A nurse cares for a client with a nephrostomy tube and notes...

A nurse cares for a client with a nephrostomy tube and notes that the drainage has decreased. Which action should the nurse take first?

A. Document the finding in the client's record.
B. Evaluate the tube as working in the hand-off report.
C. Clamp the tube in preparation for removing it.
D. Assess the client's abdomen and vital signs.

Correct Answer: D

Rationale: Decreased drainage from a nephrostomy tube may indicate obstruction, necessitating immediate assessment of the client's abdomen for pain or distention and vital signs to detect complications like infection or obstruction. This information should be reported to the provider. Documenting, evaluating in hand-off, or clamping the tube are not appropriate initial actions.

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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.

After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?

A. I will take a laxative every night before going to bed.
B. I must increase my intake of dietary fiber and fluids.
C. I only use salt when I am cooking my own food.
D. I can eat white bread to minimize gastrointestinal gas.

Correct Answer: B

Rationale: Clients with PKD often experience constipation, which can be managed by increasing dietary fiber and fluid intake. Laxatives should be used cautiously, salt intake should be restricted, and white bread is low in fiber, making it inappropriate for a high-fiber diet.

A nurse reviews laboratory results for a client with glomerulonephritis. The client's glomerular filtration rate (GFR) is 40 ml/min as measured by a 24-hour creatinine clearance. How should the nurse interpret this finding? (Select all that apply.)

A. Excessive GFR
B. Normal GFR
C. Reduced GFR
D. Potential for fluid overload
E. Potential for dehydration

Correct Answer: C,D

Rationale: A GFR of 40 ml/min is significantly reduced compared to the normal range of 100-120 ml/min, indicating impaired kidney function. This reduction increases the risk of fluid overload, leading to hypertension and pulmonary edema, rather than dehydration.

A nurse assesses a client who has a family history of polycystic kidney disease (PKD). For which clinical manifestations should the nurse assess? (Select all that apply.)

A. Nocturia
B. Dysuria
C. Increased abdominal girth
D. Dyspnea
E. Hematuria
F. Diarrhea

Correct Answer: B,C,E

Rationale: Clients with PKD commonly experience dysuria, increased abdominal girth due to kidney enlargement, and hematuria from cyst rupture or tissue damage. Nocturia, dyspnea, and diarrhea are not typically associated with PKD.

A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings should alert the nurse to urgently contact the health care provider? (Select all that apply.)

A. Clear drainage
B. Cloudy drainage at site
C. Client reports headache
D. Foul-smelling drainage
E. Urine draining from site

Correct Answer: B,D,E

Rationale: Cloudy or foul-smelling drainage and urine leaking from the nephrostomy site suggest infection or obstruction, requiring urgent provider notification. Clear drainage is normal, and a headache is unrelated unless accompanied by other concerning symptoms.