Renal PrepU Ch53 - 16, Ch54 - 18, Ch55 - 15

A client asks the nurse why a creatinine clearance test is accurate. The nurse is most correct to reply which of the following? "Creatinine is found in the urine to make the urine acidic and can be measured." "Creatinine is metabolized in the liver and excreted by the kidney at a regular rate." "Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." "Creatinine is a stress-related response that is excreted by the kidney."

"Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." 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.

A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? "Painless gross hematuria is the first symptom in renal cancer." "Very few symptoms are associated with renal cancer." "Your urine may become orange in the future." "Eating salad may result in kidney cannibalism"

"Very few symptoms are associated with renal cancer."

A client presents at the clinic with reports of urinary retention. What question should the nurse ask to obtain additional information about the client's report? "Have you had a fever and chills?" "How much fluid are you drinking?" "Do you get up at night to urinate?" "When did you last urinate?"

"When did you last urinate?" Explanation: The nurse needs to determine the last time the client voided. Reference:

The nurse advises the patient with chronic pyelonephritis that he should: Decrease his intake of calcium rich foods to prevent kidney stones. Increase fluids to 3 to 4 L/24 hours to dilute the urine. Limit his fluid intake to 1.5 L/day to minimize bladder fullness, which could cause backward pressure on the kidneys. Decrease his sodium intake to prevent fluid retention.

Increase fluids to 3 to 4 L/24 hours to dilute the urine

What is a characteristic of the intrarenal category of acute renal failure? High specific gravity Decreased creatinine Increased BUN Decreased urine sodium

Increased BUN

Retention of which electrolyte is the most life-threatening effect of renal failure? Calcium Sodium Potassium Phosphorous

Potassium

One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: restricting sources of potassium usually found in fresh fruits and vegetables. eating protein liberally. limiting iron and folic acid intake. allowing liberal use of sodium.

restricting sources of potassium usually found in fresh fruits and vegetables.

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: pyelonephritis. Urethral infection. cystitis. ureteral stones.

ureteral stones.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: a decreased serum phosphate level secondary to kidney failure. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. metabolic alkalosis secondary to retention of hydrogen ions. an increased serum calcium level secondary to kidney failure.

water and sodium retention secondary to a severe decrease in the glomerular filtration rate. Explanation: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

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? Sodium Calcium Magnesium Phosphorus

Calcium

Urine output less than 50 ml in 24 hours is called _________. Urine output of less than 400 ml in 24 hours is called ________.

Anuria Oliguria

The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: 1,500 mL of fluid 2,000 mL of fluid 500 mL of fluid 1,000 mL of fluid

1,500 mL of fluid Explanation: A 1-kg weight gain is equal to 1,000 mL of retained fluid.

Which intervention would the nurse expect to implement following urologic endoscopy? Select all that apply. Provide privacy to promote bladder emptying. Verify the client's understanding about procedure. Assist with coughing and deep breathing. Administer an antispasmodic agent. Teach leg and range-of-motion exercises.

Administer an antispasmodic agent. Provide privacy to promote bladder emptying. Explanation: The nurse would expect to administer an antispasmodic agent, such as flavoxate (Urispas), and provide privacy to promote bladder emptying. The nurse verifies the client's understanding prior to the procedure. Assisting with coughing and deep breathing and teaching leg exercises and range of motion are not specific interventions post-urologic endoscopy.

Which type of medication may be used to inhibit bladder contraction in a client with incontinence? Over-the-counter decongestant Estrogen hormone Anticholinergic agent Tricyclic antidepressants

Anticholinergic agent Explanation: Anticholinergic agents are considered first-line medications for urge incontinence. Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra. Tricyclic antidepressants decrease bladder contractions and increase bladder neck resistance. Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.

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. Enable the client to sit up and ambulate. Assess the patient's back and shoulder areas for signs of internal bleeding. Provide analgesics to the client.

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.

What is the most common presenting objective symptom of a urinary tract infection in older adults, especially in those with dementia? Back pain Change in cognitive functioning Hematuria Incontinence

Change in cognitive functioning Explanation: The most common objective finding is a change in cognitive functioning, especially in those with dementia; these clients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.

A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line fluoroquinolone antibacterial agent for UTIs has been found to be significantly effective? Septra Macrodantin Cipro Bactrim

Ciprofloxacin (Cipro) is a fluoroquinolone used to treat UTIs. Co-trimoxazole (Bactrim, Septra) is a trimethoprim-sulfamethoxazole combination medication. Nitrofurantoin (Macrodantin, Furadantin) is an anti-infective urinary tract medication.

When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? Inspect the catheter insertion site for infection. Check for thrill or bruit over the access site. Warming the Dialysate in the microwave Finishing the rest of her cashews before starting

Correct response: Check for thrill or bruit over the access site. Explanation: When preparing a client for hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency. Inspecting the catheter insertion site for infection, adding the prescribed drug to the dialysate, and warming the solution to body temperature would be necessary when preparing a client for peritoneal dialysis.

The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? Perineal pain Suprapubic pain Pain after voiding Costovertebal angle tenderness

Costovertebal angle tenderness

Which value does the nurse recognize as the best clinical measure of renal function? Creatinine clearance Circulating ADH concentration Volume of urine output Urine-specific gravity

Creatinine clearance 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.

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? Uric acid level Creatinine clearance level BUN to creatinine ratio Blood urea nitrogen (BUN)

Creatinine clearance level

Which is an effect of aging on upper and lower urinary tract function? Acid-base balance Increased glomerular filtration rate More prone to develop hypernatremia Increased blood flow to the kidneys

More prone to develop hypernatremia 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.

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? Diabetes insipidus Increased fluid intake Glomerulonephritis Decreased fluid intake

Decreased fluid intake Explanation: When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases. Disorders or conditions that cause decreased urine-specific gravity include diabetes insipidus, glomerulonephritis, and severe renal damage. Disorders that can cause increased specific gravity include diabetes, nephritis, and fluid deficit.

After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the students have understood the material when they identify which of the following as a cause of stress incontinence? Increased urine production due to metabolic conditions Decreased pelvic muscle tone due to multiple pregnancies Bladder irritation related to urinary tract infections Obstruction due to fecal impaction or enlarged prostate

Decreased pelvic muscle tone due to multiple pregnancies Explanation: Stress incontinence is due to decreased pelvic muscle tone, which is associated with multiple pregnancies, obstetric injuries, obesity, menopause, or pelvic disease. Transient incontinence is due to increased urine production related to metabolic conditions. Urge incontinence is due to bladder irritation related to urinary tract infections, bladder tumors, radiation therapy, enlarged prostate, or neurologic dysfunction. Overflow incontinence is due to obstruction from fecal impaction or enlarged prostate.

In which of the following renal disorders would one suspect a decreased urine specific gravity? Select all that apply Fluid deficits Severe renal damage Diabetes insipidus Glomerulonephritis Diabetes

Diabetes insipidus Glomerulonephritis Severe renal damage

Based on the pathophysiologic changes that occur as renal failure progresses, the nurse identifies the following indicators associated with the disease. Select all that apply. Hyperkalemia Hyperalbuminemia Anemia Hypocalcemia Metabolic alkalosis

Hyperkalemia Anemia Hypocalcemia Explanation: Hyperkalemia is due to decreased potassium excretion and excessive potassium intake. Metabolic acidosis results from decreased acid secretion by the kidney. A damaged glomerular membrane causes excess protein loss.

A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? Hypocalcemia Hyperkalemia Elevated white blood cells Elevated urea levels

Hyperkalemia Explanation: Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.

Which metabolic defects are associated with stone formation? Hypouricemia Hypoparathyroidism Hyperparathyroidism Hyperthyroidism

Hyperparathyroidism Metabolic defects such as hyperparathyroidism and hyperuricemia (gout) are associated with stone formation. Hypoparathyroidism, hyperthyroidism, and hypouricemia are not associated with stone formation.

A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? Kidney Bladder Ureter Urethra

Kidney Explanation: The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation.

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? Kidney stones Fistula Chronic renal failure Neurogenic bladder

Kidney stones

Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet? Low oxalate Low purine High sodium High protein

Low purine Explanation: A low-purine diet is used for uric acid stones; the benefits, however, are unknown. Clients with a history of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate. Only clients who have type II absorptive hypercalciuria—approximately half of the clients—need to limit calcium intake. Usually, clients are told to increase their fluid intake significantly, consume a moderate protein intake, and limit sodium. Avoiding excessive protein intake is associated with lower urinary oxalate and lower uric acid levels. Reducing sodium intake can lower urinary calcium levels.

Treatment of metabolic acidosis in chronic renal failure includes: Hemodialysis Peritoneal diaylsis No treatment Defecation into a sterile container

No treatment Explanation: The metabolic acidosis of chronic renal failure usually produces no symptoms and requires no treatment.

Which finding is an early indicator of bladder cancer? Painless hematuria Nocturia Dysuria Occasional polyuria

Painless hematuria Initially, as cancer cells destroy normal bladder tissue, bleeding occurs and causes painless hematuria. (Pain is a late symptom of bladder cancer.) Occasional polyuria may occur with diabetes mellitus or increased alcohol or caffeine intake. Nocturia commonly accompanies benign prostatic hypertrophy. Dysuria may indicate a urinary tract infection.

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? Previous episode of acute pyelonephritis History of hyperparathyroidism Recent history of streptococcal infection History of osteoporosis

Recent history of streptococcal infection

A woman comes to her health care provider's office with signs and symptoms of kidney stones. Which of the following should be the primary medical management goal? Relieve the pain. Relieve any obstruction. Prevent nephron destruction. Determine the stone type.

Relieve the pain. Explanation: The immediate objective is to relieve pain, which can be incapacitating depending on the location of the stone.

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? Hyperalbuminemia Tea-colored urine Pyuria Low blood pressure

Tea-colored urine Tea-colored urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis.

The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document? Urinary incontinence Urinary frequency Urinary urgency Urinary stasis

Urinary urgency

Tall Peaked T waves = hyperkalemia

acute renal failure.

A client is having a blood urea nitrogen (BUN) test. BUN level is: unchanged in renal disease. decreased in renal disease and urinary obstruction. increased in renal disease and urinary obstruction. decreased in nephrotic syndrome.

increased in renal disease and urinary obstruction.

A client's renal failure has become chronic. Which signs and symptoms are associated with chronic renal failure? Select all that apply. bleeding of the oral mucous membranes muscle cramps lethargy enhanced cognition

lethargy muscle cramps bleeding of the oral mucous membranes Explanation: Lethargy, muscle cramps, and bleeding of the oral mucous membranes are some of the signs and symptoms of chronic renal failure. With chronic renal failure, mental processes progressively slow as electrolyte imbalances become marked and nitrogenous wastes accumulate.

A client has been diagnosed with acute glomerulonephritis. This condition causes: No option is correct. pyuria. polyuria. proteinuria.

proteinuria.

The nurse advises the patient with chronic pyelonephritis that he should: Limit his fluid intake to 1.5 L/day to minimize bladder fullness, which could cause backward pressure on the kidneys. Decrease his sodium intake to prevent fluid retention. Increase fluids to 3 to 4 L/24 hours to dilute the urine. Decrease his intake of calcium rich foods to prevent kidney stones

Correct response: Increase fluids to 3 to 4 L/24 hours to dilute the urine. Explanation: Unless contraindicated, fluids should be increased to dilute the urine, decrease burning on urination, and prevent dehydration. A balanced diet would be recommended but there is no need to restrict sodium or calcium.

A female patient visits her primary health care provider with a complaint of frequency of urination and incontinence when she sneezes. The health care provider suspects the patient is experiencing cystitis. The nurse knows that this is most likely due to which of the following? Reflux of urine from the urethra into the bladder Dysfunction of the bladder neck or urethra. Interruption in the protective effect of glycosaminoglycan Disturbance in the normal bacterial flora of the vagina

Correct response: Reflux of urine from the urethra into the bladder Explanation: With urethrovesical reflux, coughing, sneezing, or straining causes the bladder pressure to increase, which may force urine from the bladder into the urethra. When the pressure returns to normal, the urine flows back into the bladder, bringing into the bladder bacteria from the anterior portions of the urethra.

A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect? Acute glomerulonephritis Urinary calculi Renal cell carcinoma Ureteral stricture

Urinary calculi Explanation: Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.

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: childhood asthma. family history of pernicious anemia. chronic, excessive acetaminophen use. recent streptococcal infection.

recent streptococcal infection. Explanation: 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.

A nurse receives her client care assignment. Following the report, she should give priority assessment to the client: who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L. who is experiencing mild pain from urolithiasis. who has a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L 7 days after a kidney transplant. with pinkish mucus discharge in the appliance bag 2 days after an ileal conduit.

who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L. Explanation: A sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L in a client immediately following dialysis should be the priority assessment. Pinkish mucus discharge in the appliance bag is a normal finding for a client who's had an ileal conduit, as are a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L in a client who's had a kidney transplant. Although the nurse should further assess mild pain from urolithiasis, this is an expected finding and not a priority in relation to the client with abnormal sodium and potassium levels.