PrepU- Kidney
The most frequent reason for admission to skilled care facilities includes which of the following? A. Urinary incontinence B. Congestive heart failure C. Stroke D. Myocardial infarction
A. Urinary incontinence Urinary incontinence is the most common reason for admission to skilled nursing facilities.
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? A. Assess the patient's back and shoulder areas for signs of internal bleeding. B. Distract the client's attention from the pain. C. Provide analgesics to the client. D. Enable the client to sit up and ambulate.
A. Assess the patient's back and shoulder areas for signs of internal bleeding. 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.
The nurse is providing care to a client who has had a renal biopsy. The nurse would need to be alert for signs and symptoms of which of the following? A. Bleeding B. Infection C. Dehydration D. Allergic reaction
A. Bleeding Renal biopsy carries the risk of postprocedure bleeding because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater. Dehydration and allergic reaction are not associated with a renal biopsy.
A client has been experiencing severe pain and hematuria and is hardly able to ambulate into the physician's office. The physician suspects kidney stones and orders diagnostic tests to confirm. What test would the nurse expect the physician to order? A. KUB B. ultrasound C. CT D. MRI
A. KUB An x-ray study of the abdomen includes x-rays of the kidneys, ureters, and bladder (KUB). It is performed to show the size and position of the kidneys, ureters, and bony pelvis as well as any radiopaque urinary calculi (stones), abnormal gas patterns (indicative of renal mass), and anatomic defects of the bony spinal column (indicative of neuropathic bladder dysfunction). Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. A computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen and pelvis may be obtained to diagnose renal pathology, determine kidney size, and evaluate tissue densities with or without contrast.
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? A. Kidney stones B. Neurogenic bladder C. Chronic renal failure D. Fistula
A. Kidney stones A client with hyperparathyroidism is at risk for kidney stones. The client with diabetes mellitus is a risk factor for developing chronic renal failure and neurogenic bladder. A client with radiation to the pelvis is at risk for urinary tract fistula.
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. Specific gravity compares the density of urine to the density of distilled water. Which is an example of how urine concentration is affected? A. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. B. On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. C. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has scant urine output with a high specific gravity. D. When the kidneys are diseased, the ability to concentrate urine may be impaired, and the specific gravity may vary widely.
A. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. Specific gravity is altered by the presence of blood, protein, and casts in the urine and is normally influenced primarily by hydration status. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has copious urine output with a low specific gravity. When the kidneys are diseased, the ability to concentrate urine may be impaired, and the specific gravity remains relatively constant.
The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: A. Specific gravity 1.035 B. Creatinine 0.7 mg/dL C. Protein 15 mg/dL D. Bright yellow urine
A. Specific gravity 1.035 Specific gravity is reflective of hydration status. A concentrated specific gravity, such as 1.035, is suggestive of dehydration. Bright yellow urine suggests ingestion of multiple vitamins. Proteinuria can be benign or be caused by conditions which alter kidney function. Creatinine measures the ability of the kidney to filter the blood. A level of 0.7 is within normal limits.
The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse understand that oliguria is said to be present? A. When the urine output is less than 30 mL/h B. When the urine output is about 100 mL/h C. When the urine output is between 300 and 500 mL/h D. When the urine output is between 500 and 1,000 mL/h
A. When the urine output is less than 30 mL/h Oliguria is defined as urine output <0.5 mL/kg/h
An older adult's most recent laboratory findings indicate a decrease in creatinine clearance. When performing an assessment related to potential causes, the nurse should: A. confirm all of the medications and supplements normally taken. B. assess the client's usual intake of sodium. C. confirm which beverages the client normally consumes. D. palpate the client's bladder before and after voiding.
A. confirm all of the medications and supplements normally taken. Adverse effects of medications are a common cause of decreased renal function in older adults. Quantity, rather than type, of beverages is relevant. Sodium intake does not normally cause decreased renal function. Bladder palpation can be used to confirm urinary retention, but this does not normally affect renal function as much as medications.
The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to A. drink liberal amounts of fluids. B. maintain bed rest for 2 hours. C. carefully handle urine because it is radioactive. D. notify the health care team if bloody urine is noted.
A. drink liberal amounts of fluids. After the procedure is completed, the client is encouraged to drink fluids to promote excretion of the radioisotope by the kidneys. The remaining instructions are not associated with a nuclear scan.
A client is experiencing some renal secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed in urine? A. glucose B. potassium C. creatinine D. chloride
A. glucose Amino acids and glucose typically are reabsorbed and not excreted in the urine. The filtrate that is secreted as urine usually contains water, sodium, chloride, bicarbonate, potassium, urea, creatinine, and uric acid.
A client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. This test will reveal details about: A. renal circulation. B. kidney function. C. kidney structure. D. urine production.
A. renal circulation. A renal angiography (renal arteriography) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.
A patient is being seen in the clinic for possible kidney disease. What major sensitive indicator of kidney disease does the nurse anticipate the patient will be tested for? A. Blood urea nitrogen level B. Creatinine clearance level C. Serum potassium level D. Uric acid level
B. Creatinine clearance level Creatinine is an endogenous waste product of skeletal muscle that is filtered at the glomerulus, passed through the tubules with minimal change, and excreted in the urine. Hence, 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.
Which is an effect of aging on upper and lower urinary tract function? A. Increased glomerular filtration rate B. Susceptibility to develop hypernatremia C. Increased blood flow to the kidney D. Acid-base balance
B. Susceptibility to develop hypernatremia The elderly are more susceptible to developing hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidney, and acid-base imbalances.
The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness? A. The upper abdominal quadrants on the left and right side B. The costovertebral angle C. Above the symphysis pubis D. Around the umbilicus
B. The costovertebral angle The nurse is correct to assess the kidneys for tenderness at the costovertebral angle. The other options are incorrect.
When describing the functions of the kidney to a client, which of the following would the nurse include? A. Regulation of white blood cell production B. Synthesis of vitamin K C. Control of water balance D. Secretion of enzymes
C. Control of water balance Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins.
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? A. GI absorption rate B. Therapeutic index C. Creatinine clearance D. Liver function studies
C. Creatinine clearance The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? A. Decreased blood urea nitrogen (BUN) B. Increased serum albumin C. Increased serum creatinine D. Decreased potassium
C. Increased serum creatinine In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.
Retention of which electrolyte is the most life-threatening effect of renal failure? A. Calcium B. Sodium C. Potassium D. Phosphorous
C. Potassium Retention of potassium is the most life-threatening effect of renal failure.
A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 mL. Urine output that's less than 50 ml in 24 hours is known as: A. oliguria. B. polyuria. C. anuria. D. hematuria.
C. anuria. Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine.
When the bladder contains 400 to 500 mL of urine, this is referred to as A. anuria. B. specific gravity. C. functional capacity. D. renal clearance.
C. functional capacity. A marked sense of fullness and discomfort with a strong desire to void usually occurs when the bladder contains 400 to 500 mL of urine, referred to as the "functional capacity." Anuria is a total urine output less than 50 mL in 24 hours. Specific gravity reflects the weight of particles dissolved in the urine. Renal clearance refers to the ability of the kidneys to clear solutes from the plasma.
Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? A. 20 B. 30 C. 40 D. 50
D. 50 Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal.
