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The nurse is performing a focused genitourinary and renal assessment of a patient. Where should the nurse assess for pain at the costovertebral angle?
- A. At the umbilicus and the right lower quadrant of the abdomen
- B. At the suprapubic region and the umbilicus
- C. At the lower border of the 12th rib and the spine
- D. At the 7th rib and the xyphoid process
Correct Answer: C
Rationale: The costovertebral angle is the angle formed by the lower border of the 12th rib and the spine. Renal dysfunction may produce tenderness over the costovertebral angle.
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Results of a patients 24 -hour urine sample indicate osmolality of510 \mathrm{mOsm} / \mathrm{kg}$, which is within reference range. What conclusion can the nurse draw from this assessment finding?
- A. The patients kidneys are capable of maintaining acidbase balance.
- B. The patients kidneys reabsorb most of the potassium that the patient ingests.
- C. The patients kidneys can produce sufficiently concentrated urine.
- D. The patients kidneys are producing sufficient erythropoietin.
Correct Answer: C
Rationale: Osmolality is the most accurate measurement of the kidneys ability to dilute and concentrate urine. Osmolality is not a direct indicator of renal function as it relates to erythropoietin synthesis or maintenance of acidbase balance. It does not indicate the maintenance of healthy levels of potassium, the vast majority of which is excreted.
A kidney biopsy has been scheduled for a patient with a history of acute renal failure. The patient asks the nurse why this test has been scheduled. What is the nurses best response?
- A. A biopsy is routinely ordered for all patients with renal disorders.
- B. A biopsy is generally ordered following abnormalx$-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 is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all that apply.
- A. Petechiae
- B. Pain
- C. Gastrointestinal symptoms
- D. Changes in voiding
- E. Jaundice
Correct Answer: B,C,D
Rationale: Dysfunction of the kidney can produce a complex array of symptoms throughout the body. Pain, changes in voiding, and gastrointestinal symptoms are particularly suggestive of urinary tract disease. Jaundice and petechiae are not associated with genitourinary health problems.
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 is caring for a 73-year-old patient with a urethral obstruction related to prostatic enlargement. When planning this patients care, the nurse should be aware of the consequent risk of what complication?
- A. Urinary tract infection
- B. Enuresis
- C. Polyuria
- D. Proteinuria
Correct Answer: A
Rationale: An obstruction of the bladder outlet, such as in advanced benign prostatic hyperplasia, results in abnormally high voiding pressure with a slow, prolonged flow of urine. The urine may remain in the bladder, which increases the potential of a urinary tract infection. Older male patients are at risk for prostatic enlargement, which causes urethral obstruction and can result in hydronephrosis, renal failure, and urinary tract infections.