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G R A D E S L A B. C O MChapter 62: Concepts of Care for Patients with Kidney DisordersIgnatavicius: Medical-Surgical Nursing, 10th EditionMULTIPLE CHOICE1. A nurse assesses a client with polycystic kidney disease (PKD). Which assessment findingwould alert the nurse to immediately contact the primar...

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Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)

Chapter 62: Concepts of Care for Patients with Kidney Disorders Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding

would alert the nurse to immediately contact the primary health care provider? Flank pain Periorbital edema Bloody and cloudy urine Enlarged abdomen

a. b. c. d.

ANS: B

Periorbital edema would not be a finding related to PKD and would be investigated further. Flank pain and a distended or enlarged abdomen occur in PKD because the kidneys enlarge and displace other organs. Urine can be bloody or cloudy as a result of cyst rupture or infection. DIF: Applying TOP: Integrated Process: Nursing Process: Assessment KEY: Polycystic kidney disease, Assessment MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 2. The nurse is caring for a client who has chronic pyelonephritis. What assessment finding

would the nurse expect? a. Fever b. Flank pain c. Hypertension d. Nausea and vomiting ANS: C

The client who has chronic pyelonephritis has renal damage and therefore has hypertension. The other assessment findings commonly occur in clients with acute pyelonephritis. DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment KEY: Renal disease, Chronic pyelonephritis MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 3. 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? a. “I will take a laxative every night before going to bed.” b. “I must increase my intake of dietary fiber and fluids.” c. “I shall only use salt when I am cooking my own food.” d. “I’ll eat white bread to minimize gastrointestinal gas.” ANS: B

Clients with PKD often have constipation, which can be managed with increased fiber, exercise, and drinking plenty of water. Laxatives would be used cautiously. Clients with PKD would be on a restricted salt diet, which includes not cooking with salt. White bread has a low-fiber count and would not be included in a high-fiber diet.

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files) DIF: Applying TOP: Integrated Process: Teaching/Learning KEY: Polycystic kidney disease, Health teaching MSC: Client Needs Category: Physiological Integrity: Basic Care and Comfort 4. A nurse cares for a middle-age 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 would the nurse respond? 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 empty your bladder more frequently during the day.” d. “Keep your hemoglobin A1C under 9% by keeping your blood sugar controlled.” ANS: C

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. Testing urine and using tampons will not help prevent pyelonephritis. A hemoglobin A1C of 9% is too high. DIF: Applying TOP: Integrated Process: Teaching/Learning KEY: Pyelonephritis, Health teaching MSC: Client Needs Category: Health Promotion and Maintenance 5. A nurse evaluates a client with acute glomerulonephritis (GN). Which assessment finding

would the nurse recognize as a positive response to the prescribed treatment? The client lost 11 lb (5 kg) in the past 10 days. The client’s urine specific gravity is 1.048. No blood is observed in the client’s urine. The client’s blood pressure is 152/88 mm Hg.

a. b. c. d.

ANS: A

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. A urine specific gravity of 1.048 is high. Blood is not usually seen in GN, so this finding would be expected. A blood pressure of 152/88 mm Hg is too high; this may indicate kidney damage or fluid overload. DIF: Analyzing TOP: Integrated Process: Nursing Process: Evaluation KEY: Glomerulonephritis, Management MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 6. 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 diet therapy for this condition? a. “I must decrease my intake of fat.” b. “I will increase my intake of protein.” c. “A decreased intake of carbohydrates will be required.” d. “An increased intake of vitamin C is necessary.” ANS: B

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)

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 would be matched by increased intake of protein. The client would not need to adjust fat, carbohydrates, or vitamins based on this disorder. DIF: Applying TOP: Integrated Process: Nursing Process: Evaluation KEY: Nephrotic syndrome, Diet therapy MSC: Client Needs Category: Physiological Integrity: Basic Care and Comfort 7. 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. What action would the nurse take? a. Position the client to lay on the surgical incision. b. Measure the specific gravity of the client’s urine. c. Administer intravenous pain medications. d. Assess the rate and quality of the client’s pulse. ANS: D

The nurse would first fully assess the client for signs of volume depletion and shock, and then notify the primary health care provider. The extensive nature of the surgery and the 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. Hypotension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Repositioning the patient, measuring specific gravity, and administering pain medication would not provide data necessary to make an appropriate clinical decision, nor are they appropriate interventions at this time. DIF: Applying TOP: Integrated Process: Nursing Process: Planning and Implementation KEY: Renal cancer, Perioperative nursing MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 8. The nurse is admitting a client who has acute glomerulonephritis caused by beta

streptococcus. What drug therapy would the nurse expect to be prescribed for this client? a. Antihypertensives b. Antilipidemics c. Antidepressants d. Antibiotics ANS: D

Beta streptococcus is a bacterium that can cause acute glomerulonephritis, so antibiotic therapy is indicated. DIF: Understanding TOP: Integrated Process: Planning and Implementation KEY: Glomerulonephritis, Drug therapy MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 9. 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? a. “I can prevent more damage to my kidneys by managing my blood pressure.”

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files) b. “If I have increased urination at night, I need to drink less fluid during the day.” c. “I need to see the registered dietitian to discuss limiting my protein intake.” d. “It is important that I take my antihypertensive medications as directed.” ANS: B

The client should not restrict fluids during the day due to increased urination at night. Clients with renal disease may be prescribed fluid restrictions, and would be assessed thoroughly for potential dehydration. Increased nocturnal voiding can be decreased by consuming fluids earlier in the day. Blood pressure control is needed to slow the progression of renal dysfunction. When dietary protein is restricted, refer the client to the registered dietitian nutritionist as needed. DIF: Applying TOP: Integrated Process: Teaching/Learning KEY: Kidney disorders, Self-management MSC: Client Needs Category: Health Promotion and Maintenance 10. A nurse cares for a client who has pyelonephritis. The client states, “I am embarrassed to talk

about my symptoms.” How would the nurse respond? a. “I am a professional. Your symptoms will be kept in confidence.” b. “I understand. Elimination is a private topic and shouldn’t be discussed.” c. “Take your time. It is okay to use words that are familiar to you.” d. “You seem anxious. Would you like a nurse of the same gender to care for you?” ANS: C

Clients may be uncomfortable discussing issues related to elimination and the genitourinary area. The nurse would encourage the client to use language that is familiar to the client. The nurse must assess the client and cannot take the time to stop the discussion or find another nurse to complete the assessment. DIF: Applying TOP: Integrated Process: Caring KEY: Pyelonephritis, Psychosocial response MSC: Client Needs Category: Psychological Integrity MULTIPLE RESPONSE 1. A nurse assesses a client who has a family history of polycystic kidney disease (PKD). Which

assessment findings would the nurse expect? (Select all that apply.) Nocturia Flank pain Increased abdominal girth Dysuria Hematuria Diarrhea

a. b. c. d. e. f.

ANS: B, C, E

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. Clients with PKD often experience constipation, but would not report nocturia or dysuria. DIF: Understanding TOP: Integrated Process: Nursing Process: Assessment KEY: Polycystic kidney disease, Assessment

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files) MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 2. A nurse assesses a client with nephrotic syndrome. Which assessment findings would the

nurse expect? (Select all that apply.) a. Proteinuria b. Hypoalbuminemia c. Dehydration d. Lipiduria e. Dysuria f. Costovertebral angle (CVA) tenderness ANS: A, B, D

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. Fluid overload leading to edema and hypertension is common with nephrotic syndrome; dehydration does not occur. Dysuria is present with cystitis. CVA tenderness is present with inflammatory changes in the kidney. DIF: Understanding TOP: Integrated Process: Nursing Process: Assessment KEY: Nephrotic syndrome, Assessment MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 3. A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings

would alert the nurse to urgently contact the primary health care provider? (Select all that apply.) a. Clear drainage b. Bloody drainage at site c. Patient reports headache d. Foul-smelling drainage e. Urine draining from site ANS: B, D, E

After a nephrostomy, the nurse would assess the client for complications and urgently notify the primary health care provider if drainage decreases or stops, drainage is cloudy or foul smelling, the nephrostomy site leaks blood or urine, or the client has back pain. Clear drainage is normal. A headache would be an unrelated finding. DIF: Applying TOP: Integrated Process: Nursing Process: Analysis KEY: Renal surgery, Perioperative nursing MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 4. A nurse teaches a client with polycystic kidney disease (PKD). Which statements would 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.” “Adjust your diet to prevent diarrhea.” “Contact your provider if you have visual disturbances.” “Assess your urine for renal stones.”

a. b. c. d. e.

ANS: A, B, D

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)

A client who has PKD would 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 primary health care 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. Diarrhea and renal stones are not manifestations or complications of PKD; therefore, teaching related to these concepts would be inappropriate. DIF: Applying TOP: Integrated Process: Teaching/Learning KEY: Polycystic kidney disease, Health teaching MSC: Client Needs Category: Health Promotion and Maintenance 5. The nurse is reviewing the results of a client’s urinalysis. The client has a diagnosis of acute

glomerulonephritis. Which urine findings would the nurse expect? (Select all that apply.) a. Presence of protein b. Presence of red blood cells c. Presence of white blood cells d. Acidic urine e. Dilute urine ANS: A, C, D

The nurse would expect all of these findings except that the urine is usually concentrated with a high specific gravity. DIF: Analyzing TOP: Integrated Process: Nursing Process: Assessment KEY: Glomerulonephritis, Diagnostic tests MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 6. The nurse is assessing a client with acute pyelonephritis. What assessment findings would the

nurse expect? (Select all that apply.) a. Fever b. Chills c. Tachycardia d. Tachypnea e. Flank or back pain f. Fatigue ANS: A, B, C, D, E, F

All of these assessment findings commonly occur in clients who have acute pyelonephritis because this health problem is a kidney infection. DIF: Understanding TOP: Integrated Process: Nursing Process: Assessment KEY: Acute pyelonephritis, Assessment MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation...