Chapter 53 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

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Chapter 53  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

1. The 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. A)  When the patient’s creatinine level drops below 1.2 mg/dL (110 mmol/L)
  2. B)  When the patient’s blood urea nitrogen (BUN) is above 15 mg/dL
  3. C)  When approximately 40% of nephrons are not functioning
  4. D)  When about 80% of the nephrons are no longer functioning

Ans: D

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. The listed creatinine and BUN levels are within reference ranges.

2. A 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. A)  In the ureteropelvic junction
  2. B)  In the ureteral segment near the sacroiliac junction
  3. C)  In the ureterovesical junction
  4. D)  In the urethra

Ans: A

Feedback:

The three narrowed areas of each ureter are 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 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.

3. A 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. A)  A fasting serum potassium level and a random urine sample
  2. B)  A 24-hour urine specimen and a serum creatinine level midway through the urine

    collection process

  3. C)  A BUN and serum creatinine level on three consecutive mornings
  4. D)  A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium,

    and phosphorus values

Ans: B

Feedback:

To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection, the serum creatinine level is measured.

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4. The nurse is assessing a patient’s bladder by percussion. The nurse elicits dullness after the patient has voided. How should the nurse interpret this assessment finding?

  1. A)  The patient’s bladder is not completely empty.
  2. B)  The patient has kidney enlargement.
  3. C)  The patient has a ureteral obstruction.
  4. D)  The patient has a fluid volume deficit.

Ans: A

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; in fact, these conditions result 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?

  1. A)  Increased fluid intake to produce a full bladder
  2. B)  IV administration of radiopaque contrast agent
  3. C)  Sedation and intubation
  4. D)  Injection of a radioisotope

Ans: A

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 IV urography studies, such as an IV 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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