LeMone & Burke's Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)

Chapter 28 Nursing Care of Patients with Kidney Disorders

1) A patient is diagnosed with hypertension caused by polycystic kidney disease. What might be helpful to control this patient's blood pressure?

1. ACE inhibitors

2. Kidney transplant

3. Dialysis

4. Peritoneal dialysis

Page Ref: 907

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 28.1 Describe the pathophysiology and manifestations of kidney disorders, including polycystic kidney disease, glomerular disorder, vascular kidney disorder, kidney trauma, and renal tumor, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with kidney disorders.

2) Three weeks after being treated for strep throat, a patient comes into the clinic with signs of acute glomerulonephritis. What symptom will the nurse most likely find upon assessment of this patient?

1. Periorbital edema

2. Hunger

3. Polyuria

4. Polyphagia

Page Ref: 908

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28.1 Describe the pathophysiology and manifestations of kidney disorders, including polycystic kidney disease, glomerular disorder, vascular kidney disorder, kidney trauma, and renal tumor, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with kidney disorders.

3) The nurse is planning the care of a patient with chronic glomerulonephritis. What should the nurse identify as being the goal of treatment for this patient?

1. Maintaining renal function

2. Achieving maximum independence

3. Returning to work as soon as possible

4. Lifestyle changes

Page Ref: 910-911

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 28.1 Describe the pathophysiology and manifestations of kidney disorders, including polycystic kidney disease, glomerular disorder, vascular kidney disorder, kidney trauma, and renal tumor, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with kidney disorders.

4) The nurse is caring for a patient with chronic glomerulonephritis. Which intervention should the nurse add to this patient's plan of care to address excess body fluid?

1. Weigh daily on the same scale.

2. Document energy level.

3. Schedule activities to conserve energy.

4. Assess for signs of infection.

Page Ref: 913

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 28.1 Describe the pathophysiology and manifestations of kidney disorders, including polycystic kidney disease, glomerular disorder, vascular kidney disorder, kidney trauma, and renal tumor, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with kidney disorders.

5) A patient with chronic kidney disease is diagnosed with hypertension. For which reason should this patient be treated to control blood pressure?

1. Reduces the risk of adverse effects on the kidneys.

2. It is the easiest diagnosis to treat.

3. Medications are available to treat this disorder.

4. Everyone should have low-normal blood pressure.

Page Ref: 916

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 28.1 Describe the pathophysiology and manifestations of kidney disorders, including polycystic kidney disease, glomerular disorder, vascular kidney disorder, kidney trauma, and renal tumor, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with kidney disorders.

6) A patient who is diagnosed with renal cancer states, "I only lost a few pounds! I had no other symptoms!" What should the nurse realize as being the only consistent symptom of renal cancer?

1. Hematuria

2. Flank pain

3. Nausea

4. Vomiting

Page Ref: 918

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28.1 Describe the pathophysiology and manifestations of kidney disorders, including polycystic kidney disease, glomerular disorder, vascular kidney disorder, kidney trauma, and renal tumor, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with kidney disorders.

7) The nurse is teaching a patient recovering from a nephrectomy for kidney cancer. What should the nurse include in this teaching?

1. Early recognition of a urinary tract infection (UTI)

2. Ways to limit fluids

3. Promoting high-impact sports and activities

4. Organ donor information

Page Ref: 921

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 28.1 Describe the pathophysiology and manifestations of kidney disorders, including polycystic kidney disease, glomerular disorder, vascular kidney disorder, kidney trauma, and renal tumor, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with kidney disorders.

8) An older patient is scheduled for a CT scan with and without contrast dye. What should be done prior to this CT scan?

1. Monitor renal function.

2. Assess for level of responsiveness.

3. Assess vital signs.

4. Keep the patient NPO.

Page Ref: 924

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with kidney disorders.

9) A patient with acute kidney injury (AKI) is prescribed furosemide (Lasix). Which should the nurse consider as the reason for this medication to be prescribed?

1. Reduce edema

2. Keep sodium in the body

3. Preserve protein

4. Be the gentlest diuretic to use

Page Ref: 926

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with kidney disorders.

10) A patient is scheduled to have an arteriovenous (AV) fistula created for hemodialysis. What should the nurse include when teaching the patient about this fistula? Select all that apply.

1. Avoid using the arm with the fistula for blood pressure readings.

2. A functioning fistula has a palpable pulse and bruit.

3. Ensure the use of the dominant hand and arm for placement.

4. The fistula can be used immediately after its creation.

5. Venipunctures should be performed on the arm with the fistula.

Page Ref: 929-930

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with kidney disorders.

11) A patient who is recovering from acute kidney injury (AKI) is being discharged. What should the nurse include in this patient's instructions?

1. Avoid alcohol consumption.

2. Use over-the-counter medications as needed.

3. Instruct to weigh self at least once a month.

4. Resume a normal diet.

Page Ref: 933

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with kidney disorders.

12) A patient is admitted with signs of chronic kidney disease. What finding should the nurse use to determine whether this patient is developing metabolic acidosis?

1. Kussmaul respirations

2. Low urine output

3. Muscle cramps

4. Diarrhea

Page Ref: 935

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with kidney disorders.

13) A patient with diabetes and heart disease is diagnosed with chronic kidney disease. Which medication order should the nurse question for this patient?

1. Oral antihyperglycemic agent

2. Beta-blocker

3. Calcium channel blocker

4. Analgesic

Page Ref: 938

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with kidney disorders.

14) A patient with chronic kidney disease is trying to decide between hemodialysis and peritoneal dialysis. What should the nurse encourage the patient to consider as advantages of peritoneal dialysis? Select all that apply.

1. Minimal vascular complications

2. Liberal intake of fluids

3. Better self-management

4. Better metabolite elimination

5. Lower risk of infection

Page Ref: 930-931

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with kidney disorders.

15) A patient who received a kidney transplant seven years ago is seen for increasing blood pressure and proteinuria. Of what health problem is this patient demonstrating signs?

1. Chronic rejection

2. Acute rejection

3. Renal artery stenosis

4. Pyelonephritis

Page Ref: 941

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with kidney disorders.

16) The nurse is planning care for a patient with kidney disease who is having difficulty maintaining adequate nutrition. Which intervention should the nurse include in this patient's plan of care?

1. Provide mouth care before meals.

2. Schedule meals for three times each day.

3. Provide antiemetics after meals.

4. Weigh once per week.

Page Ref: 943

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with kidney disorders.

17) The nurse is preparing to assess an older patient with age-related renal dysfunction. What should the nurse include in this assessment?

1. Evidence of medication or drug toxicity

2. Recreational activities

3. Activity status

4. Daily meal pattern

Page Ref: 911

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28.1 Describe the pathophysiology and manifestations of kidney disorders, including polycystic kidney disease, glomerular disorder, vascular kidney disorder, kidney trauma, and renal tumor, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with kidney disorders.

18) A patient is diagnosed with postrenal acute kidney injury (AKI). What should the nurse suspect caused this patient's type of kidney injury?

1. Benign prostatic hypertrophy

2. Hypovolemia

3. Sepsis

4. Drug toxicity

Page Ref: 923

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with kidney disorders.

19) A patient with polycystic kidney disease is planning to be married and asks the nurse if his children could inherit this disorder. What is the nurse's best response?

1. "Yes, this condition can be inherited."

2. "Yes, but this condition is so rare that you shouldn't worry about it."

3. "No, polycystic kidney disease occurs because of spontaneous mutations."

4. "You should ask your fiancée to come with you to your next office visit so we can discuss this."

Page Ref: 906

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 28.1 Describe the pathophysiology and manifestations of kidney disorders, including polycystic kidney disease, glomerular disorder, vascular kidney disorder, kidney trauma, and renal tumor, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with kidney disorders.

20) The nurse is completing the instructions to a patient who underwent a cadaver kidney transplant and is ready for discharge from the hospital. What patient statement indicates that further teaching is needed?

1. "I'm glad I won't have to take immunosuppressants any longer."

2. "I know to check my weight on a regular basis."

3. "I'll call my doctor if I notice any decrease in my urine output."

4. "I'll tell my friends to stay away from me if they have colds or the flu."

Page Ref: 940

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with kidney disorders.

21) The nurse is evaluating the effectiveness of dietary teaching provided to a patient with chronic kidney disease. Which menu choices indicate that the patient understands the dietary regimen?

1. Apple and oatmeal for breakfast; peanut butter sandwich for lunch; pasta with fish for dinner

2. Bacon and eggs for breakfast; hot dog with sauerkraut for lunch; baked canned ham with green peas for dinner

3. Two bananas for breakfast; rice and beans for lunch; fruit salad, green beans, and an 8-ounce steak for dinner

4. Half a cantaloupe and three eggs for breakfast; a baked potato with processed cheese spread and broccoli for lunch; chicken, pinto beans, squash, and pecan pie for dinner

Page Ref: 938-939

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with kidney disorders.

22) The nurse is caring for a patient receiving peritoneal dialysis. After completing the exchange and draining the dialysate, the nurse notices that the dialysate is cloudy. How should the nurse interpret this finding?

1. A sign of infection

2. A sign of vascular access occlusion

3. The normal appearance of dialysate

4. A sign of possible bowel perforation

Page Ref: 944

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with kidney disorders.

23) The nurse is teaching a patient about hemodialysis. How should the nurse explain this process?

1. It moves blood through a semipermeable membrane into a dialyzer that is used to remove waste products as well as correct fluid and electrolyte imbalances.

2. It allows a choice of either diffusion osmosis or ultrafiltration to remove excess water from the body.

3. It adds potassium to the blood when passing through the dialyzer and works on the principle of diffusion.

4. It will add electrolytes and water to the blood when passing through a semipermeable membrane to correct electrolyte imbalances.

Page Ref: 928

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with kidney disorders.

24) At the conclusion of a health history the nurse determines that a patient is at risk for kidney cancer. What did the nurse assess to make this clinical decision? Select all that apply.

1. Obesity

2. Over 55 years of age

3. Genetic predisposition

4. Female

5. Bladder calculi

Page Ref: 918

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28.1 Describe the pathophysiology and manifestations of kidney disorders, including polycystic kidney disease, glomerular disorder, vascular kidney disorder, kidney trauma, and renal tumor, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with kidney disorders.

25) The nurse administers epoetin alfa (Epogen) to a patient on dialysis. What should the nurse expect the therapeutic effect of this medication to be?

1. It treats the anemia seen in chronic kidney disease patients on dialysis.

2. It combats the effects of dialysis on bone marrow.

3. It promotes elimination of nephrotoxic drugs from the body.

4. It enhances absorption of iron and folate in the intestinal tract.

Page Ref: 938

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with kidney disorders.

26) A patient with an acute kidney injury is prescribed sodium polystyrene sulfonate (Kayexalate). What should the nurse instruct the patient regarding the expected effect of this medication?

1. Remove potassium.

2. Replace sodium.

3. Replace magnesium.

4. Exchange calcium for sodium.

Page Ref: 938

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with kidney disorders.

27) The nurse is preparing to administer an osmotic diuretic to a patient. What should the nurse do when providing this medication? Select all that apply.

1. Check solution for crystallization prior to IV administration.

2. Evaluate urine output after test dose is given.

3. Assess for signs of worsening heart failure.

4. Assess for orthostatic hypotension.

5. Monitor patient for signs of ototoxicity.

Page Ref: 927

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with kidney disorders.

28) A patient recovering from a total nephrectomy is being discharged. What should the nurse instruct the patient about care at home? Select all that apply.

1. Avoid contact sports and falls.

2. Older males should schedule routine screening examinations for prostatic hypertrophy.

3. Monitor weight.

4. Monitor for signs of rejection.

5. Maintain prescribed fluid restrictions.

Page Ref: 919, 921

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 28.1 Describe the pathophysiology and manifestations of kidney disorders, including polycystic kidney disease, glomerular disorder, vascular kidney disorder, kidney trauma, and renal tumor, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with kidney disorders.

29) During the assessment the nurse suspects a patient with injuries from a motor vehicle crash sustained kidney trauma. What did the nurse assess to make this clinical decision? Select all that apply.

1. Turner sign

2. Nausea and vomiting

3. Microscopic hematuria

4. Blood pressure 88/58 mmHg

5. Heart rate 118 beats per minute

Page Ref: 917

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28.1 Describe the pathophysiology and manifestations of kidney disorders, including polycystic kidney disease, glomerular disorder, vascular kidney disorder, kidney trauma, and renal tumor, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with kidney disorders.

30) A patient is in the recovery phase of acute tubular necrosis (ATN). What manifestation should the nurse observe that indicates this phase is progressing as expected? Select all that apply.

1. Elevated serum potassium level

2. Urine output excessive for intake

3. Elevated blood urea nitrogen level

4. Decrease in serum phosphate level

5. Urine output low in relation to intake

Page Ref: 924

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with kidney disorders.

31) A patient weighing 209 lbs. is suspected of being in stage 2 of an acute kidney injury. If the nurse uses the standard output of 0.5 mL/kg/hr, what is the maximum amount of urine that this patient should produce for 18 hours to confirm this stage of kidney injury? Record your answer rounding to the nearest whole number.

Page Ref: 925

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with kidney disorders.

32) A patient with chronic kidney disease is prescribed a diet containing 0.75 gram of protein per kilogram of body weight per day. The patient weighs 231 lbs. How many grams of protein should the nurse instruct the patient to ingest each day? Calculate to the nearest whole number.

Page Ref: 939

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 28.2 Describe the pathophysiology and manifestations of kidney failure (i.e., acute kidney injury and chronic kidney disease), and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with kidney disorders.