Chapter 67 - Care of Patients with Kidney Disorders
Terms in this set (55)
A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding should alert the nurse to immediately contact the health care provider?
Periorbital edema would not be a finding related to PKD and should be investigated further.
A nurse cares for a client with autosomal dominant polycystic kidney disease (ADPKD). The client asks, "Will my children develop this disease?" How should the nurse respond?
"Each of your children has a 50% risk of having ADPKD."
Children whose parent has the autosomal dominant form of PKD have a 50% chance of inheriting the gene that causes the disease. ADPKD is transmitted as an autosomal dominant trait and therefore is not gender specific.
After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?
"I must increase my intake of dietary fiber and fluids."
Clients with PKD often have constipation, which can be managed with increased fiber, exercise, and drinking plenty of water
A nurse cares for a middle-aged female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, "What can I do to help prevent these infections?" How should the nurse respond?
"Drink more water and empty your bladder more frequently during the day."
Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons. Chronically elevated blood glucose levels spill glucose into the urine, changing the pH and providing a favorable climate for bacterial growth.
A nurse evaluates a client with acute glomerulonephritis (GN). Which manifestation should the nurse recognize as a positive response to the prescribed treatment?
The client has lost 11 pounds in the past 10 days.
Fluid retention is a major feature of acute GN. This weight loss represents fluid loss, indicating that the glomeruli are performing the function of filtration.
After teaching a client with nephrotic syndrome and a normal glomerular filtration, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the nutritional therapy for this condition?
"I will increase my intake of protein."
In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and edema formation. If glomerular filtration is normal or near normal, increased protein loss should be matched by increased intake of protein.
A nurse assesses a client who is recovering from a radical nephrectomy for renal cell carcinoma. The nurse notes that the client's blood pressure has decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for this past hour. Which action should the nurse take?
Assess the rate and quality of the client's pulse.
The nurse should first fully assess the client for signs of volume depletion and shock, and then notify the provider. The radical nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for hemorrhage and adrenal insufficiency.
An emergency department nurse assesses a client with kidney trauma and notes that the client's abdomen is tender and distended and blood is visible at the urinary meatus. Which prescription should the nurse consult the provider about before implementation?
Inserting an indwelling urinary catheter
Clients with blood at the urinary meatus should not have a urinary catheter inserted via the urethra before additional diagnostic studies are done. The urethra could be torn. The nurse should question the provider about the need for a catheter; if one is needed, the provider can insert a suprapubic catheter.
After teaching a client with hypertension secondary to renal disease, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
"If I have increased urination at night, I need to drink less fluid during the day."
The client should not restrict fluids during the day due to increased urination at night. Clients with renal disease may be prescribed fluid restrictions. These clients should be assessed thoroughly for potential dehydration.
A nurse cares for a client who is recovering after a nephrostomy tube was placed 6 hours ago. The nurse notes drainage in the tube has decreased from 40 mL/hr to 12 mL over the last hour. Which action should the nurse take?
Assess the client's abdomen and vital signs.
The nephrostomy tube should continue to have a consistent amount of drainage. If the drainage slows or stops, it may be obstructed. The nurse must notify the provider, but first should carefully assess the client's abdomen for pain and distention and check vital signs so that this information can be reported as well.
A nurse teaches a client who is recovering from a nephrectomy secondary to kidney trauma. Which statement should the nurse include in this client's teaching?
"You need to avoid participating in contact sports like football."
Clients with one kidney need to avoid contact sports because the kidneys are easily injured.
A nurse provides health screening for a community health center with a large population of African-American clients. Which priority assessment should the nurse include when working with this population?
Assess blood pressure.
All interventions are important for the visiting nurse to accomplish. However, African Americans have a high rate of hypertension leading to end-stage renal disease. Each encounter that the nurse has with an African-American client provides a chance to detect hypertension and treat it.
After teaching a client with renal cancer who is prescribed temsirolimus (Torisel), the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?
"I shall keep my appointment at the infusion center each week."
Temsirolimus is administered as a weekly intravenous infusion. This medication blocks protein that is needed for cell division and therefore inhibits cell cycle progression.
A nurse cares for a client who has pyelonephritis. The client states, "I am embarrassed to talk about my symptoms." How should the nurse respond?
"Take your time. It is okay to use words that are familiar to you."
Clients may be uncomfortable discussing issues related to elimination and the genitourinary area. The nurse should encourage the client to use language that is familiar to the client.
A nurse assesses a client who has a family history of polycystic kidney disease (PKD). For which clinical manifestations should the nurse assess? (Select all that apply.)
- Flank pain
- Increased abdominal girth
Clients with PKD experience abdominal distention that manifests as flank pain and increased abdominal girth. Bloody urine is also present with tissue damage secondary to PKD.
A nurse assesses a client with nephrotic syndrome. For which clinical manifestations should the nurse assess? (Select all that apply.)
Nephrotic syndrome is caused by glomerular damage and is characterized by proteinuria (protein level higher than 3.5 g/24 hr), hypoalbuminemia, edema, and lipiduria.
A nurse reviews laboratory results for a client with glomerulonephritis. The client's glomerular filtration rate (GFR) is 40 mL/min as measured by a 24-hour creatinine clearance. How should the nurse interpret this finding? (Select all that apply.)
- Reduced GFR
- Potential for fluid overload
The GFR refers to the initial amount of urine that the kidneys filter from the blood. In the healthy adult, the normal GFR ranges between 100 and 120 mL/min, most of which is reabsorbed in the kidney tubules. A GFR of 40 mL/min is drastically reduced, with the client experiencing fluid retention and risks for hypertension and pulmonary edema as a result of excess vascular fluid.
A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings should alert the nurse to urgently contact the health care provider? (Select all that apply.)
- Bloody drainage at site
- Foul-smelling drainage
-. Urine draining from site
After a nephrostomy, the nurse should assess the client for complications and urgently notify the provider if drainage decreases or stops, drainage is cloudy or foul-smelling, the nephrostomy sites leaks blood or urine, or the client has back pain.
A nurse teaches a client with polycystic kidney disease (PKD). Which statements should the nurse include in this client's discharge teaching? (Select all that apply.)
- "Take your blood pressure every morning."
- "Weigh yourself at the same time each day."
- "Contact your provider if you have visual disturbances."
A client who has PKD should measure and record his or her blood pressure and weight daily, limit salt intake, and adjust dietary selections to prevent constipation. The client should notify the provider if urine smells foul or has blood in it, as these are signs of a urinary tract infection or glomerular injury. The client should also notify the provider if visual disturbances are experienced, as this is a sign of a possible berry aneurysm, which is a complication of PKD.
An emergency department nurse cares for a client who is severely dehydrated and is prescribed 3 L of intravenous fluid over 6 hours. At what rate (mL/hr) should the nurse set the intravenous pump to infuse the fluids? (Record your answer using a whole number.) ____ mL/hr
Because IV pumps deliver in units of milliliters per hour, the pump would have to be set at 500 mL/hr to deliver 3 L (3000 mL) over 6 hours.
Which statement made by the client newly diagnosed with polycystic kidney disease (PKD) indicates to the nurse that additional teaching for self-management is needed?
"I will restrict my sodium to less than 2 mg daily."
Rationale: Patients with PKD waste sodium rather than retaining it. They need an increased sodium and water intake. Aggressive control of hypertension is needed to preserve kidney function.
When providing care to a client who has undergone a nephrostomy for hydronephrosis, which observation alerts the nurse to a possible complication?
Urine output of 15 mL/hr
Rationale: Urine output after a nephrostomy should be at least 25 to 40 mL/hr. Tenderness is expected at a new incisional site; the slight elevation of BUN alone is not alarming or indicative of a complication specific to nephrostomy. Pink-tinged urine indicating hematuria is common after instrumentation, but frank blood or increased bleeding over time is not expected.
When assessing a client with diabetic nephropathy, which question about self-management should the nurse ask to determine whether the client is currently following best practices to slow progression of this condition?
"How do you manage your diet to keep your blood glucose levels in the target range?"
Rationale: All strategies to avoid prolonged or frequent hyperglycemia can slow progression of diabetic complications, and the open-ended question is nonjudgmental
When caring for a client with polycystic kidney disease, which goal is most important?
Preventing progression of the disease
Preventing complications and progression of the disease is the goal.
A client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the nurse's best response?
"Take your time. What is bothering you the most?"
Asking the client what is bothering him or her expresses patience and understanding when trying to identify the client's problem.
The school nurse is counseling a teenage student about how to prevent kidney trauma. Which statement by the student indicates a need for further teaching?
"I can't play any type of contact sports because my brother had kidney cancer."
Contact sports and high-risk activities should be avoided if a person has only one kidney. A family history of kidney cancer does not prohibit this type of activity
Which staff member does the charge nurse assign to a client who has benign prostatic hyperplasia and hydronephrosis and needs an indwelling catheter inserted?
LPN/LVN with 5 years of experience in an outpatient urology surgery center
Catheterization of a client with an enlarged prostate, a skill within the scope of practice of the LPN/LVN, would be performed frequently in a urology center.
When caring for a client 24 hours after a nephrectomy, the nurse notes that the client's abdomen is distended. Which action does the nurse perform next?
Check vital signs.
The client's abdomen may be distended from bleeding; hemorrhage or adrenal insufficiency causes hypotension, so vital signs should be taken to see if a change in blood pressure has occurred. The surgeon should be notified after vital signs are assessed.
A newly admitted client who is diabetic and has pyelonephritis and prescriptions for intravenous antibiotics, blood glucose monitoring every 2 hours, and insulin administration should be cared for by which staff member?
RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy
The client scheduled for nephrectomy is the most stable client; the RN caring for this client will have time to perform the frequent monitoring and interventions that are needed for the newly admitted client.
Which statement by a client with diabetic nephropathy indicates a need for further education about the disease?
"I need less insulin, so I am getting better."
When kidney function is reduced, insulin is available for a longer time and thus less of it is needed. Unfortunately, many clients believe this means that their diabetes is improving.
When assessing a client with acute glomerulonephritis, which finding causes the nurse to notify the provider?
Crackles throughout the lung fields
Crackles indicate fluid overload
resulting from kidney damage; shortness of breath and dyspnea are typically associated. The provider should be notified of this finding.
What is the appropriate range of urine output for the client who has just undergone a nephrectomy?
30 to 50 mL/hr
Urine output of 30 to 50 mL/hr or 0.5 to 1 mL/kg/hr is considered within acceptable range for the client who is post nephrectomy. Output of less than 25 to 30 mL/hr suggests decreased blood flow to the kidney and the onset or worsening of acute kidney injury.
A client with pyelonephritis has been prescribed urinary antiseptic medication. What purpose does this medication serve?
Urinary antiseptic drugs such as nitrofurantoin (Macrodantin) are prescribed to provide comfort for clients with pyelonephritis.
A client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the nurse's best response?
"Because the kidneys cannot get rid of fluid, blood pressure goes up."
In chronic kidney disease, fluid levels increase in the circulatory system.
When assessing a client with acute pyelonephritis, which findings does the nurse anticipate will be present?
The nurse is performing discharge teaching for a client after a nephrectomy for renal cell carcinoma. Which statement by the client indicates that teaching has been effective?
"My remaining kidney will provide me with normal kidney function now."
After a nephrectomy, the second kidney is expected to eventually provide adequate kidney function, but this may take days or weeks.
When caring for a client with nephrotic syndrome, which intervention should be included in the plan of care?
Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss
ACE inhibitors can decrease protein loss in the urine. Heparin is administered for DVT, but in nephrotic syndrome it may reduce urine protein and kidney insufficiency.
Which goal for a client with diabetes will best help to prevent diabetic nephropathy?
Maintain glycosylated hemoglobin (HbA1c).
Maintaining long-term control of blood glucose will help prevent the progression of diabetic nephropathy
Which clinical manifestation in a client with pyelonephritis indicates that treatment has been effective?
Decreased white blood cells in urine
A decreased presence of white blood cells in the urine indicates the eradication of infection.
Which factor is an indicator for a diagnosis of hydronephrosis?
History of urinary stones
Causes of hydronephrosis or hydroureter include tumors, stones, trauma, structural defects, and fibrosis.
During discharge teaching for a client with kidney disease, what does the nurse teach the client to do?
"Weigh yourself and take your blood pressure."
Regular weight assessment monitors fluid restriction control, while blood pressure control is necessary to reduce cardiovascular complications and slow the progression of kidney dysfunction
When preparing a client for nephrostomy tube insertion, it is essential for the nurse to monitor which factor before the procedure?
Prothrombin time (PT) and international normalized ratio (INR)
The procedure will be cancelled or delayed if coagulopathy in the form of prolonged PT/INR exists because dangerous bleeding may result.
Which assessment findings does the nurse expect in a client with kidney cancer?
- Hepatic dysfunction
- Increased sedimentation rate
When taking the health history of a client with acute glomerulonephritis (GN), the nurse questions the client about which related cause of the problem?
Recent respiratory infection
An infection often occurs before the kidney manifestations of acute GN. The onset of symptoms is about 10 days from the time of infection.
Which condition may predispose a client to chronic pyelonephritis?
Spinal cord injury
Chronic pyelonephritis occurs with spinal cord injury, bladder tumor, prostate enlargement, or urinary tract stones.
When caring for a client with hemorrhage secondary to kidney trauma, the nurse provides volume expansion. Which element does the nurse anticipate will be used?
Normal saline solution (NSS)
Isotonic solutions and crystalloid solutions are administered for volume expansion; 0.9% sodium chloride (NSS) and 5% dextrose in 0.45% sodium chloride may be used.
The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment information alarms the nurse?
Blood pressure is 98/56 mm Hg; heart rate is 118 beats/min.
Bleeding is a complication of radical nephrectomy; tachycardia and hypotension may indicate impending hypovolemic or hemorrhagic shock. The surgeon should be notified immediately and fluids should be administered, complete blood count should be checked, and blood administered, if necessary.
When caring for a client who had a nephrostomy tube inserted 4 hours ago, which is essential for the nurse to report to the health care provider?
Tube that has stopped draining
The provider must be notified when a nephrostomy tube does not drain; it could be obstructed or dislodged. Pink or red drainage is expected for 12 to 24 hours after insertion and should gradually clear.
Which information suggests that a client with diabetes may be in the early stages of kidney damage?
In the early stages of diabetic nephropathy, micro-levels of albumin are first detected in the urine.
After receiving change-of-shift report on the urology unit, which client does the nurse assess first?
Client who was involved in a motor vehicle crash and has hematuria
The nurse should be aware of the risk for kidney trauma after a motor vehicle crash; this client needs further assessment and evaluation to determine the extent of blood loss and the reason for the hematuria because hemorrhage can be life-threatening.
The nurse anticipates that a client who develops hypotension and oliguria post nephrectomy may need the addition of which element to the regimen?
Addition of a corticosteroid
Loss of water and sodium occurs in clients with adrenal insufficiency, which is followed by hypotension and oliguria; corticosteroids may be needed.
A client, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which statement by the client indicates a need for further education about her disease?
"By maintaining a low-salt diet in our house, I can prevent ADPKD in my children."
There is no way to prevent ADPKD, although early detection and management of hypertension may slow the progression of kidney damage.
The RN is working with unlicensed assistive personnel (UAP) in caring for a group of clients. Which action is best for the RN to delegate to UAP?
Assisting a client who had a radical nephrectomy 2 days ago to turn in bed
UAP would be working within legal guidelines when assisting a client to turn in bed. Although assessment of vital signs is within the scope of practice for UAP, the trauma victim should be assessed by the RN because interpretation of the vital signs is needed.
Which sign or symptom, when assessed in a client with chronic glomerulonephritis (GN), warrants a call to the health care provider?
Third heart sound (S3)
S3 indicates fluid overload secondary to failing kidneys; the provider should be notified and instructions obtained.
The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor?
Blood urea nitrogen (BUN) and creatinine
BUN and creatinine are kidney function tests. With back-pressure on the kidney, glomerular filtration is reduced or absent, resulting in permanent kidney damage.