Renal 35 question (good)
Which value represents a normal BUN-to-creatinine ratio? A. 4:1 B. 6:1 C. 8:1 D. 10:1
D
A patient who complains of a dull, continuous pain in the suprapubic area that occurs with, and at the end of, voiding would most likely be diagnosed with which of the following? A. A kidney stone B. Interstitial cystitis C. Acute pyelonephritis D. Prostatic cancer
B Pain over the suprapubic area is most likely related to the bladder. Pain intensity would increase with fullness. Pain at the end of voiding is one of the symptoms associated with interstitial cystitis. (DYSURIA)
Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? A. 10 B. 20 C. 30 D. 40
B 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.
Retention of which electrolyte is the most life-threatening effect of renal failure? A. Calcium B. Sodium C. Potassium D. Phosphorous
C
When describing the functions of the kidney to a client, which of the following would the nurse include? Select all that apply. A. Regulation of white blood cell production B. Synthesis of vitamin K C. Control of water balance D. Secretion of the enzyme renin
C, D Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins. They also produce the enzyme renin.
The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable? A. Clients have frequent urinary tract infections. B. Clients develop a neurogenic bladder. C. Clients have urinary frequency. D. Clients have chronic renal failure.
D Although all of the options may occur in the client with diabetes mellitus, the option which is most notable, and potentially life threatening, is chronic renal failure.
The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply. A. Secretion of prostaglandins B. Vitamin B production C. Regulation of blood pressure D. Vitamin D synthesis E. Secretion of insulin
A, C, D Functions of the kidney include secretion of prostaglandins, regulation of blood pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body does not produce Vitamin B.
A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about: A. chronic, excessive acetaminophen use. B. recent streptococcal infection. C. childhood asthma. D. family history of pernicious anemia.
B A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction.
When the bladder contains 400 to 500 mL of urine, this is referred to as A. anuria. B. specific gravity. C. functional capacity. D. renal clearance.
C 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.
The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions? A. "I can resume my usual activities without restriction." B. "I should increase my fluid intake for the rest of the day." C. "If I have difficulty urinating, I should contact my physician." D. "It is normal for my urine to be blood-tinged."
A A bladder ultrasound is a non-invasive procedure. The client can resume usual activities without restriction.
A creatinine level has been ordered. The nurse prepares to: A. Obtain a blood specimen. B. Collect the client's urine for 24 hours. C. Obtain a clean catch urine. D. Straight cath for a specimen.
A A creatinine level is determined from a blood sample. It is used to assess renal function.
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Which is an example of how urine concentration is affected? A. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. B. On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. C. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has scant urine output with a high specific gravity. D. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity may vary widely.
A On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has copious urine output with a low specific gravity. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity remains relatively constant.
Which is the correct term for the ability of the kidneys to clear solutes from the plasma? A. Renal clearance B. Glomerular filtration rate C. Specific gravity D. Tubular secretion
A Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. Glomerular filtration rate 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.
The health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator? A. Creatinine clearance level B. Uric acid level C. Blood urea nitrogen (BUN) D. BUN to creatinine ratio
A The creatinine clearance measures the volume of blood cleared of endogenous creatinine in 1 minute. This serves as a measure of the glomerular filtration rate. Therefore the creatinine clearance test is a sensitive indicator of renal disease progression.
A client presents to the ED reporting left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The client has also experienced nausea and emesis. The nurse suspects the client is experiencing: A. ureteral stones. B. pyelonephritis. C. cystitis. D. Urethral infection.
A The findings are constant with ureteral stones, edema or stricture, or a blood clot. The other answers do not apply. Key diagnostics in no WBC in urine (no infection) whereas in UTI there is infection,
Which is an effect of aging on upper and lower urinary tract function? A. Increased glomerular filtration rate B. More prone to develop hypernatremia C. Increased blood flow to the kidneys D. Acid-base balance
B The elderly are more prone to develop hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidneys, and acid-base imbalances.
To obtain information about the chief report and medical history of an older client, the nurse asks the client about any medication history. Why is obtaining a medication history important? A. It may indicate the client's general health. B. It may reflect the client's childhood and family illnesses. C. It may indicate multiple medications taken by the client. D. It may indicate drugs that should not be prescribed to the client.
C The nurse should obtain information about a client's medication history because older clients, 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 client is not used to obtain information about the client's general health, childhood and family illnesses, or drugs that are contraindicated for use by the client.
A client undergoes renal angiography. Which postprocedure care intervention should the nurse provide to the client? A. Encourage the client to void. B. Monitor the client for signs and symptoms of pyelonephritis. C. Palpate the pulses in the legs and feet. D. Assess for signs of electrolyte and water imbalances.
C To observe for signs of arterial occlusion in a client who has undergone renal angiography, the nurse should palpate the pulses in the legs and feet. While preparing the client for renal angiography, the nurse asks the client to void. The nurse assesses for signs of electrolyte and water imbalances during the physical examination of a client. The nurse should monitor for signs and symptoms of pyelonephritis in a client who has undergone retrograde pyelography.
In a diagnosis of a lower urinary tract infection, which structures could be affected? Select all that apply. A. bladder B. urethra C. ureter D. kidney
A, B The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.
A client asks the nurse why a creatinine clearance test is accurate. The nurse is most correct to reply which of the following? A. "Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." B. "Creatinine is metabolized in the liver and excreted by the kidney at a regular rate." C. "Creatinine is a stress-related response that is excreted by the kidney." D. "Creatinine is found in the urine to make the urine acidic and can be measured."
A A creatinine clearance test is used to determine kidney function and creatinine excretion. Creatinine results from a breakdown of phosphocreatine. It is filtered by the glomeruli and excreted at a consistent rate by the kidney.
Although the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which is NOT a function of the kidneys? A. excreting protein B. excreting nitrogen waste products C. regulating blood pressure D. stimulating RBC production
A Although the kidneys excrete excess water and nitrogen-based waste products of protein metabolism, persistent renal excretion of protein is not the function of kidneys, which are in the state of homeostasis. The kidneys assist in maintenance of acid-base and electrolyte balance; produce the enzyme renin, which helps regulate blood pressure; and produce the hormone erythropoietin.
A patient has an increase in blood osmolality when the nurse reviews the laboratory work. What can this increase indicate for the patient? A. ADH stimulation B. An increase in urine volume C. Diuresis D. Less reabsorption of water
A Antidiuretic hormone (ADH), also known as vasopressin, is a hormone that is secreted by the posterior portion of the pituitary gland in response to changes in osmolality of the blood. With decreased water intake, blood osmolality tends to increase, stimulating ADH release.
The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program? A. Hypotension B. Diabetes mellitus C. Neuromuscular disorders D. Pregnancy
A Hypertension, not hypotension, is a risk factor for kidney disease.
Common tests of renal function include which of the following? Select all that apply. A. Renal concentration test B. Creatinine clearance C. Serum creatinine D. Blood urea nitrogen (BUN) E. Arterial blood gas analysis
A, B, C, D Common tests of renal function include BUN, serum creatinine, creatinine clearance, and renal concentration tests. Arterial blood gas analysis is a test of respiratory function.
Enlargement of the prostate causes which of the following to occur? Select all that apply. A. Frequency B. Oliguria C. Anuria D. Obstruction of urine flow E. Polyuria
A, B, C, D Enlargement of the prostate gland causes obstruction of urine flow, resulting in frequency, oliguria, and anuria. Polyuria does not occur.
A client undergoes renal angiography. The nurse prepares the client for the test and provides postprocedure care. Which intervention should the nurse provide to the client after renal angiography? A. Encourage the client to void B. Monitor the client for signs and symptoms of pyelonephritis C. Palpate the pulses in the legs and feet D. Assess for signs of electrolyte and water imbalance
C To observe for signs of arterial occlusion in a client who has undergone renal angiography, the nurse should palpate the pulses in the legs and feet. While preparing the client for renal angiography, the nurse asks the client to void. The nurse assesses for signs of electrolyte and water imbalances during the physical examination of a client. The nurse should monitor for signs and symptoms of pyelonephritis in a client who has undergone retrograde pyelography.
A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 mL. Urine output that's less than 50 ml in 24 hours is known as: A. oliguria. B. polyuria. C. anuria. D. hematuria.
C Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine.
The nurse recognizes that a referral for genetic counseling is inappropriate for the client with: A. Alport syndrome B. Polycystic kidney disease C. Renal calculi D. Wilms' tumor
C Wilms' tumor, polycystic disease, and Alport are conditions that have a genetic influence. Renal calculi are not influenced by genetic factors.
The nurse analyzes a urinalysis report. He is aware that the presence of this substance in the urine indicates a blood level that exceeds the kidney's reabsorption capacity. Select the substance. A. Sodium B. Bicarbonate C. Creatinine D. Glucose
D Glucose is usually filtered at the level of the glomerulus. It does not normally appear in the urine. Renal glycosuria occurs if the glucose in the blood exceeds the amount that is able to be reabsorbed. The other substances are normally excreted in the urine.
In a diagnosis of an upper urinary tract infection, which structures could be affected? Select all that apply. A. ureter B. kidney C. bladder D. urethra
A, B The upper urinary tract is composed of the kidneys, renal pelves, and ureters.
When describing the functions of the kidney to a client, which of the following would the nurse include? A. Regulation of white blood cell production B. Synthesis of vitamin K C. Control of water balance D. Secretion of enzymes
C Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins.
Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? A. 20% B. 30% C. 40% D. 50%
D 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) concentrations.
A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact? A. The left kidney usually is slightly higher than the right one. B. The kidneys are situated just above the adrenal glands. C. The average kidney is approximately 5 cm (2 in.) long and 2 to 3 cm (0.8 to 1.2 in.) wide. D. The kidneys lie between the 10th and 12th thoracic vertebrae.
A The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4??) long, 5 to 5.8 cm (2? to 2¼?) wide, and 2.5 cm (1?) thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae.
The nurse is monitoring a client who has undergone cystoscopy because the client's history indicates urinary infection. Which of the following would the nurse need to report to the physician? A. Chills and fever B. Dysuria and discolored or malodorous urine C. Hematoma and frank bleeding D. Flank pain and rapid pulse
A The nurse should monitor for chills, fever, and septicemia in a client who has a history of urinary infection after cystoscopy. These symptoms should be observed and the physician should be notified of the findings. Hematoma formation and frank bleeding would be indications to notify the physician after a renal angiography. The nurse should inform the client who is discharged after a renal biopsy to report dysuria, discolored or malodorous urine, flank pain, and rapid pulse to the physician.
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? A. Decreased blood urea nitrogen (BUN) B. Increased serum albumin C. Increased serum creatinine D. Decreased potassium
C In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.
