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Chapter 48 Management of Patients With Kidney Disorders
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Chapter 48 Management of Patients With Kidney Disorders
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Chapter 48 Management of Patients With Kidney Disorders1. The nurse of a patient diagnosed with acute glomerulonephritis. is aware that the patient
may exhibit which of the following clinical manifestations?
A) Hematuria
B) Decrease in serum creatinine levels
C) Hypotension
D) Glucosuria
Ans: A
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Patient Needs: D-4
Feedback: The primary presenting feature of acute glomerulonephritis is hematuria (blood in
the urine), which may be microscopic (identifiable through microscopic examination) or
macroscopic or gross (visible to the eye). Proteinuria, primarily albumin which is present, is
due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and
serum creatinine levels may rise as urine output drops. The patient may be anemic primarily
from fluid retention. Some degree of edema and hypertension is noted in 75% of patients.
2. The patient is a 48-year-old man with acute renal failure. Which of the following is the
most common clinical manifestation of acute renal failure?
,A) Decrease in
BUN B) Anuria
C) Oliguria
D) Decrease in serum creatinine
Ans: C
Cognitive Level: Analysis
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 3
Patient Needs: D-4
Feedback: Acute renal failure manifests as oliguria, anuria, or normal urine volume. Oliguria
(less than 400 mL/d of urine) is the most common clinical situation seen in acute renal failure;
anuria (less than 50 mL/d of urine) and normal urine output are not as common. Regardless of
the volume of urine excreted, the patient with acute renal failure experiences rising serum
creatinine and BUN levels and retention of other metabolic waste products (azotemia)
normally excreted by the kidneys.
3. The patient with which of the following medical histories is at the greatest risk of
developing end-stage renal disease (ESRD)?
A) Polycystic kidney disease
B) Diabetes mellitus with poorly controlled hypertension
C) Vascular disorders
D) Respiratory infections
Ans: B
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
,Objective: 3
Patient Needs: D-4
Feedback: Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic
glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as
in polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may
cause ESRD. A patient with more than one of these risk factors is at the greatest risk for
developing ESRD.
4. The patient who has a history of systemic lupus erythematosus has been recently
diagnosed with ESRD. The patient has an elevated phosphorus level and has been prescribed
calcium acetate to bind the phosphorus. The nurse should instruct the patient to take the
prescribed phosphorus binding medication:
A) Only when needed
B) Daily at bedtime
C) 1 hour prior to meals
, D) With each meal
Ans: D
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 5
Patient Needs: D-2
Feedback: Both calcium carbonate and calcium acetate are medications that bind with the
phosphate and assist in excreting the phosphate from the body, in turn lowering the
phosphate levels. Phosphate binding medications must be administered with food to be
effective.
5. To reduce the risk of infection in a patient with a transplanted kidney, it is imperative for
the nurse to:
A) Wash hands carefully and frequently
B) Ensure immediate function of the donated kidney
C) Instruct the patient to wear a face mask
D) Restrict visitors
Ans: A
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 6
Patient Needs: D-4
Feedback: The nurse ensures that the patient is protected from exposure to infection by
hospital staff, visitors, and other patients with active infections. Careful handwashing is
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