N4 - test -Renal/Urinary System

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition

Chapter 69: Assessment of the Renal/Urinary System

1. Why does urine from a healthy person normally contain few, if any, protein or albumin molecules? These substances:

A. are rapidly reabsorbed from the proximal convoluted tubule.
B. break down into amino acids in the renal tubules and are excreted as nitrogen.
C. are too large, with high molecular weights and do not pass through the glomerular capillaries.
D. make up a very small percentage of whole blood so that their concentration in urine is relatively low.

2. What would be the effect on urine filtration and output if the afferent arterioles of all the nephrons in the kidney were dilated and the efferent arterioles were all constricted? _______ filtration pressure; _______ urine output.

A. Increased; increased
B. Increased; decreased
C. Decreased; increased
D. Decreased; decreased

3. How does antidiuretic hormone influence the distal convoluted tubule? _______ membrane permeability to water; _______ urine output.

A. Increases; increases
B. Increases; decreases
C. Decreases; increases
D. Decreases; decreases

4. Which change in renal function increases the older client’s risk for dehydration?

A. Decreased renal blood flow
B. Decreased activation of vitamin D
C. Decreased glomerular filtration rate
D. Decreased ability to concentrate urine

5. What does the BUN/creatinine ratio indicate for a female client given the following parameters? BUN 28 mg/dL serum creatinine 1.55 mg/dL

A. Ratio normal; renal impairment
B. Ratio normal; dehydration
C. Ratio elevated; renal impairment
D. Ratio elevated; dehydration

6. The client with an indwelling Foley catheter requires a urine specimen for culture and sensitivity. Which technique should you use to obtain the specimen?

A. Wipe the distal end of the catheter with an alcohol sponge. Separate the distal end of the catheter from the drainage collection tube and allow 5 to 10 mL of fresh urine to drain into a sterile container.
B. Clamp the catheter close to the distal end for 15 minutes. Cleanse the aspiration site on the catheter with iodine. Draw up a 2 mL specimen with a sterile needle and syringe.
C. Clamp the catheter close to the distal end for 2 hours. Have the client void around the catheter into a sterile specimen container.
D. Empty the residual urine in the collection bag completely and discard. Collect the urine that drains into the bag during the next hour.

7. Which statement made by the client indicates the need for clarification with regard to the instructions for collecting a 24-hour urine specimen for assessment of renal function? “I will:

A. continue to take my prescribed heart medicine.”
B. add the preservative to the container at the beginning of the test.”
C. begin the collection with the urine I excrete when I first get up in the morning and note the time.”
D. end the collection by urinating the last specimen exactly 24 hours after the time the test was started.”

8. Which statement made by the female client indicates a need for clarification regarding how to provide a “clean catch” urine specimen?

A. “First, I will clean my bottom from the back to the front with three swipes made with a separate clean sponge wetted with the solution.”
B. “I will start the stream of urine after I have cleaned myself and urinate into the toilet.”
C. “After I have urinated a few ounces, I will stop the stream and then urinate into the specimen cup provided.”
D. “After I have urinated about an ounce into the container, I will empty my bladder into the toilet as usual.”

9. What technique should you use to determine whether the client’s bladder is full?

A. Observe the urethra for dribbling while the client performs the Valsalva maneuver.
B. Place the client on his or her right side and observe for a low abdominal outpouching.
C. Beginning at the lowest edge of the abdomen, percuss upward toward the umbilicus and note where a dull versus a flat sound is elicited.
D. Place the client on his or her back, ask a colleague to place the side of his or her hand in the midline of the client’s abdomen, gently tap the right side of the client’s abdomen, and palpate for a fluid wave on the left side of the client’s abdomen.

10. The client who had a renal arteriogram performed two hours ago now has an absent pedal pulse on the side the catheter was placed. What is your best first action?

A. Place a sandbag on the catheter insertion site.
B. Document the finding as the only action.
C. Elevate the affected leg.
D. Notify the physician