Hinkle - Chapter 53

1. 1The care team is considering the use of dialysis in a patient whose renal function is progressively declining. Renal replacement therapy is indicated in which of the following situations?

   1. AWhen the patients creatinine level drops below 1.2 mg/dL (110 mmol/L)
   2. BWhen the patients blood urea nitrogen (BUN) is above 15 mg/dL
   3. CWhen approximately 40% of nephrons are not functioning
   4. DWhen about 80% of the nephrons are no longer functioning
2. 2A nurse knows that specific areas in the ureters have a propensity for obstruction. Prompt management
   of renal calculi is most important when the stone is located where?

   1. AIn the ureteropelvic junction
   2. BIn the ureteral segment near the sacroiliac junction
   3. CIn the ureterovesical junction
   4. DIn the urethra
3. 3A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has
   been ordered. The nurse should facilitate collection of what samples?

   1. AA fasting serum potassium level and a random urine sample
   2. BA 24-hour urine specimen and a serum creatinine level midway through the urine collection process
   3. CA BUN and serum creatinine level on three consecutive mornings
   4. DA sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values
4. 4The nurse is assessing a patients bladder by percussion. The nurse elicits dullness after the patient has
   voided. How should the nurse interpret this assessment finding?

   1. AThe patients bladder is not completely empty.
   2. BThe patient has kidney enlargement.
   3. CThe patient has a ureteral obstruction.
   4. DThe patient has a fluid volume deficit.
5. 5The nurse is providing pre-procedure teaching about an ultrasound. The nurse informs the patient that in
   preparation for an ultrasound of the lower urinary tract the patient will require what?

   1. AIncreased fluid intake to produce a full bladder
   2. BIV administration of radiopaque contrast agent
   3. CSedation and intubation
   4. DInjection of a radioisotope
6. 6The nurse is caring for a patient who has a fluid volume deficit. When evaluating this patients urinalysis
   results, what should the nurse anticipate?

   1. AA fluctuating urine specific gravity
   2. BA fixed urine specific gravity
   3. CA decreased urine specific gravity
   4. DAn increased urine specific gravity
7. 7A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse
   should be aware of what age-related change affecting the renal or urinary system?

   1. AIncreased ability to concentrate urine
   2. BIncreased bladder capacity
   3. CUrinary incontinence
   4. DDecreased glomerular filtration rate
8. 8A nurse is preparing a patient diagnosed with benign prostatic hypertrophy (BPH) for a lower urinary
   tract cystoscopic examination. The nurse informs the patient that the most common temporary
   complication experienced after this procedure is what?

   1. AUrinary retention
   2. BBladder perforation
   3. CHemorrhage
   4. DNausea
9. 9A patient with renal failure secondary to diabetic nephropathy has been admitted to the medical unit.
   What is the most life-threatening effect of renal failure for which the nurse should monitor the patient?

   1. AAccumulation of wastes
   2. BRetention of potassium
   3. CDepletion of calcium
   4. DLack of BP control
10. 10A kidney biopsy has been scheduled for a patient with a history of acute renal failure. The patient asks
    the nurse why this test has been scheduled. What is the nurses best response?

    1. AA biopsy is routinely ordered for all patients with renal disorders.
    2. BA biopsy is generally ordered following abnormal x-ray findings of the renal pelvis.
    3. CA biopsy is often ordered for patients before they have a kidney transplant.
    4. DA biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease.

11. 11The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory
    results for this patient, the nurse interprets the presence of which substances in the urine as most
    suggestive of pathology?

    1. APotassium and sodium
    2. BBicarbonate and urea
    3. CGlucose and protein
    4. DCreatinine and chloride
12. 12The nurse caring for a patient with suspected renal dysfunction calculates that the patients weight has
    increased by 5 pounds in the past 24 hours. The nurse estimates that the patient has retained
    approximately how much fluid?

    1. A1,300 mL of fluid in 24 hours
    2. B2,300 mL of fluid in 24 hours
    3. C3,100 mL of fluid in 24 hours
    4. D5,000 mL of fluid in 24 hours
13. 13The nurse is performing a focused genitourinary and renal assessment of a patient. Where should the
    nurse assess for pain at the costovertebral angle?

    1. AAt the umbilicus and the right lower quadrant of the abdomen
    2. BAt the suprapubic region and the umbilicus
    3. CAt the lower border of the 12th rib and the spine
    4. DAt the 7th rib and the xyphoid process
14. 14The staff educator is giving a class for a group of nurses new to the renal unit. The educator is discussing
    renal biopsies. In what patient would the educator tell the new nurses that renal biopsies are
    contraindicated?

    1. AA 64-year-old patient with chronic glomerulonephritis
    2. BA 57-year-old patient with proteinuria
    3. CA 42-year-old patient with morbid obesity
    4. DA 16-year-old patient with signs of kidney transplant rejection
15. 15The nurse is caring for a patient who describes changes in his 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 get to the
    restroom quickly. But when I empty my bladder, there doesnt seem to be a great deal of urine flow.
    What would the nurse expect this patients physical assessment to reveal?

    1. AHematuria
    2. BUrine retention
    3. CDehydration
    4. DRenal failure
16. 16The nurse is caring for a patient with a nursing diagnosis of deficient fluid volume. The nurses
    assessment reveals a BP of 98/52 mm Hg. The nurse should recognize that the patients kidneys will
    compensate by secreting what substance?

    1. AAntidiuretic hormone (ADH)
    2. BAldosterone
    3. CRenin
    4. DAngiotensin
17. 17A nurse is caring for a 73-year-old patient with a urethral obstruction related to prostatic enlargement.
    When planning this patients care, the nurse should be aware of the consequent risk of what
    complication?

    1. AUrinary tract infection
    2. BEnuresis
    3. CPolyuria
    4. DProteinuria
18. 18A patient with elevated BUN and creatinine values has been referred by her primary physician for
    further evaluation. The nurse should anticipate the use of what initial diagnostic test?
    

    1. AUltrasound
    2. BX-ray
    3. CComputed tomography (CT)
    4. DNuclear scan
19. 19A patient admitted to the medical unit with impaired renal function is complaining of severe, stabbing
    pain in the flank and lower abdomen. The patient is being assessed for renal calculi. The nurse
    recognizes that the stone is most likely in what anatomic location?

    1. AMeatus
    2. BBladder
    3. CUreter
    4. DUrethra
20. 20The nurse is caring for a patient who had a brush biopsy 12 hours ago. The presence of what assessment
    finding should prompt the nurse to notify the physician?

    1. AScant hematuria
    2. BRenal colic
    3. CTemperature 100.2F orally
    4. DInfiltration of the patients intravenous catheter
21. 21A patient with recurrent urinary tract infections has just undergone a cystoscopy and complains of slight
    hematuria during the first void after the procedure. What is the nurses most appropriate action?

    1. AAdminister a STAT dose of vitamin K, as ordered.
    2. BReassure the patient that this is not unexpected and then monitor the patient for further bleeding.
    3. CPromptly inform the physician of this assessment finding.
    4. DPosition the patient supine and insert a Foley catheter, as ordered.
22. 22A patient is complaining of genitourinary pain shortly after returning to the unit from a scheduled
    cystoscopy. What intervention should the nurse perform?

    1. AEncourage mobilization.
    2. BApply topical lidocaine to the patients meatus, as ordered.
    3. CApply moist heat to the patients lower abdomen.
    4. DApply an ice pack to the patients perineum.
23. 23The nurse is caring for a patient who is going to have an open renal biopsy. What would be an important
    nursing action in preparing this patient for the procedure?

    1. ADiscuss the patients diagnosis with the family.
    2. BBathe the patient before the procedure with antiseptic skin wash.
    3. CAdminister antivirals before sending the patient for the procedure.
    4. DKeep the patient NPO prior to the procedure.
24. 24The nurse is caring for a patient scheduled for renal angiography following a motor vehicle accident.
    What patient preparation should the nurse most likely provide before this test?

    1. AAdministration of IV potassium chloride
    2. BAdministration of a laxative
    3. CAdministration of Gastrografin
    4. DAdministration of a 24-hour urine test
25. 25Diagnostic testing of an adult patient reveals renal glycosuria. The nurse should recognize the need for the patient to be assessed for what health problem?

    1. ADiabetes insipidus
    2. BSyndrome of inappropriate antidiuretic hormone secretion (SIADH)
    3. CDiabetes mellitus
    4. DRenal carcinoma
26. 26A patient with a diagnosis of respiratory acidosis is experiencing renal compensation. What function
    does the kidney perform to assist in restoring acidbase balance?

    1. ASequestering free hydrogen ions in the nephrons
    2. BReturning bicarbonate to the bodys circulation
    3. CReturning acid to the bodys circulation
    4. DExcreting bicarbonate in the urine
27. 27A patients most recent laboratory findings indicate a glomerular filtration rate (GFR) of 58 mL/min. The
    nurse should recognize what implication of this diagnostic finding?

    1. AThe patient is likely to have a decreased level of blood urea nitrogen (BUN).
    2. BThe patient is at risk for hypokalemia.
    3. CThe patient is likely to have irregular voiding patterns.
    4. DThe patient is likely to have increased serum creatinine levels.
28. 28A patient has experienced excessive losses of bicarbonate and has subsequently developed an acidbase
    imbalance. How will this lost bicarbonate be replaced?

    1. AThe kidneys will excrete increased quantities of acid.
    2. BBicarbonate will be released from the adrenal medulla.
    3. CAlveoli in the lungs will synthesize new bicarbonate.
    4. DRenal tubular cells will generate new bicarbonate.
29. 29A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What
    related health education should the nurse provide to an older adult?

    1. AIf possible, try to drink at least 4 liters of fluid daily.
    2. BEnsure that you avoid replacing water with other beverages.
    3. CRemember to drink frequently, even if you dont feel thirsty.
    4. DMake sure you eat plenty of salt in order to stimulate thirst.
30. 30A patient is scheduled for a diagnostic MRI of the lower urinary system. What pre-procedure education
    should the nurse include?

    1. AThe need to be NPO for 12 hours prior to the test
    2. BRelaxation techniques to apply during the test
    3. CThe need for conscious sedation prior to the test
    4. DThe need to limit fluid intake to 1 liter in the 24 hours before the test
31. 31Results of a patients 24-hour urine sample indicate osmolality of 510 mOsm/kg, which is within
    reference range. What conclusion can the nurse draw from this assessment finding?

    1. AThe patients kidneys are capable of maintaining acidbase balance.
    2. BThe patients kidneys reabsorb most of the potassium that the patient ingests.
    3. CThe patients kidneys can produce sufficiently concentrated urine.
    4. DThe patients kidneys are producing sufficient erythropoietin.
32. 32A patient is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary
    dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all
    that apply.

    1. APetechiae
    2. BPain
    3. CGastrointestinal symptoms
    4. DChanges in voiding
    5. EJaundice
33. 33A patient asks the nurse why kidney problems can cause gastrointestinal disturbances. What relationship
    should the nurse describe?

    1. AThe right kidneys proximity to the pancreas, liver, and gallbladder
    2. BThe indirect impact of digestive enzymes on renal function
    3. CThat the peritoneum encapsulates the GI system and the kidneys
    4. DThe left kidneys connection to the common bile duct
34. 34A patient with a history of progressively worsening fatigue is undergoing a comprehensive assessment
    which includes test of renal function relating to erythropoiesis. When assessing the oxygen transport
    ability of the blood, the nurse should prioritize the review of what blood value?

    1. AHematocrit
    2. BHemoglobin
    3. CErythrocyte sedimentation rate (ESR)
    4. DSerum creatinine
35. 35The nurse is reviewing the electronic health record of a patient with a history of incontinence. The nurse
    reads that the physician assessed the patients deep tendon reflexes. What condition of the urinary/renal
    system does this assessment address?

    1. ARenal calculi
    2. BBladder dysfunction
    3. CBenign prostatic hyperplasia (BPH)
    4. DRecurrent urinary tract infections (UTIs)
36. 36A patient with a history of incontinence will undergo urodynamic testing in the physicians office.
    Because voiding in the presence of others can cause situational anxiety, the nurse should perform what
    action?

    1. AAdminister diuretics as ordered.
    2. BPush fluids for several hours prior to the test.
    3. CDiscuss possible test results as the patient voids.
    4. DHelp the patient to relax before and during the test.
37. 37A nurse is working with a patient who will undergo invasive urologic testing. The nurse has informed
    the patient that slight hematuria may occur after the testing is complete. The nurse should recommend
    what action to help resolve hematuria?

    1. AIncreased fluid intake following the test
    2. BUse of an OTC diuretic after the test
    3. CGentle massage of the lower abdomen
    4. DActivity limitation for the first 12 hours after the test
38. 38The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that
    this test will include what assessment parameters? Select all that apply.

    1. ASpecific gravity of the patients urine
    2. BTesting for the presence of glucose in the patients urine
    3. CMicroscopic examination of urine sediment for RBCs
    4. DMicroscopic examination of urine sediment for casts
    5. ETesting for BUN and creatinine in the patients urine
39. 39Dipstick testing of an older adult patients urine indicates the presence of protein. Which of the following
    statements is true of this assessment finding? Select all that apply.

    1. AThis finding needs to be considered in light of other forms of testing.
    2. BThis finding is a risk factor for urinary incontinence.
    3. CThis finding is likely the result of an age-related physiologic change.
    4. DThis result confirms that the patient has diabetes.
40. 40What nursing action should the nurse perform when caring for a patient undergoing diagnostic testing of
    the renal-urologic system?

    1. AWithhold medications until 12 hours post-testing.
    2. BEnsure that the patient knows the importance of temporary fluid restriction after testing.
    3. CInform the patient of his or her medical diagnosis after reviewing the results.
    4. DAssess the patients understanding of the test results after their completion.

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Nursing (N21) Quiz on Hinkle - Chapter 53, created by N R on 16/03/2022.

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