MULTIPLE CHOICE

1. The nurse is palpating a client’s kidneys. The client’s right kidney is easily palpated, but the nurse cannot palpate the left kidney. What is the nurse’s interpretation of this finding?

a.            The problem involves the right kidney.

b.            The problem involves the left kidney.

c.             Both kidneys are in the normal position.

d.            The client is at increased risk for kidney impairment.

ANS: C

Normally, the left kidney is situated more deeply, and often it cannot be palpated. This is a normal finding.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1476

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

2. A client’s urinalysis results show a protein level of 1.8 mg/dL. Which action by the nurse is best?

a.            Inform the health care provider.

b.            Ask the client about his or her protein intake.

c.             Obtain the client’s weight.

d.            Document the finding in the chart.

ANS: A

Protein is normally reabsorbed and does not show up, except in very small amounts, in the urine. Protein greater than 0.8 mg/dL is abnormal and could indicate stress, infection, recent strenuous exercise, or glomerular problems. This finding should be reported. The other actions would not give information about the origin of the protein.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Laboratory Values) MSC: Integrated Process: Nursing Process (Implementation)

3. The nurse is reviewing a client’s urinalysis and notes a positive glucose. Which action by the nurse is best?

a.            Document the finding and call the health care provider.

b.            Collect and send another urinalysis sample to the laboratory.

c.             Review the client’s recent dietary selections.

d.            Perform a finger stick blood glucose on the client.

ANS: D

Glucose normally is not found in the urine. The normal renal threshold for glucose is about 220 mg/dL, which means that a person whose blood glucose is less than 220 mg/dL will not have glucose in the urine. A positive finding for glucose on urinalysis indicates high blood sugar. The most appropriate action would be to perform a finger stick blood glucose. If facility policy does not allow that action, calling the provider would be best. The client needs further evaluation for this abnormal result.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Laboratory Values) MSC: Integrated Process: Nursing Process (Assessment)

4. Which condition is associated with oversecretion of renin?

a.            Alzheimer’s disease

b.            Hypertension

c.             Diabetes mellitus

d.            Diabetes insipidus

ANS: B

Renin is secreted when special cells in the distal convoluted tubule (DCT), called the macula densa, sense changes in blood volume and pressure. When the macula densa cells sense that blood volume is low, blood pressure is low, or blood sodium levels are low, renin is secreted. Renin then converts angiotensinogen into angiotensin I. This leads to a series of reactions that cause secretion of the hormone aldosterone. This hormone increases kidney reabsorption of sodium and water, increasing blood pressure, blood volume, and blood sodium levels. Inappropriate or excessive renin secretion is a major cause of persistent hypertension.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1471

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

5. A client’s urinalysis results reveal a urine osmolarity of 1200 mOsm/L. Which action by the nurse is most appropriate?

a.            Initiate a fluid restriction.

b.            Prepare to administer a diuretic.

c.             Institute seizure precautions.

d.            Encourage the client to increase fluid intake.

ANS: D

Normal urine osmolarity ranges from 300 to 900 mOsm/L. This client’s urine is more concentrated, indicating dehydration. The nurse should encourage the client to drink more water. The other options are not appropriate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Laboratory Values) MSC: Integrated Process: Nursing Process (Implementation)

6. Which is the result of stimulation of erythropoietin production in the kidney tissue?

a.            Increased blood flow to the kidney

b.            Inhibition of vitamin D and loss of bone density

c.             Increased bone marrow production of red blood cells

d.            Inhibition of active transport of sodium and hyponatremia

ANS: C

Erythropoietin is produced in the kidney and is released in response to decreased oxygen tension in the renal blood supply. Erythropoietin stimulates red blood cell (RBC) production in the bone marrow.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1471

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

7. The nurse is reviewing a client’s laboratory test results and notes a blood urea nitrogen (BUN) of 35 mg/dL and a creatinine of 1.0 mg/dL. What new order does the nurse anticipate?

a.            Increase the client’s IV fluids.

b.            Prepare the client for dialysis.

c.             Place the client on a fluid restriction.

d.            Obtain urine for culture and sensitivity.

ANS: A

Normal BUN is 10 to 20 mg/dL. Normal creatinine is 0.6 to 1.2 mg/dL (males) or 0.5 to 1.1 mg/dL (females). Creatinine is more specific for kidney function than is BUN because BUN can be affected by several factors (dehydration, high-protein diet, and others). This client’s creatinine is normal, which suggests a non-renal cause of the elevated BUN. A common cause of increased BUN is dehydration, so the nurse should anticipate giving the client more fluids.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Laboratory Values) MSC: Integrated Process: Nursing Process (Analysis)