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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 nutritional therapy for this condition?
“A decrease of intake of potassium is necessary.”
“I must decrease my intake of fat.”
“A decreased intake of carbohydrates will be required.”
“I will increase my intake of protein.”
“I will increase my intake of protein.”
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 should be matched by increased intake of protein. The client would not need to adjust fat, carbohydrates, or vitamins based on this disorder. Liberal potassium intake is indicated unless hyperkalemic.
A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, and a urine output of 350 mL/day. What is the best action by the nurse?
Ask to have the laboratory redraw the blood specimen.
Place the client on a cardiac monitor immediately.
Continue to monitor the client’s intake and output.
Teach the client to limit high-potassium foods.
Place the client on a cardiac monitor immediately.
The priority action by the nurse should be to check the cardiac status with a monitor. High potassium levels can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but not the best immediate action.
The nurse is assessing a new client with reports of acute fatigue and a sore tounge that is visibly smooth and beefy red. This client is demonstrating signs and symptoms associated from what form of hematologic disorder?
A. Megaloblastic anemia
B. Hemophilia
C. Sickle cell disease
D. Thrombocytopenia
A. Megaloblastic anemia
A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this client’s care?
Electrolyte and fluid imbalance
Edema and pain
Hyperglycemia
Cardiac and respiratory status
Electrolyte and fluid imbalance
This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance is essential. Edema and pain are not usually a problem with fluid loss. There could be changes in the client’s cardiac, respiratory if the electrolyte imbalance is not treated. Hyperglycemia is not associated with the diuretic phase.
A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide Glucotrol. Which statement should the nurse include in the this clients teaching?
A. Discontinue the medication if you develop a urinary infection
B. Change position slowly when you get out of bed
C. If you miss a dose of this drug notify you healthcare provider immediately
D. Avoid taking non-steroidal anti-inflammatory drug NSAIDS
D. Avoid taking non-steroidal anti-inflammatory drug NSAIDS
What glomerular filtration rate (GFR) would the nurse estimate for a 30-year-old patient with a creatinine clearance result of 60 mL/min?
80 ml/min
60 mL/min
90 mL/min
120 mL/min
60 mL/mi
The creatinine clearance approximates the GFR. The other responses are not accurate.
The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about treatment with:
antibiotics.
anticoagulants.
diuretics.
antihypertensives.
anticoagulants.
Flank pain in a patient with nephrotic syndrome suggests a renal vein thrombosis and anticoagulation is needed. Antibiotics are used to treat a patient with flank pain caused by pyelonephritis. Fungal pyelonephritis is uncommon and is treated with antifungals. Antihypertensives are used if the patient has high blood pressure. Diuretics are not indicated.
The healthcare provider suspects the smogyi effect in a 50 year old patient who’s 6am blood glucose is 230mg/dl. Which action will the nurse teach the patient to take?
A. Check the blood glucose during the night
B. Limit simple carbohydrates in your diet
C. Increase the long acting insulin dose
D. Start taking your blood glucose before each meal and use a sliding scale to maintain glucose
control.
A. Check the blood glucose during the night
A client with acute kidney injury has a blood pressure of 75/55 mmhg. The healthcare provider ordered 1000mL of normal saline to be flushed over one hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurses priority.
A. Take the clients pulse
B. Call the respiratory rapid response team for support
C. Slow down the normal saline infusion
D. Calculate the mean arterial pressure
C. Slow down the normal saline infusion
The nurse is caring for a client after kidney surgery. When assessing for bleeding, what assessment parameter should the nurse evaluate?
Pain intensity
Oral intake
Radiation of pain
Level of consciousness
Level of consciousness
Bleeding is a major complication of kidney surgery. The nurse's role is to observe for these complications, to report their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision, and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood, and fluid volume and cardiac output. Bleeding is not normally evidencedby changes in pain or oral intake.
A nurse is teaching a client with diabetes mellitus who asks, “Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?” How should the nurse respond?
“Glucose in the blood prevents the formation of lactic acid and prevents acidosis.”
“If your blood sugar isn't high enough you will get sick.”
“Glucose is the only fuel used by the body to produce the energy that it needs.”
“Your brain needs a constant supply of glucose because it cannot store it.”
“Your brain needs a constant supply of glucose because it cannot store it.”
Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body’s circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation. Although "you will get sick" is correct, the other option more specific teaching.
A 48-yr-old male patient who weighs 242 lb (110 kg) undergoes a nephrectomy for massive kidney trauma from a motor vehicle crash. Which postoperative assessment finding is most important to communicate to the surgeon?
Blood pressure is 102/58.
Urine output is 20 mL/hr for 2 hours.
Incisional pain level is reported as 9/10.
Crackles are heard at bilateral lung bases.
Urine output is 20 mL/hr for 2 hours.
Because the urine output should be at least 0.5 mL/kg/hr, a 40-mL output for 2 hours indicates that the patient may have decreased renal perfusion because of bleeding, inadequate fluid intake, or obstruction at the suture site. The blood pressure requires ongoing monitoring but does not indicate inadequate perfusion at this time. The patient should cough and deep breathe, but the crackles do not indicate a need for an immediate change in therapy. The incisional pain should be addressed, but this is not as potentially life threatening as decreased renal perfusion. In addition, the nurse can medicate the patient for pain.
A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45% normal saline. Which action should the nurse take first?
Administer 25 mL dextrose 50% (D50) IV push.
Insert a new intravenous access line.
Encourage the client to drink orange juice.
Administer 1 mg of intramuscular glucagon.
Administer 1 mg of intramuscular glucagon.
The client’s blood glucose level is dangerously low. The nurse needs to administer glucagon IM immediately to increase the client’s blood glucose level. The nurse should insert a new IV after administering the glucagon and can use the new IV site for future doses of D50 if the client’s blood glucose level does not rise. Once the client is awake, orange juice may be administered orally along with a form of protein such as a peanut butter.
A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is
to send a glass of milk or orange juice to the patient in the diagnostic testing area.
Take the lunch tray to the patient in the diagnostic testing area.
ask that diagnostic testing area staff to start a 5% dextrose IV.
request that if testing is further delayed, the patient be returned to the unit to eat.
request that if testing is further delayed, the patient be returned to the unit to eat.
Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia. Administration of an IV solution is unnecessarily invasive for the patient. A glass of milk or juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in these items. Patients are not allowed to eat in the diagnostic testing areas.
A 56 year old patient is admitted to the hospital with new onset nephrotic syndrome. Which data will the nurse expect?
A. Elevated urine ketones
B. Recent weight gain
C. Decreased blood pressure
D. Increased urine output
B. Recent weight gain
The health care provider suspects the Somogyi effect in a 50-yr-old patient
whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?
Check the blood glucose during the night
Limit simple carbohydrates in your diet.
Increase the long-acting insulin dose.
Start taking your blood glucose before each meal and use a sliding scale to maintain glucose control.
Check the blood glucose during the night
If the Somogyi effect is causing the patient’s increased morning glucose level, the patient will experience hypoglycemia between 2:00 and 4:00 AM. The dose of insulin will be reduced, rather than increased. A bedtime snack is used to prevent hypoglycemic episodes during the night. Glucose and carbohydrate control during the day does not have an effect the Somogyi effect.
A 56-yr-old female patient is admitted to the hospital with new-onset nephrotic syndrome. Which assessment data will the nurse expect?
Decreased blood pressure
Elevated urine ketones
Increased urine output
Recent weight gain
Recent weight gain
The patient with a nephrotic syndrome will have weight gain associated with edema. Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal because of the edema. Urine protein is high. Ketones are not related to nephrotic syndrome. Decreased urine output is the typical symptom of nephrotic syndrome.
Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective?
The periorbital and peripheral edema are resolved.
The patient denies frequency with voiding
The patient denies burning with voiding.
The antistreptolysin-O (ASO) titer has decreased.
The periorbital and peripheral edema are resolved.
Because edema is a common clinical manifestation of glomerulonephritis, resolution of the edema indicates that the prescribed therapies have been effective. Nitrites will be negative and the patient will not experience dysuria because the patient does not have a urinary tract infection. Antibodies to streptococcus will persist after a streptococcal infection.
The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform the physician that the client may be exhibiting signs of acute kidney injury (AKI)?
The client's urine is cloudy with a foul odor.
The client reports an inability to initiate voiding.
The client complains of acute flank pain.
The client's average urine output has been 10 mL/hr for several hours.
The client's average urine output has been 10 mL/hr for several hours.
Oliguria (500 mL/day of urine) is the most common clinical situation seen in AKI. Flank pain and inability to initiate voiding are not characteristic of AKI. Cloudy, foul-smelling urine is suggestive of a urinary tract infection.
A nurse cares for a client who is recovering after a nephrostomy tube was placed 6 hours ago. The nurse notes drainage in the tube has decreased from 40 mL/hr to 12 mL over the last hour. Which action should the nurse take?
Document the finding in the client’s record.
Report the tube as working in the hand-off report.
Clamp the tube in preparation for removing it.
Assess the client’s abdomen and vital signs.
Assess the client’s abdomen and vital signs.
The nephrostomy tube should continue to have a consistent amount of drainage. If the drainage slows or stops, it may be obstructed. The nurse must notify the provider, but first should carefully assess the client’s abdomen for pain and distention and check vital signs so that this information can be reported as well. The other interventions are not appropriate.
A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia?
4:00 PM
10:00 AM
2:00 PM
12:00 PM
10:00 AM
The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk
A male client comes into the emergency department with a serum creatinine of 2.2mg/dl and a blood urea nitrogen (BUN) of 24ml/dL. What question should the nurse ask first when taking this clients history?
A. Have you traveled recently
B. Have you had a diet that is low in protein recently
C. Have you been taking aspirin, ibuprofen or naproxen recently
D. Do you have anyone in your family with renal failure
C. Have you been taking aspirin, ibuprofen or naproxen recently
Which assessment finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider?
Cloudy and foul-smelling urine
Temperature 100.1° F
Complaint of flank pain
Blood pressure 90/48 mm Hg
Blood pressure 90/48 mm Hg
The low blood pressure indicates that urosepsis and septic shock may be occurring and should be immediately reported. The other findings are typical of pyelonephritis.
A nurse cares for a client who is recovering after a nephrostomy tube was placed six hours ago. The nurse notes drainage in the tube has deceased from 40ml to 12ml over the last hour. Which action should the nurse take?
A. Clamp the tube in preparation for removing it
B. Assess the clients abdomen and vital signs
C. Document the findings in the clients record
D. Report the tune as working in the hand off report
B. Assess the clients abdomen and vital signs
A diabetes nurse is assessing a client's knowledge of self-care skills. What would be the most appropriate way for the educator to assess the client's knowledge of nutritional therapy in diabetes?
Ask the client to keep a food diary and review it with the nurse.
Ask the client to describe a typical day's food intake.
Have the client describe an optimally healthy meal.
Have the client's family describe what he typically eats.
Ask the client to keep a food diary and review it with the nurse.
Reviewing the client's actual food intake is the most accurate method of gauging the client's diet.