TestgBankg-gBrunnerg&gSuddarth'sgTextbookgofgMedical-SurgicalgNursingg14eg(Hinkleg2017) 997
Chapter 53: Assessment of Kidney and Urinary Function
g g g g g g g
1. Thegcaregteamgisgconsideringgthegusegofgdialysisgingagpatientgwhosegrenalgfunctiongisgprogressivelygde
clining.gRenalgreplacementgtherapygisgindicatedgingwhichgofgthegfollowinggsituations?
A) Wheng theg patientsg creatinineg levelg dropsg belowg 1.2g mg/dLg (110g mmol/L)
B) Wheng theg patientsg bloodg ureag nitrogeng (BUN)g isg aboveg 15g mg/dL
C) Wheng approximatelyg 40%g ofg nephronsg areg notg functioning
Whengaboutg80%gofgthegnephronsgaregnoglongergfunctioningg
D)
Ans: D
Feedback:
Whengthegtotalgnumbergofgfunctioninggnephronsgisglessgthang20%,grenalgreplacementgtherapygneedsgtogbegcon
sidered.gDialysisgisgangexamplegofgagrenalgreplacementgtherapy.gPriorgtogtheglossgofgaboutg80%gofgthegnephron
gfunctioninggability,gthegpatientgmayghavegmildgsymptomsgofgcompromisedgrenalgfunction,gbutgsymptomgman
agementgisgoftengobtainedgthroughgdietarygmodificationsgandgdruggtherapy.gTheglistedgcreatininegandgBUNgle
velsgaregwithingreferencegranges.
2. Agnursegknowsgthatgspecificgareasgingtheguretersghavegagpropensitygforgobstruction.gPromptgmanagementg o
fgrenalgcalculigisgmostgimportantgwhengthegstonegisglocatedgwhere?
A) Ing theg ureteropelvicg junction
B) Ing theg ureteralg segmentg nearg theg sacroiliacg junction
C) Ing theg ureterovesicalg junction
D) Ingthegurethra
Ans: A
Feedback:
Thegthreegnarrowedgareasgofgeachguretergaregthegureteropelvicgjunction,gthegureteralgsegmentgneargthegsacroili
acgjunction,gandgthegureterovescialgjunction.gThesegthreegareasgofgtheguretersghavegagpropensitygforgobstructio
ngbygrenalgcalculigorgstricture.gObstructiongofgthegureteropelvicgjunctiongisgmostgseriousgbecauseg ofg itsg close
g proximityg tog theg kidneyg andg theg riskg ofg associatedg kidneyg dysfunction.g Theg urethrag isg notg partgofgthegurete
r.
,TestgBankg-gBrunnerg&gSuddarth'sgTextbookgofgMedical-SurgicalgNursingg14eg(Hinkleg2017) 998
3. Agnursegisgcaringgforgagpatientgwithgimpairedgrenalgfunction.gAgcreatininegclearancegmeasurementghasgbe
engordered.gThegnursegshouldgfacilitategcollectiongofgwhatgsamples?
A) Ag fastingg serumg potassiumg levelg andg ag randomg urineg sample
B) Ag24-
hourgurinegspecimengandgagserumgcreatinineglevelgmidwaygthroughgthegurinegcollectiongprocess
C) Ag BUNg andg serumg creatinineg levelg ong threeg consecutiveg mornings
D) Agsterilegurinegspecimengandgangelectrolytegpanel,gincludinggsodium,gpotassium,gcalcium,gandgp
hosphorusgvalues
Ans: B
Feedback:
Togcalculategcreatininegclearance,gag24-
hourgurinegspecimengisgcollected.gMidwaygthroughgthegcollection,gthegserumgcreatinineglevelgisgmeasured.
4. Thegnursegisgassessinggagpatientsgbladdergbygpercussion.gThegnursegelicitsgdullnessgaftergthegpatientghasgvo
ided.gHowgshouldgthegnurseginterpretgthisgassessmentgfinding?
A) Theg patientsg bladderg isg notg completelyg empty.
B) Theg patientg hasg kidneyg enlargement.
C) Theg patientg hasg ag ureteralg obstruction.
D) Theg patientg hasgag fluidg volumeg deficit.
Ans: A
Feedback:
Dullnessgtogpercussiongofgthegbladdergfollowinggvoidinggindicatesgincompletegbladdergemptying.gEnlarge
mentgofgthegkidneysgcangbegattributedgtognumerousgconditionsgsuchgasgpolycysticgkidneygdiseaseg orghydro
nephrosisgandgisgnotgrelatedgtogbladdergfullness.gDehydrationgandgureteralgobstructiongaregnotgrelatedgtogbl
addergfullness;gingfact,gthesegconditionsgresultgingdecreasedgflowgofgurinegtogthegbladder.
5. Thegnursegisgprovidinggpre-
proceduregteachinggaboutgangultrasound.gThegnurseginformsgthegpatientgthatging preparationgforgangultrasound
gofgtheglowergurinarygtractgthegpatientgwillgrequiregwhat?
A) Increasedg fluidg intakeg tog produceg ag fullg bladder
,TestgBankg-gBrunnerg&gSuddarth'sgTextbookgofgMedical-SurgicalgNursingg14eg(Hinkleg2017) 999
B) IVg administrationg ofg radiopaqueg contrastg agent
C) Sedationg andg intubation
D) Injectiong ofgag radioisotope
Ans: A
Feedback:
Ultrasonographygrequiresgagfullgbladder;gtherefore,gfluidgintakegshouldgbegencouragedgbeforegthegprocedur
es.gThegadministrationgofgagradiopaquegcontrastgagentgisgrequiredgtogperformgIVgurographygstudies,gsuchga
sgangIVgpyelogram.gUltrasonographygisgagquickgandgpainlessgdiagnosticgtestgandgdoesgnotgrequiregsedationg
orgintubation.gTheginjectiongofgagradioisotopegisgrequiredgforgnucleargscangandgultrasonographygisgnotgingth
isgcategorygofgdiagnosticgstudies.
6. Thegnursegisgcaringgforgagpatientgwhoghasgagfluidgvolumegdeficit.gWhengevaluatinggthisgpatientsgurinalysisgre
sults,gwhatgshouldgthegnurseganticipate?
A) Ag fluctuatingg urineg specificg gravity
B) Ag fixedg urineg specificg gravity
C) Ag decreasedg urineg specificg gravity
D) Angincreasedgurinegspecificggravityg
Ans: D
Feedback:
Urinegspecificggravitygdependsglargelygonghydrationgstatus.gAgdecreasegingfluidgintakegwillgleadgtogangincre
asegingthegurinegspecificggravity.gWithghighgfluidgintake,gspecificggravitygdecreases.gIngpatientsgwithgkidne
ygdisease,gurinegspecificggravitygdoesgnotgvarygwithgfluidgintake,gandgthegpatientsgurinegisgsaidgtog havegagfi
xedgspecificggravity.
7. Aggeriatricgnursegisgperforminggangassessmentgofgbodygsystemsgongang85-year-
oldgpatient.gThegnursegshouldgbegawaregofgwhatgage-
relatedgchangegaffectinggthegrenalgorgurinarygsystem?
A) Increasedg abilityg tog concentrateg urine
B) Increasedg bladderg capacity
C) Urinaryg incontinence
, TestgBankg-gBrunnerg&gSuddarth'sgTextbookgofgMedical-SurgicalgNursingg14eg(Hinkleg2017) 1000
D) Decreasedgglomerulargfiltrationgrateg
Ans: D
Feedback:
Manygage-
relatedgchangesgingthegrenalgandgurinarygsystemsgshouldgbegtakengintogconsiderationgwhengtakinggaghealthg
historygofgthegoldergadult.gOnegchangegincludesgagdecreasedgglomerulargsurfacegareagresultinggingagdecreas
edgglomerulargfiltrationgrate.gOthergchangesgincludegthegdecreasedgabilitygtogconcentrategurinegandgagdecre
asedgbladdergcapacity.gItgalsogshouldgbegunderstoodgthatgurinarygincontinencegisgnotgagnormalgage-
relatedgchange,gbutgisgcommongingoldergadults,gespeciallygingwomengbecausegofgtheglossgofgpelvicgmusclegt
one.
8. Agnursegisgpreparinggagpatientgdiagnosedgwithgbenigngprostaticghypertrophyg(BPH)gforgaglowergurinarygtra
ctgcystoscopicgexamination.gThegnurseginformsgthegpatientgthatgthegmostgcommongtemporarygcomplicatio
ngexperiencedgaftergthisgproceduregisgwhat?
A) Urinaryg retention
B) Bladderg perforation
C) Hemorrhage
D) Nausea
Ans: A
Feedback:
Afterg ag cystoscopicg examination,g theg patientg withg obstructiveg pathologyg mayg experienceg urineg retentiong
ifgtheginstrumentsgusedgduringgthegexaminationgcausedgedema.gThegnursegwillgcarefullygmonitorgtheg patien
tgwithgprostaticghyperplasiagforgurinegretention.gPost-
procedure,gthegpatientgwillgexperiencegsomeghematuria,gbutgisgnotgatggreatgriskgforghemorrhage.gUnlessgtheg
conditiongisgassociatedgwithganothergdisorder,gnauseagisgnotgcommonlygassociatedgwithgthisgdiagnosticgstud
y.gBladdergperforationgisgrare.
9. Agpatientgwithgrenalgfailuregsecondarygtogdiabeticgnephropathyghasgbeengadmittedgtogthegmedicalgunit.gWha
tg isg theg mostg life-threateningg effectg ofg renalg failureg forg whichg theg nurseg shouldg monitorg theg patient?
A) Accumulationg ofg wastes
B) Retentiong ofg potassium
C) Depletiong ofg calcium
D) Lackgofg BPg control
Chapter 53: Assessment of Kidney and Urinary Function
g g g g g g g
1. Thegcaregteamgisgconsideringgthegusegofgdialysisgingagpatientgwhosegrenalgfunctiongisgprogressivelygde
clining.gRenalgreplacementgtherapygisgindicatedgingwhichgofgthegfollowinggsituations?
A) Wheng theg patientsg creatinineg levelg dropsg belowg 1.2g mg/dLg (110g mmol/L)
B) Wheng theg patientsg bloodg ureag nitrogeng (BUN)g isg aboveg 15g mg/dL
C) Wheng approximatelyg 40%g ofg nephronsg areg notg functioning
Whengaboutg80%gofgthegnephronsgaregnoglongergfunctioningg
D)
Ans: D
Feedback:
Whengthegtotalgnumbergofgfunctioninggnephronsgisglessgthang20%,grenalgreplacementgtherapygneedsgtogbegcon
sidered.gDialysisgisgangexamplegofgagrenalgreplacementgtherapy.gPriorgtogtheglossgofgaboutg80%gofgthegnephron
gfunctioninggability,gthegpatientgmayghavegmildgsymptomsgofgcompromisedgrenalgfunction,gbutgsymptomgman
agementgisgoftengobtainedgthroughgdietarygmodificationsgandgdruggtherapy.gTheglistedgcreatininegandgBUNgle
velsgaregwithingreferencegranges.
2. Agnursegknowsgthatgspecificgareasgingtheguretersghavegagpropensitygforgobstruction.gPromptgmanagementg o
fgrenalgcalculigisgmostgimportantgwhengthegstonegisglocatedgwhere?
A) Ing theg ureteropelvicg junction
B) Ing theg ureteralg segmentg nearg theg sacroiliacg junction
C) Ing theg ureterovesicalg junction
D) Ingthegurethra
Ans: A
Feedback:
Thegthreegnarrowedgareasgofgeachguretergaregthegureteropelvicgjunction,gthegureteralgsegmentgneargthegsacroili
acgjunction,gandgthegureterovescialgjunction.gThesegthreegareasgofgtheguretersghavegagpropensitygforgobstructio
ngbygrenalgcalculigorgstricture.gObstructiongofgthegureteropelvicgjunctiongisgmostgseriousgbecauseg ofg itsg close
g proximityg tog theg kidneyg andg theg riskg ofg associatedg kidneyg dysfunction.g Theg urethrag isg notg partgofgthegurete
r.
,TestgBankg-gBrunnerg&gSuddarth'sgTextbookgofgMedical-SurgicalgNursingg14eg(Hinkleg2017) 998
3. Agnursegisgcaringgforgagpatientgwithgimpairedgrenalgfunction.gAgcreatininegclearancegmeasurementghasgbe
engordered.gThegnursegshouldgfacilitategcollectiongofgwhatgsamples?
A) Ag fastingg serumg potassiumg levelg andg ag randomg urineg sample
B) Ag24-
hourgurinegspecimengandgagserumgcreatinineglevelgmidwaygthroughgthegurinegcollectiongprocess
C) Ag BUNg andg serumg creatinineg levelg ong threeg consecutiveg mornings
D) Agsterilegurinegspecimengandgangelectrolytegpanel,gincludinggsodium,gpotassium,gcalcium,gandgp
hosphorusgvalues
Ans: B
Feedback:
Togcalculategcreatininegclearance,gag24-
hourgurinegspecimengisgcollected.gMidwaygthroughgthegcollection,gthegserumgcreatinineglevelgisgmeasured.
4. Thegnursegisgassessinggagpatientsgbladdergbygpercussion.gThegnursegelicitsgdullnessgaftergthegpatientghasgvo
ided.gHowgshouldgthegnurseginterpretgthisgassessmentgfinding?
A) Theg patientsg bladderg isg notg completelyg empty.
B) Theg patientg hasg kidneyg enlargement.
C) Theg patientg hasg ag ureteralg obstruction.
D) Theg patientg hasgag fluidg volumeg deficit.
Ans: A
Feedback:
Dullnessgtogpercussiongofgthegbladdergfollowinggvoidinggindicatesgincompletegbladdergemptying.gEnlarge
mentgofgthegkidneysgcangbegattributedgtognumerousgconditionsgsuchgasgpolycysticgkidneygdiseaseg orghydro
nephrosisgandgisgnotgrelatedgtogbladdergfullness.gDehydrationgandgureteralgobstructiongaregnotgrelatedgtogbl
addergfullness;gingfact,gthesegconditionsgresultgingdecreasedgflowgofgurinegtogthegbladder.
5. Thegnursegisgprovidinggpre-
proceduregteachinggaboutgangultrasound.gThegnurseginformsgthegpatientgthatging preparationgforgangultrasound
gofgtheglowergurinarygtractgthegpatientgwillgrequiregwhat?
A) Increasedg fluidg intakeg tog produceg ag fullg bladder
,TestgBankg-gBrunnerg&gSuddarth'sgTextbookgofgMedical-SurgicalgNursingg14eg(Hinkleg2017) 999
B) IVg administrationg ofg radiopaqueg contrastg agent
C) Sedationg andg intubation
D) Injectiong ofgag radioisotope
Ans: A
Feedback:
Ultrasonographygrequiresgagfullgbladder;gtherefore,gfluidgintakegshouldgbegencouragedgbeforegthegprocedur
es.gThegadministrationgofgagradiopaquegcontrastgagentgisgrequiredgtogperformgIVgurographygstudies,gsuchga
sgangIVgpyelogram.gUltrasonographygisgagquickgandgpainlessgdiagnosticgtestgandgdoesgnotgrequiregsedationg
orgintubation.gTheginjectiongofgagradioisotopegisgrequiredgforgnucleargscangandgultrasonographygisgnotgingth
isgcategorygofgdiagnosticgstudies.
6. Thegnursegisgcaringgforgagpatientgwhoghasgagfluidgvolumegdeficit.gWhengevaluatinggthisgpatientsgurinalysisgre
sults,gwhatgshouldgthegnurseganticipate?
A) Ag fluctuatingg urineg specificg gravity
B) Ag fixedg urineg specificg gravity
C) Ag decreasedg urineg specificg gravity
D) Angincreasedgurinegspecificggravityg
Ans: D
Feedback:
Urinegspecificggravitygdependsglargelygonghydrationgstatus.gAgdecreasegingfluidgintakegwillgleadgtogangincre
asegingthegurinegspecificggravity.gWithghighgfluidgintake,gspecificggravitygdecreases.gIngpatientsgwithgkidne
ygdisease,gurinegspecificggravitygdoesgnotgvarygwithgfluidgintake,gandgthegpatientsgurinegisgsaidgtog havegagfi
xedgspecificggravity.
7. Aggeriatricgnursegisgperforminggangassessmentgofgbodygsystemsgongang85-year-
oldgpatient.gThegnursegshouldgbegawaregofgwhatgage-
relatedgchangegaffectinggthegrenalgorgurinarygsystem?
A) Increasedg abilityg tog concentrateg urine
B) Increasedg bladderg capacity
C) Urinaryg incontinence
, TestgBankg-gBrunnerg&gSuddarth'sgTextbookgofgMedical-SurgicalgNursingg14eg(Hinkleg2017) 1000
D) Decreasedgglomerulargfiltrationgrateg
Ans: D
Feedback:
Manygage-
relatedgchangesgingthegrenalgandgurinarygsystemsgshouldgbegtakengintogconsiderationgwhengtakinggaghealthg
historygofgthegoldergadult.gOnegchangegincludesgagdecreasedgglomerulargsurfacegareagresultinggingagdecreas
edgglomerulargfiltrationgrate.gOthergchangesgincludegthegdecreasedgabilitygtogconcentrategurinegandgagdecre
asedgbladdergcapacity.gItgalsogshouldgbegunderstoodgthatgurinarygincontinencegisgnotgagnormalgage-
relatedgchange,gbutgisgcommongingoldergadults,gespeciallygingwomengbecausegofgtheglossgofgpelvicgmusclegt
one.
8. Agnursegisgpreparinggagpatientgdiagnosedgwithgbenigngprostaticghypertrophyg(BPH)gforgaglowergurinarygtra
ctgcystoscopicgexamination.gThegnurseginformsgthegpatientgthatgthegmostgcommongtemporarygcomplicatio
ngexperiencedgaftergthisgproceduregisgwhat?
A) Urinaryg retention
B) Bladderg perforation
C) Hemorrhage
D) Nausea
Ans: A
Feedback:
Afterg ag cystoscopicg examination,g theg patientg withg obstructiveg pathologyg mayg experienceg urineg retentiong
ifgtheginstrumentsgusedgduringgthegexaminationgcausedgedema.gThegnursegwillgcarefullygmonitorgtheg patien
tgwithgprostaticghyperplasiagforgurinegretention.gPost-
procedure,gthegpatientgwillgexperiencegsomeghematuria,gbutgisgnotgatggreatgriskgforghemorrhage.gUnlessgtheg
conditiongisgassociatedgwithganothergdisorder,gnauseagisgnotgcommonlygassociatedgwithgthisgdiagnosticgstud
y.gBladdergperforationgisgrare.
9. Agpatientgwithgrenalgfailuregsecondarygtogdiabeticgnephropathyghasgbeengadmittedgtogthegmedicalgunit.gWha
tg isg theg mostg life-threateningg effectg ofg renalg failureg forg whichg theg nurseg shouldg monitorg theg patient?
A) Accumulationg ofg wastes
B) Retentiong ofg potassium
C) Depletiong ofg calcium
D) Lackgofg BPg control
