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A client asks the nurse why a creatinine clearance test is an accurate indicator of kidney function. The nurse is most correct to reply which of the following?
- A. Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney.
- B. Creatinine is metabolized in the liver and excreted by the kidney at a regular rate.
- C. Creatinine is a stress-related response that is excreted by the kidney.
- D. Creatinine is found in the urine to make the urine acidic and can be measured.
Correct Answer: A
Rationale: A creatinine clearance test is used to determine kidney function and creatinine excretion. Creatinine results from a breakdown of phosphocreatine. It is filtered by the glomeruli and excreted at a consistent rate by the kidney.
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A gerontologic consideration of aging is the decreased ability to concentrate urine. This consideration leads to an increased susceptibility to dehydration further complicated by a deficit in thirst. Which nursing action would be most appropriate to address this concern?
- A. Encourage the client to decrease fluid intake.
- B. Instruct the client to double void.
- C. Offer the client use of the bathroom.
- D. Monitor the client for signs of drug toxicity.
Correct Answer: C
Rationale: A dull sound when percussing over the bladder indicates a full bladder. Because the bladder is full, the nurse would offer the client use of the bathroom. Tenderness over the kidney can indicate an infection or stones. Bruits are an abnormal vascular sound that does not indicate the need to use the bathroom. Ingesting water does not mean that the client has to void at this time.
A client has a full bladder. Which sound would the nurse expect to hear on percussion?
- A. Tympany
- B. Dullness
- C. Resonance
- D. Flatness
Correct Answer: B
Rationale: Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very dense tissue, such as the bone or muscle.
The nurse is caring for a client about to undergo urologic testing. Which nursing action is best to comfort the client?
- A. Reassure the client the nurses are here to help and all will be fine.
- B. Allow for client's family to be present during testing.
- C. Provide for privacy and allow verbalization of concerns.
- D. Allow the client to determine the care to be provided.
Correct Answer: C
Rationale: Clients undergoing diagnostic testing are often anxious and worried. Clients having urologic testing may also feel embarrassed. Telling the client that all will be well dismisses the client's concerns. Provide privacy, reassurance, and information and maintain professional and empathic attitude. Allowing families to be present during testing and the client to determine care is not appropriate and may be distracting to the client.
The nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client's symptoms and urine specific gravity is anticipated?
- A. The specific gravity will be relatively constant
- B. The specific gravity will equal to one
- C. The specific gravity will be high
- D. The specific gravity will be low
Correct Answer: C
Rationale: The nurse assesses all of the data to make an informed decision on client status. On a hot day, the client found outside will be perspiring. When dehydration occurs, a client will have low urine output and increased specific gravity of urine. In kidney disease, the specific gravity may remain relatively constant. The density of distilled water is one. A low specific gravity is noted in a client with high fluid intake and who is not losing systemic fluid.
The nurse is caring for an 84-year-old client who is being admitted for diagnostic studies for a potential renal disorder. The nurse planning care has initiated a care plan of 'knowledge deficiency related to poor understanding of diagnostic studies as manifested by client statements of not understanding diagnostic procedures and elevated anxiety.' Which nursing intervention(s) does the nurse include in the plan of care?
- A. Assess client's level of understanding.
- B. Provide written reading material.
- C. Remain with client and answer questions.
- D. Administer an ordered sedative.
- E. Use simple language.
- F. Direct instruction to family.
Correct Answer: A,C,D,E
Rationale: The nurse is caring for a client who is unsure of the diagnostic study and is anxious. The nursing interventions to assist the client begin with understanding knowledge base following an assessment of understanding. Next, remaining with client and answering questions in simple terms alleviates anxiety and opens teaching and communication. If all consents are signed, an ordered sedative may diminish client anxiety. Providing written material at this time is not helpful and may increase anxiety. All instruction should be primarily directed toward the client but include all family members.