EAQ
When the nurse is providing discharge instructions for a patient diagnosed with acute kidney injury, which question by the nurse best assess the patient's understanding of the condition? A. "Which medications did the doctor prescribe?" B. "Do you understand the condition you have?" C. "Can you tell me what happens with your condition?" D. "Can you tell me if you are allergic to any medications?"
Answer: "Can you tell me what happens with your condition?" Rationale: The question, "Can you tell me what happens with your condition?" prompts the patient to tell the nurse his or her understanding of the condition in his or her own words. The nurse can then determine how effective the teaching has been. The questions, "Which medications did the doctor prescribe?", "Do you understand the condition you have?", and "Can you tell me if you are allergic to any medications?" are closed-ended question that do not prompt the patient to elaborate on his or her condition and are not the best questions to assess the patient's understanding of the condition.
To determine a patient's kidney function, which diagnostic test would the nurse review to obtain the patient's glomerular filtration rate (GFR)? A. Urine osmolarity B. Urine electrolytes C. Creatinine clearance D. Total catecholamines
Answer: Creatinine clearance Rationale: The creatinine clearance test is a calculated measure of the GFR. The amount of creatinine cleared from the blood and filtered into the urine is a measure of the total volume of urine excreted in a defined period. A urine electrolyte test determines the volume of electrolytes, such as sodium and chloride, filtered out with the urine. Urine osmolarity measures the concentration of particles in the urine such as electrolytes, glucose, urea, and creatinine. Total catecholamines determines the amount of epinephrine and norepinephrine in the urine.
Which age-related change would the nurse associate with a patient's report of nocturia? A. Increased secretion of aldosterone B. Decreased ability to concentrate urine C. Increased production of erythropoietin D. Decreased production of antidiuretic hormone
Answer: Decreased ability to concentrate urine Rationale: Nocturia may result from decreased kidney-concentrating ability associated with aging. Age-related changes include increased production of antidiuretic hormone, decreased production of erythropoietin, and decreased secretion of aldosterone.
For a patient with a genetic malformation of the proximal convoluted tubules (PCTs) of the nephrons, which alteration would the nurse anticipate as a direct result of the malformation? A. Electrolyte imbalance B. Impaired solute removal C. Decrease in renal blood flow D. Glomerular filtration imbalance
Answer: Electrolyte imbalance Rationale: The PCT of the renal nephron is the site of reabsorption of sodium, chloride, water, glucose, amino acids, potassium, calcium, bicarbonate, phosphate, and urea. An abnormality to the PCT will cause an electrolyte imbalance. The cause of impaired solute removal would be an alteration to the peritubular capillaries (PTCs), not the PCT. The cause of a decrease in renal blood flow may be a variety of factors; however, the PCT is not involved in renal blood flow. An alteration in the glomerulus may cause an imbalance to the glomerular filtration rate, not the PCT.
Which factor would the nurse associate with the potential cause of a patient's nephrogenic systemic fibrosis? A. Exposure to gases B. Exposure to certain dyes C. Exposure to hydrocarbons D. Exposure to gadolinium-enhanced MRI
Answer: Exposure to gadolinium-enhanced MRI Rationale: The exposure to gadolinium-enhanced MRI can result in nephrogenic systemic fibrosis. Exposure to gases, certain dyes, and hydrocarbons may impair kidney function but would not cause nephrogenic systemic fibrosis.
Aging does not affect which anatomic structure or function or the kidney? A. Tubule length B. Thickened blood vessels C. Glomerular filtration rate D. Juxtamedullary nephron functions
Answer: Juxtamedullary nephron functions Rationale: Age does not affect the medulla of the kidney. Therefore preservation of the juxtamedullary nephron functions occurs. Tubule length decreases with age, which results in an inability to concentrate urine in older adults. Thickening of the blood vessels results in reduced blood flow to the kidney. The glomerular filtration rate decreases with age and increases the risk for fluid overload.
When the nurse is providing emergency department care for a patient with a severely elevated serum creatinine level, which pathologic condition may increase the patient's serum creatinine level? A. Liver failure with severe ascites B. Diabetes with uncontrolled glucose regulation C. Vascular disease with damage to the endothelium D. Kidney disease
Answer: Kidney disease Rationale: No pathologic condition increases the serum creatinine level other than kidney disease. Liver failure, diabetes, and vascular disease do not increase the serum creatinine level unless renal disease also occurs.
Which condition would the nurse associate with a patient whose laboratory results indicate a serum creatinine level of 1.8 mg/dL? A. Kidney impairment B. Severe hepatic damage C. Decreased muscle mass D. Decreased kidney perfusion
Answer: Kidney impairment Rationale: An increased level of serum creatinine indicates kidney impairment. Normal creatinine for an adult man is 0.6 to 1.2 mg/dL, and for an adult woman it is 0.5 to 1.1 mg/dL. A decreased level of blood urea nitrogen may indicate severe hepatic damage. A decreased level of serum creatinine may indicate a decrease in muscle mass. An increased level of blood urea nitrogen may indicate decreased kidney perfusion.
Which priority intervention would the nurse implement when providing care for a patient with a glomerular filtration rate (GFR) of 45 mL/min secondary to kidney disease? A. Encourage voiding or urine. B. Maintain an adequate fluid intake. C. Report data to the primary health care provider. D. Consider the data normal, and do not take any action.
Answer: Maintain an adequate fluid intake. Rationale: A normal GFR is 120 mL/min for a health young adult and 65 mL/min for an older adult. The hormone renin helps regulate blood flow, GFR, and blood pressure. A decrease in the kidney's GFR may indicate a decrease in the ability to regulate water balance. The kidneys are less able to conserve water, so fluid intake should be adequate. Encouraging the patient to void is not necessary. In this situation, the nurse may act first and notify primary health care provider later. The nurse should not consider this a normal situation, and the nurse needs to intervene.
Which purpose statement would the nurse associate with scheduled radiography of the kidneys, ureters, and bladder (KUB)? A. Determine postvoid residual. B. Measure the size of both kidneys. C. Detect the presence of urinary reflux. D. Stage a tumor detected through palpation.
Answer: Measure the size of both kidneys. Rationale: A KUB is a plain film of the abdomen used to measure the size of the kidneys. The x-ray may also screen for the presence of two kidneys and detect gross obstruction. The KUB does not help stage a tumor. MRI or CT scans help stage cancer tumors. A bladder scanner assists in determining a postpaid residual volume. Voiding cystourethrography (VCUG) detects urinary reflux from vesicourethral junctions.
To determine the functional ability of the kidney, which diagnostic test is safe for patient with kidney failure? A. Radiography B. Nuclear renal scan C. CT D. MRI
Answer: Nuclear renal scan Rationale: A nuclear renal scan provides functional information of the kidney in patients with kidney failure. The scan does not expose patients to iodinated contrast dye, which can increase risk for further kidney damage. Radiography detects a gross obstruction in the kidneys. Ct evaluates contour masses. MRI provides an improved contrast between normal and abnormal tissue.
Which diagnostic test would the nurse review for an estimated glomerular filtration rate (GFR)? A. Radiography B. Ultrasonography C. Nuclear renal scan D. MRI
Answer: Nuclear renal scan Rationale: Health care providers use a nuclear renal scan to estimate the GFR. Radiography detects any gross obstruction in the kidneys. Ultrasonography identifies the size of a tumor in the kidneys. MRI is useful to determine the stages of cancer.
When a patient is recovering from a kidney biopsy, which clinical manifestation would the nurse associate with the patient's internal bleeding or a hematoma? A. Pink-tinged urine B. Increased urine output C. Increased blood pressure D. Pain radiating to the flank
Answer: Pain radiating to the flank Rationale: Pain at the biopsy site that radiates to the flank and around the site of the abdomen indicates internal bleeding or a hematoma is forming around the kidney. Pink-tinged urine indicates the presence of blood or hematuria in the urine. The patient with a hematoma has decreased urine output, decreased blood pressure, other signs of hypovolemia, or shock.
Which patient is at risk if the nurse attempts to palpate the patient's kidney? A. Patient with an enlarged kidney B. Patient with a tumor in the kidney C. Patient with a low body mass index D. Patient with a thin abdominal musculature
Answer: Patient with a tumor in the kidney Rationale: Palpation helps in the physical assessment of the kidney. In a patient with a tumor, the nurse should not palpate the kidney as the assessment may harm the patient. Palpation would help identify an enlarged kidney. Palpation is easier in patients with low body mass index and thin abdominal musculature because kidneys are located deeper in the body.
For a patient reporting right flank pain, which action would the nurse implement when preparing to percuss the patient's flank area? A. Position the patient in an upright position, form the hand into a cupped position, and firmly strike the patient's costovertebral area. B. Position the patient in a prone position, and place a flattened hand on the patient's costovertebral area. C. Position the patient in a standing position, clench the hand into a fist, and firmly thump the patient's constovertebral area. D. Position the patient in sitting position, clench the hand into a fist, and firmly thump the patient's costovertebral area.
Answer: Position the patient in sitting position, clench the hand into a fist, and firmly thump the patient's costovertebral area. Rationale: When assessing the patient's flank pain, the nurse should position the patient an upright sitting, side-lying, or supine position, clench the hand into a fist, and firmly thump the patient's costovertebral area. The nurse should not place the patient in a prone or standing position when percussing the patient's flank area. Additionally, the nurse should not form his or her hand into a cupped position when percussing the patient's flank area.
When preparing a patient for a kidney biopsy, the nurse would complete which required assessment before sending the patient for the procedure? Select all that apply. A. Prothrombin time (PT) B. Blood pressure C. Hemoglobin D. Bladder scan E. Platelet count
Answer: Prothrombin time (PT) Blood pressure Hemoglobin Platelet count Rationale: The patient is at risk for bleeding after a kidney biopsy, so performing coagulation studies such as platelet count, activated partial prothrombin time (aPTT), PT, and bleeding time before the biopsy is a requirement. Hypertension puts the patient at an increased risk for bleeding, so the health care provider may prescribe administration antihypertensive medications before the procedure. The patient's hemoglobin is determined to assess the need for a blood transfusion. A bladder scan determines the amount of retained urine, but this assessment is not necessary before a kidney biopsy.
Which parameter would the nurse examine to assess a patient's acid-base balance? A. Sodium level B. Calcium level C. Potassium level D. Bicarbonate level
Answer: Bicarbonate level Rationale: Assessing the bicarbonate levels in a patient would assess the acid-base balance in a patient because bicarbonate reabsorption in the kidneys maintains acid-base balance. Sodium helps maintain fluid balance. Calcium controls calcium balance. Potassium maintains fluid volume and osmolarity.
Which risk would the nurse anticipate in a patient with an age-related decrease in the glomerular filtration rate (GFR)? A. Oliguria B. Dehydration C. Drug reactions D. Hypernatremia
Answer: Drug reactions Rationale: Age-related changes such as decreased GFR, reduced kidney mass, and reduced blood flow contribute to reduced drug clearance. This increases the risk of drug reactions and kidney damage from drugs and contrast dyes. The patient will not develop oliguria (urinary output less than 400 mL/24 hr). Because of tubular changes with agin, the patient has a decreased ability to concentrate urine, resulting in nocturnal polyuria, or urination at night. A reduced gFR increases the risk for fluid overload. Tubular changes and impairment of the thirst mechanism increase the risk for dehydration and increased blood sodium levels.
Which aspect of a patient's renal function is most important for the nurse to assess? A. Production of erythropoietin B. Blood pressure regulation C. Maintenance of body fluid volume D. Conversion of vitamin D into an active form
Answer: Maintenance of body fluid volume Rationale: Maintaining body fluid volume is the most important function of the kidneys. Producing erythropoietin, regulating blood pressure, and converting vitamin D into an active form are also functions of the kidneys, but they are not the most important ones.
Which symptom would the nurse assess when providing care for a patient with uremia? A. Insomnia B. Cyanosis of the skin C. Nausea and vomiting D. Tenderness at the costovertebral angle (CVA)
Answer: Nausea and vomiting Rationale: Manifestations of uremia include anorexia, nausea, vomiting, weakness, and fatigue. CVA tenderness is a sign of inflammation or infection in the renal pelvis. Cyanosis is related to poor tissue perfusion. Insomnia is nonspecific and potentially caused by psychoemotional factors, medications, or other problems.
Which kidney hormone regulates infrarenal blood flow by vasodilation or vasoconstriction? A. Renin B. Bradykinins C. Erythropoietin D. Prostaglandins
Answer: Prostaglandins Rationale: Kidney tissues secrete prostaglandins, which regulate infrarenal blood flow by vasodilation or vasoconstriction. Granular cells produce renin to assist in raising the blood pressure as a result of angiotensin and aldosterone secretion. The juxtaglomerular cells of the arterioles secrete bradykinins to increase blood flow and vascular permeability. Erythropoietin, produced by kidney parenchyma, stimulates bone marrow to make red blood cells.
When the nurse is assessing a patient's renal status during the admission process to a medical surgical unit, which question by the nurse best determines if the patient's urine output is adequate? A. "Is your urine output usually around 1500 mL every day?" B. "Is your urine output usually around 3000 mL every day?" C. "Does your urine output usually stay the same on a daily basis?" D. "Does your urine output usually match the amount of fluid you drink?"
Answer: "Does your urine output usually match the amount of fluid you drink?" Rationale: Asking the patient, "Does your urine output usually match the amount of fluid you drink?" is an easy reference for the patient and best determines if the patient's urine output is adequate. Asking the patient, "Is your urine output usually around 1500 mL every day?" is not the best question to determine if the patient's urine output is adequate because the patient cannot normally remember exact amounts of urine outputs. Asking the patient, "Is your urine output usually around 3000 mL every day?" is not appropriate because 3000 mL is twice the normal urine output. Asking the patient, "Does your urine output usually stay the same on a daily basis?" is not the best question to determine if the patient's urine output is adequate because the patient's usual urine output may be abnormal.
For a patient with acute kidney injury, which question best assists the nurse when assessing the patient's history of hypertension? A. "Do you have high blood pressure?" B. "Do you take high blood pressure medication?" C. "Do you monitor your blood pressure at home?" D. "Have you ever been told your blood pressure is high?"
Answer: "Have you ever been told your blood pressure is high?" Rationale: Asking the patient, "Have you ever been told your blood pressure is high?" prompts the patient to tell the nurse about any history of hypertension. Asking the patient, "Do you have high blood pressure?" is appropriate; however, this question is not the best way to assess the patient's history of hypertension because the patient may not know what high blood pressure is. Asking the patient, Do you take high blood pressure medication?" does not determine the patient's history of hypertension. Asking the patient, "Do you monitor your blood pressure at home?" does not determine the patient's history of hypertension.
Which nurse response best answers a patient's question regarding the difference between nephritis and nephrosis after receiving a diagnosis of nephritis? A. "Nephritis is the inflammation of the kidney, and nephrosis is the degeneration of the kidney." B. "Nephrosis is the inflammation of the kidney, and nephritis is the degeneration of the kidney." C. "There are no differences between nephritis and nephrosis. These terms may be used interchangeably." D. "There are only minor differences between nephritis and nephrosis. These terms may be used interchangeably."
Answer: "Nephritis is the inflammation of the kidney, and nephrosis is the degeneration of the kidney." Rationale: Nephritis is the inflammation of the kidney, and nephrosis is the degeneration of the kidney. Historically, lay adults interchanged these terms; however, there are significant differences between these terms.
Which statement by the nurse indicates a need for further education on serum creatinine? A. "Older adults have a decreased serum creatinine level." B. "The serum creatinine level is a good indicator of kidney function." C. "The serum creatinine level is slightly higher in men than in women." D. "Athletes have a slightly higher than normal level of serum creatinine level."
Answer: "Older adults have a decreased serum creatinine level." Rationale: Muscle mass and the amount of creatinine produced decreases with age. However, because of decreased rates of creatinine clearance, serum creatinine levels remain relatively constant in older adults in the absence of renal pathology. The production of serum creatinine occurs when muscle and other proteins break down. The serum creatinine level is a good indicator of kidney function because protein breakdown is usually constant. Men have relatively more muscle mass than women, so their serum creatinine level may be slightly higher. Athletes usually have greater muscle mass, so they may have a slightly higher-than average serum creatinine level.
When teaching a patient about a scheduled kidney, ureter, and bladder (KUB) x-ray, which statement would the nurse include in the teachings? A. "You should fast at least 4 hours before this test." B. "You do not any special preparation for this test." C. "You need to be able to lie flat on your abdomen for this test." D. "You should not take your diabetes medication before this test."
Answer: "You do not need any special preparation for this test." Rationale: The KUB procedure is a plain film on the abdomen obtained without any specific patient preparation. The nurse should not test he patient to fast or stop any medications before the KUB procedure. The patient should be in the supine, not prone, position for the duration of the KUB procedure.
The nurse would associate the kidney's release of renin with which functional response? A. Blood pressure B. Vitamin D activation C. Fluids and electrolytes D. Red blood cells (RBC) formation
Answer: Blood pressure Rationale: The kidneys produce and release renin in response to decreased blood flow. The renin-angiotensin-aldosterone system activation decreases urine output, and angiotensin II causes vasoconstriction to increase the blood pressure. The kidneys convert vitamin D to an active form, but renin is not involved in this process. the kidneys maintain fluid and electrolyte balance within the nephron unit. The kidneys produce erythropoietin, and the hormone release occurs in response to decreased oxygen tension in the kidney's blood supply. Erythropoietin triggers RBC production in the bone marrow.
Which potential risk would the nurse associate with a patient who consumes 2 L of fluid daily while on a high-protein diet? A. Nocturia B. Calculi formation C. Urinary tract infection D. Urinary incontinence
Answer: Calculi formation Rationale: The patient on a high-protein diet with poor fluid intake can develop calculi or stone formation. The patient with urinary stasis is likely to have urinary tract infection. Weakened bladder muscles may occur as a result of aging and lead to urinary incontinence. Nocturia occurs because of decreased renal concentrating capacity as a result of aging.
Which laboratory test would the nurse associate with the best indicator of kidney function? A. Creatinine B. Alkaline phosphatase C. Blood urea nitrogen (BUN) D. Aspartate aminotransferase (AST)
Answer: Creatinine Rationale: Creatinine excretion, the end product of muscle metabolism, remains relatively steady and therefore in the best indicator of renal function. Protein or fluid intake may affect the results of a BUN. Measures of hepatic function includes the AST and alkaline phosphatase levels.
Which laboratory result would the nurse use as the best indicator of kidney function when providing care for a patient who developed glomerulonephritis after a streptococcal infection? A. Urinalysis (UA) B. Serum creatinine C. Blood urea nitrogen (BUN) D. Blood urea nitrogen (BUN)/creatinine ratio E. Urine culture and sensitivity
Answer: Serum creatinine Rationale: The breakdown of muscle and other proteins produce a waste product, serum creatinine. Because protein breakdown is usually constant, the serum creatinine level is the best indicator of kidney function. Urinalysis is the analysis of the urine, but it is not the best indicator the patient's kidney function. Although BUN assists in the best indicator of kidney function. Urinalysis is the analysis of the urine, but it is not the best indicator the patient's kidney function. Although BUN assists in the assessment of kidney function, it is not the best indicator of kidney function because the level of patient hydration affects the data. The BUN/creatinine ratio may determine if non-kidney-related problems are increasing the BUN level. This test is not the best test to asses the patient's kidney function. The urine culture and sensitivity verify the organism causing the infection; the test does not indicate kidney function.
When assessing a patient suspected of having pyelonephritis, which patient position provides the best opportunity for the nurse to auscultate the renal vessels? A. Prone B. Supine C. Left lateral recumbent D. Right lateral recumbent
Answer: Supine Rationale: The nurse should place the patient in the supine position, lying flat on the back, to auscultate the renal vessels. Placing the patient in the prone, left lateral recumbent, or right lateral recumbent positions are not the correct positions of patient placement for auscultating the renal vessels.
Which causative factor would the nurse associate with an athlete hospitalize with kidney dysfunction? A. Short-term use of analgesics B. Performing high-impact exercises C. Taking dietary supplementation with synthetic creatine D. Short-term use of NSAIDs
Answer: Taking dietary supplementation with synthetic creatine Rationale: Dietary supplementation with synthetic creatine results in an increase of muscle mass, but it causes compromised kidney function. Long-term use of analgesics leads to kidney dysfunction. High-impact exercises may not affect kidney function. Long-term use of NSAIDs, especially acetaminophen, leads to reduced kidney function.
Which interpretation would the nurse formulate as the cause of a patient's blood urea nitrogen (BUN)/creatinine ratio being 4.4? A. The patient eats a high-protein diet. B. The patient has fluid volume excess. C. The patient has obstructive uropathy. D. The patient has decreased muscle mass.
Answer: The patient has fluid volume excess. Rationale: The normal range of BUN/creatinine ratio is 6 to 25; 15.5 is an optimum level for adults. A decrease in this ratio may indicate fluid volume excess. A high-protein diet may be associated with an increased level of BUN. Obstructive uropathy is associated with an increased level of BUN/creatinine ratio. Decreased muscle mass may be associated with a low serum creatinine level.
Which type of physiologic change in the kidney would the nurse associate with nocturnal polyuria in older adults? A. Tubular changes B. Thickening of blood vessels C. Fluid and electrolyte imbalance D. Increased glomerular filtration rate
Answer: Tubular changes Rationale: Tubule length decreases in older adults, which reduces the ability to filter blood and excrete waste products. These changes may result in an inability to produce concentrated urine, leading to nocturnal polyuria. A thickening of the blood vessels results in the reduction in blood flow to the kidneys. Along with other age-related changes, a change in the thirst mechanism also leads to an increased risk for disturbances of fluid and electrolyte balance in older adults. The glomerular filtration rate decreases as a normal part of the aging process; it will not increase.
Which age-related change to the renal system would the nurse recognize as the likely cause of a patient's reports of nocturia disrupting sleep and daytime urgency with low-volume urine output? A. Blood flow to the kidneys decreased with age. B. Glomerular filtration rate (GFR) decreases with age. C. Hormonal changes with aging increase the release of renin. D. Tubular changes with agin decrease the ability to concentrate urine.
Answer: Tubular changes with aging decrease the ability to concentrate urine. Rationale: Tubular changes with aging decrease the ability to concentrate urine, resulting in urgency (a sense of nearly uncontrollable need to urinate) and nocturnal polyuria (increased urination at night). Blood flow to the kidney decreases with age, as does the GFR; however, these do not directly cause urgency and polyuria. Hormonal changes with aging decrease the release of renin.
