Renal System

Question 1

Differentiate between ARF and CRF.

Answer 1

Acute renal failure - often reversible, abrupt deterioration of kidney function.
Chronic renal failure - irreversible, slow deterioration of kidney function characterized by increasing BUN and creatinine. Eventually dialysis is required.

Question 2

During the oliguric phase of renal failure, protein should be severely restricted. What is the rationale for this restriction?

Answer 2

Toxic metabolites that accumulate in the blood (urea, creatinine) are derived mainly from protein catabolism.

Question 3

Identify two nursing interventions for the client on hemodialysis.

Answer 3

Do not take BP or perform venipuncture on the arm with the AV shunt, fistula, or graft.
Assess access site for thrill and bruit.

Question 4

A client in renal failure asks why antacids are being given. How should the nurse reply?

Answer 4

Calcium and aluminum antacids bind phosphates and help keep phosphates from being absorbed into bloodstream, thereby preventing rising phosphate levels, must be taken with meals.

Question 5

List four essential elements of a teaching plan for clients with frequent UTIs.

Answer 5

Fluid intake 3 L/day
Good handwashing
Void every 2-3 hours during waking hours
Take all prescribed medications
Wear cotton undergarments

Question 6

What are the most important nursing interventions for clients with possible renal calculi?

Answer 6

Straining all urine is the most important intervention.
Other interventions include accurate I&O documentation and administering analgesics as needed.

Question 7

What discharge instructions should be given to a client who has had urinary calculi?

Answer 7

Maintain high fluid intake of 3-4 L/day.
Pursue follow-up care (stones tend to recure).
Follow prescribed diet based on calculi content.
Avoid supine position.

Question 8

After TURP, hematuria should subside by what postoperative day?

Answer 8

The fourth day

Question 9

After the urinary catheter is removed in the TURP client, what are three priority nursing actions?

Answer 9

Continued strict I&O.
Continued observations for hematuria.
Inform client burning and frequency is a possible outcome and may last up to a week.

Question 10

After kidney surgery, what are the primary assessments the nurse should make?

Answer 10

Respiratory status - breathing is guarded because of pain
Circulatory status - the kidney is very vascular and excessive bleeding can occur
Pain assessment
Urinary assessment - most important, assessment of urinary output