequate breathing and prevent the risk of ineffective breathing. Administering isotonic fluid therapy, keeping the drainage catheter below the level of insertion, and monitoring temperature are important aspects of post-operative care, but they do not directly address the risk of ineffective breathing pattern.

Question 15

When assessing a client with chronic glomerulonephritis, the nurse notes that the client has generalized edema. The nurse documents this as which of the following?

Accepted Answer

Generalized edema is also known as anasarca, which is a severe and widespread form of edema. Periorbital edema refers to swelling around the eyes; uremic frost is a rare manifestation of severe kidney failure in which urea and other waste products are excreted through the skin, appearing as a frost-like substance on the skin; hydronephrosis is a condition in which urine backs up into the kidneys, causing them to swell.

Question 16

A male client who is admitted with the diagnosis of urinary calculi complains of excruciating pain. The pain is suspected to be caused by increased pressure in the renal pelvis. Which measure would be most appropriate to provide pain relief?

Accepted Answer

Encouraging frequent ambulation can help facilitate the passage of the urinary calculi, which can in turn reduce the pressure in the renal pelvis and alleviate the excruciating pain.

Question 17

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase?

Accepted Answer

During the second phase of acute renal failure, the patient typically experiences oliguria, which is a decrease in urine output. This is caused by a reduction in glomerular filtration rate and impaired tubular function. The first phase is the initial insult or injury to the kidneys, while the third phase is the recovery phase characterized by diuresis and restoration of kidney function. Acute tubular necrosis may occur during any phase of acute renal failure but is not specific to the second phase.

Question 18

A client is undergoing peritoneal dialysis as medical treatment for acute renal failure. Before the next instillation, the nurse observes that the client has marked abdominal distention accompanied by pain. Which of the following nursing actions is likely to offer an immediate solution to this problem?

Accepted Answer

Delaying the next dialysis cycle will allow the client's abdomen to rest and possibly decrease the discomfort and distention. Administering analgesics may provide temporary relief but will not address the underlying issue. Instilling more fluid may exacerbate the issue by adding to the already distended abdomen. Helping the client to ambulate may also be beneficial in promoting peristalsis and decreasing abdominal distention, but it is not the immediate solution to this problem.

Question 19

The nurse is caring for several older clients. Which client would the nurse be especially alert for signs and symptoms of pyelonephritis?

Accepted Answer

Pyelonephritis is a kidney infection that typically starts in the urethra or bladder and ascends to the kidneys. Clients with urinary obstruction are at an increased risk for developing pyelonephritis because the obstruction can lead to urine stasis, which allows bacteria to grow and multiply. Clients with acute renal failure, a urinary tumor, or preexisting chronic glomerulonephritis may be at risk for other kidney-related complications, but they are not necessarily at an increased risk for pyelonephritis.

Question 20

A client with decreased renal function is to receive a low-protein diet. The client asks the nurse why he needs this type of diet. The nurse would incorporate which reason into the response?

Accepted Answer

A low-protein diet lessens the workload on the kidneys by reducing the amount of nitrogen waste products that need to be processed and eliminated.

Quiz 58: Caring Forclients With Disorders of the Kidneys and Ureters