Exam 5 Kidney/Renal Prep U

The health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator? 1)Creatinine clearance level 2)Uric acid level 3)Blood urea nitrogen (BUN) 4)BUN to creatinine ratio

1)Creatinine clearance level The creatinine clearance measures the volume of blood cleared of endogenous creatinine in 1 minute. This serves as a measure of the glomerular filtration rate. Therefore the creatinine clearance test is a sensitive indicator of renal disease progression.

The nurse is preparing the client for magnetic resonance imaging (MRI) of the kidney. Which statement by the client requires action by the nurse? 1)I took my blood pressure medication with my morning coffee an hour ago." 2)"I had my last cigarette 3 hours ago with my morning coffee." 3)"I did not take my multivitamin this morning." 4)"I do not have a pacemaker, artificial heart valve, or artificial joints."

"I took my blood pressure medication with my morning coffee an hour ago." The client should not eat for at least 1 hour before an MRI. Alcohol, caffeine-containing beverages, and smoking should be avoided for at least 2 hours before an MRI. The client can take his or her usual medications except for iron supplements prior to the procedure

The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions? 1)"I can resume my usual activities without restriction." 2)"I should increase my fluid intake for the rest of the day." 3)"If I have difficulty urinating, I should contact my physician." 4)"It is normal for my urine to be blood-tinged."

1)"I can resume my usual activities without restriction." A bladder ultrasound is a non-invasive procedure. The client can resume usual activities without restriction.

An older client is experiencing an increasingly troublesome need to urinate several times through the night. The client's prostate is within normal limits, and the physician prescribes limiting fluid intake after the evening meal. What is another important intervention to keep the client safe? 1)Increase fluid intake throughout the day. 2)Decrease overall fluid intake. 3)Decrease salt intake. 4)Increase protein intake.

1)Increase fluid intake throughout the day. Older persons may need to drink more fluids throughout the day to allow for limiting their intake after the evening meal.

The nurse recognizes that a referral for genetic counseling is inappropriate for the client with: 1)Renal calculi 2)Alport syndrome 3)Polycystic kidney disease 4)Wilms' tumor

1)Renal calculi Wilms' tumor, polycystic disease, and Alport are conditions that have a genetic influence. Renal calculi are not influenced by genetic factors.

BUN Levels

Normal BUN 10-20 mg/dL Critical BUN >100 mg/dL

Creatinine Levels

Normal Creatinine: Male: 0.6-1.2 mg/dL Female 0.5-1.1 mg/dL Critical Critical Creatinine: >4 mg/dL

The term used to describe total urine output less than 0.5 mL/kg/hr is 1)oliguria. 2)anuria. 3)nocturia. 4)dysuria.

Oliguria Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output less than 50 mL in 24 hours.

The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program? 1)Hypotension 2)Diabetes mellitus 3)Neuromuscular disorders 4)Pregnancy

1)Hypotension Hypertension, not hypotension, is a risk factor for kidney disease

While reviewing a client's chart, the nurse notes the client has been experiencing enuresis. To assess whether this remains an ongoing problem for the client, the nurse asks which question? 1)"Do you have a strong desire to void?" 2)"Do you urinate while sleeping?" 3)"Does it burn when you urinate?" 4)"Is it painful when you urinate?"

2)"Do you urinate while sleeping?" Enuresis is defined as involuntary voiding during sleep. The remaining questions do not relate to this problem associated with changes in the client's voiding pattern.

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? 1)10% 2)20% 3)30% 4)40%

2)20% Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 L/day of filtrate.

Which hormone causes the kidneys to reabsorb sodium? 1)Antidiuretic hormone 2)Aldosterone 3)Growth hormone 4)Prostaglandins

2)Aldosterone Aldosterone is a hormone synthesized and released by the adrenal cortex. Antidiuretic hormone is secreted by the posterior pituitary gland. Growth hormone and prostaglandins do not cause the kidneys to reabsorb sodium.

A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate, I can't control it and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence? 1)Stress 2)Urge 3)Overflow 4)Functional

2)Urge Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding in time to reach a toilet

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. Which is an example of how urine concentration is affected? 1)On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. 2)On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. 3)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. 4)When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity may vary widely.

On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. 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 caring for a client scheduled for urodynamic testing. Following the procedure, which information does the nurse provide to the client? 1)"Contact the primary provider if you experience fever, chills, or lower back pain." 2)"You will be sent home with a urinary catheter." 3)"You may resume consuming caffeinated, carbonated, and alcoholic beverages." 4)"You can stop taking the prescribed antibiotic."

1)"Contact the primary provider if you experience fever, chills, or lower back pain." The client must be made aware of the signs of a urinary tract infection after the procedure. The client should contact the primary provider if fever, chills, lower back pain, or continued dysuria and hematuria occur.

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? 1)Bleeding 2)Infection 3)Dehydration 4)Allergic reaction

1)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.

Which nursing assessment finding indicates the client with renal dysfunction has not met expected outcomes? 1)Client reports increasing fatigue. 2)Client rates pain at a 3 on a scale of 0 to 10. 3)Client denies frequency and urgency. 4)Urine output is 100 ml/hr.

1)Client reports increasing fatigue. Fatigue, shortness of breath, and exercise intolerance are consistent with unexplained anemia, which can be secondary to gradual renal dysfunction.

A client with a history of chronic renal infections is to undergo CT with contrast. Before the procedure, the nurse should complete which action? 1)Place emergency medical equipment in the procedure room. 2)Instruct the client to maintain a full bladder for the diagnostic test. 3)Hold the client's iron supplement until after the diagnostic test. 4)Keep the client NPO for 1 hour before the scan.

1)Place emergency medical equipment in the procedure room. For some clients, contrast agents are nephrotoxic and allergenic. Emergency equipment and medications should be available in case of an anaphylactic reaction to the contrast agent. Emergency supplies include epinephrine, corticosteroids, vasopressors, oxygen, and airway and suction equipment. The client is instructed to maintain a full bladder for an ultrasonography. The other instructions/interventions relate to magnetic resonance imaging.

The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to: 1)drink liberal amounts of fluids. 2)maintain bed rest for 2 hours. 3)carefully handle urine because it is radioactive. 4)notify the health care team if bloody urine is noted.

1)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 secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? 1)glucose 2)potassium 3)creatinine 4)chloride

1)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.

At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much is this loss equal to? 1)0.5 lb 2)1.0 lb 3)1.5 lb 4)2 lb

1.0 lb The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1-kg (2-lb) weight loss is equal to 1,000 mL.

The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium? 1)Butter 2)Citrus fruits 3)Cooked white rice 4)Salad oils

2)Citrus fruits Foods and fluids containing potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee) are restricted.

The nurse recognizes which condition as an integumentary manifestation of chronic renal failure? 1)Asterixis 2)Gray-bronze skin color 3)Tremors 4)Seizures

2)Gray-bronze skin color Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.

The nurse observes that the client's urine is orange. Which additional assessment would be important for this client? 1)Bleeding 2)Intake of medication such as phenytoin 3)Intake of multiple vitamin preparations 4)Infection

2)Intake of medication such as phenytoin Urine that is orange may be caused by intake of phenytoin or other medications. Orange to amber-colored urine may also indicate concentrated urine due to dehydration or fever. Urine that is pink to red may indicate lower urinary tract bleeding. Urine that is bright yellow is an anticipated abnormal finding in the client taking a multiple vitamin preparation.

Examination of a client's bladder stones reveals that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet? 1)Low oxalate 2)Low purine 3)High protein 4)High sodium

2)Low purine A low-purine diet is used for uric acid stones, although the benefits are unknown. Clients with a history of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate

A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? 1)Monitor the client for signs of electrolyte and water imbalance. 2)Monitor the client for an allergy to iodine contrast material. 3)Assess the client's mental changes. 4)Evaluate the client for periorbital edema.

2)Monitor the client for an allergy to iodine contrast material. A renal angiography procedure will be contraindicated if the client is allergic to iodine contrast material. Therefore, it is important for the nurse to monitor the client for an allergy to iodine contrast material. The nurse monitors the client for the signs of electrolyte and water imbalance, mental changes, and periorbital edema at any time regardless of the test being done.

Which is an effect of aging on upper and lower urinary tract function? 1)Increased glomerular filtration rate 2)More prone to develop hypernatremia 3)Increased blood flow to the kidneys 4)Acid-base balance

2)More prone to develop hypernatremia The elderly are more prone to develop hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidneys, and acid-base imbalances.

The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder? 1)Incontinence 2)Dysuria 3)Hematuria 4)Frequency

3)Hematuria The most common first symptom of a malignant tumor is hematuria. Most malignant tumors are vascular; thus, abnormal bleeding can be a first sign of abnormality. The client then has symptoms of incontinence (a later sign), dysuria and frequency.

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? 1)Previous episode of acute pyelonephritis 2)History of hyperparathyroidism 3)Recent history of streptococcal infection 4)History of osteoporosis

3)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 group of students is reviewing for a test on the urinary and renal system. The students demonstrate understanding of the information when they identify which of the following as part of the upper urinary tract? 1)Bladder 2)Urethra 3)Ureters 4)Pelvic floor muscles

3)Ureters The upper urinary tract is composed of the kidneys, renal pelvis, and ureters. The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.

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: 1)oliguria. 2)polyuria. 3)anuria. 4)hematuria.

3)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.

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: 1)keep the client's knee on the affected side bent for 6 hours. 2)apply pressure to the puncture site for 30 minutes. 3)check the client's pedal pulses frequently. 4)remove the dressing on the puncture site after vital signs stabilize.

3)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 is reviewing the results of a client's renal function study. The nurse understands that which value represent a normal BUN-to-creatinine ratio? 1)4:1 2)6:1 3)8:1 4)10:1

4)10:1 A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect.

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? 1)Pats skin dry after bathing 2)Uses moisturizing creams 3)Keeps nails trimmed short 4)Brief, hot daily showers

4)Brief, hot daily showers Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.

The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition? 1)Adventitia (connective tissue) 2)Detrusor muscle 3)Submucosal layer of connective tissue 4)Inner layer of epithelium

Detrusor muscle The bladder wall contains four layers. The smooth muscle layer beneath the adventitia is known as the detrusor layer. When this muscle contracts, urine is released from the bladder. When the bladder is relaxed, the muscle fibers are closed and act as a sphincter.

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? 1)Encourage oral fluids. 2)Administer furosemide (Lasix) 20 mg IV 3)Start hemodialysis after a temporary access is obtained. 4)Start IV fluids with a normal saline solution bolus followed by a maintenance dose.

Start IV fluids with a normal saline solution bolus followed by a maintenance dose. The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? 1)Serum potassium level of 4.9 mEq/L 2)Serum sodium level of 135 mEq/L 3)Temperature of 99.2° F (37.3° C) 4)Urine output of 20 ml/hour

Urine output of 20 ml/hour Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification.

Urine Specific Gravity

Urine specific gravity results will fall between 1.002 and 1.030 if your kidneys are functioning normally