Nokea
The staff educator is giving a class for a group of nurses new to the renal unit. The educator is discussing renal biopsies. In what patient would the educator tell the new nurses that renal biopsies are contraindicated?
- A. A 64-year-old patient with chronic glomerulonephritis
- B. A 57-year-old patient with proteinuria
- C. A 42-year-old patient with morbid obesity
- D. A 16-year-old patient with signs of kidney transplant rejection
Correct Answer: C
Rationale: There are several contraindications to a kidney biopsy, including bleeding tendencies, uncontrolled hypertension, a solitary kidney, and morbid obesity. Indications for a renal biopsy include unexplained acute renal failure, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.
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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.
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.
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 geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse should be aware of what age-related change affecting the renal or urinary system?
- A. Increased ability to concentrate urine
- B. Increased bladder capacity
- C. Urinary incontinence
- D. Decreased glomerular filtration rate
Correct Answer: D
Rationale: Many age-related changes in the renal and urinary systems should be taken into consideration when taking a health history of the older adult. One change includes a decreased glomerular surface area resulting in a decreased glomerular filtration rate. Other changes include the decreased ability to concentrate urine and a decreased bladder capacity. It also should be understood that urinary incontinence is not a normal age-related change, but is common in older adults, especially in women because of the loss of pelvic muscle tone.
The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, the nurse interprets the presence of which substances in the urine as most suggestive of pathology?
- A. Potassium and sodium
- B. Bicarbonate and urea
- C. Glucose and protein
- D. Creatinine and chloride
Correct Answer: C
Rationale: The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that it is not excreted in the urine.