Chapter 44 Management of Patients With Renal Disorders

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Chapter 44  Management of Patients With Renal Disorders

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

Multiple Choice

1. A nursing instructor is talking with her clinical group about patients with acute glomerulonephritis. The instructor tells the students that the patient may exhibit which of the following clinical manifestations?
A) Hematuria
B) Decrease in serum creatinine levels
C) Hypotension
D) Glucosuria

Ans: A
Chapter: 44
Client Needs: D-4
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Page and Header: 1315, Primary Glomerular Diseases

Feedback: The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due

to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. The patient may be anemic primarily from fluid retention. Some degree of edema and hypertension is noted in 75% of patients

2. You are caring for a patient with acute renal failure. What is the most common clinical manifestation of acute renal failure?
A) Decrease in BUN
B) Anuria

C) Oliguria
D) Decrease in serum creatinine

Ans: C
Chapter: 44
Client Needs: D-4
Cognitive Level: Analysis
Difficulty: Easy
Integrated Process: Nursing Process Objective: 4
Page and Header: 1320, Acute Renal Failure

Feedback: Acute renal failure manifests as oliguria, anuria, or normal urine volume. Oliguria (less than 500 mL/d of urine) is the most common clinical situation seen in acute renal failure; anuria (less than 50 mL/d of urine) and normal urine output are not as common. Regardless of the volume of urine excreted, the patient with acute renal failure experiences rising serum creatinine and BUN levels and retention of other metabolic waste products (azotemia) normally excreted by the kidneys.

3. The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently diagnosed with ESRD. The patient has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. What is an important instruction that the nurse should give the patient about how to take the prescribed phosphorus-binding medication? A) Only when needed
B) Daily at bedtime
C) One hour prior to meals
D) With each meal

Ans: D
Chapter: 44
Client Needs: D-2
Cognitive Level: Application

Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 4
Page and Header: 1326, Chronic Renal Failure (End-Stage Renal Disease)

Feedback: Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding medications must be administered with food to be effective. Therefore options A, B, and C are incorrect.

4. The nurse is working on the renal transplant unit. To reduce the risk of infection in a patient with a transplanted kidney, it is imperative for the nurse to do what?
A) Wash hands carefully and frequently.
B) Ensure immediate function of the donated kidney.

C) Instruct the patient to wear a face mask. D) Restrict visitors.

Ans: A
Chapter: 44
Client Needs: D-4
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 5
Page and Header: 1354, Kidney Transplantation

Feedback: The nurse ensures that the patient is protected from exposure to infection by hospital staff, visitors, and other patients with active infections. Careful hand washing is imperative; face masks may be worn by hospital staff and visitors to reduce the risk for transmitting infectious agents while the patient is receiving high doses of immunosuppressants. The nurse would not ensure immediate functioning of the donated kidney, instruct the patient to wear a face mask, or restrict visitors.

5. The nurse is caring for a patient receiving hemodialysis treatments. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient?
A) Using a stethoscope for auscultating the fistula is contraindicated.

B) The patient feels best immediately after the dialysis treatment.
C) Taking a blood pressure reading on the affected arm can cause clotting of the fistula. D) The patient shouldn’t feel pain during initiation of dialysis.

Ans: C
Chapter: 44
Client Needs: D-3
Cognitive Level: Application Difficulty: Moderate
Integrated Process: Nursing Process Objective: 6
Page and Header: 1345, Dialysis

Feedback: When blood flow is reduced through the access for any reason (hypotension, application of blood pressure cuff or tourniquet), the access can clot. Auscultation of a bruit in the fistula is one way to determine patency. Typically, patients feel fatigued immediately after hemodialysis because of the rapid change in fluid and electrolyte status. Although the area over the fistula may have some decreased sensation, the needle stick is still painful.

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