Chapter 54Renal Dysfunction: Nursing Management My Nursing Test Banks

Chapter 54Renal Dysfunction: Nursing Management

MULTIPLE CHOICE

1.The nurse, caring for a client diagnosed with pyelonephritis, realizes that common risk factors for the development of this disorder include all of the following EXCEPT:

1.

urinary retention.

2.

urinary calculi.

3.

prostate gland hypertrophy.

4.

orthostatic hypotension.

ANS: 4

One of the causes of pyelonephritis is urinary retention. Causes of urinary retention are prostate gland hypertrophy, masses, urinary calculi, or ureteral obstruction. Orthostatic hypotension does not cause pyelonephritis.

PTS: 1 DIF: Analyze REF: Pyelonephritis: Etiology

2.A client is diagnosed with autosomal dominant polycystic kidney disease. During data collection, which assessment finding would the nurse expect to discover?

1.

Decreasing abdominal girth and proteinuria

2.

Urinary tract infection and hypotension

3.

Pain and hematuria

4.

Irregularly shaped kidney and glucosuria

ANS: 3

Pain and hematuria are common manifestations of autosomal dominant polycystic kidney disease. Other signs may include increasing abdominal girth, proteinuria, urinary tract infection, hypertension, and enlarged, irregularly shaped kidneys.

PTS:1DIF:Apply

REF: Polycystic Kidney Disease: Assessment with Clinical Manifestations

3.A client is being prescribed medication to treat polycystic kidney disease. Which of the following medications would be indicated for this client?

1.

Cephalosporin

2.

Antifungal

3.

Antihypertensive

4.

Antiarrhythmic

ANS: 1

Cephalosporins are considered first line antibiotics for management of cysts with polycystic kidney disease. Antifungal, antihypertensives, and antiarrhythmic medications are not used to treat this disorder.

PTS:1DIF:Apply

REF: Box 54-1 Antibiotic Therapy for Infected Cysts in Patients with Polycystic Kidney Disease

4.A client is diagnosed with resistant polycystic kidney disease. The medications which may be indicated for this client would be:

1.

penicillin and aminoglycosides.

2.

clindamycin and gentamicin.

3.

metolazone and amiloride.

4.

pyridium and urogesic.

ANS: 2

Clindamycin and gentamicin are lipid-soluble antibiotics used to penetrate the resistant cysts. Penicillin and aminoglycosides are part of the first-line management of polycystic kidney disease. Metolazone and amiloride are diuretics. Pyridium and Urogesic are nonopioid analgesics.

PTS:1DIF:Analyze

REF: Box 54-1 Antibiotic Therapy for Infected Cysts in Patients with Polycystic Kidney Disease

5.A client is diagnosed with rhabdomyolysis. The nurse realizes that an emergency condition that may occur with this diagnosis would be:

1.

shortness of breath.

2.

joint aches.

3.

pulmonary hemorrhage.

4.

compartment syndrome.

ANS: 4

Rhabdomyolysis is a condition of muscle tissue destruction. Compartment syndrome may develop with extensive muscle damage. Shortness of breath, joint aches, and pulmonary hemorrhage are assessment findings of Wegeners granulomatosis.

PTS: 1 DIF: Analyze REF: Rhabdomyolysis: Etiology; Pathophysiology

6.During the admitting assessment process, a client asks, What is oliguria? Based on the nurses knowledge, the best response would be:

1.

Oliguria is a urine output less than 50 mL in 24 hours.

2.

Oliguria is a urine output less than 250 mL in 24 hours.

3.

Oliguria is a urine output less than 400 mL in 24 hours.

4.

Oliguria is a decreased urine output indicative of disease.

ANS: 3

Oliguria is a decrease in urine output; however, this response is not specific enough. Oliguria demonstrates a urine output of 400 mL/24 hours. Anuria is a urine output of 50 mL/24 hours. Even though a urine output of less than 250 mL in 24 hours would be considered oliguria, the definition is that of less than 400 mL of urine within 24 hours.

PTS: 1 DIF: Apply REF: Acute Renal Failure: Pathophysiology

7.A client is diagnosed with acute renal failure. Which of the following diagnostic studies will the nurse be most concerned with?

1.

Blood glucose and HbA1c

2.

Toxicology screening and chloride level

3.

Potassium and digitalis levels

4.

Chest x-ray study and magnesium level

ANS: 3

A client who is prescribed digitalis who also has a low potassium level can experience cardiac arrest. Blood glucose and HbA1c are tests usually performed on the patient with diabetes mellitus. Toxicology screening and chloride level could be assessed for a variety of health problems. Chest x-ray and magnesium level can be assessed for a variety of health problems.

PTS:1DIF:Analyze

REF: Table 54-2 Alterations in ARF/AKI and the Mechanisms of the Alterations

8.A client has been prescribed a restricted potassium diet. An appropriate snack for the client would be:

1.

banana.

2.

applesauce.

3.

orange juice.

4.

dried dates.

ANS: 2

Bananas, oranges, and dried fruit are high-potassium food sources. Applesauce is the low-potassium snack.

PTS:1DIF:Apply

REF: Acute Renal Failure/Acute Kidney Injury: Nutrition

9.A client diagnosed with chronic renal failure is prescribed a diet low in protein. The rationale for this diet is that:

1.

protein sources are broken down and converted to urea, which is then filtered by the kidney.

2.

protein sources are of low biological value.

3.

protein increases calcium and sodium levels.

4.

deficit protein metabolism breaks down muscle tissue.

ANS: 1

Protein in the diet increases the amount of nitrogen waste the kidney must handle. Protein does not have low biological value. Protein does not increase calcium and sodium levels. A deficit in protein metabolism does not break down muscle tissue.

PTS: 1 DIF: Analyze REF: Chronic Renal Failure: Nutrition

10.A client diagnosed with chronic renal failure asks the nurse, Whats the difference between hemodialysis and peritoneal dialysis? Which of the following statements best explains the difference?

1.

Hemodialysis is done three times a week and lasts 3 to 4 hours; peritoneal dialysis is done daily.

2.

Hemodialysis uses a graft or fistula and pumps blood through a semipermeable membrane in a hemodialyzer as the filter. Peritoneal dialysis uses the peritoneal lining of the abdominal cavity as the filter.

3.

Hemodialysis and peritoneal dialysis use different equipment.

4.

There are different dietary requirements for hemodialysis and peritoneal dialysis.

ANS: 2

All are differences between hemodialysis and peritoneal dialysis; however, hemodialysis uses a graft or fistula and pumps blood through a semipermeable membrane in a hemodialyzer as the filter. Peritoneal dialysis uses the peritoneal lining of the abdominal cavity as the filter explains the mechanism between hemodialysis and peritoneal dialysis.

PTS:1DIF:Apply

REF: Chronic Renal Failure: Hemodialysis; Peritoneal Dialysis and Chronic Ambulatory Peritoneal Dialysis

11.The nurse would expect that a client recovering from a kidney transplant would be prescribed all the following medications EXCEPT:

1.

prednisone.

2.

cyclosporine.

3.

azathioprine.

4.

vancomycin.

ANS: 4

Prednisone, cyclosporine, and azathioprine are common medications prescribed for renal transplant clients. Vancomycin can be nephrotoxic.

PTS: 1 DIF: Analyze REF: Chronic Renal Failure: Renal Transplantation

12.A client diagnosed with acute renal failure from an intrarenal cause should be instructed to:

1.

expect blood in the urine.

2.

avoid using NSAIDs.

3.

increase fluids.

4.

maintain a normal activity schedule.

ANS: 2

NSAIDs contribute to intrarenal vascular constriction. Clients with this disorder should be instructed to avoid using NSAIDs. The client diagnosed with acute renal failure from an intrarenal cause should not expect blood in the urine, to increase fluids, or to maintain a normal activity schedule.

PTS: 1 DIF: Apply REF: Table 54-1 Etiology of ARF/AKI

13.A client diagnosed with acute renal failure has a magnesium level of 1.0 mg/dL Which of the following will the nurse most likely assess in this client?

1.

Broad, flat T-waves

2.

ST depression

3.

Prolonged QT

4.

No clinical signs

ANS: 4

Magnesium blood levels may be low in the client diagnosed with acute renal failure, or there may be no clinical signs associated with this level. The other choices are clinical signs associated with hypokalemia.

PTS:1DIF:Apply

REF: Table 54-2 Alterations in ARF/AKI and the Mechanisms of the Alterations

14.After the nurse provides a client diagnosed with acute renal failure with Kayexalate 30 grams by mouth, the client begins to experience frequent loose bowel movements. Which of the following does this clients response indicate to the nurse?

1.

The client needs to be treated with insulin and dextrose.

2.

The client needs to receive sodium bicarbonate.

3.

The client needs an additional dose of Kayexalate.

4.

The client is experiencing a response that is indicative of successful treatment.

ANS: 4

After receiving an oral dose of Kayexalate, loose bowel movements should occur. This is indicative of successful treatment. The client does not need to be treated with insulin and dextrose. The client does not need to receive sodium bicarbonate. The client does not need an additional dose of Kayexalate unless the potassium level remains elevated.

PTS: 1 DIF: Analyze REF: Box 54-3 Management of Hyperkalemia

MULTIPLE RESPONSE

1.The nurse is assessing circulation through a clients arteriovenous shunt. Which of the following are signs of a patent site? (Select all that apply.)

1.

Normal blood pressure

2.

Positive bruit

3.

Pulse present distal to the site

4.

Dry dressing

5.

Palpable thrill

6.

Good skin turgor

ANS: 2, 5

A positive bruit and palpable thrill indicate potential site patency. Blood pressure and a dry dressing do not assess circulation to the shunt. Good skin turgor does not indicate good circulation through the shunt. A pulse present distal to the site is a normal finding that does not indicate site patency.

PTS:1DIF:Analyze

REF:Box 54-7 Management of Vascular Access Devices in Dialysis

2.For a client to be diagnosed with Anti-Glomerular Basement Membrane disease, the nurse realizes that which of the following characteristics must be present? (Select all that apply.)

1.

Antiglomerular basement membrane (GBM) antibodies

2.

Sinus infection

3.

Pulmonary hemorrhage

4.

Proliferative glomerulonephritis

5.

Increased heart rate

6.

Rapidly dropping blood pressure

ANS: 1, 3, 4

Anti-glomerular basement membrane disease must include the three characteristics of proliferative glomerulonephritis, pulmonary hemorrhage, and the presence of anti-GBM antibodies. Sinus infection is an assessment finding of Wegeners granulomatosis. Increased heart rate and rapidly dropping blood pressure are not characteristics of this disorder.

PTS: 1 DIF: Analyze REF: Anti-GBM Disease (Goodpastures Syndrome)

3.During discharge teaching with a client diagnosed with autosomal dominant polycystic kidney disease, the nurse should stress which of the following points? (Select all that apply.)

1.

Take more tub baths.

2.

Void frequently.

3.

Practice good perineal hygiene.

4.

Void after intercourse.

5.

Take showers.

6.

Limit fluids.

ANS: 2, 3, 4, 5

Tub baths should be avoided for female patients. The client should not be instructed to limit fluids. Discharge teaching should include frequent voiding, good perineal hygiene, voiding after intercourse, and taking showers instead of tub baths.

PTS:1DIF:Apply

REF: Polycystic Kidney Disease: Patient and Family Teaching

4.The nurse is caring for a client diagnosed with pyelonephritis. Which of the following are appropriate interventions that the nurse should perform? (Select all that apply.)

1.

Ensure adequate hydration.

2.

Monitor vital signs and fluid balance.

3.

Insert a urinary catheter.

4.

Provide urinary antiseptics.

5.

Monitor electrolytes and creatinine level.

6.

Monitor hemoglobin level.

ANS: 1, 2, 4, 5

The nurse should ensure the client has adequate hydration. The nurse should monitor the clients vital signs, fluid balance, electrolytes, and creatinine level. Urinary antiseptics should be provided as prescribed. A urinary catheter is discouraged because of the risk of urinary tract infection. Monitoring of the hemoglobin level is not necessary with this disorder.

PTS:1DIF:Apply

REF: Pyelonephritis: Collaborative Management Including Nursing Intervention Classifications (NIC)

5.The nurse is caring for a client diagnosed with chronic renal failure. Which of the following would be considered expected manifestations of this disorder? (Select all that apply.)

1.

Left ventricular dysfunction

2.

Anemia

3.

Diarrhea

4.

Constipation

5.

Prickly burning sensation of the extremities

6.

Restless legs

ANS: 1, 2, 4, 5, 6

Clinical manifestations for a client diagnosed with chronic renal failure are many. Some of these manifestations include left ventricular dysfunction, anemia, constipation; prickly burning sensation of the extremities, and restless legs. Diarrhea is not a common clinical manifestation of this disorder.

PTS:1DIF:Analyze

REF:Table 54-5 Clinical Manifestations of Chronic Kidney Failure

6.A client is diagnosed with Wegeners granulomatosis. Which of the following will the nurse most likely assess in this client? (Select all that apply.)

1.

Shortness of breath and cough

2.

Tinnitus

3.

Abdominal pain

4.

Conjunctivitis

5.

Muscle aches

6.

Vomiting

ANS: 1, 2, 4, 5

Assessment findings that may be present in Wegeners granulomatosis include upper and lower respiratory symptoms such as shortness of breath and cough, hearing deficit and tinnitus, visual disturbances or conjunctivitis,  and joint and muscle aches. Abdominal pain and vomiting are not associated with this disorder.

PTS:1DIF:Apply

REF: Skills 360: Assessment of Wegeners Granulomatosis

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