Ch43 Renal
25. What is the largest number of pyramids that a healthy kidney has? A) 18 B) 16 C) 12 D) 8
Ans: A Page and Header: 1293, Anatomic and Physiologic Overview Feedback: Each kidney contains approximately 8 to 18 pyramids. Therefore options B, C, and D are incorrect.
37. A student asks the pathophysiology instructor what the function of rennin is in the body. What is the instructor's best response to the student's question? A) "Renin is directly involved in the control of arterial blood pressure and it is essential for proper functioning of the glomerulus." B) "Renin is involved in venous blood pressure and controls the flow of blood through the tubules." C) "Renin is directly involved in the control of arterial blood pressure and the flow of blood through the pyramids of the kidney." D) "Renin is involved in venous blood pressure and it is essential for proper functioning of the glomerulus."
Ans: A Page and Header: 1294, Anatomic and Physiologic Overview Feedback: Renin is a hormone directly involved in the control of arterial blood pressure; it is essential for proper functioning of the glomerulus
2. There are three areas of the ureters that have a propensity for obstruction. Prompt management of renal calculi is most important when the stone is located where? A) In the ureteropelvic junction B) In the ureteral segment near the sacroiliac junction C) In the ureterovesical junction D) In the urethra
Ans: A Page and Header: 1295, Anatomic and Physiologic Overview Feedback: There are three narrowed areas of each ureter: the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovescial junction. These three areas of the ureters have a propensity for obstruction by renal calculi or stricture. Obstruction of the ureteropelvic junction is the most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction. The urethra is not part of the ureter, so option D is incorrect.
29. The pituitary gland, in response to increasing serum osmolality, stimulates what to secrete aldosterone? A) Adrenal cortex B) Renal tubules C) Glomerulus D) Bowman's capsule
Ans: A Page and Header: 1297, Anatomic and Physiologic Overview Feedback: The adrenal cortex secretes aldosterone in response to stimulation by the pituitary gland, which occurs in response to poor perfusion or increasing serum osmolality. The result is an increase in blood pressure. The renal tubules, glomerulus, and Bowman's capsule do not secrete aldosterone.
17. A nurse is caring for a 73-year-old male patient with a urethral obstruction related to prostatic enlargement. The nurse is aware this may result in what? A) A urinary tract infection B) Enuresis C) Polyuria D) Proteinuria
Ans: A Page and Header: 1298, Anatomic and Physiologic Overview Feedback: An obstruction of the bladder outlet, such as in advanced benign prostatic hyperplasia, results in abnormally high voiding pressure with a slow, prolonged flow of urine. The urine may remain in the bladder, which increases the potential of a urinary tract infection. Older male patients are at risk for prostatic enlargement, which causes urethral obstruction and can result in hydronephrosis, renal failure, and urinary tract infections.
33. A patient asks her nurse why kidney problems can cause gastrointestinal disturbances. What would be the nurse's best answer? A) "The right kidney's proximity to the pancreas, liver and gallbladder" B) "The right kidney's nearness to stomach, pancreas, and spleen" C) "The left kidney's nearness to the pancreas, liver, and gallbladder" D) "The left kidney's nearness to the colon, duodenum, and common bile duct"
Ans: A Page and Header: 1301, Assessment of the Renal and Urinary Tract Systems Feedback: The proximity of the right kidney to the colon, duodenum, head of the pancreas, common bile duct, liver, and gallbladder may cause gastrointestinal disturbances. The proximity of the left kidney to the colon (splenic flexure), stomach, pancreas, and spleen may also result in intestinal symptoms.
4. The nurse is assessing a patient's bladder by percussion. The nurse elicits dullness after voiding. What does this finding indicate? A) Incomplete bladder emptying B) Kidney enlargement C) Ureteral obstruction D) Dehydration
Ans: A Page and Header: 1302, Assessment of the Renal and Urinary Tract Systems Feedback: Dullness to percussion of the bladder following voiding indicates incomplete bladder emptying. Enlargement of the kidneys can be attributed to numerous conditions such as polycystic kidney disease or hydronephrosis and is not related to bladder fullness. Dehydration and ureteral obstruction are not related to bladder fullness, and in fact these conditions results in decreased flow of urine to the bladder.
18. A patient with elevated BUN and creatinine values has been sent to the emergency department by her primary physician for further evaluation. Based upon the physician's orders, the nurse caring for this patient in the emergency department prepares the patient for what commonly used diagnostic test? A) Ultrasound B) X-ray C) Computer tomography D) Nuclear scan
Ans: A Page and Header: 1306, Diagnostic Evaluation Feedback: Ultrasonography is a noninvasive procedure that passes sound waves into the body through a transducer to detect abnormalities of internal tissues and organs. Structures of the urinary system create characteristic ultrasonographic images. Because of its sensitivity, ultrasonography has replaced many other diagnostic tests as the initial diagnostic procedure. Options B, C, and D are not used as initial diagnostic tests.
5. The nurse is providing pre-procedure teaching about an ultrasound. The nurse informs the patient that in preparation for an ultrasound of the lower urinary tract the patient will require what? A) Increased fluid intake to produce a full bladder B) Intravenous administration of radiopaque contrast agent C) Sedation and intubation D) The injection of a radioisotope
Ans: A Page and Header: 1306, Diagnostic Evaluation Feedback: Ultrasonography requires a full bladder; therefore, fluid intake should be encouraged before the procedures. The administration of a radiopaque contrast agent is required to perform intravenous urography studies such as an intravenous pyelogram. Ultrasonography is a quick and painless diagnostic test and does not require sedation or intubation. The injection of a radioisotope is required for nuclear scan and ultrasonography is not in this category of diagnostic studies.
8. A nurse is preparing a patient diagnosed with benign prostatic hypertrophy for a lower urinary tract cystoscopic examination. The nurse informs the patient that the most common temporary complication experienced after this procedure is what? A) Urinary retention B) High rate of bladder perforation C) Hemorrhage D) Nausea
Ans: A Page and Header: 1309, Diagnostic Evaluation Feedback: After a cystoscopic examination, the patient with obstructive pathology may experience urine retention if the instruments used during the examination caused edema. The nurse will carefully monitor the patient with prostatic hyperplasia for urine retention. Post-procedure, the pain will experience some hematuria, but is not at great risk for hemorrhage. Unless the condition is associated with another disorder, nausea is not commonly associated with this diagnostic study. While the complications for this diagnostic study are numerous and infrequent, the risk for bladder perforation is rare.
38. What is being examined in a urinalysis? (Mark all that apply.) A) Specific gravity B) Look for renal glycosuria C) Microscopic examination of urine sediment for RBCs D) Microscopic examination of urine sediment for casts E) Microscopic examination of urine sediment for mast cells
Ans: A, B, C, D Page and Header: 1303, Diagnostic Evaluation Feedback: Urine examination includes the following: urine color; urine clarity and odor; urine pH and specific gravity; tests to detect protein, glucose, and ketone bodies in the urine (proteinuria, renal glycosuria, and ketonuria, respectively); microscopic examination of the urine sediment after centrifugation to detect RBCs (hematuria), white blood cells (pyuria), casts (cylindruria), crystals (crystalluria), and bacteria (bacteriuria). Option E is a detractor for this question.
21. A patient is admitted for renal dysfunction. The nurse knows that the kidneys receive 20% to 25% of the total cardiac output. This means that all of the body's blood circulates through the kidneys how many times an hour? A) 15 B) 12 C) 9 D) 6
Ans: B Page and Header: 1294, Anatomic and Physiologic Overview Feedback: The kidneys receive 20% to 25% of the total cardiac output, which means that all of the body's blood circulates through the kidneys approximately 12 times per hour. Therefore options A, C, and D are incorrect
9. A diabetic patient with renal failure has been admitted to your unit. What is the most life-threatening effect of renal failure you will monitor for? A) Accumulation of wastes B) Retention of potassium C) Depletion of calcium D) Lack of blood pressure control
Ans: B Page and Header: 1297, Anatomic and Physiologic Overview Feedback: Retention of potassium is the most life-threatening effect of renal failure. Aldosterone causes the kidney to excrete potassium, in contrast to aldosterone's effects on sodium described previously. Acid-base balance, the amount of dietary potassium intake, and the flow rate of the filtrate in the distal tubule also influence the amount of potassium secreted into the urine. Hypocalcemia, the accumulation of wastes, and lack of blood pressure control are complications associated with renal failure, but do not have same level of threat to the patient's well-being as hyperkalemia.
3. A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has been ordered. The nurse is aware that the specimens needed for the calculation of the patient's creatinine clearance will include what? A) A fasting serum potassium level and a random urine sample B) A 24-hour urine specimen collection and a serum creatinine level midway through the urine collection process C) A blood, urea, nitrogen level, and serum creatinine level on three consecutive mornings D) A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values
Ans: B Page and Header: 1297, Anatomic and Physiologic Overview Feedback: To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection, the serum creatinine level is measured. The following formula is then used to calculate the creatinine clearance: (Volume of urine [mL/min] × urine creatinine [mL/min]) serum creatinine (mg/dL)
26. What function does the kidney perform to assist in maintaining acid-base balance within the necessary normal range? A) Excrete acid in the lungs B) Return bicarbonate to the body's circulation C) Return acid to the body's circulation D) Excrete bicarbonate in the urine
Ans: B Page and Header: 1297, Anatomic and Physiologic Overview Feedback: The kidney performs two major functions to assist in this balance. The first is to reabsorb and return to the body's circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine. Therefore options A, C, and D are incorrect.
15. The nurse is caring for a patient who describes his changes in voiding patterns. The patient states, "I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there does not seem to be a great deal of urine flow." What would the nurse expect this patient's physical assessment will likely reveal? A) Hematuria B) Urine retention C) Dehydration D) Renal failure
Ans: B Page and Header: 1300, Assessment of the Renal and Urinary Tract Systems Feedback: Increased urinary urgency and frequency coupled with decreasing urine volumes strongly suggest urine retention. Hematuria may be an accompanying symptom, but is likely related to a urinary tract infection secondary to the retention of urine. Dehydration and renal failure both result in a decrease in urine output, but the patient with these conditions does not have normal urine production and decreased or minimal flow of urine to the bladder. The symptoms of urgency and frequency do not accompany renal failure and dehydration due to decreased urine production.
34. The nursing instructor is talking about monitoring laboratory tests in renal and urinary tract dysfunction. What is monitored to assess for anemia? A) Hematocrit B) Hemoglobin C) Oxygen level D) Peripheral blood flow
Ans: B Page and Header: 1301, Assessment of the Renal and Urinary Tract Systems Feedback: Although historically hematocrit has been the blood test of choice when assessing a patient for anemia, use of the hemoglobin level rather than hematocrit is currently recommended, because that measurement is a better assessment of the oxygen transport ability of the blood. The assessment of oxygen level and peripheral blood flow are not assessments that will give you any information on anemia.
12. The nurse caring for a patient with suspected renal dysfunction is assessing ankle and sacral edema and the presence of crackles in the bases of the lungs bilaterally. A daily weight indicates that the patient's weight has increased by 5 pounds in the past 24 hours. The nurse notes that evaluation of the patient's intake and output records for the prior 24 hours indicate greater fluid intake than urine output. Based upon the assessment findings and the daily weight information, the nurse estimates that the patient has retained how much fluid? A) 1258 mL of fluid in 24 hours B) 2273 mL of fluid in 24 hours C) 2500 mL of fluid in 24 hours D) 5000 mL of fluid in 24 hours
Ans: B Page and Header: 1303, Assessment of the Renal and Urinary Tract Systems Feedback: An increase in body weight commonly accompanies edema. To calculate the approximate weight gain from fluid retention, remember that 1 kg of weight gain equals approximately 1000 mL of fluid. Note that the patient is demonstrating a 5-pound weight gain from the prior day's weight. Calculate the fluid gain for this patient as follows: 5 pounds / 2.2 kg = 2.272 kg × 1000= 2273 mL of fluid
35. The nurse is assessing the deep tendon reflexes on a patient with incontinence. What condition of the urinary/renal system does the nurse expect to illicit specific information on? A) Renal calculi B) Benign prostatic hyperplasia C) Bladder dysfunction D) Acute renal failure
Ans: B Page and Header: 1304, Diagnostic Evaluation Feedback: The deep tendon reflexes of the knee are examined for quality and symmetry. This is an important part of testing for neurologic causes of bladder dysfunction, because the sacral area, which innervates the lower extremities, is the same peripheral nerve area responsible for urinary continence. Therefore options A, C, and D are incorrect.
30. A patient you are caring for is having a diagnostic MRI of the lower urinary system. How would you prepare the patient for this test? A) Teaching methods of communication to the patient B) Teaching relaxation to the patient C) Teaching the patient he or she will have to lie still in a tube D) Teaching the patient that the MRI machine makes a lot of noise
Ans: B Page and Header: 1307, Diagnostic Evaluation Feedback: Patient preparation should include teaching relaxation techniques and informing the patient that he or she will be able to communicate with the staff by means of a microphone located inside the scanner. This makes option A incorrect. Teaching the patient to lay still in the scanner and that the MRI makes noise are important points in teaching, but not as important as teaching the relaxation to the patient.
24. The nurse is caring for a patient scheduled for an infusion drip pyelography. What patient preparation is necessary for this test? A) Restriction of fluids B) Fluids are not restricted C) Serum electrolytes D) 24-hour urine test
Ans: B Page and Header: 1308, Diagnostic Evaluation Feedback: Infusion drip pyelography requires IV infusion of a large volume of a dilute contrast agent to opacify the renal parenchyma and fill the urinary tract. This examination method is useful when prolonged opacification of the drainage structures is desired so that tomograms (body-section radiography) can be made. Images are obtained at specified intervals after the start of the infusion. These images show the filled and distended collecting system. The patient preparation is the same as for excretory urography, except that fluids are not restricted. A 24-hour urine test and serum electrolytes are not needed in preparation for an infusion drip pyelography.
32. What symptoms are particularly suggestive of urinary tract disease? (Mark all that apply.) A) Tachacardia B) Pain C) Gastrointestinal symptoms D) Changes in voiding E) Hemoptysis
Ans: B, C, D Page and Header: 1299, Assessment of the Renal and Urinary Tract Systems Feedback: Dysfunction of the kidney can produce a complex array of symptoms throughout the body. Pain, changes in voiding, and gastrointestinal symptoms are particularly suggestive of urinary tract disease.
39. You are taking a history on a patient newly diagnosed with renal cancer. What questions would you be sure to include when you talk with this patient? (Mark all that apply.) A) Ask about intussusceptions. B) Ask about urinary incontinence. C) Ask about previous renal or urinary diagnostic tests. D) Ask about the patient's chief concern. E) Ask about gallstones.
Ans: B, C, D Page and Header: 1299, Assessment of the Renal and Urinary Tract Systems Feedback: When obtaining the health history, the nurse should inquire about the following: the patient's chief concern or reason for seeking health care, the onset of the problem, and its effect on the patient's quality of life; the location, character, and duration of pain, if present, and its relationship to voiding; factors that precipitate pain, and those that relieve it; history of urinary tract infections, including past treatment or hospitalization for urinary tract infection; fever or chills; previous renal or urinary diagnostic tests or use of indwelling urinary catheters; dysuria and when during voiding (ie, at initiation or at termination of voiding) it occurs; hesitancy, straining, or pain during or after urination; urinary incontinence (stress incontinence, urge incontinence, overflow incontinence, or functional incontinence); hematuria or change in color or volume of urine; nocturia and its date of onset; renal calculi (kidney stones), passage of stones or gravel in urine; female patients: number and type (vaginal or cesarean) of deliveries; use of forceps; vaginal infection, discharge, or irritation; contraceptive practices; history of anuria (decreased urine production) or other renal problem; presence or history of genital lesions or sexually transmitted diseases; use of tobacco, alcohol, or recreational drugs; any prescription and over-the-counter medications (including those prescribed for renal or urinary problems). Intussusception is the telescoping of a piece of the bowel into another piece of the bowel and is not something you would ask about in this health history. Nor would you ask about gallstones.
22. When fluids are filtered by the glomerular membrane of Bowman's capsule where does the filtrate go? A) Back into the blood B) Into the nephrons C) Fills the space in Bowman's capsule D) Fills the nephron
Ans: C Page and Header: 1294, Anatomic and Physiologic Overview Feedback: Pressure changes and the permeability of the glomerular membrane of Bowman's capsule facilitate the passage of fluids and various substances from the blood vessels, filling the space within Bowman's capsule with this filtered solution. Therefore options A, B, and D are incorrect.
16. The pathophysilolgy instructor is talking to the pre-nursing students about hypovolemia and the kidneys. The instructor points out that when the blood pressure is low due to dehydration the body will compensate by secreting what? A) Antidiuretic hormone B) Aldosterone C) Renin D) Angiotensin
Ans: C Page and Header: 1297, Anatomic and Physiologic Overview Feedback: Regulation of blood pressure is also a function of the kidney. Specialized vessels of the kidney called the vasa recta constantly monitor blood pressure as blood begins its passage into the kidney. When the vasa recta detect a decrease in blood pressure, specialized juxtaglomerular cells near the afferent arteriole, distal tubule, and efferent arteriole secrete the hormone renin. Renin converts angiotensinogen to angiotensin I, which is then converted to angiotensin II, the most powerful vasoconstrictor known. The vasoconstriction causes the blood pressure to increase. The adrenal cortex secretes aldosterone in response to stimulation by the pituitary gland, which in turn is in response to poor perfusion or increasing serum osmolality. The result is an increase in blood pressure. When the vasa recta recognize the increase in blood pressure, renin secretion stops. Failure of this feedback mechanism is one of the primary causes of hypertension. Therefore options A, B, and D are incorrect.
11. The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient the nurse recalls that several substances are filtered from the blood by the glomerulus and these substances are then excreted in the urine. The nurse identifies the presence of which substances in the urine as abnormal findings? A) Potassium and sodium B) Bicarbonate and urea C) Glucose and protein D) Creatinine and chloride
Ans: C Page and Header: 1297, Anatomic and Physiologic Overview Feedback: The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that it is not excreted in the urine.
27. Voiding is activated by interaction between the sympathetic and parasympathetic nervous systems causing a coordinated sequence of events. This interaction between the sympathetic and parasympathetic nervous systems is called what? A) Angiotension-micutition arc B) Renal-ureter-bladder arc C) Micturition reflex arc D) Micturition stimulus arc
Ans: C Page and Header: 1298, Anatomic and Physiologic Overview Feedback: Micturition (voiding) normally occurs approximately eight times in a 24-hour period. It is activated via the micturition reflex arc within the sympathetic and parasympathetic nervous systems, which causes a coordinated sequence of events. Options A, B, and D are detractors for this question.
19. A patient admitted to your unit with impaired renal function is complaining of severe, sharp, stabbing pain that is colicky in nature in the flank and lower abdomen. The patient is being assessed for renal calculi. The nurse recognizes that the stone is most likely located where in the patient? A) Kidney B) Bladder C) Ureter D) Urethra
Ans: C Page and Header: 1300, Assessment of the Renal and Urinary Tract Systems Feedback: Ureteral pain is characterized as a dull continuous pain that may be intense with voiding. The pain may be described as sharp or stabbing if the bladder is full.
13. The nursing instructor is teaching the students assessment skills in the lab. Where would the instructor teach the students to assess for pain at the costovertebral angle? A) At the umbilicus and the right lower quadrant of the abdomen B) At the suprapubic region and the umbilicus C) At the lower border of the 12th rib and the spine D) At the 7th rib and the xyphoid process
Ans: C Page and Header: 1302, Assessment of the Renal and Urinary Tract Systems Feedback: The costovertebral angle is the angle formed by the lower border of the 12th rib and the spine. Renal dysfunction may produce tenderness over the costovertebral angle. Options A, B, and D are incorrect as they are not the location of the costovertebral angle.
31. You are caring for a patient with renal dysfunction. The patient tells you that the pain in their right flank has gotten worse. Why would you notify the physician of the increased pain? A) Pain promotes dilute urine and flushing of the lower urinary tract. B) Delayed emptying of the bladder and poor hygiene may contribute to pain secondary to renal or urinary tract dysfunction. C) Pain may indicate progression or recurrence of dysfunction, or untoward signs. D) A high level of fear or apprehension can interfere with learning and cooperation.
Ans: C Page and Header: 1305, Diagnostic Evaluation Feedback: Report increased pain to the physician, as it may indicate progression or recurrence of dysfunction, or untoward signs (calculi or bleeding). Pain does not promote dilute urine or flushing of the lower urinary tract. Pain does not delay emptying of the bladder. Pain can cause a high level of fear or apprehension that interferes with learning, but you wouldn't notify the physician of it.
20. The nurse is caring for a patient who had a brush biopsy 12 hours ago. What will the nurse notify the physician of? A) Hematuria B) Renal colic C) Temperature 100.2°F orally D) Infiltration of the patient's intravenous catheter infusing dextrose 5% and .45 normal saline solution
Ans: C Page and Header: 1309, Diagnostic Evaluation Feedback: After the procedure, the patient will likely received intravenous fluids to help clear the kidneys and prevent clot formation. Infiltration of the IV site requires the notification of the IV team or placement of a new IV catheter by the staff nurse, so that fluid administration will continue. Hematuria and renal colic are common and expected findings after the performance of a renal brush biopsy. The physician should be notified of the patient's body temperature, as likely indicates the onset of an infectious process.
14. The staff educator is giving a class for a group of nurses new to the renal unit. The educator is discussing renal biopsies. In what patient would the educator tell the new nurses that renal biopsies are contraindicated? A) A 64-year-old patient with chronic glomerulonephritis B) A 57-year-old patient with proteinuria C) A 42-year-old patient with morbid obesity D) A 16-year-old patient with signs of kidney transplant rejection
Ans: C Page and Header: 1309, Diagnostic Evaluation Feedback: There are several contraindications to a kidney biopsy including bleeding tendencies, uncontrolled hypertension, a solitary kidney, and morbid obesity. Indications for a renal biopsy include unexplained acute renal failure, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.
1. A patient with renal insufficiency has been hospitalized on your unit. The patient knows that renal function depends upon the functional status of nephrons. The patient asks you when she will need to start dialysis based upon loss of nephron function. What would you respond? A) "When about 50% of the nephrons are no longer functioning." B) "When about 60% of the nephrons are no longer functioning." C) "When about 70% of the nephrons are no longer functioning." D) "When about 80% of the nephrons are no longer functioning."
Ans: D Page and Header: 1294, Anatomic and Physiologic Overview Feedback: When the total number of functioning nephrons is less than 20%, renal replacement therapy needs to be considered. Dialysis is an example of a renal replacement therapy. Prior to the loss of about 80% of the nephron functioning ability, the patient may have mild symptoms of compromised renal function, but symptom management is often obtained through dietary modifications and drug therapy. Therefore options A, B, and C are incorrect.
28. In a patient who loses bicarbonate from the body, how does it get replaced? A) The renal tubules secrete new bicarbonate into the urine. B) The juxtaglomerular cells secrete new bicarbonate into the blood. C) The juxtaglomerular cells generate new bicarbonate. D) Renal tubular cells generate new bicarbonate.
Ans: D Page and Header: 1297, Anatomic and Physiologic Overview Feedback: To replace any lost bicarbonate, the renal tubular cells generate new bicarbonate through a variety of chemical reactions. This newly generated bicarbonate is then reabsorbed by the tubules and returned to the body. This makes options A, B, and C incorrect.
7. A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse realizes that what particular change is an age-related change affecting the renal or urinary system? A) Increased ability to concentrate urine B) Increased bladder capacity C) Urinary incontinence D) Decreased glomerular filtration rate
Ans: D Page and Header: 1298, Anatomic and Physiologic Overview Feedback: Many age-related changes in the renal and urinary systems should be taken into consideration when taking a health history of the older adult. One change includes a decreased glomerular surface area resulting in a decreased glomerular filtration rate. Other changes include the decreased ability to concentrate urine and a decreased bladder capacity. It also should be understood that urinary incontinence is not a normal age-related change, but is common in older adults, especially in women because of the loss of pelvic muscle tone.
36. Urodynamic testing is carried out in the urologist's office to study incontinence. Because voiding in the presence of others can cause a situational anxiety, the nurse must do what? A) Note the patient's urge to push. B) Note the character of the patient's stream. C) Discuss test results as they are formulated. D) Help the patient relax.
Ans: D Page and Header: 1303, Diagnostic Evaluation Feedback: Voiding in the presence of others can frequently cause guarding, a natural reflex that inhibits voiding due to situational anxiety. Because the outcomes of these studies determine the plan of care, the nurse must help the patient relax by providing as much privacy and explanation about the procedure as possible. The nurse would not note the patient's urge to push; noting the character of the patient's stream would be in writing and it would not help to relieve the situational anxiety of the patient; discussing the test results as they are formulated is inappropriate.
6. The nurse is caring for a patient who is not allowed oral intake of fluid or food. When evaluating this patient's urinalysis, what would the nurse anticipate? A) A fluctuating urine specific gravity B) A fixed urine specific gravity C) A decreased urine specific gravity D) An increased urine specific gravity
Ans: D Page and Header: 1304, Diagnostic Evaluation Feedback: Urine specific gravity depends largely on hydration status. A decrease in fluid intake (such as a "nothing by mouth" status) will lead to an increase in the urine specific gravity. With high fluid intake, specific gravity decreases. In patients with kidney disease, urine specific gravity does not vary with fluid intake, and the patient's urine is said to have a fixed specific gravity.
40. What nursing diagnosis would be a priority when caring for a patient undergoing diagnostic testing of the renal-urologic system? A) Reinforce information provided to patient about test results and implications for follow-up care. B) Assess patient's level of understanding of planned diagnostic tests. C) Provide a description of tests in language the patient can understand. D) Assess patient's understanding of test results after their completion.
Ans: D Page and Header: 1305, Diagnostic Evaluation Feedback: Apprehension may interfere with patient's ability to understand information and results provided by health care team. The other diagnoses are relevant for this patient but not as important.
10. A kidney biopsy has been scheduled for a patient with a history of acute renal failure. The patient asks the nurse why this test has been scheduled. What is the nurse's best response? A) "A biopsy is routinely ordered for all patients with renal disorders." B) "A biopsy is generally ordered following abnormal x-ray findings of the renal pelvis." C) "A biopsy is often ordered for patients before they have a kidney transplant." D) "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."
Ans: D Page and Header: 1309, Diagnostic Evaluation Feedback: Biopsy of the kidney is used in diagnosing and evaluating the extent of kidney disease. Indications for biopsy include unexplained acute renal failure, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies. Options A, B, and C are incorrect.
23. You are caring for a patient who is going to have an open renal biopsy. What would be an important nursing action in preparing this patient for the procedure? A) Discuss the diagnosis with the family. B) Bathe the patient before the procedure with aseptic soap. C) Give antibiotics before sending the patient to surgery. D) Keep the patient NPO.
Ans: D Page and Header: 1309, Diagnostic Evaluation Feedback: Preparation for an open biopsy is similar to that for any major abdominal surgery. When preparing the patient for an open biopsy you would keep the patient NPO. You may discuss the diagnosis with the family, but that is not a preparation for the procedure. You would not bathe an adult patient, who can bathe himself or herself; and a parent would bathe a child patient. Antibiotics for an open procedure are usually given when the patient is in surgery.