Assess and Manage Kidney and Urinary System (Exam 5)

The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL?

1,000 mL

The normal BUN level ranges____________ the normal serum creatinine level ranges__________

8 to 23 mg/dl 0.7 to 1.5 mg/dl

A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan? a) Take the client's blood pressure in the left arm b) Keep the AV fistula site dry. c) Assess the AV fistula for a bruit and thrill. d) Keep the AV fistula wrapped in gauze.

Assess the AV fistula for a bruit and thrill. if these findings aren't present, the fistula isn't functioning, venous access site must be evaluated at least every shift. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.

During hemodialysis, excess water is removed from the blood by which of the following?

Osmosis

hallmark of the diagnosis of nephrotic syndrome?

Proteinuria (predominantly albumin) exceeding 3.5 g/day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may also occur. Proteinuria and microscopic hematuria may persist for many months; in fact, 20% of patients have some degree of persistent proteinuria or decreased glomerular filtration rate (GFR) 1 year after presentation

The nurse is performing a renal assessment on a client with prostate cancer. Which clinical manifestation suggests prostate cancer? Select all that apply. a) Hesitancy b) Nocturia c) Palpitations d) Chills e) Dyspnea

a & b) urinary hesitancy and nocturia

A 30-year-old male patient presents to the clinic for an employment physical. The nurse notes protein in the patient's urine. The nurse understands that transient proteinuria can be caused by which of the following? Select all that apply. a) Fever b) Diabetes mellitus c) Strenuous exercise d) NSAIDs e) Prolonged standing

a) Fever c) Strenuous exercise e) Prolonged standing

An instructor is preparing a class on renal cancer for a group of students. What are possible risk factors?

age with most renal cancers occurring after age 60, male gender, tobacco use, occupational exposure to industrial chemicals, obesity, unopposed estrogen therapy, polycystic kidney disease, and treatment for renal failure.

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? a) Pneumonia caused by shallow breathing because of severe incisional pain b) Abdominal distention owing to reflex cessation of intestinal peristalsis c) Hypovolemic shock caused by hemorrhage d) Paralytic ileus caused by manipulation of the colon during surger

c) Hypovolemic shock caused by hemorrhage If bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack

A 44-year-old client is in the hospital unit where you practice nursing. From the results of a series of diagnostic tests, she has been diagnosed with acute glomerulonephritis. What would you expect to find as a result of this condition? a) Polyuria b) No option is correct. c) Proteinuria d) Pyuria

c) Proteinuria The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine.

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek's sign. What deficit does the nurse suspect the patient has? a) Magnesium b) Phosphorus c) Sodium d) Calcium

d) Calcium Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.

The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom? a) Impaired immunologic response b) Electrolyte imbalances c) Azotemia d) Diminished erythropoietin production

d) Diminished erythropoietin production Erythropoietin is a hormone produced in the kidneys, and this production is inadequate in chronic renal failure, which results in anemia. Azotemia, impaired immune response, and electrolyte imbalance are associated with chronic renal failure but not indicated with anemia

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? a) Nephrotic syndrome b) Obstruction of the lower urinary tract c) Acute renal failure d) Infection

d) Infection Frequency, urgency, and dysuria are commonly associated with urinary tract infection. Hesitancy and enuresis may indicate an obstruction. Oliguria or anuria and proteinuria might suggest acute renal failure. Nocturia is associated with nephrotic syndrome.

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? a) Obstruction of the lower urinary tract b) Nephrotic syndrome c) Acute renal failure d) Infection

d) Infection Frequency, urgency, and dysuria are commonly associated with urinary tract infection. Hesitancy and enuresis may indicate an obstruction. Oliguria or anuria and proteinuria might suggest acute renal failure. Nocturia is associated with nephrotic syndrome.

A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram? a) Increased alertness b) Hypoventilation c) Unusually smooth skin d) Pruritus

d) Pruritus The nurse should be alert for pruritus and urticaria, which may indicate a mild anaphylactic reaction to the arteriogram dye. Decreased alertness may occur as well as dyspnea.

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. a) Shortened QRS complex b) Prolonged ST segment c) Multiple spiked P waves d) Tall, peaked T waves

d) Tall, peaked T waves Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex

Assessment finding with ESRD

yellow-gray pallor results of anemia and uremia

A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? a) Encourage use of incentive spirometer every 2 hours. b) Keep the drainage catheter below the level of insertion. c) Monitor temperature every 4 hours. d) Administer isotonic fluid therapy as ordered.

a) Encourage use of incentive spirometer every 2 hours. To address the issue of ineffective breathing pattern, encouraging the use of incentive spirometer would be most appropriate to help increase alveolar ventilation. Administering isotonic fluid therapy would be appropriate for issues involving fluid loss such as bleeding or hemorrhage. Keeping the drainage catheter below the level of insertion would be appropriate to reduce the risk of obstruction leading to acute pain. Monitoring the temperature every 4 hours would be appropriate to reduce the client's risk for infection

A 42-year-old client is being seen by a urologist in the group where you practice nursing. She is experiencing some secretion abnormalities, for which diagnostics are being performed. Which of the following substances are typically reabsorbed and not secreted in urine? a) Glucose b) Creatinine c) Chloride d) Potassium

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 has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? a) Increase carbohydrates and limit protein intake. b) Eliminate fat intake and increase protein intake. c) Increase fat intake and limit carbohydrates. d) Increase protein, carbohydrates, and fat intake.

a) Increase carbohydrates and limit protein intake. Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.

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

a) Recent history of streptococcal infection Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.

Which is the correct term for the ability of the kidneys to clear solutes from the plasma? a) Renal clearance b) Glomerular filtration rate (GFR) c) Tubular secretion d) Specific gravity

a) Renal clearance Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. GFR is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.

A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate? a) "Try washing clothes with a strong detergent to ensure that all impurities are gone." b) "Keep your showers brief, patting your skin dry after showering." c) "Liberally apply alcohol to the areas of your skin where you itch the most." d) "When you shower, use really warm water and an antibacterial soap."

b) "Keep your showers brief, patting your skin dry after showering." The client with pruritus needs to keep the skin clean and dry. The client should take brief showers with tepid water, pat the skin dry, use moisturizing lotions or creams, and avoid scratching. In addition, the client should use a mild laundry detergent to wash close and an extra rinse cycle to remove all detergent or add 1 tsp vinegar per quart of water to the rinse cycle to remove any detergent residue

A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan? a) Take the client's blood pressure in the left arm. b) Assess the AV fistula for a bruit and thrill. c) Keep the AV fistula site dry. d) Keep the AV fistula wrapped in gauze.

b) Assess the AV fistula for a bruit and thrill. The nurse needs to assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek's sign. What deficit does the nurse suspect the patient has? a) Magnesium b) Calcium c) Phosphorus d) Sodium

b) Calcium Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.

A client has a full bladder. Which sound would the nurse expect to hear on percussion? a) Resonance b) Dullness c) Flatness d) Tympany

b) Dullness Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very dense tissue, such as the bone or muscle.

A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should a) remove the dressing on the puncture site after vital signs stabilize. b) keep the client's knee on the affected side bent for 6 hours. c) check the client's pedal pulses frequently. d) apply pressure to the puncture site for 30 minutes.

check the client's pedal pulses frequently After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely.

Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Select the correct example of how urine concentration is affected from among the following statements. a) On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. b) On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. c) When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity may vary widely. d) 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.

b) On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity.

A 30-year-old male patient presents to the clinic for an employment physical. The nurse notes protein in the patient's urine. The nurse understands that transient proteinuria can be caused by which of the following? Select all that apply. a) Diabetes mellitus b) Strenuous exercise c) Fever d) NSAIDs e) Prolonged standing

b) Strenuous exercise c) Fever e) Prolonged standing Proteinuria may be a benign finding, or it may signify serious disease. Common benign causes of transient proteinuria are fever, strenuous exercise, and prolonged standing

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) Uric acid level c) Creatinine clearance level d) Serum potassium level

c) 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

The nurse is performing a renal assessment on a client with prostate cancer. Which clinical manifestation suggests prostate cancer? Select all that apply. a) Palpitations b) Chills c) Hesitancy d) Nocturia e) Dyspnea

c) Hesitancy d) Nocturia

A nurse is preparing an education program about renal disease. Which risk factor should the nurse include when teaching? Select all that apply. a) Seizures b) Hypotension c) Immobility d) Sickle-cell anemia e) Spinal cord injury

c) Immobility d) Sickle-cell anemia e) Spinal cord injury Risk factors for renal disease include immobility, sickle-cell anemia, and spinal cord injury. Immobility promotes kidney stone formation. Sickle-cell anemia increases the risk for chronic kidney disease. Spinal cord injury can lead to neurogenic bladder, urinary tract infection, and urinary incontinence.

Which of the following hormones is secreted by the juxtaglomerular apparatus? a) Aldosterone b) Antidiuretic hormone (ADH) c) Renin d) Calcitonin

c) Renin Renin is a hormone directly involved in the control of arterial blood pressure; it is essential for proper functioning of the glomerulus. ADH, also known as vasopressin, plays a key role in the regulation of extracellular fluid by excreting or retaining water. Calcitonin regulates calcium and phosphorous metabolism.

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? a) Ureteral stricture b) Renal cell carcinoma c) Urinary calculi d) Acute glomerulonephritis

c) Urinary calculi 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.