Renal N172 HESI
Which instruction would the nurse give to a client with renal calculi? Select all that apply. One, some, or all responses may be correct. A. "Drink plenty of water." B. "Have spinach soup every day." C. "Substitute lemon juice for tea." D. "Include high amounts of protein in the diet." E. "Consume foods rich in omega-3 fatty acids."
A. "Drink plenty of water." C. "Substitute lemon juice for tea." Rationale Renal calculi is the formation of kidney stones. Drinking plenty of water will keep the body hydrated and prevent further formation of stones. Tea contains caffeine, a diuretic, which causes dehydration. The client must be advised to replace tea with lemon juice. Spinach is rich in oxalates. Consuming spinach soup may aggravate the problem, due to the formation of oxalate crystals. Excessive consumption of proteins may precipitate uric acid stones. The use of proteins should not be encouraged. Foods rich in omega-3 fatty acids are beneficial in maintaining good health. However, the use of omega-3 fatty acids, specifically in the treatment, mitigation, or prevention of kidney stones, is not justified.
Which response would the nurse give to a client with end-stage renal disease who states, "I heard that it is inevitable that I will need a kidney transplant. If so, which one of my kidneys will be removed?" A. "Neither of your kidneys will be removed unless they become infected." B. "The kidney that is the most diseased is removed and replaced with a new one." C. "Your primary health care provider determines which kidney is replaced with a new one." D. "Your right kidney will be removed, because it has a longer renal vein, making transplantation easier."
A. "Neither of your kidneys will be removed unless they become infected." Rationale During a renal transplant, removal of the recipient's own kidneys does not occur unless a chronic infection is present. The primary health care provider will not decide which kidney is replaced, the most diseased kidney will not be removed, and the right kidney will stay because the kidneys are left in place; the new kidney is placed in the right lower quadrant and protected by the iliac crest.
Which statement would the nurse include in the preoperative teaching plan of a client who, after receiving hemodialysis for several years, has a kidney transplant scheduled? Select all that apply. One, some, or all responses may be correct. A. "The kidney may not function immediately." B. "Precautions are needed to prevent infection." C. "A urinary catheter will be present postoperatively." D. "Immunosuppressive medications will be given preoperatively." E. "The arteriovenous fistula will be used for drawing blood specimens preoperatively."
A. "The kidney may not function immediately." B. "Precautions are needed to prevent infection." C. "A urinary catheter will be present postoperatively." Rationale Because infection is a major complication of a kidney transplant, prevention begins with the recognition of the earliest signs and symptoms. The transplanted kidney does not always function immediately; the client should know that dialysis may have to be continued. Just before surgery a urinary catheter is inserted and an antibiotic may be instilled into the bladder to decrease the risk of infection. Immunosuppressive therapy begins after the kidney transplant, not before surgery. The nurse should never use the vascular access for drawing blood or instilling intravenous medications.
Which statement made by the student nurse regarding the gross anatomy and physiology of the kidneys indicates the need for additional teaching? A. "The right kidney is a little longer and narrower than the left kidney." B. "The existence of three kidneys with normal kidney function is normal!" C. "The presence of a single kidney with normal kidney function is normal!" D. "The urinary bladder lies directly behind the pubic bone."
A. "The right kidney is a little longer and narrower than the left kidney." Rationale Generally in a human body, the left-side kidney is slightly longer and narrower compared with the right-side kidney. The nurse should intervene to correct this misconception. All the other statements are correct. There could be three kidneys in a human body, and as long as the kidney function is normal, the client would be normal. A single horseshoe-shaped kidney could occasionally be found in certain clients, and this is normal if the kidney function is normal. The urinary bladder lies directly behind the pubic bone.
At which frequency would the nurse assess the urinary output of a client with end-stage renal disease (ESRD) who received a kidney transplant and is transferred to the postanesthesia care unit? A. 1 hour B. 2 hours C. 15 minutes D. 30 minutes
A. 1 hour Rationale Hourly output is critical in assessing kidney function; decreasing urinary output is a sign of rejection. Every 2 hours is too infrequent for monitoring output immediately after a kidney transplant; the priority is to monitor output more frequently to evaluate function of the new kidney. Monitoring the urine output every 15 or 30 minutes is not necessary.
Which male client would the nurse note as having the highest risk for development of clinical manifestations related to prostate cancer? A. African American 55-year-old B. White 45-year-old C. Asian 55-year-old D. Hispanic 45-year-old
A. African American 55-year-old Rationale Cancer of the prostate is rare before age 50 years but increases with age. African American men develop cancer of the prostate more often and at an earlier age than white men do. African American men develop prostate cancer more often than any other ethnic group. Asian American men have a lower incidence than white men do.
For which complications would the nurse monitor a client hospitalized with end-stage kidney disease? Select all that apply. One, some, or all responses may be correct. A. Anemia B. Dyspnea C. Jaundice D. Hyperexcitability E. Hypophosphatemia
A. Anemia B. Dyspnea Rationale Anemia results from decreased production of erythropoietin by the kidneys, which causes decreased erythropoiesis by bone marrow. Dyspnea is a result of fluid overload, which is associated with chronic kidney failure. Jaundice occurs with biliary obstruction or liver disorders, not with kidney failure. Hyperphosphatemia occurs with kidney failure, not hypophosphatemia. Hyperexcitability is not a feature of end-stage kidney disease.
Which action would the nurse take when a client has returned from surgery with a nephrostomy tube? Select all that apply. One, some, or all responses may be correct. A. Ensure free drainage of urine. B. Milk the tube every 2 hours. C. Keep an accurate record of intake and output. D. Instill 12 mL of normal saline every 8 hours. E. Observe and document urine characteristics.
A. Ensure free drainage of urine. C. Keep an accurate record of intake and output. E. Observe and document urine characteristics. Rationale The tube must be kept patent to prevent urine backup, hydronephrosis, and kidney damage. Keeping an accurate record of intake and output and observing the urine drainage color and consistency is important to identify possible complications. Milking the tube every 2 hours is unnecessary. Instill no more than 5 mL of normal saline only if prescribed.
Which intervention would prevent urinary stasis and formation of renal calculi in an immobile client? A. Increasing oral fluid intake to 2 to 3 L/day B. Maintaining bed rest after discharge C. Limiting fluid intake to 1 L/day D. Voiding at least every hour
A. Increasing oral fluid intake to 2 to 3 L/day Rationale Increasing oral fluid intake to 2 to 3 L/day, if not contraindicated, will dilute urine and promote urine flow, thus preventing stasis and complications such as renal calculi. Bed rest and limited fluid intake may lead to urinary stasis and increase the risk for the formation of renal calculi. Voiding at least every hour has no effect on urinary stasis and renal calculi.
Which factor affects the client's ability to perform postoperative deep breathing and coughing requirements after a nephrectomy for renal cancer? A. Location of the client's surgical incision B. Increased anxiety about the prognosis C. Inflammatory process associated with surgery D. Pulmonary congestion from preoperative medications
A. Location of the client's surgical incision Rationale The location of the surgical site in relation to the diaphragm increases incisional pain when deep breathing or coughing. Anxiety about the prognosis should not interfere with the ability to deep breathe and cough, especially when encouraged by the nurse. Inflammatory changes will cause discomfort in the area of any incision but are not necessarily the prime factor preventing deep breathing after a nephrectomy. The client will need to cough and deep breathe if there is congestion in the lungs.
Which item would a nurse instruct a client with calcium oxalate kidney stones to limit the intake of when providing dietary teaching? A. Sodium B. Gravies C. Red wines D. Organ meat
A. Sodium Rationale High sodium intake in clients with calcium oxalate kidney stones will reduce kidney tubular reabsorption of calcium. The nurse should instruct the client to reduce sodium intake. Clients with uric acid kidney stones should decrease their intake of gravies and red wines. Clients with struvite, uric acid, and cystine types of kidney stones should limit their intake of animal proteins such as organ meats.
Which response would the nurse give to a client with an acute kidney injury who has peritoneal dialysis (PD) prescribed and asks why the procedure is necessary? A. "PD prevents the development of serious heart problems by removing the damaged tissues." B. "PD helps perform some of the work usually performed by your kidneys." C. "PD stabilizes the kidney damage and may 'restart' your kidneys to perform better than before." D. "PD speeds recovery because the kidneys are not responding to regulating hormones."
B. "PD helps perform some of the work usually performed by your kidneys." Rationale PD removes chemicals, wastes, and fluids usually removed from the body by the kidneys. The mention of heart problems is a threatening response and may cause increased fear or anxiety. Telling the patient that PD may 'restart' your kidneys so that they perform better than before is misleading. PD helps maintain fluid and electrolytes; in acute kidney injury, damage occurs in the nephrons, so the PD may or may not speed recovery.
A client with renal failure receives prescriptions for vitamin D and calcium supplements. The client asks the nurse, "Why do I need to take these?" The nurse explains that, with renal failure, which condition exists? A. A decrease in the inactive forms of vitamin D in the body B. A decrease in the active metabolite of vitamin D in the body C. An increase in the conversion of skin cholesterol into vitamin D D. An increase in the vitamin D-associated intestinal absorption of calcium
B. A decrease in the active metabolite of vitamin D in the body Rationale Renal failure results in a decrease in the active metabolite of vitamin D because inactive vitamin D gets activated in the liver and then in the kidneys. Food sources of vitamin D and sunlight contribute to an inactive form of the hormone in the body. Inactive vitamin D will decrease if foods rich in vitamin D are not consumed or exposure to sunlight is reduced. Conversion of skin cholesterol to vitamin D depends on exposure to sunlight and not renal impairment. In renal failure there is less active vitamin D and therefore less intestinal absorption of calcium.
Which condition can be prevented when a client with chronic kidney disease receives medication to manage anemia? A. Uremic frost B. Chronic fatigue C. Tubular necrosis D. Dependent edema
B. Chronic fatigue Rationale Kidney failure results in impaired erythropoietin production, which causes anemia and chronic fatigue; treating the anemia will help in managing the fatigue. Uremic frost results because urea compounds and other waste products of metabolism that are not excreted by the kidneys are brought to the skin by small, superficial capillaries and are excreted and deposited on the skin. Tubular necrosis is a pathological condition of the kidneys that can lead to kidney failure. The anemia and dependent edema associated with kidney failure are not interrelated.
A client who has renal failure asks the nurse why anemia keeps recurring. Which reason would the nurse explain to the client? A. Increase in blood pressure B. Decrease in erythropoietin C. Increase in serum phosphate levels D. Decrease in sodium concentration
B. Decrease in erythropoietin Rationale The hormone erythropoietin, produced by the kidneys, stimulates the bone marrow to produce red blood cells. In renal failure, there is a deficiency of erythropoietin that often results in the client developing anemia. The nurse is instructed to administer blood. In renal failure, increased blood pressure is due to impairment of renal vasodilator factors and is not treated by administration of blood. Phosphate is retained in the body during renal failure, causing binding of calcium leading to bone demineralization, not anemia. Increase in urinary sodium concentration and decrease in serum sodium concentration trigger the release of renin from the juxtaglomerular cells.
Which assessment finding in a hospitalized client with a history of chronic kidney disease would alert the nurse to suspect kidney insufficiency? A. Facial flushing B. Edema and pruritus C. Dribbling after voiding D. Diminished force of urination
B. Edema and pruritus Rationale The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease.
Which food item would the nurse instruct a client whose pathology report states a urinary calculus is composed of uric acid to avoid? A. Milk B. Liver C. Cheese D. Vegetables
B. Liver Rationale A low-purine diet controls the development of uric acid stones. Clients with uric acid stones should avoid foods high in purine, such as organ meats and extracts. The client should avoid milk if he or she had calcium stones, not uric acid stones. The client should avoid cheese or animal protein if he or she had cysteine stones, not uric acid stones. The client does not need to avoid vegetables when on a low-purine diet.
Which assessment findings would the nurse expect in the client hospitalized with a diagnosis of severe chronic kidney disease? Select all that apply. One, some, or all responses may be correct. A. Polyuria B. Paresthesias C. Hypertension D. Metabolic alkalosis E. Widening pulse pressure
B. Paresthesias C. Hypertension Rationale Paresthesias occur as a result of excess nitrogenous wastes, altered fluid and electrolytes, and altered regulatory functions. Nonfunctioning kidneys cause fluid retention that may result in hypervolemia and hypertension. Polyuria occurs because of extensive nephron damage and may occur in the early stage of kidney disease but not in the severe stage. Metabolic acidosis, not alkalosis, results from the inability to excrete hydrogen ions and retain bicarbonate. Widening pulse pressure occurs with increased intracranial pressure, not with kidney dysfunction.
An older adult who has an endocrine disorder is scheduled for a diagnostic study with contrast medium. The nurse identifies that it is essential for which laboratory test to be performed before the procedure? A. Urine pH B. Serum creatinine C. Serum albumin D. Creatinine clearance
B. Serum creatinine Rationale If a contrast medium is used in older adults with an elevated serum creatinine, it may cause renal failure. Thus the nurse would assess the client's renal function before the diagnostic by checking the serum creatinine to assess for renal failure. Urinary pH may not help the nurse assess the client's risk of renal failure. A serum albumin test is performed if symptoms of liver disease or other liver problems are present; it is not routinely done before contrast medium tests. Creatinine clearance helps assess the glomerular filtration rate.
Which laboratory test provides evidence consistent with a client having renal impairment? Select all that apply. One, some, or all responses may be correct. A. Serum albumin: 4.7 g/dL(6.815 pmol/L) B. Serum creatinine: 2.0 mg/dL (176.8 umol/L) C. Serum potassium: 5.9 mEq/L (5.9 mmol/L) D. Serum cholesterol: 120 mg/dL (3.108 mmol/L) E. Blood urea nitrogen (BUN): 32 mg/dL (11.424 mmol/L)
B. Serum creatinine: 2.0 mg/dL (176.8 umol/L) C. Serum potassium: 5.9 mEq/L (5.9 mmol/L) E. Blood urea nitrogen (BUN): 32 mg/dL (11.424 mmol/L) Rationale Renal impairment is marked by increased serum creatinine concentration, BUN, and potassium ion concentration levels. The normal serum creatinine concentration lies between 0.5 and 1.5 mg/dL (44.2-132.6 umol/L). A serum creatinine value of 2.0 mg/dL (176.8 umol/L) indicates renal impairment. The normal concentration of potassium ions in serum ranges from 3.5 to 5 mEq/L (3.5-5 mmol/L). A potassium ion concentration of 5.9 mEq/L (5.9 mmol/L) indicates kidney dysfunction. The normal value of BUN lies between 7 and 20 mg/dL (2.45-7.14 mmol/L). A BUN value of 32 mg/dL (11.424 mmol/L) indicates renal impairment. The normal range of serum albumin concentration lies between 3.5 to 5.5 g/dL (5.075-7.975 mol/L). A cholesterol value less than 200 mg/dL (5.18 mmol/L) is normal.
Which type of stone composition is suspected when the laboratory values of a client with renal calculi reveal a serum calcium within expected limits and an elevated serum purine? A. Cystine B. Uric acid C. Calcium oxalate D. Magnesium ammonium phosphate
B. Uric acid Rationale Purines are precursors of uric acid, which crystallizes. Cystine stones are caused by a rare hereditary defect resulting in defective absorption of cysteine in the gastrointestinal tract and kidneys (inborn error of cystine metabolism). Serum purine will not be elevated if the stone is composed of calcium oxalate. A struvite stone sometimes is called a magnesium ammonium phosphate stone and is precipitated by recurrent urinary tract infections.
Which statement indicates the nurse has a correct understanding of kidney ultrasonography? A. "Kidney ultrasonography primarily makes use of iodinated contrast dye." B. "Kidney ultrasonography is performed on the client with an empty bladder." C. "Kidney ultrasonography makes use of sound waves and has minimal risk." D. "Kidney ultrasonography provides three-dimensional information regarding kidneys."
C. "Kidney ultrasonography makes use of sound waves and has minimal risk." Rationale Kidney ultrasonography is a minimal-risk diagnostic procedure. Ultrasonography makes use of sound waves, which when reflected from internal organs of varying densities produce images of the kidneys, bladder, and associated structures on the display screen. Although a dye can be used in computed tomography (CT), it is not the primary method. Generally, when performing a kidney ultrasonography, the client's bladder is full. A CT scan gives three-dimensional information about the kidney and associated structures.
Which response would the nurse use after receiving instructions regarding dressing changes and care of a recently inserted nephrostomy tube when the client states "I hope I can handle all this at home; it's a lot to remember"? A. "I'm sure you can do it." B. "Oh, a family member can do it for you." C. "You seem to be nervous about going home." D. "Perhaps you can stay in the hospital another day."
C. "You seem to be nervous about going home." Rationale The response "You seem to be nervous about going home" is the best reply. Reflection conveys acceptance and encourages further communication. The response "I'm sure you can do it" is false reassurance that does not help reduce anxiety. The response "Oh, a family member can do it for you" provides false reassurance and removes the focus from the client's needs. The response "Perhaps you can stay in the hospital another day" is unrealistic, and it is too late to suggest this.
Which clinical indicator would the nurse monitor in a client with end-stage renal disease (ESRD)? A. Polyuria B. Jaundice C. Azotemia D. Hypotension
C. Azotemia Rationale Azotemia is an increase in nitrogenous waste (particularly urea) in the blood, which is common with ESRD. Excessive nephron damage in ESRD causes oliguria, not polyuria; excessive urination is common in early kidney insufficiency because of the inability to concentrate urine. Jaundice is common to biliary obstruction, not to ESRD. The blood pressure may be elevated because of the hypervolemia associated with increased total body fluid.
Which clinical indicator would the nurse expect for a client who has end-stage renal disease (ESRD): Select all that apply. One, some, or all responses may be correct. A. Polyuria B. Jaundice C. Azotemia D. Hypertension E. Polycythemia
C. Azotemia D. Hypertension Rationale Azotemia is an increase in nitrogenous waste, particularly urea, in the blood; this is common in ESRD. Hypertension occurs as a result of fluid and sodium overload and dysfunction of the renin-angiotensin-aldosterone system. Excessive nephron damage in ESRD causes oliguria, not polyuria; excessive urination is common in early kidney insufficiency from an inability to concentrate urine. Jaundice is common with biliary obstruction, not ESRD. Anemia, not polycythemia, occurs because of decreased erythropoietin, decreased red blood cell (RBC) production, and decreased RBC survival time.
Which nursing instruction would the nurse provide to a diabetic client who developed renal disease? Select all that apply. One, some, or all responses may be correct. A. Recommend the client drink boiled water. B. Suggest the client go for morning walks. C. Instruct the client to check their blood pressure regularly. D. Direct the client to contact their primary health care provider before taking ibuprofen. E. Encourage the client to undergo a microalbuminuria test yearly.
C. Instruct the client to check their blood pressure regularly. D. Direct the client to contact their primary health care provider before taking ibuprofen. E. Encourage the client to undergo a microalbuminuria test yearly. Rationale High blood pressure affects normal kidney function. Clients with renal disease must monitor blood pressure because increased blood pressure can damage the vessel walls of the kidneys, thereby causing kidney damage and leading to kidney failure. Clients with renal disease would be encouraged to check their blood pressure regularly. Drugs such as ibuprofen are potent nephrotoxic agents; therefore the client must contact their primary health care provider before ingestion to avoid further complications. Diabetic clients would undertake a microalbuminuria test yearly to determine the risk of developing end-stage kidney disease. Drinking boiled water may reduce the risk of infections; however, this instruction is less beneficial than the other interventions. Going for a walk will improve the overall health of the client, but it is not a specific intervention related to kidney function.
Which goal is the nurse trying to achieve with continuous bladder irrigations (CBI) of a client who has undergone a suprapubic prostatectomy for cancer of the prostate? A. Stimulate continuous formation of urine. B. Facilitate the measurement of urinary output. C. Prevent the development of clots in the bladder. D. Provide continuous pressure on the prostatic fossa.
C. Prevent the development of clots in the bladder. Rationale A continuous flushing of the bladder dilutes the bloody urine and empties the bladder, preventing clots. Fluid instilled into the bladder does not affect kidney function. Urinary output can be measured regardless of the amount of fluid instilled. The urinary retention catheter is not designed to exert pressure on the prostatic fossa.
Which process is a function of the kidney hormones? A. Prostaglandin increases blood flow and vascular permeability. B. Bradykinin regulates intrarenal blood flow via vasodilation or vasoconstriction. C. Renin raises blood pressure because of angiotensin and aldosterone secretion. D. Erythropoietin promotes calcium absorption in the gastrointestinal tract.
C. Renin raises blood pressure because of angiotensin and aldosterone secretion. Rationale Renin is a kidney hormone that raises blood pressure as a result of angiotensin and aldosterone secretion. Prostaglandin is a kidney hormone that regulates intrarenal blood flow via vasodilation or vasoconstriction. Bradykinin is a kidney hormone that increases blood flow and vascular permeability. Erythropoietin is a kidney hormone that stimulates the bone marrow to make red blood cells.
Which factor would a nurse suspect as the likely cause in a client with cancer of the prostate who requests the urinal frequently but either does not void or voids in very small amounts? A. Edema B. Dysuria C. Retention D. Suppression
C. Retention Rationale An enlarged prostate constricts the urethra, interfering with urine flow and causing retention. When the bladder fills and approaches capacity, small amounts can be voided, but the bladder never empties completely. Edema does not cause the client to void frequently in small amounts. Dysuria is painful or difficult urination, which is not part of the client's responses. The urge to void is caused by stimulation of the stretch receptors as the bladder fills with urine; in suppression, little or no urine is produced.
Which activities would the nurse include when teaching adults about activities that increase the risk of developing bladder cancer? Select all that apply. One, some, or all responses may be correct. A. Jogging 3 miles (4.8 km) a day B. Drinking three cans of cola a day C. Smoking two packs of cigarettes a day D. Working with dyes used in rubber every day E. Using a jackhammer and chainsaw every day
C. Smoking two packs of cigarettes a day D. Working with dyes used in rubber every day Rationale The occurrence of bladder cancer is related to smoking. Dyes in rubber and hair dyes are environmental carcinogens; working with them daily increases an individual's risk of bladder cancer. Jogging is unrelated to the development of cancer of the bladder. Ingestion of cola has not been linked to cancer of the bladder. Vibrations may result in musculoskeletal or kidney problems but are unrelated to cancer of the bladder.
For which potential complication would the nurse monitor a client receiving continuous ambulatory peritoneal dialysis for end-stage kidney disease? Select all that apply. One, some, or all responses may be correct. A. Pruritus B. Oliguria C. Tachycardia D. Cloudy outflow E. Abdominal pain
C. Tachycardia D. Cloudy outflow E. Abdominal pain Rationale Tachycardia can be a symptom of peritonitis, a complication of peritoneal dialysis; the heart rate increases to meet the metabolic demands associated with infection. Cloudy or opaque dialysate outflow (effluent) is the earliest sign of peritonitis; the cloudiness is a result of the constituents associated with an infectious process. Abdominal pain is associated with peritonitis, a complication of peritoneal dialysis; pain results from peritoneal inflammation, abdominal distention, and involuntary muscle spasms. Severe itching (pruritus) results from the deposits of metabolic waste products in the skin; dialysis removes metabolic waste products, preventing this adaptation associated with kidney failure. The production of abnormally small amounts of urine (oliguria) is a sign of kidney failure, not a complication of peritoneal dialysis.
Which information would the nurse include when teaching postoperative care to a client with a large calculus in the calyces of the right kidney who has surgery scheduled for removal of the stone? A. The calculi are too large for transurethral removal. B. During the surgery, removal of the right ureter occurs. C. After surgery, a suprapubic catheter will be in place. D. After surgery, there will be a small incision in the right flank area.
D. After surgery, there will be a small incision in the right flank area. Rationale The client will have a small incision in the right flank area after surgery. If the calculus was in the renal pelvis, the client could have a percutaneous pyelolithotomy performed. Transurethral removal of a large ureteral calculus involves using a ureteroscopic ultrasonic lithotripsy. Removal of the calculus may occur without damage to the ureter. Placement of a suprapubic catheter usually is unnecessary unless there is damage to the ureter during the procedure.
The nurse reviews the kidney function blood studies of four clients. Which client's results indicate kidney impairment? Client Serum creatinine/Blood urea nitrogen (BUN) Client 1: 0.1 mg/dL (8.84 mmol/L) //16 mg/dL (5.712 mmol/L) Client 2: 0.8 mg/dL (70.72 mmol/L) // 18 mg/dL (6.426 mmol/L) Client 3: 1.2 mg/đL (106.08 mmol/L) // 20 mg/dL (7,14 mmol/L) Client 4: 1.9 mg/dL (167.96 mmol/L) // 22 mg/dL (7.85 mmol/L) A. Client 1 B. Client 2 C. Client 3 D. Client 4
D. Client 4 Rationale Elevated creatinine level signifies impaired kidney function or kidney disease. As the kidneys become impaired for any reason, the creatinine level in the blood will rise due to poor clearance of creatinine by the kidneys. Abnormally high levels of creatinine thus warn of possible malfunction or failure of the kidneys. If the kidneys are not able to remove urea from the blood normally, the blood urea nitrogen (BUN) level rises. The normal range of serum creatinine lies between 0.6 and 1.2 mg/dL (53.04-106.08 mol/L). The normal range of BUN lies between 10 and 20 mg/dL (3.57-7.14 mmol/L). Client 4's levels indicate kidney impairment. The serum creatinine and BUN are within normal limits for clients 1, 2, and 3.
Which client's urine diagnostic report would support the nurse's suspicion that a client is at risk to develop end-stage kidney disease? Client/ Urinary Albumin Concentration Client A: 98 mg/24 hr Client B: 198 mg/24 hr Client C: 298 mg/24 hr Client D: 398 mg/24 hr A. Client A B. Client B C. Client C D. Client D
D. Client D Rationale Clients with urinary albumin levels greater than 300 mg/24 h (200 mcg/min) are at risk of developing end-stage kidney disease. Client D has a serum albumin concentration of 398 mg/24 h, which indicates that the client may develop end-stage kidney disease. The findings of client D support the nurse's suspicion. Serum albumin levels in the range of 30 to 299 mg/24 h indicate persistent albuminuria, which is an early stage of nephropathy, especially in diabetic clients. The serum albumin concentrations of clients A, B, and C, which are 98, 198, and 298 mg/24 h, respectively, are indicative of microalbuminuria.
Which instruction would the nurse give to the client having a residual urine test? A. Void right after a urinary catheter is removed. B. Collect a specimen of urine during midstream. C. Attempt to void when a urinary catheter is in place. D. Empty the bladder before a urinary catheter is inserted.
D. Empty the bladder before a urinary catheter is inserted. Rationale Emptying the bladder before a urinary catheter is inserted measures how much urine remains in the bladder after voiding. Residual urine is the urine left in the bladder after urinating. After voiding, the client is catheterized, or a bladder scan can be used. The bladder will be empty of urine when the urinary catheter is removed. Collecting a specimen of urine during midstream is known as a clean-catch, or midstream, urine specimen, not a residual urine test. The urinary catheter will prevent urine accumulation.
Which clinical manifestation would indicate the cancer is in an early stage in a male client with a preliminary diagnosis of cancer of the urinary bladder? A. Dysuria B. Retention C. Hesitancy D. Hematuria
D. Hematuria Rationale Hematuria is the most common early sign of cancer of the urinary system, probably because of the urinary system's rich vascular network. Dysuria is not specific for bladder cancer. Retention and hesitancy are not specific for bladder cancer; usually they are associated with an enlarged prostate in the male.
Which factor may contribute to a client developing urinary calculi? A. Increased fluid intake B. Urine specific gravity of 1.017 C. Jogging 3 miles (4.8 km) a day D. History of hyperparathyroidism
D. History of hyperparathyroidism Rationale Hyperparathyroidism results in high serum calcium levels; as the blood is filtered through the nephron, precipitates of calcium may form calculi. Increased fluid intake will discourage stone formation by preventing stagnation of urine. A urine specific gravity of 1.017 is within the expected range of 1.010 to 1.030 and will not increase the risk of developing urinary calculi. A jogging schedule of 3 miles (4.8 km) daily reduces the risk of developing urinary calculi; activity improves glomerular filtration and inhibits calcium from leaving the bone.
Which part of the renal system does furosemide exerts its effects? A. Distal tubule B. Collecting duct C. Glomerulus of the nephron D. Loop of Henle
D. Loop of Henle Rationale Furosemide acts in the ascending limb of the loop of Henle in the kidney. Thiazides act in the distal tubule in the kidney. Potassium-sparing diuretics act in the collecting duct in the kidney. Plasma expanders, not diuretics, act in the glomerulus of the nephron in the kidney.
Which laboratory test would the nurse discuss the need to monitor throughout the course of prostate cancer when a client asks, "How much more blood will they need? Don't they have enough?" A. Albumin B. Creatinine C. Blood urea nitrogen (BUN) D. Prostate-specific antigen (PSA)
D. Prostate-specific antigen (PSA) Rationale The PSA is an indication of the presence of prostate cancer; the higher the level, the greater the tumor burden. The health care provider will monitor the PSA levels throughout the course of the disease and periodically thereafter. Albumin is a protein and an indicator of nutritional and fluid status. Creatinine and BUN levels indicate renal function and may elevate when blockage of the urethra occurs from an enlarged prostate, but the reports do not indicate metastasis or prostate cancer.
Which description of pain would the nurse expect a client with a ureteral calculus to report? A. Boring-type pain that is located in the flank B. Dull and constant at the costovertebral angle C. Located at the level of the kidneys and occurring with each urination D. Spasmodic and radiating from the side to the suprapubic area
D. Spasmodic and radiating from the side to the suprapubic area Rationale Pain with ureteral stones is caused by spasm (renal colic) and is excruciating and intermittent; it follows the path of the ureter to the bladder down to the groin. Pain is spasmodic and excruciating, not boring, dull, or constant. Pain intensifies as the calculus lodges in the ureter and spasms occur in an attempt to dislodge it. Pain at the costovertebral angle can indicate urinary tract infection. The pain is episodic and not located at the level of the kidneys.