Ch. 18 Kidney Clinical and Diagnostic Procedures

Patient has been admitted who is severely malnourished. The patient's serum albumin is very low. Which finding would the nurse expect to see in this patient? a) Peripheral edema b) Extra heart sounds c) Hypertension d) Hyponatremia

A

When calculating the anion gap, what is the predominant cation? a) Sodium b) Potassium c) Chloride d) Bicarbonate

A

A patient is admitted with acute kidney injury. The nurse would expect to see elevated values in which laboratory results? (Select all that apply). a) Blood urea nitrogen (BUN) b) Creatinine c) Glucose d) Hemoglobin and hematocrit e) Protein

A, B With kidney dysfunction, the blood urea nitrogen (BUN) is elevated because of a decrease in the glomerular filtration rate and resulting decrease in urea excretion. Elevations in the BUN can be correlated with the clinical manifestations of uremia; as the BUN rises, symptoms of uremia become more pronounced. Creatinine levels are fairly constant and are affected by fewer factors than BUN. As a result, the serum creatinine level is a more sensitive and specific indicator of kidney function than BUN. Creatinine excess occurs most often in persons with acute kidney injury resulting from impaired excretion. Decreased hematocrit value can indicate fluid volume excess because of the dilutional effect of the extra fluid load. Decreases also can result from anemias, blood loss, liver damage, or hemolytic reactions. In individuals with acute kidney injury, anemia may occur early in the disease.

A patient has been admitted in acute kidney failure with a 10-lb weight gain over 5 days. Which findings may be present in the patient? (Select all that apply.) a) S3 or S4 b) Distended neck veins c) Crackles d) Tachycardia with hypotension e) Edema that disappears with elevation of extremity

A, B, C The patient is in fluid overload. An S3 or S4, distended neck veins, and crackles may be present in the patient. Tachycardia with hypotension is indicative of hypovolemia. Dependent edema that disappears with elevation of the extremity is indicative of poor circulation.

A patient has been admitted with acute kidney injury. The nurse knows the most important consideration for evaluating the patient's fluid status is what parameter? Select two. a) Daily weights b) Urine and serum osmolality c) Intake and output d) Hemoglobin and hematocrit levels

A, C

A patient was admitted with acute kidney injury. Which urinalysis value reflects a decreased ability of the kidneys to concentrate urine? a) pH of 5.0 b) Specific gravity of 1.000 c) No casts d) Urine sodium of 140 mEq/24 hr

B

What causes the presence of myoglobin in urine? (Select all that apply.) a) Infection b) Crush injury c) Acidosis d) Rhabdomyolysis e) Volume deficit

B, D Myoglobin: protein found in heart and skeletal muscle

A patient has been on complete bed rest for 3 days. The practitioner has left orders to get the patient out of bed for meals. The patient complains of feeling dizzy and faint while sitting at the bedside. The nurse suspects that the patient is experiencing what problem? a) Orthostatic hypertension b) Orthostatic hypotension c) Hypervolemia d) Electrolyte imbalance

B

A patient is admitted in acute heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. Which diagnostic tests would provide the best information about the internal kidney structures, such as the parenchyma, calyces, pelvis, ureters, and bladder? a) Kidney-ureter-bladder (KUB) b) Intravenous pyelography (IVP) c) Renal ultrasonography (USG) d) Renal angiography

B

A patient was admitted with acute heart failure a few days ago. Today the patient's urine has a specific gravity of 1.040. What could be the potential cause for this value? a) Volume overload b) Volume deficit c) Acidosis d) Urine ketones

B

Percussion of kidneys is usually done to assess what parameter? a) Size and shape of the kidneys b) Presence of pain in the renal area c) Presence of a fluid wave d) Patient's overall fluid status

B

A patient has been admitted in acute heart failure. Which parameter would indicate to the nurse that the patient is fluid overloaded? a) Central venous pressure of 4 mm Hg b) Pulmonary artery occlusion pressure (PAOP) of 18 mm Hg c) Cardiac index of 2.5 L/min/m2 d) Mean arterial pressure of 40 mm Hg

B normal: (9-18)

A patient is admitted in acute kidney injury. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. The nurse suspects the main cause of ascites is what condition? a) Hypovolemia b) Dehydration c) Volume overload d) Liver damage

C

A patient was admitted with acute heart failure who has been receiving diuretic therapy. The nurse suspects the patient is hypovolemic. What auscultatory parameter would confirm the nurse's suspicion? a) Hypertension b) Third or fourth heart sound c) Orthostatic hypotension d) Vascular bruit

C

A patient was admitted with acute heart failure. The nurse is assessing the patient for peripheral edema. The nurse presses two fingers over the tibial area, and it takes 1 minute before the indention disappears. What would the nurse in the medical record? a) +1 pitting edema b) +2 pitting edema c) +3 pitting edema d) +4 pitting edema

C

As serum osmolality rises, intravascular fluid equilibrium will be maintained by the release of what substance? a) Ketones b) Glucagon c) Antidiuretic hormone d) Potassium

C

A patient is admitted with acute kidney injury. The patient's weight upon admission was 176 lb and the next day it is 184 lb. What is the approximate amount of fluid retained with this weight gain? a) 800 mL b) 2200 mL c) 3600 mL d) 8000 mL

C (453 mL in one pound) (Round to 450!)

A patient was admitted with multiple trauma who has been volume resuscitated. The nurse suspects the patient is fluid overloaded. Which assessment findings would confirm the nurse's suspicion? a) Venous filling of the hand veins greater than 5 seconds b) Distended neck veins in the supine position c) Presence of orthostatic hypotension d) Presence of a third heart sound

D

In a patient with a distended abdomen differentiating ascites from solid bowel contents is accomplished by performing what assessment? a) Auscultation of bowel sounds b) Palpation of the liver margin c) Measuring abdominal girth d) Eliciting a fluid wave

D

The patient complains of a metallic taste and loss of appetite. The nurse is concerned that the patient has developed what problem? a) Glycosuria b) Proteinuria c) Myoglobin d) Uremia

D Uremia is a raised level in the blood of urea and other nitrogenous waste compounds that are normally eliminated by the kidneys.