Chapter 48: Management of Patients with Kidney Disorders

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1. The nurse is assessing a client A. Hematuria

suspected of having developed
acute glomerulonephritis. The Rationale: The primary presenting fea-
nurse should expect to address ture of acute glomerulonephritis is hema-
what clinical manifestation that is turia (blood in the urine), which may
characteristic of this health prob- be microscopic (identifiable through mi-
lem? croscopic examination) or macroscopic
A. Hematuria or gross (visible to the eye). Protein-
B. Precipitous decrease in serum uria, primarily albumin, which is present,
creatinine levels is due to increased permeability of the
C. Hypotension unresolved by glomerular membrane. Blood urea nitro-
fluid administration gen (BUN) and serum creatinine levels
D. Glucosuria may rise as urine output drops. Glu-
cosuria does not normally accompany
glomerulonephritis, and hypertension is
much more likely than hypotension.

2. The nurse is caring for an acutely C. Average urine output has been 10
ill client. What assessment find- mL/hr for several hours.
ing should prompt the nurse to in-
form the health care provider that Rationale: Oliguria (<400 mL/day of
the client may be exhibiting signs urine or 0.5 mL/kg an hour over 6 hours)
of acute kidney injury (AKI)? is the most common clinical situation
A. An inability to initiate voiding seen in AKI. The client's inability to void
for 2 days. and/or urine hesitancy is typically seen
B. The urine is cloudy and has with kidney stones, prostate problems,
visible sediment with a foul odor. and/or a urinary tract infection (UTI).
C. Average urine output has been Urine that has visible sediment and is
10 mL/hr for several hours. cloudy and foul smelling is more sug-
D. Client reports left-sided flank gestive of a UTI. Acute flank pain is
pain. sometimes seen in AKI. Generally, flank
pain has some connection to a variety
of kidney diseases like acute glomerular
inflammation and polycystic kidney dis-
ease.

3. The nurse is caring for a client D. With each meal

with a history of systemic lupus
erythematosus who has been re- Rationale: Both calcium carbonate and
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 Chapter 48: Management of Patients with Kidney Disorders
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cently diagnosed with end-stage calcium acetate are medications that
kidney disease (ESKD). The client bind with the phosphate and assist in
has an elevated phosphorus level excreting the phosphate from the body,
and has been prescribed calcium in turn lowering the phosphate levels.
acetate to bind the phosphorus. Phosphate-binding medications must be
The nurse should teach the client given with food to be effective.
to take the prescribed medication
at what time?
A. Only when needed
B. Daily at bedtime
C. First thing in the morning
D. With each meal

4. The nurse is working on the re- A. Wash hands carefully and frequently.
nal transplant unit. To reduce the
risk of infection in a client with Rationale: The nurse ensures that the
a transplanted kidney, it is imper- client is protected from exposure to in-
ative for the nurse to take what fection by hospital staff, visitors, and oth-
action? er clients with active infections. Careful
A. Wash hands carefully and fre- handwashing is imperative; face masks
quently. may be worn by hospital staff and visitors
B. Ensure immediate function of to reduce the risk for transmitting infec-
the donated kidney. tious agents while the client is receiving
C. Instruct the client to wear a high doses of immunosuppressants. Vis-
face mask. itors may be limited, but are not normally
D. Bar visitors from the client's barred outright. Ensuring kidney function
room. is vital, but does not prevent infection.

5. The nurse is caring for a client re- C. Taking a BP reading on the affected
ceiving hemodialysis three times arm can damage the fistula
weekly. The client has had
surgery to form an arteriovenous Rationale: When blood flow is reduced
fistula. What is most important for through the access for any reason (hy-
the nurse to be aware of when potension, application of BP cuff/tourni-
providing care for this client? quet), the access site can clot. Ausculta-
A. Using a stethoscope for aus- tion of a bruit in the fistula is one way to
cultating the fistula is contraindi- determine patency. Typically, clients feel
cated fatigued immediately after hemodialysis
B. The client feels best immedi- because of the rapid change in fluid and

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 Chapter 48: Management of Patients with Kidney Disorders
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ately after the dialysis treatment electrolyte status. Although the area over
C. Taking a BP reading on the af- the fistula may have some decreased
fected arm can damage the fistula sensation, a needle stick is still painful.
D. The client should not feel pain
during initiation of dialysis

6. A client has a glomerular filtra- C. Stage 3

tion rate (GFR) of 43 mL/min/1.73
m2. Based on this GFR, the nurse Rationale: Stages of chronic kidney dis-
interprets that the client's chronic ease are based on the GFR. Stage 3 is
kidney disease is at what stage? defined by a GFR in the range of 30 to
A. Stage 1 59 mL/min/1.73 m2. This is considered a
B. Stage 2 moderate decrease in GFR.
C. Stage 3
D. Stage 4

7. An inpatient client with acute B. Pruritus

kidney injury (AKI) has moder- E. Excoriation
ate edema to both legs. What re-
sulting skin conditions would in- Rationale: The skin may be dry or sus-
crease the client's likelihood of ceptible to breakdown as a result of
skin breakdown? Select all that edema. Excoriation and itching (pruri-
apply. tus) may result from the deposits of ir-
A. Atopic dermatitis ritating toxins in the client's tissue due
B. Pruritus to AKI. Prevention recommendations in-
C. Psoriasis clude bathing in cool water, assisting or
D. Urticaria encouraging frequent turning and reposi-
E. Excoriation tioning as well as keeping the skin clean
and moisturized. Clients should be in-
structed to keep nails trimmed to help
prevent scratches. Atopic dermatitis or
eczema has strong genetic links and is
commonly associated with asthma and
hay fever. Eczema results in red, dry,
and itchy patches of skin. Urticaria or
hives are raised, red welts that sudden-
ly appear on the skin and are usually
caused by an allergic reaction. Psoriasis
is a chronic skin condition characterized

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 Chapter 48: Management of Patients with Kidney Disorders
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by thick red patches or plaques of skin
covered with white or silvery scales. Pso-
riasis is usually linked to an autoimmune
response.

8. A client admitted with nephrot- D. Excess fluid volume related to gener-

ic syndrome is being cared for alized edema
on the medical unit. When writ-
ing this client's care plan, based Rationale: The major clinical manifesta-
on the major clinical manifes- tion of nephrotic syndrome is edema, so
tation of nephrotic syndrome, the appropriate nursing diagnosis is "Ex-
what nursing diagnosis should cess fluid volume related to generalized
the nurse include? edema." Edema is usually soft, pitting,
A. Constipation related to immo- and commonly occurs around the eyes,
bility in dependent areas, and in the abdomen.
B. Risk for injury related to al-
tered thought processes
C. Hyperthermia related to the in-
flammatory process
D. Excess fluid volume related to
generalized edema

9. The nurse coming on shift on the B. A client with diabetes mellitus and
medical unit is taking a report on poorly controlled hypertension
four clients. What client does the
nurse know is at the greatest risk Rationale: Systemic diseases, such as
of developing ESKD? diabetes mellitus (leading cause); hy-
A. A client with a history of poly- pertension; chronic glomerulonephritis;
cystic kidney disease pyelonephritis; obstruction of the urinary
B. A client with diabetes mellitus tract; hereditary lesions, such as in poly-
and poorly controlled hyperten- cystic kidney disease; vascular disor-
sion ders; infections; medications; or toxic
C. A client who is morbidly obese agents may cause ESKD. A client with
with a history of vascular disor- more than one of these risk factors is
ders at the greatest risk for developing ESKD.
D. A client with severe chronic ob- Therefore, the client with diabetes and
structive pulmonary disease hypertension is likely at highest risk for
ESKD.

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10. The nurse is caring for a client A. Assessment of the quantity of the
postoperative day 4 following a client's urine output
kidney transplant. When assess-
ing for potential signs and symp- Rationale: After kidney transplantation,
toms of rejection, what assess- the nurse should perform all of the listed
ment should the nurse prioritize? assessments. However, oliguria is con-
A. Assessment of the quantity of sidered to be more suggestive of re-
the client's urine output jection than changes to the client's ab-
B. Assessment of the client's in- domen or incision.
cision
C. Assessment of the client's ab-
dominal girth
D. Assessment for flank or ab-
dominal pain

11. The nurse is caring for a client in C. Hyperkalemia

acute kidney injury (AKI). Which
complication would most clear- Rationale: Hyperkalemia (high potassi-
ly warrant the administration of um) is a common complication of AKI.
polystyrene sulfonate? If the client's potassium is elevated but
A. Hypernatremia does not cause ECG (electrocardiog-
B. Hypomagnesemia raphy) changes, then polystyrene sul-
C. Hyperkalemia fonate may be administered since it re-
D. Hypercalcemia duces serum potassium levels. It is not
recommended for emergency treatment
since it takes more than 6 hours to work.
Polystyrene sulfonate does not treat low
(hypo) magnesium, high sodium (hyper-
natremia), or high calcium (hypercal-
cemia).

12. The nurse is caring for a client A. Burns

whose acute kidney injury (AKI)
resulted from a prerenal cause. Rationale: AKI has categories that iden-
Which condition most likely tify causation. These are prerenal, in-
caused this client's health prob- trarenal, and postrenal. Prerenal AKI re-
lem? sults from hypoperfusion of the kidney
A. Burns caused by volume depletion. Common
B. Glomerulonephritis causes are burns, hemorrhage, gas-

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C. Ureterolithiasis trointestinal losses, sepsis, and shock.
D. Pregnancy Glomerulonephritis and ureterolithiasis
(kidney stones) are associated with in-
trarenal causes. Pregnancy is linked to
postrenal AKI (obstructions distal to the
kidney).

13. A client with diabetic nephropa- A. "Hemodialysis is a treatment option

thy has end-stage renal disease that is usually required three times a
and is starting dialysis. What week."
should the nurse teach the client
about hemodialysis? Rationale: Hemodialysis is the most
A. "Hemodialysis is a treatment commonly used method of dialysis.
option that is usually required Clients receiving hemodialysis must un-
three times a week." dergo treatment for the rest of their
B. "Hemodialysis is a program lives or until they undergo successful
that will require you to commit to kidney transplantation. Treatment usually
daily treatment." occurs three times a week for at least 3
C. "This will require you to have to 4 hours per treatment. Peritoneal dial-
surgery and a catheter will need ysis, not hemodialysis, requires place-
to be inserted into your ab- ment of a catheter inserted into the ab-
domen." domen.
D. "Hemodialysis is a treatment
that is used for a few months until
your kidney heals and starts to
produce urine again."

14. A client with end-stage renal dis- A. Inform the health care provider and
ease receives continuous am- assess the client for signs of infection.
bulatory peritoneal dialysis. The
nurse observes that the dialysate Rationale: Peritonitis is the most com-
drainage fluid is cloudy. What is mon and serious complication of peri-
the nurse's most appropriate ac- toneal dialysis. The first sign of peri-
tion? tonitis is cloudy dialysate drainage flu-
A. Inform the health care provider id, so prompt reporting to the primary
and assess the client for signs of provider and rapid assessment for oth-
infection. er signs of infection are warranted. Ad-
B. Flush the peritoneal catheter ministration of an IV bolus is not neces-
with normal saline. sary or appropriate and the health care

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C. Remove the catheter prompt- provider would determine whether re-
ly and have the catheter tip cul- moval of the catheter is required. Flush-
tured. ing the catheter does not address the risk
D. Administer a bolus of IV nor- for infection.
mal saline as prescribed.

15. The nurse is planning client A. "A vein and an artery in your arm will
teaching for a client with be attached surgically."
end-stage kidney disease who is
scheduled for the creation of a Rationale: The fistula joins an artery and
fistula. The nurse should teach a vein, either side-to-side or end-to-end.
the client what information about This access will need several weeks to
the fistula? "mature" before it can be used. The client
A. "A vein and an artery in your is encouraged to perform exercises to
arm will be attached surgically." increase the size of the affected vessels
B. "The arm should be immobi- (e.g., squeezing a rubber ball for forearm
lized for 4 to 6 days." fistulas). Two needles will be inserted into
C. "One needle will be inserted the fistula for each dialysis treatment.
into the fistula for each dialysis
treatment."
D. "The fistula can be used 5 to 7
days after the surgery for dialysis
treatment."

16. A client with end-stage kidney A. Decreased protein intake

disease is scheduled to begin he- B. Decreased sodium intake
modialysis. The nurse is work- D. Fluid restriction
ing with the client to adapt the
client's diet to maximize the Rationale: Restricting dietary protein de-
therapeutic effect and minimize creases the accumulation of nitrogenous
the risks of complications. The wastes, reduces uremic symptoms, and
client's diet should include which may even postpone the initiation of dial-
of the following modifications? ysis for a few months. Restriction of fluid
Select all that apply. is also part of the dietary prescription
A. Decreased protein intake because fluid accumulation may occur.
B. Decreased sodium intake As well, sodium is usually restricted to
C. Increased potassium intake 2 to 3 g/day. Potassium intake is usually
D. Fluid restriction limited, not increased, and there is no
E. Vitamin D supplementation

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 Chapter 48: Management of Patients with Kidney Disorders
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particular need for vitamin D supplemen-
tation.

17. A client is scheduled for a CT B. Provide adequate hydration before the

scan of the abdomen with con- procedure and administration of acetyl-
trast. The client has a baseline cysteine
creatinine level of 2.3 mg/dL (203
mol/L). In preparing this client for Rationale: Radiocontrast-induced
the procedure, the nurse antici- nephropathy is a major cause of hos-
pates what orders? pital-acquired acute kidney injury. Base-
A. Monitor the client's electrolyte line levels of creatinine greater than 2
values every hour before the pro- mg/dL (177 mol/L) identify the client as
cedure. being at high risk. Preprocedure hydra-
B. Provide adequate hydration tion the day prior to the test is effective
before the procedure and admin- in prevention. The nurse would not mon-
istration of acetylcysteine itor the client's electrolytes every hour
C. Start hemodialysis immediate- pre-procedure because this would not
ly prior to the CT scan change the client's risk factors. To de-
D. Obtain a creatinine clearance crease this risk factor, an intervention
by collecting a 24-hour urine is needed. Nothing in the scenario indi-
specimen. cates the need for hemodialysis. A crea-
tinine clearance is not necessary prior to
a CT scan with contrast.

18. A client is admitted to the ICU C. Continuous venovenous hemodialysis

after a motor vehicle accident. (CVVHD)
On the second day of the hos-
pital admission, the client de- Rationale: CVVHD facilitates the re-
velops acute kidney injury. The moval of uremic toxins and fluid. The he-
client is hemodynamically unsta- modynamic effects of CVVHD are usual-
ble, and renal replacement ther- ly mild in comparison to hemodialysis, so
apy is needed to manage the CVVHD is best tolerated by an unstable
client's hypervolemia and hyper- client. Peritoneal dialysis is not the best
kalemia. Which of the following choice, as the client may have sustained
therapies will the client's hemo- abdominal injuries during the accident
dynamic status best tolerate? and catheter placement would be risky.
A. Hemodialysis Plasmapheresis does not achieve fluid
B. Peritoneal dialysis removal and electrolyte balance.
C. Continuous venovenous he-

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modialysis (CVVHD)
D. Plasmapheresis

19. A client has presented with signs D. Current medication use

and symptoms that are character-
istic of acute kidney injury, but Rationale: The kidneys are susceptible
preliminary assessment reveals to the adverse effects of medications
no obvious risk factors for this because they are repeatedly exposed
health problem. The nurse should to substances in the blood. Nephrotoxic
recognize the need to interview medications are a more likely cause of
the client about what priority top- AKI than diet, allergies, or stress.
ic?
A. Typical diet
B. Allergy status
C. Psychosocial stressors
D. Current medication use

20. An older adult client diagnosed C. Age-related physiologic changes

with cancer is admitted to the D. Chronic systemic disease
oncology unit for surgical treat- E. Nothing by mouth (NPO) status
ment. The client has been on
chemotherapeutic agents to de- Rationale: Changes in kidney function
crease tumor size prior to the with normal aging increase the suscep-
planned surgery. The nurse car- tibility of older clients to kidney dys-
ing for the client is aware that function and kidney injury. In addition,
what precipitating factors in this the presence of chronic, systemic dis-
client may contribute to acute eases increases the risk of AKI. This
kidney injury (AKI)? Select all client was on chemotherapeutic agents
that apply. that frequently cause nausea and vomit-
A. Anxiety and agitation ing, which contribute to dehydration. Old-
B. Low body mass index (BMI) er adult clients taking medications may
C. Age-related physiologic cause alterations in renal flow and clear-
changes ance. The client was made NPO prior to
D. Chronic systemic disease surgery, making them more susceptible
E. Nothing by mouth (NPO) status to AKI even with parenteral fluids. A low
BMI and anxiety are not risk factors for
acute renal disease.

21.

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A client is being treated for AKI B. Excess fluid volume
and the client daily weights have
been ordered. The nurse notes Rationale: If the client with AKI gains
a weight gain of 3 pounds (1.4 or does not lose weight, fluid retention
kg) over the past 48 hours. What should be suspected. Short-term weight
nursing diagnosis is suggested gain is not associated with excessive
by this assessment finding? caloric intake or a sedentary lifestyle.
A. Imbalanced nutrition: More Failure to thrive is not associated with
than body requirements weight gain.
B. Excess fluid volume
C. Sedentary lifestyle
D. Adult failure to thrive

22. A 15-year-old is admitted to D. Streptococcal infection

the renal unit with a diagnosis
of postinfectious glomerular dis- Rationale: Postinfectious causes of
ease. The nurse should recognize postinfectious glomerular disease are
that this form of kidney disease group A beta-hemolytic streptococcal in-
may have been precipitated by fection of the throat that precedes the on-
what event? set of glomerulonephritis by 2 to 3 weeks.
A. Psychosocial stress Menarche, stress, and hypersensitivity
B. Hypersensitivity to an immu- are not typical causes.
nization
C. Menarche
D. Streptococcal infection

23. A client on the medical unit has a B. The client's disease is incurable and
documented history of polycystic the nurse's interventions will be support-
kidney disease (PKD). What prin- ive.
ciple should guide the nurse's
care of this client? Rationale: Nursing actions focus on sup-
A. The disease is self-limiting port and symptom control. It is not
and cysts usually resolve spon- self-limiting and is not treated surgically
taneously in the fifth or sixth or with lithotripsy.
decade of life.
B. The client's disease is incur-
able and the nurse's interven-
tions will be supportive.
C. The client will eventually re-

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 Chapter 48: Management of Patients with Kidney Disorders
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quire surgical removal of his or
her renal cysts.
D. The client is likely to respond
favorably to lithotripsy treatment
of the cysts.

24. The nurse is providing a health C. Smoking cessation

education workshop to a group
of adults focusing on cancer pre- Rationale: Tobacco use is a significant
vention. The nurse should em- risk factor for renal cancer, surpassing
phasize what action in order to the significance of high alcohol and sodi-
reduce participants' risks of renal um intake. Immunizations do not address
carcinoma? an individual's risk of renal cancer.
A. Avoiding heavy alcohol use
B. Control of sodium intake
C. Smoking cessation
D. Adherence to recommended
immunization schedules

25. The nurse performing the health D. Polycystic kidney disease (PKD)
interview of a client with a new
onset of periorbital edema has Rationale: PKD is a genetic disorder
completed a genogram, noting characterized by the growth of numerous
the health history of the client's cysts in the kidneys. Nephritic syndrome,
siblings, parents, and grandpar- acute glomerulonephritis, and nephrotic
ents. This assessment addresses syndrome are not genetic disorders.
the client's risk of what kidney
disorder?
A. Nephritic syndrome
B. Acute glomerulonephritis
C. Nephrotic syndrome
D. Polycystic kidney disease
(PKD)

26. A client is brought to the renal B. Managing postoperative pain

unit from the PACU status postre-
section of a renal tumor. Which Rationale: The client requires frequent
of the following nursing actions analgesia during the postoperative peri-
should the nurse prioritize in the od and assistance with turning, cough-

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 Chapter 48: Management of Patients with Kidney Disorders
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care of this client? ing, use of incentive spirometry, and
A. Increasing oral intake deep breathing to prevent atelectasis
B. Managing postoperative pain and other pulmonary complications. In-
C. Managing dialysis creasing oral intake and mobility are not
D. Increasing mobility priority nursing actions in the immedi-
ate postoperative care of this client. Dial-
ysis is not necessary following kidney
surgery.

27. A nurse is caring for a client C. Dehydration

who is in the diuresis phase of
acute kidney injury. The nurse Rationale: The diuresis period is marked
should closely monitor the client by a gradual increase in urine output,
for what complication during this which signals that glomerular filtration
phase? has started to recover. The client must
A. Hypokalemia be observed closely for dehydration dur-
B. Hypocalcemia ing this phase; if dehydration occurs, the
C. Dehydration uremic symptoms are likely to increase.
D. Acute flank pain Excessive losses of potassium and calci-
um are not typical during this phase, and
diuresis does not normally result in pain.

28. The nurse is caring for a client's A. Providing emotional support for the
status after a motor vehicle ac- family
cident. The client has developed B. Monitoring for complications
AKI. What are the nurse's roles in C. Participating in emergency treatment
caring for this client? Select all of fluid and electrolyte imbalances
that apply. D. Providing nursing care for primary dis-
A. Providing emotional support order (trauma)
for the family
B. Monitoring for complications Rationale: The nurse has an impor-
C. Participating in emergency tant role in caring for the client with
treatment of fluid and electrolyte AKI. The nurse monitors for complica-
imbalances tions, participates in emergency treat-
D. Providing nursing care for pri- ment of fluid and electrolyte imbalances,
mary disorder (trauma) assesses the client's progress and re-
E. Directing nutritional interven- sponse to treatment, and provides phys-
tions ical and emotional support. Addition-
ally, the nurse keeps family members

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 Chapter 48: Management of Patients with Kidney Disorders
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informed about the client's condition,
helps them understand the treatments,
and provides psychological support. Al-
though the development of AKI may be
the most serious problem, the nurse con-
tinues to provide nursing care indicat-
ed for the primary disorder (e.g., burns,
shock, trauma, obstruction of the uri-
nary tract). The nurse does not direct the
client's nutritional status; the dietitian and
the health care provider normally collab-
orate on directing the client's nutritional
status.

29. A 76-year-old client with ESKD B. "Kidney transplants in peoples your

has been told by the health care age are as successful as they are in
provider that it is time to consid- younger clients."
er hemodialysis until a transplant
can be found. The client tells the Rationale: Although there is no specif-
nurse about feeling unsure about ic age limitation for renal transplanta-
undergoing a kidney transplant. tion, concomitant disorders (e.g., coro-
What would be an appropriate re- nary artery disease, peripheral vascular
sponse for the nurse to make? disease) have made it a less common
A. "The decision is certainly treatment for the older adult. However,
yours to make, but be sure not to the success rate of the surgery is compa-
make a mistake." rable to that for younger clients. The oth-
B. "Kidney transplants in peoples er listed options either belittle the client
your age are as successful as or give the client misinformation.
they are in younger clients."
C. "I understand your hesitancy
to commit to a transplant surgery.
Success is relatively rare."
D. "Have you talked this over with
your family?"

30. The nurse has identified the nurs- A. Maintain aseptic technique when ad-
ing diagnosis of "Risk for Infec- ministering dialysate.
tion" in a client who undergoes
peritoneal dialysis. What nursing Rationale: Aseptic technique is used to

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action best addresses this risk? prevent peritonitis and other infectious
A. Maintain aseptic technique complications of peritoneal dialysis. It is
when administering dialysate. not necessary to cleanse the skin with
B. Wash the skin surrounding the soap and water prior to each exchange.
catheter site with soap and water Antibiotics may be added to dialysate to
prior to each exchange. treat infection, but they are not used to
C. Add antibiotics to the dialysate prevent infection.
as prescribed.
D. Administer prophylactic antibi-
otics by mouth or IV as pre-
scribed.

31. The nurse is caring for a client A. Assess the client for signs of bleeding
who has returned to the post- and inform the primary provider.
surgical suite after postanesthet-
ic recovery from a nephrecto- Rationale: Bleeding is a major compli-
my. The nurse's most recent as- cation of kidney surgery, and if missed
sessment reveals increased se- can lead to hypovolemic (decreased vol-
dation, shortness of breath, hy- ume of circulating blood) and hemor-
potension, and low urine output rhagic shock. Bleeding can be suspect-
over the last 2 hours. What is the ed when the client experiences fatigue,
nurse's best response? shortness of breath, and urine output of
A. Assess the client for signs of less than 400 mL within 24 hours. The
bleeding and inform the primary postoperative client is monitored closely
provider. and these findings should be reported
B. Perform a full neurological as- to the primary care provider. Ruling out
sessment and notify the primary the complication of the life-threatening
care provider. condition of bleeding is the priority deci-
C. Increase the frequency of tak- sion for this client. Performing a full neu-
ing vital signs, monitor urine out- rological assessment will be warranted
put, and notify the provider. after the priority complications of surgery
D. Palpate the client's torso bilat- are ruled out. Increasing the monitoring
erally for flank pain and notify the of vital signs and urine output are just
primary care provider. small parts of assessing the client for
bleeding. Palpating the client's torso for
flank pain may increase the client's pain
and does not (in itself) address the most
common cause of the client's signs and
symptoms.
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32. The critical care nurse is monitor- B. Absence of drain output

ing the client's urine output and
drains following renal surgery. Rationale: Urine output and drainage
What should the nurse prompt- from tubes inserted during surgery are
ly report to the primary care monitored for amount, color, and type
provider? or characteristics. Decreased or absent
A. Increased pain on movement drainage is promptly reported because
B. Absence of drain output it may indicate obstruction that could
C. Increased urine output cause pain, infection, and disruption of
D. Blood-tinged serosan- the suture lines. Reporting increased
guineous drain output pain on movement has nothing to do with
the scenario described. Increased urine
output and serosanguineous drainage
are expected.

33. The nurse is creating an educa- C. Inspection and care of the incision
tion plan for a client who un-
derwent a nephrectomy for the Rationale: The nurse teaches the client
treatment of a renal tumor. What to inspect and care for the incision
should the nurse include in the and perform other general postoperative
teaching plan? care, including activity and lifting restric-
A. The importance of increased tions, driving a vehicle, and pain man-
fluid intake agement. There would be no need to
B. Signs and symptoms of rejec- teach the signs or symptoms of rejec-
tion tion as there has been no transplant. In-
C. Inspection and care of the inci- creased fluid intake is not normally rec-
sion ommended and the client has minimal
D. Techniques for preventing control on the future risk for metastasis.
metastasis

34. A client with end stage renal dis- D. Renal osteodystrophy

ease (ESKD) is being treated for
a right ankle fracture unrelated Rationale: An abnormality seen in ESKD
to a fall. The client's lab values is called renal osteodystrophy or uremic
show high phosphate levels, low bone disease. It is a disease that involves
calcium levels, and low vitamin complex changes in calcium, phosphate,
D levels. What is the most likely and parathormone balances. Damage
reason for this client's fracture? seen in ESKD results in an increase in
A. Osteoporosis phosphate and a decrease in calcium
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 Chapter 48: Management of Patients with Kidney Disorders
Study online at https://quizlet.com/_c7zt38
B. Codman triangle (reciprocal relationship), which causes
C. Hypertrophic osteoarthropa- increased production from the parathy-
thy roid. Clients with ESKD cannot handle
D. Renal osteodystrophy these increases, effectively resulting in
bone changes and bone disease. All of
the other choices can cause fractures
but are not typically suspected in a client
with ESRD with the presented lab values.
Osteoporosis, where bone becomes brit-
tle and fragile, is usually diagnosed with
a bone density scan. Codman triangle
is a radiologic sign seen commonly on
x-rays. It is usually an indication of bone
tumors. Hypertrophic osteoarthropathy
(HOA) is characterized by abnormal pro-
liferation (growth) of skin and periosteal
tissue involving the extremities. Diagno-
sis is typically from x-rays and physical
findings.

35. The nurse is caring for a client A. Quantity of output

who has just returned to the B. Color of the output
postsurgical unit following re- C. Visible characteristics of the output
nal surgery. When assessing
the client's output from surgical Rationale: Urine output and drainage
drains, the nurse should physi- from tubes inserted during surgery are
cally assess what parameter(s)? monitored for amount, color, and type
Select all that apply. or characteristics. Decreased or absent
A. Quantity of output drainage from the surgical drains are
B. Color of the output reported and may indicate obstruction.
C. Visible characteristics of the Specific gravity and pH are not normally
output assessed at the bedside but are sent to
D. Specific gravity of the output the lab if needed. Those two tests are not
E. Potential hydrogen (pH) of the part of the recommendations.
output

36. The nurse is caring for a client af- C. Level of consciousness

ter kidney surgery. When assess-
ing for bleeding, what assess- Rationale: Bleeding is a major complica-

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 Chapter 48: Management of Patients with Kidney Disorders
Study online at https://quizlet.com/_c7zt38
ment parameter should the nurse tion of kidney surgery. The nurse's role
evaluate? is to observe for these complications, to
A. Oral intake report their signs and symptoms, and
B. Pain intensity to administer prescribed parenteral flu-
C. Level of consciousness ids and blood and blood components.
D. Radiation of pain Monitoring of vital signs, skin condition,
the urinary drainage system, the surgical
incision, and the level of consciousness
is necessary to detect evidence of bleed-
ing, decreased circulating blood, and flu-
id volume and cardiac output. Bleeding
is not normally evidenced by changes in
pain or oral intake.

37. A nurse is providing education A. The cuffs are constructed of Dacron

to the family of a client be- polyester material.
ginning peritoneal dialysis. The B. The cuffs will help stabilize the
family ask questions concerning catheter.
catheter placement and stabiliza- C. The cuffs prevent the dialysate from
tion. Which information will the leaking.
nurse provide about the cuffs? D. The cuffs provide a barrier against
Select all that apply. microorganisms.
A. The cuffs are constructed of
Dacron polyester material. Rationale: Most catheters used for peri-
B. The cuffs will help stabilize the toneal dialysis have two cuffs, which are
catheter. made of Dacron polyester. The cuffs sta-
C. The cuffs prevent the dialysate bilize the catheter, limit movement, pre-
from leaking. vent leaks, and provide a barrier against
D. The cuffs provide a barrier microorganisms. They do not absorb
against microorganisms. dialysate.
E. The cuffs will absorb the
dialysate.

38. A client with chronic kidney dis- B. Reposition the client to facilitate
ease is completing an exchange drainage.
during peritoneal dialysis. The
nurse observes that the peri- Rationale: If the peritoneal fluid does not
toneal fluid is draining slowly drain properly, the nurse can facilitate
and that the client's abdomen is drainage by turning the client from side

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 Chapter 48: Management of Patients with Kidney Disorders
Study online at https://quizlet.com/_c7zt38
increasing in girth. What is the to side or raising the head of the bed.
nurse's most appropriate action? The catheter should never be pushed
A. Advance the catheter 2 to 4 cm further into the peritoneal cavity. It would
further into the peritoneal cavity. be unsafe to aspirate or to infuse more
B. Reposition the client to facili- dialysate.
tate drainage.
C. Aspirate from the catheter us-
ing a 60-mL syringe.
D. Infuse 50 mL of additional
dialysate.

39. A football player is thought to A) Hematuria is the most common mani-

have sustained an injury to his festation of renal trauma and blood loss-
kidneys from being tackled from es may be microscopic, so laboratory
behind. The ER nurse caring for analysis is essential.
the patient reviews the initial or-
ders written by the physician and Feedback: Hematuria is the most com-
notes that an order to collect all mon manifestation of renal trauma; its
voided urine and send it to the presence after trauma suggests renal in-
laboratory for analysis. The nurse jury. Hematuria may not occur, or it may
understands that this nursing in- be detectable only on microscopic exam-
tervention is important for what ination. All urine should be saved and
reason? sent to the laboratory for analysis to de-
A) Hematuria is the most com- tect RBCs and to evaluate the course
mon manifestation of renal trau- of bleeding. Measuring intake and output
ma and blood losses may be mi- is not a function of the laboratory. The
croscopic, so laboratory analysis laboratory does not save urine to test
is essential. creatinine clearance at a later time. The
B) Intake and output calculations laboratory does not monitor the urine for
are essential and the laboratory sodium or potassium concentration.
will calculate the precise urine
output produced by this patient.
C) A creatinine clearance study
may be ordered at a later time and
the laboratory will hold all urine
until it is determined if the test
will be necessary.
D) There is great concern about
electrolyte imbalances and the
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 Chapter 48: Management of Patients with Kidney Disorders
Study online at https://quizlet.com/_c7zt38
laboratory will monitor the urine
for changes in potassium and
sodium concentrations.

40. Renal failure can have prerenal, A) Heart failure

renal, or postrenal causes. A pa-
tient with acute kidney injury Feedback: By causing inadequate re-
is being assessed to determine nal perfusion, heart failure can lead to
where, physiologically, the cause prerenal failure. Glomerulonephritis and
is. If the cause is found to be prer- aminoglycoside toxicity are renal caus-
enal, which condition most likely es, and ureterolithiasis is a postrenal
caused it? cause.
A) Heart failure
B) Glomerulonephritis
C) Ureterolithiasis
D) Aminoglycoside toxicity

41. A patient on the critical care unit B) Recognize this as an expected find-
is postoperative day 1 following ing.
kidney transplantation from a liv-
ing donor. The nurses most re- Feedback: A kidney from a living donor
cent assessments indicate that related to the patient usually begins to
the patient is producing copious function immediately after surgery and
quantities of dilute urine. What is may produce large quantities of dilute
the nurses most appropriate re- urine. This is not suggestive of rejection
sponse? and treatment is not warranted. There is
A) Assess the patient for further no obvious need to report this finding.
signs or symptoms of rejection.
B) Recognize this as an expected
finding.
C) Inform the primary care
provider of this finding.
D) Administer exogenous antidi-
uretic hormone as ordered.

42. The nurse is caring for a patient B) Assess for the presence of peripheral
with acute glomerular inflamma- edema.
tion. When assessing for the D) Assess the patients BP.
characteristic signs and symp-

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 Chapter 48: Management of Patients with Kidney Disorders
Study online at https://quizlet.com/_c7zt38
toms of this health problem, the Feedback: Most patients with acute
nurse should include which as- glomerular inflammation have some de-
sessments? gree of edema and hypertension. Dys-
A) Percuss for pain in the right rhythmias, RLQ pain, and changes
lower abdominal quadrant. in mental status are not among the
B) Assess for the presence of pe- most common manifestations of acute
ripheral edema. glomerular inflammation.
C) Auscultate the patients apical
heart rate for dysrhythmias.
D) Assess the patients BP.
E) Assess the patients orienta-
tion and judgement.

43. The nurse is caring for a patient A) Assess the patient for signs of bleed-
who has returned to the postsur- ing and inform the physician.
gical suite after post-anesthet-
ic recovery from a nephrectomy. Feedback: Bleeding may be suspect-
The nurse's most recent assess- ed when the patient experiences fa-
ment reveals a significant drop in tigue and when urine output is less than
level of consciousness and BP as 30 mL/hr. The physician must be made
well as scant urine output over aware of this finding promptly. Palpating
the past hour. What is the nurse's the patients flanks would cause intense
best response? pain that is of no benefit to assessment.
A) Assess the patient for signs
of bleeding and inform the physi-
cian.
B) Monitor the patients vital signs
every 15 minutes for the next
hour.
C) Reposition the patient and re-
assess vital signs.
D) Palpate the patients flanks for
pain and inform the physician.

44. A patient with chronic kidney D) Assess for a thrill or bruit over the
disease has been hospitalized vascular access site each shift.
and is receiving hemodialysis
on a scheduled basis. The nurse Feedback: The bruit, or thrill, over the
should include which of the fol- venous access site must be evaluated

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 Chapter 48: Management of Patients with Kidney Disorders
Study online at https://quizlet.com/_c7zt38
lowing actions in the plan of at least every shift. Frequent dressing
care? changes are unnecessary and the pa-
A) Ensure that the patient moves tient does not normally need to immobi-
the extremity with the vascular lize the site. The site must not be used
access site as little as possible. for purposes other than dialysis.
B) Change the dressing over
the vascular access site at least
every 12 hours.
C) Utilize the vascular access site
for infusion of IV fluids.
D) Assess for a thrill or bruit over
the vascular access site each
shift.

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