Acute Kidney Injury
A nurse is collecting data from a client who has a severe infection and has been receiving cefotaxime for the past week. Which of the following findings indicates a potentially serious adverse reaction to this medication that the nurse should report for the provider?
A. diaphoresis
B. epistaxis
C. diarrhea
D. alopecia
C. This could indicate a C diff infection which is a complication of antibiotics
A nurse is reinforcing teaching with a group of parents about malignant renal and intra-abdominal cancers of childhood. The nurse should include that which of the following cancers is the most common malignant renal and intra-abdominal tumor of childhood?
A. Ewing sarcoma
B. Osteosarcoma
C. Neuroblastoma
D. Wilms' tumor
D.
Wilms' tumor, or nephroblastoma, is the most common malignant renal and intra-abdominal tumor of childhood.
A nurse is reviewing data for a client who has chronic kidney disease. Which of the following data should the nurse identify as the best indicator of fluid volume status?
A. Daily weight
B. Serum sodium
C. Skin turgor
D. I&O
A. According to evidence-based practice, the nurse should identify that the best indicator of fluid volume status is daily weight. Weight provides the most accurate indicator of fluid volume status.
A nurse is reviewing the urinalysis results of a client who reports urinary frequency and burning. Which of the following findings should the nurse report to the provider?
A. Urine specific gravity 1.020
B. Microscopic hematuria
C. Amber yellow urine color
D. Absence of glucose in the urine
B. Hematuria indicates the presence of blood in the urine, which is a finding associated with urinary tract infection. The nurse should report this finding to the provider so the client can receive appropriate treatment.
A nurse in a clinic is collecting data from a client who has cystitis. Which of the following findings should the nurse expect?
A. Suprapubic tenderness
B. Oliguria
C. Generalized edema
D. Proteinuria
A. The nurse should expect a client who has cystitis to report tenderness upon palpation of the bladder in the suprapubic region of the abdomen.
A nurse is reviewing the medical record of a client who has acute kidney injury. Which of the following findings should the nurse recognize as a potential causative factor?
A. History of chronic alcohol abuse
B. Recent CT scan with contrast dye
C. History of hypertension
D. Recent hospital stay for deep vein thrombosis
B. Recent CT scan with contrast dye.
The nurse should recognize that nephrotoxins, such as contrast dye, can result in acute tubular necrosis which is one of the most common causes of acute kidney injury.
A nurse is reinforcing teaching with a client who has a severe UTI about levofloxacin. Which of the following information about adverse reactions should the nurse reinforce? (Select all that apply).
A. observe for pain and swelling of Achilles tendon
B. watch for vaginal yeast infection
C. inspect the mouth for cottage-cheese like lesions
D. this is a urinary analgesic, not an antibiotic
E. the urine will be orange-red in color
A, B, C.
A nurse is reviewing laboratory findings for a client who has acute kidney disease. Which of the following findings should the nurse expect?
A. BUN 8 mg/dL (normal 7 - 20)
B. Serum creatinine 6 mg/dL (normal 0.7 -1.2)
C. Hemoglobin 19 g/dL (normal 12 - 16)
D. Serum potassium 3.0 mEq/L (normal 3.5 - 5.0)
B. Serum creatinine 6 mg/dL (normal 0.7 -1.2)
A nurse is caring for a female client who has a prescription for an indwelling urinary catheter. Which of the following actions should the nurse take first?
A. Clean the perineum from front to back.
B. Lubricate the catheter.
C. Explain to the client that she will feel temporary discomfort.
D. Arrange the sterile items on the sterile field.
C. Explain to the client that she will feel temporary discomfort.
According to evidence-based practice the nurse should first explain the procedure to the client, including what sensations she might feel. This will help reduce the client's anxiety and facilitate the performance of the procedure.
A nurse is reinforcing teaching with a client who has a urinary tract infection (UTI). Which of the following risk factors should the nurse include in the teaching?
A. COPD
B. Diabetes mellitus
C. Anemia
D. Osteoporosis
B. Diabetes mellitus
Diabetes mellitus is considered a risk factor for a UTI due to the increased amount of glucose present in the urine.
A nurse is reinforcing teaching with a client about the oliguric phase of acute kidney injury. The nurse knows that a patient with oliguria has:
A. Urine output of <1L/24hrs
B. Urine output of <100mL/24hrs
C. Urine output of <400mL/24hrs
D. No urine output in 24hrs
C. Oliguria is between 100 - 400mL urine output per 24hrs. <100 mL UOP in 24hrs is called anuria.
A nurse is caring for a client who has a new diagnosis of urolithiasis. Which of the following risk factors should the nurse identify as contributing to this diagnosis?
A. Low levels of serum calcium
B. Female gender
C. High-purine diet
D. Drinking large quantities of fluids
C. High-purine diet
Excessive intake of purines is a risk factor for uric acid stones.
A nurse is planning a low-protein diet for a client who has chronic renal failure. The client states, “Why do I have to be concerned with protein?” Which of the following responses is appropriate?
A. "Protein breakdown produces waste product that can build up in your body."
B. "High protein intake can cause calcium retention."
C. "Protein impairs the body’s ability to store potassium."
D. "A low-protein diet will help your body retain more fluid."
A. "Protein breakdown produces waste product that can build up in your body."
The nurse should explain to the client that protein metabolism produces waste products, which the impaired kidneys are unable to excrete from the body.
A nurse is preparing to remove a male client’s urinary catheter. After performing hand hygiene, which of the following actions should the nurse take?
A. Position the client supine with thighs slightly parted.
B. Have the client bear down during removal.
C. Cleanse the perineal area with an antiseptic.
D. Deflate the balloon halfway and then pull out the catheter.
A. Just as with catheter insertion, the supine position with the client flexing her knees allows good visualization of the catheter and the perineal area.
Bearing down during catheter insertion helps relax the external sphincter and facilitate insertion; however, with the catheter in place, it dilates the sphincter somewhat, so breathing and bearing down activities do not affect the procedure.
The nurse should cleanse the area with an antiseptic prior to catheter insertion. After removal, the nurse should cleanse the area with soap and water if necessary to remove any urine or other material and then dry it thoroughly. The nurse should deflate the balloon completely before pulling out the catheter to avoid traumatizing the urethra.
A nurse is assisting in planning care for a client who has cystitis. Which of the following interventions should be included in the plan of care?
A. Instruct the client to take antibiotics until dysuria is no longer present.
B. Instruct the client to avoid drinking caffeinated beverages.
C. Direct the client to wash underclothing in bleach.
D. Inform the client that taking Vitamin E supplements will decrease the incidence of cystitis.
B. The client should be instructed to take the full course of the prescribed antibiotic. Caffeinated beverages should be avoided by clients who have cystitis as they can irritate the mucosa of the bladder resulting in painful spasms. The client should be directed to avoid washing underclothing in strong detergents or bleach. The client should be informed that taking Vitamin C, not vitamin E, supplements increases the acidity of the urine and decreases the frequency of cystitis.
A nurse is assisting in the post-dialysis plan of care for a client who is receiving hemodialysis treatment for chronic kidney disease. Which of the following interventions should the nurse include in the plan of care?
A. Monitor the client for hypertension.
B. Check the client’s temperature for hypothermia.
C. Monitor the client for bleeding.
D. Check the client for increased urine output.
C. The nurse should monitor for bleeding at least for 1 hr after the procedure because heparin is administered during the hemodialysis treatment and places the client at risk for bleeding. The nurse should check the client’s temperature for an elevation because the dialysis machine warms the blood slightly. The nurse should also check the temperature for manifestations of an infection. The nurse should monitor for hypotension during the post-dialysis period and require rehydration with IV fluids because of fluid removal. The nurse should expect the client to continue to have oliguria when the client has chronic kidney disease.
A nurse is contributing to the plan of care for a client who has urolithiasis. Which of the following interventions should the nurse include in the plan?
A. Tell the client to expect a decrease in urine output.
B. Provide the client a high protein diet.
C. Maintain the client on bed rest.
D. Encourage the client to drink 3 L of fluids per day.
D. The nurse should encourage a fluid intake of 2,500 to 4,000 mL of fluid per day to wash the calculi down the urinary tract. The nurse should encourage the client to ambulate as tolerated to help move the calculi down the urinary tract. The nurse should restrict protein below the RDA. A high protein diet might cause super increased calcium and uric acid in the client’s urine, which can increase the risk of stone formation. The nurse should identify that a decrease in urine output can indicate a urinary obstruction and report it to the provider immediately.
A patient calls the clinic two days after a cystoscopy and reports experiencing persistent burning during urination, a fever of 101°F (38.3°C), and cloudy urine. What is the nurse's best response?
A. "Increase your fluid intake and monitor your symptoms for another day."
B. "These are normal symptoms after a cystoscopy; there is no need to worry."
C. "You may have developed an infection. You should come in for evaluation immediately."
D. "Take an over-the-counter pain reliever and drink cranberry juice to relieve the symptoms."
Correct Answer: C. "You may have developed an infection. You should come in for evaluation immediately."
Rationale:
Fever, cloudy urine, and persistent burning are signs of a possible urinary tract infection (UTI), which can occur after a cystoscopy. The patient should be evaluated by a healthcare provider promptly to confirm the diagnosis and begin treatment. Ignoring these symptoms could lead to complications such as a kidney infection
A nurse is reviewing the chart of a client who is scheduled to have radiological studies of the kidneys performed with the use of IV contrast dye. Which of the following client medications should the nurse withhold prior to the examination?
A. Simvastatin
B. Metformin
C. Valsartan
D. Pantoprazole
B. The nurse should recognize that metformin is used to treat type 2 diabetes and can cause lactic acidosis and renal failure when given along with IV contrast dye. It should be held for 24 hr prior to and 48 hr following the procedure.
Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation?
1. Urine is clear amber
2. Urination is not painful.
3. Urge incontinence is not present
4. A reddish orange discoloration of the urine is present
2. Urination is not painful
Rationale: phenazopyridine is a urinary analgesic. It is effective when it eliminates pain and burning with urination. It does not eliminate the bacteria causing the infection, so it would not make the urine clear amber. It does not treat urge incontinence. It will cause the client to have reddish-orange discoloration of urine but this is a side effect of the medication, not the desired effect
A nurse is caring for a client who is in the oliguric phase of acute kidney injury. Which of the following actions should the nurse take?
A. Provide a diet high in protein.
B. Provide ibuprofen for retroperitoneal discomfort.
C. Monitor intake and output hourly
D. Encourage the client to consume at least 2 L of fluid daily.
C. The nurse should closely monitor the client for signs of fluid imbalance. This includes hourly monitoring of intake and output, along with daily weights. If there are sudden changes, or the urinary output is less than 30 mL/hr, the provider must be notified immediately. The client who is in the oliguric stage of acute kidney injury is not producing urine and will be placed on fluid restrictions, often less than 1,200 mL daily which includes intravenous fluids. Excessive fluid intake can result in fluid overload.The nurse should avoid administering medications that are nephrotoxic to a client who has acute kidney injury. The injury to the kidney causes an increase in drug excretion which can lead to toxic levels. The client with acute kidney injury is limited on their protein intake as this decreases the risk of the client developing chronic renal failure.
The nurse is providing dietary education to a patient with a history of calcium oxalate kidney stones. Which of the following foods should the nurse instruct the patient to avoid?
A. Milk and yogurt.
B. Spinach and beets.
C. Bananas and apples.
D. Lean chicken and fish.
Correct Answer: B. Spinach and beets.
Rationale:
Spinach and beets are high in oxalates, which can contribute to the formation of calcium oxalate stones. Patients prone to this type of kidney stone should limit foods rich in oxalates. Milk and yogurt are sources of calcium but are not restricted unless otherwise advised. Bananas, apples, and lean meats are generally safe and not associated with oxalate formation.
A nurse is reinforcing teaching for a client who has chronic kidney disease about the process of continuous ambulatory peritoneal dialysis (CABD). Which of the following should the nurse include in the teaching?
A. The dialyzing solution infuses using an infusion pump.
B. CAPD dialysis is the treatment of choice for a client who has a history of abdominal trauma.
C. The dialysis is continuous 24 hr a day, 7 days a week.
D. The dialyzing solution is suspended at the level of the umbilicus during the infusion.
C. The dialysis is continuous 24 hr a day, 7 days a week. The client who is treated with CAPD is using a self-dialysis method that is continuous 24 hr a day, 7 days a week. The dialyzing solution has a dwelling time of 4 to 8 hr before the fluid is drained. The client who does CABD infuses the dialyzing solution by gravity. The client should suspend the dialyzing solution above the level of the abdomen for gravity infusion after attaching the tubing to the permanent implantable peritoneal dialysis catheter.
A nurse is preparing a client for a kidney biopsy. Which of the following actions should the nurse take?
A. The client should eat a meal 1 hour prior to the procedure.
B. Inform the client that the biopsy is performed while lying supine during the procedure.
C. Administer a cleansing enema before the procedure.
D. Review the coagulation studies before the procedure.
D. The nurse should review the coagulation studies before the procedure because of the risk of bleeding during a kidney biopsy. The nurse should not administer a cleansing enema to the client because it is not needed as preparation for a kidney biopsy. The nurse should inform the client that the biopsy is performed while lying prone for easy access of the kidney. The nurse should instruct the client to remain NPO 4 to 6 hr before the procedure because mild sedation, not general anesthesia, is administered at the time of the procedure.
A nurse is gathering medical history from a client admitted for pyelonephritis. Which of the following should the nurse expect the client to report when asked about their medical history?
A. The client reports that they took a lot of ibuprofen for arthritis for many years.
B. The client states that they remember their mother saying their grandma had this same genetic disease.
C. The client reports that they had two urinary tract infections (UTI) in the past 10 months.
D. The client states that they consume a high calcium diet and have had high calcium in their blood.
C. The client reports that they had two urinary tract infections (UTI) in the past 10 months.