Nokea
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.
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The client with chronic kidney disease is exhibiting signs of anemia. Which is the best nursing rationale for this symptom?
- A. Azotemia
- B. Diminished erythropoietin production
- C. Impaired immunologic response
- D. Electrolyte imbalances
Correct Answer: B
Rationale: Erythropoietin is a hormone produced in the kidneys, and this production is inadequate in chronic renal failure, which results in anemia. Azotemia, impaired immune response, and electrolyte imbalance are associated with chronic kidney disease but not indicated with anemia.
The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client?
- A. Urine output of 35 to 40 ml/hour
- B. Pain of 3 out of 10, 1 hour after analgesic administration
- C. SpO2 at 90% with fine crackles in the lung bases
- D. Blood tinged drainage in Jackson-Pratt drainage tube
Correct Answer: C
Rationale: Altered Breathing Pattern and Ineffective Airway Clearance Risk are often a challenge in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output are monitored to maintain a urine output of greater than 30 ml/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.
Following ureteroscopy, for the removal of ureteral calculus, a stent is temporarily left in place. The client asks what purpose the stent provides. Which is the correct response from the nurse?
- A. The stent is coated with an anti-infective to promote healing.
- B. The stent will catch any debris or blood clots left behind.
- C. The stent will provide easier passing of future stones.
- D. Inflammation from the stone can block the flow of urine.
Correct Answer: D
Rationale: Calculi can traumatize the lining of the ureters, resulting in inflammation and possible obstruction of urine flow. A stent is left behind to allow free-flowing urine until inflammatory process has resolved. Stents are not used for anti-infective properties or to catch debris or clots. Stents are not permanently placed for preventative measures.
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.
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.