Urinary and Burns Exam Review
A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in: 1 minute 24 hours 1 hour 30 minutes
1 minute
A patient comes into the emergency room with major burns that occurred 5 hours ago. The nurse knows that upper airway edema is most pronounced: 3-6 hours after burn 1-2 hours after burn 8-12 hours after burn 14-18 hours after burn
8-12 hours after burn (after beginning fluid resuscitation) -provide humidified oxygen -assess for crowing, stridor, or dyspnea which indicates need for intubation
A nurse is caring for a 73-year-old patient with a urethral obstruction related to prostatic enlargement. When planning this patient's care, the nurse should be aware of the consequent risk of what complication? A) Urinary tract infection B) Enuresis C) Polyuria D) Proteinuria
A) Urinary tract infection
The nurse is reviewing the client's lab results. Which lab result requires follow up by the nurse? (SATA) Urine specific gravity 1.020 BUN 28mg/dL Serum creatinine 0.8 mg/dL Urine RBC 20 Urine WBC 1
BUN 28mg/dL Urine RBC 20
A nurse is caring for a patient with AKI. What foods should the nurse discourage? (SATA) Bananas Oranges Apples Cantaloupe Coffee
Bananas Oranges Cantaloupe Coffee -avoid potassium and phosphorus
A nurse is conducting a health history on a patient who is seeing her health care provider for symptoms consistent with a UTI. The nurse understands that the most common route of infection is which of the following? Through the bloodstream (hematogenous spread) By ascending infection (transurethral) Due to a fistula (direct extension) The result of urethra abrasion (sexual intercourse)
By ascending infection (transurethral)
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: oliguria. polyuria. anuria. hematuria.
anuria. Rationale: 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.
The most important intervention in the nutritional support of a patient with a burn injury is to provide adequate nutrition and calories to: increase metabolic rate. increase glucose demands. increase skeletal muscle breakdown. decrease catabolism.
decrease catabolism. Rationale: Nutritional support with optimized protein intake can decrease the protein losses by approximately 50%. A marked increase in metabolic rate is seen after a burn injury and interventions are instituted to decrease metabolic rate and catabolism
A client asks the nurse why a creatinine clearance test is accurate. The nurse is most correct to reply which of the following? "Creatinine is found in the urine to make the urine acidic and can be measured." "Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." "Creatinine is a stress-related response that is excreted by the kidney." "Creatinine is metabolized in the liver and excreted by the kidney at a regular rate."
"Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney."
A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? "This medication will relieve your pain." "This medication should be taken at bedtime." "This medication will prevent re-infection." "This will kill the organism causing the infection."
"This medication will relieve your pain." Rationale: Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.
An investment banker, with chronic renal failure, informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? "The risk of peritonitis is greater with this type of dialysis." "This type of dialysis will provide more independence." "Peritoneal dialysis will require more work for you." "Peritoneal dialysis does not work well for every client."
"This type of dialysis will provide more independence."
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. 25 mL 100 mL 150 mL 50 mL
150 mL
When describing the functions of the kidney to a client, which of the following would the nurse include? Regulation of white blood cell production Synthesis of vitamin K Control of water balance Secretion of the enzyme renin
Control of water balance Secretion of the enzyme renin
Ms. Linden is in end-stage chronic renal failure and is being added to the transplant list. You are explaining to her how donors are found for clients needing kidneys. You would be accurate in telling her which of the following? Donors are selected from compatible living donors. Donors must be relatives. Donors with hypertension may qualify. The client is placed on a transplant list at the local hospital.
Donors are selected from compatible living donors.
A creatinine level has been ordered. The nurse prepares to: Obtain a blood specimen. Collect the client's urine for 24 hours. Obtain a clean catch urine. Straight cath for a specimen.
Obtain a blood specimen. Rationale: collect serum creatinine with a blood sample
The nurse recognizes that a referral for genetic counseling is inappropriate for the client with: Alport syndrome Renal calculi Polycystic kidney disease Wilms' tumor
Renal calculi
A nurse is preparing an education program about renal disease. Which risk factor should the nurse include when teaching? (SATA) Sickle-cell anemia Seizures Immobility Hypotension Spinal cord injury
Sickle-cell anemia Immobility Spinal cord injury
The nurse is caring for a client with recurrent urinary tract infections. Which of the following body structures would the nurse instruct as the most frequent cause of women's urinary tract infections? The urethra The bladder The rectum The ureters
The urethra
Which clinical finding should a nurse look for in a client with chronic renal failure? Hypotension Uremia Metabolic alkalosis Polycythemia
Uremia Rationale: 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.
The nurse is caring for a patient with ESKD. Which of the following acid-base imbalances is associated with this disorder? pH 7.20, PaCO2 36, HCO3 14- pH 7.31, PaCO2 48, HCO3 24- pH 7.47, PaCO2 45, HCO3 33- pH 7.50, PaCO2 29, HCO3 22-
pH 7.20, PaCO2 36, HCO3 14- Rationale: Metabolic acidosis is a complication of ESKD
What lab value is unexpected during fluid remobilization of major burns? Hematocrit of 45% ph 7.20 PaO2 38 HCO3 15 serum potassium 3.2 serum sodium 140
serum sodium 140 Hyponatremia is expected due to the extreme dilution
A client tells a nurse they have a sulfa allergy, which of the following medications should the nurse question? silver nitrate mafenide acetate polymyxin B silver sulfadiazine
silver sulfadiazine -pain free -apply using a clean glove -causes gray, blue-green discoloration -causes neutropenia/leukopenia
Urinary tract infections increase with age and disability. The nurse is aware that the elderly often fail to exhibit the typical symptoms of a UTI. Therefore, a urine culture and sensitivity should be obtained. What bacteria would the nurse expect to find to help confirm the diagnosis of a UTI? Pseudomonas Staphylococcus Escherichia coli Enterococcus
Escherichia coli
Which of the following is a cause of a calcium renal stone? Gout Excessive intake of vitamin D Neurogenic bladder Foreign bodies
Excessive intake of vitamin D
In starting your new job as a nurse with a group of renal specialists, you begin your orientation with a thorough review of renal function. Although the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which of the following is NOT a function of the kidneys? Excreting protein Stimulating RBC production Excreting nitrogen waste products Regulating blood pressure
Excreting protein
A nurse is preop teaching with a client who is scheduled for a kidney transplant about rejection of a transplanted kidney. Which of the following statements should the nurse include in the teaching? (SATA) Expect an immediate removal of the donor kidney for a hyper acute rejection You may need to begin dialysis to monitor your kidney function for a hyper acute rejection A fever is a manifestation of an acute rejection Fluid retention is a manifestation of an acute rejection Your provider will increase your immunosuppressive meds for chronic rejection
Expect an immediate removal of the donor kidney for a hyper acute rejection A fever is a manifestation of an acute rejection Fluid retention is a manifestation of an acute rejection
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? Diuresis Fever Absence of pain Weight loss
Fever
Which of the following is a characteristic of the intrarenal category of AKI? Decreased creatinine Increased BUN High specific gravity Decreased urine sodium
Increased BUN Rationale: The intrarenal category of AKI encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.
A patient with a severe electrical burn injury is being treated in the burn unit. Which of the following laboratory results would cause the nurse the most concern? K+: 5.0 mEq/L Serum Urea: 9.9mmol/L Na+: 145 mEq/L Ca: 2.25mmol/L
Serum Urea: 9.9mmol/L Rationale: The nurse should report decreased urine output or increased serum urea and creatinine values to the physician. These laboratory values indicate possible renal failure.
A patient presents to the ED complaining of left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The patient has also experienced nausea and emesis. The nurse suspects the patient is experiencing which of the following? Ureteral stones Pyelonephritis Cystitis Infection of the urethra
Ureteral stones
A client who is scheduled for kidney transplantation surgery is assessed by the nurse for risk factors of surgery. Which of the following findings increase the clients risk of surgery? (SATA) Age older than 70 BMI 41 Administering NPH each morning Past hx of lymphoma BP 120/70
Age older than 70 BMI 41 Administering NPH each morning Past hx of lymphoma
A nurse is assessing a burn that is charred without pain. The nurse documents this type of burn as..? Deep partial thickness Full thickness Superficial partial thickness Deep full thickness
Full thickness
Bill Jenkins has suffered from a burn on his leg related to an engine fire. Burn depth is determined by assessing the color, characteristics of the skin, and sensation in the area. When the burn area was assessed, it was determined that he felt no pain in the area and that it appeared charred. What depth of burn injury would he be said to have? Full thickness (third degree) Superficial (first degree) Superficial partial-thickness and deep partial-thickness (second degree) Fourth degree
Full thickness (third degree)
When assessing a client with partial-thickness burns over 60% of the body, which finding should the nurse report immediately? Complaints of intense thirst Moderate to severe pain Urine output of 70 ml the first hour Hoarseness of the voice
Hoarseness of the voice Rationale: Hoarseness is indicative of injury to the respiratory system and could indicate the need for immediate intubation
A patient will be receiving biologic dressings. The nurse understands that biologic dressings, which use skin from a live or recently deceased humans, are known by what name? Autografts Heterografts Homografts Xenografts
Homografts
Which of the following is to be expected soon after a major burn? (SATA) Hypotension Tachycardia Anxiety Hypertension Bradycardia
Hypotension Tachycardia Anxiety
The nurse observes a client's uric acid level of 9.3 mg/dL. When teaching the client about ways to decrease the uric acid level, which diet would the nurse suggest? A low-sodium diet A low-purine diet A diet high in fruits and vegetables A diet high in calcium
A low-purine diet
In the acute phase of a burn injury, what lab value should the nurse report? hypernatremia hypokalemia hyperkalemia hypercalcemia
hyperkalemia -cells burst causing release of potassium
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? Kidney stone formation Proteinuria Chronic kidney disease Neurogenic bladder
Chronic kidney disease
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? Neurogenic bladder Kidney stone formation Proteinuria Chronic kidney disease
Chronic kidney disease
A creatinine clearance test has been ordered. The nurse prepares to: Collect the client's urine for 24 hours. Obtain a blood specimen. Obtain a clean catch urine. Insert a straight catheter for a specimen.
Collect the client's urine for 24 hours.
Which type of burn injury involves destruction of the epidermis and upper layers of the dermis and injury to the deeper portions of the dermis? Superficial partial thickness Deep partial-thickness Full-thickness Fourth degree
Deep partial-thickness
The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following? Fistula Kidney stones Neurogenic bladder Chronic renal failure
Kidney stones
A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? Hypotension Weight loss Polyuria Abdominal pain
Abdominal pain
During the acute phase of burn injury, the nurse to assess for signs of potassium shifting during what time frame? within 24 hours between 24-48 hours At the beginning of the 3rd day Beginning day 4-5
Beginning day 4-5
A creatinine clearance test is ordered for a patient with possible renal insufficiency. It is necessary for the nurse to collect which of the following serum levels midway through the 24-hour urine collection? Osmolality Hemoglobin Creatinine BUN
Creatinine
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? GI absorption rate Therapeutic index Creatinine clearance Liver function studies
Creatinine clearance
A patient presents to the ED complaining of left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The patient has also experienced nausea and emesis. The nurse suspects the patient is experiencing which of the following? Cystitis Pyelonephritis Ureteral stones Infection of the urethra
Ureteral stones
Which metabolic defects are associated with stone formation? Hypoparathyroidism Hypouricemia Hyperparathyroidism Hyperthyroidism
Hyperparathyroidism Rationale: Metabolic defects such as hyperparathyroidism and hyperuricemia (gout) are associated with stone formation
The nurse is caring for a client diagnosed with bladder cancer and requiring a cystectomy. The nurse overhears the physician instructing the client on the presence of a stoma with temporary pouch. In gathering information for the client, which urinary diversion would the nurse select? Kock Pouch Ureterosigmoidostomy Indiana Pouch Ileal conduit
Ileal conduit Rationale: When the physician is discussing a stoma, the nurse recognizes that the client will have an ileal conduit which is a cetaceous urinary diversion.
A nurse knows that specific areas in the ureters have a propensity for obstruction. Prompt management of renal calculi is most important when the stone is located where? In the ureteropelvic junction In the ureteral segment near the sacroiliac junction In the ureterovesical junction In the urethra
In the ureteropelvic junction Rationale: the three narrowed areas of each ureter are the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovescial junction. These three areas of the ureters have a propensity for obstruction by renal calculi or stricture. Obstruction of the ureteropelvic junction is most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction.
The nurse is providing wound care for a client with burns to the lower extremities. Which topical antibacterial agent carries a side effect of leukopenia that the nurse should monitor for within 48 hours after application? Cerium nitrate solution Gentamicin sulfate Sulfadiazine, silver (Silvadene) Mafenide (Sulfamylon)
Sulfadiazine, silver (Silvadene)
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. Sodium Bicarbonate Creatinine Glucose
Glucose
A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? Elevated urea levels Hyperkalemia Hypocalcemia Elevated white blood cells
Hyperkalemia Rationale: 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.
In the diuresis period of AKI, the nurse should observe the patient closely for what complication? Dehydration Hypokalemia Oliguria Renal calculi
Dehydration Rationale: Dehydration is a complication during the diuresis phase related to elevated urine output and continued symptoms of uremia
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? Encouraging coughing and deep breathing Promoting carbohydrate intake Limiting fluid intake Providing pain-relief measures
Limiting fluid intake
The nurse that which topical antibacterial agent does not penetrate eschar? Acticoat mafenide acetate silver nitrate 0.5% silver sulfadiazine 1%
silver nitrate 0.5%
How should a nurse apply silver nitrate? Apply a thin layer with a glove Apply twice daily Apply using a gauze dressing Apply once weekly
Apply using a gauze dressing -also depletes sodium and potassium -stains clothes and linen -reduces fluid evaporation
A chronic renal failure client complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? Elevated serum creatinine Hyperkalemia Hyperphosphatemia Elevated urea and nitrogen
Hyperphosphatemia Rationale: Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia
The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable? Clients have frequent urinary tract infections. Clients have urinary frequency. Clients develop a neurogenic bladder. Clients have chronic renal failure.
Clients have chronic renal failure.
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? Acute rejection Hyperacute rejection Chronic rejection Simple rejection
Hyperacute rejection Rationale: 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.
Patients with urolithiasis need to be encouraged to: Increase their fluid intake so that they can excrete 2.5 to 4 liters every day. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. Supplement their diet with calcium needed to replace losses to renal calculi. Limit their voiding to every 6 to 8 hours so that increased volume can increase hydrostatic pressure, which will help push stones along the urinary system.
Increase their fluid intake so that they can excrete 2.5 to 4 liters every day.
A 54-year-old machinist is being seen by a physician within the urology group where you practice nursing. He has been experiencing severe pain and hematuria and hardly able to ambulate into the physician's office. The physician orders diagnostic tests to confirm his suspicion of kidney stones. What test would you expect the physician to order? Ultrasound KUB CT MRI
KUB
A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? Kidney Ureter Bladder Urethra
Kidney
In a client who has been burned, which medication should the nurse expect to use to prevent infection? Permethrin (LyClear) Diazepam (Valium) Mafenide (Sulfamylon) Meperidine (Pethidine)
Mafenide (Sulfamylon)
Which of the following medications can cause metabolic acidosis? Silver sulfadiazine Gentamicin Silver nitrate Mafenide acetate
Mafenide acetate -painful to apply -provide analgesic prior to application -applied twice daily
A nurse is teaching a client who is postoperative following a kidney transplant and is taking cyclosporine. Which of the following instructions should the nurse include? Decrease your intake of protein rich food Take this medication with grapefruit juice Monitor for and report sore throat Expect your skin to turn yellow
Monitor for and report sore throat
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? Mucosal Adventitia Detrusor Connective tissue
Mucosal Rationale: 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.
A nurse is planning postoperative care for a client following a kidney transplant. Which should be included in plan of care? (SATA) Obtain daily weights Assess dressings for bloody drainage Replace hourly urine output with IV fluids Expect oliguria in the first 4 hours Monitor serum electrolytes
Obtain daily weights Assess dressings for bloody drainage Replace hourly urine output with IV fluids Monitor serum electrolytes
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? Diuresis Oliguria Acute tubular necrosis Restored glomerular function
Oliguria Rationale: Initiation -> oliguria -> diuresis -> recovery
After being exposed to smoke and flames from a house fire, which assessment finding is most important in determining care of the client? Presence of soot around nasal passages Fracture of the fibula with displacement Elevation of blood pressure and heart rate Partial-thickness burns to hands and wrists
Presence of soot around nasal passages Rationale: If the client has soot or evidence of carbon about the nasal passages, the nurse should anticipate respiratory difficulties
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. Renal medulla Renal cortex Renal pelvis Renal papilla
Renal cortex
The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client?(SATA) Secretion of prostaglandins Vitamin B production Regulation of blood pressure Vitamin D synthesis Secretion of insulin
Secretion of prostaglandins Regulation of blood pressure Vitamin D synthesis
Which of the following would a nurse classify as a prerenal cause of acute renal failure? Polycystic disease Ureteral stricture Prostatic hypertrophy Septic shock
Septic shock Rationale: Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias.
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: recent streptococcal infection. chronic, excessive acetaminophen use. family history of pernicious anemia. childhood asthma.
recent streptococcal infection
