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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.
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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 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.
The nurse caring for a patient with suspected renal dysfunction calculates that the patients weight has increased by 5 pounds in the past 24 hours. The nurse estimates that the patient has retained approximately how much fluid?
- A. $1,300 \mathrm{~mL}$ of fluid in 24 hours
- B. $2,300 \mathrm{~mL}$ of fluid in 24 hours
- C. $3,100 \mathrm{~mL}$ of fluid in 24 hours
- D. $5,000 \mathrm{~mL}$ of fluid in 24 hours
Correct Answer: B
Rationale: An increase in body weight commonly accompanies edema. To calculate the approximate weight gain from fluid retention, remember that1 \mathrm{~kg}$ of weight gain equals approximately1,000 \mathrm{~mL}$ of fluid. Five lbs=2.27 \mathrm{~kg}=2,270 \mathrm{~mL}$.
A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult?
- A. If possible, try to drink at least 4 liters of fluid daily.
- B. Ensure that you avoid replacing water with other beverages.
- C. Remember to drink frequently, even if you dont feel thirsty.
- D. Make sure you eat plenty of salt in order to stimulate thirst.
Correct Answer: C
Rationale: The nurse emphasizes the need to drink throughout the day even if the patient does not feel thirsty, because the thirst stimulation is decreased. Four liters of daily fluid intake is excessive and fluids other than water are acceptable in most cases. Additional salt intake is not recommended as a prompt for increased fluid intake.
A nurse is preparing a patient diagnosed with benign prostatic hypertrophy (BPH) for a lower urinary tract cystoscopic examination. The nurse informs the patient that the most common temporary complication experienced after this procedure is what?
- A. Urinary retention
- B. Bladder perforation
- C. Hemorrhage
- D. Nausea
Correct Answer: A
Rationale: After a cystoscopic examination, the patient with obstructive pathology may experience urine retention if the instruments used during the examination caused edema. The nurse will carefully monitor the patient with prostatic hyperplasia for urine retention. Post-procedure, the patient will experience some hematuria, but is not at great risk for hemorrhage. Unless the condition is associated with another disorder, nausea is not commonly associated with this diagnostic study. Bladder perforation is rare.