Question 1

A nurse cares for a client who has pyelonephritis.The client states,"I am embarrassed to talk about my symptoms." How should the nurse respond?

Accepted Answer

Clients may be uncomfortable discussing issues related to elimination and the genitourinary area.The nurse should encourage the client to use language that is familiar to the client.The nurse should not make promises that cannot be kept,like keeping the client's symptoms confidential.The nurse must assess the client and cannot take the time to stop the discussion or find another nurse to complete the assessment.

Question 2

A nurse teaches a client who is recovering from a nephrectomy secondary to kidney trauma.Which statement should the nurse include in this client's teaching?

Accepted Answer

Clients with one kidney need to avoid contact sports because the kidneys are easily injured.The client will not be required to restrict salt and fluids,end up on dialysis,or have new hypertension because of the nephrectomy.

Question 3

A nurse assesses a client who has a family history of polycystic kidney disease (PKD).For which clinical manifestations should the nurse assess? (Select all that apply.)

Accepted Answer

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.

Question 4

A nurse assesses a client with polycystic kidney disease (PKD).Which assessment finding should alert the nurse to immediately contact the health care provider?

Accepted Answer

Periorbital edema would not be a finding related to PKD and should 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.

Question 5

After teaching a client with hypertension secondary to renal disease,the nurse assesses the client's understanding.Which statement made by the client indicates a need for additional teaching?

Accepted Answer

The client should not restrict fluids during the day due to increased urination at night.Clients with renal disease may be prescribed fluid restrictions.These clients should 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 as needed.

Question 6

A nurse cares for a middle-aged female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year.The client asks,"What can I do to help prevent these infections?" How should the nurse respond?

Accepted Answer

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 A?c of 9% is too high.

Question 7

A nurse teaches a client with polycystic kidney disease (PKD).Which statements should the nurse include in this client's discharge teaching? (Select all that apply.)

Accepted Answer

A client who has PKD should 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 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.

Question 8

After teaching a client with early polycystic kidney disease (PKD)about nutritional therapy,the nurse assesses the client's understanding.Which statement made by the client indicates a correct understanding of the teaching?

Accepted Answer

Clients with PKD often have constipation,which can be managed with increased fiber,exercise,and drinking plenty of water.Laxatives should be used cautiously.Clients with PKD should 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.

Question 9

A nurse cares for a client who is recovering after a nephrostomy tube was placed 6 hours ago.The nurse notes drainage in the tube has decreased from 40 mL/hr to 12 mL over the last hour.Which action should the nurse take?

Accepted Answer

The nephrostomy tube should continue to have a consistent amount of drainage.If the drainage slows or stops,it may be obstructed.The nurse must notify the provider,but first should carefully assess the client's abdomen for pain and distention and check vital signs so that this information can be reported as well.The other interventions are not appropriate.

Question 10

A nurse reviews laboratory results for a client with glomerulonephritis.The client's glomerular filtration rate (GFR)is 40 mL/min as measured by a 24-hour creatinine clearance.How should the nurse interpret this finding? (Select all that apply.)

Accepted Answer

The GFR refers to the initial amount of urine that the kidneys filter from the blood.In the healthy adult,the normal GFR ranges between 100 and 120 mL/min,most of which is reabsorbed in the kidney tubules.A GFR of 40 mL/min is drastically reduced,with the client experiencing fluid retention and risks for hypertension and pulmonary edema as a result of excess vascular fluid.

Question 11

A nurse assesses a client who is recovering from a radical nephrectomy for renal cell carcinoma.The nurse notes that the client's blood pressure has decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for this past hour.Which action should the nurse take?

Accepted Answer

The nurse should first fully assess the client for signs of volume depletion and shock,and then notify the provider.The radical 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.Re-positioning the client,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.

Question 12

After teaching a client with renal cancer who is prescribed temsirolimus (Torisel),the nurse assesses the client's understanding.Which statement made by the client indicates a correct understanding of the teaching?

Accepted Answer

Temsirolimus is administered as a weekly intravenous infusion.This medication blocks protein that is needed for cell division and therefore inhibits cell cycle progression.This medication is not taken orally,and clients do not need to follow a specific diet.

Question 13

A nurse cares for a client with autosomal dominant polycystic kidney disease (ADPKD).The client asks,"Will my children develop this disease?" How should the nurse respond?

Accepted Answer

Children whose parent has the autosomal dominant form of PKD have a 50% chance of inheriting the gene that causes the disease.ADPKD is transmitted as an autosomal dominant trait and therefore is not gender specific.Both parents do not need to have this disorder.

Question 14

An emergency department nurse assesses a client with kidney trauma and notes that the client's abdomen is tender and distended and blood is visible at the urinary meatus.Which prescription should the nurse consult the provider about before implementation?

Accepted Answer

Clients with blood at the urinary meatus should not have a urinary catheter inserted via the urethra before additional diagnostic studies are done.The urethra could be torn.The nurse should question the provider about the need for a catheter; if one is needed,the provider can insert a suprapubic catheter.The nurse should monitor the client's vital signs closely,send blood for type and crossmatch in case the client needs blood products,and administer intravenous fluids.

Question 15

A nurse evaluates a client with acute glomerulonephritis (GN).Which manifestation should the nurse recognize as a positive response to the prescribed treatment?

Accepted Answer

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.

Question 16

A nurse provides health screening for a community health center with a large population of African-American clients.Which priority assessment should the nurse include when working with this population?

Accepted Answer

All interventions are important for the visiting nurse to accomplish.However,African Americans have a high rate of hypertension leading to end-stage renal disease.Each encounter that the nurse has with an African-American client provides a chance to detect hypertension and treat it.If the client is already on antihypertensive medication,assessing blood pressure monitors therapy.

Question 17

A nurse assesses a client with nephrotic syndrome.For which clinical manifestations should the nurse assess? (Select all that apply.)

Accepted Answer

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.

Question 18

A nurse assesses a client who is recovering from a nephrostomy.Which assessment findings should alert the nurse to urgently contact the health care provider? (Select all that apply.)

Accepted Answer

After a nephrostomy,the nurse should assess the client for complications and urgently notify the provider if drainage decreases or stops,drainage is cloudy or foul-smelling,the nephrostomy sites leaks blood or urine,or the client has back pain.Clear drainage is normal.A headache would be an unrelated finding.

Question 19

After teaching a client with nephrotic syndrome and a normal glomerular filtration,the nurse assesses the client's understanding.Which statement made by the client indicates a correct understanding of the nutritional therapy for this condition?

Accepted Answer

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 should be matched by increased intake of protein.The client would not need to adjust fat,carbohydrates,or vitamins based on this disorder.

Question 20

An emergency department nurse cares for a client who is severely dehydrated and is prescribed 3 L of intravenous fluid over 6 hours.At what rate (mL/hr)should the nurse set the intravenous pump to infuse the fluids? (Record your answer using a whole number.)____ mL/hr

Accepted Answer

The answer of An emergency department nurse cares for a...

Quiz 67: Care of Patients with Kidney Disorders

A nurse cares for a client who has pyelonephritis.The client states,"I am embarrassed to talk about my symptoms." How should the nurse respond?

A nurse teaches a client who is recovering from a nephrectomy secondary to kidney trauma.Which statement should the nurse include in this client's teaching?

A nurse assesses a client who has a family history of polycystic kidney disease (PKD) .For which clinical manifestations should the nurse assess? (Select all that apply.)

A nurse assesses a client with polycystic kidney disease (PKD) .Which assessment finding should alert the nurse to immediately contact the health care provider?

After teaching a client with hypertension secondary to renal disease,the nurse assesses the client's understanding.Which statement made by the client indicates a need for additional teaching?

A nurse cares for a middle-aged female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year.The client asks,"What can I do to help prevent these infections?" How should the nurse respond?

A nurse teaches a client with polycystic kidney disease (PKD) .Which statements should the nurse include in this client's discharge teaching? (Select all that apply.)

After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy,the nurse assesses the client's understanding.Which statement made by the client indicates a correct understanding of the teaching?

A nurse cares for a client who is recovering after a nephrostomy tube was placed 6 hours ago.The nurse notes drainage in the tube has decreased from 40 mL/hr to 12 mL over the last hour.Which action should the nurse take?

A nurse reviews laboratory results for a client with glomerulonephritis.The client's glomerular filtration rate (GFR) is 40 mL/min as measured by a 24-hour creatinine clearance.How should the nurse interpret this finding? (Select all that apply.)