PNVN 1631 Module 8 Exam Questions With Answers 2023/2024 (MED SURG Genitourinary System)

PNVN 1631 Module 8 Exam Questions With Answers 2023/2024 (MED SURG Genitourinary System) The patient, age 30, has a history of renal calculi and is admitted to the hospital with gross hematuria and severe colicky left flank pain that radiates to his left testicle. An intravenous pyelogram confirms the presence of a 4-mm renal calculus in the proximal left ureter. Physician orders include morphine 1mg q4h prn, strain all urine, and encourage fluids to 4,000 mL/day. In planning care for this patient, the nurse gives the highest priority to which nursing diagnosis? Anxiety related to unclear outcome of condition Risk for injury related to disorientation Ineffective health maintenance related to lack of knowledge about prevention of stones Pain related to irritation of a stone Nursing diagnoses include, but are not limited to, patient pain related to mobility of renal calculus. Question 2 1 / 1 pts A nurse is caring for a client who has been diagnosed as having a kidney mass. The client asks the nurse the reason for a renal biopsy, when other tests such as computerized tomography (CT) and ultrasound are available. In formulating a response, the nurse incorporates the knowledge that a renal biopsy: Provides an outline of the renal vascular system Determines if the mass is growing rapidly or slowly Gives specific cytological information, malignancy determination about the lesion Helps differentiate between a solid mass and a fluid-filled cyst Rationale: Renal biopsy is a definitive test that gives specific information about whether the lesion is benign or malignant. An ultrasound discriminates between a fluid-filled cyst and a solid mass. Renal arteriography outlines the renal vascular system. Question 3 1 / 1 pts A nurse is assisting a client with cystitis to select foods that are appropriate for an acid-ash diet. The nurse encourages the client to eat which of the following foods? Strawberries Garden peas Cheese Ice cream Rationale: Foods that are allowed on an acid-ash diet include meat, fish, shellfish, cheese, eggs, poultry, grains, cranberries, prunes, plums, corn, lentils, and foods with high amounts of chlorine, phosphorus, and sulfur. Foods that are not included are milk and milk products such as ice cream, all vegetables except corn and lentils, all fruits except cranberries, plums, and prunes, and foods containing high amounts of sodium, potassium, calcium, and magnesium. Question 4 1 / 1 pts Mr. Jelly is undergoing peritoneal dialysis (CAPD). The dialysate dwell time is completed, and the clamp is opened to allow the dialysate to drain. The nurse notes that drainage has stopped and only 500ml has drained; the amount of dialysate instilled was 1500 ml. Which of the following interventions would be done first? Clamp the catheter and instill more dialysate at the next exchange time Check the catheter for kinks or obstruction Call the physician Instruct the patient to take deep breaths Rationale: When observing for the outflow of the dialysate, the nurse should check for kinks and clamped/constricted tubing and instruct the patient to turn side to side to allow dialysate with regards to the anatomy of the peritoneum that fluids may be still in pockets t the sides. Question 5 1 / 1 pts A client who has chronic glomerunephritis has deteriorated to the early stages of renal failure. When receiving shift report from the nurse, what information correlates with renal failure? Weight loss Anemia Hypotension Fever Rationale: Anemia is common in clients with renal failure. If kidney function is diminished, anemia occurs from the decreased RBC production resulting from discontinued production or erythropoietin. Question 6 1 / 1 pts Renin is produced in a specialized region/structure of the kidney which greatly affects blood pressure is called the: Loop of Henle glomerulus renal capsule juxtaglomerular apparatus Rationale: Renin is produced by juxtaglomerular cells also known as granular cells that can lead to excess activity of the renin-angiotensin system, hypertension and an increase in blood volume. These will lead to second hyperaldosteronism, which will cause hypertension, high blood sodium, low blood potassium, and metabolic alkalosis. Question 7 1 / 1 pts If this client is typical of others with glomerulonephritis, what finding would the nurse expect to observe when conducting a head-to-toe physical assessment? peripheral edema absence of body hair flushed appearance skin hemorrhages Rationale: A common sign associated with glomerulonephritis is peripheral edema that ranges from slight ankle edema in the evening to generalized fluid retention that may compromise cardiac function. Question 8 1 / 1 pts A patient has nephrotic syndrome. Which of these statements made by the patient indicates that she understands the dietary modifications? “Carbohydrate restriction will be difficult.” “I will need to drink more milk to get my calcium.” “Potassium restriction won’t be hard since I don’t like fruit.” “I will need to increase protein and decrease sodium intake.” Rationale: Medical management for nephrotic syndrome depends on the extent of tissue involvement and may include the use of corticosteroids and a low-sodium, high-protein diet. Question 9 1 / 1 pts The amount of water that is eliminated with the urine is regulated by a complex mechanism within the nephron and influenced by a hormone from the posterior pituitary gland called Antidiuretic hormone (ADH) Renin hormone. ACTH. Pitocin. Rationale: ADH causes the cells of the distal convoluted tubules to increase their rate of water reabsorption. Question 10 1 / 1 pts ABG Value pH: 7.46 [HCO3 - ]: 30 mEq/L PaCO2: 45 mmHg respiratory acidosis. complete uncompensated normal ABG respiratory alkalosis, partial compensated metabolic alkalosis, partial uncompensated metabolic acidosis, complete compensation Question 11 1 / 1 pts A series of examinations and diagnostic tests are ordered to determine whether a client has cancer of the prostate gland. What diagnostic test should the nurse schedule per orders before any rectal examination? Kidneys, ureters, bladder x-ray Prostate specific antigen tes (PSA) Needle biopsy of the prostate gland Transrectal ultrasound examination Rationale: PSA is believed to be a tumor marker for malignancies involving the prostate gland. Question 12 1 / 1 pts An older client has been treated for dehydration and pneumonia. The nurse evaluates that the client’s dehydration has been successfully treated if the blood urea nitrogen (BUN) level drops to: 46 mg/dL 19 mg/dL 32 mg/dL 5 mg/dL Rationale: The normal BUN for the older adult is 8 to 21 mg/dL. Thus option 1 is correct. Values such as those in options 3 and 4 are high and reflect continued dehydration. Option 2 reflects a lower-than-normal value, which can occur with fluid overload. Question 13 1 / 1 pts A nurse is assisting in planning a diet for the client with acute renal failure (ARF). The nurse plans to restrict which of the following dietary components from this client's diet? Potassium Fat Vitamins Carbohydrates Rationale: In the client with renal failure, potassium intake must be restricted as much as possible (30 to 50 mEq/day). The primary mechanism of potassium removal during ARF is dialysis. Options 1, 2, and 3 are not normally restricted in the client with ARF. Question 14 1 / 1 pts The following constituent of the urinalysis test indicates possible renal disease, muscle exertion, or dehydration positive blood bacteriuria proteinuria positive glucose Rationale: Protein in the urine usually indicates possible renal disease, muscle exertion, or dehydration. Positive glucose indicates diabetes. Positive bilirubin indicates liver disease with obstruction or damage. Positive bacteria indicate urinary infection. Question 15 1 / 1 pts A hemodialysis client with a left arm fistula is at risk for arterial insufficiency syndrome. The nurse monitors this client for which manifestation of this disorder? Aching pain, pallor, and edema of the left arm Warmth, redness, and pain in the left hand Edema and red discoloration of the left arm Pallor, cool to touch, diminished pulse, and pain in the left hand Rationale: Arterial insufficiency syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and diminished pulse distal to the fistula and complains of pain distal to the fistula, which is caused by tissue ischemia. Warmth, redness, and pain would more likely characterize a problem with infection. Options 3 and 4 are not characteristics of steal syndrome. Question 16 1 / 1 pts A nurse is reviewing the client's record and notes that the physician has documented that the client has a renal disorder. On review of the laboratory results, the nurse would most likely expect to note which of the following? Decreased red blood cell (RBC) count Decreased white blood cell (WBC) count Elevated blood urea nitrogen (BUN) and creatinine level Decreased hemoglobin level Rationale: BUN testing is a frequently used laboratory test to determine renal function. The BUN level starts to rise when the glomerular filtration rate falls below 40% to 60%. A decreased hemoglobin and RBC count may be noted if bleeding from the urinary tract occurs or if erythropoietic function by the kidney is impaired. An increased WBC is most likely to be noted in renal disease. Question 17 1 / 1 pts A nurse collects a urine specimen for a urinalysis from a client recently diagnosed with polycystic disease of the kidneys. The nurse documents that the urine is dilute and that the specific gravity of the urine is low. Based on this documentation, which of the following specific gravity results was present? 1.020 1.000 1.030 1.010 Rationale: Specific gravity is a measure of the concentration of particles in the urine. A normal range of urine specific gravity is approximately 1.005 to 1.030. Early in polycystic kidney disease, the ability of the kidneys to concentrate urine decreases. Options 2, 3, and 4 indicate a normal range for specific gravity. IncorrectQuestion 18 0 / 1 pts Approximately how much volume of urine would stimulate the conscious desire to urinate?