Deck 52: Assessment of Kidney and Urinary Function

Question 1

The care team is considering the use of dialysis in a patient whose renal function is progressively declining. Renal replacement therapy is indicated in which of the following situations?

A) When the patients creatinine level drops below $1.2 \mathrm{mg} / \mathrm{dL}(110 \mathrm{mmol} / \mathrm{L})$
B) When the patients blood urea nitrogen (BUN) is above $15 \mathrm{mg} / \mathrm{dL}$
C) When approximately $40 \%$ of nephrons are not functioning
D)When about $80 \%$ of the nephrons are no longer functioning

Answer 1

When about $80 \%$ of the nephrons are no longer functioning

Question 2

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?

A) In the ureteropelvic junction
B) In the ureteral segment near the sacroiliac junction
C) In the ureterovesical junction
D) In the urethra

Answer 2

In the ureteropelvic junction

Question 3

A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has been ordered. The nurse should facilitate collection of what samples?

A) A fasting serum potassium level and a random urine sample
B) A 24-hour urine specimen and a serum creatinine level midway through the urine collection process
C) A BUN and serum creatinine level on three consecutive mornings
D) A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values

Answer 3

A 24-hour urine specimen and a serum creatinine level midway through the urine collection process

Question 4

The nurse is assessing a patients bladder by percussion. The nurse elicits dullness after the patient has voided. How should the nurse interpret this assessment finding?

A) The patients bladder is not completely empty.
B) The patient has kidney enlargement.
C) The patient has a ureteral obstruction.
D) The patient has a fluid volume deficit.

Question 5

The nurse is providing pre-procedure teaching about an ultrasound. The nurse informs the patient that in preparation for an ultrasound of the lower urinary tract the patient will require what?

A) Increased fluid intake to produce a full bladder
B) IV administration of radiopaque contrast agent
C) Sedation and intubation
D) Injection of a radioisotope

Question 6

The nurse is caring for a patient who has a fluid volume deficit. When evaluating this patients urinalysis results, what should the nurse anticipate?

A) A fluctuating urine specific gravity
B) A fixed urine specific gravity
C) A decreased urine specific gravity
D) An increased urine specific gravity

Question 7

A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse should be aware of what age-related change affecting the renal or urinary system?

A) Increased ability to concentrate urine
B) Increased bladder capacity
C) Urinary incontinence
D) Decreased glomerular filtration rate

Question 8

A nurse is preparing a patient diagnosed with benign prostatic hypertrophy (BPH) for a lower urinary tract cystoscopic examination. The nurse informs the patient that the most common temporary complication experienced after this procedure is what?

A) Urinary retention
B) Bladder perforation
C) Hemorrhage
D) Nausea

Question 9

A patient with renal failure secondary to diabetic nephropathy has been admitted to the medical unit. What is the most life-threatening effect of renal failure for which the nurse should monitor the patient?

A) Accumulation of wastes
B) Retention of potassium
C) Depletion of calcium
D) Lack of BP control

Question 10

A kidney biopsy has been scheduled for a patient with a history of acute renal failure. The patient asks the nurse why this test has been scheduled. What is the nurses best response?

A) A biopsy is routinely ordered for all patients with renal disorders.
B) A biopsy is generally ordered following abnormal x-ray findings of the renal pelvis.
C) A biopsy is often ordered for patients before they have a kidney transplant.
D) A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease.

Question 11

The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, the nurse interprets the presence of which substances in the urine as most suggestive of pathology?

A) Potassium and sodium
B) Bicarbonate and urea
C) Glucose and protein
D) Creatinine and chloride

Question 12

The nurse caring for a patient with suspected renal dysfunction calculates that the patients weight has increased by 5 pounds in the past 24 hours. The nurse estimates that the patient has retained approximately how much fluid?

A) 1,300 mL of fluid in 24 hours
B) 2,300 mL of fluid in 24 hours
C) 3,100 mL of fluid in 24 hours
D) 5,000 mL of fluid in 24 hours

Question 13

The nurse is performing a focused genitourinary and renal assessment of a patient. Where should the nurse assess for pain at the costovertebral angle?

A) At the umbilicus and the right lower quadrant of the abdomen
B) At the suprapubic region and the umbilicus
C) At the lower border of the 12th rib and the spine
D) At the 7th rib and the xyphoid process

Question 14

The staff educator is giving a class for a group of nurses new to the renal unit. The educator is discussing renal biopsies. In what patient would the educator tell the new nurses that renal biopsies are contraindicated?

A) A 64-year-old patient with chronic glomerulonephritis
B) A 57-year-old patient with proteinuria
C) A 42-year-old patient with morbid obesity
D) A 16-year-old patient with signs of kidney transplant rejection

Question 15

The nurse is caring for a patient who describes changes in his voiding patterns. The patient states, I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesnt seem to be a great deal of urine flow. What would the nurse expect this patients physical assessment to reveal?

A) Hematuria
B) Urine retention
C) Dehydration
D) Renal failure

Question 16

The nurse is caring for a patient with a nursing diagnosis of deficient fluid volume. The nurses assessment reveals a BP of $98 / 52 \mathrm{~mm} \mathrm{Hg}$ . The nurse should recognize that the patients kidneys will compensate by secreting what substance?

A) Antidiuretic hormone (ADH)
B) Aldosterone
C) Renin
D) Angiotensin

Question 17

A nurse is caring for a 73-year-old patient with a urethral obstruction related to prostatic enlargement. When planning this patients care, the nurse should be aware of the consequent risk of what complication?

A) Urinary tract infection
B) Enuresis
C) Polyuria
D) Proteinuria

Question 18

A patient with elevated BUN and creatinine values has been referred by her primary physician for further evaluation. The nurse should anticipate the use of what initial diagnostic test?

A) Ultrasound
B) X-ray
C) Computed tomography (CT)
D) Nuclear scan

Question 19

A patient admitted to the medical unit with impaired renal function is complaining of severe, stabbing pain in the flank and lower abdomen. The patient is being assessed for renal calculi. The nurse recognizes that the stone is most likely in what anatomic location?

A) Meatus
B) Bladder
C) Ureter
D) Urethra

Question 20

The nurse is caring for a patient who had a brush biopsy 12 hours ago. The presence of what assessment finding should prompt the nurse to notify the physician?

A) Scant hematuria
B) Renal colic
C) Temperature $100.2 \mathrm{~F}$ orally
D) Infiltration of the patients intravenous catheter

Question 21

A patient with recurrent urinary tract infections has just undergone a cystoscopy and complains of slight hematuria during the first void after the procedure. What is the nurses most appropriate action?

A) Administer a STAT dose of vitamin $\mathrm{K}$ , as ordered.
B) Reassure the patient that this is not unexpected and then monitor the patient for further bleeding.
C) Promptly inform the physician of this assessment finding.
D) Position the patient supine and insert a Foley catheter, as ordered.

Question 22

A patient is complaining of genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform?

A) Encourage mobilization.
B) Apply topical lidocaine to the patients meatus, as ordered.
C) Apply moist heat to the patients lower abdomen.
D) Apply an ice pack to the patients perineum.

Question 23

The nurse is caring for a patient who is going to have an open renal biopsy. What would be an important nursing action in preparing this patient for the procedure?

A) Discuss the patients diagnosis with the family.
B) Bathe the patient before the procedure with antiseptic skin wash.
C) Administer antivirals before sending the patient for the procedure.
D) Keep the patient NPO prior to the procedure.

Question 24

The nurse is caring for a patient scheduled for renal angiography following a motor vehicle accident. What patient preparation should the nurse most likely provide before this test?

A) Administration of IV potassium chloride
B) Administration of a laxative
C) Administration of Gastrografin
D) Administration of a 24-hour urine test

Question 25

Diagnostic testing of an adult patient reveals renal glycosuria. The nurse should recognize the need for
The patient to be assessed for what health problem?

A) Diabetes insipidus
B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C) Diabetes mellitus
D) Renal carcinoma

Question 26

A patient with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acidbase balance?

A) Sequestering free hydrogen ions in the nephrons
B) Returning bicarbonate to the bodys circulation
C) Returning acid to the bodys circulation
D) Excreting bicarbonate in the urine

Question 27

A patients most recent laboratory findings indicate a glomerular filtration rate (GFR) of $58 \mathrm{~mL} / \mathrm{min}$ . The nurse should recognize what implication of this diagnostic finding?

A) The patient is likely to have a decreased level of blood urea nitrogen (BUN).
B) The patient is at risk for hypokalemia.
C) The patient is likely to have irregular voiding patterns.
D) The patient is likely to have increased serum creatinine levels.

Question 28

A patient has experienced excessive losses of bicarbonate and has subsequently developed an acidbase imbalance. How will this lost bicarbonate be replaced?

A) The kidneys will excrete increased quantities of acid.
B) Bicarbonate will be released from the adrenal medulla.
C) Alveoli in the lungs will synthesize new bicarbonate.
D) Renal tubular cells will generate new bicarbonate.

Question 29

A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult?

A) If possible, try to drink at least 4 liters of fluid daily.
B) Ensure that you avoid replacing water with other beverages.
C) Remember to drink frequently, even if you dont feel thirsty.
D) Make sure you eat plenty of salt in order to stimulate thirst.

Question 30

A patient is scheduled for a diagnostic MRI of the lower urinary system. What pre-procedure education should the nurse include?

A) The need to be NPO for 12 hours prior to the test
B) Relaxation techniques to apply during the test
C) The need for conscious sedation prior to the test
D) The need to limit fluid intake to 1 liter in the 24 hours before the test

Question 31

Results of a patients 24 -hour urine sample indicate osmolality of $510 \mathrm{mOsm} / \mathrm{kg}$ , which is within reference range. What conclusion can the nurse draw from this assessment finding?

A) The patients kidneys are capable of maintaining acidbase balance.
B) The patients kidneys reabsorb most of the potassium that the patient ingests.
C) The patients kidneys can produce sufficiently concentrated urine.
D) The patients kidneys are producing sufficient erythropoietin.

Question 32

A patient is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all that apply.

A) Petechiae
B) Pain
C) Gastrointestinal symptoms
D) Changes in voiding
E) Jaundice

Question 33

A patient asks the nurse why kidney problems can cause gastrointestinal disturbances. What relationship should the nurse describe?

A) The right kidneys proximity to the pancreas, liver, and gallbladder
B) The indirect impact of digestive enzymes on renal function
C) That the peritoneum encapsulates the GI system and the kidneys
D) The left kidneys connection to the common bile duct

Question 34

A patient with a history of progressively worsening fatigue is undergoing a comprehensive assessment which includes test of renal function relating to erythropoiesis. When assessing the oxygen transport ability of the blood, the nurse should prioritize the review of what blood value?

A) Hematocrit
B) Hemoglobin
C) Erythrocyte sedimentation rate (ESR)
D) Serum creatinine

Question 35

The nurse is reviewing the electronic health record of a patient with a history of incontinence. The nurse reads that the physician assessed the patients deep tendon reflexes. What condition of the urinary/renal system does this assessment address?

A) Renal calculi
B) Bladder dysfunction
C) Benign prostatic hyperplasia (BPH)
D) Recurrent urinary tract infections (UTIs)

Question 36

A patient with a history of incontinence will undergo urodynamic testing in the physicians office. Because voiding in the presence of others can cause situational anxiety, the nurse should perform what action?

A) Administer diuretics as ordered.
B) Push fluids for several hours prior to the test.
C) Discuss possible test results as the patient voids.
D) Help the patient to relax before and during the test.

Question 37

A nurse is working with a patient who will undergo invasive urologic testing. The nurse has informed the patient that slight hematuria may occur after the testing is complete. The nurse should recommend what action to help resolve hematuria?

A) Increased fluid intake following the test
B) Use of an OTC diuretic after the test
C) Gentle massage of the lower abdomen
D) Activity limitation for the first 12 hours after the test

Question 38

The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply.

A) Specific gravity of the patients urine
B) Testing for the presence of glucose in the patients urine
C) Microscopic examination of urine sediment for RBCs
D) Microscopic examination of urine sediment for casts
E) Testing for BUN and creatinine in the patients urine

Question 39

Dipstick testing of an older adult patients urine indicates the presence of protein. Which of the following statements is true of this assessment finding?

A) This finding needs to be considered in light of other forms of testing.
B) This finding is a risk factor for urinary incontinence.
C) This finding is likely the result of an age-related physiologic change.
D) This result confirms that the patient has diabetes. Select all that apply.

Question 40

What nursing action should the nurse perform when caring for a patient undergoing diagnostic testing of the renal-urologic system?

A) Withhold medications until 12 hours post-testing.
B) Ensure that the patient knows the importance of temporary fluid restriction after testing.
C) Inform the patient of his or her medical diagnosis after reviewing the results.
D) Assess the patients understanding of the test results after their completion.