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A client with chronic glomerulonephritis has generalized edema. Which response by the nurse best describes why anasarca occurs with this disorder?
- A. Loss of serum protein causes the body's fluids to shift.
- B. High albumin levels in the blood attracts more fluid into the blood vessels.
- C. Too little sodium in the diet results in anasarca.
- D. When urine is retained in the body, it shifts the body's fluid into tissue spaces.
Correct Answer: A
Rationale: Anasarca is caused by the shift of fluid from the intravascular space to interstitial and intracellular locations, not by a shift of fluid from the tissues into the blood vessels. The fluid shift results from depletion of protein from the blood (serum) to the urine. Sodium intake should be limited in clients with renal disease, and too little sodium intake does not result in anasarca. Urinary retention is not indicated with anasarca.
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The client with chronic kidney disease complains of intense itching. Which assessment finding would indicate the need for further nursing education?
- A. Pats skin dry after bathing
- B. Uses moisturizing creams
- C. Keeps nails trimmed short
- D. Brief, hot daily showers
Correct Answer: D
Rationale: Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoiding scratching and keeping nails trimmed short is indicated in the management of pruritus.
A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead the nurse to support that the client is experiencing rejection?
- A. Hypertension
- B. Weight loss
- C. Polyuria
- D. Tenderness over transplant site
Correct Answer: D
Rationale: Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.
A client is experiencing acute glomerulonephritis. Which assessment finding by the nurse is most important in determining the severity of the client's condition?
- A. Presence of albumin in the urine
- B. Dark smoky colored urine
- C. Blurred vision
- D. Peripheral edema
Correct Answer: C
Rationale: Visual disturbances can be indicative of rising blood pressure in a client with acute glomerulonephritis. Severe hypertension needs prompt treatment to prevent convulsions. Presence of albumin (protein) and RBCs in the urine, along with periorbital and peripheral edema, are common symptoms associated with glomerulonephritis.
The home health nurse reviews medications taken by the client with polycystic kidney disease. Which medication should be addressed first?
- A. Lovastatin
- B. Methylprednisolone
- C. Furosemide
- D. Ibuprofen
Correct Answer: D
Rationale: Nephrotoxic drugs are not administered to clients with renal disease unless no other therapeutic agent is available. Ibuprofen (Motrin) is a nephrotoxic drug and nephrotoxic medications, such as nonsteroidal anti-inflammatory drugs and cephalosporin antibiotics, should be avoided in treating clients with polycystic kidney disease. Lovastatin (Mevacor) (antihyperlipidemic agent) and methylprednisolone (Depo-Medrol) (steroid) are drugs presently being reviewed for slowing the rate of disease progression in clients with polycystic kidney disease and are not considered nephrotoxic. Furosemide (Lasix) is a diuretic and has no significance in causing renal damage.
When assessing a client with chronic glomerulonephritis, the nurse notes that the client has generalized edema. How does the nurse document this?
- A. Periorbital edema
- B. Anasarca
- C. Uremic frost
- D. Hydronephrosis
Correct Answer: B
Rationale: Generalized edema known as anasarca is a common finding with chronic glomerulonephritis. Periorbital edema refers to puffiness around the eyes. Uremic frost is a precipitate that forms on the skin in clients with chronic renal failure. Hydronephrosis refers to a condition involving distention of the renal pelvis.