Iggy Ch 68 SG - assessment of the Renal/urinary System

Question 1

_______________: also known as vasopressin

Answer 1

antidiuretic hormone (ADH)

Question 2

______________: series of specialized capillary loops.

Answer 2

glomerulus

Question 3

___________________: Acts on distal tubule and collecting duct to increase sodium and water excretion

Answer 3

prostaglandin E2 (PGE2)

Question 4

__________: needed to absorb calcium in the intestinal tract and to regulate calcium balance.

Answer 4

Vitamin D

Question 5

__________:small hormone that dilates the afferent arteriole and increases capillary membrane permeability to some solutes.

Answer 5

bradykinin

Question 6

A patient has sustained a minor kidney injury. Which structure must remain functional in order for urine to be removed from the blood?

a. Medulla
b. Nephron
c. Caylx
d. Capsule

Answer 6

b.

Nephron

Question 7

Blood flows in to the ______and through these specialized capillaries, water and small particles are filtered from the blood to make urine.

Answer 7

glomerulus

Question 8

Renin is a hormone that helps regulate which functions? (select all that apply)

a. blood flow
b. production of platelets
c. glomerular filtration rate (GFR)
d. Heart rate
e. Blood pressure

Answer 8

A,C,E

a. blood flow
c. glomerular filtration rate (GFR)
e. blood pressure

Question 9

What substance increases kidney reabsorption of sodium and water?

a. bradykinins
b. aldosterone
c. antidiuretic hormone
d. renin

Answer 9

b. aldosterone

Question 10

___________________:is a hormone produced by the kidney parenchyma that stimulates the one marrow to make red blood cells.

Answer 10

erytropoietin

Question 11

Which hormone is released from the posterior pituitary and makes the distal convoluted tubule and the collecting duct permeable to water to maximize reabsorption and produce a concentrated urine?

a. aldosterone
b. vasopressin
c. bradykinins
d. natriuetic

Answer 11

b. vasopressin

Question 12

Based on knowledge of the normal function of the kidney, which large particles are not found in the urine because they are too large to filter through the glomerular capillary walls? (select all that apply)

a. Blood cells
b. albumin
c. other proteins
d. electrolytes
e. water

Answer 12

A,B & C

a. Blood cells
b. albumin
c. other proteins

Question 13

What is the average urine output of a healthy adult for a 24-hour period?

a. 500 mL to 1000 mL per day
b. 1500 mL to 2000 mL per day
c. 3000 mL to 5000 mL per day
d. 5000 mL to 7000 mL per day

Answer 13

B.

b. 1500 mL to 2000 mL per day

Question 14

Kidney function, in particular the GFR, is compromised when the systolic blood pressure drops below what reading?

a. 50 mm Hg
b. 70 mm Hg
c. 80 mm Hg
d. 100 mm Hg

Answer 14

B

b. 70 mm Hg

Question 15

Damage to which renal structure or tissue can change the actual production of urine?

a. Kidney parenchyma
b. . Convoluted tubules
c. Calyces
d. Ureters

Answer 15

B

b.. Convoluted tubules

Question 16

A patient has been immobilized for several days after a motor vehicle accident. The nurse encourages ambulation to stimulate the movement of urine through the ureter by what phenomenon?

a. peristalsis
b. gravity
c. pelvic pressure
d. backflow

Answer 16

a. peristalsis

Question 17

Which renal change associated with aging does the nurse expect an older adult patient to report?

a. Nocturnal polyuria
b. Micturition
c. Hermaturia
d. Dysuria

Answer 17

a. Nocturnal polyuria

Question 18

An older adult male patient has a history of an enlarged prostate. the patient is lost likely to report which symptom associated with this condition.

a. inability to sense the urge to void.
b. difficulty starting the urine stream
c. excreating large amounts of very dilute urine.
d. frequent leakage of small amounts of urine.

Answer 18

b. difficulty starting the urine stream

Question 19

Impairment in the thirst mechanism associated with aging makes an older adult patient more vulnerable to which disorder?

a. hypovolemia
b. hypocalcemia
c. hypokalemia
d. hyponatremia

Answer 19

a. hypovolemia

Question 20

the nurse is talking to a group of older women about changes in the urinary system related to aging. what symptom is likely to be the common concern for this group?

a. incontinence
b. hematuria
c. retention
d. dysuria

Answer 20

a. incontinence

Question 21

the most important roles of the kidneys are to maintain body fluid ______ and ________, and to filter _______ products for elimination

Answer 21

Volume
composition’
Waste

Question 22

The kidneys help to regulate blood pressure and __________ balance.

Answer 22

Acid-base

Question 23

The kidneys have a rich blood supply and receive _____% to _________% of the total cardiac output.

Answer 23

20% to 25%

Question 24

Normal GFR averages _____ mL/min

Answer 24

125 mL/min

Question 25

GFR is controlled by blood _____ and blood ________.

Answer 25

pressure | flow

Question 26

___________ increases tubular permeability to water, allowing water to leave the tube ad be reabsorbed into the capillaries

Answer 26

(ADH) antidiuretic hormone

Question 27

Where sodium goes, ________follows.

Answer 27

water

Question 28

During water reabsorption. the membrane of the distal convoluted tubule is more permerable to water due to the influence of ___________.

Answer 28

(ADH) antidiuretic hormone

Question 29

The primary function of the proxmal convoluted tubule is _________ of water and electrolytes.

Answer 29

reabsorption

Question 30

The nurse is taking a history on a 55-year-old patient who denies any serious chronic health problems. Which sudden-onset sign/symptom suggests possible kidney disease in this patient? a. weakness b. hypertension c. confusion d. dysrhythmia

Answer 30

b. hypertension

Question 31

Which patient narrative describes the symptom of dysuria? a. "I have to pee all the time." b. "I have to wait before the pee starts." c. "It burns when I pee." d. "It feels like I'm going to pee in my pants."

Answer 31

c. "It burns when I pee."

Question 32

The nurse and nutritionist are evaluating the diet and nutritional therapies for a patient with kidney problems. Blood urea nitrogen (BUN) levels for this patient are being tracked because of the direct relationship to the intake and metabolism of which substance? a. lipids b. carbohydrates c. protein d. fluids

Answer 32

c. protein

Question 33

The nurse is taking a history on a patient with a change in urinary patterns. In addition to the medical and surgical history, what does the nurse ask the patient about to complete the assessment? (select all that apply) a. occupational exposure to toxins b. use of illicit substances, such as cocaine c. financial resources for payment of treatments d. religious beliefs about urination e. potential exposure to sexually transmitted disease.

Answer 33

a. occupational exposure to toxins b. use of illicit substances, such as cocaine e. potential exposure to sexually transmitted disease.

Question 34

The nurse is determining whether a patient has a history of hypertension because of the potential of hypertension because of the potential for kidney problems. which question is best to elicit this information? a. "do you have high blood pressure?" b. "do you take any blood pressure medications?" c. Have you ever been told that your blood pressure was high?" d. "when was the last time you had your blood pressure checked?"

Answer 34

c. Have you ever been told that your blood pressure was high?"

Question 35

A patient appears very uncomfortable with the nurse's questions about urinary infections and patterns. What is the best technique for the nurse to use to elicit relevant information and decrease the patient's discomfort? a. defer the questions until a later time. b. direct the questions toward a family member. c. use anatomic or medical terminology. d. Use the patient's own terminology.

Answer 35

d. Use the patient's own terminology.

Question 36

The nurse is taking a nutritional history on a patient. The patient states, " I really don't drink as much water as I should." What is the nurse's best response? a. " we should probably all drink more water than we do." b. "It's an easy thing to forget; just try to remember to drink more." c. "what would encourage you to drink the recommended 3 liters per days?" d. "I'd like you to read this brochure about kidney health and fluids."

Answer 36

c. "what would encourage you to drink the recommended 3 liters per days?"

Question 37

When patients have problems with the kidneys or urinary tract, what is the most common symptom that prompts them to seek medical attention? a. change in the frequency or mount of urination. b. pain in flank or abdomen or pain when urinating. c. Noticing a change in the color or odor of the urine. d. Exposure to nephrotoxic substance

Answer 37

b. pain in flank or abdomen or pain when urinating.

Question 38

Which ethnic group has the highest risk for end-stage kidney disease secondary to diabetes mellitus and hypertension? a. Caucasian americans b. African americans c. Asian americans d. native americans

Answer 38

b. African Americans

Question 39

which over the counter product used by a patient does the nurse explore further for potential impact on kidney function? a. peroxide containing mouthwash b. milk of magnesia laxative c. Vitamin c d. NSAIDs

Answer 39

d. NSAIDs

Question 40

The nurse is performing an assessment on the renal system. what is the first step in the assessment process? a. percuss the lower abdomen; continue toward umbilicus. b. Observe the flank region for asymmetry or discoloration. c. Listen for bruit over each renal artery. d. lightly palpate the abdomen in all quadrants.

Answer 40

b. Observe the flank region for asymmetry or discoloration.

Question 41

the nurse is auscultating the renal artery and hears bruit. What does this finding indicate? a. Acute kidney injury b. Renal artery stenosis c. Renal artery aneurysm d. Renal tumor

Answer 41

b. Renal artery stenosis

Question 42

A patient has anorexia, nausea, and vomiting, muscle cramping, and prutitus. how does the nurse interpret these findings? a. Oliguria b. Azotemia c. Anuria d. Uremia

Answer 42

d. Uremia

Question 43

A pt is diagnosed with renal artery stenosis. which sound does the nurse expect to hear by auscultation when a bruit is present in the renal artery? a. Quite, pulsating sound b. swishing sound. c. Faint wheezing d. No sound at all.

Answer 43

b. swishing sound.

Question 44

Which volume of urine does the nurse expect to find documented for a pt who is oliguric? a. Between 100 and 400 mL in 24 hours b. Greater that 2000 mL in 24 hours c. Less than 100 mL in 24 hours d. greater than 400 mL during the night.

Answer 44

a. Between 100 and 400 mL in 24 hours

Question 45

the nurse is assessing a pt for bladder distension. what technique does the nurse use? a. Gently palpate for the outline of the bladder, percuss the lower abd, continue toward the umbilicus until dull sounds are no longer produced. b. Gently palpate for the outline of the bladder, auscultate for sounds in the lower abdomen. c. place one hand under the back and palpate with the other hand over the bladder, percuss the lower abd until tympanic sounds are no longer heard. d. Use the hand to depress the bladder as the pt takes a deep breath, then percuss

Answer 45

a. Gently palpate for the outline of the bladder, percuss the lower abd, continue toward the umbilicus until dull sounds are no longer produced.

Question 46

A pt report flank pain or tenderness. What technique does the nurse use to assess for costovertebral tenderness? a. percuss the non-tender flank and assess for rebound. b. thump the CVA area with the flat surface of the hand. c. Thump the CVA area with a clenched fist. d. Place one hand flat over the CVA area, thump with the other fist.

Answer 46

d. Place one hand flat over the CVA area, thump with the other fist.

Question 47

the nurse is preparing to assess a female pt's urethra prior to the insertion of a Foley Catheter. In addition to sterile gloves, which equipment does the nurse obtain to perform the initial assessment? a. Glass slide b. Good light source c. speculum d. cotton swab

Answer 47

b. Good light source

Question 48

A female pt who has been running 3 to 4 times per week for the past 2 weeks is being seen for a routine physical. Urinalysis results reveal a protein level of >0.8 mg/dL and a white blood cell count of 4 per high powered field. what might be the cause of these findings? a. UTI b. hepatic or biliary disease c. kidney infection d. strenuous exercise

Answer 48

d. strenuous exercise

Question 49

Keytones in the urine may indicate which occurrence or process? (select all that apply) a. incomplete metabolism of fatty acids b. increased glomerular membrane permeability c. kidney disease d. Body's use of fat instead of glucose for cellular energy. e. UTI

Answer 49

a. incomplete metabolism of fatty acids | d. Body's use of fat instead of glucose for cellular energy.

Question 50

_________: less than 7 acidic, greater than 7 alkaline

Answer 50

pH

Question 51

_______: only identified by microscopic examination for protein.

Answer 51

Microalbuminuria

Question 52

_____: structure found around cell. bacteria, protein , and clumps.

Answer 52

Cast

Question 53

_____: urine is normally sterile; these multiply and grow.

Answer 53

bacteria

Question 54

_____: urochrome pigment

Answer 54

Color

Question 55

_____:1.005 to 1.030

Answer 55

specific gravity

Question 56

_____: not normally in the urine

Answer 56

protein

Question 57

______: cells, casts, crystals, and bacteria

Answer 57

sediment

Question 58

_____: various salts.

Answer 58

crystals

Question 59

______: epithelial cells, RBC, WBC, tubular cells

Answer 59

cells

Question 60

_____: not seen in the urine until blood sugar above 220 mg/dL

Answer 60

glucose

Question 61

_______: cloudiness or haziness

Answer 61

turbidity

Question 62

_____: faint ammonia

Answer 62

odor

Question 63

the nurse is caring for a pt with dehydration. which laboratory test results does the nurse anticipate to see for this pt? a. BUN and creatinine ratio stay the same. b. Bun rises faster that the creatinine level. c. creatinine rises faster that BUN. d. Bun and creatinine have a direct relationship.

Answer 63

b. Bun rises faster that the creatinine level.

Question 64

What does the BUN test measure? a. Kidney excretion of urea nitrogen b. GFR c. creatinine clearance d. urine output

Answer 64

a. Kidney excretion of urea nitrogen

Question 65

Which pt is most likely to have a decreased calcium level? a. pt w/ nephritis. b. pt w/ cystitis c. pt w/ a Foley catheter d. pt w/ urinary retention

Answer 65

a. pt w/ nephritis.

Question 66

the nurse performs a dipstick urine stest for a pt being evaluated for kidney problems. Glucose present in the urine. how does the nurse interpret this result? a. Blood glucose level is greater that 220 mg/dL b. the kidneys are failing to filter any glucose. c. the pt is at risk for hypoglycemia d. the renal threshold has not been exceeded.

Answer 66

a. Blood glucose level is greater that 220 mg/dL

Question 67

In addition to kidney disease, which pt condition causes the BUN to rise above the normal range? a. anemia b. Asthma c. Infection d. malnutrition

Answer 67

c. infection

Question 68

the community health nurse is taking to a group of African American adults about renal health.the nurse encourages the participants to have which type of yearly examination to screen for kidney problems? a. kidney ultrasound b. serum creatinine and blood urea nitrogen. c. urinalysis and microalbuminuria d. 24 hours urine collection

Answer 68

c. urinalysis and microalbuminuria

Question 69

Which test in the best indicator of kidney function? a. Urine osmolarity b. serum creatinine c. Urine pH d. Color of urine

Answer 69

b. serum creatinine

Question 70

In relation to kidney problems, what does an increase in the ratio of BUN to serum creatinine indicate? a. Highly suggestive of kidney dysfunction b. definitive for kidney dysfunction c. Suggest nonkidney factors causing an elevation in BUN. d. suggest nonkidney factors causing an elevation in serum creatinine

Answer 70

c. Suggest nonkidney factors causing an elevation in BUN.

Question 71

Which urine characteristic listed on a urinalysis report arouses the nurse's suspicion of a problem in the urinary tract? a. Cloudiness b. straw color c. ammonia odor d. one cast per high powered field

Answer 71

a. Cloudiness

Question 72

A patient has urinalysis ordered. when is the best time for the nurse to collect the specimen? a. in the evening b. after a meal c. in the morning d. after a fluid bolus

Answer 72

c. in the morning

Question 73

During the day, the nursing student is measuring urine output and observing for urine characteristics in a patient. Which abnormal finding in the urine is the most urgent finding that must be reported to the supervising nurse? a. specific gravity is decreased b. output is decreased c. pH is decreased d. color has changed.

Answer 73

b. output is decreased

Question 74

a 24 hour urine specimen is required from a patient. Which strategy is best to ensure that all the urine is collected for the full 24 hour period? a. instruct the unlicensed assistive personnel (UAP) to collect all the urine. b. put a bedpan or commode next to the bed as a reminder. c. Place a sign in the bathroom reminding the patient to save the urine. d. verbally remind the patient about the test.

Answer 74

c. Place a sign in the bathroom reminding the patient to save the urine.

Question 75

place the steps of using a bedside bladder scanner in the correct order using the numbers 1 through 8. a. Select the male or female icon on the bladder scanner. b. Aim the scan head towards the expected location of the bladder. c. Place the probe midline about 1.5 inches (4cm) above the pubic bone. d. Explain the purpose and what sensations to expect. e. listen for the sound of a beep and a volume display. f. place the ultrasound probe with gel right above the symphysis pubis. g. press and release the scan button h. repeat for best accuracy.

Answer 75

``` 1 = d 2 = a 3 = f 4 = c 5 = b 6 = g 7 = e 8 = h ```

Question 76

A patient is scheduled for an IV urography. Which medications is discontinued at the time of the procedure and for at least 48 hours until kidney function has been re-evaluated. a. Glucophage (metformin) b. diphenhydramine (benadryl) c. prednisone (deltasone) d. acetycysteine (mucomyst)

Answer 76

a. Glucophage (metformin)

Question 77

Several patients are scheduled for testing to diagnose potential kidney problems. Which test requires a patient to have a urinary catheter inserted before the test? a. IV urography b. Computed tomography c. cystography d. kidney scan

Answer 77

c. cystography

Question 78

A patient has had an IV urography. What is included in the postprocedural care for this patient? a. bowel cleansing with laxatives b. IV or oral fluid hydration c. administration of captopril (capoten) d. Insertion of a urinary catheter

Answer 78

b. IV or oral fluid hydration

Question 79

Which diagnostic test incorporates contrast dye, but does not place a patient at risk for nephrotoxicity? a. IV urography b. renal angiography c. voiding cystourethrogram d. Computed tomography

Answer 79

c. voiding cystourethrogram

Question 80

The nurse is reviewing the results of a pt's ultrasound of the kidney. the report reveals an enlarged kidney which suggest which possible problem? a. polycystic kidney b. kidney infection c. renal carcinoma d. chronic kidney disease

Answer 80

a.polycystic kidney

Question 81

A pt returns to the unit after a kidney scan. which instruction about the pt's urine does the nurse give to the UAP caring for the pt? a. it is radioactive, so it should be handled w/ special biohazard precautions. b. it does not place anyone at risk because of the small amount of radioactive material. c. its radioactivity is dangerous only to those who are pregnant. d. It is potentially dangerous if allowed to sit for prolonged periods in the commode.

Answer 81

b. it does not place anyone at risk because of the small amount of radioactive material.

Question 82

The nurse is alerted by the radiology dept that a pt had a "captopril renal scan" What does the nurse monitor for when the pt returns from the procedure. a. cardiac dysrhythmias b. urine discoloration c. signs of dehydration d. orthostatic hypotension

Answer 82

d. orthostatic hypotension

Question 83

the nurse is teaching a pt scheduled for an ultrasonography. What preprocedural instruction does the nurse give the pt? a. Void just before the test begins b. dink a lot of water. c. stop routine medications d. complete a bowel preparation

Answer 83

b. dink a lot of water.

Question 84

a pt had a cystoscopy. after the procedure, what does the nurse expect to see in this pt? a. pink-tinged urine b. bloody urine c. very dilute urine d. decreased urine output

Answer 84

a. pink-tinged urine

Question 85

a pt is scheduled for retograde urethrography. Postprocedural care is similar to postprocedural care given for which test? a. ultrasonography b. computed tomography c. IV urography d. cystoscopy

Answer 85

c. IV urography

Question 86

a pt has undergone a kidney biopsy. what does the nurse monitor for in the pt related to this procedure? a. nephrotoxicity b. hemorrhage c. urinary retention d. hypertension

Answer 86

b. hemorrhage

Question 87

a ot has undergone a kidney biopsy. In the immediate pstprocedural period, the nurse notifies the health care provider about which findings? (select all that apply) a. Hematuria b. localized pain at the site c. "tamponade effect" d. Decreasing urine output e. flank pain f. decreasing blood pressure

Answer 87

a,d,e,f a. Hematuria d. Decreasing urine output e. flank pain f. decreasing blood pressure