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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
Correct Answer: B
Rationale: Retention of potassium is the most life-threatening effect of renal failure. Aldosterone causes the kidney to excrete potassium, in contrast to aldosterones effects on sodium described previously. Acidbase balance, the amount of dietary potassium intake, and the flow rate of the filtrate in the distal tubule also influence the amount of potassium secreted into the urine. Hypocalcemia, the accumulation of wastes, and lack of BP control are complications associated with renal failure, but do not have same level of threat to the patients well-being as hyperkalemia.
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A patient is complaining of genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform?
- A. Encourage mobilization.
- B. Apply topical lidocaine to the patients meatus, as ordered.
- C. Apply moist heat to the patients lower abdomen.
- D. Apply an ice pack to the patients perineum.
Correct Answer: C
Rationale: Following cystoscopy, moist heat to the lower abdomen and warm sitz baths are helpful in relieving pain and relaxing the muscles. Ice, lidocaine, and mobilization are not recommended interventions.
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.
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
Correct Answer: D
Rationale: 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.
A patient is scheduled for a diagnostic MRI of the lower urinary system. What pre-procedure education should the nurse include?
- A. The need to be NPO for 12 hours prior to the test
- B. Relaxation techniques to apply during the test
- C. The need for conscious sedation prior to the test
- D. The need to limit fluid intake to 1 liter in the 24 hours before the test
Correct Answer: B
Rationale: Patient preparation should include teaching relaxation techniques because the patient needs to remain still during an MRI. The patient does not normally need to be NPO or fluid-restricted before the test and conscious sedation is not usually implemented.
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.