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?
A) When the patients creatinine level drops below 1.2 mg/dL (110 mmol/L)
B) When the patients blood urea ...
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 997
Chapter 53: Assessment of Kidney and Urinary Function
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?
A) When the patients creatinine level drops below 1.2 mg/dL (110 mmol/L)
B) When the patients blood urea nitrogen (BUN) is above 15 mg/dL
C) When approximately 40% of nephrons are not functioning
When about 80% of the nephrons are no longer functioning
D)
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?
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
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.
,Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 998
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?
A) A fasting serum potassium level and a random urine sample
B) A 24-hour urine specimen and a serum creatinine level midway through the urine collection
process
C) A BUN 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
Feedback:
To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection,
the serum creatinine level is measured.
4. The nurse is assessing a patients bladder by percussion. The nurse elicits dullness after the patient has
voided. How should the nurse interpret this assessment finding?
A) The patients bladder is not completely empty.
B) The patient has kidney enlargement.
C) The patient has a ureteral obstruction.
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?
A) Increased fluid intake to produce a full bladder
,Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 999
B) IV administration of radiopaque contrast agent
C) Sedation and intubation
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.
6. The nurse is caring for a patient who has a fluid volume deficit. When evaluating this patients urinalysis
results, what should the nurse anticipate?
A) A fluctuating urine specific gravity
B) A fixed urine specific gravity
C) A decreased urine specific gravity
D) An increased urine specific gravity
Ans: D
Feedback:
Urine specific gravity depends largely on hydration status. A decrease in fluid intake will lead to an
increase in the urine specific gravity. With high fluid intake, specific gravity decreases. In patients with
kidney disease, urine specific gravity does not vary with fluid intake, and the patients urine is said to
have a fixed specific gravity.
7. A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse
should be aware of what age-related change affecting the renal or urinary system?
A) Increased ability to concentrate urine
B) Increased bladder capacity
C) Urinary incontinence
, Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1000
D) Decreased glomerular filtration rate
Ans: D
Feedback:
Many age-related changes in the renal and urinary systems should be taken into consideration when
taking a health history of the older adult. One change includes a decreased glomerular surface area
resulting in a decreased glomerular filtration rate. Other changes include the decreased ability to
concentrate urine and a decreased bladder capacity. It also should be understood that urinary
incontinence is not a normal age-related change, but is common in older adults, especially in women
because of the loss of pelvic muscle tone.
8. A nurse is preparing a patient diagnosed with benign prostatic hypertrophy (BPH) for a lower urinary
tract cystoscopic examination. The nurse informs the patient that the most common temporary
complication experienced after this procedure is what?
A) Urinary retention
B) Bladder perforation
C) Hemorrhage
D) Nausea
Ans: A
Feedback:
After a cystoscopic examination, the patient with obstructive pathology may experience urine retention
if the instruments used during the examination caused edema. The nurse will carefully monitor the
patient with prostatic hyperplasia for urine retention. Post-procedure, the patient will experience some
hematuria, but is not at great risk for hemorrhage. Unless the condition is associated with another
disorder, nausea is not commonly associated with this diagnostic study. Bladder perforation is rare.
9. A patient with renal failure secondary to diabetic nephropathy has been admitted to the medical unit.
What is the most life-threatening effect of renal failure for which the nurse should monitor the patient?
A) Accumulation of wastes
B) Retention of potassium
C) Depletion of calcium
D) Lack of BP control
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