Question 1

Given the diagnosis of acute glomerulonephritis, the appropriate nursing diagnosis would be

Accepted Answer

Rest is essential for both physical and emotional health. There is a direct correlation between activity and the amount of hematuria and proteinuria.

Question 2

A client has nephritis. Which intervention can the nurse institute to best encourage the client to attain adequate emotional rest?

Accepted Answer

Nephritis is a long-term illness requiring both emotional and physical rest, and has an uncertain outcome. The best nursing intervention is to help the client work through and learn to deal with emotions related to the illness. Encouraging the family to visit is also helpful. Having the client schedule specific rest periods may be too rigid for the client and may increase anxiety. Anti-anxiety medications can certainly be considered, but only after all other options have been tried first.

Question 3

As part of the care plan for a client with pyelonephritis, the nurse should

Accepted Answer

Adequate treatment of the infection quickly reverses the dysuria, pyuria, and frequency. Fluid intake of 3 to 4 L/day is recommended to help dilute the urine and to reduce irritation and burning.

Question 4

The nurse caring for a client admitted for massive blood loss from ruptured esophageal varices would assess closely for

Accepted Answer

Loss of circulating volume from hemorrhage can reduce kidney perfusion and consequently urine production.

Question 5

A client with hydronephrosis has undergone stent placement to relieve the obstruction. The priority action of the nurse is to

Accepted Answer

All options are valid after stent placement to treat hydronephrosis with obstruction. But fluid management during this period is crucial; hourly fluid replacement is based on the previous hour's output. The diuresis after the surgery is likely to be profuse, and fluid volume deficit is a risk.

Question 6

A client with nephrotic syndrome is being taught about self-care at home. The teaching plan should include information on

Accepted Answer

Because of massive edema, the client with nephrotic syndrome is sedentary and the skin is thin and prone to rapid breakdown. Fluids are usually restricted, and the diet is high in calories and low in protein. Clients are prone to infections but are not routinely given prophylactic antibiotics.

Question 7

For a client after nephrectomy and based on the location of the incision, the nurse would formulate the nursing diagnosis of

Accepted Answer

Deep breathing and coughing are difficult for the post-nephrectomy patient because the incision is very close to the diaphragm. This puts the client at high risk for respiratory complications. The other options are possible diagnoses, too, but are not related to the location of the incision.

Question 8

A client has renal cancer and is scheduled for a nephrectomy. Preoperatively, the nurse finds the client very quiet with a worried facial expression. Which statement by the nurse would be most appropriate?

Accepted Answer

Along with all the typical worries that a newly diagnosed cancer client has, the client undergoing nephrectomy often has concerns about living with only one kidney. While about 35% of clients with renal cancer have metastases when diagnosed, telling the client not to worry is dismissive of his/her fears. Chemotherapy has poor results with renal cancer, probably because it grows so slowly.

Question 9

A nurse is caring for a client with chronic kidney disease who is admitted for pneumonia. The nurse would expect that an appropriate antibiotic that the physician might consider is a/an

Accepted Answer

High-risk antibiotics include cephalosporins, sulfonamides, polymyxins, aminoglycosides, and amphotericin B.

Question 10

In the nursing care plan for a client with acute pyelonephritis, the nurse would include teaching the client to

Accepted Answer

The client must understand that prolonged antibiotic therapy suppresses recurrent infections and that completing therapy is of vital importance. Clients should increase their fluid intake to 3-4 L/day. Bed rest is not prescribed and antihypertensive medications should continue because of the correlation between high blood pressure and kidney problems.

Question 11

A nurse could advise a group of employees at a work-site health fair that one health promotion measure that may help reduce the risk of renal cancer is

Accepted Answer

Although the cause of renal cancer is not known, links have been established between renal cancer and smoking; hypertension; obesity; and exposure to lead, cadmium, and phosphates.

Question 12

The nurse who notes documentation of Grey Turner's sign in a client who experienced renal trauma would interpret this to be a manifestation of

Accepted Answer

The nurse may see bruises over the renal trauma client's flank and lower back secondary to retroperitoneal hemorrhage, a development called Turner's sign or Grey Turner's sign. The other manifestations are not seen at all (d) or would not be seen in the acute phase, but might be seen later as kidney damage is a possible long-term sequela of trauma.

Question 13

In the care plan for a client after nephrectomy, the nurse would include an intervention for

Accepted Answer

One of the greatest challenges in the client with nephrectomy is reestablishing effective breathing patterns. Deep breathing and coughing are very difficult because the incision is so close to the diaphragm.

Question 14

In a client with glomerulonephritis, the nurse would assess for the cardinal manifestation of

Accepted Answer

The cardinal manifestation of glomerulonephritis is hypertension.

Question 15

When obtaining the history of a client with acute glomerulonephritis, the nurse should be sure to ask about

Accepted Answer

The comprehensive history from the client with acute glomerulonephritis should include information about recent upper respiratory tract infections (e.g., strep throat), skin infections, scarlet fever, and any history of glomerulonephritis.

Question 16

Acute renal artery obstruction would be suspected in a client if the nurse assessed sudden

Accepted Answer

Acute renal artery obstruction manifests relatively quickly as a sudden episode of flank pain over the affected kidney or abdominal pain and fever. The other three options are not assessed in an acute renal artery obstruction.

Question 17

For a client with renal trauma exhibiting gross hematuria, the nurse would enforce the activity limitation of

Accepted Answer

If there is gross hematuria, bed rest is required until the urine clears.

Question 18

A nurse assessing a client with a renal abscess would expect to find

Accepted Answer

Clients with a renal abscess typically have high fever and moderate to severe pain. Unlike that in clients with pyelonephritis, the urine is usually sterile because the abscess does not reach into the urinary collecting system.

Question 19

The nurse warns a client with insulin-dependent diabetes mellitus (IDDM) who has developed proteinuria that this finding is significant because

Accepted Answer

The client with IDDM inevitably develops renal failure within 5 to 10 years after the appearance of significant proteinuria, regardless of diabetic control. Good glycemic control and carefully controlling any hypertension can delay or prevent renal complications.

Question 20

The nurse would anticipate that a client with rhabdomyolysis would exhibit

Accepted Answer

The release of substances from damaged muscles results in myoglobinemia, myoglobinuria (seen as brown urine and confirmed through urinalysis), hyperkalemia, hyperphosphatemia, hyperuricemia, and elevated creatine kinase.

Quiz 35: Management of Clients with Renal Disorders