Nokea
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.
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A patient asks the nurse why kidney problems can cause gastrointestinal disturbances. What relationship should the nurse describe?
- A. The right kidneys proximity to the pancreas, liver, and gallbladder
- B. The indirect impact of digestive enzymes on renal function
- C. That the peritoneum encapsulates the GI system and the kidneys
- D. The left kidneys connection to the common bile duct
Correct Answer: A
Rationale: The proximity of the right kidney to the colon, duodenum, head of the pancreas, common bile duct, liver, and gallbladder may cause GI disturbances. The proximity of the left kidney to the colon (splenic flexure), stomach, pancreas, and spleen may also result in intestinal symptoms. Digestive enzymes do not affect renal function and the left kidney is not connected to the common bile duct.
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.
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 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 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.