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A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding should alert the nurse to routinely contact the health care provider?
- A. Flank pain
- B. Periorbital edema
- C. Blood and cloudy urine
- D. Enlarged abdomen
Correct Answer: B
Rationale: Periorbital edema is not a typical finding associated with PKD and warrants further investigation, as it may indicate another underlying condition. Flank pain, enlarged abdomen, and bloody or cloudy urine are common symptoms of PKD due to kidney enlargement, cyst rupture, or infection.
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A nurse cares for a middle-aged female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, 'What can I do to help prevent these infections?' How should the nurse respond?
- A. Test your urine daily for the presence of ketone bodies and proteins.
- B. Use tampons rather than sanitary napkins during your menstrual period.
- C. Drink more water and empty your bladder more frequently during the day.
- D. Keep your hemoglobin A1C under 9% by keeping your blood sugar controlled.
Correct Answer: C
Rationale: Increasing fluid intake (especially water) and frequent voiding help flush bacteria from the urinary tract, reducing the risk of pyelonephritis. Chronically elevated blood glucose in diabetes can promote bacterial growth, but frequent voiding is the most direct preventive measure. Testing urine for ketones/proteins, using tampons, or controlling hemoglobin A1C are not as directly related to preventing urinary tract infections.
The nurse should first fully assess the client for signs of volume depletion and shock, and then notify the provider. The radical nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypertension is a clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypertension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Which action should the nurse take first?
- A. Reposition the client to promote comfort.
- B. Measure the specific gravity of the client's urine.
- C. Administer intravenous pain medications.
- D. Assess the rate and quality of the client's pulse.
Correct Answer: D
Rationale: Assessing the rate and quality of the client's pulse is critical to evaluate for signs of volume depletion or shock, which are potential complications post-nephrectomy due to hemorrhage or adrenal insufficiency. This assessment provides essential data before notifying the provider. Repositioning, measuring urine specific gravity, or administering pain medication do not address the immediate risk of these complications.
A nurse teaches a client with polycystic kidney disease (PKD). Which statements should the nurse include in this client's discharge teaching? (Select all that apply.)
- A. Take your blood pressure every morning.
- B. Weigh yourself at the same time each day.
- C. Adjust your diet to prevent diarrhea.
- D. Contact your provider if you have visual disturbances.
- E. Assess your urine for renal stones.
Correct Answer: A,B,D
Rationale: Clients with PKD should monitor blood pressure and weight daily to track hypertension and fluid status, and report visual disturbances, which may indicate a berry aneurysm. Adjusting diet to prevent constipation, not diarrhea, is appropriate, and renal stones are not a primary concern in PKD.
An emergency department nurse cares for a client who is severely dehydrated and is prescribed 3 L of intravenous fluid over 6 hours. At what rate should the nurse set the intravenous pump to infuse the fluids? (Record your answer using a whole number.)
- A. 100 ml/hr
- B. 250 ml/hr
- C. 500 ml/hr
- D. 750 ml/hr
Correct Answer: C
Rationale: To deliver 3 L (3000 ml) over 6 hours, the infusion rate is calculated as 3000 ml ÷ 6 hours = 500 ml/hr. This rate ensures the prescribed volume is administered within the specified time frame.
A nurse assesses a client with nephrotic syndrome. For which clinical manifestations should the nurse assess? (Select all that apply.)
- A. Proteinuria
- B. Hypoalbuminemia
- C. Dehydration
- D. Lipiduria
- E. Dysuria
- F. Costovertebral angle (CVA) tenderness
Correct Answer: A,B,D
Rationale: Nephrotic syndrome is characterized by proteinuria (>3.5 g/24 hr), hypoalbuminemia, and lipiduria due to glomerular damage. Dehydration is unlikely due to fluid overload, and dysuria and CVA tenderness are associated with infections like cystitis or pyelonephritis, not nephrotic syndrome.