Chapter 62: Concepts of Care for Patients with Kidney Disorders

Front

A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding would alert the nurse to immediately contact the primary health care provider?

Back

Periorbital edema

Answer explanation

Periorbital edema would not be a finding related to PKD and would 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.

Front

What assessment finding would the nurse expect in a client with chronic pyelonephritis?

Back

Hypertension

Answer explanation

The client who has chronic pyelonephritis has renal damage and therefore has hypertension. The other assessment findings

commonly occur in clients with acute pyelonephritis.

Front

Understanding of nutritional therapy for early polycystic kidney disease (PKD).

Back

Increase intake of dietary fiber and fluids.

Answer explanation

Clients with PKD often have constipation, which can be managed with increased fiber, exercise, and drinking plenty of water.

Laxatives would be used cautiously. Clients with PKD would 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.

Front

How can a middle-aged female client with diabetes mellitus prevent recurrent acute pyelonephritis infections?

Back

Drink more water and empty your bladder more frequently during the day.

Answer explanation

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 A1C of 9% is too high.

Front

A nurse evaluates a client with acute glomerulonephritis (GN). Which assessment finding would the nurse recognize as a positive response to the prescribed treatment?

Back

The client lost 11 lb (5 kg) in the past 10 days.

Answer explanation

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.

Front

What dietary change indicates a correct understanding of diet therapy for nephrotic syndrome with normal glomerular filtration?

Back

I will increase my intake of protein.

Answer explanation

In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and edema formation. If glomerular

filtration is normal or near normal, increased protein loss would be matched by increased intake of protein. The client would not

need to adjust fat, carbohydrates, or vitamins based on this disorder.

Front

A nurse assesses a client recovering from a radical nephrectomy for renal cell carcinoma. The client’s blood pressure decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for the past hour. What action would the nurse take?

Back

Assess the rate and quality of the client’s pulse.

Answer explanation

The nurse would first fully assess the client for signs of volume depletion and shock, and then notify the primary health care

provider. The extensive nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for

hemorrhage and adrenal insufficiency. Hypotension is a clinical manifestation associated with both hemorrhage and adrenal

insufficiency. Hypotension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function

effectively. Repositioning the patient, measuring specific gravity, and administering pain medication would not provide data

necessary to make an appropriate clinical decision, nor are they appropriate interventions at this time.

Front

What drug therapy is expected for a client with acute glomerulonephritis caused by beta streptococcus?

Back

Antibiotics

Answer explanation

Beta streptococcus is a bacterium that can cause acute glomerulonephritis, so antibiotic therapy is indicated.

Front

After teaching a client with hypertension secondary to renal disease, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for additional teaching?

• “I can prevent more damage to my kidneys by managing my blood pressure.”
• “If I have increased urination at night, I need to drink less fluid during the day.”
• “I need to see the registered dietitian to discuss limiting my protein intake.”
• “It is important that I take my antihypertensive medications as directed.”

Back

“If I have increased urination at night, I need to drink less fluid during the day.”

Answer explanation

The client should not restrict fluids during the day due to increased urination at night. Clients with renal disease may be prescribed

fluid restrictions, and would be assessed thoroughly for potential dehydration. Increased nocturnal voiding can be decreased by

consuming fluids earlier in the day. Blood pressure control is needed to slow the progression of renal dysfunction. When dietary

protein is restricted, refer the client to the registered dietitian nutritionist as needed.

Front

How should a nurse respond to a client with pyelonephritis who is embarrassed to talk about symptoms?

Back

“Take your time. It is okay to use words that are familiar to you.”

Answer explanation

Clients may be uncomfortable discussing issues related to elimination and the genitourinary area. The nurse would encourage the

client to use language that is familiar to the client. The nurse must assess the client and cannot take the time to stop the discussion

or find another nurse to complete the assessment.