NURS 223 - MS Q3, Study Guide

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

A (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.)

The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following? a) Metabolic alkalosis b) Hypophosphatemia c) Hypokalemia d) Anemia

D (Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic glomerulonephritis.)

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a) Weight loss b) Absence of pain c) Diuresis d) Fever

D (Fever is an indicator of infection or transplant rejection.)

The nurse is passing out medications on a medical-surgical unit. A male patient is preparing for hemodialysis. The patient is ordered to receive numerous medications including antihypertensives. Which of the following is the best action for the nurse to take? a) Administer the medications as ordered. b) Ask the patient if he wants to take his medications. c) Check with the dialysis nurse about the medications. d) Hold the medications until after dialysis.

D (No rationale available)

Which of the following nursing actions is most important in caring for the client following lithotripsy? a) Administer allopurinol (Zyloprim). b) Notify the physician of hematuria. c) Monitor the continuous bladder irrigation. d) Strain the urine carefully for stone fragments.

D (The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical analysis.)

The nurse is caring for a patient who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed which of the following? a) Acute rejection b) Chronic rejection c) Simple rejection d) Hyperacute rejection

D (After a kidney transplant, rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years. A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized glomerular capillary thrombosis and necrosis. The term "simple" is not used in the categorization of types of rejection of kidney transplants.)

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: a) "As the disease progresses, you will most likely require renal replacement therapy." b) "Draining of the cysts and antibiotic therapy will cure your disease." c) "Dietary changes can reverse the damage that has occurred in your kidneys." d) "Genetic testing will determine the best treatment for your condition."

A (There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.)

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about: a) childhood asthma. b) chronic, excessive acetaminophen use. c) family history of pernicious anemia. d) recent streptococcal infection.

d) recent streptococcal infection. A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction.

The laboratory results for a patient with renal failure, accompanied by decreased glomerular filtration, would be evaluated frequently. Which of the following is the most sensitive indicator of renal function? a) Serum creatinine of 1.5 mg/dL b) Creatinine clearance of 90 mL/min c) Urinary protein level of 150 mg/24h. d) BUN of 20 mg/dLb

A (As glomerular filtration decreases, the serum creatinine and BUN levels increase and the creatinine clearance decreases. Serum creatinine is the more sensitive indicator of renal function because of its constant production in the body. The BUN is affected not only by renal disease but also by protein intake in the diet, tissue catabolism, fluid intake, parenteral nutrition, and medications such as corticosteroids.)

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? a) Oliguria b) Acute tubular necrosis c) Diuresis d) Restored glomerular function

A (During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.)

A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? a) "Very few symptoms are associated with renal cancer." b) "You should have sought treatment earlier." c) "Squamous cell carcinomas do not present with detectable symptoms." d) "Painless gross hematuria is the first symptom in renal cancer."

A (Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease. Adenocarcinomas are the most common renal cancer (about 80%),whereas squamous cell renal cancers are rare. It is not therapeutic to place doubt or blame for delayed diagnosis.)

A male client who is admitted with the diagnosis of urinary calculi complains of excruciating pain. The pain is suspected to be caused by increased pressure in the renal pelvis. Which measure would be most appropriate to provide pain relief? a) Encourage frequent ambulation. b) Encourage deep-breathing exercises. c) Encourage the client to void every 2 to 3 hours. d) Restrict the client's sodium intake.

A (When a client with urinary calculi complains of excruciating pain, the client should be encouraged to ambulate. This is because the supine position increases colic, while ambulation relieves it. Also, adequate fluid intake should be suggested to promote the passage of stones and to prevent urinary stasis, or the formation of new stones. The client should be encouraged to void when there is a risk of infection related to urinary stasis. The suggestion for restricting sodium intake is offered to a client with chronic glomerulonephritis, not urinary calculi. The nurse should promote deep-breathing exercises to provide relief to a client recovering from surgery who has an ineffective breathing pattern.)

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a) Urine output of 250 ml/24 hours b) Temperature of 100.2° F (37.8° C) c) Serum creatinine level of 1.2 mg/dl d) Blood urea nitrogen (BUN) level of 22 mg/dl

A (ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.)

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? a) Cola-colored urine b) Hyperalbuminemia c) Peripheral neuropathy d) Hypotension

A (Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.)

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) Assess the AV fistula for a bruit and thrill. b) Keep the AV fistula site dry. c) Take the client's blood pressure in the left arm. d) Keep the AV fistula wrapped in gauze.

A (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 client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a) Risk for infection b) Impaired urinary elimination c) Toileting self-care deficit d) Activity intolerance

A (The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.)

Which clinical finding should a nurse look for in a client with chronic renal failure? a) Uremia b) Polycythemia c) Hypotension d) Metabolic alkalosis

A (Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.)

A client in chronic renal failure becomes confused and complains of abdominal cramping, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? a) Hyperkalemia b) Elevated white blood cells c) Hypocalcemia d) Elevated urea levels

A (Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.)

Nephrotoxicity can occur as a result of the use of aminoglycosides such as gentamicin. Select all of the following statements which are true. a) Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity. b) Signs of nephrotoxicity may not occur until the client has received 5 or more days of therapy. c) All statements are true. d) Nephrotoxicity from the use of the aminoglycosides is reversible if the drug is discontinued as soon as the symptoms appear.

A) Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity. B) Signs of nephrotoxicity may not occur until the client has received 5 or more days of therapy. D) Nephrotoxicity from the use of the aminoglycosides is reversible if the drug is discontinued as soon as the symptoms appear. Rationale: Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity. Signs of nephrotoxicity may not occur until the client has received 5 or more days of therapy. Nephrotoxicity from the use of the aminoglycosides is reversible if the drug is discontinued as soon as the symptoms appear.

The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply. a) Phosphate 5.0 mg/dL; tachycardia and nausea and emesis b) Calcium 7.5 mg/dL; hypotension and irritability c) Chloride 90 mEq/L; irritability and seizures d) Potassium 6.4 mEq/L; dysrhythmias and abdominal distention e) Magnesium 1.5 mg/dL; mood changes and insomnia

A, B, D (Decreased calcium, increased potassium, and increased phosphate levels are associated with ESKD, along with the signs and symptoms associated with these serum values. Decreased magnesium and chloride levels are not associated with ESKD.)

Patient education regarding a fistulae or graft includes which of the following? Select all that apply. a) Check daily for thrill and bruit. b) No IV or blood pressure taken on extremity with dialysis access. c) Cleanse site b.i.d. d) Avoid compression of the site. e) No tight clothing.

A, B, D, E (The nurse teaches the patient with fistulae or grafts to check daily for a thrill and bruit. Further teaching includes avoiding compression of the site; not permitting blood to be drawn, an IV to be inserted, or blood pressure to be taken on the extremity with the dialysis access; not to wear tight clothing, carry bags or pocketbooks on that side, and not lie on or sleep on the area. The site is not cleansed unless it is being accessed for hemodialysis.)

The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? (Select all that apply.) a) Red blood cells in the urine b) Proteinuria c) Polyuria d) Hemoglobin of 12.8 g/dL e) White cell casts in the urine

A, B, E (The primary presenting features of an acute glomerular inflammation are hematuria, edema, azotemia (an abnormal concentration of nitrogenous wastes in the blood), and proteinuria (excess protein in the urine) (Porth & Matfin, 2009). The urine may appear cola colored because of red blood cells (RBCs) and protein plugs or casts; RBC casts indicate glomerular injury.)

Mr. Jarvis's renal failure has become chronic. You are seeing him in clinic and he discusses the various signs and symptoms he is experiencing. Select all of the following which you know to be associated with chronic renal failure. a) Muscle cramps b) Enhanced cognition c) Bleeding of the oral mucous membranes d) Lethargy

A, C, D (Lethargy, muscle cramps, and bleeding of the oral mucous membranes are some of the signs and symptoms of chronic renal failure. With chronic renal failure, mental processes progressively slow as electrolyte imbalances become marked and nitrogenous wastes accumulate.)

Common tests of renal function include which of the following? Select all that apply. a) Serum creatinine b) Arterial blood gas analysis c) Blood urea nitrogen (BUN) d) Creatinine clearance e) Renal concentration test

A, C, D, E (Common tests of renal function include BUN, serum creatinine, creatinine clearance, and renal concentration tests. Arterial blood gas analysis is a test of respiratory function.)

In which of the following renal disorders would one suspect a decreased urine specific gravity? Select all that apply a) Glomerulonephritis b) Diabetes c) Severe renal damage d) Fluid deficits e) Diabetes insipidus

A, C, E (Disorders or conditions that cause decreased urine specific gravity (ie, dilute urine) include diabetes insipidus, glomerulonephritis, and severe renal damage that may cause a fixed specific gravity of 1.010. Etiologies associated with increased urine specific gravity include diabetes mellitus, patients who have recently received high density radiopaque dyes, and fluid deficit.)

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? a) Low blood pressure b) Tea-colored urine c) Left upper quadrant pain d) Pyuria

B (Tea-colored urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis.)

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: a) increased urine output. b) weight loss. c) increased blood pressure. d) hematuria.

B (Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.)

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes: a) acute bone pain and confusion. b) confusion, headache, and seizures. c) weakness, tingling, and cardiac arrhythmias. d) hypotension, tachycardia, and tachypnea.

B (Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiological functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication.)

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? a) Providing pain-relief measures b) Limiting fluid intake c) Encouraging coughing and deep breathing d) Promoting carbohydrate intake

B (During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.)

A 32 year old female client has come to your clinic with a complaint of hematuria, or the presence of red blood cells in the urine. Of the following, which is not a cause of hematuria? a) Renal stones b) Lithium toxicity c) Extreme exercise d) Acute glomerulonephritis

B (Hematuria may be caused by cancer of the genitourinary tract, acute glomerulonephritis, renal stones, renal tuberculosis, blood dyscrasias, trauma, extreme exercise, rheumatic fever, hemophilia, leukemia, or sickle cell trait or disease.)

As an inflammatory response in the glomerular capillary membrane, the renal filtration system is disrupted. Although diagnostic urinalysis can reveal glomerulonephritis, many of those suffering with glomerulonephritis exhibit what symptoms? a) Fever b) No symptoms c) Polyuria d) Headache

B (Many clients with glomerulonephritis have no symptoms. Early symptoms may be so slight that the client does not seek medical attention.)

The nurse is helping a patient to correctly perform peritoneal dialysis at home. The nurse must educate the patient about the procedure. Which educational information should the nurse provide to the patient? a) Keep the catheter stabilized to the abdomen, below the belt line b) Wear a mask while handling any dialysate solutions c) Keep the dialysis supplies in a clean area, away from children and pets d) Clean the catheter insertion site daily with soap

C (It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a patient has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine (Betadine), not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.)

The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? a) BUN of 18 mg/dL. b) Glomerular filtration rate (GFR) of 100 mL/min. c) Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. d) Serum creatinine of 1.2 mg/dL.

C (The normal BUN:Cr ratio is less than 15. Prerenal azotemia is caused by hypoperfusion of the kidneys due to a nonrenal cause. Over time, higher than normal blood levels of urea or other nitrogen-containing compounds will develop.)

A client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for: a) dehydration. b) paresthesia. c) cardiac arrhythmia. d) pruritus.

C (As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn't cause paresthesia (sensations of numbness and tingling). Dehydration doesn't occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. In the client with ARF, pruritus results from increased phosphates and isn't associated with hyperkalemia.)

The nurse is educating a patient who is required to restrict potassium intake. What foods would the nurse suggest the patient eliminate that are rich in potassium? a) Cooked white rice b) Salad oils c) Citrus fruits d) Butter

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

An expected outcome for the hemodialysis client is: a) The client identifies signs and symptoms of rejection. b) The client demonstrates how to administer the dialysate by gravity. c) The client explains how to assess the venous access site. d) The client verbalizes the dwell time for the dialysate.

C (Hemodialysis requires the creation of an arterio-venous access site. The absence of a palpable thrill suggests the AV site is blocked or clotted.)

Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? a) Blood tinged drainage in Jackson-Pratt drainage tube b) Urine output of 35 to 40 mL/hour c) SpO2 at 90% with fine crackles in the lung bases d) Pain of 3 out of 10, 1 hour after analgesic administration

C (The Risk for Ineffective Breathing Pattern is often a challenge in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output is monitored to maintain a urine output of greater than 30 mL/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.)

Which of the following is a characteristic of the intrarenal category of acute renal failure? a) Decreased creatinine b) High specific gravity c) Increased BUN d) Decreased urine sodium

C (The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.)

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? a) "Let's wait until after the surgery to discuss your treatment plan." b) "The doctor may decide to delay the use of immunosuppressant drugs." c) "Immunosuppressive drugs guarantee organ success." d) "Even a perfect match does not guarantee organ rejection."

D (Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.)

The nurse is administering calcium acetate (PhosLo) to a patient with ESKD. When is the best time for the nurse to administer this medication? a) 2 hours before meals b) 2 hours after meals c) At bedtime with 8 ounces of fluid d) With food

D (Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. The nurse administers phosphate binders with food for them to be effective.)

A client has undergone a renal transplant and returns to the healthcare agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? a) Polyuria b) Hypotension c) Weight loss d) Abdominal pain

D (Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.)

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? a) Avoid carrying heavy items. b) Auscultate the lungs frequently. c) Perform deep-breathing exercises vigorously. d) Wear a mask when performing exchanges.

D (The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.)

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) hematuria. c) polyuria. d) anuria.

D (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.)

The nurse notes that the client's urine is blood-tinged following cystoscopy. Which of the following nursing actions should the nurse do next? a) Instruct the client to increase fluid intake. b) Inspect the client's urinary meatus. c) Notify the physician of the finding. d) Document the finding in the health record.

D (The physician does not need to be contacted as blood-tinged urine is an expected finding following cystoscopy due to trauma of the procedure. The nurse should document the finding and continue to monitor the client. The client should be encouraged to increase fluid intake to help flush the urinary tract of microorganisms. The urinary meatus does not need to be inspected.)

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? a) 20% b) 30% c) 40% d) 10%

a) 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.

Serum sodium plays a major role in maintaining fluid and electrolyte balance. Choose all the correct statements that apply. a) Aldosterone causes renal reabsorption of sodium. b) About 45% of sodium in the renal filtrate is absorbed. c) The normal serum sodium level is 90 to 120 mmol/L. d) Angiotensin II controls the release of aldosterone. e) Renin, an enzyme released by the kidneys, activates the RAS system to ensure adequate filtration.

a) Aldosterone causes renal reabsorption of sodium. d) Angiotensin II controls the release of aldosterone. e) Renin, an enzyme released by the kidneys, activates the RAS system to ensure adequate filtration. The renin-angiotensin system (RAS) maintains the balance of fluid volume. Refer to Figure 26-4 in the text.

A 32-year-old client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure and postprocedural assessments. What postprocedural assessment will you perform on the client? a) All options are correct. b) Palpate pedal pulses. c) Monitor site condition. d) Hypersensitivity response

a) All options are correct. After the procedure, the physician applies a pressure dressing to the femoral area, which remains in place for several hours. The nurse palpates the pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Monitoring the pressure dressing is important to note frank bleeding or hematoma formation. If either condition occurs, the nurse immediately notifies the physician. Another important assessment is for hypersensitivity responses to contrast material. The client remains on bed rest for 4 to 8 hours. The nurse also monitors and documents intake and output.

An appropriate nursing intervention for the client following a nuclear scan of the kidney is to: a) Encourage high fluid intake. b) Apply moist heat to the flank area. c) Strain all urine for 48 hours. d) Monitor for hematuria.

a) Encourage high fluid intake. A nuclear scan of the kidney involves the IV administration of a radioisotope. Fluid intake is encouraged to flush the urinary tract to promote excretion of the isotope. Monitoring for hematuria, applying heat, and straining urine do not address the potential renal complications associated with the radioisotope.

When the bladder contains 350 mL or more of urine, this is referred to as which of the following? a) Functional capacity b) Renal clearance c) Specific gravity d) Anuria

a) Functional capacity A marked sense of fullness and discomfort, with a strong desire to void, usually occurs when the bladder contains 350 mL or more of urine, referred to as the "functional capacity." Anuria is a total urine output of 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.

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

a) Immobility b) Spinal cord injury c) Sickle-cell anemia 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.

To obtain information about the chief complaint and medical history of an older male patient, the nurse asks the patient about his medication history. What is the importance of obtaining a medication history? a) It may indicate multiple medications administered by the patient. b) It may indicate drugs that should not be prescribed to the patient. c) It may reflect the patient's childhood and family illnesses. d) It may indicate the patient's general health.

a) It may indicate multiple medications administered by the patient. The nurse should obtain information about a patient's medication history because older patients, in particular, may be taking multiple medications that may affect their renal function. The medication history in general indicates the probable risk factors of renal or urologic disorders. The medication history of an older patient is not used to obtain information about the patient's general health, childhood and family illnesses, or drugs that are restricted to the patient.

The term used to describe total urine output of less than 400 mL in 24 hours is a) oliguria. b) nocturia. c) dysuria. d) anuria.

a) oliguria. Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output of less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Dysuria refers to painful or difficult urination.

A patient is having an MAG3 renogram and is informed that radioactive material will be injected to determine kidney function. What should the nurse instruct the patient to do during the procedure? a) Lie still on the table for approximately 35 minutes. b) Take deep breaths and hold them at various times throughout the procedure. c) Drink contrast material at various intervals during the procedure. d) Turn from side to side to get a variety of views during the procedure.

a) Lie still on the table for approximately 35 minutes. This relatively new scan is used to further evaluate kidney function in some centers. The patient is given an injection containing a small amount of radioactive material, which will show how the kidneys are functioning. The patient needs to lie still for about 35 minutes while special cameras take images.

Enlargement of the prostate causes which of the following to occur? Select all that apply. a) Oliguria b) Frequency c) Obstruction of urine flow d) Polyuria e) Anuria

a) Oliguria b) Frequency c) Obstruction of urine flow e) Anuria Enlargement of the prostate gland causes obstruction of urine flow, resulting in frequency, oliguria, and anuria. Polyuria does not occur.

The nurse is caring for a patient complaining of orange-colored urine. The nurse suspects which of the following as the cause of the urine discoloration? a) Pyridium (phenazopyridium HCl) b) Infection c) Metronidazole (Flagyl) d) Phenytoin (Dilantin)

a) Pyridium (phenazopyridium HCl) Orange to amber-colored urine is caused by concentrated urine due to dehydration, fever, bile, excess bilirubin or carotene, and the medications Pyridium (phenazopyridium HCl) and nitrofurantoin (Furadantin). Infection would cause yellow to milky white urine. Phenytoin (Dilantin) would cause the urine to become pink to red in color. Metronidazole (Flagyl) would cause the urine to become brown to black in color.

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) Strenuous exercise b) Prolonged standing c) NSAIDs d) Diabetes mellitus e) Fever

a) Strenuous exercise b) Prolonged standing e) Fever 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. Causes of persistent proteinuria include glomerular diseases, malignancies, collagen diseases, diabetes, preeclampsia, hypothyroidism, heart failure, exposure to heavy metals, and use of medications, such as drugs, NSAIDs, and angiotensin-converting enzyme (ACE) inhibitors.

The nurse is assessing a patient upon admission to the hospital. What significant nursing assessment data is relevant to renal function? (Select all that apply.) a) The patient's occupation b) The patient's financial status c) The ability of the patient to manage activities of daily living d) Any voiding disorders e) The presence of hypertension or diabetes

a) The patient's occupation d) Any voiding disorders e) The presence of hypertension or diabetes When obtaining the health history, the nurse should inquire about the following: dysuria (painful or difficult urination), as well as when during voiding (i.e., at initiation or at termination of voiding) this occurs; occupational, recreational, or environmental exposure to chemicals (plastics, pitch, tar, rubber); hypertension; or diabetes.

A client asks the nurse why a creatinine clearance test is accurate. The nurse is most correct to reply which of the following? a) "Creatinine is found in the urine to make the urine acidic and can be measured." b) "Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." c) "Creatinine is a stress-related response that is excreted by the kidney." d) "Creatinine is metabolized in the liver and excreted by the kidney at a regular rate."

b) "Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." A creatinine clearance test is used to determine kidney function and creatinine excretion. Creatinine results from a breakdown of phosphocreatine. It is filtered by the glomeruli and excreted at a consistent rate by the kidney.

A female patient presents to the health clinical for a routine physical examination. The nurse observes that the patient's urine is bright yellow in color. Which of the following questions is most appropriate for the nurse to ask the patient? a) "Do you take phenytoin (Dilantin) daily?" b) "Do you take multiple vitamin preparations?" c) "Have you noticed any vaginal bleeding?" d) "Have you had a recent urinary tract infection?"

b) "Do you take multiple vitamin preparations?" Urine that is bright yellow is an anticipated abnormal finding in the patient taking a multiple vitamin preparation. Urine that is orange may be caused by intake of Dilantin 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. Yellow to milky white urine may indicate infection, pyuria, or, in the female patient, the use of vaginal creams.

A nurse measures a patient's urinary output every 8 hours. The nurse weighs the importance of these results by comparing the normal 24-hour urinary output with the patient's condition and medication. The normal 24-hour output should be: a) 0.4 to 0.8 L/day b) 1 to 2 L/day c) 3.5 to 4 L/day d) 2.5 to 3 L/day

b) 1 to 2 L/day The normal output of urine every 24 hours is 800 to 1,500 mL. Refer to Table 26-1 in the text. The significance of the 24-hour result will depend on the patient's medical condition.

The nurse is caring for a client prescribed gentamicin 110 mg every 8 hours for 10 days. Which laboratory study is anticipated to monitor medication side effects? a) Blood chemistry b) BUN and serum creatinine c) Creatinine clearance test d) Urine osmolality

b) BUN and serum creatinine The client who is on a therapeutic regimen of gentamicin is ordered laboratory studies of a BUN and serum creatinine to monitor for signs of nephrotoxicity related to medication therapy. Nephrotoxicity from the use of an aminoglycoside is reversible if the medication is discontinued. The other laboratory studies do not focus on nephrotoxicity.

A creatinine clearance test has been ordered. The nurse prepares to: a) Obtain a blood specimen. b) Collect the client's urine for 24 hours. c) Insert a straight catheter for a specimen. d) Obtain a clean catch urine.

b) Collect the client's urine for 24 hours. A creatinine clearance test is a 24-hour urine test and is useful in evaluating renal disease.

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) Uric acid level b) Creatinine clearance level c) Blood urea nitrogen level d) Serum potassium 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.

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? a) Uric acid level b) Creatinine clearance level c) Blood urea nitrogen (BUN) d) BUN to creatinine ratio

b) 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 client is admitted to the nursing unit for a biopsy of the urinary tract tissue. When planning nursing care for the postoperative period, which nursing intervention documents the prescribed activity level? a) Ambulate the client in the hall b) Maintain the client on bedrest c) Assist the client for bathroom privileges d) Activity as tolerated

b) Maintain the client on bedrest In the postoperative period, the client remains on bed rest as the nurse assess for signs of bleeding. If the client is to be discharged on the following day, the client is to maintain limited activity for several days to avoid spontaneous bleeding.

The nephrons are the functional units of the kidney, responsible for the initial formation of urine. The nurse knows that damage to the area of the kidney where the nephrons are located will affect urine formation. Identify that area. a) Renal pelvis b) Renal cortex c) Renal medulla d) Renal papilla

b) Renal cortex The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex.

The most frequent reason for admission to skilled care facilities includes which of the following? a) Stroke b) Urinary incontinence c) Congestive heart failure d) Myocardial infarction

b) Urinary incontinence Urinary incontinence is the most common reason for admission to skilled nursing facilities.

The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? a) "I should remove all jewelry before the test." b) "I should let the staff know if I feel claustrophobic." c) "I will feel a warm sensation as the dye is injected." d) "I will need to drink all of the dye as quickly as possible."

c) "I will feel a warm sensation as the dye is injected." A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected.

Which statement by the client preparing for a voiding cystourethrography indicates further teaching by the nurse is needed? a) "My bladder will be filled with dye using a urinary catheter." b) "Pictures will be taken of my bladder as I urinate, using ultrasound." c) "The dye is injected through an IV." d) "I will need to drink all of the dye as quickly as possible."

c) "The dye is injected through an IV." A contrast agent is instilled into the bladder through a urinary catheter. Fluroroscopy is used to examine the lower urinary tract.

A patient has a history of multiple urinary tract infections. The nurse catheterized the patient and confirmed the presence of residual urine. Select the urine volume that is significantly associated with the risk of infection. a) 100 mL b) 50 mL c) 150 mL d) 25 mL

c) 150 mL Residual urine volume of more than 100 mL is significantly associated with the risk of infection. Amounts of less than 100 are within a normal range.

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? a) 40 b) 30 c) 50 d) 20

c) 50 Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal.

The nurse is caring for a patient with a medical history of sickle cell anemia. The nurse understands this predisposes the patient to which of the following possible renal or urologic disorders? a) Kidney stone formation b) Neurogenic bladder c) Chronic kidney disease d) Proteinuria

c) Chronic kidney disease A medical history of sickle cell anemia predisposes the patient to the development of chronic kidney disease. The other disorders are not associated with the development of sickle cell anemia.

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? a) Liver function studies b) Therapeutic index c) Creatinine clearance d) GI absorption rate

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 client has undergone diagnostic testing that involved the insertion of a lighted tube with a telescopic lens. The nurse identifies this test as which of the following? a) Renal angiography b) Excretory urogram c) Cystoscopy d) Intravenous pyelography

c) Cystoscopy Cystoscopy is the visual examination of the inside of the bladder using an instrument called a cystoscope, a lighted tube with a telescopic lens. Renal angiography involves the passage of a catheter up the femoral artery into the aorta to the level of the renal vessels. Intravenous pyelography or excretory urography is a radiologic study that involves the use of a contrast medium to evaluate the kidneys' ability to excrete it.

The nurse analyzes a urinalysis report. He is aware that the presence of this substance in the urine indicates a blood level that exceeds the kidney's reabsorption capacity. Select the substance. a) Bicarbonate b) Sodium c) Glucose d) Creatinine

c) Glucose Glucose is usually filtered at the level of the glomerulus. It does not normally appear in the urine. Renal glycosuria occurs if the glucose in the blood exceeds the amount that is able to be reabsorbed. The other substances are normally excreted in the urine.

A patient with a history of chronic renal infections is ordered a CT scan with contrast. Prior to the procedure, the nurse should complete which of the following? a) Hold the patient's iron supplement until after the diagnostic test. b) Instruct the patient to maintain a full bladder for the diagnostic test. c) Place emergency medical equipment in the procedure room. d) Keep the patient NPO 1 hour prior to the scan.

c) Place emergency medical equipment in the procedure room. For some patients, 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 patient is instructed to maintain a full bladder for an ultrasonography. The other instructions/interventions relate to an MRI.

Which of the following is an effect of aging on upper and lower urinary tract function? a) Increased GFR b) Acid-base balance c) Susceptibility to develop hypernatremia d) Increased blood flow to the kidney

c) Susceptibility to develop hypernatremia The elderly are more susceptible to develop hypernatremia. These patients typically have a decreased GFR, decreased blood flow to the kidney, and acid-base imbalances.

The nurse is educating a patient about preparation for an IV urography. What should the nurse be sure to include in the preparation instructions? a) The patient will have enemas until the urine is clear. b) The patient is restricted from eating or drinking from midnight until after the test. c) The patient may have liquids before the test. d) A liquid restriction for 8 to 10 hours before the test is required

c) The patient may have liquids before the test. IV urography may be used as the initial assessment of many suspected urologic conditions, especially lesions in the kidneys and ureters. The patient preparation is the same as for excretory urography, except fluids are not restricted.

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

d) "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.

A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client? a) "A contrast medium will be used to help see the structures better." b) "You'll have a pressure dressing on your groin after the test." c) "An x-ray will be done to view your kidneys, ureters, and bladder." d) "You don't need to do any fasting before this noninvasive test."

d) "You don't need to do any fasting before this noninvasive test." Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. It is not invasive, does not require the injection of a radiopaque dye, and does not require fasting or bowel preparation. An x-ray of the abdomen to view the kidneys, ureters, and bladder is called a KUB. A contrast medium is used for computed tomography of the abdomen and pelvis. A pressure dressing is applied to the groin after a renal arteriogram.

A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? a) With the first specimen voided after 8:00 am b) At 8:00 am, with or without a specimen c) 6 hours after the urine is discarded d) After discarding the 8:00 am specimen

d) After discarding the 8:00 am specimen A 24-hour collection of urine is the primary test of renal clearance used to evaluate how well the kidney performs this important excretory function. The client is initially instructed to void and discard the urine. The collection bottle is marked with the time the client voided. Thereafter, all the urine is collected for the entire 24 hours. The last urine is voided at the same time the test originally began.

Following a cystoscopy, the client has a nursing diagnosis of acute pain related to the trauma of the procedure to the urinary tract. An appropriate nursing intervention is to: a) Monitor for urinary retention. b) Administer prescribed antibiotics. c) Apply moist heat to the flank area. d) Assist with warm sitz baths.

d) Assist with warm sitz baths. Acute pain can be relieved with warm sitz baths. The nurse should monitor the client for urinary retention, which can help detect a potential cause of pain, but this nursing action does not relieve pain. Antibiotics may be prescribed to prevent infection. The pain associated with cystoscopy tends to be confined to the perineal area and lower abdomen not the flank area.

A patient is having a problem with retention of urine in the bladder. Which of the following diagnostic tests measures the amount of residual urine in the bladder? a) IV urography b) Nuclear scan c) Cystography d) Bladder ultrasonography

d) Bladder ultrasonography A bladder ultrasonography is a noninvasive method of measuring urine volume in the bladder; automatic calculations display the urine volume. A nuclear scan provides information about kidney perfusion and function. It is used to evaluate acute and chronic renal failure. Cystography aids in evaluating vesicourethral reflux and in assessing bladder injury. IV urography provides an approximate estimate of renal function and may be used as the initial assessment of many urologic problems.

The nurse observes the patient's urine to be orange. Which additional assessment would be important for this patient? a) Bleeding b) Intake of multiple vitamin preparations c) Infection d) Intake of medication such as phenytoin (Dilantin)

d) Intake of medication such as phenytoin (Dilantin) Urine that is orange may be caused by intake of Dilantin 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 patient taking a multiple vitamin preparation. Yellow to milky white urine may indicate infection, pyuria, or in the female patient, the use of vaginal creams.

The wall of the bladder has four layers. Which of the following layers contains a membrane that prevents reabsorption of urine stored in the bladder? a) Detrusor b) Connective tissue c) Adventitia d) Mucosal

d) Mucosal Beneath the detrusor is a submucosal layer of loose connective tissue that serves as an interface between the detrusor and the innermost layer, a mucosal lining. This inner layer contains specialized transitional cell epithelium, a membrane that is impermeable to water and prevents reabsorption of urine stored in the bladder.

Retention of which electrolyte is the most life-threatening effect of renal failure? a) Calcium b) Phosphorous c) Sodium d) Potassium

d) Potassium Retention of potassium is the most life-threatening effect of renal failure.

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

d) 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. Keeping the client's knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse should leave this dressing in place for several hours — and only remove it if instructed to do so.