Chronic Kidney Disease Management, Exams of Biology

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BIOL 43900 EAQ Renal Exam Questions And Answers

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Which patient position would the nurse select when preparing to palpate a patient’s kidneys during an assessment? 1 3 Seated at the edge of the bed 4 Standing, facing away from the nurse To palpate the right kidney, the patient is positioned supine and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney. The normal- sized left kidney is rarely palpable because the spleen lies directly on top of it. The kidney is not palpable while the patient is prone, seated, or standing. Test-Taking Tip: Anxiety leading to an exam is normal. Reduce your stress by studying often, not long. Spend at least 15 minutes every day reviewing the "old" material. Supine position Correct 2 Prone position

This action alone will greatly reduce anxiety. The more time you devote to reviewing past material, the more confident you will feel about your knowledge of the topics. Start this review process on the first day of the semester. Don't wait until the middle to end of the semester to try to cram information. 71 % of students nationwide answered this question correctly. View Topics Stats Issue with this question? Which action would the nurse implement when preparing a patient for a scheduled IV pyelogram (IVP)? Administer a cathartic or enema the morning of the procedure. 2 Assess the patient for allergies to penicillin prior to obtaining permission. 3 Advise the patient that a metallic taste may occur during the procedure. 4 Keep the patient NPO for four hours prior to procedure. Confidence: Pretty sure  13252750792 Correct 1

View Topics Stats Issue with this question? Which specimen alterations develop over time and require examination of urine specimens within one hour of collection? Select all that apply. 1 3 Urine becomes more acidic. Correct 4 Urine becomes more alkaline. Correct 5 Red blood cells (RBCs) hemolyze. 56% of students nationwide answered this question correctly. Nursing responsibilities in caring for a patient undergoing an IVP include administration of a cathartic or enema to empty the colon of feces and gas. The nurse will also assess the patient for iodine sensitivity, keep the patient NPO for eight hours prior to the procedure, and advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur. Test-Taking Tip: Get a good night's sleep before an exam. Staying up all night to study before an exam rarely helps anyone. It usually interferes with the ability to concentrate. Confidence: Pretty sure  13252753678 Bacteria multiply rapidly. Correct 2 Urinary casts form.

The specimen should be examined within one hour of voiding. Otherwise, bacteria multiply rapidly, RBCs hemolyze, casts (molds of renal tubules) disintegrate, and the urine becomes alkaline as a result of urea-splitting bacteria. Casts do not form if the urine is not examined in a timely manner. 42 % of students nationwide answered this question correctly. View Topics Stats Confidence: Pretty sure  13252750754 Issue with this question?

Which area of the urinary system would the nurse suspect as having an obstruction when the patient reports acute, severe, renal colicky pain in the lower abdomen? 1 Kidney 2 Urethra 3 Bladder Correct 4 Ureterovesical junction (UVJ) The UVJ is the narrowest part of the urethra and is easily obstructed by urinary calculi. With a stone in the kidney or at the ureteropelvic junction (UPJ), the pain may be dull costovertebral flank pain. Stones in the bladder do not cause obstruction or symptoms unless they are staghorn stones. The urethra seldom has obstruction related to stones. Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2:00 a.m., study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is

working for you. If you are distracted or falling asleep, you may want to change when and where you are studying. 63 % of students nationwide answered this question correctly. View Topics Stats Issue with this question? Aging has which effect on the patient’s urinary system and affects the action of bumetanide (Bumex)? Decreased function of the loop of Henle 2 Benign enlargement of prostatic tissues 3 Decreased sensation of bladder capacity 4 Confidence: Pretty sure  13252750781 Correct 1 Less absorption in the Bowman's capsule Bumetanide is a loop diuretic that acts in the loop of Henle to decrease reabsorption of sodium and chloride. Because the loop of Henle loses function with aging, the excretion of drugs becomes less and less efficient. Thus the circulating levels of drugs are increased and their

View Topics Stats Issue with this question? Which physiologic processes performed by the kidneys would the nurse teach a patient recently diagnosed with chronic renal disease? Select all that apply. Correct 1 Production of renin Correct 2 Activation of vitamin D Correct 3 Erythropoietin production 4 Carbohydrate metabolism 5 Hemolysis of old red blood cells (RBCs) 66% of students nationwide answered this question correctly. The benign enlargement of prostatic tissue, a decreased sensation of bladder capacity, and loss of concentrating ability do not affect directly the action of loop diuretics. Test-Taking Tip: Work with a study group to create and take practice tests. Think of the kinds of questions you would ask if you were composing the test. Consider what would be a good question, what would be the right answer, and what would be other answers that would appear right but would in fact be incorrect. Confidence: Pretty sure  13252756404

In addition to urine formation, the kidneys release renin to maintain BP, activate vitamin D to maintain calcium levels, and produce erythropoietin to stimulate RBC production by the bone marrow. Carbohydrate metabolism and hemolysis of old RBCs are not physiologic functions performed by the kidneys. 46 % of students nationwide answered this question correctly. View Topics Stats Issue with this question? Because the maximum bladder capacity of an adult individual is mL of urine, the nurse anticipates no more than that amount upon Confidence: Just a guess  13252749423

insertion of a catheter for urinary retention. Fill in the blank using a whole number and no punctuation. View Topics Stats Issue with this question? Which interventions would the nurse implement for the patient who takes aspirin daily and is scheduled for a renal biopsy? Select all that apply. 1 Ask the patient to have a full bladder for the procedure. Correct 2 Ensure that the patient signed the procedure’s consent 37% of students nationwide answered this question correctly. On average, 200 to 250 mL of urine in the bladder cause moderate distention and the urge to urinate. When the quantity of urine reaches approximately 400 to 600 mL, the person feels uncomfortable. Bladder capacity varies with the individual but generally ranges from 600 to 1000 mL. STUDY TIP: A helpful method for decreasing test stress is to practice self- affirmation. After you have adequately studied and really know the material, start looking in the mirror each time you pass one and say to yourself— preferably out loud—"I know this material, and I will do well on the test." After several times of watching and hearing yourself reaffirm your knowledge, you will gain inner confidence and be able to perform much better during the test period. This technique really works for students who are adventurous enough to use it. It may feel silly at first, but if it works, who cares? It will work for performing skills in clinical as well, as long as you have practiced the skill sufficiently. Confidence: Just a guess  13252753694

form. Correct 3 Draw blood for typing and crossmatching by the blood bank. 4 Prepare the patient the prior evening by administering an enema. Correct 5 Instruct the patient to stop taking aspirin several days before the procedure. The nurse’s responsibility is to ensure the presence of a signed consent form, obtain a type and crossmatch from the patient, ascertain coagulation status through patient history, and ensure that the patient is not currently taking aspirin before a renal biopsy. A full bladder or preparation of the bowel is not required for renal biopsy. 52 % of students nationwide answered this question correctly.

View Topics Stats Issue with this question? Which instruction would the nurse include when teaching a patient the correct method to obtain a composite urine sample? 1 Collect and save all urine for a period of 24 hours. 2 First thing in the morning, collect a single urine sample, and refrigerate. 3 After discarding the first voided urine, collect hourly urine specimens for three hours. Correct 4 Discard the first urine specimen, then save all urine in a container for a designated time. The responsibility of the nurse is to explain the correct way to collect a composite urine sample. To begin the procedure, instruct the patient to urinate and discard this first urine specimen. Note the time as the start of the test. The patient should then save all urine from subsequent urinations in a Confidence: Just a guess  13252753688

container for a designated period. At the end of the designated period, the patient should urinate and add that urine to the container. Remind the patient to save all urine during the study period. A urine sample collected over 24 hours usually tests creatinine clearance. The first morning sample of urine is most suitable for urinalysis because it contains the highest concentration of the chemical and cells needing to be tested. Three urine samples collected at hourly intervals test renal concentration abilities. Test-Taking Tip: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question. 50 % of students nationwide answered this question correctly. Confidence: Pretty sure Stats Issue with this question? Which instruction would the nurse provide the patient about collecting a urine sample for a prescribed quantitative urine protein test? Correct 1

Collect all urine for 24 hours, per protocol.

Collect the urine sample after fasting for six hours. A quantitative (total) urine protein test requires a 24-hour urine collection and provides a more accurate indication of the protein content in urine. Urine cultures require a midstream urine specimen. An early morning urine sample cannot determine the total loss of protein. Overnight fasting is not required to assess protein loss. Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer. 62 % of students nationwide answered this question correctly. View Topics Stats Issue with this question? When preparing a patient with chronic kidney disease (CKD) for a urologic study requiring a bowel cleansing, which safe/proper bowel preparation would the nurse Collect an early morning, first-void urine sample. Incorrect 3 Collect a midstream, clean-catch urine sample. Confidence: Pretty sure  13252753698

administer the evening prior to the procedure? Select all that apply. Correct 1 Bisacodyl (Dulcolax) Incorrect 2 Fleet phosphate enemas Incorrect 3 Magnesium citrate 4 Docusate (Colace) Correct 5 Soap suds enemas Commonly used bowel preparations include soap suds enemas, castor oil, and bisacodyl tablets or suppositories. Some bowel preparations, such as magnesium citrate and Fleet enema, are contraindicated because magnesium or the phosphates in the Fleet enema cannot be excreted by the kidneys in patients with kidney failure. Docusate is a stool softener, not a laxative. 39 % of students nationwide answered this question correctly. View Topics  13252756407

Confidence: Just a guess Stats Issue with this question? Which items may be the potential cause of a patient’s renal calculi? Select all that apply. Incorrect 1 Caffeine Correct 2 Dehydration Correct 3 Dairy products Incorrect 4 Green/herbal teas Correct 5 Foods high in proteins Dehydration may contribute to urinary tract infections (UTIs), calculi formation, and kidney failure. Large intake of particular foods, such as dairy products or foods high in proteins, may also lead to calculi formation. Caffeine, alcohol, carbonated beverages, some artificial sweeteners, or spicy foods often aggravate urinary inflammatory diseases but do not necessarily lead to calculi formation. Green tea and some herbal teas also cause

diuresis and not calculi formation. 51 % of students nationwide answered this question correctly. Confidence: Pretty sure Stats Issue with this question? Which finding corresponds with nonoliguric acute kidney injury (AKI)? 1 Urinary output of 150 mL/day 2 Urinary output of 250 mL/day 3 Urinary output of 350 mL/day Urinary output of 450 mL/day Correct 4

View Topics Stats Issue with this question? The nurse planning care for a patient with acute kidney injury (AKI) recognizes that the interventions of highest priority are directly related to which nursing diagnosis? 1 3 Activity intolerance 4 Imbalanced nutrition: less than body requirements The issue of excess fluid volume is the primary problem of AKI and the highest priority for the nurse in this situation. When urine output decreases, fluid retention occurs. The severity of the manifestations depends on the extent of the fluid overload. In the case of reduced urine output (anuria and oliguria), the neck veins may become distended with a bounding 80% of students nationwide answered this question correctly. Nonoliguric AKI has a urine output greater than 400 mL/day. About 50% of patients with AKI will be nonoliguric, making the initial diagnosis more difficult. A urine output of less than 400 mL/day indicates oliguric AKI. Confidence: Pretty sure  13168185691 Excess fluid volume Correct 2 Ineffective coping

pulse. Edema and hypertension may develop. Fluid overload can eventually lead to heart failure (HF), pulmonary edema, and pericardial and pleural effusions. The nursing diagnosis of ineffective coping is due to the acute severity of the illness. The nursing diagnosis of activity intolerance is related to the various AKI clinical manifestations. The nursing diagnosis of imbalanced nutrition, less than body requirements, is due to a decrease in appetite as a result of AKI. 91 % of students nationwide answered this question correctly. View Topics Stats Issue with this question? The nurse provides postoperative care 18 hours after a patient received a kidney during transplant surgery. Which is an expected assessment finding for this patient during this stage of recovery? 1 Confidence: Pretty sure  13168181126

Hypokalemia 2 Hyponatremia Large urine output 4 Leukocytosis with cloudy urine output Patients frequently experience diuresis (a large volume of urine output) in the hours and days immediately following a kidney transplant. Hypokalemia, hyponatremia, and signs of infection are unexpected findings that warrant prompt intervention. STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past. 73 % of students nationwide answered this question correctly. View Topics Stats Issue with this question? Confidence: Just a guess  13168176672 Correct 3

Which clinical action plan is most appropriate for a patient in stage 3 of chronic kidney disease? 1 Diagnosis and treatment 2 Estimation of progression 3 Renal replacement therapy Evaluation and treatment of complications Correct 4 A patient in stage 3 of chronic kidney disease has a moderate decrease in the glomerular filtration rate (GFR). The most appropriate clinical action plan for this patient is evaluation and treatment of complications. Diagnosis and treatment is the clinical action plan for patients in stage 1 of chronic kidney disease. Estimation of progression is the clinical action plan for patients in stage 2 of chronic kidney disease because this stage is associated with kidney damage with mild decrease in GFR. Renal replacement therapy is the clinical action plan for patients in stage 5, which is associated with kidney failure.

View Topics Stats Issue with this question? The nurse suspects that which electrolyte abnormality is a cause of cerebral edema in a patient with chronic kidney disease? 1 3 Hypermagnesemia 4 Hypophosphatemia Damaged tubules cannot conserve sodium. Urinary sodium excretion may increase, resulting in normal or below-normal levels of serum sodium. Uncontrolled hyponatremia or water excess can lead to cerebral edema. Hyperkalemia can cause cardiac dysrhythmias. Hypermagnesemia may lead to absence of reflexes, decreased mental status, and 75% of students nationwide answered this question correctly. times when four or five consecutive questions have the same letter or number for the correct answer. Confidence: Pretty sure  13168185641 Hyponatremia Correct 2 Hyperkalemia

hypotension. Hypophosphatemia can lead to bone weakness, fractures, and muscle damage. 67 % of students nationwide answered this question correctly. View Topics Stats Issue with this question? Which is an intrarenal cause of acute kidney injury? 1 Renal artery thrombosis 2 Neuromuscular disorders 3 Benign prostatic hyperplasia Confidence: Pretty sure  13168191091 Hemolytic blood transfusion reaction Correct 4 Hemolytic blood transfusion reaction is an intrarenal cause of acute kidney injury. Renal artery thrombosis is a prerenal cause of acute kidney

View Topics Stats Issue with this question? The nurse provides education for a group of nursing students about cardiovascular problems associated with chronic kidney disease (CKD). The nurse explains that arterial stiffness is related to which event? 1 2 3 Decrease in the sodium bicarbonate level Correct 4 Excessive calcium deposition in the vascular smooth layer A patient with CKD may have arterial stiffness due to calcium deposition in the vascular smooth layer of the blood vessels. Excessive sodium retention causes extracellular fluid accumulation that leads to hypertension and edema. Decrease in the sodium bicarbonate level in the body leads to metabolic 55% of students nationwide answered this question correctly. Neuromuscular disorders and benign prostatic hyperplasia are postrenal causes of acute kidney injury. Confidence: Pretty sure  13168185639 Increase in nitrogenous waste products Excessive sodium retention

acidosis. Accumulation of the nitrogenous waste products leads to neurologic complications. 77 % of students nationwide answered this question correctly. View Topics Stats Issue with this question? The nursing student provides dietary education for a patient with acute kidney injury (AKI). The nurse intervenes when the student encourages the patient to increase the intake of which foods? 1 3 Foods rich in calcium 4 Foods rich in carbohydrates Confidence: Pretty sure  13168191085 Foods rich in potassium Correct 2 Foods rich in fiber