Nokea
The nurse is assessing a patients bladder by percussion. The nurse elicits dullness after the patient has voided. How should the nurse interpret this assessment finding?
- A. The patients bladder is not completely empty.
- B. The patient has kidney enlargement.
- C. The patient has a ureteral obstruction.
- D. The patient has a fluid volume deficit.
Correct Answer: A
Rationale: Dullness to percussion of the bladder following voiding indicates incomplete bladder emptying. Enlargement of the kidneys can be attributed to numerous conditions such as polycystic kidney disease or hydronephrosis and is not related to bladder fullness. Dehydration and ureteral obstruction are not related to bladder fullness; in fact, these conditions result in decreased flow of urine to the bladder.
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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}$. The nurse should recognize that the patients kidneys will compensate by secreting what substance?
- A. Antidiuretic hormone (ADH)
- B. Aldosterone
- C. Renin
- D. Angiotensin
Correct Answer: C
Rationale: When the vasa recta detect a decrease in BP, specialized juxtaglomerular cells near the afferent arteriole, distal tubule, and efferent arteriole secrete the hormone renin. Renin converts angiotensinogen to angiotensin I, which is then converted to angiotensin II. The vasoconstriction causes the BP to increase. The adrenal cortex secretes aldosterone in response to stimulation by the pituitary gland, which in turn is in response to poor perfusion or increasing serum osmolality. The result is an increase in BP.
The nurse is caring for a patient scheduled for renal angiography following a motor vehicle accident. What patient preparation should the nurse most likely provide before this test?
- A. Administration of IV potassium chloride
- B. Administration of a laxative
- C. Administration of Gastrografin
- D. Administration of a 24-hour urine test
Correct Answer: B
Rationale: Before the procedure, a laxative may be prescribed to evacuate the colon so that unobstructedx$-rays can be obtained. A 24-hour urine test is not necessary prior to the procedure. Gastrografin and potassium chloride are not administered prior to renal angiography.
The nurse is providing pre-procedure teaching about an ultrasound. The nurse informs the patient that in preparation for an ultrasound of the lower urinary tract the patient will require what?
- A. Increased fluid intake to produce a full bladder
- B. IV administration of radiopaque contrast agent
- C. Sedation and intubation
- D. Injection of a radioisotope
Correct Answer: A
Rationale: Ultrasonography requires a full bladder; therefore, fluid intake should be encouraged before the procedures. The administration of a radiopaque contrast agent is required to perform IV urography studies, such as an IV pyelogram. Ultrasonography is a quick and painless diagnostic test and does not require sedation or intubation. The injection of a radioisotope is required for nuclear scan and ultrasonography is not in this category of diagnostic studies.
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 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.