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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.
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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 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 cares for a client who has pyelonephritis. The client states, 'I am embarrassed to talk about my symptoms and I don't want to talk to my nurse.' How should the nurse respond?
- A. I am a professional. Your symptoms will be kept in confidence.
- B. I understand. Elimination is a private topic and shouldn't be discussed.
- C. Take your time. It is okay to use words that are familiar to you.
- D. You seem anxious. Would you like a nurse of the same gender to care for you?
Correct Answer: C
Rationale: Encouraging the client to use familiar language helps facilitate discussion about sensitive genitourinary symptoms. Promising absolute confidentiality may not be feasible, dismissing the topic is inappropriate, and changing nurses does not address the client's discomfort with communication.
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.