lOMoAR cPSD| 11763056
Renal Test Bank
Medical Surgical 1 (Rasmussen University)
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Page 1 of 49
, lOMoAR cPSD| 11763056
Chapter 65: Assessment of the Renal/Urinary System
Ignatavicius: Medical-Surgical Nursing, 8th Edition
MULTIPLE CHOICE
1. A nurse reviews the urinalysis of a client and notes the presence of glucose. Which action should the nurse take?
a. Document findings and continue to monitor the client.
b. Contact the provider and recommend a 24-hour urine test.
c. Review the client’s recent dietary selections.
d. 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?
a. Alzheimer’s disease
b. Hypertension
c. Diabetes mellitus
d. 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?
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, lOMoAR cPSD| 11763056
a. Contact the provider and recommend a low-sodium diet.
b. Prepare to administer an intravenous diuretic.
c. Obtain a suction device and implement seizure precautions.
d. 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?
a. “Red blood cells produce erythropoietin, which increases blood flow to the kidneys.”
b. “Your anemia and renal insufficiency are related to inadequate vitamin D and a loss of bone density.”
c. “Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow.”
d. “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
5. A nurse contacts the health care provider after reviewing a client’s laboratory results and noting a blood urea nitrogen (BUN) of 35 mg/dL and
a creatinine of 1.0 mg/dL. For which action should the nurse recommend a prescription?
a. Intravenous fluids
b. Hemodialysis
c. Fluid restriction
d. Urine 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 BUN, because BUN can be affected by several factors (dehydration, high-protein diet, and catabolism). This client’s
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, lOMoAR cPSD| 11763056
creatinine is normal, which suggests a non-renal cause for the elevated BUN. A common cause of increased BUN is dehydration, so the nurse
should anticipate giving the client more fluids, not placing the client on fluid restrictions. Hemodialysis is not an appropriate treatment for
dehydration. The lab results do not indicate an infection; therefore, a urine culture and sensitivity is not appropriate.
DIF: Applying/Application REF: 1355
KEY: Urinary/renal system| assessment/diagnostic examination| hydration
MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
6. A nurse cares for a client with an increased blood urea nitrogen (BUN)/creatinine ratio. Which action should the nurse take first?
a. Assess the client’s dietary habits.
b. Inquire about the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
c. Hold the client’s metformin (Glucophage).
d. Contact the health care provider immediately.
ANS: A
An elevated BUN/creatinine ratio is often indicative of dehydration, urinary obstruction, catabolism, or a high-protein diet. The nurse should
inquire about the client’s dietary habits. Kidney damage related to NSAID use most likely would manifest with elevations in both BUN and
creatinine, but no change in the ratio. The nurse should obtain more assessment data before holding any medications or contacting the
provider.
DIF: Applying/Application REF: 1355
KEY: Urinary/renal system| assessment/diagnostic examination| nutritional requirements
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
7. A nurse cares for a client with a urine specific gravity of 1.040. Which action should the nurse take?
a. Obtain a urine culture and sensitivity.
b. Place the client on restricted fluids.
c. Assess the client’s creatinine level.
d. Increase the client’s fluid intake.
ANS: D
Normal specific gravity for urine is 1.005 to 1.030. A high specific gravity can occur with dehydration, decreased kidney blood flow (often
because of dehydration), and the presence of antidiuretic hormone. Increasing the client’s fluid intake would be a beneficial intervention.
Assessing the creatinine or obtaining a urine culture would not provide data necessary for the nurse to make a clinical decision.
DIF: Applying/Application REF: 1356
KEY: Urinary/renal system| assessment/diagnostic examination| hydration
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
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Renal Test Bank
Medical Surgical 1 (Rasmussen University)
StuDocu is not sponsored or endorsed by any college or university
Page 1 of 49
, lOMoAR cPSD| 11763056
Chapter 65: Assessment of the Renal/Urinary System
Ignatavicius: Medical-Surgical Nursing, 8th Edition
MULTIPLE CHOICE
1. A nurse reviews the urinalysis of a client and notes the presence of glucose. Which action should the nurse take?
a. Document findings and continue to monitor the client.
b. Contact the provider and recommend a 24-hour urine test.
c. Review the client’s recent dietary selections.
d. 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?
a. Alzheimer’s disease
b. Hypertension
c. Diabetes mellitus
d. 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?
Downloaded by GEOFREY GEOFFREY ()
, lOMoAR cPSD| 11763056
a. Contact the provider and recommend a low-sodium diet.
b. Prepare to administer an intravenous diuretic.
c. Obtain a suction device and implement seizure precautions.
d. 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?
a. “Red blood cells produce erythropoietin, which increases blood flow to the kidneys.”
b. “Your anemia and renal insufficiency are related to inadequate vitamin D and a loss of bone density.”
c. “Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow.”
d. “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
5. A nurse contacts the health care provider after reviewing a client’s laboratory results and noting a blood urea nitrogen (BUN) of 35 mg/dL and
a creatinine of 1.0 mg/dL. For which action should the nurse recommend a prescription?
a. Intravenous fluids
b. Hemodialysis
c. Fluid restriction
d. Urine 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 BUN, because BUN can be affected by several factors (dehydration, high-protein diet, and catabolism). This client’s
Downloaded by GEOFREY GEOFFREY ()
, lOMoAR cPSD| 11763056
creatinine is normal, which suggests a non-renal cause for the elevated BUN. A common cause of increased BUN is dehydration, so the nurse
should anticipate giving the client more fluids, not placing the client on fluid restrictions. Hemodialysis is not an appropriate treatment for
dehydration. The lab results do not indicate an infection; therefore, a urine culture and sensitivity is not appropriate.
DIF: Applying/Application REF: 1355
KEY: Urinary/renal system| assessment/diagnostic examination| hydration
MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
6. A nurse cares for a client with an increased blood urea nitrogen (BUN)/creatinine ratio. Which action should the nurse take first?
a. Assess the client’s dietary habits.
b. Inquire about the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
c. Hold the client’s metformin (Glucophage).
d. Contact the health care provider immediately.
ANS: A
An elevated BUN/creatinine ratio is often indicative of dehydration, urinary obstruction, catabolism, or a high-protein diet. The nurse should
inquire about the client’s dietary habits. Kidney damage related to NSAID use most likely would manifest with elevations in both BUN and
creatinine, but no change in the ratio. The nurse should obtain more assessment data before holding any medications or contacting the
provider.
DIF: Applying/Application REF: 1355
KEY: Urinary/renal system| assessment/diagnostic examination| nutritional requirements
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
7. A nurse cares for a client with a urine specific gravity of 1.040. Which action should the nurse take?
a. Obtain a urine culture and sensitivity.
b. Place the client on restricted fluids.
c. Assess the client’s creatinine level.
d. Increase the client’s fluid intake.
ANS: D
Normal specific gravity for urine is 1.005 to 1.030. A high specific gravity can occur with dehydration, decreased kidney blood flow (often
because of dehydration), and the presence of antidiuretic hormone. Increasing the client’s fluid intake would be a beneficial intervention.
Assessing the creatinine or obtaining a urine culture would not provide data necessary for the nurse to make a clinical decision.
DIF: Applying/Application REF: 1356
KEY: Urinary/renal system| assessment/diagnostic examination| hydration
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
Downloaded by GEOFREY GEOFFREY ()
