Chapter 67: Care of Patients with Kidney Disorders

Chapter 67: Care of Patients with Kidney Disorders

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding should alert the nurse to immediately contact the health care provider?
   1. Flank pain
   2. Periorbital edema
   3. Bloody and cloudy urine
   4. Enlarged abdomen

ANS:   B

Periorbital edema would not be a finding related to PKD and should be investigated further. Flank pain and a distended or enlarged abdomen occur in PKD because the kidneys enlarge and displace other organs. Urine can be bloody or cloudy as a result of cyst rupture or infection.

DIF:     Applying/Application                         REF:    1396

KEY:   Polycystic kidney disease

MSC:   Integrated Process: Nursing Process: Assessment                 NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

2. A nurse cares for a client with autosomal dominant polycystic kidney disease (ADPKD). The client asks, “Will my children develop this disease?” How should the nurse respond?
   1. “No genetic link is known, so your children are not at increased risk.”
   2. “Your sons will develop this disease because it has a sex-linked gene.”
   3. “Only if both you and your spouse are carriers of this disease.”
   4. “Each of your children has a 50% risk of having ADPKD.”

ANS:   D

Children whose parent has the autosomal dominant form of PKD have a 50% chance of inheriting the gene that causes the disease. ADPKD is transmitted as an autosomal dominant trait and therefore is not gender specific. Both parents do not need to have this disorder.

DIF:     Understanding/Comprehension         REF:    1396                 KEY: Polycystic kidney disease| genetics                                                          MSC:   Integrated Process: Teaching/Learning NOT:             Client Needs Category: Safe and Effective Care Environment: Management of Care

3. 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?
   1. “I will take a laxative every night before going to bed.”
   2. “I must increase my intake of dietary fiber and fluids.”
   3. “I shall only use salt when I am cooking my own food.”
   4. “I’ll eat white bread to minimize gastrointestinal gas.”

ANS:   B

Clients with PKD often have constipation, which can be managed with increased fiber, exercise, and drinking plenty of water. Laxatives should be used cautiously. Clients with PKD should be on a restricted salt diet, which includes not cooking with salt. White bread has a low fiber count and would not be included in a high-fiber diet.

DIF:            Applying/Application                         REF:    1397                 KEY: Polycystic kidney disease| nutritional requirements                                         MSC: Integrated Process: Nursing Process: Evaluation                      NOT:                                                 Client Needs Category: Physiological Integrity: Basic Care and Comfort

4. 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?
   1. “Test your urine daily for the presence of ketone bodies and proteins.”
   2. “Use tampons rather than sanitary napkins during your menstrual period.”
   3. “Drink more water and empty your bladder more frequently during the day.”
   4. “Keep your hemoglobin A_1c under 9% by keeping your blood sugar controlled.”

ANS:           C

Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons. Chronically elevated blood glucose levels spill glucose into the urine, changing the pH and providing a favorable climate for bacterial growth. The neuropathy associated with diabetes reduces bladder tone and reduces the client’s sensation of bladder fullness. Thus, even with large amounts of urine, the client voids less frequently, allowing stasis and overgrowth of microorganisms. Increasing fluid intake (specifically water) and voiding frequently prevent stasis and bacterial overgrowth. Testing urine and using tampons will not help prevent pyelonephritis. A hemoglobin A_1c of 9% is too high.

DIF:            Applying/Application                         REF:    1399                 KEY:    Diabetes mellitus| pyelonephritis                                                        MSC:   Integrated Process: Teaching/Learning NOT:                     Client Needs Category: Health Promotion and Maintenance

5. A nurse evaluates a client with acute glomerulonephritis (GN). Which manifestation should the nurse recognize as a positive response to the prescribed treatment?
   1. The client has lost 11 pounds in the past 10 days.
   2. The client’s urine specific gravity is 1.048.
   3. No blood is observed in the client’s urine.
   4. The client’s blood pressure is 152/88 mm Hg.

ANS:           A

Fluid retention is a major feature of acute GN. This weight loss represents fluid loss, indicating that the glomeruli are performing the function of filtration. A urine specific gravity of 1.048 is high. Blood is not usually seen in GN, so this finding would be expected. A blood pressure of 152/88 mm Hg is too high; this may indicate kidney damage or fluid overload.

DIF:            Applying/Application                         REF:    1402

KEY:          Glomerulonephritis

MSC:          Integrated Process: Nursing Process: Evaluation

NOT:          Client Needs Category: Physiological Integrity: Pharmacological and Parenteral

Therapies