Care of Patients with Renal Disorders
Terms in this set (19)
Which clinical manifestation in a client with renal impairment is associated with
polycystic kidney disease rather than an infectious process?
A. Flank pain
B. Periorbital edema
C. Bloody and cloudy urine
D. Enlarged or protruding abdomen
A protruding and distended abdomen is common because the cystic kidneys swell and
push abdominal contents forward and displace other abdominal organs.
The client is a 30-year-old man who has type 1 polycystic kidney disease (PKD-1).
He asks whether his children could develop this disease. What is the nurse's best
A. "Because there is no identifiable pattern of inheritance with this disease, your
children are not at an increased risk for developing polycystic kidney disease."
B. "Because the disease is sex-linked (x-linked) recessive, only your sons will be
C. "Because this is a recessive disorder, your wife would also have to have the disease
for your children to have polycystic kidney disease."
D. "Because this is a dominant disorder, each of your children would have a 50% risk of
having polycystic kidney disease."
Polycystic kidney disease type 1 (PKD-1) is transmitted as an autosomal dominant trait
and, therefore, is not gender-specific. If one parent has PKD-1, each child has a 50% risk
for the disorder. If both parents have PKD-1, the risk is even greater.
The client with polycystic kidney disease and hypertension is prescribed to take a
diuretic for blood pressure control. Which of the following statements by the client
indicates a need for clarification regarding this management?
A. "I will weigh myself every day."
B. "I will drink only 1 L of fluid each day."
C. "I will avoid aspirin and aspirin-containing drugs."
D. "I will avoid nonsteroidal anti-inflammatory drugs."
Diuretics for blood pressure control can lead to fluid volume depletion and decrease
blood flow to the kidney, further decreasing renal function. Fluid volume intake is not
restricted until the kidney no longer responds to diuretics.
What dietary modifications should the nurse teach the client with polycystic kidney
A. Increased protein intake, decreased potassium intake
B. Increased fiber intake, decreased sodium intake
C. Decreased fluid intake, increased magnesium intake
D. Decreased calcium intake, increased chloride intake
Major problems associated with PKD are constipation and hypertension. An increase in
dietary fiber and unrestricted fluid intake can help prevent or relieve constipation.
Hypertension is a serious problem, and a sodium restriction can be helpful.
Which client is at greatest risk for a hydroureter?
A. 68-year-old man with chronic hypertension
B. 68-year-old woman with diabetic nephropathy
C. 28-year-old woman with frequent cystitis
D. 28-year-old man with frequent renal calculi
A hydroureter is most commonly caused by obstruction in the mid to upper portion of the
urinary system. Large kidney stones (renal calculi) can block the flow of urine either in
the renal pelvis or in the ureter. The kidney continues to make urine and the volume
backs up into the kidney.
Which clinical manifestation in a client with a urinary tract infection alerts the nurse
to the possibility of acute pyelonephritis?
A. Burning on urination
B. Cloudy, dark urine
C. Fever and chills
Lower urinary tract infections (cystitis and urethritis) are rarely associated with systemic
symptoms of fever and chills.
The 48-year-old client with diabetes mellitus is being treated for her third episode of
acute pyelonephritis in the past year. She asks what she could do to help prevent these
infections. What is the nurse's best response?
A. "Test your urine daily for the presence of ketone bodies and proteins."
B. "Use tampons rather than sanitary napkins during your menstrual period."
C. "Drink more water and try to empty your bladder at least every 2 to 3 hours while
you are awake."
D. "Inject your insulin in larger doses or more frequently to keep your blood sugar
lower so the microorganisms have fewer nutrients for growth."
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. The neuropathy associated
with diabetes reduces bladder tone and reduces the client's sensation of bladder fullness.
Thus, even with large amounts of urine, the client voids less frequently, allowing stasis
and overgrowth of microorganisms. Increasing fluid intake (specifically water) and
voiding frequently prevent stasis and bacterial overgrowth.
The client has just been diagnosed with acute glomerular nephritis. Which question
should the nurse ask this client in attempting to establish a cause?
A. "Are you sexually active?"
B. "Do you have pain or burning on urination?"
C. "Has anyone in your family had chronic kidney problems?"
D. "Have you had any type of infection within the last 2 weeks?"
The most common cause of acute glomerular nephritis is the presence of a systemic
infection resulting in the formation of antigen-antibody complexes, which precipitate in
the kidney tissues.
The client with acute glomerular nephritis has periorbital edema. What additional
assessment should the nurse obtain or perform with this client?
A. Auscultate breath sounds.
B. Check blood glucose levels.
C. Measure deep tendon reflexes.
D. Test urine for the presence of protein.
Acute glomerular nephritis can cause sodium and water retention. When clients have
edema, they may also have circulatory overload with pulmonary edema.
The client with glomerular nephritis has a glomerular filtration rate (GFR) of 40
mL/min, as measured by a 24-hour creatinine clearance. What is the nurse's
interpretation of this finding?
A. Excessive glomerular filtration rate, client at risk for dehydration
B. Excessive glomerular filtration rate, client at risk for fluid overload
C. Reduced glomerular filtration rate, client at risk for dehydration
D. Reduced glomerular filtration rate, client at risk for fluid overload
The glomerular filtration rate refers to the initial amount of urine that the kidneys filter
from the blood. In the healthy adult, the normal glomerular filtration rate ranges between
100 and 120 mL/min, most of which is reabsorbed in the kidney tubules, so that the
normal urine output rate averages 30 to 60 mL/hr. A GRF of 40 mL/min is drastically
reduced, with the client experiencing fluid retention and a risk for hypertension and
pulmonary edema as a result of excess vascular fluid.
What is the pathologic process causing the decreased GFR associated with acute
A. Decreased renal-induced constriction of the renal arteries
B. Necrosis of 70% or more of the nephrons secondary to increased kidney interstitial
C. Scar tissue formation throughout the proximal convoluted tubule secondary to
toxin-induced collagen synthesis
D. Thickened capillary membranes secondary to immune complex deposition and
Most forms of glomerulonephritis are associated with accumulation of immune
complexes in the glomeruli and glomerular capillaries, thickening the capillaries and
impeding filtration. The immune complexes activate many mediators, including
complement, leukocytes, and coagulation proteins, responsible for the resultant renal
What clinical manifestation indicates to the nurse that the client with glomerular
nephritis being treated in the community is responding as expected to the prescribed
A. The client has lost 11 pounds in the past 10 days.
B. The client's urine specific gravity is 1.048.
C. No blood is observed in the client's urine.
D. The client is thirsty
Fluid retention is a major feature of glomerular nephritis. This weight loss represents
fluid loss, indicating that the glomeruli are performing the function of filtration.
The client has nephrotic syndrome with a normal glomerular filtration rate. What
dietary modification should the nurse teach this client?
A. Decreased intake of protein
B. Increased intake of protein
C. Decreased intake of carbohydrates
D. Increased intake of carbohydrates
In nephrotic syndrome, the renal loss of protein is significant, leading to
hypoalbuminemia and edema formation. If glomerular filtration is normal or near-normal,
the increased protein loss should be matched by an increased intake of protein.
What is the priority nursing diagnosis for the client with nephrosclerosis?
A. Risk for Impaired Skin Integrity
B. Risk for Infection
C. Disturbed Body Image
D. Deficient Knowledge
The major cause of nephrosclerosis is poorly controlled hypertension as a result of
atherosclerosis and/or diabetes. Control of the hypertension is essential to preserve renal
function and avoid the need for renal replacement therapy. Teaching the client the need
for and how to manage drug therapy for this condition is key to preventing complications.
In order to plan appropriate care, for which electrolyte imbalance should the nurse
monitor the client with renal cell carcinoma?
Renal cell carcinoma tissues frequently produce ectopic hormones, including parathyroid
hormone. The increased production of parathyroid hormone leads to decreased renal
excretion of calcium and an increase in the serum calcium concentration.
In assessing the client who had a radical nephrectomy for a renal cell carcinoma 6
hours ago, a nurse notes that the client's blood pressure has decreased from 134/90 to
100/56 and the urine output is 20 mL for this past hour. What is the nurse's best first
A. Position the client so that the remaining kidney is not dependent.
B. Measure the specific gravity of the urine.
C. Document the findings as the only action.
D. Notify the physician.
The radical nature of the surgery and proximity of the surgery to the adrenal gland put the
client at risk for hemorrhage and adrenal insufficiency. Hypotension is a clinical
manifestation associated with both hemorrhage and adrenal insufficiency. The
hypotension is particularly dangerous to the remaining kidney, which must receive
adequate perfusion to function effectively.
What should the nurse emphasize when providing home-going instructions to the
client who has undergone a nephrectomy?
A. "Be sure to limit your intake of fluid to no more than 2000 mL/day."
B. "Test your urine daily for ketone bodies and blood."
C. "You should never participate in contact sports."
D. "Avoid all alcoholic beverages."
The remaining kidney must perform the excreting and metabolic functions of two
kidneys. The kidneys are located in an injury-prone area posterior to the peritoneal cavity
and are poorly protected against trauma. Clients with one kidney should not participate in
The nurse is interviewing a client with a family history of polycystic kidney disease
(PCKD). Which of the following manifestations are typical of PCKD? (Select all that
B. Flank pain
F. Bloody urine
G. Increased abdominal girth
B, F, G
Rationale: Flank pain and abdominal girth size are related to the distention, and bloody
urine is seen with tissue damage secondary to the PCKD. The client may also have
constipation and hypertension.
The nurse is caring for a client with nephrotic syndrome. Which of the following
manifestations are typical? (Select all that apply.)
A. Proteinuria less than 3 g/24 hr
C. Fluid volume deficit
G. CVA tenderness
Rationale: Nephrotic syndrome is due to glomerular damage and is characterized by
proteinuria higher than 3.5 g/24 hr, hypoalbuminemia, edema, and lipiduria. The client
may also have hypertension from the fluid volume excess. CVA tenderness is present
with inflammatory changes in the kidney; dysuria and frequency are present with cystitis.
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