Chapter 54: Management of Patients with Kidney Disorders

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Ans: A
The nurse is assessing a patient suspected of having developed Feedback:
acute glomerulonephritis. The nurse should expect to address The primary presenting feature of acute glomerulonephritis is
what clinical manifestation that is characteristic of this health hematuria (blood in the urine), which may be microscopic (identi-
problem? fiable through microscopic examination) or macroscopic or gross
A) Hematuria (visible to the eye). Proteinuria, primarily albumin, which is pre-
B) Precipitous decrease in serum creatinine levels sent, is due to increased permeability of the glomerular mem-
C) Hypotension unresolved by fluid administration brane. Blood urea nitrogen (BUN) and serum creatinine levels
D) Glucosuria may rise as urine output drops. Some degree of edema and
hypertension is noted in most patients.
The nurse is caring for acutely ill patient. What assessment finding
should prompt the nurse to inform the physician that the patient Ans: C
may be exhibiting signs of acute kidney injury (AKI)? Feedback:
A) The patient is complains of an inability to initiate voiding. Oliguria (<500 mL/d of urine) is the most common clinical situation
B) The patients urine is cloudy with a foul odor. seen in AKI. Flank pain and inability to initiate voiding are not
C) The patients average urine output has been 10 mL/hr for characteristic of AKI. Cloudy, foul-smelling urine is suggestive of
several hours. a urinary tract infection.
D) The patient complains of acute flank pain.
The nurse is caring for a patient with a history of systemic lupus
erythematosus who has been recently diagnosed with end-stage
Ans: D
kidney disease (ESKD). The patient has an elevated phosphorus
Feedback:
level and has been prescribed calcium acetate to bind the phos-
Both calcium carbonate and calcium acetate are medications
phorus. The nurse should teach the patient to take the prescribed
that bind with the phosphate and assist in excreting the phos-
phosphorus-binding medication at what time?
phate from the body, in turn lowering the phosphate levels. Phos-
A) Only when needed
phate-binding medications must be administered with food to be
B) Daily at bedtime
effective.
C) First thing in the morning
D) With each meal
Ans: A
Feedback:
The nurse is working on the renal transplant unit. To reduce
The nurse ensures that the patient is protected from exposure to
the risk of infection in a patient with a transplanted kidney, it is
infection by hospital staff, visitors, and other patients with active
imperative for the nurse to do what?
infections. Careful handwashing is imperative; face masks may be
A) Wash hands carefully and frequently.
worn by hospital staff and visitors to reduce the risk for transmitting
B) Ensure immediate function of the donated kidney.
infectious agents while the patient is receiving high doses of im-
C) Instruct the patient to wear a face mask.
munosuppressants. Visitors may be limited, but are not normally
D) Bar visitors from the patients room.
barred outright. Ensuring kidney function is vital, but does not
prevent infection.
The nurse is caring for a patient receiving hemodialysis three
Ans: C
times weekly. The patient has had surgery to form an arteriove-
Feedback:
nous fistula. What is most important for the nurse to be aware of
When blood flow is reduced through the access for any reason
when providing care for this patient?
(hypotension, application of BP cuff/tourniquet), the access site
A) Using a stethoscope for auscultating the fistula is contraindi-
can clot. Auscultation of a bruit in the fistula is one way to de-
cated.
termine patency. Typically, patients feel fatigued immediately after
B) The patient feels best immediately after the dialysis treatment.
hemodialysis because of the rapid change in fluid and electrolyte
C) Taking a BP reading on the affected arm can damage the
status. Although the area over the fistula may have some de-
fistula.
creased sensation, a needle stick is still painful.
D) The patient should not feel pain during initiation of dialysis.
A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73
nr2. Based on this GFR, the nurse interprets that the patients Ans: C
chronic kidney disease is at what stage? Feedback:
A) Stage 1 Stages of chronic renal failure are based on the GFR. Stage 3 is
B) Stage 2 defined by a GFR in the range of 30 to 59 mL/min/1.73 m2. This
C) Stage 3 is considered a moderate decrease in GFR.
D) Stage 4
A football player is thought to have sustained an injury to his
kidneys from being tackled from behind. The ER nurse caring for
Ans: A
the patient reviews the initial orders written by the physician and
Feedback:
notes that an order to collect all voided urine and send it to the
laboratory for analysis. The nurse understands that this nursing

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 Chapter 54: Management of Patients with Kidney Disorders
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intervention is important for what reason?
A) Hematuria is the most common manifestation of renal trauma
Hematuria is the most common manifestation of renal trauma; its
and blood losses may be microscopic, so laboratory analysis is
presence after trauma suggests renal injury. Hematuria may not
essential.
occur, or it may be detectable only on microscopic examination.
B) Intake and output calculations are essential and the laboratory
All urine should be saved and sent to the laboratory for analysis
will calculate the precise urine output produced by this patient.
to detect RBCs and to evaluate the course of bleeding. Measuring
C) A creatinine clearance study may be ordered at a later time
intake and output is not a function of the laboratory. The laboratory
and the laboratory will hold all urine until it is determined if the
does not save urine to test creatinine clearance at a later time.
test will be necessary.
The laboratory does not monitor the urine for sodium or potassium
D) There is great concern about electrolyte imbalances and the
concentrations.
laboratory will monitor the urine for changes in potassium and
sodium concentrations.
A patient admitted with nephrotic syndrome is being cared for
Ans: D
on the medical unit. When writing this patients care plan, based
Feedback:
on the major clinical manifestation of nephrotic syndrome, what
The major clinical manifestation of nephrotic syndrome is ede-
nursing diagnosis should the nurse include?
ma, so the appropriate nursing diagnosis is Excess fluid volume
A) Constipation related to immobility
related to generalized edema. Edema is usually soft, pitting, and
B) Risk for injury related to altered thought processes
commonly occurs around the eyes, in dependent areas, and in the
C) Hyperthermia related to the inflammatory process
abdomen.
D) Excess fluid volume related to generalized edema
Ans: B
The nurse coming on shift on the medical unit is taking a report on
Feedback:
four patients. What patient does the nurse know is at the greatest
Systemic diseases, such as diabetes mellitus (leading cause);
risk of developing ESKD?
hypertension; chronic glomerulonephritis; pyelonephritis; obstruc-
A) A patient with a history of polycystic kidney disease
tion of the urinary tract; hereditary lesions, such as in polycystic
B) A patient with diabetes mellitus and poorly controlled hyper-
kidney disease; vascular disorders; infections; medications; or
tension
toxic agents may cause ESKD. A patient with more than one of
C) A patient who is morbidly obese with a history of vascular
these risk factors is at the greatest risk for developing ESKD.
disorders
Therefore, the patient with diabetes and hypertension is likely at
D) A patient with severe chronic obstructive pulmonary disease
highest risk for ESKD.
The nurse is caring for a patient postoperative day 4 following a
Ans: A
kidney transplant. When assessing for potential signs and symp-
Feedback:
toms of rejection, what assessment should the nurse prioritize?
After kidney transplantation, the nurse should perform all of the
A) Assessment of the quantity of the patients urine output
listed assessments. However, oliguria is considered to be more
B) Assessment of the patients incision
suggestive of rejection than changes to the patients abdomen or
C) Assessment of the patients abdominal girth
incision.
D) Assessment for flank or abdominal pain
The nurse is caring for a patient in acute kidney injury. Which of
the following complications would Ans: C
most clearly warrant the administration of polystyrene sulfonate Feedback:
(Kayexalate)? Hyperkalemia, a common complication of acute kidney injury, is
A) Hypernatremia life-threatening if immediate action is not taken to reverse it. The
B) Hypomagnesemia administration of polystyrene sulfonate reduces serum potassium
C) Hyperkalemia levels.
D) Hypercalcemia
Renal failure can have prerenal, renal, or postrenal causes. A
patient with acute kidney injury is being assessed to determine
Ans: A
where, physiologically, the cause is. If the cause is found to be
Feedback:
prerenal, which condition most likely caused it?
By causing inadequate renal perfusion, heart failure can lead to
A) Heart failure
prerenal failure. Glomerulonephritis and aminoglycoside toxicity
B) Glomerulonephritis
are renal causes, and ureterolithiasis is a postrenal cause.
C) Ureterolithiasis
D) Aminoglycoside toxicity
A 45-year-old man with diabetic nephropathy has ESKD and is
starting dialysis. What should the nurse teach the patient about Ans: A
hemodialysis? Feedback:
A) Hemodialysis is a treatment option that is usually required Hemodialysis is the most commonly used method of dialysis.
three times a week. Patients receiving hemodialysis must undergo treatment for the
B) Hemodialysis is a program that will require you to commit to rest of their lives or until they undergo successful kidney trans-
daily treatment.

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 Chapter 54: Management of Patients with Kidney Disorders
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C) This will require you to have surgery and a catheter will need
to be inserted into your abdomen. plantation. Treatments usually occur three times a week for at least
D) Hemodialysis is a treatment that is used for a few months until 3 to 4 hours per treatment.
your kidney heals and starts to produce urine again.
Ans: A
A patient with ESKD receives continuous ambulatory peritoneal
Feedback:
dialysis. The nurse observes that the dialysate drainage fluid is
Peritonitis is the most common and serious complication of peri-
cloudy. What is the nurses most appropriate action?
toneal dialysis. The first sign of peritonitis is cloudy dialysate
A) Inform the physician and assess the patient for signs of infec-
drainage fluid, so prompt reporting to the primary care provider
tion.
and rapid assessment for other signs of infection are warranted.
B) Flush the peritoneal catheter with normal saline.
Administration of an IV bolus is not necessary or appropriate and
C) Remove the catheter promptly and have the catheter tip cul-
the physician would determine whether removal of the catheter
tured.
is required. Flushing the catheter does not address the risk for
D) Administer a bolus of IV normal saline as ordered.
infection.
The nurse is planning patient teaching for a patient with ESKD
who is scheduled for the creation of a fistula. The nurse would Ans: A
include which of the following in teaching the patient about the Feedback:
fistula? The fistula joins an artery and a vein, either side-to-side or
A) A vein and an artery in your arm will be attached surgically. end-to-end. This access will need time, usually 2 to 3 months,
B) The arm should be immobilized for 4 to 6 days. to mature before it can be used. The patient is encouraged to
C) One needle will be inserted into the fistula for each dialysis perform exercises to increase the size of the affected vessels (e.g.,
treatment. squeezing a rubber ball for forearm fistulas). Two needles will be
D) The fistula can be used 2 days after the surgery for dialysis inserted into the fistula for each dialysis treatment.
treatment.
A patient with ESKD is scheduled to begin hemodialysis. The
Ans: A, B, D
nurse is working with the patient to adapt the patients diet to
Feedback:
maximize the therapeutic effect and minimize the risks of com-
Restricting dietary protein decreases the accumulation of nitroge-
plications. The patients diet should include which of the following
nous wastes, reduces uremic symptoms, and may even postpone
modifications? Select all that apply.
the initiation of dialysis for a few months. Restriction of fluid is
A) Decreased protein intake
also part of the dietary prescription because fluid accumulation
B) Decreased sodium intake
may occur. As well, sodium is usually restricted to 2 to 3 g/day.
C) Increased potassium intake
Potassium intake is usually limited, not increased, and there is no
D) Fluid restriction
particular need for vitamin D supplementation.
E) Vitamin D supplementation
A patient on the critical care unit is postoperative day 1 following
kidney transplantation from a living donor. The nurses most re- Ans: B
cent assessments indicate that the patient is producing copious Feedback:
quantities of dilute urine. What is the nurses most appropriate A kidney from a living donor related to the patient usually begins
response? to function immediately after surgery and may produce large
A) Assess the patient for further signs or symptoms of rejection. quantities of dilute urine. This is not suggestive of rejection and
B) Recognize this as an expected finding. treatment is not warranted. There is no obvious need to report this
C) Inform the primary care provider of this finding. finding.
D) Administer exogenous antidiuretic hormone as ordered.
Ans: B
A patient is scheduled for a CT scan of the abdomen with con-
Feedback:
trast. The patient has a baseline creatinine level of 2.3 mg/dL.
Radiocontrast-induced nephropathy is a major cause of hos-
In preparing this patient for the procedure, the nurse anticipates
pital-acquired acute kidney injury. Baseline levels of creatinine
what orders?
greater than 2 mg/dL identify the patient as being high risk.
A) Monitor the patients electrolyte values every hour before the
Preprocedure hydration and prescription of acetylcysteine (Mu-
procedure.
comyst) the day prior to the test is effective in prevention. The
B) Preprocedure hydration and administration of acetylcysteine
nurse would not monitor the patients electrolytes every hour pre-
C) Hemodialysis immediately prior to the CT scan
procedure. Nothing in the scenario indicates the need for he-
D) Obtain a creatinine clearance by collecting a 24-hour urine
modialysis. A creatinine clearance is not necessary prior to a CT
specimen.
scan with contrast.
The nurse is caring for a patient with acute glomerular inflamma-
tion. When assessing for the characteristic signs and symptoms Ans: B, D
of this health problem, the nurse should include which assess- Feedback:
ments? Select all that apply. Most patients with acute glomerular inflammation have some
A) Percuss for pain in the right lower abdominal quadrant. degree of edema and hypertension. Dysrhythmias, RLQ pain,
B) Assess for the presence of peripheral edema.

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C) Auscultate the patients apical heart rate for dysrhythmias.
and changes in mental status are not among the most common
D) Assess the patients BP.
manifestations of acute glomerular inflammation.
E) Assess the patients orientation and judgment.
A patient is admitted to the ICU after a motor vehicle accident. On
Ans: C
the second day of the hospital admission, the patient develops
Feedback:
acute kidney injury. The patient is hemodynamically unstable,
CVVHD facilitates the removal of uremic toxins and fluid. The
but renal replacement therapy is needed to manage the patients
hemodynamic effects of CVVHD are usually mild in comparison to
hypervolemia and hyperkalemia. Which of the following therapies
hemodialysis, so CVVHD is best tolerated by an unstable patient.
will the patients hemodynamic status best tolerate?
Peritoneal dialysis is not the best choice, as the patient may have
A) Hemodialysis
sustained abdominal injuries during the accident and catheter
B) Peritoneal dialysis
placement would be risky. Plasmapheresis does not achieve fluid
C) Continuous venovenous hemodialysis (CVVHD)
removal and electrolyte balance.
D) Plasmapheresis
A patient has presented with signs and symptoms that are char-
acteristic of acute kidney injury, but preliminary assessment re-
Ans: D
veals no obvious risk factors for this health problem. The nurse
Feedback:
should recognize the need to interview the patient about what
The kidneys are susceptible to the adverse effects of medications
topic?
because they are repeatedly exposed to substances in the blood.
A) Typical diet
Nephrotoxic medications are a more likely cause of AKI than diet,
B) Allergy status
allergies, or stress.
C) Psychosocial stressors
D) Current medication use
An 84-year-old woman diagnosed with cancer is admitted to the
oncology unit for surgical treatment. The patient has been on
Ans: C, D
chemotherapeutic agents to decrease the tumor size prior to the
Feedback:
planned surgery. The nurse caring for the patient is aware that
Changes in kidney function with normal aging increase the sus-
what precipitating factors in this patient may contribute to AKI?
ceptibility of elderly patients to kidney dysfunction and renal fail-
Select all that apply.
ure. In addition, the presence of chronic, systemic diseases in-
A) Anxiety
creases the risk of AKI. Low BMI and anxiety are not risk factors for
B) Low BMI
acute renal disease. NPO status is not a risk, provided adequate
C) Age-related physiologic changes
parenteral hydration is administered.
D) Chronic systemic disease
E) NPO status
A patient is being treated for AKI and the patient daily weights
have been ordered. The nurse notes a weight gain of 3 pounds Ans: B
over the past 48 hours. What nursing diagnosis is suggested by Feedback:
this assessment finding? If the patient with AKI gains or does not lose weight, fluid retention
A) Imbalanced nutrition: More than body requirements should be suspected. Short-term weight gain is not associated
B) Excess fluid volume with excessive caloric intake or a sedentary lifestyle. Failure to
C) Sedentary lifestyle thrive is not associated with weight gain.
D) Adult failure to thrive
A 15-year-old is admitted to the renal unit with a diagnosis of
postinfectious glomerular disease. The nurse should recognize Ans: D
that this form of kidney disease may have been precipitated by Feedback:
what event? Postinfectious causes of postinfectious glomerular disease are
A) Psychosocial stress group A beta-hemolytic streptococcal infection of the throat that
B) Hypersensitivity to an immunization precedes the onset of glomerulonephritis by 2 to 3 weeks. Menar-
C) Menarche che, stress, and hypersensitivity are not typical causes.
D) Streptococcal infection
A patient on the medical unit has a documented history of poly-
cystic kidney disease (PKD). What principle should guide the
nurses care of this patient?
A) The disease is self-limiting and cysts usually resolve sponta- Ans: B
neously in the fifth or sixth decade of life. Feedback:
B) The patients disease is incurable and the nurses interventions PKD is incurable and care focuses on support and symptom
will be supportive. control. It is not self-limiting and is not treated surgically or with
C) The patient will eventually require surgical removal of his or her lithotripsy.
renal cysts.
D) The patient is likely to respond favorably to lithotripsy treatment
of the cysts.

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The nurse is providing a health education workshop to a group
of adults focusing on cancer prevention. The nurse should em-
Ans: C
phasize what action in order to reduce participants risks of renal
Feedback:
carcinoma?
Tobacco use is a significant risk factor for renal cancer, surpassing
A) Avoiding heavy alcohol use
the significance of high alcohol and sodium intake. Immunizations
B) Control of sodium intake
do not address an individuals risk of renal cancer.
C) Smoking cessation
D) Adherence to recommended immunization schedules
The nurse performing the health interview of a patient with a new
onset of periorbital edema has completed a genogram, noting the
health history of the patients siblings, parents, and grandparents. Ans: D
This assessment addresses the patients risk of what kidney dis- Feedback:
order? PKD is a genetic disorder characterized by the growth of nu-
A) Nephritic syndrome merous cysts in the kidneys. Nephritic syndrome, acute glomeru-
B) Acute glomerulonephritis lonephritis, and nephrotic syndrome are not genetic disorders.
C) Nephrotic syndrome
D) Polycystic kidney disease (PKD)
Ans: B
A patient is brought to the renal unit from the PACU status post
Feedback:
resection of a renal tumor. Which of the following nursing actions
The patient requires frequent analgesia during the postoperative
should the nurse prioritize in the care of this patient?
period and assistance with turning, coughing, use of incentive
A) Increasing oral intake
spirometry, and deep breathing to prevent atelectasis and other
B) Managing postoperative pain
pulmonary complications. Increasing oral intake and mobility are
C) Managing dialysis
not priority nursing actions in the immediate postoperative care of
D) Increasing mobility
this patient. Dialysis is not necessary following kidney surgery.
Ans: C
A nurse is caring for a patient who is in the diuresis phase of AKI. Feedback:
The nurse should closely monitor the patient for what complication The diuresis period is marked by a gradual increase in urine
during this phase? output, which signals that glomerular filtration has started to re-
A) Hypokalemia cover. The patient must be observed closely for dehydration during
B) Hypocalcemia this phase; if dehydration occurs, the uremic symptoms are likely
C) Dehydration to increase. Excessive losses of potassium and calcium are not
D) Acute flank pain typical during this phase, and diuresis does not normally result in
pain.
Ans: A, B, C, D
Feedback:
The nurse has an important role in caring for the patient with
The nurse is caring for a patient status after a motor vehicle AKI. The nurse monitors for complications, participates in emer-
accident. The patient has developed AKI. What is the nurses role gency treatment of fluid and electrolyte imbalances, assesses
in caring for this patient? Select all that apply. the patients progress and response to treatment, and provides
A) Providing emotional support for the family physical and emotional support. Additionally, the nurse keeps
B) Monitoring for complications family members informed about the patients condition, helps them
C) Participating in emergency treatment of fluid and electrolyte understand the treatments, and provides psychological support.
imbalances Although the development of AKI may be the most serious prob-
D) Providing nursing care for primary disorder (trauma) lem, the nurse continues to provide nursing care indicated for the
E) Directing nutritional interventions primary disorder (e.g., burns, shock, trauma, obstruction of the
urinary tract). The nurse does not direct the patients nutritional
status; the dietician and the physician normally collaborate on
directing the patients nutritional status.
A 71-year-old patient with ESKD has been told by the physician
that it is time to consider hemodialysis until a transplant can
be found. The patient tells the nurse she is not sure she wants Ans: B
to undergo a kidney transplant. What would be an appropriate Feedback:
response for the nurse to make? Although there is no specific age limitation for renal transplanta-
A) The decision is certainly yours to make, but be sure not to make tion, concomitant disorders (e.g., coronary artery disease, periph-
a mistake. eral vascular disease) have made it a less common treatment for
B) Kidney transplants in patients your age are as successful as the elderly. However, the outcome is comparable to that of younger
they are in younger patients. patients. The other listed options either belittle the patient or give
C) I understand your hesitancy to commit to a transplant surgery. the patient misinformation.
Success is comparatively rare.
D) Have you talked this over with your family?
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The nurse has identified the nursing diagnosis of risk for infection
Ans: A
in a patient who undergoes peritoneal dialysis. What nursing
Feedback:
action best addresses this risk?
Aseptic technique is used to prevent peritonitis and other infec-
A) Maintain aseptic technique when administering dialysate.
tious complications of peritoneal dialysis. It is not necessary to
B) Wash the skin surrounding the catheter site with soap and
cleanse the skin with soap and water prior to each exchange.
water prior to each exchange.
Antibiotics may be added to dialysate to treat infection, but they
C) Add antibiotics to the dialysate as ordered.
are not used to prevent infection.
D) Administer prophylactic antibiotics by mouth or IV as ordered.
The nurse is caring for a patient who has returned to the postsur-
gical suite after post-anesthetic recovery from a nephrectomy. The
nurses most recent hourly assessment reveals a significant drop
Ans: A
in level of consciousness and BP as well as scant urine output
Feedback:
over the past hour. What is the nurses best response?
Bleeding may be suspected when the patient experiences fatigue
A) Assess the patient for signs of bleeding and inform the physi-
and when urine output is less than 30 mL/h. The physician must be
cian.
made aware of this finding promptly. Palpating the patients flanks
B) Monitor the patients vital signs every 15 minutes for the next
would cause intense pain that is of no benefit to assessment.
hour.
C) Reposition the patient and reassess vital signs.
D) Palpate the patients flanks for pain and inform the physician.
Ans: B
Feedback:
The critical care nurse is monitoring the patients urine output and
Urine output and drainage from tubes inserted during surgery
drains following renal surgery. What should the nurse promptly
are monitored for amount, color, and type or characteristics. De-
report to the physician?
creased or absent drainage is promptly reported to the physi-
A) Increased pain on movement
cian because it may indicate obstruction that could cause pain,
B) Absence of drain output
infection, and disruption of the suture lines. Reporting increased
C) Increased urine output
pain on movement has nothing to do with the scenario described.
D) Blood-tinged serosanguineous drain output
Increased urine output and serosanguineous drainage are ex-
pected.
Ans: C
The nurse is creating an education plan for a patient who under- Feedback:
went a nephrectomy for the treatment of a The nurse teaches the patient to inspect and care for the incision
renal tumor. What should the nurse include in the teaching plan? and perform other general postoperative care, including activi-
A) The importance of increased fluid intake ty and lifting restrictions, driving, and pain management. There
B) Signs and symptoms of rejection would be no need to teach the signs or symptoms of rejection as
C) Inspection and care of the incision there has been no transplant. Increased fluid intake is not normally
D) Techniques for preventing metastasis recommended and the patient has minimal control on the future
risk for metastasis.
A patient with chronic kidney disease has been hospitalized and
is receiving hemodialysis on a scheduled basis. The nurse should
include which of the following actions in the plan of care? Ans: D
A) Ensure that the patient moves the extremity with the vascular Feedback:
access site as little as possible. The bruit, or thrill, over the venous access site must be evaluated
B) Change the dressing over the vascular access site at least at least every shift. Frequent dressing changes are unnecessary
every 12 hours. and the patient does not normally need to immobilize the site. The
C) Utilize the vascular access site for infusion of IV fluids. site must not be used for purposes other than dialysis.
D) Assess for a thrill or bruit over the vascular access site each
shift.
The nurse is caring for a patient who has just returned to the
post-surgical unit following renal surgery. When assessing the
patients output from surgical drains, the nurse should assess what Ans: A,B,C
parameters? Select all that apply. Feedback:
A) Quantity of output Urine output and drainage from tubes inserted during surgery are
B) Color of the output monitored for amount, color, and type or characteristics. Odor and
C) Visible characteristics of the output pH are not normally assessed.
D) Odor of the output
E) pH of the output
Ans: C
The nurse is caring for a patient after kidney surgery. The nurse is
Feedback:
aware that bleeding is a major complication of kidney surgery and
Bleeding is a major complication of kidney surgery. If undetected

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 Chapter 54: Management of Patients with Kidney Disorders
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and untreated, this can result in hypovolemia and hemorrhagic
that if it goes undetected and untreated can result in hypovolemia shock. The nurses role is to observe for these complications, to
and hemorrhagic shock in the patient. When assessing for bleed- report their signs and symptoms, and to administer prescribed
ing, what assessment parameter should the nurse evaluate? parenteral fluids and blood and blood components. Monitoring
A) Oral intake of vital signs, skin condition, the urinary drainage system, the
B) Pain intensity surgical incision, and the level of consciousness is necessary to
C) Level of consciousness detect evidence of bleeding, decreased circulating blood, and fluid
D) Radiation of pain volume and cardiac output. Bleeding is not normally evidenced by
changes in pain or oral intake.
A nurse on the renal unit is caring for a patient who will soon begin
peritoneal dialysis. The family of the patient asks for education
about the peritoneal dialysis catheter that has been placed in the
patients peritoneum. The nurse explains the three sections of the Ans: A, B, C, D
catheter and talks about the two cuffs on the dialysis catheter. Feedback:
What would the nurse explain about the cuffs? Select all that Most of these catheters have two cuffs, which are made of Dacron
apply. polyester. The cuffs stabilize the catheter, limit movement, prevent
A) The cuffs are made of Dacron polyester. leaks, and provide a barrier against microorganisms. They do not
B) The cuffs stabilize the catheter. absorb dialysate.
C) The cuffs prevent the dialysate from leaking.
D) The cuffs provide a barrier against microorganisms.
E) The cuffs absorb dialysate
A patient with chronic kidney disease is completing an exchange
Ans: B
during peritoneal dialysis. The nurse observes that the peritoneal
Feedback:
fluid is draining slowly and that the patients abdomen is increasing
If the peritoneal fluid does not drain properly, the nurse can facili-
in girth. What is the nurses most appropriate action?
tate drainage by turning the patient from side to side or raising the
A) Advance the catheter 2 to 4 cm further into the peritoneal cavity.
head of the bed. The catheter should never be pushed further into
B) Reposition the patient to facilitate drainage.
the peritoneal cavity. It would be unsafe to aspirate or to infuse
C) Aspirate from the catheter using a 60-mL syringe.
more dialysate.
D) Infuse 50 mL of additional dialysate.

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