ATI Care of Patients with Renal Disorders, Questions and Answers with Explanations, 100% Correct, Download to Score A

Test Bank

MULTIPLE CHOICE

1. On assessment of a client with polycystic kidney disease (PKD), which finding is of greatest concern to the nurse?

a.            Flank pain

b.            Periorbital edema

c.             Bloody and cloudy urine

d.            Enlarged abdomen

ANS: B

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 owing to cyst rupture or infection. Periorbital edema would not be a finding related to PKD and should be investigated further.

DIF: Cognitive Level: Comprehension/Understanding REF: Chart 70-1, p. 1520

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

2. A client with autosomal dominant polycystic kidney disease (ADPKD) asks whether his children could develop this disease. Which is the nurse’s best response?

a.            “No genetic link is known, so your children are not at increased risk.”

b.            “The disease is sex linked, so only your sons could be affected.”

c.             “Both you and your wife must have the disease for your children to develop it.”

d.            “Each of your children has a 50% risk of having ADPKD.”

ANS: D

ADPKD is transmitted as an autosomal dominant trait and therefore is not gender specific. Children whose parents have the autosomal dominant form of PKD have a 50% chance of inheriting the gene that causes the disease.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1519

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Teaching/Learning

3. A client with polycystic kidney disease and hypertension is prescribed a diuretic for blood pressure control. Which statement by the client indicates the need for further teaching regarding these orders?

a.            “I will weigh myself every day at the same time.”

b.            “I will drink only 1 liter of fluid each day.”

c.             “I will avoid aspirin and aspirin-containing drugs.”

d.            “I will avoid nonsteroidal anti-inflammatory drugs.”

ANS: B

Diuretics for blood pressure control can lead to fluid volume depletion and can decrease blood flow to the kidney, further decreasing renal function. The client should be instructed to drink at least 2500 mL/24 hr. NSAIDs should be used cautiously because they can reduce kidney blood flow. Aspirin products increase the risk for bleeding and should be avoided.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Illness Management) MSC: Integrated Process: Nursing Process (Evaluation)

4. A client with polycystic kidney disease (PKD) has received extensive teaching in the clinic. Which statement by the client indicates that an important goal related to nutrition is being met?

a.            “I take a laxative every night before going to bed.”

b.            “I have a soft bowel movement every morning.”

c.             “Food tastes so much better since I can use salt again.”

d.            “The white bread I am eating does not cause gas.”

ANS: B

Clients with PKD often have constipation, which can be managed with increased fiber, exercise, and drinking plenty of water. A soft bowel movement on a regular basis indicates that the client is preventing constipation. Laxatives should be used cautiously, and the need for their use indicates that the goal of preventing constipation via nutritional means is not being met. Clients with PKD should be on a restricted salt diet. White bread has a low fiber count and would not be included in a high-fiber diet.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Evaluation)

5. A client has a large renal calculus. Which assessment finding may indicate the development of a complication?

a.            Blood pressure of 178/94 mmHg

b.            Urine output of 5600 mL/24 hr

c.             Client reports of pain on urination

d.            Asymmetric, tender flank area

ANS: D

Hydronephrosis, indicated by an asymmetric flank with tenderness, is commonly caused by obstruction such as a renal calculus. As the kidney continues to make urine, the volume of urine backs up into the kidney, increasing pressure, and the kidney is enlarged as a result. An asymmetric tender flank would be one manifestation of this condition. Polyuria, dysuria, and hypertension are not complications associated with renal calculi.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

6. A client is hospitalized with a urinary tract infection (UTI). Which clinical manifestation alerts the nurse to the possibility of a complication from the UTI?

a.            Burning on urination

b.            Cloudy, dark urine

c.             Fever and chills

d.            Hematuria

ANS: C

Lower urinary tract infections are rarely associated with systemic symptoms of fever and chills. A client with a UTI who develops fever and chills should be assessed for the development of pyelonephritis. The other options can be seen with UTI.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

7. A middle-aged client with diabetes mellitus is being treated for the third episode of acute pyelonephritis in the past year and asks what can be done to help prevent these infections. Which is the nurse’s best response?

a.            “Test your urine daily for the presence of ketone bodies and proteins.”

b.            “Use tampons rather than sanitary napkins during your menstrual period.”

c.             “Drink more water and empty your bladder every 2 to 3 hours during the day.”

d.            “Keep your hemoglobin A1c 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 wearing tampons will not help prevent pyelonephritis. A hemoglobin A1c of 9% is too high.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

8. In assessing a client recently diagnosed with acute glomerulonephritis, the nurse asks which question to determine potential contributing factors?

a.            “Are you sexually active?”

b.            “Do you have pain or burning on urination?”

c.             “Has anyone in your family had chronic kidney problems?”

d.            “Have you had a cold or sore throat within the last 2 weeks?”

ANS: D

The most common cause of acute glomerulonephritis is the presence of a systemic infection (often a skin or respiratory infection) resulting in the formation of antigen-antibody complexes, which precipitate in the kidney tissues. The other questions would not assess for contributing causes.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)