Chapter 44

Question 1

A nursing instructor is talking with her clinical group about patients with acute glomerulonephritis. The instructor tells the students that the patient may exhibit which of the following clinical manifestations?

Answer 1

Hematuria

Question 2

You are caring for a patient with acute renal failure. What is the most common clinical manifestation of acute renal failure?

Answer 2

Oliguria

Question 3

The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently diagnosed with ESRD. The patient has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. What is an important instruction that the nurse should give the patient about how to take the prescribed phosphorus-binding medication?

Answer 3

With each meal

Question 4

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

Answer 4

Wash hands carefully and frequently.

Question 5

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

Answer 5

Taking a blood pressure reading on the affected arm can cause clotting of the fistula.

Question 6

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

Answer 6

Stage 3

Question 7

A college football player is brought to the emergency room by paramedics after a blunt trauma injury received during a game. There is a high suspicion that the patient has sustained an injury to his kidneys from being tackled from behind. The emergency room nurse caring for the patient reviews the initial orders written by the physician and notes that an order has been written to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important because

Answer 7

Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.

Question 8

A patient admitted with nephrotic syndrome is being cared for on your unit. When writing this patient’s care plan, based upon the major clinical manifestation of nephrotic syndrome, what nursing diagnosis would you include?

Answer 8

Excess fluid volume related to generalized edema

Question 9

The nurse coming on shift is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing end-stage renal disease (ESRD)?

Answer 9

Diabetes mellitus with poorly controlled hypertension

Question 10

A patient waiting for a kidney transplant asks the nurse what signs and symptoms most likely indicate rejection. What would be the nurse’s best response?

Answer 10

“Oliguria is a sign of rejection.”

Question 11

The nurse is caring for a patient in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:

Answer 11

Hyperkalemia.

Question 12

Renal failure can have prerenal, renal, or postrenal causes. A patient presents with acute renal failure and is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it?

Answer 12

Heart failure

Question 13

A 45-year-old man with diabetic nephropathy has end-stage renal failure and is starting dialysis. He asks for information about hemodialysis. What would the nurse include in the teaching for this patient?

Answer 13

Hemodialysis is a treatment option that is required three times a week

Question 14

A patient is receiving patient education prior to beginning continuous ambulatory peritoneal dialysis. What would the nurse teach the patient that the most common complication associated with this procedure is

Answer 14

Peritonitis

Question 15

The nurse is planning patient teaching for a patient with end-stage renal disease who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula?

Answer 15

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

Question 16

A patient with ESRD is scheduled for his first hemodialysis treatment. The patient asks the nurse what common complications may occur from the treatment. What would be the nurse’s best reply?

Answer 16

“Hypotension and cramping may occur.”

Question 17

A living organ donor is 1 hour postoperative after donating a kidney. The critical care nurse caring for the patient notes that the patient is clammy and pale. The nurse knows the patient is exhibiting symptoms of what?

Answer 17

Shock

Question 18

A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders?

Answer 18

Preprocedure hydration and administration of acetylcysteine

Question 19

The nurse caring for a patient with acute glomerulonephritis would expect the patient’s urine to what?

Answer 19

Have a cola-color

Question 20

A patient is admitted to the intensive care unit after a motor vehicle accident. On the second day of the hospital admission, the patient develops acute renal failure. The patient is hemodynamically unstable, but renal replacement therapy is needed to manage the patient’s hypervolemia and hyperkalemia. Which of the following therapies will the patient’s hemodynamic status best tolerate?

Answer 20

Continuous venovenous hemodialysis (CVVHD)

Question 21

A specific disease process is a major cause of CKD and ESRD. It is a disease that develops usually after prolonged hypertension and diabetes. What disease process is this?

Answer 21

Nephrosclerosis

Question 22

A 16-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. What is a cause of postinfectious glomerular disease?

Answer 22

Group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks

Question 23

A patient presents at the walk-in clinic complaining of edema around the eyes and flank tenderness bilaterally. Acute glomerular inflammation is suspected. What tests would the nurse expect to be ordered to confirm the diagnosis?

Answer 23

Urinalysis

Question 24

The nurse is caring for a patient with chronic glomerulonephritis. What can cause chronic glomerulonephritis?

Answer 24

of acute nephritic syndrome

Question 25

What disease of the kidney is genetic in nature and leads to kidney failure?

Answer 25

Polycystic kidney disease

Question 26

A patient is brought to the renal unit from the PACU status post resection of a renal tumor. What would be a priority nursing action in the care of this patient?

Answer 26

Management of postoperative pain

Question 27

A nurse is caring for a renal patient in the dieresis period of ARF. What must the patient be observed closely for during this phase?

Answer 27

Dehydration

Question 28

A 71-year-old patient has ESRD and has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The patient tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to make?

Answer 28

“Kidney transplants in patients your age are as successful as they are in younger patients.”

Question 29

Peritonitis is a common and dangerous complication of peritoneal dialysis. What is a nursing action that helps these patients fight peritonitis?

Answer 29

Aminoglycosides are added to the dialysate for subsequent exchanges.

Question 30

The critical care nurse is monitoring her patient’s urine output and drainage from tubes inserted intraoperatively. What would the nurse promptly report to the physician?

Answer 30

Absent drainage

Question 31

You are writing a teaching plan for a patient you are caring for status post resection of a renal tumor. What would you include in that teaching plan?

Answer 31

To inspect and care for the incision

Question 32

A patient, status post resection of renal tumor, is being discharged home. You are planning discharge for this patient. What would you include in a teaching plan for this patient?

Answer 32

Continuing care

Question 33

The nurse is caring for a postoperative kidney surgery patient. The nurse is aware that bleeding is a major complication of kidney surgery and that if it goes undetected and untreated the result can be hypovolemia and hemorrhagic shock in the patient. What assessment parameters are necessary to assess for bleeding in this postoperative patient?

Answer 33

Oral intake

Question 34

A critical care nurse is caring for a trauma patient who has gone into acute renal failure. The critical care nurse knows that he can set up, initiate, maintain, and terminate what system of dialysis for this patient?

Answer 34

Continuous venovenous hemofiltration