Chapter 35: Management of Clients with Renal Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 35: Management of Clients with Renal Disorders

MULTIPLE CHOICE

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

a.

insulin requirements should be lowered.

b.

it indicates that the clients diabetes is uncontrolled.

c.

renal failure will most likely develop in 5 to 10 years.

d.

renal failure will result if diabetes is not well controlled.

ANS: C

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.

DIF: Comprehension/Understanding REF: p. 780 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

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

a.

complete the entire course of antibiotics.

b.

drink 4000 ml of fluid daily.

c.

maintain complete bed rest.

d.

withhold antihypertensive medications.

ANS: A

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.

DIF: Application/Applying REF: p. 786 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alterations Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

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

a.

Deficient Knowledge related to decreasing risk factors

b.

Fatigue related to increased metabolic demands and anemia

c.

Impaired Urinary Elimination related to dysuria, pyuria, and frequency

d.

Risk for Deficient Fluid Volume related to fever, nausea, vomiting, and diarrhea

ANS: B

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

DIF: Application/Applying REF: p. 796 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

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

a.

a history of hypertension.

b.

a history of long-term analgesic use.

c.

recent respiratory tract infections.

d.

recent urinary tract infections.

ANS: C

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.

DIF: Application/Applying REF: p. 795 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

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

a.

a high-protein diet.

b.

diligent skin care.

c.

forcing fluids.

d.

prophylactic antibiotics.

ANS: B

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.

DIF: Application/Applying REF: p. 796 OBJ: Intervention

MSC: Health Promotion Prevention and/or Early Detection of Health Problems-Self Care

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

a.

Encourage the family to visit often.

b.

Have the client schedule specific rest periods.

c.

Help the client deal with emotional reactions.

d.

Request anti-anxiety medication from the physician.

ANS: C

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.

DIF: Application/Applying REF: p. 796 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

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

a.

encouraging ambulation.

b.

maintaining adequate hydration.

c.

maintaining patency of wound drains.

d.

promoting effective breathing patterns.

ANS: D

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.

DIF: Analysis/Analyzing REF: p. 790 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

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

a.

bacteria in the urine.

b.

high fever.

c.

hypertension.

d.

oliguria.

ANS: B

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.

DIF: Comprehension/Understanding REF: p. 785 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

9. The nurse would anticipate that a client with rhabdomyolysis would exhibit

a.

brown-tinged urine.

b.

gross hematuria.

c.

hypokalemia.

d.

hypophosphatemia.

ANS: A

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.

DIF: Comprehension/Understanding REF: p. 781 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

10. 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

a.

aminoglycoside.

b.

cephalosporin.

c.

penicillin.

d.

sulfonamide.

ANS: C

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

DIF: Application/Applying REF: p. 782 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

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

a.

assess for manifestations of fluid overload.

b.

encourage increased activity.

c.

increase fluid intake to 3 to 4 L/day.

d.

watch for early manifestations of anaphylaxis.

ANS: C

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.

DIF: Application/Applying REF: p. 786 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

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

a.

assess serum electrolytes and glucose levels.

b.

monitor for manifestations of urinary tract infection.

c.

monitor vital signs every 30 minutes for the first 4 hours.

d.

provide accurate hourly fluid volume replacement.

ANS: D

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 hours output. The diuresis after the surgery is likely to be profuse, and fluid volume deficit is a risk.

DIF: Analysis/Analyzing REF: p. 787 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

13. 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

a.

consuming a low-protein diet.

b.

getting plenty of exercise.

c.

limiting antibiotic use.

d.

not smoking.

ANS: D

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.

DIF: Comprehension/Understanding REF: p. 787 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

14. 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?

a.

Chemotherapy has very good results when given after surgery.

b.

Dont worry; only about 35% of clients have advanced disease when diagnosed.

c.

Most people are worried before they go to surgery to remove cancer.

d.

You look concerned. Are you worried about having only one kidney?

ANS: D

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.

DIF: Application/Applying REF: p. 787 OBJ: Assessment

MSC: Psychosocial Integrity Coping and Adaptation-Grief and Loss

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

a.

Acute Pain related to surgery

b.

Anxiety related to long-term outcome

c.

Risk for Impaired Skin Integrity related to immobility

d.

Risk for Injury: Postoperative Complications related to surgical procedure

ANS: D

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.

DIF: Analysis/Analyzing REF: p. 790 OBJ: Diagnosis

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

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

a.

albuminuria related to renal hypertension.

b.

decreasing urine output related to hypovolemia.

c.

hematuria related to glomerular damage.

d.

urine changes related to rhabdomyolysis.

ANS: B

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

DIF: Analysis/Analyzing REF: p. 781 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

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

a.

edema.

b.

fever.

c.

hypertension.

d.

pyuria.

ANS: C

The cardinal manifestation of glomerulonephritis is hypertension.

DIF: Comprehension/Understanding REF: p. 794 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

18. The nurse who notes documentation of Grey Turners sign in a client who experienced renal trauma would interpret this to be a manifestation of

a.

increased blood urea nitrogen.

b.

proteinuria.

c.

retroperitoneal hemorrhage.

d.

urine specific gravity of 1.20.

ANS: C

The nurse may see bruises over the renal trauma clients flank and lower back secondary to retroperitoneal hemorrhage, a development called Turners sign or Grey Turners 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.

DIF: Comprehension/Understanding REF: pp. 799-800 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

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

a.

ambulation in hall once daily.

b.

ambulation in room only.

c.

bed rest.

d.

bathroom privileges.

ANS: C

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

DIF: Application/Applying REF: p. 800 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

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

a.

flank pain over the affected kidney.

b.

hypothermia.

c.

increase in urine output.

d.

intermittent fever and sweating.

ANS: A

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.

DIF: Application/Applying REF: pp. 801-802 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

21. Health promotion measures the nurse could suggest to clients to prevent renal artery disease are

a.

avoiding UTIs, or seeking prompt treatment if they occur.

b.

eating a Mediterranean style diet.

c.

the same as those for cardiovascular disease.

d.

unknown; it appears that it is an inherited condition.

ANS: C

Ninety percent of all renal artery disease is caused by atherosclerosis or fibromuscular dysplasia. Health promotion activities are the same as those for atherosclerosis and cardiovascular disease. The Mediterranean style diet is being investigated for heart-healthy benefits, but is not proven. The other two options will not reduce risk for renal artery disease.

DIF: Comprehension/Understanding REF: p. 801 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

22. In caring for a client who underwent renal angioplasty and stent placement, the nurse would anticipate administering a(n)

a.

antiplatelet agent.

b.

aminoglycoside antibiotic.

c.

beta-adrenergic blocker.

d.

diuretic.

ANS: A

If a stent is placed, an antiplatelet agent or anticoagulant may be prescribed to minimize the risk of acute thrombosis in the post-angioplasty client.

DIF: Comprehension/Understanding REF: p. 802 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

23. The nurse explains that polycystic kidney disease ultimately results in

a.

acute renal failure.

b.

chronic renal failure.

c.

glomerulonephritis.

d.

pyelonephritis.

ANS: B

Polycystic disease ultimately results in chronic renal failure.

DIF: Comprehension/Understanding REF: p. 804 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

24. An 88-year-old client has glomerulonephritis, is quite edematous, and has an order for large doses of diuretics. Before administering the first dose, the most appropriate action by the nurse would be to

a.

call the physician to clarify the order.

b.

educate the client as to the drugs effects.

c.

have the unlicensed assistive personnel take a set of vital signs.

d.

plan to administer the diuretics evenly spaced throughout the day.

ANS: A

The diuretic will cause fluid volume shifting and hopefully, the excretion of extra fluid from the client. However, diuresis in an older client must be handled carefully as they are not able to tolerate sudden shifts in vascular volume. Before administering a large dose of a diuretic to this client, the nurse should clarify the order. Of course, option b is always a correct answer, and a set of vital signs would help the nurse monitor and assess the clients reaction. Depending on how the diuretics are ordered, option d may or may not be appropriate.

DIF: Analysis/Analyzing REF: p. 792 OBJ: Intervention

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Age Related Differences

MULTIPLE RESPONSE

1. A female client has recurrent urinary tract infections (UTIs). Important self-care measures the nurse could teach this client to protect her kidneys include (Select all that apply)

a.

acidifying the urine by drinking cranberry juice.

b.

ensuring adequate fluid intake.

c.

seeking medical attention at the first sign of UTI.

d.

wiping the perineal area from front to back.

ANS: A, B, C, D

All options are good health promotion measures to prevent UTIs, and hence prevent pyelonephritis.

DIF: Application/Applying REF: p. 784 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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