ATI LPN
Test Bank for Medical Surgical Nursing: Concepts for Interprofessional Collaborative Care 10th Edition
Chapter 67 : Care of Patients with Kidney Disorders Questions
Question 1 of 5
The nurse should first fully assess the client for signs of volume depletion and shock, and then notify the provider. The radical nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypertension is a clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypertension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Which action should the nurse take first?
Correct Answer: D
Rationale: Assessing the rate and quality of the client's pulse is critical to evaluate for signs of volume depletion or shock, which are potential complications post-nephrectomy due to hemorrhage or adrenal insufficiency. This assessment provides essential data before notifying the provider. Repositioning, measuring urine specific gravity, or administering pain medication do not address the immediate risk of these complications.
Question 2 of 5
A nurse cares for a client with a nephrostomy tube and notes that the drainage has decreased. Which action should the nurse take first?
Correct Answer: D
Rationale: Decreased drainage from a nephrostomy tube may indicate obstruction, necessitating immediate assessment of the client's abdomen for pain or distention and vital signs to detect complications like infection or obstruction. This information should be reported to the provider. Documenting, evaluating in hand-off, or clamping the tube are not appropriate initial actions.
Question 3 of 5
A nurse teaches a client who is recovering from a nephrectomy secondary to kidney trauma. Which statement should the nurse include in this client's teaching?
Correct Answer: D
Rationale: Clients with one kidney should avoid contact sports to prevent injury to the remaining kidney. Salt and fluid restriction, dialysis, or new hypertension medications are not typically required post-nephrectomy unless other complications arise.
Question 4 of 5
A nurse provides health screening for a community health center with a large population of African American clients. Which priority assessment should the nurse include when working with this population?
Correct Answer: B
Rationale: African Americans have a high prevalence of hypertension, which is a leading cause of end-stage renal disease. Assessing blood pressure is a priority to monitor and manage this risk. While other assessments are important, blood pressure screening is critical for this population.
Question 5 of 5
After teaching a client with renal cancer who is prescribed temsirolimus (Torisel), the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?
Correct Answer: B
Rationale: Temsirolimus is administered weekly via intravenous infusion, so keeping infusion center appointments is correct. It is not taken orally, does not require dietary restrictions like limiting green leafy vegetables, and while infections should be reported, the statement about not taking it if ill is not accurate.