Chapter 68: Assessment of the Renal/Urinary System Nursing School Test Banks

Chapter 68: Assessment of the Renal/Urinary System

Test Bank

MULTIPLE CHOICE

1. The nurse is palpating a clients kidneys. The clients right kidney is easily palpated, but the nurse cannot palpate the left kidney. What is the nurses interpretation of this finding?

a.

The problem involves the right kidney.

b.

The problem involves the left kidney.

c.

Both kidneys are in the normal position.

d.

The client is at increased risk for kidney impairment.

ANS: C

Normally, the left kidney is situated more deeply, and often it cannot be palpated. This is a normal finding.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1476

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

2. A clients urinalysis results show a protein level of 1.8 mg/dL. Which action by the nurse is best?

a.

Inform the health care provider.

b.

Ask the client about his or her protein intake.

c.

Obtain the clients weight.

d.

Document the finding in the chart.

ANS: A

Protein is normally reabsorbed and does not show up, except in very small amounts, in the urine. Protein greater than 0.8 mg/dL is abnormal and could indicate stress, infection, recent strenuous exercise, or glomerular problems. This finding should be reported. The other actions would not give information about the origin of the protein.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory Values) MSC: Integrated Process: Nursing Process (Implementation)

3. The nurse is reviewing a clients urinalysis and notes a positive glucose. Which action by the nurse is best?

a.

Document the finding and call the health care provider.

b.

Collect and send another urinalysis sample to the laboratory.

c.

Review the clients recent dietary selections.

d.

Perform a finger stick blood glucose on the client.

ANS: D

Glucose normally is not found in the urine. The normal renal threshold for glucose is about 220 mg/dL, which means that a person whose blood glucose is less than 220 mg/dL 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 finger stick blood glucose. If facility policy does not allow that action, calling the provider would be best. The client needs further evaluation for this abnormal result.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory Values) MSC: Integrated Process: Nursing Process (Assessment)

4. Which condition is associated with oversecretion of renin?

a.

Alzheimers disease

b.

Hypertension

c.

Diabetes mellitus

d.

Diabetes insipidus

ANS: B

Renin is secreted when special cells in the distal convoluted tubule (DCT), called the macula densa, sense changes in blood volume and pressure. When the macula densa cells sense that blood volume is low, blood pressure is low, 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.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1471

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

5. A clients urinalysis results reveal a urine osmolarity of 1200 mOsm/L. Which action by the nurse is most appropriate?

a.

Initiate a fluid restriction.

b.

Prepare to administer a diuretic.

c.

Institute seizure precautions.

d.

Encourage the client to increase fluid intake.

ANS: D

Normal urine osmolarity ranges from 300 to 900 mOsm/L. This clients urine is more concentrated, indicating dehydration. The nurse should encourage the client to drink more water. The other options are not appropriate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory Values) MSC: Integrated Process: Nursing Process (Implementation)

6. Which is the result of stimulation of erythropoietin production in the kidney tissue?

a.

Increased blood flow to the kidney

b.

Inhibition of vitamin D and loss of bone density

c.

Increased bone marrow production of red blood cells

d.

Inhibition of active transport of sodium and hyponatremia

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 (RBC) production in the bone marrow.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1471

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

7. The nurse is reviewing a clients laboratory test results and notes a blood urea nitrogen (BUN) of 35 mg/dL and a creatinine of 1.0 mg/dL. What new order does the nurse anticipate?

a.

Increase the clients IV fluids.

b.

Prepare the client for dialysis.

c.

Place the client on a fluid restriction.

d.

Obtain urine for culture and sensitivity.

ANS: A

Normal BUN is 10 to 20 mg/dL. Normal creatinine is 0.6 to 1.2 mg/dL (males) or 0.5 to 1.1 mg/dL (females). Creatinine is more specific for kidney function than is BUN because BUN can be affected by several factors (dehydration, high-protein diet, and others). This clients creatinine is normal, which suggests a non-renal cause of the elevated BUN. A common cause of increased BUN is dehydration, so the nurse should anticipate giving the client more fluids.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory Values) MSC: Integrated Process: Nursing Process (Analysis)

8. The nursing assistant is using a bladder scanner on a client. Which action by the nursing assistant requires further education on the use of this device?

a.

Consistently choosing the female icon for all female clients

b.

Consistently choosing the male icon for all male clients

c.

Applying ultrasound gel to the scanning head and removing it when finished

d.

Taking at least two readings by using the aiming icon to place the scanning head.

ANS: A

The nursing assistant 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 nursing assistant should choose the male icon. The other actions are correct.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1482

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialSystem-Specific Assessments) MSC: Integrated Process: Nursing Process (Assessment)

9. A client has an increased BUN/creatinine ratio. Which action by the nurse is most appropriate?

a.

Assess the clients dietary habits.

b.

Inquire about the use of NSAIDs.

c.

Hold the clients metformin (Glucophage).

d.

Notify the health care provider immediately.

ANS: A

An elevated BUN-creatinine ratio is often indicative of dehydration, urinary obstruction, catabolism, or a high-protein diet. The nurse should inquire about the clients dietary habits. Kidney damage related to NSAIDs most likely would manifest with elevations in both BUN and creatinine, but no change in the ratio.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory Values) MSC: Integrated Process: Nursing Process (Assessment)

10. A clients urine specific gravity is 1.040. Which action by the nurse is best?

a.

Obtain a urine culture and sensitivity.

b.

Place the client on restricted fluids.

c.

Review the clients creatinine level.

d.

Increase the clients 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 the presence of antidiuretic hormone (ADH). Increasing the clients fluid intake would be a beneficial intervention. The other interventions are not warranted.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory Values) MSC: Integrated Process: Nursing Process (Implementation)

11. Which assessment maneuver does the nurse perform first when assessing the renal system at the same time as the abdomen?

a.

Abdominal percussion

b.

Abdominal auscultation

c.

Abdominal palpation

d.

Renal palpation

ANS: B

Auscultation precedes percussion and palpation because the nurse needs to auscultate for abdominal bruits before performing palpation or percussion of the abdominal and renal components of a physical assessment. Also, palpation and percussion can change bowel sounds. Renal palpation is often done by the advanced practice nurse.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialSystem-Specific Assessments) MSC: Integrated Process: Nursing Process (Assessment)

12. A client was admitted for a myocardial infarction and cardiogenic shock. Two days later, which laboratory test results does the nurse expect to see?

a.

Blood urea nitrogen (BUN) of 52 mg/dL

b.

Creatinine of 2.3 mg/dL

c.

BUN of 10 mg/dL

d.

BUN-creatinine ratio of 8:1

ANS: A

Shock leads to decreased renal perfusion. An elevated BUN accompanies this condition. The creatinine should be normal because no kidney damage occurred. A low BUN signifies overhydration, malnutrition, or liver damage. The low BUN-creatinine ratio indicates fluid volume excess or acute renal tubular acidosis.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory Values) MSC: Integrated Process: Nursing Process (Analysis)

13. A clients urine specific gravity is 1.018. Which is the nurses best action?

a.

Ask the client for a 24-hour recall of liquid intake.

b.

Document the finding in the clients chart.

c.

Obtain a specimen for culture.

d.

Notify the health care provider.

ANS: B

This specific gravity is within the normal range for urine.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory Values) MSC: Integrated Process: Nursing Process (Analysis)

14. Which condition would trigger the release of antidiuretic hormone (ADH)?

a.

Overhydration

b.

Dehydration

c.

Hemorrhage

d.

Edema

ANS: B

ADH increases tubular permeability to water, leading to absorption of more water into the capillaries. Antidiuretic hormone is triggered by a rising extracellular fluid (ECF) osmolarity, as occurs in dehydration.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1470

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

15. The female clients urinalysis shows all the following results. Which does the nurse document as abnormal?

a.

pH 5.6

b.

Ketone bodies present

c.

Specific gravity of 1.030

d.

Two white blood cells per high-power field

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. The other results are normal.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory Values) MSC: Integrated Process: Nursing Process (Assessment)

16. A client scheduled for intravenous urography informs the nurse of the following allergies. Which one does the nurse report to the health care provider immediately?

a.

Seafood

b.

Penicillin

c.

Bee stings

d.

Red food dye

ANS: A

Clients with seafood allergies often have severe allergic reactions to the standard dyes used during intravenous urography.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Diagnostic Tests/Treatments/Procedures)

MSC: Integrated Process: Nursing Process (Assessment)

17. A client scheduled to have intravenous urography has diabetes and is taking the antidiabetic agent metformin (Glucophage). What does the nurse tell this client?

a.

Call your diabetes doctor and tell him or her that you are having an intravenous urogram performed using dye.

b.

Do not take your metformin the morning of the test because you are not going to be eating anything and you could become hypoglycemic.

c.

You must start on an antibiotic before this test because your risk of infection is greater as a result of your diabetes.

d.

You must take your metformin immediately before the test is performed because the IV fluid and the dye contain significant amounts of sugar.

ANS: A

Metformin can cause lactic acidosis and renal impairment as the result of an interaction with the dye. This drug must be discontinued for 48 hours before the procedure and not started again after the procedure until urine output is well established. The clients endocrinologist (or health care provider managing the diabetes) needs to provide alternative therapy for the client until the metformin can be resumed.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Diagnostic Tests/Treatments/Procedures)

MSC: Integrated Process: Nursing Process (Implementation)

18. A client is going home after urography. Which instruction or precaution does the nurse teach this client?

a.

Avoid direct contact with the urine for 24 hours until the radioisotope clears.

b.

You may have some dribbling of urine for several weeks after this procedure.

c.

Be sure to drink at least 3 liters of fluids today to help eliminate the dye faster.

d.

Your skin may become slightly yellow from the dye used in this procedure.

ANS: C

Dyes used in urography are potentially nephrotoxic. A large fluid intake will help the client eliminate the dye rapidly. The other statements are not accurate.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1484

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Diagnostic Tests/Treatments/Procedures)

MSC: Integrated Process: Teaching/Learning

19. Two hours after a closed percutaneous kidney biopsy, the client reports a dramatic increase in pain. What is the nurses best first action?

a.

Reposition the client on the operative side.

b.

Administer the prescribed opioid analgesic.

c.

Assess the pulse rate and blood pressure.

d.

Check the Foley catheter for kinks.

ANS: C

An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of internal hemorrhage. A change in vital signs can indicate that hemorrhage is occurring. Before other actions, the nurse must assess the clients hemodynamic status.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Diagnostic Tests/Treatments/Procedures)

MSC: Integrated Process: Nursing Process (Implementation)

20. A client is scheduled to have renography (kidney scan). The client voices concern about discomfort during the procedure. Which is the nurses best response?

a.

Before the test, you will be given a sedative to reduce any pain.

b.

A local anesthetic agent will be used, so you wont feel any pain.

c.

No more discomfort is felt with the scan than with an ordinary x-ray.

d.

The only pain will occur when you have your IV line started.

ANS: D

This test involves intravenous injection of the radioisotope and subsequent recording of the emission by a scintillator.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Principles of Teaching/Learning)

MSC: Integrated Process: Teaching/Learning

21. To obtain a sterile urine specimen from a client with a Foley catheter, the nurse begins by applying a clamp to the drainage tubing distal to the injection port. What does the nurse do next?

a.

Clamp another section of the tube to create a fixed sample section for retrieval.

b.

Insert a syringe into the injection port and aspirate the quantity of urine required.

c.

Clean the injection port cap of the drainage tubing with povidone-iodine solution.

d.

Withdraw 10 mL of urine and discard it; then withdraw 10 mL more for the sample.

ANS: C

It is important to clean the injection port cap of the catheter drainage tubing with an appropriate antiseptic, such as povidone-iodine solution or alcohol. This will help prevent surface contamination before injection of the syringe.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1479

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialSystem-Specific Assessments) MSC: Integrated Process: Nursing Process (Implementation)

MULTIPLE RESPONSE

1. Which results are normal in a urinalysis? (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 range. The other values are abnormal.

DIF: Cognitive Level: Knowledge/Remembering REF: Chart 68-4, 1478

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory Values) MSC: Integrated Process: Nursing Process (Assessment)

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