Chapter 60: Assessment of the Renal/Urinary
System
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse contacts the primary health care provider after reviewing a client’s laboratory
results and noting a blood urea nitrogen (BUN) of 35 mg/dL (12.5 mmol/L) and a
serum creatinine of 1.0 mg/dL (88.4 mcmol/L). What collaborative care measure
would the nurse recommend?
a. Intravenous fluids
b. Hemodialysis
c. Fluid restriction
d. Urine culture and sensitivity
ANS: A
Normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Normal creatinine is 0.6 to 1.2
mg/dL (53.0 to 106.1 mcmol/L) (males) or 0.5 to 1.1 mg/dL (44.2 to 97.2 mcmol/L)
(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 creatinine is normal, which suggests a nonrenal cause for the elevated
BUN. A common cause of increased BUN is dehydration, so the nurse would
recommend 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 are not appropriate.
DIF: Applying TOP: Integrated Process: Nursing Process: Analysis
KEY: Urinary, Renal system, Diagnostic tests MSC: Client
, Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
2. The nurse is assessing a group of clients for their risk of kidney disease. Which
racial/ethnic group is at the greatest risk as they age?
a. Latino Americans
b. African Americans
c. Jewish Americans
d. Asian Americans
ANS: B
Older African Americans have a greater age-related decrease in glomerular filtration
rate when compared to other racial-ethnic groups. In addition, blood flow decreases
and sodium excretion is less effective in older hypertensive African Americans. These
changes make this group most at risk for kidney disease.
DIF: Remembering TOP: Integrated Process: Culture and Spirituality
KEY: Kidney disorders, Human Development MSC: Client
Needs Category: Physiological Integrity: Physiological Adaptation
3. A nurse cares for a client with a urine specific gravity of 1.040. What action would 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
presence of antidiuretic hormone. Increasing the client’s fluid intake would be a
System
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse contacts the primary health care provider after reviewing a client’s laboratory
results and noting a blood urea nitrogen (BUN) of 35 mg/dL (12.5 mmol/L) and a
serum creatinine of 1.0 mg/dL (88.4 mcmol/L). What collaborative care measure
would the nurse recommend?
a. Intravenous fluids
b. Hemodialysis
c. Fluid restriction
d. Urine culture and sensitivity
ANS: A
Normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Normal creatinine is 0.6 to 1.2
mg/dL (53.0 to 106.1 mcmol/L) (males) or 0.5 to 1.1 mg/dL (44.2 to 97.2 mcmol/L)
(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 creatinine is normal, which suggests a nonrenal cause for the elevated
BUN. A common cause of increased BUN is dehydration, so the nurse would
recommend 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 are not appropriate.
DIF: Applying TOP: Integrated Process: Nursing Process: Analysis
KEY: Urinary, Renal system, Diagnostic tests MSC: Client
, Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
2. The nurse is assessing a group of clients for their risk of kidney disease. Which
racial/ethnic group is at the greatest risk as they age?
a. Latino Americans
b. African Americans
c. Jewish Americans
d. Asian Americans
ANS: B
Older African Americans have a greater age-related decrease in glomerular filtration
rate when compared to other racial-ethnic groups. In addition, blood flow decreases
and sodium excretion is less effective in older hypertensive African Americans. These
changes make this group most at risk for kidney disease.
DIF: Remembering TOP: Integrated Process: Culture and Spirituality
KEY: Kidney disorders, Human Development MSC: Client
Needs Category: Physiological Integrity: Physiological Adaptation
3. A nurse cares for a client with a urine specific gravity of 1.040. What action would 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
presence of antidiuretic hormone. Increasing the client’s fluid intake would be a
