Diagnostics
Results from protein and muscle breakdown.
* Kidney disease is the only condition that can permanently increase this value. Dehydration, low blood volume, and certain medications can temporarily raise this value.
Serum Creatinine
Classified in three stages and with three types, this condition includes the sudden cessation of renal function that occurs when blood flow to the kidneys is significantly compromised.
AKI - Acute Kidney Injury
A nurse is teaching a client who has chronic kidney disease and is to begin hemodialysis. Which of the following information should the nurse include in the teaching?
A. Hemodialysis restores kidney function.
B. Hemodialysis replaces hormonal function of the renal system.
C. Hemodialysis allows an unrestricted diet.
D. Hemodialysis returns a balance to serum electrolytes.
D. The nurse should explain to the client that hemodialysis restores electrolyte balance by reomving excess sodium, potassium, fluids, and waste products, and also restores acid-base balance.
A nruse is completing the admission assessment of a client who has renal calculi. Which of the following findings should the nurse expect?
A. Bradycardia
B. Diaphoresis
C. Nocturia
D. Bradypnea
B. - Diaphoresis is a manifestation associated with a client who has renal calculi.
A nurse is caring for a client who has a urinary tract infection (UTI). Which of the following is the priority intervention by the nurse?
A. Offer a warm sitz bath.
B. Recommend drinking cranberry juice.
C. Encourage increased fluids.
D. Administer the prescribed Furadantin (nitrofurantoin).
D. The greatest risk to the client is injury to the renal system and urosepsis from the UTI. The priority intervention, then, is to administer antibiotics (the Furadantin).
Results from the breakdown of protein in the liver, creating this byproduct excreted by the kidneys.
*Factors affecting this value are dehydration, infection, chemotherapy, steroid therapy and re absorption of blood in the liver from damaged tissue.
*When this value is elevated it can suggest kidney disease.
Blood Urea Nitrogen (BUN)
The stage of AKI when the serum creatinine is at least three times the baseline and the urinary output is less than 0.3 ml/kg/hr for 12 hours or more.
Stage 3 (failure stage)
A nurse is preparing to initiate hemodialysis for a client who has AKI. Which of the following actions should the nurse take? (Select all that apply.)
A. Review the medications the client currently takes.
B. Assess the AV Fistula for a bruit.
C. Calculate the client's hourly urine output.
D. Measure the client's weight.
E. Check serum electrolytes.
F. Use the access site area for venipuncture.
A., B., D., E.
C. is not correct because the client's hourly urine output can vary with the amount of kidney fuction and does not determine the need for dialysis.
F. The nurse should never use the access site area for venipuncture because compression form the tourniquet can cause loss of the vascular access.
A nurse is reviewing discharge instructions with a client who had spontaneous passage of a calcium phosphate renal calculus. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)
A. Limit intake of food high in animal protein.
B. Reduce sodium intake.
C. Strain urine for 48 hours.
D. Report burning with urination to the provider.
E. Increase fluid intake to 3 liters per day.
A., B., D., E.
C is wrong because the client does not need to continue straining the urine once the calculus has passed.
A nurse is reviewing urinalysis results for four clients. Which of the following urinalysis results indicates a urinary tract infection?
A. Positive for hyaline casts
B. Positive for leukocyte esterase
C. Positive for ketones
D. Positive for crystals
B. A postive leukocyte esterase indicates a UTI.
Nursing considerations for this procedure:
*Client receives sedation and ongoing monitoring.
* Nursing considerations before this procedure includes reviewing coagulation studies and maintaining the patient NPO for at least 4 to 6 hours prior to this procedure.
*Nursing considerations after the procedure :
Monitor VS following sedation.
Assess dressing and urinary output (for hematuria).
Review Hgb and Hct values
Administer PRN pain medication.
Complications includes hemorrhage, infection, cloudy, fowl smelling, urine, urgency, and urine positive for leukocyte esterase and nitratites, sediment and RBC's.
Kidney Biopsy
The stage of chronic kidney disease when the GFR is 15 to 29 ml/min
Stage 4 - Severe kidney damage with severe decrease in GFR.
A nurse is planning care for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse take? (Select all that apply.)
A. Monitor serum glucose levels.
B. Report cloudy dialysate return.
C. Warm the dailysate in a microwave oven.
D. Assess for shortness of breath.
E. Check the access site dressing for wetness.
F. Maintain medical asepsis when accessing the catheter insertion site.
A., B.,D., E.
C is wrong because the nruse should avoid warming the dialysate in a microwave oven, which causes uneven heating of the solution.
F is wrong because the nruse should maintain surgical NOT MEDICAL, asepsis when accessing the catheter insertion site to prevent infection.
A nurse is teaching a client who is scheduled for ESWL (extracorporeal shock wave lithotripsy). Which of the following statements by the client indicates understanding of the teaching?
A. "I will be fully awake during the procedure."
B. "Lithotripsy will reduce my changes of having stones in the future."
C. "I will report any bruising that occurs to my doctor."
D. "Straining my urine following the procedure is important."
D. A client is instructed to strain urine following lithotripsy to verify that the calculi have passed.
A nurse is planning postprocedure care for a client who received hemodialysis. Which of the following interventions should the nruse include in the plan of care? (Select all that apply.)
A. Check BUN and serum creatinine.
B. Evaluate blood pressure on the arm with the AV access.
C. Observe for signs of hypovolemia.
D. Assess the access site for bleeding.
E. Administer medication the nurse withheld prior to dialysis.
A., C., D., and E.
B is wrong because the nurse should never measure blood pressure on the extremity that has the AV access site because it can cause collapse of the AV fistula or graft.
This procedure detects urethral or bladder injury after instillation of contrast dye through a urinary catheter to provide an image of the bladder and the ureters.
VCUG - Voiding Cystourethrogram
A hereditary congenital disorder affecting mostly Caucasians in which clusters of fluid-filled cysts develop in the nephrons. Healthy kidney tiussue is replaced by multiple non-functioning cysts.
PKD - Polycystic kidney disease
A client who is scheduled for kidney transplantation surgery is assessed by the nurse for risk factors of surgery. Which of the following findings increase the client's risk of surgery (Select all that apply.)
A. Age older than 70 years
B. BMI of 41
C. Administering NPH insulin each morning
D. Past history of lymphoma
E. Blood pressure averaging 120/70 mm Hg
E is wrong because blood pressure averaging 120/70 mm Hg is within the expected reference range and does NOT place the client at a greater risk for complications of surgery, lifelong immunosuppression, and organ rejection.
A nurse is caring for a client who has a left renal calculus and an indwelling urinary catheter. Which of the following assessment findings is the priority for the nurse to report to the provider?
A. Flank pain that radiates to the lower abdomen.
B. Client report of nausea.
C. Absent urine output for 1 hour.
D. Serum WBC 15,000/ mm3
C. The greatest risk to this client is damage to the kidney resulting from obstruction of urine flow by the renal calculus. Therefore,the priority finding for the nurse to report to the provider is anuria.
A nurse is teaching a client who is postoperative following a kidney transplant and is taking cyclosporine. Which of the following instructions should the nurse include?
A. "Decrease your intake of protein-rich foods."
B. "Take this mediation with grapefruit juice."
C. "Monitor for and report a sore throat to your provider."
D. "Expect your skin to turn yellow."
C. - The client should report any manifestations of an infection because this medication causes immunosuppression.
These are three diagnostic exams with the same first name:
Identifies obstruction or structural disorders of the ureters and renal pelvis of the kidneys by instilling contrast dye during a cystoscopy.
Identifies fistulas, diverticula, and tumors in the bladder and/or urethra by instilling contrast dye during a cystoscopy.
Retrograde pyelogram (renal pelvis and kidneys)
Retrograde cystogram (bladder)
and
Retrograde urethrogram (urethra)
A nurse is planning care for a client who has postrenal AKI due to metastatic cancer. The client has a serum creatinine of 5 mg/dL. Which of the following interventions should the nruse include in the plan? (Select all that apply)
A. Provide a high-protein diet.
B. Assess the urine for blood.
C. Monitor for intermittent anuria.
D. Weigh the client once per week.
E. Provide NSAIDs for pain.
A., B., and C.
D is wrong because the nurse should weigh the patient daily.
E is wrong because the nurse should not administer NSAIDs, which are toxic to the nephrons in the kidney.
A is correct because the nurse should provide a high protein diet due to the high rate of protein breakdown that occurs with AKI.
B is correct because the nruse should assess urine for blood, stones, and particles indicating an obstruction of the urinary structures that leave the kidney.
C is correct because the nurse should assess for intermittent anuria due to obstruction or damage to kidneys to urinary structure.
A nurse is caring for several clients. Which of the following clients are at risk for developing pyelonephritis? (Select all that apply.)
A. A client who is at 32 weeks of gestation.
B. A client who has kidney calculi.
C. A client who has a urine pH of 4.2.
D. A client who has a neurogenic bladder.
E. A client who has diabetes mellitus.
A., B., D., E.
C is wrong because the expected reference range for urine pH is 4.6 to 8.0. Alkaline urine promotes bacteria growth and causing pyelonephritis.
A nurse is completing discharge instructions with a client who has spontaneously passed a calcium oxalate calculus. To decrease the chances of recurrence, the nurse should instruct the client to avoid which of the following foods? (Select all that apply).
A. Red meat
B. Black tea
C. Cheese
D. Whole grains
E. Spinach
B. and E.
Black tea and spinach are sources of oxalate.
A nurse is preopertative teaching with a client who is scheduled for a kidney transplant about rejection of a transplanted kidney. Which of the following statements should the nurse include in the teaching? (Select all that apply.)
A. "Expect an immediate removal of the donor kidney for a hyperacute rejection."
B. "You may need to begin dialysis to monitor your kidney function for a hyperacute rejection."
C. "A fever is a manifestation of an acute rejection."
D. "Fluid retention is a manifestation of an acute rejection."
E. "Your provider will increase your immunosuppressive medications for a chronic rejection."
A., C., and D.
B is wrong because dialysis can be required as a conservative treatment to monitor the client's kidney function for the progression of chronic kidney failure following transplant (not rejection).
E is wrong because immunosuppressants are increased to treat an ACUTE rejection (not chronic).