Chapter 65: Assessment of the Renal/Urinary System

Chapter 65: Assessment of the Renal/Urinary System

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A nurse reviews the urinalysis of a client and notes the presence of glucose. Which action should the nurse take?
   1. Document findings and continue to monitor the client.
   2. Contact the provider and recommend a 24-hour urine test.
   3. Review the client’s recent dietary selections.
   4. Perform a capillary artery glucose assessment.

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 capillary artery glucose assessment. The client needs further evaluation for this abnormal result; therefore, documenting and continuing to monitor is not appropriate. Requesting a 24-hour urine test or reviewing the client’s dietary selections will not assist the nurse to make a clinical decision related to this abnormality.

DIF:     Applying/Application                         REF: 1348                   KEY: Urinary/renal system| assessment/diagnostic examination| capillary artery blood glucose MSC: Integrated Process: Nursing Process: Assessment NOT:                            Client Needs Category: Physiological Integrity: Reduction of Risk Potential

2. A nurse reviews the health history of a client with an oversecretion of renin. Which disorder should the nurse correlate with this assessment finding?
   1. Alzheimer’s disease
   2. Hypertension
   3. Diabetes mellitus
   4. Viral hepatitis

ANS:   B

Renin is secreted when special cells in the distal convoluted tubule, called the macula densa, sense changes in blood volume and pressure. When the macula densa cells sense that blood volume, blood pressure, 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. Renin has no impact on Alzheimer’s disease, diabetes mellitus, or viral hepatitis.

DIF:     Understanding/Comprehension         REF: 1346                   KEY: Urinary/renal system| health screening                                                          MSC:             Integrated Process: Nursing Process: Assessment                                       NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

3. A nurse reviews the urinalysis results of a client and notes a urine osmolality of 1200 mOsm/L. Which action should the nurse take?
   1. Contact the provider and recommend a low-sodium diet.
   2. Prepare to administer an intravenous diuretic.
   3. Obtain a suction device and implement seizure precautions.
   4. Encourage the client to drink more fluids.

ANS:           D

Normal urine osmolality 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. Dehydration can be associated with elevated serum sodium levels. Although a low-sodium diet may be appropriate for this client, this diet change will not have a significant impact on urine osmolality. A diuretic would increase urine output and decrease urine osmolality further. Low serum sodium levels, not elevated serum levels, place the client at risk for seizure activity. These options would further contribute to the client’s dehydration or elevate the osmolality.

DIF:            Applying/Application                         REF: 1359                   KEY: Urinary/renal system| assessment/diagnostic examination  MSC:           Integrated Process: Nursing Process: Implementation                      NOT:                                                 Client Needs Category: Physiological Integrity: Basic Care and Comfort

4. A nurse assesses a client with renal insufficiency and a low red blood cell count. The client asks, “Is my anemia related to the renal insufficiency?” How should the nurse respond?
   1. “Red blood cells produce erythropoietin, which increases blood flow to the kidneys.”
   2. “Your anemia and renal insufficiency are related to inadequate vitamin D and a loss of bone density.”
   3. “Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow.”
   4. “Kidney insufficiency inhibits active transportation of red blood cells throughout

the blood.”

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 production in the bone marrow. Anemia and renal insufficiency are not manifestations of vitamin D deficiency. The kidneys do not play a role in the transportation of red blood cells or any other cells in the blood.

DIF:            Remembering/Knowledge                 REF: 1349                   KEY: Urinary/renal system| assessment/diagnostic examination  MSC:           Integrated Process: Nursing Process: Assessment      NOT:          Client Needs Category: Physiological Integrity: Physiological Adaptation