Nokea
The nurse is providing education to a client with acute glomerulonephritis. What should the nurse include in the teaching? Select all that apply.
- A. Identify high-sodium foods to include in the diet to increase dietary sodium.
- B. Explain the purpose of diuretic therapy or other prescribed medications, the dosing regimen, and side effects.
- C. Recommend regular blood pressure monitoring.
- D. Caution the client to avoid contact with persons who have infections.
- E. Advise the client that weight gain is an expected outcome.
Correct Answer: B,C,D
Rationale: The nurse should explain the purpose of diuretic therapy or other prescribed medications, the dosing regimen, and side effects, recommend regular blood pressure monitoring, and caution the client to avoid contact with persons who have infections. The nurse should identify the specific amount of sodium that the client is allowed and identify sources of sodium to avoid. The nurse should also advise the client to contact the primary provider if urinary volumes diminish, or if headaches, nosebleeds, or unexpected weight gain occur.
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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.
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.
A client with chronic glomerulonephritis has generalized edema. Which response by the nurse best describes why anasarca occurs with this disorder?
- A. Loss of serum protein causes the body's fluids to shift.
- B. High albumin levels in the blood attracts more fluid into the blood vessels.
- C. Too little sodium in the diet results in anasarca.
- D. When urine is retained in the body, it shifts the body's fluid into tissue spaces.
Correct Answer: A
Rationale: Anasarca is caused by the shift of fluid from the intravascular space to interstitial and intracellular locations, not by a shift of fluid from the tissues into the blood vessels. The fluid shift results from depletion of protein from the blood (serum) to the urine. Sodium intake should be limited in clients with renal disease, and too little sodium intake does not result in anasarca. Urinary retention is not indicated with anasarca.
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.