Chapter 19: Renal Clinical Assessment and Diagnostic Procedures

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. In assessing the breath sounds of a patient with renal disease, the nurse hears a pericardial friction rub. This suggests that:

a.	pneumonia has developed because of immobility and ineffective breathing.
b.	uremia has led to pericarditis.
c.	inadequate hydration has caused internal organs to adhere to each other.
d.	the patient is having an adverse reaction to medications given for renal failure.

 

ANS:   B

The presence of a pericardial friction rub indicates pericarditis, which may result from uremia in a patient with kidney failure.

 

DIF:    Cognitive Level: Analysis      REF:    393

OBJ:    Nursing Process: Assessment TOP:    Renal Clinical Assessment

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

2. Which of the following assessment findings would indicate fluid volume excess?

a.	Venous filling of the hand veins greater than 5 seconds
b.	Distended neck veins in the supine position
c.	Presence of orthostatic hypotension
d.	Auscultation of a third heart sound

 

ANS:   D

Auscultation of the heart requires not only assessing rate and rhythm, but also listening for extra sounds. Fluid overload is often accompanied by a third or fourth heart sound, which is best heard with the bell of the stethoscope.

 

DIF:    Cognitive Level: Application REF:    393

OBJ:    Nursing Process: Assessment TOP:    Renal Clinical Assessment

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

3. The report of a renal patient’s laboratory results shows that the blood urea nitrogen (BUN) level is less than 25 mg/dL. To fully understand the patient’s renal status, the nurse must consider this value along with:

a.	osmolality.
b.	anion gap.
c.	creatinine level.
d.	hemoglobin level.

 

ANS:   C

BUN level is never evaluated in isolation, but is always considered in relation to a known serum creatinine level. Creatinine levels are fairly constant and are affected by fewer factors than BUN level is. A typical ratio of BUN to creatinine is approximately 10:1. A change in this ratio generally indicates kidney dysfunction and is very useful in identifying the cause of the acute kidney dysfunction.

 

DIF:    Cognitive Level: Comprehension       REF:    396

OBJ:    Nursing Process: Assessment TOP:    Renal Laboratory Studies

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential

 

4. While reviewing the patient’s urinary electrolyte values, the nurse notes that the urine sodium level is less than 10 mmol/L. This is suggestive of:

a.	healthy kidney function.
b.	renal failure.
c.	prerenal failure.
d.	increased urinary sodium level.

 

ANS:   C

Prerenal failure may be the cause of reduced levels of urinary sodium.

 

DIF:    Cognitive Level: Comprehension       REF:    Table 19-3

OBJ:    Nursing Process: Assessment TOP:    Renal Laboratory Studies

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential

 

5. A patient is admitted to the unit following a motorcycle accident. The patient has a purplish discoloration on the left flank and is complaining of abdominal pain. The nurse suspects the patient has a:

a.	broken rib.
b.	kidney injury.
c.	ruptured spleen.
d.	ruptured bladder.

 

ANS:   B

Kidney trauma is suspected if a purplish discoloration is present on the flank (Grey-Turner sign) or near the posterior 11th or 12th ribs. Bruising, abdominal distention, and abdominal guarding may also signal kidney trauma or a hematoma around a kidney.

 

DIF:    Cognitive Level: Analysis      REF:    392

OBJ:    Nursing Process: Assessment TOP:    Renal Clinical Assessment

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential