Chapter 47: Kidney and Urinary Function

An appropriate nursing intervention for the client following a nuclear scan of the kidney is to: Apply moist heat to the flank area. Encourage high fluid intake. Monitor for hematuria. Strain all urine for 48 hours.

A. Encourage high fluid intake.A nuclear scan of the kidney involves the IV administration of a radioisotope. Fluid intake is encouraged to flush the urinary tract to promote excretion of the isotope. Monitoring for hematuria, applying heat, and straining urine do not address the potential renal complications associated with the radioisotope

The nurse is assessing a patient upon admission to the hospital. What significant nursing assessment data is relevant to renal function? Select all that apply. Any voiding disorders The presence of hypertension or diabetes The patient's occupation The ability of the patient to manage activities of daily living The patient's financial status

Any voiding disorders The presence of hypertension or diabetes The patient's occupation

A client has undergone diagnostic testing that involved the insertion of a lighted tube with a telescopic lens. The nurse identifies this test as which of the following? Excretory urogram Renal angiography Cystoscopy Intravenous pyelography

Cystoscopy

A client is undergoing a renal angiogram after a traumatic accident. What post-procedural assessments would the nurse perform on the client? Select all that apply. Palpates the pulses in the legs and feet. Monitor hypersensitivity response. Monitor site condition. Administer an enema. Apply a warm compress to site.

Monitor hypersensitivity response.Palpates the pulses in the legs and feet.Monitor site condition.

A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? Monitor the client for an allergy to iodine contrast material. Monitor the client for signs of electrolyte and water imbalance. Evaluate the client for periorbital edema. Assess the client's mental changes.

Monitor the client for an allergy to iodine contrast material.

A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact? The average kidney is approximately 5 cm (2 in.) long and 2 to 3 cm (0.8 to 1.2 in.) wide. The kidneys lie between the 10th and 12th thoracic vertebrae. The left kidney usually is slightly higher than the right one. The kidneys are situated just above the adrenal glands.

The left kidney usually is slightly higher than the right one.

A nurse is preparing an education program about renal disease. Which risk factor should the nurse include when teaching? Select all that apply. Sickle-cell anemia Spinal cord injury Immobility Hypotension Seizures

a) Immobilityb) Spinal cord injuryc) Sickle-cell anemiaRisk factors for renal disease include immobility, sickle-cell anemia, and spinal cord injury. Immobility promotes kidney stone formation. Sickle-cell anemia increases the risk for chronic kidney disease. Spinal cord injury can lead to neurogenic bladder, urinary tract infection, and urinary incontinence.

A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 mL. Urine output that's less than 50 ml in 24 hours is known as: anuria. oliguria. polyuria. hematuria.

anuria - Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine.

An older adult's most recent laboratory findings indicate a decrease in creatinine clearance. When performing an assessment related to potential causes, the nurse should: assess the client's usual intake of sodium. palpate the client's bladder before and after voiding. confirm which beverages the client normally consumes. confirm all of the medications and supplements normally taken.

confirm all of the medications and supplements normally taken. Explanation: Adverse effects of medications are a common cause of decreased renal function in older adults. Quantity, rather than type, of beverages is relevant. Sodium intake does not normally cause decreased renal function. Bladder palpation can be used to confirm urinary retention, but this does not normally affect renal function as much as medications.

The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? Pain after voiding Perineal pain Costovertebral angle tenderness Suprapubic pain

costovertebral angle tenderness Acute pyelonephritiis is characterized by costovertebal angle tenderness. Suprapubic pain is suggestive of bladder distention or infection. Urethral trauma and irritation of the bladder neck can cause pain after voiding. Perineal pain is experienced by male clients with prostate cancer or prostatitis.

The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition? Submucosal layer of connective tissue Detrusor muscle Inner layer of epithelium Adventitia (connective tissue)

detrusor muscle

The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to notify the health care team if bloody urine is noted. maintain bed rest for 2 hours. carefully handle urine because it is radioactive. drink liberal amounts of fluids.

drink liberal amounts of fluids.

When the bladder contains 400 to 500 mL of urine, this is referred to as renal clearance. functional capacity. specific gravity. anuria.

functional capacity.

A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? creatinine glucose potassium chloride

glucose

The term used to describe total urine output less than 0.5 mL/kg/hour is nocturia. dysuria. oliguria. anuria.

oliguria.

A nurse is describing the renal system to a client with a kidney disorder. Which structure would the nurse identify as emptying into the ureters? Glomerulus Renal pelvis Nephron Parenchyma

renal pelvis

Which of the following hormones is secreted by the juxtaglomerular apparatus? Antidiuretic hormone (ADH) Renin Calcitonin Aldosterone

renin

Following a cystoscopy, the client has a nursing diagnosis of acute pain related to the trauma of the procedure to the urinary tract. An appropriate nursing intervention is to: Monitor for urinary retention. Administer prescribed antibiotics. Apply moist heat to the flank area. Assist with warm sitz baths.

warm sitz bath Acute pain can be relieved with warm sitz baths. The nurse should monitor the client for urinary retention, which can help detect a potential cause of pain, but this nursing action does not relieve pain. Antibiotics may be prescribed to prevent infection. The pain associated with cystoscopy tends to be confined to the perineal area and lower abdomen not the flank area.

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? 20 30 40 50

50% Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal. Renal function can be assessed most accurately if several tests are performed and their results are analyzed together. Common tests of renal function include renal concentration tests, creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein metabolism) levels.

The nurse is completing a full exam of the client's renal system. Which assessment finding best documents the need to offer the use of the bathroom? Tenderness over the kidneys Bruits noted over the abdominal area The ingestion of 8 oz of water A dull sound when percussing over the bladder

A dull sound when percussing over the bladderExplanation:A dull sound when percussing over the bladder indicates a full bladder. Because the bladder is full, the nurse would offer for the client to use the bathroom. Tenderness over the kidney can indicate an infection or stones. Bruits are an abnormal vascular sound that does not indicate the need to use the bathroom. Ingesting water does not mean that the client has to void at this time. (less)

A patient has an increase in blood osmolality when the nurse reviews the laboratory work. What can this increase indicate for the patient? Diuresis Less reabsorption of water ADH stimulation An increase in urine volume

ADH stimulation

A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient reports severe pain in the back, arms, and shoulders. Which intervention should be offered by the nurse? Assess the patient's back and shoulder areas for signs of internal bleeding. Provide analgesics to the patient. Distract the patient's attention from the pain. Enable the patient to sit up and ambulate.

Asses the patient's back and shoulder areas for signs of internal bleeding. Explanation: After a renal biopsy, the patient is on bed rest. It is important to assess the dressing frequently for signs of bleeding and evaluate the type and severity of pain. Severe pain in the back, shoulder, or abdomen may indicate bleeding. In such a case, the nurse should notify the physician about these signs and symptoms. Distracting the patient's attention, helping the patient to sit up or ambulate, and providing analgesics may only aggravate the patient's pain and, therefore, should not be performed by the nurse. 1552

Which of the following is used to identify vesicoureteral reflux? IV urography Bladder ultrasonography Renal angiography Voiding cystourethrography

Bladder ultrasonography

The nurse is providing care to a client who has had a kidney biopsy. The nurse would need to be alert for signs and symptoms of which of the following? Bleeding Infection Dehydration Allergic reaction

Correct response: Bleeding Explanation: Renal biopsy carries the risk of postprocedure bleeding because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater. Dehydration and allergic reaction are not associated with a renal biopsy.

The nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration? infection metronidazole phenytoin phenazopyridine hydrochloride

Correct response: phenazopyridine hydrochloride Explanation: Orange to amber-colored urine is caused by concentrated urine due to dehydration, fever, bile, excess bilirubin or carotene, and the medications phenazopyridium hydrochloride and nitrofurantoin. Infection would cause yellow to milky white urine. Phenytoin would cause the urine to become pink to red. Metronidazole would cause the urine to become brown to black.

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? Increased fluid intake Glomerulonephritis Diabetes insipidus Decreased fluid intake

Decreased fluid intake

The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following? Chronic renal failure Fistula Neurogenic bladder Kidney stones

Kidney stones [A client with hyperparathyroidism is at risk for kidney stones. The client with diabetes mellitus is a risk factor for developing chronic renal failure and neurogenic bladder. A client with radiation to the pelvis is at risk for urinary tract fistula.]

Retention of which electrolyte is the most life-threatening effect of renal failure? Sodium Calcium Potassium Phosphorous

Potassium

The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: Protein 15 mg/dL Specific gravity 1.035 Creatinine 0.7 mg/dL Bright yellow urine

Specific gravity 1.035 Explanation: Specific gravity is reflective of hydration status. A concentrated specific gravity, such as 1.035, is suggestive of dehydration. Bright yellow urine suggests ingestion of multiple vitamins. Proteinuria can be benign or be caused by conditions which alter kidney function. Creatinine measures the ability of the kidney to filter the blood. A level of 0.7 is within normal limits.

The nurse is preparing the procedure room for a client who will undergo an intravenous pyelogram. Which item(s) should the nurse include? Antihypertensive agents Dressings and tape Suction equipment Padded tongue blades

Suction equipment R:The contrast agent injected into the client for an intravenous pyelogram is allergenic and nephrotoxic. Emergency supplies and equipment should be readily available in case the client experiences an anaphylactic reaction, including airway and suction equipment, oxygen, epinephrine, corticosteroids, and vasopressors.

Which term best describes a total urine output less than 500 mL in 24 hours? Oliguria Nocturia Dysuria Polyuria

Oliguria

A patient is being seen in the clinic for possible kidney disease. What major sensitive indicator of kidney disease does the nurse anticipate the patient will be tested for? Blood urea nitrogen level Serum potassium level Uric acid level Creatinine clearance level

Creatinine clearance levelCreatinine is an endogenous waste product of skeletal muscle that is filtered at the glomerulus, passed through the tubules with minimal change, and excreted in the urine. Hence, creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

A female client presents to the health clinic for a routine physical examination. The nurse observes that the client's urine is bright yellow. Which question is most appropriate for the nurse to ask the client? "Have you had a recent urinary tract infection?" "Do you take multiple vitamin preparations?" "Have you noticed any vaginal bleeding?" "Do you take phenytoin daily?"

do you take multiple vitamin preparations Explanation: Urine that is bright yellow is an anticipated abnormal finding in the client taking a multivitamin preparation. Urine that is orange may be caused by intake of phenytoin or other medications. Orange- to amber-colored urine may also indicate concentrated urine due to dehydration or fever. Urine that is pink to red may indicate lower urinary tract bleeding. Yellow to milky white urine may indicate infection, pyuria, or, in the female client, the use of vaginal creams. 1548

A nurse is assisting the physician conducting a cystogram. The client has an intravenous (IV) infusion of D5W at 40 ml/hr. The physician inserts a urinary catheter into the bladder and instills a total of 350 ml of a contrast agent. The nurse empties 500 ml from the urinary catheter drainage bag at the conclusion of the procedure. How many milliliters does the nurse record as urine?

150mL Explanation: The urinary drainage bag contains both the contrast agent and urine at the conclusion of the procedure. Total contents (500 ml) in the drainage bag consist of 350 ml of contrast agent and 150 ml of urine.

A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? At 8:00 am, with or without a specimen 6 hours after the urine is discarded With the first specimen voided after 8:00 am After discarding the 8:00 am specimen

After discarding the 8:00 am specimen Explanation: A 24-hour collection of urine is the primary test of renal clearance used to evaluate how well the kidney performs this important excretory function. The client is initially instructed to void and discard the urine. The collection bottle is marked with the time the client voided. Thereafter, all the urine is collected for the entire 24 hours. The last urine is voided at the same time the test originally began.

The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client be assessed for an allergy to iodine? Radiography Computed tomography with contrast Bladder ultrasonography Cystoscopy

Computed tomography with contrast Explanation: The nurse is correct to assess for an allergy to iodine when a computed tomography with contrast medium is prescribed. Uroflowmetry, cystoscopy, and bladder ultrasonography are performed without the use of contrast medium.

A client presents to the ED reporting left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The client has also experienced nausea and emesis. The nurse suspects the client is experiencing: Urethral infection. cystitis. ureteral stones. pyelonephritis.

Urethral infection.

The nurse is caring for a client scheduled for urodynamic testing. Following the procedure, which information does the nurse provide to the client? "You will be sent home with a urinary catheter." "Contact the primary provider if you experience fever, chills, or lower back pain." "You can stop taking the prescribed antibiotic." "You may resume consuming caffeinated, carbonated, and alcoholic beverages."

"Contact the primary provider if you experience fever, chills, or lower back pain." The client must be made aware of the signs of a urinary tract infection after the procedure. The client should contact the primary provider if fever, chills, lower back pain, or continued dysuria and hematuria occur. The client will have catheters placed during the procedure but will not be sent home with one. The client should be told to avoid caffeinated, carbonated, and alcoholic beverages after the procedure because these can further irritate the bladder. These symptoms usually decrease or subside by the day after the procedure. If the client received an antibiotic medication before the procedure, they should be told to continue taking the complete course of medication after the procedure. This is a measure to prevent infection.

The nurse is preparing the client for magnetic resonance imaging (MRI) of the kidney. Which statement by the client requires action by the nurse? "I took my blood pressure medication with my morning coffee an hour ago." "I do not have a pacemaker, artificial heart valve, or artificial joints." "I did not take my multivitamin this morning." "I had my last cigarette 3 hours ago with my morning coffee."

"I took my blood pressure medication with my morning coffee an hour ago."Explanation:The client should not eat for at least 1 hour before an MRI. Alcohol, caffeine-containing beverages, and smoking should be avoided for at least 2 hours before an MRI. The client can take his or her usual medications except for iron supplements prior to the procedure.

The nurse is reviewing the results of a client's renal function study. The nurse understands that which value represent a normal BUN-to-creatinine ratio? 4:1 6:1 8:1 10:1

10:1

Following a renal biopsy, a client reports severe pain in the back, the arms, and the shoulders. Which intervention should be offered by the nurse? Distract the client's attention from the pain. Assess the patient's back and shoulder areas for signs of internal bleeding. Provide analgesics to the client. Enable the client to sit up and ambulate.

Assess the patient's back and shoulder areas for signs of internal bleeding.

Serum sodium plays a major role in maintaining fluid and electrolyte balance. Choose all the correct statements that apply. Aldosterone causes renal reabsorption of sodium. Angiotensin II controls the release of aldosterone. Renin, an enzyme released by the kidneys, activates the RAS system to ensure adequate filtration. About 45% of sodium in the renal filtrate is absorbed. The normal serum sodium level is 90 to 120 mmol/L.

Aldosterone causes renal reabsorption of sodium.Angiotensin II controls the release of aldosterone.Renin, an enzyme released by the kidneys, activates the RAS system to ensure adequate filtration. R: The renin-angiotensin system (RAS) maintains the balance of fluid volume. Refer to Figure 26-4 in the text.

A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should: remove the dressing on the puncture site after vital signs stabilize. keep the client's knee on the affected side bent for 6 hours. apply pressure to the puncture site for 30 minutes. check the client's pedal pulses frequently.

Correct response: check the client's pedal pulses frequently. Explanation: After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the client's knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse should leave this dressing in place for several hours — and only remove it if instructed to do so.

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? Therapeutic index Creatinine clearance Liver function studies GI absorption rate

D) Creatinine clearanceThe physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

A patient had a renal angiography and is being brought back to the hospital room. What nursing interventions should the nurse carry out after the procedure to detect complications? Select all that apply. Examine the puncture site for swelling and hematoma formation. Compare color and temperature between the involved and uninvolved extremities. Apply warm compresses to the insertion site to decrease swelling. Assess peripheral pulses. Increase the amount of IV fluids to prevent clot formation.

Examine the puncture site for swelling and hematoma formation. Assess peripheral pulses. Compare color and temperature between the involved and uninvolved extremities.

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? Nephrotic syndrome Obstruction of the lower urinary tract Infection Acute renal failure

Infection Frequency, urgency, and dysuria are commonly associated with urinary tract infection. Hesitancy and enuresis may indicate an obstruction. Oliguria or anuria and proteinuria might suggest acute renal failure. Nocturia is associated with nephrotic syndrome.

The client is admitted to the nursing unit for a biopsy of the urinary tract tissue. When planning nursing care for the postoperative period, which nursing intervention documents the prescribed activity level? Activity as tolerated Assist the client for bathroom privileges Ambulate the client in the hall Maintain the client on bedrest

Maintain the client on bedrest Explanation: In the postoperative period, the client remains on bed rest as the nurse assess for signs of bleeding. If the client is to be discharged on the following day, the client is to maintain limited activity for several days to avoid spontaneous bleeding.

Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. Specific gravity compares the density of urine to the density of distilled water. Which is an example of how urine concentration is affected? On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. When the kidneys are diseased, the ability to concentrate urine may be impaired, and the specific gravity may vary widely. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has scant urine output with a high specific gravity.

On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has copious urine output with a low specific gravity. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity remains relatively constant.

A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram? Pruritus Hypoventilation Increased alertness Unusually smooth skin

Pruritus

The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure? Renin Cortisol Albumin Vasopressin

Renin Renin is directly involved in the control of arterial blood pressure. It is also essential for the proper functioning of the glomerulus and management of the body's renin-angiotensin system (RAS).

Which nursing assessment finding indicates the client has not met expected outcomes? The client consumes 75% of lunch following an intravenous pyelogram. The client has blood-tinged urine following brush biopsy. The client reports a pain rating of 3 two hours post-kidney biopsy. The client voids 75 cc four hours post cystoscopy.

The client voids 75 cc four hours post cystoscopy .Explanation:Urinary retention is an undesirable outcome following cystoscopy. A pain rating of 3 is an achieveable and expected outcome following kidney biopsy. Blood-tinged urine is an expected finding following cystoscopy due to trauma of the procedure. A client would be expected to eat and retain a meal following an intravenous pyelogram

The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse understand that oliguria is said to be present? When the urine output is between 500 and 1,000 mL/h When the urine output is less than 30 mL/h When the urine output is about 100 mL/h When the urine output is between 300 and 500 mL/h

When the urine output is less than 30 mL/h

A client is having a blood urea nitrogen (BUN) test. BUN level is: decreased in nephrotic syndrome. decreased in renal disease and urinary obstruction. increased in renal disease and urinary obstruction. unchanged in renal disease.

increased in renal disease and urinary obstruction.

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about: chronic, excessive acetaminophen use. childhood asthma. family history of pernicious anemia. recent streptococcal infection.

recent streptococcal infection.

A client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. This test will reveal details about: renal circulation. kidney structure. urine production. kidney function.

renal circulation.

A group of students is reviewing for a test on the urinary and renal system. The students demonstrate understanding of the information when they identify which of the following as part of the upper urinary tract? Pelvic floor muscles Ureters Bladder Urethra

ureters Explanation: The upper urinary tract is composed of the kidneys, renal pelvis, and ureters. The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.