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G R A D E S L A B. C O MChapter 60: Assessment of the Renal/Urinary SystemIgnatavicius: Medical-Surgical Nursing, 10th EditionMULTIPLE CHOICE1. A nurse reviews the urinalysis of a client and notes the presence of glucose. What actionwould the nurse take?a. Document findings and continue to monitor t...

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Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)

Chapter 60: Assessment of the Renal/Urinary System Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse reviews the urinalysis of a client and notes the presence of glucose. What action

would the nurse take? Document findings and continue to monitor the client. Contact the primary health care provider and recommend a 24-hour urine test. Review the client’s recent dietary selections over 3 days. Perform a finger stick blood glucose assessment.

a. b. c. d.

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. DIF: Applying TOP: Integrated Process: Nursing Process: Assessment KEY: Urinary, Renal system, Diagnostic tests MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 2. A nurse reviews the health history of a client with an oversecretion of renin. Which disorder

would the nurse correlate with this assessment finding? Alzheimer disease Hypertension Diabetes mellitus Viral hepatitis

a. b. c. d.

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. DIF: Understanding TOP: Integrated Process: Nursing Process: Assessment KEY: Urinary, Renal system, Assessment MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 3. 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.

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files) 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. DIF: Applying TOP: Integrated Process: Nursing Process: Planning and Implementation KEY: Urinary, Renal system, Assessment MSC: Client Needs Category: Physiological Integrity: Basic Care and Comfort 4. 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. DIF: Remembering TOP: Integrated Process: Teaching/Learning KEY: Urinary, Renal system, Assessment MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 5. 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

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)

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. DIF: Applying TOP: Integrated Process: Nursing Process: Analysis KEY: Urinary, Renal system, Diagnostic tests MSC: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 6. 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. DIF: Remembering TOP: Integrated Process: Culture and Spirituality KEY: Kidney disorders, Human Development MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 7. 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. DIF: TOP: KEY: MSC:

Understanding Integrated Process: Nursing Process: Implementation Urinary, Renal system, Diagnostic tests Client Needs Category: Physiological Integrity: Basic Care and Comfort

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files) 8. 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. DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment KEY: Urinary, Renal system, Diagnostic tests MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 9. 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. A change in vital signs (elevated pulse and decreased blood pressure) can indicate that hemorrhage is occurring. DIF: Applying TOP: Integrated Process: Nursing Process: Planning and Implementation KEY: Urinary, Renal system, Assessment MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 10. 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. DIF: Applying TOP: Integrated Process: Communication and Documentation KEY: Urinary, Renal system, Delegation MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files) MULTIPLE RESPONSE 1. 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.) pH: 6 Specific gravity: 1.015 Protein: 1.2 mg/dL Glucose: negative Nitrate: small Leukocyte esterase: positive

a. b. c. d. e. f.

ANS: A, B, D

The pH, specific gravity, and glucose are all within normal ranges. The other values are abnormal. DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment KEY: Urinary, Renal system, Diagnostic tests MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 2. The nurse is preparing a client for a percutaneous kidney biopsy. Which laboratory tests

results would the nurse review prior to the procedure? (Select all that apply.) a. Hemoglobin b. Hematocrit c. Sodium d. Potassium e. Platelet count f. Prothrombin time ANS: A, B, E, F

Kidneys are very vascular and the client is at risk for bleeding after a biopsy. Therefore, it is essential that the nurse review preprocedure laboratory test results for anemia and coagulation problems. DIF: Applying TOP: Integrated Process: Nursing Process: Assessment KEY: Urinary, Renal system, Diagnostic tests MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 3. A nurse assesses a client recovering from a cystoscopy. Which assessment findings would

alert the nurse to urgently contact the primary health care provider? (Select all that apply.) a. Decrease in urine output b. Tolerating oral fluids c. Prescription for metformin d. Blood clots present in the urine e. Burning sensation when urinating ANS: A, D

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files)

The nurse would monitor urine output and contact the primary health care provider if urine output decreases or becomes absent. The nurse would also assess for blood in the client’s urine. The urine may be pink-tinged, but gross bleeding or blood clots should not be present. If bleeding is present, the nurse would urgently contact the primary health care provider. Tolerating oral fluids is a positive outcome and does not need intervention. Metformin would be a concern if the patient received dye; no dye is used in a cystoscopy procedure. The client may experience a burning sensation when urinating after this procedure; this would not require a call to the primary health care provider. DIF: Applying TOP: Integrated Process: Nursing Process: Analysis KEY: Urinary, Renal system, Diagnostic tests MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 4. A nurse prepares a client for a percutaneous kidney biopsy. What actions should the nurse

take prior to this procedure? (Select all that apply.) a. Keep the client NPO for 4 to 6 hours. b. Review coagulation study results. c. Maintain strict bedrest in a supine position. d. Assess for blood in the client’s urine. e. Administer client’s antihypertensive medications. ANS: A, B, E

Prior to a percutaneous kidney biopsy, the patient should be NPO for 4 to 6 hours. Coagulation studies should be completed to prevent bleeding after the biopsy. Blood pressure medications should be administered to prevent hypertension before and after the procedure. There is no need to keep the patient on bedrest or assess for blood in the client’s urine prior to the procedure; these interventions should be implemented after a percutaneous kidney biopsy. DIF: Applying TOP: Integrated Process: Nursing Process: Planning and Implementation KEY: Urinary, Renal system, Diagnostic tests MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 5. A nurse plans care for an older adult patient. Which interventions should the nurse include in

this client’s plan of care to promote kidney health? (Select all that apply.) Ensure adequate fluid intake. Leave the bathroom light on at night. Encourage use of the toilet every 6 hours. Delegate bladder training instructions to the assistive personnel (AP). Provide thorough perineal care after each voiding. Assess for urinary retention and urinary tract infection.

a. b. c. d. e. f.

ANS: A, B, E, F

The nurse should ensure that the client receives adequate fluid intake and has adequate lighting to ambulate safely to the bathroom at night, encourage the client to use the toilet every 2 hours, provide thorough perineal care after each voiding, and assess for urinary retention and urinary tract infections. The nurse would not delegate any teaching to the AP, including bladder training instructions. The AP may participate in bladder training activities, including encouraging and assisting the client to the bathroom at specific times. DIF: Understanding TOP: Integrated Process: Nursing Process: Planning and Implementation

Test Bank for Medical Surgical Nursing 10th Edition Ignatavicius (Test Bank PDF Files) KEY: Urinary, Renal system, Safety MSC: Client Needs Category: Health Promotion and Maintenance...