Author Question: After teaching a client with hypertension secondary to renal disease, the nurse assesses the ... (Read 53 times)

tfester · **on:** Jun 25, 2018

After teaching a client with hypertension secondary to renal disease, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?

a. I can prevent more damage to my kidneys by managing my blood pressure.
b. If I have increased urination at night, I need to drink less fluid during the day.
c. I need to see the registered dietitian to discuss limiting my protein intake.
d. It is important that I take my antihypertensive medications as directed.

Question 2

A nurse assesses a client who is recovering from a radical nephrectomy for renal cell carcinoma. The nurse notes that the client's blood pressure has decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for this past hour.

Which action should the nurse take?
a.
Position the client to lay on the surgical incision.
b.
Measure the specific gravity of the client's urine.
c.
Administer intravenous pain medications.
d.
Assess the rate and quality of the client's pulse.

lorealeza77 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: B
The client should not restrict fluids during the day due to increased urination at night. Clients with renal disease may be prescribed fluid restrictions. These clients should be assessed thoroughly for potential dehydration. Increased nocturnal voiding can be decreased by consuming fluids earlier in the day. Blood pressure control is needed to slow the progression of renal dysfunction. When dietary protein is restricted, refer the client to the registered dietitian as needed.

Answer to Question 2

ANS: D
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. Hypotension is a clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypotension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Re-positioning the client, measuring specific gravity, and administering pain medication would not provide data necessary to make an appropriate clinical decision, nor are they appropriate interventions at this time.