Chapter 43 Flashcards
Learning the Renal System
- A patient with renal insufficiency has been hospitalized on your unit. The patient knows that renal function depends upon the functional status of nephrons. The patient asks you when she will need to start dialysis based upon loss of nephron function. What would you respond?
A. “When about 50% of the nephrons are no longer functioning.”
B. “When about 60% of the nephrons are no longer functioning.”
C. “When about 70% of the nephrons are no longer functioning.”
D. “When about 80% of the nephrons are no longer functioning.”
- There are three areas of the ureters that 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
- A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has been ordered. The nurse is aware that the specimens needed for the calculation of the patient’s creatinine clearance will include what?
A. A fasting serum potassium level and a random urine sample
B. A 24-hour urine specimen collection and a serum creatinine level midway through the urine collection process
C. A blood, urea, nitrogen level, and serum creatinine level on three consecutive mornings
D. A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values
- The nurse is assessing a patient’s bladder by percussion. The nurse elicits dullness after voiding. What does this finding indicate?
A. Incomplete bladder emptying
B. Kidney enlargement
C. Ureteral obstruction
D. Dehydration
- 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. Intravenous administration of radiopaque contrast agent
C. Sedation and intubation
D. The injection of a radioisotope
- The nurse is caring for a patient who is not allowed oral intake of fluid or food. When evaluating this patient’s urinalysis, what would 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
- A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse realizes that what particular change is an 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
- A nurse is preparing a patient diagnosed with benign prostatic hypertrophy 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. High rate of bladder perforation
C. Hemorrhage
D. Nausea
- A diabetic patient with renal failure has been admitted to your unit. What is the most life-threatening effect of renal failure you will monitor for?
A. Accumulation of wastes
B. Retention of potassium
C. Depletion of calcium
D. Lack of blood pressure control
- 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 nurse’s 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.”
- The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient the nurse recalls that several substances are filtered from the blood by the glomerulus and these substances are then excreted in the urine. The nurse identifies the presence of which substances in the urine as abnormal findings? (I have questions about this)
A. Potassium and sodium B. Bicarbonate and urea C. Glucose and protein D. Creatinine and chloride (i think answer is C but she picked D... why?)
- The nurse is caring for a patient who describes his changes in 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 does not seem to be a great deal of urine flow.” What would the nurse expect this patient’s physical assessment will likely reveal?
A. Hematuria
B. Urine retention
C. Dehydration
D. Renal failure
- A nurse is caring for a 73-year-old male patient with a urethral obstruction related to prostatic enlargement. The nurse is aware this may result in what?
A. A urinary tract infection
B. Enuresis
C. Polyuria
D. Proteinuria
- A patient with elevated BUN and creatinine values has been sent to the emergency department by her primary physician for further evaluation. Based upon the physician’s orders, the nurse caring for this patient in the emergency department prepares the patient for what commonly used diagnostic test?
A. Ultrasound
B. X-ray
C. Computer tomography
D. Nuclear scan
- A patient admitted to your unit with impaired renal function is complaining of severe, sharp, stabbing pain that is colicky in nature in the flank and lower abdomen. The patient is being assessed for renal calculi. The nurse recognizes that the stone is most likely located where in the patient?
A. Kidney
B. Bladder
C. Ureter
D. Urethra
- The nurse is caring for a patient who had a brush biopsy 12 hours ago. What will the nurse notify the physician of?
A. Hematuria B. Renal colic C. Temperature 100.2°F orally D. Infiltration of the patient's intravenous catheter infusing dextrose 5% and .45 normal saline solution (why not report a temp?)
- A patient is admitted for renal dysfunction. The nurse knows that the kidneys receive 20% to 25% of the total cardiac output. This means that all of the body’s blood circulates through the kidneys how many times an hour?
A. 15
B. 12
C. 9
D. 6
- When fluids are filtered by the glomerular membrane of Bowman’s capsule where does the filtrate go?
A. Back into the blood
B. Into the nephrons
C. Fills the space in Bowman’s capsule
D. Fills the nephron
- You are 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 diagnosis with the family.
B. Bathe the patient before the procedure with aseptic soap.
C. Give antibiotics before sending the patient to surgery.
D. Keep the patient NPO.
- The nurse is caring for a patient scheduled for an infusion drip pyelography. What patient preparation is necessary for this test?
A. Restriction of fluids
B. Fluids are not restricted
C. Serum electrolytes
D. 24-hour urine test
- What is the largest number of pyramids that a healthy kidney has?
A. 18
B. 16
C. 12
D. 8
- What function does the kidney perform to assist in maintaining acid–base balance within the necessary normal range?
A. Excrete acid in the lungs
B. Return bicarbonate to the body’s circulation
C. Return acid to the body’s circulation
D. Excrete bicarbonate in the urine
- Voiding is activated by interaction between the sympathetic and parasympathetic nervous systems causing a coordinated sequence of events. This interaction between the sympathetic and parasympathetic nervous systems is called what?
A. Angiotension-micutition arc
B. Renal-ureter-bladder arc
C. Micturition reflex arc
D. Micturition stimulus arc
- In a patient who loses bicarbonate from the body, how does it get replaced?
A. The renal tubules secrete new bicarbonate into the urine.
B. The juxtaglomerular cells secrete new bicarbonate into the blood.
C. The juxtaglomerular cells generate new bicarbonate.
D. Renal tubular cells generate new bicarbonate.
- The pituitary gland, in response to increasing serum osmolality, stimulates what to secrete aldosterone?
A. Adrenal cortex
B. Renal tubules
C. Glomerulus
D. Bowman’s capsule
- A patient you are caring for is having a diagnostic MRI of the lower urinary system. How would you prepare the patient for this test?
A. Teaching methods of communication to the patient
B. Teaching relaxation to the patient
C. Teaching the patient he or she will have to lie still in a tube
D. Teaching the patient that the MRI machine makes a lot of noise
- You are caring for a patient with renal dysfunction. The patient tells you that the pain in their right flank has gotten worse. Why would you notify the physician of the increased pain?
A. Pain promotes dilute urine and flushing of the lower urinary tract.
B. Delayed emptying of the bladder and poor hygiene may contribute to pain secondary to renal or urinary tract dysfunction.
C. Pain may indicate progression or recurrence of dysfunction, or untoward signs.
D. A high level of fear or apprehension can interfere with learning and cooperation.
- A patient asks her nurse why kidney problems can cause gastrointestinal disturbances. What would be the nurse’s best answer?
A. “The right kidney’s proximity to the pancreas, liver and gallbladder”
B. “The right kidney’s nearness to stomach, pancreas, and spleen”
C. “The left kidney’s nearness to the pancreas, liver, and gallbladder”
D. “The left kidney’s nearness to the colon, duodenum, and common bile duct”
- The nursing instructor is talking about monitoring laboratory tests in renal and urinary tract dysfunction. What is monitored to assess for anemia?
A. Hematocrit
B. Hemoglobin
C. Oxygen level
D. Peripheral blood flow
- The nurse is assessing the deep tendon reflexes on a patient with incontinence. What condition of the urinary/renal system does the nurse expect to illicit specific information on?
A. Renal calculi
B. Benign prostatic hyperplasia
C. Bladder dysfunction
D. Acute renal failure
- Urodynamic testing is carried out in the urologist’s office to study incontinence. Because voiding in the presence of others can cause a situational anxiety, the nurse must do what?
A. Note the patient’s urge to push.
B. Note the character of the patient’s stream.
C. Discuss test results as they are formulated.
D. Help the patient relax.
- What nursing diagnosis would be a priority when caring for a patient undergoing diagnostic testing of the renal-urologic system?
A. Reinforce information provided to patient about test results and implications for follow-up care.
B. Assess patient’s level of understanding of planned diagnostic tests.
C. Provide a description of tests in language the patient can understand.
D. Assess patient’s understanding of test results after their completion.
