Chapter 47,48,49
The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following? Fistula Chronic renal failure Neurogenic bladder Kidney stones
Kidney stones Explanation: A client with hyperparathyroidism is at risk for kidney stones. The client with diabetes mellitus is a risk factor for developing chronic renal failure and neurogenic bladder. A client with radiation to the pelvis is at risk for urinary tract fistula.
The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client be assessed for an allergy to iodine? Computed tomography with contrast Cystoscopy Radiography Bladder ultrasonography
Computed tomography with contrast Explanation: The nurse is correct to assess for an allergy to iodine when a computed tomography with contrast medium is prescribed. Uroflowmetry, cystoscopy, and bladder ultrasonography are performed without the use of contrast medium
A female client presents to the health clinic for a routine physical examination. The nurse observes that the client's urine is bright yellow. Which question is most appropriate for the nurse to ask the client? "Do you take phenytoin daily?" "Have you noticed any vaginal bleeding?" Have you had a recent urinary tract infection?" Do you take multiple vitamin preparations?"
"Do you take multiple vitamin preparations?" Explanation: Urine that is bright yellow is an anticipated abnormal finding in the client taking a multivitamin preparation. Urine that is orange may be caused by intake of phenytoin 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 client, the use of vaginal creams.
Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective? "Ultrafiltration methods take much longer than hemodialysis." "There are few complications with renal replacement therapies." A special access is created in my vein for peritoneal dialysis." A family member can help me perform hemodialysis in my home."
"Ultrafiltration methods take much longer than hemodialysis." Explanation: Ultrafiltration methods (CVVH, CVVHD) are better tolerated by unstable clients as fluid is removed slowly, resulting in mild hemodynamic effects.
When fluid intake is normal, the specific gravity of urine should be: 1.000 Less than 1.010 Greater than 1.025 1.010 to 1.025
1.010 to 1.025 Explanation: Urine-specific gravity is a measurement of the kidneys' ability to concentrate urine. The specific gravity of water is 1.000. A urine-specific gravity less than 1.010 may indicate inadequate fluid intake. A urine-specific gravity greater than 1.025 may indicate dehydration.
A group of students is reviewing the process of urine elimination. The students demonstrate understanding of the process when they identify which amount of urine as triggering the reflex? 350 mL 50 mL 250 mL 150 mL
150 mL Explanation: The desire to urinate comes from the feeling of bladder fullness. A nerve reflex is triggered when approximately 150 to 200 mL of urine accumulates
Following a renal biopsy, a client reports severe pain in the back, the arms, and the shoulders. Which intervention should be offered by the nurse? Distract the client's attention from the pain. Provide analgesics to the client. Enable the client to sit up and ambulate. Assess the patient's back and shoulder areas for signs of internal bleeding.
Assess the patient's back and shoulder areas for signs of internal bleeding. Explanation: After a renal biopsy, the client should be on bed rest. The nurse observes the urine for signs of hematuria. It is important to assess the dressing frequently for signs of bleeding, monitor vital signs, and evaluate the type and severity of pain. Severe pain in the back, shoulder, or abdomen may indicate bleeding. In such a case, the nurse should notify the physician about these signs and symptoms. The nurse should also assess the client for difficulty voiding and encourage adequate fluid intake.
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75% Increased pH with decreased hydrogen ions Increased serum levels of potassium, magnesium, and calcium
Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL Explanation: The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl. A BUN level of 100 mg/dl and a serum creatinine of 6.5 mg/dl are abnormally elevated results, reflecting CRF and the kidneys' decreased ability to remove nonprotein nitrogen waste from the blood. CRF causes decreased pH and increased hydrogen ions — not vice versa. CRF also increases serum levels of potassium, magnesium, and phosphorous, and decreases serum levels of calcium. A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls within the normal range of 60% to 75%.
The nurse is caring for a client after a cystoscopic examination. Following the procedure, the nurse informs the client that which effect may occur? Severe abdominal pain Blood-tinged urine Nausea and emesis Diarrhea
Blood-tinged urine Explanation: Postprocedural management is directed at relieving any discomfort resulting from the examination. Some burning upon 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 client should not experience severe abdominal pain.
Which value does the nurse recognize as the best clinical measure of renal function? Circulating ADH concentration Urine-specific gravity Volume of urine output Creatinine clearance
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) decrease.
A client has undergone diagnostic testing that involved the insertion of a lighted tube with a telescopic lens. The nurse identifies this test as which of the following? Excretory urogram Renal angiography Intravenous pyelography Cystoscopy
Cystoscopy Explanation: Cystoscopy is the visual examination of the inside of the bladder using an instrument called a cystoscope, a lighted tube with a telescopic lens. Renal angiography involves the passage of a catheter up the femoral artery into the aorta to the level of the renal vessels. Intravenous pyelography or excretory urography is a radiologic study that involves the use of a contrast medium to evaluate the kidneys' ability to excrete it.
A client presents at the testing center for an intravenous pyelogram. What question should the nurse ask to ensure the safety of the client? "Do you have any allergies?" " Do you have a pacemaker?" " Have you any artificial joints?" " Who has come with you today?"
Do you have any allergies?" Explanation: Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood.
An 82-year-old client experiences urinary incontinence. Which factor should the nurse assess before beginning a bladder training program for this client? Smoking habits History of allergies Occupational history Physical and environmental conditions
Physical and environmental conditions Explanation: It is essential to assess the client's physical and environmental conditions before beginning a bladder training program, because the client may not be able to reach the bathroom in time. During the bladder training program, a change in environment may be an effective suggestion for the client. It is not so essential to assess the client's history of allergy, occupation, and smoking habits before beginning a bladder training program.
A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram? Unusually smooth skin Hypoventilation Pruritus Increased alertness
Pruritus Explanation: The nurse should be alert for pruritus and urticaria, which may indicate a mild anaphylactic reaction to the arteriogram dye. Decreased (not increased) alertness may occur as well as dyspnea (not hypoventilation). Unusually smooth skin isn't a sign of anaphylaxis.
Which of the following is an age-related change associated with the renal system? Increased bladder capacity Renal arteries thicken Blood flow increase Kidney weight increases
Renal arteries thicken Explanation: Age-related changes include thickening of the renal arteries, a decrease in the weight of the kidney, blood flow decrease by approximately 10% per decade, and decreased bladder capacity.
The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness? Above the symphysis pubis Around the umbilicus The upper abdominal quadrants on the left and right side The costovertebral angle
The costovertebral angle Explanation: The nurse is correct to assess the kidneys for tenderness at the costovertebral angle. The other options are incorrect.
The term used to describe total urine output less than 0.5 mL/kg/hour is oliguria. dysuria. anuria. nocturia.
oliguria. Explanation: Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Dysuria refers to painful or difficult urination.
The nurse is able to identify which condition as uremia? An excess of protein in the blood An excess of blood in the urine An excess of protein in the urine An excess of urea in the blood
An excess of urea in the blood Explanation: Uremia is an excess of urea and other nitrogenous wastes in the blood. Azotemia is the concentration of nitrogenous wastes in the blood. Hematuria is blood in the urine. Proteinuria is protein in the urine. Hyperproteinemia is an excess of protein in the blood.
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? Phosphorus Calcium Sodium Magnesium
Calcium Explanation: Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.
Which nursing assessment finding indicates the client with renal dysfunction has not met expected outcomes? Client reports increasing fatigue. Urine output is 100 ml/hr. Client rates pain at a 3 on a scale of 0 to 10. Client denies frequency and urgency.
Client reports increasing fatigue. Explanation: Fatigue, shortness of breath, and exercise intolerance are consistent with unexplained anemia, which can be secondary to gradual renal dysfunction.
The nurse recognizes that a referral for genetic counseling is inappropriate for the client with: Polycystic kidney disease Alport syndrome Renal calculi Wilms' tumor
Renal calculi Explanation: Wilms' tumor, polycystic disease, and Alport are conditions that have a genetic influence. Renal calculi are not influenced by genetic factors.
Which type of incontinence is the involuntary loss of urine through an intact urethra as a result of coughing? Overflow Stress Reflex Urge
Stress Explanation: Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing position. Reflex incontinence is the involuntary loss of urine because of hyperreflexia in the absence of normal sensations usually associated with voiding. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Overflow incontinence is the involuntary loss of urine associated with overdistention of the bladder
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. Shortened QRS complex Prolonged ST segment Multiple spiked P waves Tall, peaked T waves
Tall, peaked T waves Explanation: Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.
A group of students is reviewing for a test on the urinary and renal system. The students demonstrate understanding of the information when they identify which of the following as part of the upper urinary tract? Ureters Urethra Bladder Pelvic floor muscles
Ureters Explanation: The upper urinary tract is composed of the kidneys, renal pelvis, and ureters. The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.
A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 mL. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of: prostate irritation. microorganism transfer. client discomfort. incorrect urine
microorganism transfer. Explanation: Bladder ultrasonic scanning, a noninvasive way of calculating the amount of urine in the bladder, reduces the risk of transferring microorganisms into the bladder. Use of a straight catheter to measure residual urine increases the transfer of microorganisms into the bladder, and increases, rather than reduces, client discomfort. A bladder ultrasonic scan doesn't reduce the risk of prostate irritation or incorrect urine output values.
A client has been diagnosed with acute glomerulonephritis. This condition causes: polyuria. pyuria. No option is correct. proteinuria.
proteinuria. Explanation: The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided.
A client with urinary retention needs to undergo a procedure to insert an indwelling catheter. Before catheterization, the nurse would discuss with the physician information about insertion of a nasogastric tube. placement of IV and central venous pressure lines. administering cleansing enemas. the type and size of the catheter to be used.
the type and size of the catheter to be used. Explanation: Before catheterization, the nurse should inquire about the type and size of the catheter to be used and whether the catheter should be removed or retained in place after the bladder is empty. Inserting a nasogastric tube, administering enemas, and placing IV lines are measures taken during preoperative and postoperative preparation in the case of surgery.
A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address? "My physician diagnosed me with hypertension 3 months ago." "I haven't eaten since midnight." "I'm allergic to shellfish." "I've had diabetes for 4 years."
"I'm allergic to shellfish." Explanation: An allergy to iodine, shellfish, or other seafood should immediately be investigated because the contrast agent used in the procedure may contain iodine, which can cause a severe allergic reaction. Although contrast agents should be used cautiously in clients with diabetes mellitus, investigating this isn't the nurse's priority if the client also has a shellfish allergy. It's appropriate for the client to not eat after midnight before the procedure. The client's hypertension isn't a priority because this condition is the likely reason the renal angiography was ordered
The nurse is completing a full exam of the client's renal system. Which assessment finding best documents the need to offer the use of the bathroom? Tenderness over the kidneys Bruits noted over the abdominal area A dull sound when percussing over the bladder The ingestion of 8 oz of water
A dull sound when percussing over the bladder Explanation: A dull sound when percussing over the bladder indicates a full bladder. Because the bladder is full, the nurse would offer for the client to use the bathroom. Tenderness over the kidney can indicate an infection or stones. Bruits are an abnormal vascular sound that does not indicate the need to use the bathroom. Ingesting water does not mean that the client has to void at this time. Assess the patient's back and shoulder areas for signs of internal bleeding. Explanation:
Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys? Computed tomography (CT scan) Radiography Cystoscopy Angiography
Angiography Explanation: Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the internal bladder.
When the bladder contains 400 to 500 mL of urine, this is referred to as renal clearance. specific gravity. functional capacity. anuria.
functional capacity. Explanation: A marked sense of fullness and discomfort with a strong desire to void usually occurs when the bladder contains 400 to 500 mL of urine, referred to as the "functional capacity." Anuria is a total urine output 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.
