Unit R- Renal Flashcards
Which diagnostic test allows visualization of the renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes?
a. Renal ultrasound
b. Computed tomography
c. Intravenous pyelography
d. Voiding cystourethrography
ANS: A
The transmission of ultrasonic waves through the renal parenchyma allows visualization of the renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes. Computed tomography uses external radiation, and sometimes contrast media are used. Intravenous pyelography uses contrast medium and external radiation for x-ray films. Contrast medium is injected into the bladder through the urethral opening for voiding cystourethrography. External radiation for x-ray films is used before, during, and after voiding.
Which diagnostic finding is present when a child has primary nephrotic syndrome?
a. Hyperalbuminemia
b. Positive ASO titer
c. Leukocytosis
d. Proteinuria
ANS: D
Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the liver’s inability to synthesize proteins to balance the loss. ASO titer is negative in a child with primary nephrotic syndrome. Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.
Which factor predisposes a child to urinary tract infections?
a. Increased fluid intake
b. Short urethra in young girls
c. Prostatic secretions in males
d. Frequent emptying of the bladder
ANS: B
The short urethra in females provides a ready pathway for invasions of organisms. Increased fluid intake and frequent bladder emptying offer protective measures against urinary tract infections. Prostatic secretions have antibacterial properties that inhibit bacteria.
What should the nurse recommend to prevent urinary tract infections in young girls?
a. Wearing cotton underpants
b. Limiting bathing as much as possible
c. Increasing fluids; decreasing salt intake
d. Cleansing the perineum with water after voiding
ANS: A
Cotton underpants are preferable to nylon underpants. No evidence exists that limiting bathing, increasing fluids, decreasing salt intake, or cleansing the perineum with water decreases urinary tract infections in young girls.
An objective of care for the child with nephrosis is what desired outcome?
a. Reduced blood pressure
b. Reduced excretion of urinary protein
c. Increased excretion of urinary protein
d. Increased ability of tissues to retain fluid
ANS: B
The objectives of therapy for the child with nephrosis include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimizing of complications associated with therapy. Blood pressure is usually not elevated in nephrosis. Increased excretion of urinary protein and increased ability of tissues to retain fluid are part of the disease process and must be reversed.
What intervention is a component of the therapeutic management of nephrosis?
a. Corticosteroids
b. Antihypertensive agents
c. Long-term diuretics
d. Increased fluids to promote diuresis
ANS: A
Corticosteroids are the first line of therapy for nephrosis. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated.
What is a common side effect of cNoUrtRicSoINstGerToBi.dCOthMerapy?
a. Fever
b. Hypertension
c. Weight loss
d. Increased appetite
ANS: D
Side effects of corticosteroid therapy include an increased appetite. Fever is not a side effect of therapy. It may be an indication of infection. Hypertension is not usually associated with initial corticosteroid therapy. Weight gain, not weight loss, is associated with corticosteroid therapy.
The nurse closely monitors the temperature of a child diagnosed with nephrosis. The purpose of this is to detect an early sign of what undesirable outcome?
a. Infection
b. Hypertension
c. Encephalopathy
d. Edema
ANS:A
Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy. An increased temperature could be an indication of an infection, but it is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms.
The diet of a child with nephrosis usually includes requirement?
a. High protein
b. Salt restriction
c. Low fat
d. High carbohydrate
Salt is usually restricted (but not eliminated) during the edema phase. The child has very little appetite during the acute phase. Favorite foods are provided (with the exception of high-salt ones) in an attempt to provide nutritionally complete meals.
A child is admitted with acute glomerulonephritis. The nurse would expect the urinalysis during this acute phase to show:
a. bacteriuria and hematuria.
b. hematuria and proteinuria.
c. bacteriuria and increased specific gravity.
d. proteinuria and decreased specific gravity.
ANS: B
Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.
What is the most appropriate nursing diagnosis for the child with acute glomerulonephritis?
a. Risk for Injury related to malignant process and treatment.
b. Deficient Fluid Volume related to excessive losses.
c. Excess Fluid Volume related to decreased plasma filtration.
d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces.
ANS: C
Glomerulonephritis has a decreased filtration of plasma. The decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. A fluid volume excess is found. The fluid accumulation is secondary to the decreased plasma filtration, not fluid accumulation.
What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux?
a. The importance of taking prophylactic antibiotics
b. Suggestions for how to maintain fluid restrictions
c. The use of bubble baths as an incentive to increase bath time
d. The need for the child to hold urine for 6 to 8 hours
ANS: A
Prophylactic antibiotics are used to prevent urinary tract infections (UTIs) in a child with vesicoureteral reflux, although this treatment plan has become controversial. Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs. Bubble baths should be avoided to prevent urethral irritation and possible UTI. To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate.
What is the most common cause of acute renal failure in children?
a. Pyelonephritis
b. Tubular destruction
c. Urinary tract obstruction
d. Severe dehydration
ANS: D
The most common cause of acute renal failure in children is dehydration or other causes of
poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular
destruction are not common causes of acute renal failure in children. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.
The nurse, caring for a child with acute renal failure, should recognize event as a sign of hyperkalemia?
a. Dyspnea
b. Seizure
c. Oliguria
d. Cardiac arrhythmia
ANS: D
Hyperkalemia is the most common threat to the life of the child. Signs of hyperkalemia include electrocardiographic anomalies such as prolonged QRS complex, depressed ST segments, peaked T waves, bradycardia, or heart block. Dyspnea, seizure, and oliguria are not manifestations of hyperkalemia.
When a child diagnosed with chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as what?
a. Uremia
b. Oliguria
c. Proteinuria
d. Pyelonephritis
ANS: A
Uremia is the retention of nitrogenous products, producing toxic symptoms. Oliguria is diminished urine output. Proteinuria is the presence of protein, usually albumin, in the urine. Pyelonephritis is an inflammation of the kidney and renal pelvis.
What major complication is noted in a child with chronic renal failure?
a. Hypokalemia
b. Metabolic alkalosis
c. Water and sodium retention
d. Excessive excretion of blood urea nitrogen
ANS: C
Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure.
Which clinical manifestation wouNldUbReSIsNeGenTBin.CaOcMhild with chronic renal failure?
a. Hypotension
b. Massive hematuria
c. Hypokalemia
d. Unpleasant “uremic” breath odor
ANS: D
Children with chronic renal failure have a characteristic breath odor resulting from the retention of waste products. Hypertension may be a complication of chronic renal failure. With chronic renal failure, little or no urine output occurs. Hyperkalemia is a concern in chronic renal failure.
One of the clinical manifestations of chronic renal failure is uremic frost. Which best describes this term?
a. Deposits of urea crystals in urine
b. Deposits of urea crystals on skin
c. Overexcretion of blood urea nitrogen
d. Inability of body to tolerate cold temperatures
ANS:B
Uremic frost is the deposition of urea crystals on the skin, not in the urine. The kidneys are unable to excrete blood urea nitrogen, leading to elevated levels. There is no relation between cold temperatures and uremic frost.
Calcium carbonate is given with meals to a child with chronic renal disease. The purpose of this is to achieve which desired result?
a. Prevent vomiting
b. Bind phosphorus
c. Stimulate appetite
d. Increase absorption of fat-soluble vitamins
ANS: B
Oral calcium carbonate preparations combine with phosphorus to decrease gastrointestinal absorption and the serum levels of phosphate; serum calcium levels are increased by the calcium carbonate, and vitamin D administration is necessary to increase calcium absorption. Calcium carbonate does not prevent vomiting, stimulate appetite, or increase the absorption of fat-soluble vitamins.
The diet of a child with chronic renal failure is usually characterized as:
a. high in protein.
b. low in vitamin D.
c. low in phosphorus.
d. supplemented with vitamins A, E, and K
ANS: C
Dietary phosphorus is controlled to prevent or control the calcium/phosphorus imbalance by the reduction of protein and milk intake. Protein should be limited in chronic renal failure to decrease intake of phosphorus. Vitamin D therapy is administered in chronic renal failure to increase calcium absorption. Supplementation with vitamins A, E, and K is not part of dietary management in chronic renal disease.
The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. What should the nurse contribute this behavior to?
a. Neurologic manifestations that occur with dialysis
b. Physiologic manifestations of renal disease
c. Adolescents having few coping mechanisms
d. Adolescents often resenting the control and enforced dependence imposed by
dialysis
ANS:D
Older children and adolescents need control. The necessity of dialysis forces the adolescent into a dependent relationship, which results in these behaviors. Neurologic manifestations that occur with dialysis and physiologic manifestations of renal disease are a function of the age of the child, not neurologic or physiologic manifestations of the dialysis. Adolescents do have coping mechanisms, but they need to have some control over their disease management.
What is an advantage of peritoneal dialysis?
a. Treatments are done in hospitals.
b. Protein loss is less extensive.
c. Dietary limitations are not necessary.
d. Parents and older children can perform treatments.
ANS: D
Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves. Treatments can be done at home. Protein loss is not significantly different. The dietary limitations are necessary, but they are not as stringent as those for hemodialysis.
Which statement is descriptive of renal transplantation in children?
a. It is an acceptable means of treatment after age 10 years.
b. It is preferred means of renal replacement therapy in children.
c. Children can receive kidneys only from other children.
d. The decision for transplantation is difficult since a relatively normal lifestyle is not
possible.
ANS: B
Renal transplantation offers the opportunity for a relatively normal lifestyle versus dependence on dialysis and is the preferred means of renal replacement therapy in end-stage renal disease. It can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes.
Which intervention is appropriate when examining a male infant for cryptorchidism?
a. Cooling the examiner’s hands
b. Taking a rectal temperature
c. Eliciting the cremasteric reflex
d. Warming the room
ANS:D
Cryptorchidism is the failure of one or both testes to descend normally through inguinal canal. For the infant’s comfort, the infant should be examined in a warm room with the examiner’s hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold. Examining the infant with cold hands is uncomfortable for the infant and likely to cause the infant’s testes to retract into the inguinal canal. It may also cause the infant to be uncooperative during the examination. A rectal temperature yields no information about cryptorchidism. Testes can retract into the inguinal canal if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis.
The narrowing of preputial opening of foreskin is referred to as what? a. Chordee
b. Phimosis
c. Epispadias
d. Hypospadias
ANS: B
Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.
The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate?
a. pH
b. Osmolality
c. Creatinine clearance
d. Protein level
ANS: C
The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a substance that is freely filtered by the glomerulus and secreted by the renal tubule cells. The pH and osmolality are not estimates of glomerular filtration. Although protein in the urine demonstrates abnormal glomerular permeability, it is not a measure of filtration rate.
The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect?
a. Fever with a positive blood culture
b. Proteinuria and edema
c. Oliguria and hypertension
d. Anemia and thrombocytopenia
ANS:A
Symptoms of urosepsis include a febrile urinary tract infection coexisting with systemic signs of bacterial illness; blood culture reveals the presence of a urinary pathogen. Proteinuria and edema are symptoms of minimal change nephrotic syndrome. Oliguria and hypertension are symptoms of acute glomerulonephritis. Anemia and thrombocytopenia are symptoms of hemolytic uremic syndrome.
A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse’s best response should be to identify which occurrence?
a. Blood pressure will stabilize.
b. Child will have more energy.
c. Urine will be free of protein.
d. Urinary output will increase.
ANS: D
An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.
A preschool child is being admitted to the hospital with dehydration and a urinary tract infection (UTI). Which urinalysis result should the nurse expect with these conditions?
a. WBC <1; specific gravity 1.008
b. WBC <2; specific gravity 1.025
c. WBC >2; specific gravity 1.016
d. WBC >2; specific gravity 1.030
ANS:D
The white blood cell (WBC) count in a routine urinalysis should be <1 or 2. Over that amount indicates a urinary tract inflammatory process. The urinalysis specific gravity for children with normal fluid intake is 1.016 to 1.022. When the specific gravity is high, dehydration is indicated. A low specific gravity is seen with excessive fluid intake, distal tubular dysfunction, or insufficient antidiuretic hormone secretion.
The nurse is conducting teaching for an adolescent being discharged to home after a renal transplantation. The adolescent needs further teaching if which statement is made?
a. “I will report any fever to my primary health care provider.”
b. “I am glad I only have to take the immunosuppressant medication for 2 weeks.”
c. “I will observe my incision for any redness or swelling.”
d. “I won’t miss doing kidney dialysis every week.”
ANS: B
The immunosuppressant medications are taken indefinitely after a renal transplantation, so they should not be discontinued after 2 weeks. Reporting a fever and observing an incision for redness and swelling are accurate statements. The adolescent is correct in indicating dialysis will not need to be done after the transplantation.
A school-age child with chronic renal failure is admitted to the hospital with a serum potassium level of 5.2 mEq/L. Which prescribed medication should the nurse plan to administer?
a. Spironolactone
b. Sodium polystyrene sulfonate
c. Lactulose
d. Calcium carbonate
ANS:B
Normal serum potassium levels in a school-age child are 3.5 to 5 mEq/L. Sodium polystyrene sulfonate is administered to reduce serum potassium levels. Spironolactone is a potassium-sparing diuretic and should not be used if the serum potassium is elevated. Lactulose is administered to reduce ammonia levels in patients with liver disease. Calcium carbonate may be prescribed as a calcium supplement, but it will not reduce serum potassium levels.
What are the primary clinical manifestations of acute glomerulonephritis? (Select all that apply.)
a. Oliguria
b. Hematuria
c. Proteinuria
d. Hypertension
e. Bacteriuria
ANS: A, B, C, D
The principal feature of acute glomerulonephritis include oliguria, edema, hypertension and circulatory congestion, hematuria, and proteinuria. Bacteriuria is not a principal feature of acute glomerulonephritis.
The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations would be observed? (Select all that apply.)
a. Vomiting
b. Jaundice
c. Failure to gain weight
d. Swelling of the face
e. Back pain
f. Persistent diaper rash
ANS: A, C, F
Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations observed in an infant with a urinary tract infection. Jaundice, swelling of the face, and back pain would not be observed in an infant with a urinary tract infection.
A child with secondary enuresis who reports of dysuria or urgency should be evaluated for what condition? (Select all that apply.) a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. Urinary tract infection (UTI )e. Diabetes mellitus
ANS: D, E
Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.
A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child? (Select all that apply.)
a. Apples
b. Bananas
c. Cheese
d. Carrot sticks
e. Strawberries
ANS: A, D, E
Moderate sodium restriction and even fluid restriction may be instituted for children with
acute glomerulonephritis. Foods with substantial amounts of potassium and sodium are
generally restricted during the period of oliguria. Apples, carrot sticks, and strawberries would
be items low in sodium and allowed. Bananas are high in potassium and cheese is high in
sodium. Those items would be restricted.
A school-age child has been admitted to the hospital diagnosed with minimal-change nephrotic syndrome. Which clinical manifestations should the nurse expect to assess? (Select all that apply.)
a. Weight loss
b. Generalized edema
c. Proteinuria > 2+
d. Fatigue
e. Irritability
ANS: B, C, D, E
The disease is suspected on the basis of clinical manifestations that include generalized edema, steadily gaining weight; appearing edematous; and then becoming anorexic, irritable, and less active. The hallmark of this syndrome is proteinuria (higher than 2+ on urine dipstick)
A nurse reviews the urinalysis of a client and notes the presence of glucose. What action would the nurse take?
a. Document findings and continue to monitor the client.
b. Contact the primary health care provider and recommend a 24-hour urine test.
c. Review the client’s recent dietary selections over 3 days.
d. Perform a finger stick blood glucose assessment
ANS: D
Glucose normally is not found in the urine. The normal renal threshold for glucose is about 220 mg/dL (12.2 mmol/L), which means that a person whose blood glucose is less than 220 mg/dL (12.2 mmol/L) will not have glucose in the urine. A positive finding for glucose on urinalysis indicates high blood sugar. The most appropriate action would be to perform a blood glucose assessment. The client needs further evaluation for this abnormal result; therefore, documenting and continuing to monitor are not appropriate. Requesting a 24-hour urine test or reviewing the client’s dietary selections will not assist the nurse to make a clinical decision related to this abnormality.
A nurse reviews the health history of a client with an oversecretion of renin. Which disorder would the nurse correlate with this assessment finding?
a. Alzheimer disease
b. Hypertension
c. Diabetes mellitus
d. Viral hepatitis
ANS: B
Renin is secreted when special cells in the distal convoluted tubule, called the macula densa, sense changes in blood volume and pressure. When the macula densa cells sense that blood volume, blood pressure, or blood sodium levels are low, renin is secreted. Renin then converts angiotensinogen into angiotensin I. This leads to a series of reactions that cause secretion of the hormone aldosterone. This hormone increases kidney reabsorption of sodium and water, increasing blood pressure, blood volume, and blood sodium levels. Inappropriate or excessive renin secretion is a major cause of persistent hypertension. Renin has no impact on Alzheimer disease, diabetes mellitus, or viral hepatitis.
A nurse reviews the urinalysis results of a client and notes a urine osmolality of 1200 mOsm/kg (1200 mmol/kg). Which action would the nurse take?
a. Contact the primary health care provider to recommend a low-sodium diet
b. Prepare to administer an intravenous diuretic.
c. Encourage the client to drink more fluids.
d. Obtain a suction device and implement seizure precautions.
ANS: C
Normal urine osmolality ranges from 300 to 900 mOsm/kg (300 to 900 mmol/kg). This client’s urine is more concentrated, indicating dehydration. The nurse would encourage the client to drink more water. Dehydration can be associated with elevated serum sodium levels. Although a low-sodium diet may be appropriate for this client, this diet change will not have a significant impact on urine osmolality. A diuretic would increase urine output and decrease urine osmolality further. Low serum sodium levels, not elevated serum levels, place the client at risk for seizure activity. These options would further contribute to the client’s dehydration or elevate the osmolality.
A nurse assesses a client with renal insufficiency and a low red blood cell count. The client asks, “Is my anemia related to my kidney problem?” How would the nurse respond?
a. “Red blood cells produce erythropoietin, which increases blood flow to the
kidneys.”
b. “Your anemia and kidney problem are related to inadequate vitamin D and a loss
of bone density.”
c. “Erythropoietin is usually released from the kidneys and stimulates red blood cell
production in the bone marrow.”
d. “Kidney insufficiency inhibits active transportation of red blood cells throughout
the blood.”
ANS: C
Erythropoietin is produced in the kidney and is released in response to decreased oxygen tension in the renal blood supply. Erythropoietin stimulates red blood cell production in the bone marrow. Anemia and renal insufficiency are not manifestations of vitamin D deficiency. The kidneys do not play a role in the transportation of red blood cells or any other cells in the blood.
A nurse contacts the primary health care provider after reviewing a client’s laboratory results and noting a blood urea nitrogen (BUN) of 35 mg/dL (12.5 mmol/L) and a serum creatinine of 1.0 mg/dL (88.4 mcmol/L). What collaborative care measure would the nurse recommend?
a. Intravenous fluids
b. Hemodialysis
c. Fluid restriction
d. Urine culture and sensitivity
ANS:A
Normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Normal creatinine is 0.6 to 1.2 mg/dL (53.0 to 106.1 mcmol/L) (males) or 0.5 to 1.1 mg/dL (44.2 to 97.2 mcmol/L) (females). Creatinine is more specific for kidney function than BUN, because BUN can be affected by several factors (dehydration, high-protein diet, and catabolism). This client’s creatinine is normal, which suggests a nonrenal cause for the elevated BUN. A common cause of increased BUN is dehydration, so the nurse would recommend giving the client more fluids, not placing the client on fluid restrictions. Hemodialysis is not an appropriate treatment for dehydration. The lab results do not indicate an infection; therefore, a urine culture and sensitivity are not appropriate.
The nurse is assessing a group of clients for their risk of kidney disease. Which racial/ethnic group is at the greatest risk as they age?
a. Latino Americans
b. African Americans
c. Jewish Americans
d. Asian Americans
ANS: B
Older African Americans have a greater age-related decrease in glomerular filtration rate when compared to other racial-ethnic groups. In addition, blood flow decreases and sodium excretion is less effective in older hypertensive African Americans. These changes make this group most at risk for kidney disease.
A nurse cares for a client with a urine specific gravity of 1.040. What action would the nurse take?
a. Obtain a urine culture and sensitivity.
b. Place the client on restricted fluids.
c. Assess the client’s creatinine level.
d. Increase the client’s fluid intake.
ANS: D
Normal specific gravity for urine is 1.005 to 1.030. A high specific gravity can occur with dehydration, decreased kidney blood flow (often because of dehydration), and presence of antidiuretic hormone. Increasing the client’s fluid intake would be a beneficial intervention. Assessing the creatinine or obtaining a urine culture would not provide data necessary for the nurse to make a clinical decision.
A nurse reviews a client’s laboratory results. Which results from the client’s urinalysis would the nurse recognize as abnormal?
a. pH of 5.6
b. Ketone bodies present
c. Specific gravity of 1.020
d. Clear and yellow color
ANS: B
Ketone bodies are by-products of incomplete metabolism of fatty acids. Normally, no ketones are present in urine. Ketone bodies are produced when fat sources are used instead of glucose to provide cellular energy. A pH between 4.6 and 8, specific gravity between 1.005 and 1.030, and clear yellow urine are normal findings in a urinalysis.
A nurse cares for a client who is recovering from a closed percutaneous kidney biopsy. The client states, “My pain has suddenly increased from a 3 to a 10 on a scale of 0-10.” Which action would the nurse take first?
a. Reposition the client on the operative side.
b. Administer the prescribed opioid analgesic.
c. Assess the client’s pulse rate and blood pressure.
d. Examine the color of the client’s urine.
ANS: C
An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of possible internal hemorrhage. AGRchAaDngEeSinLvAiBta.l sCigOnMs (elevated pulse and decreased blood pressure) can indicate that hemorrhage is occurring.
The nurse delegates completing a bladder scan to assistive personnel (AP). Which action by the AP indicates that the nurse must provide additional instructions when delegating this task?
a. Selecting the female icon for all female patients and male icon for all male patients
b. Telling the client, “This test measures the amount of urine in your bladder.”
c. Applying ultrasound gel to the scanning head and removing it when finished
d. Taking at least two readings using the aiming icon to place the scanning head
ANS: A
The AP should use the female icon for women who have not had a hysterectomy. This allows the scanner to subtract the volume of the uterus from readings. If a woman has had a hysterectomy, the AP should choose the male icon. The AP should explain the procedure to the client, apply gel to the scanning head and clean it after use, and take at least two readings.
A nurse reviews a client’s laboratory results. Which results from the client’s urinalysis would the nurse identify as normal? (Select all that apply.)
a. pH:6
b. Specific gravity: 1.015
c. Protein: 1.2 mg/dL
d. Glucose: negative
e. Nitrate: small
f. Leukocyte esterase: positive
ANS: A,B,D
The pH, specific gravity, and glucose are all within normal ranges. The other values are abnormal.
