Chapter 58, Caring for Clients With Disorders of the Kidneys.
1.The nurse performs a physical examination on a client diagnosed with acute
pyelonephritis to assist in determining which of the following?
A) Abnormalities in urine
B) Location of discomfort
C) Elevated calcium levels
D) Structural defects in the kidneys
Ans: B
Feedback:
The physical examination of a client with pyelonephritis helps the nurse determine the
location of discomfort and signs of fluid retention, such as peripheral edema or shortness
of breath. Observing and documenting the characteristics of the client's urine helps the
nurse detect abnormalities in the urine. Laboratory blood tests reveal elevated calcium
levels, whereas radiography and ultrasonography depict structural defects in the kidneys.
2.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?
A) Disconnect the catheter and reapply.
B) Loosen the tubing clamp.
C) Inform the physician that catheter may need repositioning.
D) Stop the process for 5 minutes and resume
later. Ans: C
Feedback:
The nurse instills dialysate solution and clamps the tubing. If the return flow rate is slow,
the nurse asks the client to move from side to side. If this maneuver is unsuccessful, the
physician may need to reposition the catheter. The nurse should not tamper with the
catheter settings because this may worsen the client's condition or damage the apparatus.
Also, stopping the process and resuming it after 5 minutes will not help increase the
return flow of the dialysate.
3. The nurse is caring for several older clients. Which client would the nurse be
especially alert for signs and symptoms of pyelonephritis?
A) A client with acute renal failure
B) A client with a urinary tumor
C) A female client with preexisting chronic glomerulonephritis
D) A client with urinary obstruction
Ans: D
Feedback:
The client with urinary obstruction is at the highest risk of developing pyelonephritis
because a urinary obstruction is the most common cause of pyelonephritis in older adults.
Acute glomerulonephritis usually occurs in older adults with preexisting chronic
glomerulonephritis. Older clients with acute renal failure or urinary tumor are not at high
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, Chapter 58, Caring for Clients With Disorders of the Kidneys.
risk for developing pyelonephritis.
4. 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?
A) Periorbital edema
B) Anasarca
C) Uremic frost
D) Hydronephrosis
Ans: B
Feedback:
Generalized edema known as anasarca is a common finding with chronic
glomerulonephritis. Periorbital edema refers to puffiness around the eyes. Uremic frost is
a precipitate that forms on the skin in clients with chronic renal failure. Hydronephrosis
refers to a condition involving distention of the renal pelvis.
5.A client is diagnosed with polycystic kidney disease. Which of the following would the
nurse most likely assess?
A) Hypertension
B) Flank pain
C) Fever
D) Periorbital edema
Ans: A
Feedback:
Hypertension is present in approximately 75% of clients with polycystic kidney disease at
the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and
abdominal pain also may be noted based on the size and effects of the cysts. Fever would
suggest an infection. Periorbital edema is noted with acute glomerulonephritis.
6.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?
A) Acute glomerulonephritis
B) Ureteral stricture
C) Urinary calculi
D) Renal cell carcinoma
Ans: C
Feedback:
Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones
may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the
suprapubic region and external genitalia is the classic symptom of urinary calculi. The
pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the
stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the
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1.The nurse performs a physical examination on a client diagnosed with acute
pyelonephritis to assist in determining which of the following?
A) Abnormalities in urine
B) Location of discomfort
C) Elevated calcium levels
D) Structural defects in the kidneys
Ans: B
Feedback:
The physical examination of a client with pyelonephritis helps the nurse determine the
location of discomfort and signs of fluid retention, such as peripheral edema or shortness
of breath. Observing and documenting the characteristics of the client's urine helps the
nurse detect abnormalities in the urine. Laboratory blood tests reveal elevated calcium
levels, whereas radiography and ultrasonography depict structural defects in the kidneys.
2.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?
A) Disconnect the catheter and reapply.
B) Loosen the tubing clamp.
C) Inform the physician that catheter may need repositioning.
D) Stop the process for 5 minutes and resume
later. Ans: C
Feedback:
The nurse instills dialysate solution and clamps the tubing. If the return flow rate is slow,
the nurse asks the client to move from side to side. If this maneuver is unsuccessful, the
physician may need to reposition the catheter. The nurse should not tamper with the
catheter settings because this may worsen the client's condition or damage the apparatus.
Also, stopping the process and resuming it after 5 minutes will not help increase the
return flow of the dialysate.
3. The nurse is caring for several older clients. Which client would the nurse be
especially alert for signs and symptoms of pyelonephritis?
A) A client with acute renal failure
B) A client with a urinary tumor
C) A female client with preexisting chronic glomerulonephritis
D) A client with urinary obstruction
Ans: D
Feedback:
The client with urinary obstruction is at the highest risk of developing pyelonephritis
because a urinary obstruction is the most common cause of pyelonephritis in older adults.
Acute glomerulonephritis usually occurs in older adults with preexisting chronic
glomerulonephritis. Older clients with acute renal failure or urinary tumor are not at high
Page 1
, Chapter 58, Caring for Clients With Disorders of the Kidneys.
risk for developing pyelonephritis.
4. 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?
A) Periorbital edema
B) Anasarca
C) Uremic frost
D) Hydronephrosis
Ans: B
Feedback:
Generalized edema known as anasarca is a common finding with chronic
glomerulonephritis. Periorbital edema refers to puffiness around the eyes. Uremic frost is
a precipitate that forms on the skin in clients with chronic renal failure. Hydronephrosis
refers to a condition involving distention of the renal pelvis.
5.A client is diagnosed with polycystic kidney disease. Which of the following would the
nurse most likely assess?
A) Hypertension
B) Flank pain
C) Fever
D) Periorbital edema
Ans: A
Feedback:
Hypertension is present in approximately 75% of clients with polycystic kidney disease at
the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and
abdominal pain also may be noted based on the size and effects of the cysts. Fever would
suggest an infection. Periorbital edema is noted with acute glomerulonephritis.
6.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?
A) Acute glomerulonephritis
B) Ureteral stricture
C) Urinary calculi
D) Renal cell carcinoma
Ans: C
Feedback:
Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones
may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the
suprapubic region and external genitalia is the classic symptom of urinary calculi. The
pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the
stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the
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