Chapter 52Assessment of Renal Function My Nursing Test Banks

Chapter 52Assessment of Renal Function

MULTIPLE CHOICE

1.The nurse has provided basic information to a client about the kidneys. Which of the following client statements would indicate that additional instruction would be needed?

1.

A person cannot survive without both kidneys.

2.

The kidneys are approximately 4.5 inches long.

3.

The kidneys are positioned in the retroperitoneal space.

4.

The right kidney is lower than the left.

ANS: 1

The client statement that would indicate the need for more instruction is a person cannot survive without both kidneys. A person can easily survive with a single kidney. The other client statements would not indicate the need for additional instruction.

PTS: 1 DIF: Analyze REF: Anatomy and Physiology: Kidneys

2.The nurse is assessing the renal system of an elderly client. Which of the following is not an age-related change seen in the renal system?

1.

Decreased glomerular filtration rate

2.

Decreased muscle tone and elasticity in the ureters, bladder, and urinary sphincter

3.

Prostatic hypoplasia in the male

4.

Nocturia

ANS: 3

Prostatic hyperplasia, not hypoplasia, is the age-related change often seen in elderly male patients resulting in urinary retention. The other choices are age-related changes that can occur in the renal system.

PTS:1DIF:Analyze

REF: Respecting Our Differences: Age-Related Changes in the Renal System

3.A client with an alteration in the renal system is demonstrating inconsistent blood pressure control. The nurse realizes that the substance produced by the kidneys that assists in blood pressure control is:

1.

antidiuretic hormone.

2.

erythropoietin.

3.

renin.

4.

vitamin D.

ANS: 3

Renin is produced by the kidneys and helps control blood pressure. Antidiuretic hormone is produced by the posterior pituitary. Erythropoietin stimulates the production of red blood cells. Vitamin D is activated by the kidneys and influences calcium metabolism.

PTS: 1 DIF: Analyze REF: Renin-Angiotensin System

4.A client has had a sudden 5-kg weight gain. The nurse calculates the clients fluid retention as being:

1.

2.5 L.

2.

5 L.

3.

10 L.

4.

15 L.

ANS: 2

A sudden increase of daily weight can indicate retention of body fluids. A weight gain of 1 kg would indicate retention of 1 L of fluid. The client who had a 5 kg weight gain would have a fluid retention of 5 L.

PTS: 1 DIF: Apply REF: Red Flag: Fluid Volume Excess

5.The nurse is collecting a 24-hour urine specimen from a client with an indwelling urinary catheter. How should the nurse collect this specimen?

1.

Empty the catheter bag once a shift and place the urine in a collection container on ice.

2.

Disconnect the catheter from the tubing and drain the urine directly into the collection container.

3.

Aspirate urine from the tubing port with a sterile needle every hour and place in a collection container on ice.

4.

Place the catheter bag on ice and empty regularly into the collection bottle, which is  also kept on ice.

ANS: 4

When collecting a 24-hour urine specimen from a client with an indwelling catheter, the nurse should place the catheter bag on ice and empty regularly into the collection bottle which is also to be kept on ice. The other choices are incorrect and could cause inaccurate test results.

PTS: 1 DIF: Apply REF: Table 52-1 Urine Studies

6.The nurse needs to collect a urine specimen for culture from a client who does not have an indwelling urinary catheter. Which of the following instructions would the nurse provide the client regarding how to collect this sample?

1.

Decrease your water intake so the sample will be more concentrated.

2.

I will need to catheterize you to obtain urine.

3.

Please use the wipe and cup for the sample.

4.

When you use the urinal, please call so that I can get the sample.

ANS: 3

A urine specimen obtained from a non-catheterized client should be collected using a specimen cup and by using the proper cleansing technique. The nurse should not instruct the client to reduce fluid intake. The nurse does not need to catheterize the client to obtain the specimen. The nurse should not be using urine from a urinal for this specimen.

PTS: 1 DIF: Apply REF: Table 52-1 Urine Studies

7.The nurse is reviewing the results of serum laboratory tests conducted on a client. Which of the following results should be reported?

1.

Calcium 8.5 mg/dL

2.

Potassium 6.1 mEq/L

3.

Serum creatinine 1.4 mg/dL

4.

Sodium 144 mEq/L

ANS: 2

Normal potassium levels are between 3.5 and 5 mEq/L. The other values are within normal limits.

PTS: 1 DIF: Apply REF: Table 52-2 Blood Studies

8.A client, diagnosed with renal calculi, is experiencing extreme pain. The nurse explains to the client that the cause of the pain is due to the:

1.

stone scratching the kidney tissue.

2.

stone scraping against the bladder.

3.

buildup of pressure in the ureters.

4.

spasms of the urethra.

ANS: 3

Pressure receptors in the ureters generate the extreme pain experienced during the passage of renal calculi. Pain associated with renal calculi is not caused by the stone scratching the kidney tissue or scraping against the bladder. The pain is not caused by urethral spasms.

PTS: 1 DIF: Apply REF: Ureters

9.A client has sustained trauma to the trigone portion of the bladder. The nurse realizes that which of the following will be affected in this client?

1.

The ureters and urethra

2.

The nephrons

3.

The detrusor muscle will spasm

4.

The ability to concentrate urine will be lost

ANS: 1

The trigone of the bladder accommodates the orifices of the ureters and the urethra. The nephrons are the functional unit of the kidney. Trauma to the trigone portion of the bladder may or may not cause detrusor muscle spasms. Damage to the bladder will not cause the kidney to lose the ability to concentrate urine.

PTS:1DIF:AnalyzeREF:Urinary Bladder

10.The nurse is assessing the skin of a client diagnosed with renal insufficiency. Which of the following is the nurse most likely going to assess in this client?

1.

Evidence of scratching

2.

Bruises

3.

Flushing

4.

Moist skin with good turgor

ANS: 1

Signs of persistent scratching often occurs in the client with renal disorders because of the phosphorus or calcium imbalances. Bruising and flushing are not typically associated with this disorder. The skin of a client with a renal disorder can be dry and lack turgor or be grossly edematous.

PTS: 1 DIF: Apply REF: Skin

11.A client diagnosed with a kidney disorder is scheduled for a diagnostic test that uses a contrast agent. Which of the following can be done to protect this clients kidney functioning?

1.

Restrict fluids.

2.

Administer acetylcysteine as prescribed.

3.

Provide 0.9% normal saline through an intravenous access device.

4.

Maintain bed rest.

ANS: 2

To protect renal function in a client with a kidney disorder who needs to receive a contrast agent for a diagnostic test, the client would be provided with acetylcysteine or sodium bicarbonate. The client should not have fluids restricted. An intravenous infusion of normal saline will not protect the kidneys from possible damage from the contrast agent. Maintaining bed rest will not protect the kidneys from the contrast agent.

PTS:1DIF:Apply

REF: Red Flag: Using Contrast Agents in Renal Diagnostics

12.A client is scheduled for a renal ultrasound and a barium swallow. The nurse realizes that which of the following should be done regarding these diagnostic tests?

1.

Complete the barium swallow first.

2.

Complete the renal ultrasound first.

3.

Complete the barium swallow and then have the renal ultrasound done immediately afterward.

4.

Wait 8 hours after the barium swallow to complete the renal ultrasound.

ANS: 2

A renal ultrasound must be done before any diagnostic tests that use barium. If this is not possible, at least 24 hours must elapse between the barium swallow and the renal ultrasound.

PTS:1DIF:Analyze

REF:Red Flag: Potential Problems Associated with Renal Ultrasounds

13.A client with chronic renal disease asks the nurse why she needs to receive erythropoietin injections. Which of the following should the nurse respond to this client?

1.

It makes more vitamin D in your body.

2.

It encourages your kidneys to remove more waste products.

3.

It stimulates red blood cell production in the bone marrow.

4.

It helps remove ammonia from your blood.

ANS: 3

Erythropoietin stimulates red blood cell production in the bone marrow, which is compromised in renal failure. This is what the nurse should respond to the client. Erythropoietin does not make vitamin D, remove waste products, or remove ammonia from the blood.

PTS: 1 DIF: Apply REF: Table 52-2 Blood Studies

MULTIPLE RESPONSE

1.A nurse is assessing a client for signs of decreased kidney function. Which of the following are symptoms of possible decreased kidney function? (Select all that apply.)

1.

Increased appetite

2.

Metallic taste in the mouth

3.

Pruritus

4.

Reduced energy level

5.

Urine output of 240 mL in 8  hours

6.

Weight gain

ANS: 2, 3, 4, 6

Signs of decreased kidney function are a reduced energy level, metallic taste in the mouth, anorexia, nausea, pruritus, decreased ability to concentrate, decreased urine output, and weight gain from fluid retention. Increased appetite and urine output of 240 mL in 8 hours are not seen in a client with decreased kidney function.

PTS:1DIF:AnalyzeREF:Health History

2.The nurse is reviewing a clients current medication list for those that can be nephrotoxic. Which of the following medications can be nephrotoxic? (Select all that apply.)

1.

Amphotericin B

2.

Chloroquine

3.

Erythromycin

4.

Gentamicin

5.

Tobramycin

6.

Vancomycin

ANS: 1, 4, 5, 6

Potentially nephrotoxic drugs are amikacin, gentamicin, amphotericin B, sulfonamides, tobramycin, vancomycin, chemotherapeutic agents, contrast medium, ethylene glycol, nonsteroidal anti-inflammatory drugs (NSAIDs), gold, and other heavy metals. Chloroquine and Erythromycin are not nephrotoxic medications.

PTS:1DIF:Apply

REF:Box 52-3 Potentially Nephrotoxic Drugs and Other Agents

3.A nurse is collecting a 24-hour urine sample from a client without an indwelling urinary catheter. Which of the following are steps for collecting the sample? (Select all that apply.)

1.

Discard the first void and save all subsequent urine for 24 hours.

2.

Discard the last void.

3.

Record the first void as the beginning time.

4.

Save all urine in a 24-hour period.

5.

Save the first void.

6.

Save all urine voided except the last specimen.

ANS: 1, 3

The 24-hour urine collection procedure would include discarding the first void and recording the time as the start time. Each subsequent void would be collected and saved until the 24-hour period ends. This includes the last void. Since the first void is discarded, all urine in a 24-hour period is not saved.

PTS: 1 DIF: Apply REF: Table 52-1 Urine Studies

4.The nurse realizes that a client diagnosed with kidney disease is at risk for acid-base imbalances. Which of the following explains how the kidney contributes to acid-base balance? (Select all that apply.)

1.

Secretes hydrogen ions

2.

Reabsorbs bicarbonate

3.

Generates new bicarbonate

4.

Produces erythropoietin

5.

Converts vitamin D

6.

Excretes waste products from protein metabolism

ANS: 1, 2, 3

The kidneys contribute to acid-base balance by secreting hydrogen ions, reabsorbing bicarbonate, or generating new bicarbonate. The production of erythropoietin aids in the making of red blood cells. The conversion of vitamin D supports calcium metabolism. The excretion of waste products from protein metabolism does not contribute to acid-base balance.

PTS: 1 DIF: Analyze REF: Box 52-1 Functions of the Kidney

5.A client has a disorder that is affecting the reabsorption ability of the kidney. Which of the following does the renal tubule usually reabsorb to support body functions? (Select all that apply.)

1.

Water

2.

Glucose

3.

Amino acids

4.

Vitamins

5.

Calcium

6.

Ammonia

ANS: 1, 2, 3, 4, 5

In the kidney, tubular reabsorption includes water, glucose, amino acids, vitamins, bicarbonates, calcium, magnesium, sodium, and potassium. Ammonia is secreted from the renal tubule.

PTS:1DIF:Analyze

REF: Figure 52-5 Processes and Structures of the Nephron

6.A client is recovering from a renal biopsy. After this procedure, the nurse should instruct the client to notify the nurse for which of the following? (Select all that apply.)

1.

Problems voiding

2.

Obvious blood in the urine

3.

Increased pain

4.

Fever

5.

Painful urination

6.

Constipation

ANS: 1, 2, 3, 4, 5

After a renal biopsy, the client should be instructed to notify the nurse with problems voiding, obvious blood in the urine, increased pain, fever, or painful urination. Constipation is not considered an effect of a renal biopsy.

PTS:1DIF:ApplyREF:Nursing Management

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