Deck 28: Nursing Care of Patients With Kidney Disorders

Question 1

A patient with chronic kidney disease is trying to decide between hemodialysis and peritoneal dialysis. What should the nurse encourage the patient to consider as advantages of peritoneal dialysis?

A) minimal vascular complications
B) liberal intake of fluids
C) better self-management
D) better metabolite elimination
E) lower risk of infection

Answer 1

minimal vascular complications
liberal intake of fluids
better self-management

Question 2

A patient who received a kidney transplant seven years ago is seen for increasing blood pressure and proteinuria. The nurse realizes that this patient is demonstrating signs of what health problem?

A) chronic rejection
B) acute rejection
C) renal artery stenosis
D) pyelonephritis

Answer 2

chronic rejection

Question 3

An older patient is admitted to the hospital with cardiac complications associated with diabetes. What should be of concern to the nurse regarding this patient's medications?

A) the type and amount of medications in relation to the patient's renal function
B) whether the patient is taking the prescribed dosages
C) what vitamins and supplements this patient is taking
D) the costs of the patient's medications

Answer 3

the type and amount of medications in relation to the patient's renal function

Question 4

A patient who is recovering from acute kidney injury (AKI) is being discharged. What should the nurse include in this patient's instructions?

A) Avoid alcohol consumption.
B) Use over-the-counter medications as needed.
C) Instruct to weigh self at least once a month.
D) Resume a normal diet.

Question 5

A patient is diagnosed with hypertension caused by polycystic kidney disease. What might be helpful to control this patient's blood pressure?

A) ACE inhibitors
B) kidney transplant
C) dialysis
D) peritoneal dialysis

Question 6

A patient is admitted with signs of chronic kidney disease. What finding should the nurse use to determine whether this patient is developing metabolic acidosis?

A) Kussmaul respirations
B) low urine output
C) muscle cramps
D) diarrhea

Question 7

A patient with polycystic kidney disease is planning to be married and asks the nurse if his children could inherit this disorder. What is the nurse's best response?

A) "Yes, this condition can be inherited."
B) "Yes, but this condition is so rare that you shouldn't worry about it."
C) "No, polycystic kidney disease occurs because of spontaneous mutations."
D) "You should ask your fiancée to come with you to your next office visit so we can discuss this."

Question 8

A patient who is diagnosed with renal cancer states, "I only lost a few pounds! I had no other symptoms!" What should the nurse realize as being the only consistent symptom of renal cancer?

A) hematuria
B) flank pain
C) nausea
D) vomiting

Question 9

The nurse is planning care for a patient with kidney disease who is having difficulty maintaining adequate nutrition. Which intervention should the nurse include in this patient's plan of care?

A) Provide mouth care before meals.
B) Schedule meals for three times each day.
C) Provide antiemetics after meals.
D) Weigh once per week.

Question 10

A patient with diabetes and heart disease is diagnosed with chronic kidney disease. Which medication order should the nurse question for this patient?

A) oral antihyperglycemic agent
B) beta-blocker
C) calcium channel blocker
D) analgesic

Question 11

Three weeks after being treated for strep throat, a patient comes into the clinic with signs of acute glomerulonephritis. What symptom will the nurse most likely find upon assessment of this patient?

A) periorbital edema
B) hunger
C) polyuria
D) polyphagia

Question 12

An older patient is scheduled for a CT scan with and without contrast dye. What should be done prior to this CT scan?

A) Monitor renal function.
B) Assess for level of responsiveness.
C) Assess vital signs.
D) Keep the patient NPO.

Question 13

The nurse is teaching a patient recovering from a nephrectomy for kidney cancer. What should the nurse include in this teaching?

A) early recognition of a urinary tract infection (UTI)
B) ways to limit fluids
C) promoting high-impact sports and activities
D) organ donor information

Question 14

The nurse is preparing to assess an older patient with age-related renal dysfunction. What should the nurse include in this assessment?

A) evidence of medication or drug toxicity
B) recreational activities
C) activity status
D) daily meal pattern

Question 15

A patient with chronic kidney disease is diagnosed with hypertension. The nurse realizes that this patient's blood pressure needs to be controlled because

A) not doing so increases the risk of adverse effects on the kidneys.
B) it is the easiest diagnosis to treat.
C) medications are available to treat this disorder.
D) everyone should have low-normal blood pressure.

Question 16

A patient is scheduled to have an arteriovenous (AV) fistula created for hemodialysis. What should the nurse include when teaching the patient about this fistula?

A) Avoid using the arm with the fistula for blood pressure readings.
B) A functioning fistula has a palpable pulse and bruit.
C) Ensure the use of the dominant hand and arm for placement.
D) The fistula can be used immediately after its creation.
E) Venipunctures should be performed on the arm with the fistula.

Question 17

A patient with acute kidney injury (AKI) is prescribed furosemide (Lasix). The nurse realizes that this medication will be helpful to the patient because it will

A) reduce edema.
B) keep sodium in the body.
C) preserve protein.
D) be the gentlest diuretic to use.

Question 18

A patient is diagnosed with postrenal acute kidney injury (AKI). The nurse realizes that this type of kidney injury can be caused by what health problem?

A) benign prostatic hypertrophy
B) hypovolemia
C) sepsis
D) drug toxicity

Question 19

The nurse is caring for a patient with chronic glomerulonephritis. Which intervention should the nurse add to this patient's plan of care to address excess body fluid?

A) Weigh daily on the same scale.
B) Document energy level.
C) Schedule activities to conserve energy.
D) Assess for signs of infection.

Question 20

The nurse is planning the care of a patient with chronic glomerulonephritis. What should the nurse identify as being the goal of treatment for this patient?

A) maintaining renal function
B) achieving maximum independence
C) returning to work as soon as possible
D) lifestyle changes

Question 21

The nurse is teaching a patient about hemodialysis. How should the nurse explain this process?

A) It moves blood through a semipermeable membrane into a dialyzer that is used to remove waste products as well as correct fluid and electrolyte imbalances.
B) It allows a choice of either diffusion osmosis or ultrafiltration to remove excess water from the body.
C) It adds potassium to the blood when passing through the dialyzer and works on the principle of diffusion.
D) It will add electrolytes and water to the blood when passing through a semipermeable membrane to correct electrolyte imbalances.

Question 22

Which method indicates that the nurse correctly calculated maintenance fluid intake for a patient with acute kidney injury (AKI) who is on fluid restriction?

A) $\begin{array}{|l|}\hline \text {Output in previous 24 hours:}\\ 825 \mathrm{~mL} \\ \text {Intake permitted today:}\\1325 \mathrm{~mL}\\\hline \end{array}$

B) $\begin{array}{|l|}\hline \text {Output in previous 24 hours:}\\665 \mathrm{~mL} \\ \text {Intake permitted today:}\\0700-1500=600 \mathrm{~mL}\\\hline \end{array}$

C) $\begin{array}{|l|}\hline \text {Intake permitted 24 hours:}\\ 1400\mathrm{~mL} \\ \text {Output in previous 24 hours:}\\1275\mathrm{~mL}\\\hline \end{array}$

D) $\begin{array}{|l|}\hline \text {Intake in previous 24 hours:}\\ 1250\mathrm{~mL} \\ \text {Intake permitted 24 hours:}\\0700-1500=700 \mathrm{~mL} \\1500-2200=250 \mathrm{~mL}\\\hline \end{array}$

Question 23

The nurse is preparing to assess a patient with nephrotic syndrome. Place an "X" over the area of the body where the nurse would assess for severe edema in this patient.

Question 24

The nurse administers epoetin alfa (Epogen) to a patient on dialysis. What should the nurse expect the therapeutic effect of this medication to be?

A) It treats the anemia seen in chronic kidney disease patients on dialysis.
B) It combats the effects of dialysis on bone marrow.
C) It promotes elimination of nephrotoxic drugs from the body.
D) It enhances absorption of iron and folate in the intestinal tract.

Question 25

The nurse recognizes that the risk for dehydration in the elderly increases significantly due to which age-related change in renal function?

A) decreased ability of the kidney to concentrate urine
B) hypoplasia
C) presence of renal cysts
D) reduced clearance of drugs excreted by the kidney

Question 26

A patient recovering from a total nephrectomy is being discharged. What should the nurse instruct the patient about care at home?

A) Avoid contact sports and falls.
B) Older males should schedule routine screening exams for prostatic hypertrophy.
C) Monitor weight.
D) Monitor for signs of rejection.
E) Maintain prescribed fluid restrictions.

Question 27

The nurse is caring for a patient receiving peritoneal dialysis. After completing the exchange and draining the dialysate, the nurse notices that the dialysate is cloudy. How should the nurse interpret this finding?

A) a sign of infection
B) a sign of vascular access occlusion
C) the normal appearance of dialysate
D) a sign of possible bowel perforation

Question 28

The nurse is reviewing the laboratory results for a newly admitted patient. Based on these results, the nurse should anticipate that the patient will need further testing for what health problem? $$\begin{array} { | l | l | } \hline \text { Laboratory Test } & \text { Results } \\\hline \text { Urinalysis: } & \\\hline \text { Specific Gravity } & 1.010 \\\hline \text { Protein } & 30 \mathrm { mg } / \mathrm { dL } \\\hline \text { RBCs } & > 30 / \mathrm { HPF } \\\hline \text { WBCs } & > 20 / \mathrm { mm } ^ { 3 } \\\hline \text { Culture, throat } & \text { Pos. for group A beta-hemolytic streptococci } \\\hline \text { ASO Titer } & 300 \mathrm { Todd } \text { units } \\\hline \text { BUN } & 75 \mathrm { mg } / \mathrm { dL } \\\hline \text { Serum Creatinine } & 3 \mathrm { mg } / \mathrm { dL } \\\hline\end{array}$$

A) acute proliferative glomerulonephritis
B) nothing because these tests are within normal limits
C) prerenal acute kidney injury (AKI)
D) end-stage kidney disease

Question 29

The nurse is preparing to administer an osmotic diuretic to a patient. What should the nurse do when providing this medication?

A) Check solution for crystallization prior to IV administration.
B) Evaluate urine output after test dose is given.
C) Assess for signs of worsening heart failure.
D) Assess for orthostatic hypotension.
E) Monitor patient for signs of ototoxicity.

Question 30

The nurse is assessing a patient with this type of device in the arm. For what should the nurse assess this patient?

A) a bruit upon auscultation
B) a thrill upon auscultation
C) a bruit upon palpation
D) a thrill upon inspection

Question 31

A patient with end-stage kidney disease selects to perform peritoneal dialysis in the home. Where should the nurse instruct the patient that the catheter for this type of dialysis will be placed? Place an X on the area of the diagram.

Question 32

During the assessment the nurse suspects a patient with injuries from a motor vehicle crash sustained kidney trauma. What did the nurse assess to make this clinical decision?

A) Turner sign
B) nausea and vomiting
C) microscopic hematuria
D) blood pressure 88/58 mm Hg
E) heart rate 118 beats per minute

Question 33

A patient is in the recovery phase of acute tubular necrosis (ATN). What manifestations should the nurse observe that indicate this phase is progressing as expected?

A) elevated serum potassium level
B) urine output excessive for intake
C) elevated blood urea nitrogen level
D) decrease in serum phosphate level
E) urine output low in relation to intake

Question 34

The nurse is completing the instructions to a patient who underwent a cadaver kidney transplant and is ready for discharge from the hospital. What patient statement indicates that further teaching is needed?

A) "I'm glad I won't have to take immunosuppressants any longer."
B) "I know to check my weight on a regular basis."
C) "I'll call my doctor if I notice any decrease in my urine output."
D) "I'll tell my friends to stay away from me if they have colds or the flu."

Question 35

At the conclusion of a health history the nurse determines that a patient is at risk for kidney cancer. What did the nurse assess to make this clinical decision?

A) obesity
B) over 55 years of age
C) genetic predisposition
D) female
E) bladder calculi

Question 36

A patient is scheduled for a kidney transplant. Indicate where on the diagrams the nurse instructs the patient that the new kidney will be located.

Question 37

The nurse instructs a patient with acute kidney injury that the expected result of taking sodium polystyrene sulfonate (Kayexalate) is to do what?

A) remove potassium
B) replace sodium
C) replace magnesium
D) exchange calcium for sodium

Question 38

The nurse is reviewing a patient's medical record. What health problem should the nurse suspect is occurring with this patient? $$\begin{array} { | l | l | } \hline \text { Blood Test Results } & \text { Objective Data: } \\\hline \text { BUN: } 75 \mathrm { mg } / \mathrm { dL } & \text { Urine: brown } \\\hline \text { Protein: } 4 & \text { Periorbital edema present } \\\hline \begin{array} { l } \text { Creatinine: } 8 \\\mathrm { mg } / \mathrm { dL }\end{array} & \text { 3+ edema of extremities } \\\hline & \text { BP: } 168 / 118\\\hline\end{array}$$

A) acute poststreptococcal glomerulonephritis
B) azotemia
C) acute kidney injury
D) kidney trauma

Question 39

The nurse is evaluating the effectiveness of dietary teaching provided to a patient with chronic kidney disease. Which menu choices indicate that the patient understands the dietary regimen?

A) apple and oatmeal for breakfast; peanut butter sandwich for lunch; pasta with fish for dinner
B) bacon and eggs for breakfast; hot dog with sauerkraut for lunch; baked canned ham with green peas for dinner
C) two bananas for breakfast; rice and beans for lunch; fruit salad, green beans, and an 8-ounce steak for dinner
D) half a cantaloupe and three eggs for breakfast; a baked potato with processed cheese spread and broccoli for lunch; chicken, pinto beans, squash, and pecan pie for dinner

Question 40

A patient weighing 209 lbs. is suspected of being in stage 2 of an acute kidney injury. If the nurse uses the standard output of 0.5mL/kg/h, what is the maximum amount of urine that this patient should produce for 18 hours to confirm this stage of kidney injury?

Question 41

A patient with chronic kidney disease is prescribed a diet containing 0.75 grams of protein per kg of body weight per day. The patient weighs 231 lbs. How many grams of protein should the nurse instruct the patient to ingest each day?