Chapter 36 med surg
___ 1. The nurse is reviewing the anatomy of the kidney with a patient scheduled for renal surgery. What should the nurse explain as being the structural and functional unit of the kidney? a. Cortex b. Medulla c. Pyramid d. Nephron
1. ANS: D The nephron is the structural and functional unit of the kidney. Urine is formed in the approximately 1 million nephrons in each kidney. A. B. C. Cortex, medulla, and pyramid are different parts of the kidney.
____ 10. The nurse is to obtain orthostatic blood pressure measurements for a patient on dialysis for end-stage renal disease. What should the nurse do when measuring this patients blood pressure? a. Take blood pressure before and after dialysis treatments .b. Check blood pressure every minute three times for four readings. c. Obtain blood pressure while the patient is lying, sitting, and standing. d. Monitor blood pressure before and after an antihypertensive medication is given.
10. ANS: C A drop in blood pressure accompanied by a rise in pulse rate as the patient rises to sitting or standing positions is called orthostatic or postural hypotension and may indicate fluid deficit. The nurse will check blood pressure while the patient is lying, sitting, and standing. A. B. D. These do not describe the correct approach to measure orthostatic blood pressure measurements.
11. The nurse is collecting data from a patient with kidney disease. Which adventitious lung sound should the nurse recognize as being caused by fluid overload? a. Stridor b. Crackles c. Wheezes d. Pleural friction rub
11. ANS: B Assessment of vital signs, lung sounds, edema, daily weights, and intake and output can provide valuable data related to urinary function. Fluid retention in the lungs is manifested as crackles, which are popping sounds heard on inspiration and sometimes on expiration. C. Wheezes might be heard however do not necessarily indicate fluid overload. A. D. Stridor and pleural friction rub are not heard in fluid overload.
___ 24. The nurse determines that a patients urine output is normal. How many mL of urine did the patient void within the last 24 hours? a. 150 to 400 mL b. 250 to 500 mL c. 750 to 1000 mL d. 1000 to 2000 mL
24. ANS: D Normal urinary output is 1000 to 2000 mL per 24 hours. A. B. C. These volumes represent inadequate amounts of urine output for 24 hours.
__ 12. A patient is scheduled for an intravenous pyelogram (IVP). What care should the nurse provide before the patient has this procedure? a. IV antibiotics b. Opioid pain medication c. Enema evening before the test d. Bedrest for 16 hours before the test
12. ANS: C For an IVP, enemas may be given the evening before the test to empty the colon. A. B. D. The patient does not need antibiotics, opioid medication, or bedrest before the procedure.
___ 13. The nurse is caring for a patient who is scheduled for a cystoscopy (C&P) with basket extraction of a stone. What is the most important postoperative care for the nurse to provide? a. Limiting fluid intake b. Measuring urine output c. Monitoring daily weights d. Observing for acute kidney injury
13. ANS: B Care following a C&P includes measuring urine to make sure the patient has not developed urinary retention from swelling of the urinary meatus. A. Fluids should be encouraged. C. Daily weights is not necessary for this procedure. D. The patient is not at risk for developing an acute kidney injury.
_ 15. The nurse is collecting data from a patient with stress incontinence. Which finding should the nurse document? a. The patient is unable to tell when there is the need to urinate.b. The patient is unable to hold urine when under emotional stress.c. The patient is unable to reach the bathroom and urinates in underwear.d. The patient loses small amounts of urine when he or she coughs or sneezes.
15. ANS: D Stress incontinence is the involuntary loss of less than 50 mL of urine associated with increasing abdominal pressure during coughing, sneezing, laughing, or other physical activities. A. B. C. These statements do not describe stress incontinence.
____ 16. The nurse is caring for a male patient with functional incontinence. What action should the nurse take to help prevent incontinence? a. Teach the patient how to do Kegel exercises. b. Ensure that the patient has ready access to the urinal. c. Teach the patient to increase the time between voiding. d. Give the patient cranberry juice to keep the urine acidic.
16. ANS: B Functional incontinence is the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory, or disorientation, so ensuring access to a urinal is important. A. Kegel exercises are helpful with stress or urge incontinence. C. Prolonging the time between voiding is helpful for urge incontinence. D. Cranberry juice does not affect continence.
___ 17. A patient is being evaluated for renal dialysis. What creatinine clearance value should the nurse realize this patient must have to live without needing dialysis treatments? a. 5 mL b. 10 mL c. 20 mL d. 50 mL
17. ANS: B A minimum creatinine clearance of 10 mL per minute is needed to live without dialysis. A. The patient would need dialysis for this value. C. D. The patient can live without dialysis with these values however they are not the minimum value to live without dialysis.
____ 18. A patient with pneumonia has a blood urea nitrogen (BUN) of 32 mg/dL and creatinine of 0.8 mg/dL. What should the nurse realize is the most probable explanation for this finding? a. The patient is dehydrated. b. The patient has septicemia. c. The patient is malnourished. d. The patient has kidney damage.
18. ANS: A BUN elevates with dehydration, because the loss of water makes the blood more concentrated. Creatinine levels are a very good indicator of kidney function. B. C. D. There is not enough information to determine if the patient is septic, malnourished, or has kidney damage.
_ 19. The nurse is caring for a patient with kidney disease. How should the nurse end a 24-hour urine test at the end of the 24 hours? a. The final voiding before 24 hours is discarded. b. The patient voids at the end of 24 hours, adding it to the collection container. c. One hundred milliliters of collected urine is placed into a specimen cup and sent to the laboratory. d. The patient voids, and the first and last specimens from 24 hours are sent to the laboratory.
19. ANS: B The patient is in a prone position, usually with a sandbag under the abdomen, and the biopsy is taken through the flank area. A. C. D. These positions are not appropriate when obtaining a renal biopsy.
___ 2. The nurse is caring for a patient with a kidney infection. When providing prescribed medications, the nurse should recall that which structure is the capillary network in each nephron? a. Corpuscles b. Glomerulus c. Renal tubules d. Bowmans capsule
2. ANS: B The glomerulus is a capillary network that arises from an afferent arteriole and empties into an efferent arteriole. A. C. D. These structures are not the capillary network with a nephron.
__ 20. The nurse is helping to prepare a patient for a renal biopsy. In which position should the nurse help the patient assume? a. Sims b. Prone c. Supine d. Fowlers
20. ANS: B The patient is in a prone position, usually with a sandbag under the abdomen, and the biopsy is taken through the flank area. A. C. D. These positions are not appropriate when obtaining a renal biopsy.
_ 21. The nurse is caring for a patient recovering from a renal biopsy. For which complication should the nurse monitor the patient during the 24 hours after the procedure? a. Polyuria b. Bleeding c. Infection d. Urinary obstruction
21. ANS: B Grossly bloody urine, falling blood pressure, and rising pulse are signs of bleeding and are reported immediately. A. C. D. Polyuria, infection, and urinary obstruction are not complications typically associated with a renal biopsy.
____ 22. A patient recovering from radiological studies of the renal system has a nursing diagnosis of Impaired Urinary Elimination. Which outcome indicates that the nursing interventions have been effective? a. Patient voids 35 mL/hour of clear urine. b. Patient voids 30 mL/hour of cloudy urine. c. Patient voids 10 mL/hour of reddish urine. d. Patient voids an average of 15 mL/hour of dark-colored urine.
22. ANS: A An expected outcome would be for the patient to maintain a urine output greater than 30 mL per hour in the post-procedure period. B. Cloudy urine could indicate an infection. C. Only 10 mL of red urine could indicate renal failure. D. Urine output should be at least 30 mL/hr.
__ 23. The nurse is instructing a patient on the use of Kegel exercises. How many times a day should the nurse recommend that these exercises be performed? a. 10 to 20 b. 15 to 30 c. 30 to 80 d. 85 to 100
23. ANS: C The patient should be advised to perform these exercises 30 to 80 times per day. A. B. D. The exercises need to be done more than 30 times a day however not as much as 85 to 100 times a day.
____ 25. The nurse is catheterizing a patient after voiding to determine the amount of residual urine in the bladder. What should the nurse consider as being the normal amount of urine within the bladder after urination? a. 50 mL b. 75 mL c. 100 mL d. 150 mL
25. ANS: A Normally, the bladder contains less than 50 mL after urination. B. C. D. These represent excessive amounts of residual urine after voiding.
_ 26. The nurse learns that a patient has a urine pH of 7.9. What question should the nurse ask the patient after learning of this laboratory value? a. Are you a vegetarian? b. Are you lactose intolerant? c. How much protein do you eat each day? d. How much acetaminophen do you take each day?
26. ANS: A The pH range of urine is 4.6 to 8.0, with an average of 6.0. Diet has the greatest influence on urine pH. A vegetarian diet results in more alkaline urine. B. Lactose does not influence urine pH. C. A high-protein diet results in more acidic urine. D. Acetaminophen use does not influence urine pH.
__ 27. During an assessment, the nurse notes that a patient has crystals deposited on the skin. What should this finding indicate to the nurse? a. Gout b. Uremic frost c. Poor hygiene d. Metabolic alkalosis
27. ANS: B The presence of crystals on the skin is called uremic frost and is a late sign of waste products building up in the blood (uremia). When the waste products are not filtered by the kidneys or with treatment, they can come out through the skin and look like a coating of frost in the winter. A. C. D. Crystal deposits on the skin do not indicate gout, poor hygiene, or metabolic alkalosis.
____ 28. A female patient is embarrassed because of not being able to walk to the bathroom in time before become incontinent of urine. Which type of incontinence should the nurse plan care for this patient? a. Urge b. Total c. Stress d. Functional
28. ANS: A Urge incontinence is the involuntary loss of urine associated with an abrupt and strong desire to void. The patient typically reports being unable to make it to the bathroom in time. B. Total incontinence is a continuous and unpredictable loss of urine. It usually results from surgery, trauma, or a malformation of the ureter. C. Stress incontinence is the involuntary loss of less than 50 mL of urine associated with increasing abdominal pressure during coughing, sneezing, laughing, or other physical activities. D. Functional incontinence is the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory, or disorientation.
__ 29. The nurse is making a visit to the home of a patient with functional incontinence. Which observation indicates that teaching about the disorder has been effective? a. Patient wearing sweat pants b. Patient drinking a cup of coffee c. Patient sitting with the legs elevated d. Patient restricting fluid intake after 6 pm.
29. ANS: A If clothing is inhibiting timely voiding for the patient with functional incontinence, the patient should be instructed to wear clothing with Velcro fasteners or sweat pants. B. Coffee is a bladder irrigant and could precipitate voiding. C. Elevating the legs is not an action appropriate for functional incontinence. D. Restricting fluids after 6 pm is not an appropriate action for functional incontinence.
____ 3. A patient has a glomerular filtration rate of 55%. What should this value indicate to the nurse? a. This is a normal value. b. The patient is in renal failure. c. The patient needs to be on a fluid restriction. d. The patients other tests will be in the normal range.
3. ANS: D Renal function test values may be within the normal range until the glomerular filtration rate is less than 50% of normal. A. This value is not normal. B. This value does not indicate that the patient is in renal failure. C. There is no reason to place this patient on fluid restriction.
____ 30. The nurse is reviewing the results of a patients urinalysis. Which components should the nurse identify as being abnormal in urine? (Select all that apply.) a. Urea b. Water c. Protein d. Ammonia e. Hormones f. Red blood cells
30. ANS: C, F Persistent proteinuria is seen with renal disease from damage to the glomerulus. Intermittent protein in the urine can result from strenuous exercise, dehydration, or fever. Protein in the urine is a significant sign of renal problems. Blood in the urine may be caused by infection, stones, cancer, renal disease, or trauma. A. B. D. E. These components are considered normal within urine.
____ 31. The nurse is reviewing data for a patient with acute kidney injury. Which diagnostic test results should the nurse recognize that indicate kidney injury? (Select all that apply.) a. Hematocrit 20%b. Uric acid 8 ng/dLc. Serum creatinine 4.2 mg/dL d. Blood urea nitrogen 40 mg/100 mL e. Urine output of 100 mL in 24 hours f. Fixed urine specific gravity of 1.010
31. ANS: C, E, F A serum creatinine level above 1.5 mg/dL means there is kidney dysfunction. The higher the creatinine level, the more impaired the kidney function. A fixed urine specific gravity is also indicative of renal compromise and impending failure. Normal urinary output is 1000 to 2000 mL per 24 hours. Individuals with acute kidney injury experience oliguria (reduced output). A. B. D. These test results are not consistent with a renal injury.
__ 40. The nurse is contributes to the plan of care for an older patient. What should the nurse recognize as normal signs of aging within the renal system? (Select all that apply.) a. Bladder size increases b. Urethral changes position c. Number of nephrons decreases d. Detrusor muscle tone decreases e. Glomerular filtration rate increases
40. ANS: C, D With age, the number of nephrons in the kidneys decreases, often to half the original number by age 70 or 80. E. The GFR also decreases; this is in part a consequence of arteriosclerosis and diminished renal blood flow. A. The urinary bladder decreases in size. D. The tone of the detrusor muscle decreases. B. The urethra does not change position with aging.
32. The nurse reviews the process to obtain a midstream urine specimen for culture and sensitivity with a female patient. Which patient statements indicate understanding of this process? (Select all that apply.) a. A 24-hour urine specimen is needed. b. A second-voided specimen is preferred. c. I should wash from the back to the front. d. The labia should be kept separated while voiding. e. When urine starts to flow, collect it in the clean container provided. f. The genitalia should be thoroughly cleaned with the towelettes provided.
32. ANS: D, F Female patients should be told to separate the labia with one hand and keep it separated while washing with provided towelettes and collecting the specimen to decrease the risk of contamination of the specimen. B. The first morning specimen is best, but collection can occur at any time. E. The container must be sterile for a culture. A. A 24-hour specimen is not needed. C. Women should wash from the front to the back.
_ 33. The nurse is caring for a patient with an indwelling urinary catheter. Which instructions should the nurse provide to help prevent development of a urinary tract infection? (Select all that apply.) a. Limit fluid intake to decrease the flow of urine. b. Position the tubing to allow free flow of the urine. c. Use aseptic technique when emptying the drainage bag. d. Wash the perineum with an antibacterial soap every 8 hours. e. Keep the catheter securely taped to prevent catheter movement. f. Empty the urinary bag every 4 hours to prevent stagnation of urine.
33. ANS: B, C, E The nurse should instruct to position the tubing to allow free flow of urine, use aseptic technique when emptying the drainage bag, and keep the catheter securely taped or fastened to the leg. A. Fluids should be encouraged. D. The perineum should be washed daily and prn. F. The drainage bag does not need to be emptied every 4 hours.
34. A patient is recovering from a renal arteriogram. What actions should the nurse take when caring for this patient? (Select all that apply.) a. Check vital signs twice daily.b. Raise the head of the bed to 90 degrees.c. Check distal pulses in leg every 30 to 60 minutes.d. Encourage the patient to ambulate as soon as possible.e. A pressure dressing and sandbag used to apply pressure.f. Implement bedrest for 12 hours, and instruct the patient not to bend leg.
34. ANS: C, E, F Patient care following angiography includes bedrest for up to 12 hours to prevent bleeding at the injection site. Pressure dressing is applied, and a sandbag is used to apply pressure. Distal pulses in the leg are checked every 30 to 60 minutes. B. D. The patient is instructed not to bend the leg, and the head of the bed is not raised more than 45 degrees. A. Vital signs, dressing, and pulses in the affected extremity are monitored frequently.
35. The nurse is caring for a patient with an elevated uric acid level. Which health problems should the nurse consider as potentially causing this patients elevation? (Select all that apply.) a. Leukemia b. Steroid use c. Malnutrition d. Kidney disease e. Use of thiazide diuretics f. Gastrointestinal bleeding
35. ANS: A, C, D, E An elevated uric acid level can be caused by kidney disease, malnutrition, leukemia, and use of thiazide diuretics. B. F. Elevated uric acid levels are not associated with steroid use or gastrointestinal bleeding.
__ 36. The nurse is collecting data for a patient with kidney disease. Which information should the nurse identify as being normal urinalysis findings? (Select all that apply.) a. pH 3.5 b. Amber color c. Small amount of nitrite d. Red blood cells of 8/hpf e. Specific gravity of 1.010 f. Small quantities of enzymes
36. ANS: B, E, F Straw to amber color, specific gravity 1.002 to 1.028, small quantities of enzymes, and hormones would all indicate a normal analysis finding. A. Normal pH is 4.6 to 8. D. Red blood cells should be 0 to 4/hpf. C. Nitrite is negative.
__ 37. The nurse is collecting data for a patient who has suspected kidney disease. What health problems should the nurse consider as being associated with a high urine specific gravity? (Select all that apply.) a. Nephrosis b. Dehydration c. Heart failure d. Diabetes mellitus e. Diabetes insipidus f. Fluid volume excess
37. ANS: A, B, C, D A high specific gravity may occur from diabetes mellitus and high sugar concentrations in the urine, nephrosis, congestive heart failure, and dehydration. E. F. Specific gravity measurements are most likely lower in diabetes insipidus and fluid volume excess.
38. The nurse is caring for a patient with an indwelling catheter. What should the nurse include in this patients routine care? (Select all that apply.) a. Encourage fluid intake. b. Maintain a closed system. c. Secure the catheter to the patients leg. d. Clamp the catheter for 1 hour each shift. e. Remove the catheter as soon as possible. f. Use sterile technique when emptying the drainage bag.
38. ANS: A, B, C, E Routine care should include encourage fluid intake, maintain a closed system, secure the catheter to the patients leg, and remove the catheter as soon as possible. F. Aseptic technique should be used when emptying the drainage bag. D. The catheter should not routinely be clamped.
__ 39. The nurse is reviewing normal kidney function with a patient experiencing an acute kidney injury. Which hormones should the nurse include that affect kidney function? (Select all that apply.) a. Estrogen b. Aldosterone c. Parathyroid hormone d. Antidiuretic hormone (ADH) e. Atrial natriuretic hormone (ANH) f. Thyroid-stimulating hormone (TSH)
39. ANS: B, C, D, E Hormones that affect kidney function include aldosterone, which promotes reabsorption of sodium ions from the filtrate to the blood and excretion of potassium ions into the filtrate; ADH, which promotes reabsorption of water from the filtrate to the blood; ANH, which decreases reabsorption of sodium ions, which remain in the filtrate; and parathyroid hormone, which promotes reabsorption of calcium ions from the filtrate to the blood and excretion of phosphate ions into the filtrate. A. F. Estrogen and TSH do not affect renal function.
____ 4. The nurse is caring for a patient with an acidbase imbalance from kidney disease. How should the nurse explain the role of the kidneys to maintain acidbase balance in the body to the patient? a. Promoting retention of proteins b. Promoting excretion of carbon dioxide c. Conserving or excreting potassium ions d. Conserving or excreting bicarbonate ions
4. ANS: D The kidneys regulate the acidbase balance of the blood by the excretion or conservation of ions such as hydrogen or bicarbonate. A. Promoting retention of proteins will not maintain acidbase balance. B. C. Excretion of carbon dioxide or conserving or excreting potassium does not contribute to maintaining acidbase balance in the body.
41. The nurse is participating in care planning for a patient with urge incontinence. What should the nurse recommend be included in this patients plan of care? (Select all that apply.) a. Void every 2 hours. b. Practice relaxation breathing. c. Use urge inhibition techniques. d. Reduce fluid intake for several hours before sleep. e. Gradually increase length of time between voidings.
41. ANS: A, B, C, E For urge incontinence, the nurse should teach the patient to void at frequent intervals (every 2 hours) and then gradually increase the length of time between voidings. The nurse also should teach urge inhibition techniques (distraction), such as relaxation breathing. D. Reducing fluid intake is not an appropriate action to help treat urge incontinence.
_ 5. The nurse is collecting data for a patient with kidney disease. When reviewing a urinalysis report, which range should the nurse recognize as normal specific gravity of urine? a. 0.080 to 0.100 b. 1.002 to 1.035 c. 2.600 to 3.000 d. 4.612 to 5.030
5. ANS: B The usual range of specific gravity of urine is 1.002 to 1.035. A. C. D. These are not normal ranges for the urine specific gravity.
__ 6. The nurse is reviewing a urinalysis report. What should the nurse recognize as the normal average pH of urine? a. 2 b. 4.2 c. 6 d. 7.4
6. ANS: C The pH range of urine is 4.6 to 8, with an average of 6. A. B. D. These values are not considered the normal average pH of urine.
_ 7. The nurse needs to obtain a urine specimen from a female patient. What action should the nurse take when obtaining this specimen? a. Obtain the first voided urine of the day.b. Direct the patient to wash her perineum before collecting the urine specimen.c. Have the patient urinate into a bedpan, then pour the urine into the specimen container.d. Have the patient void, throw that urine away, and then collect another specimen at least 1 hour later.
7. ANS: A Direct the patient to wash her perineum before collecting the urine specimen to reduce contamination. A. If the specimen is for a routine urinalysis, the first morning voided urine is best to obtain however the type of specimen is not known. C. Pouring urine from a bedpan could cause the specimen to be contaminated. D. There is no need for the patient to provide a double specimen.
____ 9. The nurse is reviewing a patients history and physical report. What term should the nurse recognize is being used to describe waste products building up in the blood? a. Uremia b. Septicemia c. Nitrosemia d. Proteinemia
9. ANS: A Waste products (blood urea nitrogen [BUN], creatinine, etc.) building up in the blood is called uremia. B. Septicemia is a bacterial infection in the blood. C. D. These terms do not describe waste products building up in the blood.
__ 8. A patients urinalysis results are: white blood cells (WBC) 100+/hpf; red blood cells (RBC) 4/hpf; bacteria, moderate amount; nitrite, positive; specific gravity, 1.025; urine, cloudy. What should the nurse recognize these findings indicate? a. Dehydration b. Urinary tract infection c. Contamination from menstruation d. Contamination of the specimen from bacteria on the perineum
B Elevated WBCs, bacteria, nitrites, and cloudy urine indicate an infection. A. C. D. These findings do not indicate dehydration, contamination from menstruation, or bacterial contamination of the specimen.
____ 14. The nurse contributes to the plan of care for a patient with edema. Which action should the nurse take as the best indicator of this patients fluid volume status? a. Vital signs b. Skin turgor c. Daily weight d. Intake and output
C Daily weight is the single best indicator of fluid balance in the body. A. B. D. Vital signs, skin turgor, and intake and output are not the best indicators of fluid balance in the body.