Ch 53 NCLEX
While reviewing a patient's chart, the nurse notes the patient has been experiencing enuresis. To assess if this remains an ongoing problem for the patient, the nurse will ask which of the following questions? a) "Do you urinate while sleeping?" b) "Does it burn when you urinate?" c) "Do you have a strong desire to void?" d) "Is it painful when you urinate?"
a) "Do you urinate while sleeping?" Explanation: Enuresis is defined as involuntary voiding during sleep. The remaining questions do not relate to this problem associated with changes in the patient's voiding pattern.
Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? a) 50% b) 40% c) 20% d) 30%
a) 50% Explanation: Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal. Renal function can be assessed most accurately if several tests are performed and their results are analyzed together. Common tests of renal function include renal concentration tests, creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein metabolism) levels.
When fluid intake is normal, the specific gravity of urine should be which of the following? a) Less than 1.010 b) Greater than 1.025 c) 1.000 d) 1.010 to 1.025
d) 1.010 to 1.025 Explanation: Urine specific gravity is a measurement of the kidney's ability to concentrate urine. The specific gravity of water is 1.000. A urine specific gravity of less than 1.010 may indicate inadequate fluid intake. A urine specific gravity greater than 1.025 may indicate overhydration.
The nurse is preparing a patient for a nuclear scan of the kidneys. Following the procedure, the nurse will instruct the patient to complete which of the following? a) Drink liberal amounts of fluids. b) Maintain bed rest for 2 hours. c) Carefully handle urine as it is radioactive. d) Notify the health care team if bloody urine is noted.
a) Drink liberal amounts of fluids. Explanation: After the procedure is completed, the patient is encouraged to drink fluids to promote excretion of the radioisotope by the kidneys. The remaining instructions are not associated with a nuclear scan.
The nurse is caring for a patient following a cystoscopic examination. Following the procedure, the nurse informs the patient that which of the following may occur? a) Blood-tinged urine b) Nausea and emesis c) Severe abdominal pain d) Diarrhea
a) Blood-tinged urine Explanation: Postprocedural management is directed at relieving any discomfort resulting from the examination. Some burning on voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected. Moist heat to the lower abdomen and warm sitz baths are helpful in relieving pain and relaxing the muscles. Not eating and diarrhea are not expected following a cystoscopic examination. The patient should not experience severe abdominal pain.
Which of the following does the nurse recognize is the best clinical measure of renal function? a) Creatinine clearance b) Circulating ADH levels c) Volume of urine output d) Urine-specific gravity
a) Creatinine clearance Explanation: Creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decreases.
The term used to describe painful or difficult urination is which of the following? a) Dysuria b) Anuria c) Oliguria d) Nocturia
a) Dysuria Explanation: Dysuria refers to painful or difficult urination. Oliguria is urine output less than 0.5 mL/kg/hr. Anuria is used to describe total urine output of less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate.
During a routine assessment, the patient states; "I wake up all night long to go to the bathroom." The nurse will document this finding as which of the following? a) Nocturia b) Oliguria c) Dysuria d) Polyuria
a) Nocturia Explanation: Nocturia is awakening at night to urinate. Oliguria is urine output less than 0.5 mL/kg/hr Polyuria is increased urine output. Dysuria is painful or difficult urination.
A male patient undergoes a renal angiogram. Which of the following post-procedure care interventions should the nurse provide to the patient? a) Palpate the pulses in the legs and feet. b) Assess for signs of electrolyte and water imbalance. c) Encourage the patient to void. d) Monitor the patient for signs and symptoms of pyelonephritis.
a) Palpate the pulses in the legs and feet. Explanation: To observe for signs of arterial occlusion in a patient who has undergone renal angiogram, the nurse should palpate the pulses in the legs and feet. While preparing the patient for renal angiogram, the nurse asks the patient to void. It is during the physical examination of a patient that the nurse assesses for signs of electrolyte and water imbalance. The nurse should monitor for signs and symptoms of pyelonephritis in a patient who has undergone retrograde pyelogram.
A patient with a history of chronic renal infections is ordered a CT scan with contrast. Prior to the procedure, the nurse should complete which of the following? a) Place emergency medical equipment in the procedure room. b) Keep the patient NPO 1 hour prior to the scan. c) Hold the patient's iron supplement until after the diagnostic test. d) Instruct the patient to maintain a full bladder for the diagnostic test.
a) Place emergency medical equipment in the procedure room. Explanation: For some patients, contrast agents are nephrotoxic and allergenic. Emergency equipment and medications should be available in case of an anaphylactic reaction to the contrast agent. Emergency supplies include epinephrine, corticosteroids, vasopressors, oxygen, and airway and suction equipment. The patient is instructed to maintain a full bladder for an ultrasonography. The other instructions/interventions relate to an MRI.
The nurse is caring for a patient complaining of orange-colored urine. The nurse suspects which of the following as the cause of the urine discoloration? a) Pyridium (phenazopyridium HCl) b) Phenytoin (Dilantin) c) Infection d) Metronidazole (Flagyl)
a) Pyridium (phenazopyridium HCl) Explanation: Orange to amber-colored urine is caused by concentrated urine due to dehydration, fever, bile, excess bilirubin or carotene, and the medications Pyridium (phenazopyridium HCl) and nitrofurantoin (Furadantin). Infection would cause yellow to milky white urine. Phenytoin (Dilantin) would cause the urine to become pink to red in color. Metronidazole (Flagyl) would cause the urine to become brown to black in color.
Which of the following is an effect of aging on upper and lower urinary tract function? a) Susceptibility to develop hypernatremia b) Increased blood flow to the kidney c) Acid-base balance d) Increased GFR
a) Susceptibility to develop hypernatremia Explanation: The elderly are more susceptible to develop hypernatremia. These patients typically have a decreased GFR, decreased blood flow to the kidney, and acid-base imbalances.
When the bladder contains 350 mL or more of urine, this is referred to as which of the following? a) Renal clearance b) Functional capacity c) Specific gravity d) Anuria
b) Functional capacity Explanation: A marked sense of fullness and discomfort, with a strong desire to void, usually occurs when the bladder contains 350 mL or more of urine, referred to as the "functional capacity." Anuria is a total urine output of less than 50 mL in 24 hours. Specific gravity reflects the weight of particles dissolved in the urine. Renal clearance refers to the ability of the kidneys to clear solutes from the plasma.
To obtain information about the chief complaint and medical history of an older male patient, the nurse asks the patient about his medication history. What is the importance of obtaining a medication history? a) It may indicate drugs that should not be prescribed to the patient. b) It may indicate multiple medications administered taken by the patient. c) It may indicate the patient's general health. d) It may reflect the patient's childhood and family illnesses.
b) It may indicate multiple medications administered taken by the patient. Explanation: The nurse should obtain information about a patient's medication history because older patients, in particular, may be taking multiple medications that may affect their renal function. The medication history in general indicates the probable risk factors of renal or urologic disorders. The medication history of an older patient is not used to obtain information about the patient's general health, childhood and family illnesses, or drugs that are restricted to the patient.
A 30-year-old male patient presents to the clinic for an employment physical. The nurse notes protein in the patient's urine. The nurse understands that transient proteinuria can be caused by which of the following? Select all that apply. a) NSAIDs b) Prolonged standing c) Diabetes mellitus d) Fever e) Strenuous exercise
b) Prolonged standing, d) Fever, e) Strenuous exercise Explanation: Proteinuria may be a benign finding, or it may signify serious disease. Common benign causes of transient proteinuria are fever, strenuous exercise, and prolonged standing. Causes of persistent proteinuria include glomerular diseases, malignancies, collagen diseases, diabetes, preeclampsia, hypothyroidism, heart failure, exposure to heavy metals, and use of medications, such as drugs, NSAIDs, and angiotensin-converting enzyme (ACE) inhibitors.
Which is the correct term for the ability of the kidneys to clear solutes from the plasma? a) Glomerular filtration rate (GFR) b) Renal clearance c) Specific gravity d) Tubular secretion
b) Renal clearance Explanation: Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. GFR is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.
Which hormone causes the kidney to reabsorb sodium? a) Antidiuretic hormone (ADH) b) Growth hormone c) Aldosterone d) Prostaglandins
c) Aldosterone Explanation: Aldosterone is a hormone synthesized and released by the adrenal cortex. ADH is secreted by the posterior pituitary gland. Growth hormone and prostaglandins do not cause the kidney to reabsorb sodium.
A creatinine clearance test is ordered for a patient with possible renal insufficiency. It is necessary for the nurse to collect which of the following serum levels midway through the 24-hour urine collection? a) Osmolality b) BUN c) Creatinine d) Hemoglobin
c) Creatinine Explanation: To calculate creatinine clearance, a 24-hour urine specimen is collected. The serum creatinine level is measured midway through the collection.
The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which of the following? a) Glomerulonephritis b) Diabetes insipidus c) Decreased fluid intake d) Increased fluid intake
c) Decreased fluid intake Explanation: When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases. Disorders or conditions that cause decreased urine-specific gravity include diabetes insipidus, glomerulonephritis, and severe renal damage. Disorders that can cause increased specific gravity include diabetes, nephritis, and fluid deficit.
The nurse is caring for a patient scheduled for urodynamic testing. Following the procedure, the nurse provides information to the patient that includes which of the following? a) "You can stop taking the prescribed antibiotic." b) "You may resume consuming caffeinated, carbonated, and alcoholic beverages." c) "You will be sent home with a urinary catheter." d) "Contact the primary provider if you experience fever, chills, or lower back pain."
d) "Contact the primary provider if you experience fever, chills, or lower back pain." Explanation: The patient must be made aware of the signs of a urinary tract infection after the procedure. The patient should contact the primary provider if he/she experience fever, chills, lower back pain, or continued dysuria and hematuria. The patient will have catheters placed during the procedure but will not be sent home with a catheter. The patient should be told to avoid caffeinated, carbonated, and alcoholic beverages after the procedure because these can further irritate the bladder. These symptoms usually decrease or subside by the day after the procedure. If the patient received an antibiotic medication before the procedure, the patient should be told to continue taking the complete course of medication after the procedure. This is a measure to prevent infection.
A female patient presents to the health clinical for a routine physical examination. The nurse observes that the patient's urine is bright yellow in color. Which of the following questions is most appropriate for the nurse to ask the patient? a) "Have you noticed any vaginal bleeding?" b) "Have you had a recent urinary tract infection?" c) "Do you take phenytoin (Dilantin) daily?" d) "Do you take multiple vitamin preparations?"
d) "Do you take multiple vitamin preparations?" Explanation: Urine that is bright yellow is an anticipated abnormal finding in the patient taking a multiple vitamin preparation. Urine that is orange may be caused by intake of Dilantin or other medications. Orange- to amber-colored urine may also indicate concentrated urine due to dehydration or fever. Urine that is pink to red may indicate lower urinary tract bleeding. Yellow to milky white urine may indicate infection, pyuria, or, in the female patient, the use of vaginal creams.
The nurse is reviewing the results of renal function studies of a patient. The nurse understands that which of the following is a normal BUN-to-creatinine ratio? a) 6:1 b) 4:1 c) 8:1 d) 10:1
d) 10:1 Explanation: A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect.
Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? a) 40% b) 30% c) 10% d) 20%
d) 20% Explanation: Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 L/day of filtrate.
The nurse is caring for a patient with a medical history of sickle cell anemia. The nurse understands this predisposes the patient to which of the following possible renal or urologic disorders? a) Proteinuria b) Kidney stone formation c) Neurogenic bladder d) Chronic kidney disease
d) Chronic kidney disease Explanation: A medical history of sickle cell anemia predisposes the patient to the development of chronic kidney disease. The other disorders are not associated with the development of sickle cell anemia.
A patient presents to the ED complaining of left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The patient has also experienced nausea and emesis. The nurse suspects the patient is experiencing which of the following? a) Infection of the urethra b) Pyelonephritis c) Cystitis d) Ureteral stones
d) Ureteral stones Explanation: The findings are constant with ureteral stones, edema or stricture, or a blood clot. The other answers do not apply.
