Chapter 43 Assessment of Renal and Urinary Tract Function

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Chapter 43  Assessment of Renal and Urinary Tract Function

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

Multiple Choice

1. A patient with renal insufficiency has been hospitalized on your unit. The patient knows that renal function depends upon the functional status of nephrons. The patient asks you when she will need to start dialysis based upon loss of nephron function. What would you respond?
A) “When about 50% of the nephrons are no longer functioning.”

B) “When about 60% of the nephrons are no longer functioning.” C) “When about 70% of the nephrons are no longer functioning.” D) “When about 80% of the nephrons are no longer functioning.”

Ans: D
Chapter: 43
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 2
Page and Header: 1294, Anatomic and Physiologic Overview

Feedback: When the total number of functioning nephrons is less than 20%, renal replacement therapy needs to be considered. Dialysis is an example of a renal replacement therapy. Prior to the loss of about 80% of the nephron functioning ability, the patient may have mild symptoms of

compromised renal function, but symptom management is often obtained through dietary modifications and drug therapy. Therefore options A, B, and C are incorrect.

2. There are three areas of the ureters that have a propensity for obstruction. Prompt management of renal calculi is most important when the stone is located where?
A) In the ureteropelvic junction
B) In the ureteral segment near the sacroiliac junction

C) In the ureterovesical junction D) In the urethra

Ans: A
Chapter: 43
Client Needs: D-3
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 1
Page and Header: 1295, Anatomic and Physiologic Overview

Feedback: There are three narrowed areas of each ureter: the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovescial junction. These three areas of the ureters have a propensity for obstruction by renal calculi or stricture. Obstruction of the ureteropelvic junction is the most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction. The urethra is not part of the ureter, so option D is incorrect.

3. A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has been ordered. The nurse is aware that the specimens needed for the calculation of the patient’s creatinine clearance will include what?
A) A fasting serum potassium level and a random urine sample
B) A 24-hour urine specimen collection and a serum creatinine level midway through the urine collection process
C) A blood, urea, nitrogen level, and serum creatinine level on three consecutive mornings
D) A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values

Ans: B
Chapter: 43
Client Needs: D-4 Cognitive Level: Analysis

Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 3
Page and Header: 1297, Anatomic and Physiologic Overview

Feedback: To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection, the serum creatinine level is measured. The following formula is then used to calculate the creatinine clearance:

(Volume of urine [mL/min] × urine creatinine [mL/min]) serum creatinine (mg/dL)

4. The nurse is assessing a patient’s bladder by percussion. The nurse elicits dullness after voiding. What does this finding indicate?
A) Incomplete bladder emptying
B) Kidney enlargement

C) Ureteral obstruction D) Dehydration

Ans: A
Chapter: 43
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
Page and Header: 1302, Assessment of the Renal and Urinary Tract Systems

Feedback: Dullness to percussion of the bladder following voiding indicates incomplete bladder emptying. Enlargement of the kidneys can be attributed to numerous conditions such as polycystic kidney disease or hydronephrosis and is not related to bladder fullness. Dehydration and ureteral obstruction are not related to bladder fullness, and in fact these conditions results in decreased flow of urine to the bladder.

5. The 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?
A) Increased fluid intake to produce a full bladder

B) Intravenous administration of radiopaque contrast agent C) Sedation and intubation

D) The injection of a radioisotope

Ans: A
Chapter: 43
Client Needs: D-3
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning Objective: 5
Page and Header: 1306, Diagnostic Evaluation

Feedback: Ultrasonography requires a full bladder; therefore, fluid intake should be encouraged before the procedures. The administration of a radiopaque contrast agent is required to perform intravenous urography studies such as an intravenous pyelogram. Ultrasonography is a quick and painless diagnostic test and does not require sedation or intubation. The injection of a radioisotope is required for nuclear scan and ultrasonography is not in this category of diagnostic studies.

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