Chapter 48: Management of Patients with Kidney Disorders

1. The nurse is assessing a client suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem?

A. Hematuria

B. Precipitous decrease in serum creatinine levels

C. Hypotension unresolved by fluid administration

D. Glucosuria

A. Hematuria

2. The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform the health care provider that the client may be exhibiting signs of acute kidney injury (AKI)?

A. An inability to initiate voiding for 2 days.

B. The urine is cloudy and has visible sediment with a foul odor.

C. Average urine output has been 10 mL/hr for several hours.

D. Client reports left-sided flank pain.

C. Average urine output has been 10 mL/hr for several hours.

3. The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time?

A. Only when needed

B. Daily at bedtime

C. First thing in the morning

D. With each meal

D. With each meal

4. The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to take what action?

A. Wash hands carefully and frequently.

B. Ensure immediate function of the donated kidney.

C. Instruct the client to wear a face mask.

D. Bar visitors from the client's room.

A. Wash hands carefully and frequently.

5. The nurse is caring for a client receiving hemodialysis three times weekly. The client has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this client?

A. Using a stethoscope for auscultating the fistula is contraindicated

B. The client feels best immediately after the dialysis treatment

C. Taking a BP reading on the affected arm can damage the fistula

D. The client should not feel pain during initiation of dialysis

C. Taking a BP reading on the affected arm can damage the fistula

6. A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the client's chronic kidney disease is at what stage?

A. Stage 1

B. Stage 2

C. Stage 3

D. Stage 4

C. Stage 3

7. An inpatient client with acute kidney injury (AKI) has moderate edema to both legs. What resulting skin conditions would increase the client's likelihood of skin breakdown? Select all that apply.

A. Atopic dermatitis

B. Pruritus

C. Psoriasis

D. Urticaria

E. Excoriation

B. Pruritus

E. Excoriation

8. A client admitted with nephrotic syndrome is being cared for on the medical unit. When writing this client's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include?

A. Constipation related to immobility

B. Risk for injury related to altered thought processes

C. Hyperthermia related to the inflammatory process

D. Excess fluid volume related to generalized edema

D. Excess fluid volume related to generalized edema

9. The nurse coming on shift on the medical unit is taking a report on four clients. What client does the nurse know is at the greatest risk of developing ESKD?

A. A client with a history of polycystic kidney disease

B. A client with diabetes mellitus and poorly controlled hypertension

C. A client who is morbidly obese with a history of vascular disorders

D. A client with severe chronic obstructive pulmonary disease

B. A client with diabetes mellitus and poorly controlled hypertension

10. The nurse is caring for a client postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize?

A. Assessment of the quantity of the client's urine output

B. Assessment of the client's incision

C. Assessment of the client's abdominal girth

D. Assessment for flank or abdominal pain

A. Assessment of the quantity of the client's urine output

11. The nurse is caring for a client in acute kidney injury (AKI). Which complication would most clearly warrant the administration of polystyrene sulfonate?

A. Hypernatremia

B. Hypomagnesemia

C. Hyperkalemia

D. Hypercalcemia

C. Hyperkalemia

12. The nurse is caring for a client whose acute kidney injury (AKI) resulted from a prerenal cause. Which condition most likely caused this client's health problem?

A. Burns

B. Glomerulonephritis

C. Ureterolithiasis

D. Pregnancy

A. Burns

13. A client with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis?

A. "Hemodialysis is a treatment option that is usually required three times a week."

B. "Hemodialysis is a program that will require you to commit to daily treatment."

C. "This will require you to have surgery and a catheter will need to be inserted into your abdomen."

D. "Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again."

A. "Hemodialysis is a treatment option that is usually required three times a week."

14. A client with end-stage renal disease receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action?

A. Inform the health care provider and assess the client for signs of infection.

B. Flush the peritoneal catheter with normal saline.

C. Remove the catheter promptly and have the catheter tip cultured.

D. Administer a bolus of IV normal saline as prescribed

A. Inform the health care provider and assess the client for signs of infection

15. The nurse is planning client teaching for a client with end-stage kidney disease who is scheduled for the creation of a fistula. The nurse should teach the client what information about the fistula?

A. "A vein and an artery in your arm will be attached surgically."

B. "The arm should be immobilized for 4 to 6 days."

C. "One needle will be inserted into the fistula for each dialysis treatment."

D. "The fistula can be used 5 to 7 days after the surgery for dialysis treatment."

A. "A vein and an artery in your arm will be attached surgically."

16. A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client's diet to maximize the therapeutic effect and minimize the risks of complications. The client's diet should include which of the following modifications? Select all that apply.

A. Decreased protein intake

B. Decreased sodium intake

C. Increased potassium intake

D. Fluid restriction

E. Vitamin D supplementation

A. Decreased protein intake

B. Decreased sodium intake

D. Fluid restriction

17. A client is scheduled for a CT scan of the abdomen with contrast. The client has a baseline creatinine level of 2.3 mg/dL (203 mol/L). In preparing this client for the procedure, the nurse anticipates what orders?

A. Monitor the client's electrolyte values every hour before the procedure.

B. Provide adequate hydration before the procedure

C. Start hemodialysis immediately prior to the CT scan

D. Obtain a creatinine clearance by collecting a 24-hour urine specimen.

B. Provide adequate hydration before the procedure

18. A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client's hypervolemia and hyperkalemia. Which of the following therapies will the client's hemodynamic status best tolerate?

A. Hemodialysis

B. Peritoneal dialysis

C. Continuous venovenous hemodialysis (CVVHD)

D. Plasmapheresis

C. Continuous venovenous hemodialysis (CVVHD)

19. A client has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the client about what priority topic?

A. Typical diet

B. Allergy status

C. Psychosocial stressors

D. Current medication use

D. Current medication use

20. An older adult client diagnosed with cancer is admitted to the oncology unit for surgical treatment. The client has been on chemotherapeutic agents to decrease tumor size prior to the planned surgery. The nurse caring for the client is aware that what precipitating factors in this client may contribute to acute kidney injury (AKI)? Select all that apply.

A. Anxiety and agitation

B. Low body mass index (BMI)

C. Age-related physiologic changes

D. Chronic systemic disease

E. Nothing by mouth (NPO) status

C. Age-related physiologic changes

D. Chronic systemic disease

E. Nothing by mouth (NPO) status

21. A client is being treated for AKI and the client daily weights have been ordered. The nurse notes a weight gain of 3 pounds (1.4 kg) over the past 48 hours. What nursing diagnosis is suggested by this assessment finding?

A. Imbalanced nutrition: More than body requirements

B. Excess fluid volume

C. Sedentary lifestyle

D. Adult failure to thrive

B. Excess fluid volume

22. A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event?

A. Psychosocial stress

B. Hypersensitivity to an immunization

C. Menarche

D. Streptococcal infection

D. Streptococcal infection

23. A client on the medical unit has a documented history of polycystic kidney disease (PKD). What principle should guide the nurse's care of this client?

A. The disease is self-limiting and cysts usually resolve spontaneously in the fifth or sixth decade of life.

B. The client's disease is incurable and the nurse's interventions will be supportive.

C. The client will eventually require surgical removal of his or her renal cysts.

D. The client is likely to respond favorably to lithotripsy treatment of the cysts.

B. The client's disease is incurable and the nurse's interventions will be supportive.

24. The nurse is providing a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants' risks of renal carcinoma?

A. Avoiding heavy alcohol use

B. Control of sodium intake

C. Smoking cessation

D. Adherence to recommended immunization schedules

C. Smoking cessation

25. The nurse performing the health interview of a client with a new onset of periorbital edema has completed a genogram, noting the health history of the client's siblings, parents, and grandparents. This assessment addresses the client's risk of what kidney disorder?

A. Nephritic syndrome

B. Acute glomerulonephritis

C. Nephrotic syndrome

D. Polycystic kidney disease (PKD)

D. Polycystic kidney disease (PKD)

26. A client is brought to the renal unit from the PACU status postresection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this client?

A. Increasing oral intake

B. Managing postoperative pain

C. Managing dialysis

D. Increasing mobility

B. Managing postoperative pain

27. A nurse is caring for a client who is in the diuresis phase of acute kidney injury. The nurse should closely monitor the client for what complication during this phase?

A. Hypokalemia

B. Hypocalcemia

C. Dehydration

D. Acute flank pain

C. Dehydration

28. The nurse is caring for a client's status after a motor vehicle accident. The client has developed AKI. What are the nurse's roles in caring for this client? Select all that apply.

A. Providing emotional support for the family

B. Monitoring for complications

C. Participating in emergency treatment of fluid and electrolyte imbalances

D. Providing nursing care for primary disorder (trauma)

E. Directing nutritional interventions

A. Providing emotional support for the family

B. Monitoring for complications

C. Participating in emergency treatment of fluid and electrolyte imbalances

D. Providing nursing care for primary disorder (trauma)

29. A 76-year-old client with ESKD has been told by the health care provider that it is time to consider hemodialysis until a transplant can be found. The client tells the nurse about feeling unsure about undergoing a kidney transplant. What would be an appropriate response for the nurse to make?

A. "The decision is certainly yours to make, but be sure not to make a mistake."

B. "Kidney transplants in peoples your age are as successful as they are in younger clients."

C. "I understand your hesitancy to commit to a transplant surgery. Success is relatively rare."

D. "Have you talked this over with your family?"

B. "Kidney transplants in peoples your age are as successful as they are in younger clients."

30. The nurse has identified the nursing diagnosis of "Risk for Infection" in a client who undergoes peritoneal dialysis. What nursing action best addresses this risk?

A. Maintain aseptic technique when administering dialysate.

B. Wash the skin surrounding the catheter site with soap and water prior to each exchange.

C. Add antibiotics to the dialysate as prescribed.

D. Administer prophylactic antibiotics by mouth or IV as prescribed.

A. Maintain aseptic technique when administering dialysate.

31. The nurse is caring for a client who has returned to the postsurgical suite after postanesthetic recovery from a nephrectomy. The nurse's most recent assessment reveals increased sedation, shortness of breath, hypotension, and low urine output over the last 2 hours. What is the nurse's best response?

A. Assess the client for signs of bleeding and inform the primary provider.

B. Perform a full neurological assessment and notify the primary care provider.

C. Increase the frequency of taking vital signs, monitor urine output, and notify the provider.

D. Palpate the client's torso bilaterally for flank pain and notify the primary care provider.

A. Assess the client for signs of bleeding and inform the primary provider.

32. The critical care nurse is monitoring the client's urine output and drains following renal surgery. What should the nurse promptly report to the primary care provider?

A. Increased pain on movement

B. Absence of drain output

C. Increased urine output

D. Blood-tinged serosanguineous drain output

B. Absence of drain output

33. The nurse is creating an education plan for a client who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan?

A. The importance of increased fluid intake

B. Signs and symptoms of rejection

C. Inspection and care of the incision

D. Techniques for preventing metastasis

C. Inspection and care of the incision

34. A client with end stage renal disease (ESKD) is being treated for a right ankle fracture unrelated to a fall. The client's lab values show high phosphate levels, low calcium levels, and low vitamin D levels. What is the most likely reason for this client's fracture?

A. Osteoporosis

B. Codman triangle

C. Hypertrophic osteoarthropathy

D. Renal osteodystrophy

D. Renal osteodystrophy

35. The nurse is caring for a client who has just returned to the postsurgical unit following renal surgery. When assessing the client's output from surgical drains, the nurse should physically assess what parameter(s)? Select all that apply.

A. Quantity of output

B. Color of the output

C. Visible characteristics of the output

D. Specific gravity of the output

E. Potential hydrogen (pH) of the output

A. Quantity of output

B. Color of the output

C. Visible characteristics of the output

36. The nurse is caring for a client after kidney surgery. When assessing for bleeding, what assessment parameter should the nurse evaluate?

A. Oral intake

B. Pain intensity

C. Level of consciousness

D. Radiation of pain

C. Level of consciousness

37. A nurse is providing education to the family of a client beginning peritoneal dialysis. The family ask questions concerning catheter placement and stabilization. Which information will the nurse provide about the cuffs? Select all that apply.

A. The cuffs are constructed of Dacron polyester material.

B. The cuffs will help stabilize the catheter.

C. The cuffs prevent the dialysate from leaking.

D. The cuffs provide a barrier against microorganisms.

E. The cuffs will absorb the dialysate.

A. The cuffs are constructed of Dacron polyester material.

B. The cuffs will help stabilize the catheter.

C. The cuffs prevent the dialysate from leaking.

D. The cuffs provide a barrier against microorganisms.

38. A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action?

A. Advance the catheter 2 to 4 cm further into the peritoneal cavity.

B. Reposition the client to facilitate drainage.

C. Aspirate from the catheter using a 60-mL syringe.

D. Infuse 50 mL of additional dialysate.

B. Reposition the client to facilitate drainage.