Nokea
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.
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A patient with a history of progressively worsening fatigue is undergoing a comprehensive assessment which includes test of renal function relating to erythropoiesis. When assessing the oxygen transport ability of the blood, the nurse should prioritize the review of what blood value?
- A. Hematocrit
- B. Hemoglobin
- C. Erythrocyte sedimentation rate (ESR)
- D. Serum creatinine
Correct Answer: B
Rationale: Although historically hematocrit has been the blood test of choice when assessing a patient for anemia, use of the hemoglobin level rather than hematocrit is currently recommended, because that measurement is a better assessment of the oxygen transport ability of the blood. ESR and creatinine levels are not indicative of oxygen transport ability.
A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has been ordered. The nurse should facilitate collection of what samples?
- A. A fasting serum potassium level and a random urine sample
- B. A 24-hour urine specimen and a serum creatinine level midway through the urine collection process
- C. A BUN and serum creatinine level on three consecutive mornings
- D. A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values
Correct Answer: B
Rationale: To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection, the serum creatinine level is measured.
The nurse is caring for a patient who describes changes in his voiding patterns. The patient states, I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesnt seem to be a great deal of urine flow. What would the nurse expect this patients physical assessment to reveal?
- A. Hematuria
- B. Urine retention
- C. Dehydration
- D. Renal failure
Correct Answer: B
Rationale: Increased urinary urgency and frequency coupled with decreasing urine volumes strongly suggest urine retention. Hematuria may be an accompanying symptom, but is likely related to a urinary tract infection secondary to the retention of urine. Dehydration and renal failure both result in a decrease in urine output, but the patient with these conditions does not have normal urine production and decreased or minimal flow of urine to the bladder. The symptoms of urgency and frequency do not accompany renal failure and dehydration due to decreased urine production.
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.
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.