Ch 18: Kidney Clinical Assessment and Diagnostic Procedures jk
In a patient with a distended abdomen differentiating ascites from solid bowel contents is accomplished by performing what assessment? a.Auscultation of bowel sounds b.Palpation of the liver margin c.Measuring abdominal girth d.Eliciting a fluid wave
d.Eliciting a fluid wave Differentiating ascites from distortion by solid bowel contents is accomplished by producing what is called a fluid wave. The fluid wave is elicited by exerting pressure to the abdominal midline while one hand is placed on the right or left flank. Tapping the opposite flank produces a wave in the accumulated fluid that can be felt under the hands.
A patient was admitted with multiple trauma who has been volume resuscitated. The nurse suspects the patient is fluid overloaded. Which assessment findings would confirm the nurse's suspicion? a.Venous filling of the hand veins greater than 5 seconds b.Distended neck veins in the supine position c.Presence of orthostatic hypotension d.Presence of a third heart sound
d.Presence of a third heart sound Auscultation of the heart requires not only assessing rate and rhythm but also listening for extra sounds. Fluid overload is often accompanied by a third or fourth heart sound, which is best heard with the bell of the stethoscope.
The patient complains of a metallic taste and loss of appetite. The nurse is concerned that the patient has developed what problem? a.Glycosuria b.Proteinuria c.Myoglobin d.Uremia
d.Uremia A history of recent onset of nausea and vomiting or appetite loss caused by taste changes (uremia often causes a metallic taste) may provide clues to the rapid onset of kidney problems. Glycosuria is the presence of glucose in the urine. Proteinuria is the presence of protein in the urine. Myoglobin is the presence of red blood cells in the urine.
A patient is admitted with acute kidney injury. The nurse would expect to see elevated values in which laboratory results? (Select all that apply.) a.Blood urea nitrogen (BUN) b.Creatinine c.Glucose d.Hemoglobin and hematocrit e.Protein
a.Blood urea nitrogen (BUN) b.Creatinine With kidney dysfunction, the blood urea nitrogen (BUN) is elevated because of a decrease in the glomerular filtration rate and resulting decrease in urea excretion. Elevations in the BUN can be correlated with the clinical manifestations of uremia; as the BUN rises, symptoms of uremia become more pronounced. Creatinine levels are fairly constant and are affected by fewer factors than BUN. As a result, the serum creatinine level is a more sensitive and specific indicator of kidney function than BUN. Creatinine excess occurs most often in persons with acute kidney injury resulting from impaired excretion. Decreased hematocrit value can indicate fluid volume excess because of the dilutional effect of the extra fluid load. Decreases also can result from anemias, blood loss, liver damage, or hemolytic reactions. In individuals with acute kidney injury, anemia may occur early in the disease.
A patient has been admitted with acute kidney injury. The nurse knows the most important consideration for evaluating the patient's fluid status is what parameter? select two a.Daily weights b.Urine and serum osmolality c.Intake and output d.Hemoglobin and hematocrit levels
a.Daily weights c.Intake and output One of the most important assessments of kidney and fluid status is the patient's weight. In the critical care unit, weight is monitored for each patient every day and is an important vital signs measurement.
Patient has been admitted who is severely malnourished. The patient's serum albumin is very low. Which finding would the nurse expect to see in this patient? a.Peripheral edema b.Extra heart sounds c.Hypertension d.Hyponatremia
a.Peripheral edema Decreased albumin levels in the vascular space result in a plasma-to-interstitium fluid shift, creating peripheral edema. A decreased albumin level can occur as a result of protein-calorie malnutrition, which occurs in many critically ill patients in whom available stores of albumin are depleted. A decrease in the plasma oncotic pressure results, and fluid shifts from the vascular space to the interstitial space.
A patient has been admitted in acute kidney failure with a 10-lb weight gain over 5 days. Which findings may be present in the patient? (Select all that apply.) a.S3 or S4 b.Distended neck veins c.Crackles d.Tachycardia with hypotension e.Edema that disappears with elevation of extremity
a.S3 or S4 b.Distended neck veins c.Crackles The patient is in fluid overload. An S3 or S4, distended neck veins, and crackles may be present in the patient. Tachycardia with hypotension is indicative of hypovolemia. Dependent edema that disappears with elevation of the extremity is indicative of poor circulation.
When calculating the anion gap, what is the predominant cation? a.Sodium b.Potassium c.Chloride d.Bicarbonate
a.Sodium The anion gap is a calculation of the difference between the measurable extracellular plasma cations (sodium and potassium) and the measurable anions (chloride and bicarbonate). In plasma, sodium is the predominant cation, and chloride is the predominant anion.
What causes the presence of myoglobin in urine? (Select all that apply.) a.Injection b.Crush injury c.Acidosis d.Rhabdomyolysis e.Intrarenal acute kidney injury
b.Crush injury d.Rhabdomyolysis Myoglobin in the urine may result from a crush injury or rhabdomyolysis. Intrarenal acute kidney injury can result from rhabdomyolysis. Infection and acidosis do not cause myoglobin to appear in the urine.
A patient is admitted in acute heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. Which diagnostic tests would provide the best information about the internal kidney structures, such as the parenchyma, calyces, pelvis, ureters, and bladder? a.Kidney-ureter-bladder (KUB) b.Intravenous pyelography (IVP) c.Renal ultrasonography (ECHO) d.Renal angiography
b.Intravenous pyelography (IVP) Intravenous pyelography allows visualization of the internal kidney parenchyma, calyces, pelvis, ureters, and bladder. Kidney-ureter-bladder flat-plate radiography of the abdomen determines the position, size, and structure of the kidneys, urinary tract, and pelvis. It is useful for evaluating the presence of calculi and masses and is usually followed by additional tests. In ultrasonography, high-frequency sound waves are transmitted to the kidneys and urinary tract, and the image is viewed on an oscilloscope. This noninvasive procedure identifies fluid accumulation or obstruction, cysts, stones or calculi, and masses. It is useful for evaluating the kidneys before biopsy. Angiography is injection of contrast into arterial blood perfusing the kidneys. It allows for visualization of renal blood flow and may also visualize stenosis, cysts, clots, trauma, and infarctions.
A patient has been on complete bed rest for 3 days. The practitioner has left orders to get the patient out of bed for meals. The patient complains of feeling dizzy and faint while sitting at the bedside. The nurse suspects that the patient is experiencing what problem? a.Orthostatic hypertension b.Orthostatic hypotension c.Hypervolemia d.Electrolyte imbalance
b.Orthostatic hypotension Orthostatic hypotension produces subjective feelings of weakness, dizziness, or faintness. Orthostatic hypotension occurs with hypovolemia or prolonged bed rest or as a side effect of medications that affect blood volume or blood pressure.
Percussion of kidneys is usually done to assess what parameter? a.Size and shape of the kidneys b.Presence of pain in the renal area c.Presence of a fluid wave d.Patient's overall fluid status
b.Presence of pain in the renal area Percussion is performed to detect pain in the area of a kidney or to determine excess accumulation of air, fluid, or solids around the kidneys. Percussion of the kidneys also provides information about kidney location, size, and possible problems
A patient has been admitted in acute heart failure. Which parameter would indicate to the nurse that the patient is fluid overloaded? a.Central venous pressure of 4 mm Hg b.Pulmonary artery occlusion pressure (PAOP) of 18 mm Hg c.Cardiac index of 2.5 L/min/m2 d.Mean arterial pressure of 40 mm Hg
b.Pulmonary artery occlusion pressure (PAOP) of 18 mm Hg The pulmonary artery occlusion pressure (PAOP) represents the left atrial pressure required to fill the left ventricle. When the left ventricle is full at the end of diastole, this represents the volume of blood available for ejection. It is also known as left ventricular preload and is measured by the PAOP. The normal PAOP is 5 to 12 mm Hg. In fluid volume excess, PAOP rises. In fluid volume deficit, PAOP is low.
A patient was admitted with acute kidney injury. Which urinalysis value reflects a decreased ability of the kidneys to concentrate urine? a.pH of 5.0 b.Specific gravity of 1.000 c.No casts d.Urine sodium of 140 mEq/24 hr
b.Specific gravity of 1.000 Specific gravity measures the density or weight of urine compared with that of distilled water. The normal urinary specific gravity is 1.005 to 1.025. For comparison, the specific gravity of distilled water is 1.000. Because urine is composed of many solutes and substances suspended in water, the specific gravity should always be higher than that of water.
A patient was admitted with acute heart failure a few days ago. Today the patient's urine has a specific gravity of 1.040. What could be the potential cause for this value? a.Volume overload b.Volume deficit c.Acidosis d.Urine ketones
b.Volume deficit Specific gravity ranges from 1.003 to 1.030. Possible causes for increased values include volume deficit, glycosuria, proteinuria, and prerenal acute kidney injury (AKI). Possible causes for decreased values include volume overload and intrarenal AKI.
A patient was admitted with acute heart failure. The nurse is assessing the patient for peripheral edema. The nurse presses two fingers over the tibial area, and it takes 1 minute before the indention disappears. What would the nurse in the medical record? a.+1 pitting edema b.+2 pitting edema c.+3 pitting edema d.+4 pitting edema
c.+3 pitting edema The pitting edema scale includes +1 = 2-mm depth; +2 = 4-mm depth (lasting up to 15 seconds); +3 = 6-mm depth (lasting up to 60 seconds); and +4 = 8-mm depth (lasting longer than 60 seconds).
A patient is admitted with acute kidney injury. The patient's weight upon admission was 176 lb and the next day it is 184 lb. What is the approximate amount of fluid retained with this weight gain? a.800 mL b.2200 mL c.3600 mL d.8000 mL
c.3600 mL One liter of fluid equals 1 kg, which is 2.2 lb; 8 lb equals 3.6 kg, which is 3.6 liters; 3.6 liters is equal to 3600 mL.
As serum osmolality rises, intravascular fluid equilibrium will be maintained by the release of what substance? a.Ketones b.Glucagon c.Antidiuretic hormone d.Potassium
c.Antidiuretic hormone When the serum osmolality level increases, antidiuretic hormone is released from the posterior pituitary gland and stimulates increased water resorption in the kidney tubules. This expands the vascular space, returns the serum osmolality level back to normal, and results in more concentrated urine and an elevated urine osmolality level.
A patient was admitted with acute heart failure who has been receiving diuretic therapy. The nurse suspects the patient is hypovolemic. What auscultatory parameter would confirm the nurse's suspicion? a.Hypertension b.Third or fourth heart sound c.Orthostatic hypotension d.Vascular bruit
c.Orthostatic hypotension A drop in systolic blood pressure of 20 mm Hg or more, a drop in diastolic blood pressure of 10 mm Hg or more, or a rise in pulse rate of more than 15 beats/min from lying to sitting or from sitting to standing indicates orthostatic hypotension. The drop in blood pressure occurs because a sufficient preload is not immediately available when the patient changes position. The heart rate increases in an attempt to maintain cardiac output and circulation.
A patient is admitted in acute kidney injury. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. The nurse suspects the main cause of ascites is what condition? a.Hypervolemia b.Dehydration c.Volume overload d.Liver damage
c.Volume overload Individuals with acute kidney injury may have ascites caused by volume overload, which forces fluid into the abdomen because of increased capillary hydrostatic pressures. However, ascites may or may not represent fluid volume excess.
