Chapter 29- Patient Assessment- Renal System. My Nursing Test Banks

 

1.

The nurse is working with a patient with suspected acute renal failure. Which of the assessments would provide accurate information about this patients fluid balance? Select all that apply.

A)

Daily measure of patients weight at the same time, using same scale

B)

Monitoring of intake and output every 1 to 2 hours

C)

Monitoring of blood sugar levels hourly

D)

Taking x-rays of the kidneys weekly

2.

A nurse is assessing a patient with acute renal failure for pitting edema. She gently presses her finger into the edematous area on the patients foot. She measures an indention of 8 mm, which slowly returns to baseline after about 3 minutes. Which level of pitting edema does this patient exhibit?

A)

4+ (severe)

B)

3+ (moderate)

C)

2+ (mild)

D)

1+ (trace)

3.

A nurse has just received a clean-catch urine sample from the patient and is about to deliver it to the laboratory for analysis. She observes that it is dark yellow, has a cloudy or turbid appearance, and has an ammonia odor. Which of the following does the nurse suspect about the patients condition based on her observations? Select all that apply.

A)

The patient is diabetic.

B)

The patient has above-normal creatinine clearance.

C)

The patient is dehydrated.

D)

The patient has proteinuria.

E)

The patient has intrarenal hemorrhaging.

F)

The patient has a renal infection.

4.

On auscultating the patients heart, the nurse hears a third heart sound. What condition would this finding be most indicative of?

A)

Renal artery stenosis

B)

A faulty stethoscope

C)

Hypotension

D)

Fluid overload

5.

A nurse is examining a patient on dialysis. Which of the following should she especially look for in this patient?

A)

The presence of a third heart sound

B)

Pitting edema

C)

Inflammation or infection near the access site

D)

Crackles on auscultation of lungs

6.

A patient in the ICU is found to have a steady glomerular filtration rate (GFR) of 180 L/day. Over the first 3 days following admission, his urine volume averages 1 L per day. On the fourth day, however, his urine volume drops to almost zero, while his GFR remains constant. The nurse recognizes that which of the following is the most likely explanation of this phenomenon?

A)

Chronic kidney disease

B)

Abdominal compartment syndrome

C)

Renal artery stenosis

D)

Pulmonary edema

7.

An elderly woman in the ICU has an indwelling urinary catheter and is being treated for a myocardial infarction. She is diabetic but is in the habit of having several glasses of orange juice each day. Her lab test results show that her urinary pH is 7.6. The nurse should suspect which of the following factors as the cause of the elevated pH level?

A)

A urinary tract infection

B)

Ketoacidosis caused by untreated diabetes

C)

Consumption of acidic foods

D)

Dehydration

8.

A patients lab results include a finding of glucose in the urine (glycosuria). What other lab result should the nurse expect in this patient?

A)

Decreased ketones in the urine

B)

Alkaline urinary pH

C)

Elevated blood glucose

D)

Decreased urine volume

9.

A patient in the ICU with chronic renal disease has just received his lab results. The nurse knows that one of the first functions to be lost in renal disease is the ability to concentrate urine. Which of the following lab results would indicate this loss of ability to concentrate the urine?

A)

A specific gravity of urine that varies between 1.001 and 1.022, depending on the patients water balance

B)

Urine osmolality fixed within 150 mOsm of the simultaneously determined serum osmolality

C)

Urinary pH of 6.0

D)

Urine volume of 1 L/day

10.

A patient in the ICU is severely dehydrated. Which of the following findings would the nurse expect in this patient?

A)

Orthostatic hypotension on standing

B)

Third heart sound

C)

Pitting edema

D)

Rales

11.

The patient is being evaluated for renal disease. During the initial patient history, what system should the nurse focus on in addition to the renal system?

A)

Pulmonary and cardiac

B)

Neurologic and integumentary

C)

Psychological and social support

D)

All physical and other systems

12.

A patient with chronic kidney disease has a low body temperature. What is the best nursing response to this finding?

A)

Assess for signs of sepsis.

B)

Provide extra blankets.

C)

Give warm intravenous fluids.

D)

Reassess with a different thermometer.

13.

During a routine physical examination, the nurse palpates the patients left kidney just below the costal margins on the posterior aspect of the trunk. What is the most appropriate nursing action?

A)

Document this normal finding.

B)

Obtain an order for renal diagnostics.

C)

Assess for toxic ingestion.

D)

Evaluate coagulation studies.

14.

During physical examination of an ambulatory patient, the nurse finds elevated blood pressure, pulmonary crackles that do not clear with cough, jugular venous distention, liver congestion and enlargement, an S3 heart sound, and pitting edema of the feet and lower legs. What is the most likely cause of this group of findings?

A)

Fluid volume deficit

B)

Fluid volume excess

C)

Hyponatremia

D)

Leukocytosis

15.

A patient has had an arteriovenous graft inserted for dialysis. What nursing physical examination finding indicates patency of the graft?

A)

Auscultation of a bruit over the renal artery

B)

Palpation of a thrill over the graft

C)

Distal pulses are 3+ to palpation

D)

Blood pressure within normal limits

16.

A patient with renal impairment is found to have a positive Chvosteks sign. What additional information should the nurse assess for?

A)

Hyperkalemia

B)

Hyponatremia

C)

Hypocalcemia

D)

Hypermagnesemia

17.

The patients urinalysis shows proteinuria. What is the significance of this finding?

A)

Normal in late pregnancy

B)

Intrarenal acute renal failure

C)

Diminished glomerular filtration rate

D)

Compromised erythropoietin production

18.

The nurse is caring for a patient who was run over by an automobile. The patient has hematuria on admission to the emergency department. What is the most likely cause of the hematuria?

A)

Kidney trauma

B)

Kidney stones

C)

Prostatic disease

D)

Toxic damage

19.

What laboratory value is most likely to indicate renal failure?

A)

Elevated blood urea nitrogen (BUN)

B)

Low hemoglobin and hematocrit

C)

Elevated serum creatinine

D)

Normal urine osmolarity

20.

A patient has significantly decreased creatinine clearance and an elevated serum creatinine. What does this value indicate to the nurse?

A)

Improved renal function

B)

Kidney damage from disease

C)

Muscle wasting

D)

Rhabdomyolysis

21.

After a renal biopsy, what symptom indicates a significant complication of this procedure?

A)

Increasing hematuria

B)

Increased urine volume

C)

Heart rate 60 to 100

D)

Mean arterial pressure 85

22.

The nurse is caring for a patient with renal disease and is monitoring fluid balance. What is the most accurate method for assessing fluid balance?

A)

Daily weights at same time of day

B)

Episodic intake and output totals

C)

Heart rate trends

D)

Jugular venous volume measurement

Answer Key

1.

A, B

2.

A

3.

C, F

4.

D

5.

C

6.

B

7.

A

8.

C

9.

B

10.

A

11.

D

12.

B

13.

B

14.

B

15.

B

16.

C

17.

B

18.

A

19.

C

20.

B

21.

A

22.

A

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