EAQ Chapter 65: Module 1
While assessing a patient, the nurse finds that the patient has a history of stone formation and is at an increased risk for the occurrence of calculi. Which statement made by the patient would indicate the risk of acquiring renal calculi?
"I eat large amounts of protein."
Which test is useful to estimate glomerular filtration rate (GFR)?
Nuclear renal scan
Which finding in a patient's kidney, ureter, and bladder (KUB) x-ray indicates an abnormality?
The left kidney is much larger...
A patient reports continuous radiating pain into the groin. Which assessment findings made by the nurse would help in the diagnosis?
Pallor Diaphoresis Hypotension
Base on this data, which patient requires renin substrate?
Patient A
The nurse is reviewing the laboratory reports of four patients. Which patient is most likely to have kidney impairment?
Patient A
A nurse is assessing a patient prior to the patient undergoing a radiological exam with injected contrast dye. The patient tells the nurse, "I think I had a reaction to the dye the last time I had this procedure done." What is the nurse's best response?
"What kind of reaction did you experience?"
A nurse is caring for a patient who will undergo a kidney, ureter, and bladder x-ray (KUB) procedure. What statement by the nurse is appropriate when teaching the patient about the procedure?
"You do not need any special preparation for this test."
A novice nurse is working on a renal unit and has four patients who require computed tomography (CT) scans with contrast dye. Which patient does the nurse identify as having the highest risk for developing acute kidney failure due to the contrast dye?
65 year old
When caring for a patient with uremia, the nurse assesses for which symptom?
N/V
A nurse is caring for a patient with renal disease who has an increase in tubular reabsorption. What findings on physical examination does the nurse correlate to this alteration?
Decrease urine output
What risks does the nurse anticipate in the patient with an age-related decrease in the glomerular filtration rate (GFR)?
Drug reactions
A nurse is caring for a patient with a genetic malformation of the proximal convoluted tubules (PCTs) of the nephrons. What alteration will the nurse anticipate as a direct result of the patient's malformation?
Electrolyte imbalance
A patient is scheduled for radiography of the kidneys, ureters, and bladder (KUB). What is the purpose of this examination?
Measure the size...
Which diagnostic test is safe for patients with kidney failure to determine the functional ability of the kidney?
Nuclear renal scan
Which diagnostic test may be used to evaluate renal perfusion and glomerular filtration rate (GFR) in a patient without exposing the patient to iodinated contrast dye?
Nuclear renal scan
What symptoms does the nurse associate with internal bleeding or a hematoma in a patient after a kidney biopsy?
Pain radiating to the flank
The nurse has these patient assignments. Which patient does the nurse encourage to consume 2-3 liters of fluid each day?
Patient with hyperparathyroidism
A nurse is caring for a female patient who presents to the outpatient clinic with complaints of right flank pain. What action by the nurse is appropriate when percussing the patient's flank area?
Position the patient in sitting position, clench hand into a fist and firmly thump the patient's costovertebral area.
A nurse is planning care for a 75-year-old African American patient who is being treated for chronic kidney disease. When planning appropriate interventions for this patient, what variations in physiology does the nurse recognize as contributing factors of kidney disease among African American older adult patients?
African Americans have less blood flow to the kidneys than do other populations. African Americans have greater age-related changes in the GFR than do other populations.
A patient is prescribed urine tests to determine kidney function. To which diagnostic test does the nurse refer to obtain the glomerular filtration rate (GFR)?
Creatinine clearance
Which age-related change can cause nocturia?
Decreased ability to concentrate urine
A patient with suspected renal impairment is scheduled to undergo radiological imaging to assess the perfusion to the kidneys. The patient tells the nurse that he is allergic to the contrast dye given in some radiological procedures. What procedure will the nurse recommend that the patient undergo?
Renal scan with radioisotope intravenous injection
The registered nurse is teaching a student nurse about the risk factors associated with kidney problems. Which statement made by the student nurse indicates a need for further teaching?
"A high dose of acetaminophen will not affect kidney function."
A patient has returned from a captopril renal scan. Which teaching does the nurse provide when the patient returns?
"Arise slowly and call for assistance when ambulating."
A nurse is providing discharge instructions for a patient with acute kidney failure. What question by the nurse best assesses the patient's understanding of the condition?
"Can you tell me what happens with your condition?"
A home health nurse is performing an initial assessment on a patient with kidney disease. Which questions by the nurse assess the socioeconomic factors that may be contributing to the patient's current condition? .
"Do you speak English?" "Do you have a religious preference?" "Are you able to fill your prescriptions without difficulty?"
A patient with these assessment data is preparing to undergo computed tomography with contrast. Which medication does the nurse plan to administer before the procedure?
Acetylcysteine
A patient is administered captopril at the start of a renography. What care must this patient take after receiving captopril?
Avoid rapid position changes
A nurse is reviewing a patient's laboratory results and notes that the patient's urine specific gravity is decreased. What nursing intervention is most appropriate for this patient?
Check to see if the patient is taking furosemide.
Which kidney hormone regulates intrarenal blood flow by vasodilation or vasoconstriction?
Prostaglandins
A 67-year-old male patient with a history of chronic kidney disease presents to the emergency room with shortness of breath. Upon assessment, the nurse notes coarse crackles when auscultating the patient's lungs. Review of the patient's laboratory tests reveal a BUN of 6 mg/dL and a BUN/creatinine level of 4. What nursing diagnosis topic is appropriate for this patient?
Excess fluid volume
During a health fair, the primary health care provider selected a few patients who are suspected to have kidney disease for further screening. What are the probable selection criteria?
A 40-year-old patient with diabetes. A 45-year-old patient with polycystic kidney disease. A 55-year-old...
The nephron is the functional unit of the kidney. What are the characteristics of the juxtamedullary nephrons?
Their tubes dip deeply into the medulla. They concentrate urine during low fluid intake. They constitute 20% of all nephrons.
The nurse is caring for a patient with kidney disease whose glomerular filtration rate (GFR) is recorded to be 45 ml/min. What is the best nursing intervention in this situation?
To maintain...
Which parameter would assess acid-base balance in a patient?
Bicarbonate levels
Identify the function that is affected by the production of renin by the kidneys.
Blood pressure
The nurse suspects gastrointestinal (GI) bleeding in a 62-year-old patient with kidney disease. Which finding in the patient's blood report supports the nurse's suspicion?
Blood urea nitrogen (BUN) value of 25 mg/dL
What does the nurse recognize as the cause for a high blood urea nitrogen (BUN) level in a patient?
Decreased kidney perfusion
What risk does the nurse identify in a patient who is on a long-term, high-protein diet?
Formation of calculi or stones
The nurse is assessing a pregnant woman suspected to have kidney disease. Which assessment findings by the nurse would help in the diagnosis?
Increased protein levels in urine
A nurse is admitting a patient with chronic renal impairment who has a recent history of anorexia and a 15-pound unintentional weight loss. What is the likely reason for the patient's current condition?
Increases nitrogenous waste products
The nurse is caring for a patient with an elevated blood urea nitrogen (BUN) of an unknown cause. If kidney disease has been ruled out, what additional conditions would the nurse suspect as a possible cause for an elevated BUN level? .
Infection Dehydration Decreased cardiac output
What aspect of renal function is most important to assess?
Maintaining body fluid volume
The nurse is caring for a patient after a percutaneous biopsy of the kidney. What interventions does the nurse perform?
Monitor the dressing site for 24 hours. Monitor for flank pain. Monitor for hematuria. Maintain strict bedrest.
A nurse is caring for a patient in the emergency department who has a severely elevated serum creatinine level. Other than kidney disease, what pathological condition may increase the serum creatinine level?
No condition increases this level other than kidney disease.
The nurse is preparing a patient for a kidney biopsy. What prior assessments are required to ensure patient preparedness for this procedure?
PT BP HgB Platelet count
A nurse is reviewing laboratory results of a patient with chronic kidney disease. The nurse notes that the patient's erythropoietin level is very low. What finding on the patient's assessment does the nurse contribute to the patient's laboratory result?
Pale... Reduced...
The charge nurse is making patient assignments for the day shift. Which patient is best to assign to an LPN/LVN?
Patient with polycystic kidney disease who is having a kidney ultrasound
The RN is caring for a patient who has just had a kidney biopsy. Which action does the nurse perform first?
Position the patient...
A patient is advised to undergo a diagnostic test that uses high osmolarity contrast agents. Which precautionary test should be performed on the patient to prevent further complications?
Serum creatinine
A patient who is a bodybuilder is prescribed several diagnostic tests. For which diagnostic test does the nurse expect a higher than normal value without reflecting a kidney function problem?
Serum creatinine
A nurse is caring for a patient suspected of having pyelonephritis. What is the best position for the nurse to place the patient in when performing auscultation of the renal vessels?
Supine
An athlete is admitted to the hospital with kidney dysfunction. What might be a reason for causing kidney dysfunction in this patient?
Taking dietary supplement...
What changes related to aging does the nurse expect in the kidneys of an older patient?
The kidney loses cortical tissue.
What can be interpreted from a patient's laboratory report that shows a blood urea nitrogen (BUN)/creatinine ratio as 4.4?
The patient has fluid volume excess
A nurse is admitting a patient to the medical surgical floor and is assessing the patient's renal status. What question asked by the nurse best determines if the patient's urine output is adequate?
"Does your urine output usually match the amount of fluid you drink?"
A nurse is performing an assessment on a patient with an alteration in renal function. What patient statements does the nurse recognize as potential contributing factors to the patient's current condition? .
"I sometimes huff paint with my friends." "I sometimes use heroin during the week." "I smoke meth, but only on the weekends."
A nursing student is caring for a patient who has been diagnosed with nephritis. The nursing student asks the nurse preceptor what the difference is between nephritis and nephrosis. What is the nurse preceptor's best response?
"Nephritis is the inflammation of the kidney and nephrosis is the degeneration of the kidney."
The registered nurse is teaching a student nurse about serum creatinine. Which statement made by the student nurse indicates the need for further teaching?
"Serum creatinine level is decreased in older adults."
An occupational nurse is caring for a patient who works at an oil refinery and has a recent history of renal impairment. What statement made by the nurse is appropriate regarding occupational hazards and risk of renal impairment?
"Try to avoid direct contact of oil with your skin or mucous membranes."
What is the first preferred diagnostic test for a patient suspected to have kidney tumors?
CT
Which physiological abnormality in kidney function can be detected by x-rays?
Calcification
A patient who is on a high-protein diet consumes only 2 liters of fluids daily. What is the possible risk in this patient?
Calculi formation
What does the nurse expect the health care provider to prescribe for a patient before a percutaneous kidney biopsy?
Coagulation tests
Which laboratory test is the best indicator of kidney function?
Creatinine
The nurse is reviewing the laboratory reports of a patient. What does the nurse infer from these findings?
Decreased muscle mass
Which factor may cause nephrogenic systemic fibrosis?
Exposure to MRI...
The nurse is reviewing the laboratory results for an older adult patient with a renal impairment and notes the results of the glomerular filtration rate (GFR). What age-related changes to the GFR will the nurse keep in mind while reviewing the patient's laboratory results?
GFR will decrease with age. Age-related changes to the GFR increases risk for fluid excess.
A nurse is caring for a patient who is being treated for acute kidney failure. What response made by the nurse is the best way to assess the patient's history of hypertension?
Have you ever...
The nurse is reviewing the medical record for a patient with polycystic kidney disease who is scheduled for a computed tomography (CT) angiography with contrast: Which intervention is essential for the nurse to perform?
Hold metformin
When a patient with diabetes returns to the medical unit after a computed tomography (CT) with contrast dye, all of these interventions are prescribed. Which intervention does the nurse implement first?
Infuse
The nurse is performing a physical assessment of the kidneys and bladder of a patient. How does the nurse perform this assessment?
Inspect of asym...
Which anatomical structure or function of the kidney is unaffected by aging?
Juxtamed...
Which condition would the nurse suspect in a patient whose laboratory results show a serum creatinine level of 1.8 mg/dL?
Kidney impairment
A nurse is admitting an older adult patient to the medical surgical floor and notes that the patient has a long list of current medications. What age-related physiological changes does the nurse recognize as contributing factors for the risk of delayed drug clearance in this patient?
Kidney mass decreases with age Blood flow GFR decreases with age
A nurse is caring for a patient who is scheduled for surgery later in the day. When reviewing the patient's medication history, what medications will alert the nurse to the possibility of the patient developing acute renal failure during the procedure?
Laxatives Glucose regulators Beta blockers
For which patients scheduled for a computed tomography (CT) with contrast does the nurse communicate safety concerns to the health care provider?
Patient with an allergy to shrimp Patient with a history of asthma Patient with a blood urea nitrogen (BUN) of 62 mg/dL and a creatinine of 2.0 mg/dL Patient who took metformin 4 hours ago
Which patient is at risk if a kidney palpation is performed?
Patient with tumor in kidney
A nurse is assessing the renal system of a patient who is complaining of left flank pain. What does the nurse recognize as the correct procedure for assessing and percussing the patient's flank pain?
Percuss the right flank before the left.
The nurse is performing an assessment on a patient with a suspected kidney injury. What is the best reason for auscultating before percussing or palpating when assessing the renal system?
Percussion and palpation prior to auscultating may increase bowel sounds, making it more difficult to hear vascular sounds.
Which percussion technique does the nurse use to assess a patient who reports flank pain?
Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank.
A patient had a computed tomography (CT) with contrast dye 8 hours ago. Which nursing intervention is the priority for this patient?
Promoting fluid intake
A nurse is caring for a patient who has developed glomerulonephritis after a streptococcal infection. What laboratory test result will the nurse use as the best indicator for the patient's kidney function?
Serum creatinine
The nurse reviews the laboratory reports of a female patient and concludes that decreased muscle mass is present. Which finding led the nurse to this conclusion?
Serum creatinine level of 0.2 mg/dL
Which type of physiological change in the kidney is associated with nocturnal polyuria in older adults?
Tubular changes
An older adult patient tells the nurse, "I urinate so many times in the night that I don't sleep well. Also, during the day I feel like I have to urinate all the time even if I can't urinate when I try." What age-related pathophysiological changes to the patient's renal system will the nurse recognize as the likely cause of the patient's symptoms?
Tubular changes...
The nurse is assessing a patient who is suspected to have a kidney disorder. Which questions asked by the nurse may help confirm the diagnosis?
hx htn hx kidney stones