Nokea
A patient admitted to the medical unit with impaired renal function is complaining of severe, stabbing pain in the flank and lower abdomen. The patient is being assessed for renal calculi. The nurse recognizes that the stone is most likely in what anatomic location?
- A. Meatus
- B. Bladder
- C. Ureter
- D. Urethra
Correct Answer: C
Rationale: Ureteral pain is characterized as a dull continuous pain that may be intense with voiding. The pain may be described as sharp or stabbing if the bladder is full. This type of pain is inconsistent with a stone being present in the bladder. Stones are not normally situated in the urethra or meatus.
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The nurse is reviewing the electronic health record of a patient with a history of incontinence. The nurse reads that the physician assessed the patients deep tendon reflexes. What condition of the urinary/renal system does this assessment address?
- A. Renal calculi
- B. Bladder dysfunction
- C. Benign prostatic hyperplasia (BPH)
- D. Recurrent urinary tract infections (UTIs)
Correct Answer: B
Rationale: The deep tendon reflexes of the knee are examined for quality and symmetry. This is an important part of a testing for neurologic causes of bladder dysfunction, because the sacral area, which innervates the lower extremities, is in the same peripheral nerve area responsible for urinary continence. Neurologic function does not directly influence the course of renal calculi, BPH or UTIs.
The nurse is caring for a patient with a nursing diagnosis of deficient fluid volume. The nurses assessment reveals a BP of98 / 52 \mathrm{~mm} \mathrm{Hg}$. The nurse should recognize that the patients kidneys will compensate by secreting what substance?
- A. Antidiuretic hormone (ADH)
- B. Aldosterone
- C. Renin
- D. Angiotensin
Correct Answer: C
Rationale: When the vasa recta detect a decrease in BP, specialized juxtaglomerular cells near the afferent arteriole, distal tubule, and efferent arteriole secrete the hormone renin. Renin converts angiotensinogen to angiotensin I, which is then converted to angiotensin II. The vasoconstriction causes the BP to increase. The adrenal cortex secretes aldosterone in response to stimulation by the pituitary gland, which in turn is in response to poor perfusion or increasing serum osmolality. The result is an increase in BP.
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
Correct Answer: A
Rationale: 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.
A patient asks the nurse why kidney problems can cause gastrointestinal disturbances. What relationship should the nurse describe?
- A. The right kidneys proximity to the pancreas, liver, and gallbladder
- B. The indirect impact of digestive enzymes on renal function
- C. That the peritoneum encapsulates the GI system and the kidneys
- D. The left kidneys connection to the common bile duct
Correct Answer: A
Rationale: The proximity of the right kidney to the colon, duodenum, head of the pancreas, common bile duct, liver, and gallbladder may cause GI disturbances. The proximity of the left kidney to the colon (splenic flexure), stomach, pancreas, and spleen may also result in intestinal symptoms. Digestive enzymes do not affect renal function and the left kidney is not connected to the common bile duct.
A patient has experienced excessive losses of bicarbonate and has subsequently developed an acidbase imbalance. How will this lost bicarbonate be replaced?
- A. The kidneys will excrete increased quantities of acid.
- B. Bicarbonate will be released from the adrenal medulla.
- C. Alveoli in the lungs will synthesize new bicarbonate.
- D. Renal tubular cells will generate new bicarbonate.
Correct Answer: D
Rationale: To replace any lost bicarbonate, the renal tubular cells generate new bicarbonate through a variety of chemical reactions. This newly generated bicarbonate is then reabsorbed by the tubules and returned to the body. The lungs and adrenal glands do not synthesize bicarbonate. Excretion of acid compensates for a lack of bicarbonate, but it does not actively replace it.