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A patient with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acidbase balance?
- A. Sequestering free hydrogen ions in the nephrons
- B. Returning bicarbonate to the bodys circulation
- C. Returning acid to the bodys circulation
- D. Excreting bicarbonate in the urine
Correct Answer: B
Rationale: The kidney performs two major functions to assist in acidbase balance. The first is to reabsorb and return to the bodys circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine. Retaining bicarbonate will counteract an acidotic state. The nephrons do not sequester free hydrogen ions.
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The staff educator is giving a class for a group of nurses new to the renal unit. The educator is discussing renal biopsies. In what patient would the educator tell the new nurses that renal biopsies are contraindicated?
- A. A 64-year-old patient with chronic glomerulonephritis
- B. A 57-year-old patient with proteinuria
- C. A 42-year-old patient with morbid obesity
- D. A 16-year-old patient with signs of kidney transplant rejection
Correct Answer: C
Rationale: There are several contraindications to a kidney biopsy, including bleeding tendencies, uncontrolled hypertension, a solitary kidney, and morbid obesity. Indications for a renal biopsy include unexplained acute renal failure, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.
A patient with a history of incontinence will undergo urodynamic testing in the physicians office. Because voiding in the presence of others can cause situational anxiety, the nurse should perform what action?
- A. Administer diuretics as ordered.
- B. Push fluids for several hours prior to the test.
- C. Discuss possible test results as the patient voids.
- D. Help the patient to relax before and during the test.
Correct Answer: D
Rationale: Voiding in the bladder is frequently due can cause a guarding reflex that inhibits voiding due to situational anxiety. Because the patient should ensure that the outcomes of these studies determine frighten the bladder, the nurse must help you relax the bladder by providing as much privacy as possible. Diuret and fluid intake would be not sufficient to induce anxiety. It would be inappropriate to discuss test the bladder during a test.
The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, the nurse interprets the presence of which substances in the urine as most suggestive of pathology?
- A. Potassium and sodium
- B. Bicarbonate and urea
- C. Glucose and protein
- D. Creatinine and chloride
Correct Answer: C
Rationale: The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that it is not excreted in the urine.
The nurse is performing a focused genitourinary and renal assessment of a patient. Where should the nurse assess for pain at the costovertebral angle?
- A. At the umbilicus and the right lower quadrant of the abdomen
- B. At the suprapubic region and the umbilicus
- C. At the lower border of the 12th rib and the spine
- D. At the 7th rib and the xyphoid process
Correct Answer: C
Rationale: The costovertebral angle is the angle formed by the lower border of the 12th rib and the spine. Renal dysfunction may produce tenderness over the costovertebral angle.
Diagnostic testing of an adult patient reveals renal glycosuria. The nurse should recognize the need for the patient to be assessed for what health problem?
- A. Diabetes insipidus
- B. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- C. Diabetes mellitus
- D. Renal carcinoma
Correct Answer: C
Rationale: Renal glycosuria can occur on its own as a benign condition. It also occurs in poorly controlled diabetes, the most common condition that causes the blood glucose level to exceed the kidneys reabsorption capacity. Glycosuria is not associated with SIADH, diabetes insipidus, or renal carcinoma.