Kidney Disorders

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Sample questions from Kidney Disorders

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A charge nurse in the intensive care unit is reviewing the clinical status of four clients. Which client should be assigned to the most experienced nurse?

   • A.A 45-year-old client with chronic kidney disease who has a serum potassium of 5.1 mEq/L.
   • B.A 54-year-old client receiving hemodialysis who reports muscle cramping and a headache.
   • C.A 62-year-old client with acute kidney injury whose urine output was 100 mL over the last 8 hours.
   • D.A 28-year-old client post-renal transplant who has developed a temperature of 101.2 F (38.4 C).

   Rationale: The client post-renal transplant with a fever is the highest priority and requires the most experienced nurse because fever in a transplant recipient can indicate acute rejection or a life-threatening opportunistic infection, necessitating rapid assessment and intervention. A potassium of 5.1 mEq/L is slightly elevated but common in CKD and not immediately life-threatening. Oliguria (100 mL/8hr) is expected in the maintenance phase of AKI. Muscle cramping and headache are common during or after hemodialysis due to fluid and electrolyte shifts and are usually managed with standard protocols.

2. 2.Which intervention is most appropriate for a nurse to delegate to an unlicensed assistive personnel (UAP) caring for a client with an indwelling urinary catheter?

   • A.Evaluating the client's response to the removal of the catheter.
   • B.Assessing the color and clarity of the urine output.
   • C.Providing catheter care using soap and water during the morning bath.
   • D.Teaching the client how to keep the drainage bag below the level of the bladder.

   Rationale: Routine catheter care (cleaning the meatus and catheter tubing) is within the scope of practice for UAPs. Assessment, teaching, and evaluation are all nursing responsibilities that cannot be delegated. UAPs can observe and report the color of urine, but the professional assessment of clinical significance is the nurse's role.

3. 3.A client undergoing peritoneal dialysis (PD) reports that the outflow of dialysate is significantly less than the inflow. Which action should the nurse perform first?

   • A.Irrigate the peritoneal catheter with 50 mL of sterile saline.
   • B.Check the tubing for kinks and ensure the clamps are open.
   • C.Notify the healthcare provider of a possible bowel perforation.
   • D.Help the client change positions or turn from side to side.

   Rationale: The first step when PD drainage is slow or insufficient is to check for external obstructions like kinks in the tubing or closed clamps. If these are not present, the next step is to have the client change positions to shift the fluid toward the catheter. Irrigation is a later intervention and bowel perforation is a rare, severe complication not typically suggested by simple poor drainage without other symptoms like acute pain or brown effluent.

4. 4.A client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which provider order should the nurse implement first?

   • A.Obtain a urine culture and sensitivity.
   • B.Schedule a renal ultrasound to evaluate for obstruction.
   • C.Administer intravenous ciprofloxacin 400 mg every 12 hours.
   • D.Administer acetaminophen 650 mg for a temperature of 102 F.

   Answer and rationale are in the full material.

5. 5.A 32-week pregnant client is diagnosed with a urinary tract infection (UTI). Which instruction is most important for the nurse to provide?

   • A."Return to the clinic if you notice your urine is cloudy."
   • B."Drink at least 8 ounces of cranberry juice daily."
   • C."Clean the perineal area from back to front after voiding."
   • D."Complete the full course of antibiotics to prevent preterm labor."

   Answer and rationale are in the full material.