Nursing Considerations for Kidney Conditions

A nurse is caring for a client who has a new diagnosis of urolithiasis. Which of the following should the nurse identify as an associated risk factor?

• Diuretic use

• Family history

• BMI less than 25

• Hypocalcemia

Answer explanation

Family history is strongly correlated with the formation of urolithiasis. A nurse should assess a client who has kidney stones for familial tendencies toward stone formation.

A nurse is teaching a client who has acute kidney injury about the oliguric phase. Which of the following information should the nurse include in the teaching?

• Renal function is reestablished.

• BUN and creatinine levels decrease.

• Urine output is less than 400 mL per 24 hr.

• The glomerular filtration rate (GFR) recovers.

Answer explanation

Inadequate urinary output is associated with the oliguric phase of acute kidney injury. The minimum amount of urine needed to rid the body of metabolic waste products is 400 mL. Therefore, a client who is producing less than 400 mL of output in 24 hr is manifesting acute kidney injury.

A nurse is discussing kidney transplant with a client who has end-stage renal disease (ESRD). Which of the following should the nurse identify as a contraindication for this treatment?

• Breast cancer survivor for 8 years

• Pacemaker

• 65-years of age

• Alcohol use disorder

Answer explanation

The nurse should identify that a substance use disorder is a contraindication for kidney transplant.

A nurse is teaching a client who has urolithiasis (renal calculi). The nurse should explain that which of the following conditions can increase the risk for renal calculi?

• Protein in the urine

• Dehydration

• Iron deficiency

• Obesity

Answer explanation

Dehydration can cause hypercalcemia which increases the risk for renal stone formation. Inadequate fluid intake can result in urinary stasis and promote the formation of calculi.

A nurse is caring for a group of clients diagnosed with polycystic kidney disease (PKD). While teaching about ways to slow the progression to end-stage renal disease (ESRD), which of the following topics would be most important for the nurse to include?

• Blood pressure control

• Fluid restriction

• Blood glucose control

• Pain management

Answer explanation

Blood pressure control is important to control in clients who have PKD to slow the progression to ESRD.

A nurse is assessing a client who has end-stage kidney disease and is receiving hemodialysis. Which of the following findings should the nurse identify as an indication the client is experiencing fluid overload?

• The client has a 5 lb weight gain since yesterday.

• Flattened neck veins

• Oxygen saturation 93%

• Return of skin to previous position when the client’s shin is palpated

Answer explanation

The nurse should identify that a gain of 2 lb per day is stable. A gain of more than 2 lb per day or 5 lb per week is an indication of fluid overload.

A nurse is caring for a client who has an admitted diagnosis of renal calculi and medical history of hypertension and gout. The client works 6 days of the week outside in temperatures between 32.2° C to 37.8° C (90° F to 100° F). Which of the following should the nurse tell the client to prevent a reoccurrence of renal calculi?

• Eat a diet high in purine-rich foods.

• Eat a diet high in calcium oxalate-rich foods.

• Drink plenty of fluids during the day.

• Continue to take your prescribed gout medication.

Answer explanation

The nurse should encourage the client to drink fluids. Lack of adequate hydration is a risk factor for renal calculi.

A nurse is caring for a female client who has recurrent kidney stones and is scheduled for an intravenous pyelogram. Which of the following statements by the client should the nurse report to the provider?

• "I drink at least 2 quarts of fluid every day."

• "The last time I voided it was painful and red-tinged."

• "My period ended 2 days ago."

• "I don't eat shellfish because it gives me hives."

Answer explanation

The client says she experiences hives after eating shellfish, which indicates a sensitivity. The contrast dye typically used for an IVP is an iodine derivative, and the client with a shellfish sensitivity may have cross-sensitivity to iodine and a serious iodine allergy. This nurse should report these finding to the client's provider.

A nurse is caring for a male client who has a urinary tract infection. Which of the following conditions is the client most likely to develop as a result of the UTI?

• Prostatitis

• Chlamydia

• Benign prostatic hypertrophy

• Erectile dysfunction

Answer explanation

Prostatitis can be caused by an ascending urinary tract infection.

A nurse in a public clinic is researching health data on culturally diverse populations in the community.  Which of the following population groups should the nurse anticipate having end-stage renal disease due to diabetes mellitus?

• Black American

• Non-Hispanic White

• Asian American

• Hispanic/Latino

Answer explanation

The nurse should identify that underrepresented racial and ethnic groups experience health disparities, placing them at increased risk for complications of chronic diseases such as renal disease. According to statistics, the Hispanic/Latino population cohort experiences end stage renal disease more frequently than other populations at a rate of 27%.