Brunner: Medical-Surgical Nursing, 11th Edition
TEST BANK
Chapter 44: Management of Patients With Kidney Disorders
Multiple Choice
1. The nurse of a patient diagnosed with acute glomerulonephritis. is aware that the patient may
exhibit which of the following clinical manifestations?
A) Hematuria
B) Decrease in serum creatinine levels
C) Hypotension
D) Glucosuria
Ans: A
Chapter: 44
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Patient Needs: D-4
Feedback: The primary presenting feature of acute glomerulonephritis is hematuria (blood in the
urine), which may be microscopic (identifiable through microscopic examination) or
macroscopic or gross (visible to the eye). Proteinuria, primarily albumin which is present, is due
to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum
creatinine levels may rise as urine output drops. The patient may be anemic primarily from fluid
retention. Some degree of edema and hypertension is noted in 75% of patients.
2. The patient is a 48-year-old man with acute renal failure. Which of the following is the most
common clinical manifestation of acute renal failure?
A) Decrease in BUN
B) Anuria
C) Oliguria
D) Decrease in serum creatinine
Ans: C
,Brunner: Medical-Surgical Nursing, 11th Edition
TEST BANK
Chapter: 44
Cognitive Level: Analysis
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 3
Patient Needs: D-4
Feedback: Acute renal failure manifests as oliguria, anuria, or normal urine volume. Oliguria
(less than 400 mL/d of urine) is the most common clinical situation seen in acute renal failure;
anuria (less than 50 mL/d of urine) and normal urine output are not as common. Regardless of
the volume of urine excreted, the patient with acute renal failure experiences rising serum
creatinine and BUN levels and retention of other metabolic waste products (azotemia) normally
excreted by the kidneys.
3. The patient with which of the following medical histories is at the greatest risk of developing
end-stage renal disease (ESRD)?
A) Polycystic kidney disease
B) Diabetes mellitus with poorly controlled hypertension
C) Vascular disorders
D) Respiratory infections
Ans: B
Chapter: 44
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Patient Needs: D-4
Feedback: Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic
glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in
polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may cause
ESRD. A patient with more than one of these risk factors is at the greatest risk for developing
ESRD.
4. The patient who has a history of systemic lupus erythematosus has been recently diagnosed
with ESRD. The patient has an elevated phosphorus level and has been prescribed calcium
acetate to bind the phosphorus. The nurse should instruct the patient to take the prescribed
phosphorus binding medication:
A) Only when needed
B) Daily at bedtime
C) 1 hour prior to meals
, Brunner: Medical-Surgical Nursing, 11th Edition
TEST BANK
D) With each meal
Ans: D
Chapter: 44
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 5
Patient Needs: D-2
Feedback: Both calcium carbonate and calcium acetate are medications that bind with the
phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate
levels. Phosphate binding medications must be administered with food to be effective.
5. To reduce the risk of infection in a patient with a transplanted kidney, it is imperative for the
nurse to:
A) Wash hands carefully and frequently
B) Ensure immediate function of the donated kidney
C) Instruct the patient to wear a face mask
D) Restrict visitors
Ans: A
Chapter: 44
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 6
Patient Needs: D-4
Feedback: The nurse ensures that the patient is protected from exposure to infection by hospital
staff, visitors, and other patients with active infections. Careful handwashing is imperative; face
masks may be worn by hospital staff and visitors to reduce the risk for transmitting infectious
agents while the patient is receiving high doses of immunosuppressants.
6. A postoperative kidney transplant patient asks the nurse what signs and symptoms most likely
indicate rejection. The nurse's best response is:
A) Oliguria
B) Shortness of breath
C) Decreasing blood pressure
D) Weight loss
Ans: A
TEST BANK
Chapter 44: Management of Patients With Kidney Disorders
Multiple Choice
1. The nurse of a patient diagnosed with acute glomerulonephritis. is aware that the patient may
exhibit which of the following clinical manifestations?
A) Hematuria
B) Decrease in serum creatinine levels
C) Hypotension
D) Glucosuria
Ans: A
Chapter: 44
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Patient Needs: D-4
Feedback: The primary presenting feature of acute glomerulonephritis is hematuria (blood in the
urine), which may be microscopic (identifiable through microscopic examination) or
macroscopic or gross (visible to the eye). Proteinuria, primarily albumin which is present, is due
to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum
creatinine levels may rise as urine output drops. The patient may be anemic primarily from fluid
retention. Some degree of edema and hypertension is noted in 75% of patients.
2. The patient is a 48-year-old man with acute renal failure. Which of the following is the most
common clinical manifestation of acute renal failure?
A) Decrease in BUN
B) Anuria
C) Oliguria
D) Decrease in serum creatinine
Ans: C
,Brunner: Medical-Surgical Nursing, 11th Edition
TEST BANK
Chapter: 44
Cognitive Level: Analysis
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 3
Patient Needs: D-4
Feedback: Acute renal failure manifests as oliguria, anuria, or normal urine volume. Oliguria
(less than 400 mL/d of urine) is the most common clinical situation seen in acute renal failure;
anuria (less than 50 mL/d of urine) and normal urine output are not as common. Regardless of
the volume of urine excreted, the patient with acute renal failure experiences rising serum
creatinine and BUN levels and retention of other metabolic waste products (azotemia) normally
excreted by the kidneys.
3. The patient with which of the following medical histories is at the greatest risk of developing
end-stage renal disease (ESRD)?
A) Polycystic kidney disease
B) Diabetes mellitus with poorly controlled hypertension
C) Vascular disorders
D) Respiratory infections
Ans: B
Chapter: 44
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Patient Needs: D-4
Feedback: Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic
glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in
polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may cause
ESRD. A patient with more than one of these risk factors is at the greatest risk for developing
ESRD.
4. The patient who has a history of systemic lupus erythematosus has been recently diagnosed
with ESRD. The patient has an elevated phosphorus level and has been prescribed calcium
acetate to bind the phosphorus. The nurse should instruct the patient to take the prescribed
phosphorus binding medication:
A) Only when needed
B) Daily at bedtime
C) 1 hour prior to meals
, Brunner: Medical-Surgical Nursing, 11th Edition
TEST BANK
D) With each meal
Ans: D
Chapter: 44
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 5
Patient Needs: D-2
Feedback: Both calcium carbonate and calcium acetate are medications that bind with the
phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate
levels. Phosphate binding medications must be administered with food to be effective.
5. To reduce the risk of infection in a patient with a transplanted kidney, it is imperative for the
nurse to:
A) Wash hands carefully and frequently
B) Ensure immediate function of the donated kidney
C) Instruct the patient to wear a face mask
D) Restrict visitors
Ans: A
Chapter: 44
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 6
Patient Needs: D-4
Feedback: The nurse ensures that the patient is protected from exposure to infection by hospital
staff, visitors, and other patients with active infections. Careful handwashing is imperative; face
masks may be worn by hospital staff and visitors to reduce the risk for transmitting infectious
agents while the patient is receiving high doses of immunosuppressants.
6. A postoperative kidney transplant patient asks the nurse what signs and symptoms most likely
indicate rejection. The nurse's best response is:
A) Oliguria
B) Shortness of breath
C) Decreasing blood pressure
D) Weight loss
Ans: A
