Nokea
A patient with elevated BUN and creatinine values has been referred by her primary physician for further evaluation. The nurse should anticipate the use of what initial diagnostic test?
- A. Ultrasound
- B. X-ray
- C. Computed tomography (CT)
- D. Nuclear scan
Correct Answer: A
Rationale: Ultrasonography is a noninvasive procedure that passes sound waves into the body through a transducer to detect abnormalities of internal tissues and organs. Structures of the urinary system create characteristic ultrasonographic images. Because of its sensitivity, ultrasonography has replaced many other diagnostic tests as the initial diagnostic procedure.
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A nurse is caring for a 73-year-old patient with a urethral obstruction related to prostatic enlargement. When planning this patients care, the nurse should be aware of the consequent risk of what complication?
- A. Urinary tract infection
- B. Enuresis
- C. Polyuria
- D. Proteinuria
Correct Answer: A
Rationale: An obstruction of the bladder outlet, such as in advanced benign prostatic hyperplasia, results in abnormally high voiding pressure with a slow, prolonged flow of urine. The urine may remain in the bladder, which increases the potential of a urinary tract infection. Older male patients are at risk for prostatic enlargement, which causes urethral obstruction and can result in hydronephrosis, renal failure, and urinary tract infections.
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 below1.2 \mathrm{mg} / \mathrm{dL}(110 \mathrm{mmol} / \mathrm{L})$
- B. When the patients blood urea nitrogen (BUN) is above15 \mathrm{mg} / \mathrm{dL}$
- C. When approximately40 % of nephrons are not functioning
- D. When about80 % of the nephrons are no longer functioning
Correct Answer: D
Rationale: When the total number of functioning nephrons is less than20 %, renal replacement therapy needs to be considered. Dialysis is an example of a renal replacement therapy. Prior to the loss of about80 % 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.
A kidney biopsy has been scheduled for a patient with a history of acute renal failure. The patient asks the nurse why this test has been scheduled. What is the nurses best response?
- A. A biopsy is routinely ordered for all patients with renal disorders.
- B. A biopsy is generally ordered following abnormalx$-ray findings of the renal pelvis.
- C. A biopsy is often ordered for patients before they have a kidney transplant.
- D. A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease.
Correct Answer: D
Rationale: Biopsy of the kidney is used in diagnosing and evaluating the extent of kidney disease. Indications for biopsy include unexplained acute renal failure, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.
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.
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
Correct Answer: A
Rationale: 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.