Nokea
When describing the functions of the kidney to a client, which would the nurse include?
- A. Regulation of white blood cell production
- B. Synthesis of vitamin K
- C. Control of water balance
- D. Secretion of the enzyme renin
- E. Management of blood pressure
Correct Answer: C,D,E
Rationale: Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins. They also produce the enzyme renin.
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The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness?
- A. The upper abdominal quadrants on the left and right side
- B. The costovertebral angle
- C. Above the symphysis pubis
- D. Around the umbilicus
Correct Answer: B
Rationale: The nurse is correct to assess the kidneys for tenderness at the costovertebral angle. The other options are incorrect.
A gerontologic consideration of aging is the decreased ability to concentrate urine. This consideration leads to an increased susceptibility to dehydration further complicated by a deficit in thirst. Which nursing action would be most appropriate to address this concern?
- A. Encourage the client to decrease fluid intake.
- B. Instruct the client to double void.
- C. Offer the client use of the bathroom.
- D. Monitor the client for signs of drug toxicity.
Correct Answer: C
Rationale: A dull sound when percussing over the bladder indicates a full bladder. Because the bladder is full, the nurse would offer the client use of the bathroom. Tenderness over the kidney can indicate an infection or stones. Bruits are an abnormal vascular sound that does not indicate the need to use the bathroom. Ingesting water does not mean that the client has to void at this time.
A client who is suspected of urinary tract infection is asked to collect a 24-hour urine specimen for culture. Which measure can the nurse suggest to the client that may help prevent the entire urine specimen from becoming contaminated?
- A. Collect the voided urine sample primarily before 5 AM.
- B. Refrigerate the specimen until it is taken to the laboratory.
- C. Use the same receptacle for voiding and defecation.
- D. Store the collected urine away from sunlight.
Correct Answer: B
Rationale: To prevent the entire urine specimen from becoming contaminated, the urine specimen should be refrigerated until it can be taken to the laboratory. The nurse should ask the client to use separate receptacles for voiding and defecation to prevent any part of the specimen from being lost or contaminated. Urinating and collecting the urine sample only before 5 AM and collecting and storing the urine away from sunlight will not help prevent the urine specimen from becoming contaminated.
The nurse is providing care to a client who has a renal biopsy. The nurse would need to be alert for signs and symptoms of what?
- A. Bleeding
- B. Infection
- C. Dehydration
- D. Allergic reaction
Correct Answer: A
Rationale: Renal biopsy carries the risk of post-procedure bleeding because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater. Dehydration and allergic reaction are not associated with a renal biopsy.
The nurse is teaching a client with oliguria about the steps that occur during the process of urine formation in the order in which they occur. Place the steps in the order the nurse should review them.
- A. Entrance into the Bowman capsule
- B. Drainage from the collecting tubules
- C. Filtration of plasma by glomerulus
- D. Movement through the nephrons to be absorbed or excreted
- E. Flowing into the renal pelvis and down the ureter
- F. Drainage into the bladder then out the urethra
Correct Answer: C,A,D,B,E,F
Rationale: There are three main steps with sub-steps in the complex process of forming urine. The glomerular filtration begins with filtering of the blood plasma by the glomerulus. Next, the filtrate enters Bowman capsule and moves through the tubular system of the nephron and is either absorbed into circulation or excreted as urine. The formed urine drains from the collecting tubules into the renal pelvis and down each ureter to the bladder and out through the urethra.