Week 8

Question 1

Renal function (age considerations):

Answer 1

• Loss of thirst stimulation (decreased osmotic stimulation)

* >70 yrs loss of 30-50% of glomeruli function

Question 2

Diagnostic studies of renal function:

Answer 2

• Urinalysis - baseline info (mane 1st)
• 24 hr urine collection for creatinine/protein/specific components
• Blood tests (creatinine & urea- indication of waste not passing thru kidneys)
• Radiological • Radionuclide • Renal function

Question 3

Chronic Kidney Disease:

Answer 3

• An overall term describing kidney damage that deceases GFR >3 months+

Question 4

Clinical manifestations of Chronic Glomerular Nephritis:

Answer 4

• Variable (maybe nil for several years until hypertension/U&E)
• Headaches, fatigue, restless/irritability
• Increasing anorexia/anaemia/cardiomegaly

Question 5

Renal function does what?:

Answer 5

• Regulate fluid and electrolytes (excretion & re-absorption)
• Removing wastes
• Providing hormones
-Erythrocyte production
-Bone metabolism (Vit D conversion)
-BP regulation

Question 6

Medications potentially nephrotoxic:

Answer 6

• Gentamycin • Captopril • NSAIDs • Aspirin

Question 7

Phases of Acute Renal Failure:

Answer 7

1. Initiation phase
2. Oliguric phase (maintenance)
3. Diuretic phase
4. Recovery phase

Question 8

Phases of Acute Renal Failure:

Answer 8

1. Initiation phase
2. Oliguric phase
3. Diuretic phase
4. Recovery phase

Question 9

Indications for urinary catheterisation:

Answer 9

• Monitoring urine output
• Instillation of radio-opaque dye/medications
• Obtaining specimens

Question 10

Nursing management of IDC:

Answer 10

• Prevent infection
By encouraging fluids, maintaining closed system, asepsis while inserting/changing bags, free flow, don’t lift IDC bag above bed, never on floor, soap & water BD.
• Bladder training post removal

Question 11

Prostate cancer is frequently diagnosed by:

Answer 11

• Pain/fracture after it metastases

Question 12

The clinic nurse is teaching a young wife about preventing recurrent urinary tract infections. What information should the nurse include?

a. Drink liberal amounts of fluids.
b. Avoid voiding immediately after sexual intercourse.
c. Wipe back to front after going to the toilet.
d. Bathe daily.
e. Void every 6 to 8 hours.

Answer 12

a. Drink liberal amounts of fluids.

Question 13

A patient is receiving patient education prior to beginning continuous ambulatory peritoneal dialysis. What would the nurse teach the patient that the most common complication associated with this procedure is?

a. Dehydration
b. Blood loss
c. DVT
d. Peritonitis
e. Constipation

Answer 13

d. Peritonitis

Question 14

Renal failure can have pre renal, renal, or post renal causes. A patient presents with acute renal failure and is being assessed to determine where, physiologically, the cause is. If the cause is found to be pre renal, which condition most likely caused it?

a. Ureterolithiasis
b. UTI
c. Glomerulonepritis
d. Heart failure
e. Aminoglycoside toxicity

Answer 14

d. Heart failure

Question 15

The nurse is caring for a patient receiving haemodialysis treatments. The patient had surgery to form an arteriovenous fistula. What is the most important point for the nurse when providing care for this patient?

a. The patient shouldn’t feel pain during initiation of dialysis.
b. Using a stethoscope for auscultating the fistula is contraindicated.
c. The patient feels best immediately after the dialysis treatment.
d. Taking a blood pressure reading on the affected arm can cause clotting of the fistula.
e. All of the above.

Answer 15

d. Taking a blood pressure reading on the affected arm can cause clotting of the fistula.

Question 16

What function does the kidney perform to assist in maintaining acid-base balance within the necessary normal range?

a. Excrete bicarbonate in the urine
b. Excrete alkali from the body’s circulation
c. Excrete acid in the lungs
d. Return acid to the body’s circulation
e. Return bicarbonate to the body’s circulation.

Answer 16

e. Return bicarbonate to the body’s circulation.

Question 17

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 go to the toilet 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. Urine retention
b. Haematuria
c. Renal failure
d. Dehydration
e. Hypotension

Answer 17

a. Urine retention

Question 18

The nurse has implemented a bladder retraining programme in a 65-year-old woman after the removal of an indwelling catheter from this patient. The nurse places the patient on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the patient has 50 mL of urine remaining in her bladder after voiding. What would be the nurse’s best response to this finding?

a. Press on the patient’s bladder in an attempt to encourage complete emptying
b. Plan for insertion of a supra-pubic catheter
c. Avoid further interventions at this time, as this is an acceptable finding.
d. Place an indwelling urinary catheter.
e. Perform a straight catheterisation on this patient

Answer 18

c. Avoid further interventions at this time, as this is an acceptable finding.

Question 19

You are a urology nurse caring for a male pt admitted to your unit with bladder distention from prostatic hypertrophy. The physician orders placement of an indwelling urinary catheter. The nurse and urologist are both unsuccessful in catheterising this pt due to the prostatic obstruction. What approach does the nurse anticipate the physician using to drain the pt’s bladder?

a. Insertion of a suprapubic catheter
b. Medication administration to relax the bladder muscles and attempting catheterisation in 6 hours.
c. Restrict fluids and try again in 6 hours.
d. Scheduling the pt immediately for surgery to relieve the bladder obstruction.
e. Application of warm compresses to the perineum to assist with relaxation, which will result in the pt voiding on his own.

Answer 19

a. Insertion of a suprapubic catheter

Question 20

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. Depletion of calcium
c. Retention of potassium
d. Lack of blood pressure control
e. Polyuria

Answer 20

c. Retention of potassium

Question 21

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 decreased urine specific gravity.
b. None of the above
c. A fixed urine specific gravity
d. A fluctuating urine specific gravity
e. An increased urine specific gravity.

Answer 21

e. An increased urine specific gravity.

Question 22

The nurse is assessing a patient’s bladder by percussion. The nurse elicits dullness after voiding. What does this finding indicate?

a. Dehydration.
b. Kidney enlargement
c. The presence of an alien life-form.
d. Incomplete bladder emptying
e. Ureteral obstruction

Answer 22

d. Incomplete bladder emptying