Updated: Mar 27, 2022
Each of your kidneys is about the size of a fist. They're slightly below the rib cage, around the middle of your back. There are around a million microscopic structures called nephrons inside each kidney. Your blood is filtered by them. Wastes and excess water are removed, resulting in urine. Urine travels through tubes known as ureters. It travels to your bladder, which reserves pee until you need to use the restroom.
The nephrons are the target of the majority of kidney disorders. The kidneys may be unable to eliminate waste as a result of this injury. Genetic issues, trauma, and medications can all be factors. If you have diabetes, high blood pressure, or a close relative with kidney disease, you're more likely to get renal disease. Chronic renal disease wreaks havoc on the nephrons over time.
Practice Your Knowledge with this FREE nursing test bank on Renal Disorders
Answers will be provided at the end of this test bank. Feel free to copy and paste for studying purposes.
1. A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?
a) Assess the AV fistula for a bruit and thrill.
b) Keep the AV fistula site dry.
c) Take the client's blood pressure in the left arm.
d) Keep the AV fistula wrapped in gauze.
2. The nurse is caring for a patient who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed which of the following?
a) Acute rejection
b) Chronic rejection
c) Simple rejection
d) Hyperacute rejection
3. The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:
a) "As the disease progresses, you will most likely require renal replacement therapy."
b) "Draining of the cysts and antibiotic therapy will cure your disease."
c) "Dietary changes can reverse the damage that has occurred in your kidneys."
d) "Genetic testing will determine the best treatment for your condition."
4. A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
a) Risk for infection
b) Impaired urinary elimination
c) Toileting self-care deficit
d) Activity intolerance
5. A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse?
a) "Let's wait until after the surgery to discuss your treatment plan."
b) "The doctor may decide to delay the use of immunosuppressant drugs."
c) "Immunosuppressive drugs guarantee organ success."
d) "Even a perfect match does not guarantee organ rejection."
6. The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?
a) Hypovolemic shock caused by hemorrhage
b) Abdominal distention owing to reflex cessation of intestinal peristalsis
c) Paralytic ileus caused by manipulation of the colon during surgery
d) Pneumonia caused by shallow breathing because of severe incisional pain
7. Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?
a) Weight loss
b) Absence of pain
8. The nurse is educating a patient who is required to restrict potassium intake. What foods would the nurse suggest the patient eliminate that are rich in potassium?
a) Cooked white rice
b) Salad oils
c) Citrus fruits
9. Following a nephrectomy, which assessment finding is most important in determining nursing care for the client?
a) Blood tinged drainage in Jackson-Pratt drainage tube
b) Urine output of 35 to 40 mL/hour
c) SpO2 at 90% with fine crackles in the lung bases
d) Pain of 3 out of 10, 1 hour after analgesic administration
10. The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? (Select all that apply.)
a) Red blood cells in the urine
d) Hemoglobin of 12.8 g/dL
e) White cell casts in the urine
11. A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
a) Urine output of 250 ml/24 hours
b) Temperature of 100.2° F (37.8° C)
c) Serum creatinine level of 1.2 mg/dl
d) Blood urea nitrogen (BUN) level of 22 mg/dl
12. Which of the following nursing actions is most important in caring for the client following lithotripsy?
a) Administer allopurinol (Zyloprim).
b) Notify the physician of hematuria.
c) Monitor the continuous bladder irrigation.
d) Strain the urine carefully for stone fragments.
13. Which of the following is a characteristic of the intrarenal category of acute renal failure?
a) Decreased creatinine
b) High specific gravity
c) Increased BUN
d) Decreased urine sodium
14. A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?
a) Avoid carrying heavy items.
b) Auscultate the lungs frequently.
c) Perform deep-breathing exercises vigorously.
d) Wear a mask when performing exchanges.
15. The nurse is administering calcium acetate (PhosLo) to a patient with ESKD. When is the best time for the nurse to administer this medication?
a) 2 hours before meals
b) 2 hours after meals
c) At bedtime with 8 ounces of fluid
d) With food
16. Mr. Jarvis's renal failure has become chronic. You are seeing him in clinic and he discusses the various signs and symptoms he is experiencing. Select all of the following which you know to be associated with chronic renal failure.
a) Muscle cramps
b) Enhanced cognition
c) Bleeding of the oral mucous membranes
17. A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase?
b) Acute tubular necrosis
d) Restored glomerular function
18. A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 ml. Urine output that's less than 50 ml in 24 hours is known as:
19. The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following?
a) Metabolic alkalosis
20. When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?
a) Low blood pressure
b) Tea-colored urine
c) Left upper quadrant pain
(The nurse needs to assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.)
(After a kidney transplant, rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years. A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized glomerular capillary thrombosis and necrosis. The term "simple" is not used in the categorization of types of rejection of kidney transplants.)
(There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.)
(The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.)
(Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.)
(If bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack.)
(Fever is an indicator of infection or transplant rejection.)
(Foods and fluids containing potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee) are restricted.)
(The Risk for Ineffective Breathing Pattern is 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 is 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.)
10. A, B, E
(The primary presenting features of an acute glomerular inflammation are hematuria, edema, azotemia (an abnormal concentration of nitrogenous wastes in the blood), and proteinuria (excess protein in the urine) (Porth & Matfin, 2009). The urine may appear cola colored because of red blood cells (RBCs) and protein plugs or casts; RBC casts indicate glomerular injury.)
(ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.)
(The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical analysis.)
(The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.)
(The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.)
(Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. The nurse administers phosphate binders with food for them to be effective.)
16. A, C, D
(Lethargy, muscle cramps, and bleeding of the oral mucous membranes are some of the signs and symptoms of chronic renal failure. With chronic renal failure, mental processes progressively slow as electrolyte imbalances become marked and nitrogenous wastes accumulate.)
(During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.)
(Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine.)
(Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic glomerulonephritis.)
(Tea-colored urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis.)