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A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is an appropriate response by the nurse?
- A. Squamous cell carcinomas do not present with detectable symptoms.
- B. You should have sought treatment earlier.
- C. Very few symptoms are associated with renal cancer.
- D. Painless gross hematuria is the first symptom in renal cancer.
Correct Answer: C
Rationale: Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease. Adenocarcinomas are the most common renal cancer (about 80%) whereas squamous cell renal cancers are rare. It is not therapeutic to place doubt or blame for delayed diagnosis.
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A client is diagnosed with polycystic kidney disease. Which symptom would the nurse most likely assess?
- A. Hypertension
- B. Flank pain
- C. Fever
- D. Periorbital edema
Correct Answer: A
Rationale: Hypertension is often present in clients with polycystic kidney disease at the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and abdominal pain also may be noted based on the size and effects of the cysts. Fever would suggest an infection. Periorbital edema is noted with acute glomerulonephritis.
A client is administered dialystate solution through an abdominal catheter. The nurse notices that the return flow rate is slow, so the nurse advises the client to move to the other side. However, even after changing the client's position, the nurse does not observe an increase in return flow. Which of the following actions should the nurse perform to help accelerate the return flow rate?
- A. Disconnect the catheter and repay.
- B. Loosen the tubing clamp.
- C. Inform the physician that catheter may need repositioning.
- D. Stop the process for 5 minutes and resume later.
Correct Answer: C
Rationale: The nurse instills dialystate solution and clamps the tubing. If the return flow rate is slow, the nurse asks the client to move from side to side. If this maneuver is unsuccessful, the physician may need to reposition the catheter. The nurse should not tamper with the catheter settings because this may worsen the client's condition or damage the apparatus. Also, stopping the process and resuming it after 5 minutes will not help increase the return flow of the dialystate.
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.
A client who suffered hypovolemic shock during a cardiac incident has developed acute kidney injury. Which is the best nursing rationale for this complication?
- A. Decrease in the blood flow through the kidneys
- B. Obstruction of urine flow from the kidneys
- C. Blood clot formed in the kidneys interfered with the flow
- D. Structural damage occurred in the nephrons of the kidneys
Correct Answer: A
Rationale: Acute kidney injury can be caused by poor perfusion under decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but is not indicated in this client.
A client has a decreased secretion of erythropoietin from the kidneys due to end-stage kidney disease. The nurse explains that the decrease in erythropoietin will have what effect?
- A. Aemia from the decrease in maturation of red blood cells
- B. Decrease in blood sugar levels due to alteration in insulin levels
- C. Increase in blood sugar levels due to alteration in insulin levels
- D. Development of male sex characteristics
Correct Answer: A
Rationale: The kidneys secrete erythropoietin, which is a substance that promotes the maturation of red blood cells.