NURSING 160 Chapter 67: Care of Patients with Kidney Disorders

Chapter 67: Care of Patients with Kidney Disorders MULTIPLE CHOICE 1. A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding should alert the nurse to immediately contact the health care provider? a. Flank pain b. Periorbital edema c. Bloody and cloudy urine d. Enlarged abdomen ANS: B 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. DIF: Applying/Application REF: 1396 KEY: Polycystic kidney disease MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 2. 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? a. “No genetic link is known, so your children are not at increased risk.” b. “Your sons will develop this disease because it has a sex-linked gene.” c. “Only if both you and your spouse are carriers of this disease.” d. “Each of your children has a 50% risk of having ADPKD.” ANS: D 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 spe- cific. Both parents do not need to have this disorder. DIF: Understanding/Comprehension REF: 1396 KEY: Polycystic kidney disease| genetics MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 3. After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the nurse assess- es the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching? a. “I will take a laxative every night before going to bed.” b. “I must increase my intake of dietary fiber and fluids.” c. “I shall only use salt when I am cooking my own food.” d. “I’ll eat white bread to minimize gastrointestinal gas.” ANS: B 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. DIF: Applying/Application REF: 1397 KEY: Polycystic kidney disease| nutritional requirements MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort 4. 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 infec- tions?” How should the nurse respond? a. “Test your urine daily for the presence of ketone bodies and proteins.” b. “Use tampons rather than sanitary napkins during your menstrual period.” c. “Drink more water and empty your bladder more frequently during the day.” d. “Keep your hemoglobin A1c under 9% by keeping your blood sugar controlled.” ANS: C Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons. Chronically elevat- ed blood glucose levels spill glucose into the urine, changing the pH and providing a favorable climate for bac- terial growth. The neuropathy associated with diabetes reduces bladder tone and reduces the client’s sensa- tion 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 he- moglobin A1c of 9% is too high. DIF: Applying/Application REF: 1399 KEY: Diabetes mellitus| pyelonephritis MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance 5. A nurse evaluates a client with acute glomerulonephritis (GN). Which manifestation should the nurse recog- nize as a positive response to the prescribed treatment? a. The client has lost 11 pounds in the past 10 days. b. The client’s urine specific gravity is 1.048. c. No blood is observed in the client’s urine. d. The client’s blood pressure is 152/88 mm Hg. 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. DIF: Applying/Application REF: 1402 KEY: Glomerulonephritis MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 6. 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? a. “I must decrease my intake of fat.” b. “I will increase my intake of protein.” c. “A decreased intake of carbohydrates will be required.” d. “An increased intake of vitamin C is necessary.” ANS: B In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and edema forma- tion. 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. DIF: Applying/Application REF: 1404 KEY: Nephrotic syndrome| nutritional requirements MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort 7. 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? a. Position the client to lay on the surgical incision. b. Measure the specific gravity of the client’s urine. c. Administer intravenous pain medications. d. Assess the rate and quality of the client’s pulse. ANS: D 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. DIF: Applying/Application REF: 1408 KEY: Renal cancer| postoperative nursing MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 8. 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? a. Assessing vital signs every 15 minutes b. Inserting an indwelling urinary catheter c. Administering intravenous fluids at 125 mL/hr d. Typing and crossmatching for blood products ANS: B Clients with blood at the urinary meatus should not have a urinary catheter inserted via the urethra before ad- ditional 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 mon- itor the client’s vital signs closely, send blood for type and crossmatch in case the client needs blood products, and administer intravenous fluids. DIF: Applying/Application REF: 1409 KEY: Trauma| emergency nursing MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 9. After teaching a client with hypertension secondary to renal disease, the nurse assesses the client’s under- standing. Which statement made by the client indicates a need for additional teaching? a. “I can prevent more damage to my kidneys by managing my blood pressure.” b. “If I have increased urination at night, I need to drink less fluid during the day.” c. “I need to see the registered dietitian to discuss limiting my protein intake.” d. “It is important that I take my antihypertensive medications as directed.” ANS: B The client should not restrict fluids during the day due to increased urination at night. Clients with renal dis- ease may be prescribed fluid restrictions. These clients should be assessed thoroughly for potential dehydra- tion. Increased nocturnal voiding can be decreased by consuming fluids earlier in the day. Blood pressure con- trol is needed to slow the progression of renal dysfunction. When dietary protein is restricted, refer the client to the registered dietitian as needed. DIF: Applying/Application REF: 1405 KEY: Hypertension| hydration MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance 10. 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. Document the finding in the client’s record. b. Evaluate the tube as working in the hand-off report. c. Clamp the tube in preparation for removing it. d. Assess the client’s abdomen and vital signs. ANS: D 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 ab- domen for pain and distention and check vital signs so that this information can be reported as well. The other interventions are not appropriate. DIF: Applying/Application REF: 1399 KEY: Postoperative nursing MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential ...CONTINUED**