Chapter 53: Assessment of Kidney and Urinary Function, PrepU Adult 2 Assignment 12, MS 57 urinary, Chapter 53, WK 13 Test, Chapter 89 Urinary Exam, Ch 53 PrepU Assessment of Kidney & Urinary Fxn, Chapter 57 Introduction to the Urinary System, prep u…
When fluid intake is normal, the specific gravity of urine should be which of the following?
1.010 to 1.025
When fluid intake is normal, the specific gravity of urine should be:
1.010 to 1.025
When fluid intake is normal, the specific gravity of urine should be which of the following?
1.010 to 1.025.
An older female client reports that she feels like she does not urinate as strongly or quickly as she did when she was younger. The nurse educates the client that urinary flow rates do decline with aging, and that the average rate for older women is? (Fill in the blank with a number.)
10
Which of the following is a normal BUN to creatinine ratio?
10:1
Which value represents a normal BUN-to-creatinine ratio?
10:1
A kidney biopsy has been scheduled for a patient with a history of acute renal failure. The patient asks the nurse why this test has been scheduled. What is the nurses best response?
A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease.
The nurse is reviewing urine tests to obtain client baseline information. Which of the following urine tests is preferred to identify characteristics of normal and abnormal urine?
A clean-catch midstream specimen from the first voiding of the morning ✓
The nurse is reviewing urine tests to obtain client baseline information. Which of the following urine tests is preferred to identify characteristics of normal and abnormal urine?
A clean-catch midstream specimen from the first voiding of the morning.
The nurse is caring for several older clients. Which client would the nurse be especially alert for signs and symptoms of pyelonephritis?
A client with urinary obstruction ✓
The nurse is caring for a patient with a nursing diagnosis of deficient fluid volume. The nurses assessment reveals a BP of 98/52 mm Hg. The nurse should recognize that the patients kidneys will compensate by secreting what substance?
Renin
Which of the following hormones is secreted by the juxtaglomerular apparatus?
Renin
A client is scheduled for a cystoscopy for removal of a kidney polyp. What nursing measure should the nurse undertake when caring for this client?
Report any darkening urine after the cystoscopy
A client with kidney injury secondary to diabetic nephropathy has been admitted to the medical unit. What is the most life-threatening effect of kidney injury for which the nurse should monitor the client?
Retention of potassium
A diabetic patient with renal failure has been admitted to your unit. What is the most life-threatening effect of renal failure you will monitor for?
Retention of potassium
Following a voiding cystogram, the client has a nursing diagnosis of risk for infection related to the introduction of bacterial following manipulation of the urinary tract. An appropriate nursing intervention for the client is to:
Encourage high fluid intake.
A nurse is caring for a client during peritoneal dialysis as treatment for kidney failure. What measure should the nurse employ for this client?
Encourage the client to breathe deeply
A patient with renal failure secondary to diabetic nephropathy has been admitted to the medical unit. What is the most life-threatening effect of renal failure for which the nurse should monitor the patient?
Retention of potassium
The nurse is reviewing the laboratory results of a client being evaluated for urinary functioning and notes that bilirubin is present in the urine. What condition would the nurse suspect?
Hepatitis
A patient with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acidbase balance?
Returning bicarbonate to the bodys circulation
The nurse is providing preprocedure teaching about an ultrasound. The nurse informs the client that in preparation for an ultrasound of the lower urinary tract the client will require what?
Increased fluid intake to produce a full bladder
The nurse is caring for a patient who is going to have an open renal biopsy. What would be an important nursing action in preparing this patient for the procedure?
Keep the patient NPO prior to the procedure.
You are caring for a patient who is going to have an open renal biopsy. What would be an important nursing action in preparing this patient for the procedure?
Keep the patient NPO.
A nurse is caring for a client who is receiving hemodialysis. During dialysis, what measure should the nurse be prepared to implement when caring for this client?
Keep two clamps on the dressing over the cannula
A 60 year old female client experiencing stress urinary incontinence is not considered a good candidate for surgical repair of the problem. Her healthcare provider recommends a pessary. Which describes this treatment?
A device is inserted into the vagina to support the organs of the pelvis.
The nurse is completing a full exam of the renal system. Which assessment finding best documents the need to offer the use of the bathroom?
A dull sound when percussing over the bladder ✓
The nurse observes a client's uric acid level of 9.3 mg/dL. When teaching the client about ways to decrease the uric acid level, which diet would the nurse suggest?
A low-purine diet ✓
A nurse is caring for a 73-year-old male patient with a urethral obstruction related to prostatic enlargement. The nurse is aware this may result in what?
A urinary tract infection
The nurse discusses a care plan with a male patient who is to be discharged after a biopsy. He is instructed to maintain limited activity and report signs of systemic infection, urinary tract infection, or bleeding. Which additional instructions should the nurse include in the care plan?
Complete the prophylactic antibiotic therapy.
The nurse is caring for a patient who has a fluid volume deficit. When evaluating this patient's urinalysis results, what should the nurse anticipate?
An increased urine specific gravity
The nurse is caring for a patient who has a fluid volume deficit. When evaluating this patients urinalysis results, what should the nurse anticipate?
An increased urine specific gravity
The nurse is caring for a patient who has been NPO for 2 days pending a diagnostic procedure that has been repeated cancelled. When evaluating this patient's urinalysis, what would the nurse anticipate?
An increased urine specific gravity
The nurse is caring for a patient who is not allowed oral intake of fluid or food. When evaluating this patient's urinalysis, what would the nurse anticipate?
An increased urine specific gravity
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education?
Brief, hot daily showers ✓
The nurse caring for a client is providing instructions for an upcoming renal angiography. Which nursing action, explained in the preoperative instructions, is essential in the postprocedure period?
Complete a pulse assessment of the legs and feet. ✓
The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client assess for an allergy to shellfish?
Computed tomography with contrast
The hemodialysis client is scheduled to receive weekly injections of epoetin. Which is the most important consideration to be taken by the nurse in the administration of this medication?
Schedule injection on nondialysis day. ✓
When describing the functions of the kidney to a client, which of the following would the nurse include? Select all that apply.
Secretion of the enzyme renin ✓ Control of water balance ✓
A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse should be aware of what age-related change affecting the renal or urinary system?
Decreased glomerular filtration rate
A client is prescribed amitriptyline, an antidepressant for incontinence. The nurse understands which of the following reasons that this drug is an effective treatment? Select all that apply.
Decreases involuntary bladder contractions ✓ Increases bladder neck resistance ✓
An elderly client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale?
Detects calculi, cysts, or tumors ✓
A nurse is preparing a client for an intravenous pyelogram (IVP). What intervention should the nurse be prepared to implement?
Determine whether the client is allergic to shellfish
Diagnostic testing of an adult client reveals renal glycosuria. The nurse should recognize the need for the client to be assessed for what health problem?
Diabetes mellitus
Diagnostic testing of an adult patient reveals renal glycosuria. The nurse should recognize the need for the patient to be assessed for what health problem?
Diabetes mellitus
The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom?
Diminished erythropoietin production ✓
A nurse has been asked to speak to a local women's group about preventing cystitis. Which of the following would the nurse include in the presentation?
Need to urinate after engaging in sexual intercourse
A nurse has been asked to speak to a local women's group about preventing cystitis. Which of the following would the nurse include in the presentation?
Need to urinate after engaging in sexual intercourse ✓
The nurse is caring for a client with a cystoscopy tube draining urine from the bladder. When reviewing the client's history prior to administering care, which is of most concern?
New diagnosis of urosepsis ✓
During a routine assessment, the client states; "I wake up all night long to go the bathroom." The nurse documents this finding as which condition?
Nocturia
The nurse is caring for a client diagnosed with bladder cancer and requiring a cystectomy. The nurse overhears the physician instructing the client on the presence of a stoma with temporary pouch. In gathering information for the client, which urinary diversion would the nurse select?
ileal conduit ✓
A nurse is working with a client who will undergo invasive urologic testing. The nurse has informed the client that slight hematuria may occur after the testing is complete. The nurse should recommend what action to help resolve hematuria?
increased fluid intake following the test
A client is having a blood urea nitrogen (BUN) test. BUN level is:
increased in renal disease and urinary obstruction.
The nurse is caring for a client who is going to have an open renal biopsy. What nursing action should the nurse prioritize when preparing this client for the procedure?
keep the pt NPO prior to the procedure
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?
kidney stones ✓
A client is reporting hematuria, or the presence of red blood cells in the urine. What is not a cause of hematuria?
lithium toxicity
Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?
low purine ✓
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure?
The kidneys can improve over a period of months.
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure?
The kidneys can improve over a period of months. ✓
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 left kidney usually is slightly higher than the right one.
A patient admitted to the medical unit with impaired renal function is complaining of severe, stabbing pain in the flank and lower abdomen. The patient is being assessed for renal calculi. The nurse recognizes that the stone is most likely in what anatomic location?
Ureter
A patient presents to the ED complaining of left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The patient has also experienced nausea and emesis. The nurse suspects the patient is experiencing which of the following?
Ureteral stones
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?
Ureters
The nurse monitoring clients for symptoms of renal failure knows that oliguria is common in the early phases of renal failure. How would the nurse describe this condition?
Urinary output is <400 mL in a 24-hour period.
A nurse is preparing a client diagnosed with benign prostatic hyperplasia (BPH) for a lower urinary tract cystoscopic examination. The nurse should caution the client about what common temporary complication of this procedure?
Urinary retention
A nurse is preparing a patient diagnosed with benign prostatic hypertrophy (BPH) for a lower urinary tract cystoscopic examination. The nurse informs the patient that the most common temporary complication experienced after this procedure is what?
Urinary retention
A nurse is caring for a 73-year-old client with a urethral obstruction related to prostatic enlargement. When planning this client's care, the nurse should be aware of the risk of what complication?
Urinary tract infection
A nurse is caring for a 73-year-old patient with a urethral obstruction related to prostatic enlargement. When planning this patients care, the nurse should be aware of the consequent risk of what complication?
Urinary tract infection
The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document?
Urinary urgency
A client is diagnosed with hydronephrosis. What occurs in this condition?
Urine forms, but the flow of urine from the kidneys is obstructed
The nurse is assessing a client brought to the emergency department for systemic complications after a traumatic event. Which assessment finding is most suggestive of an intact urinary tract?
Urine output is pink and noted at 300 mL. ✓
The nurse is caring for a patient who describes changes in his voiding patterns. The patient states, I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesnt seem to be a great deal of urine flow. What would the nurse expect this patients physical assessment to reveal?
Urine retention
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 less than 30 mL/h
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 less than 30 mL/h Oliguria is defined as urine output <0.5 mL/kg/h
The nurse is instructing a 3-year-old's mother regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as normal finding for this age group?
enuresis ✓
Although the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which is NOT a function of the kidneys?
excreting protein
A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine?
glucose
The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder?
hematuria ✓
A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess?
hypertension ✓
As the home health nurse reviews medications taken by the client with polycystic kidney disease, which medication should be addressed first?
ibuprofen ✓
A creatinine clearance test has been ordered. The nurse prepares to:
Collect the client's urine for 24 hours.
A client has a full bladder. Which sound would the nurse expect to hear on percussion?
dullness ✓
A kidney biopsy has been scheduled for a client with a history of acute kidney injury. The client asks the nurse why this test has been scheduled. What is the nurse's best response?
"A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."
A kidney biopsy has been scheduled for a patient with a history of acute renal failure. The patient asks the nurse why this test has been scheduled. What is the nurse's best response?
"A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."
A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching?
"As long as I have one normal kidney, I should be fine." ✓
List the S/S of UTI
-Dysuria -Urinary Frequency -Hematuria -Burning Sensation -"Heavy feeling" in the abdomen
A client asks the nurse why a creatinine clearance test is accurate. The nurse is most correct to reply which of the following?
"Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." ✓
A client presents at the testing center for an intravenous pyelogram. What question should the nurse ask to ensure the safety of the client?
"Do you have any allergies?"
While reviewing a client's chart, the nurse notes the client has been experiencing enuresis. To assess whether this remains an ongoing problem for the client, the nurse asks which question?
"Do you urinate while sleeping?"
While reviewing a patient's chart, the nurse notes the patient has been experiencing enuresis. To assess if this remains an ongoing problem for the patient, the nurse will ask which of the following questions?
"Do you urinate while sleeping?"
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse?
"Even a perfect match does not guarantee organ rejection." ✓
The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions?
"I can resume my usual activities without restriction."
The nurse is caring for a 13-year-old female client diagnosed with urethritis. Which of the following assessment answers would indicate that further instruction is needed? Select all that apply.
"I take a bubble bath a couple of times per week." ✓ "I clean my private area with soap and water." ✓ "I change my sanitary napkin when it is full." ✓
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." 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 providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective?
"I will feel a warm sensation as the dye is injected."
A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address?
"I'm allergic to shellfish."
Following ureteroscopy, for the removal of ureteral calculus, a stent is temporarily left in place. The client asks what purpose the stent provides. Which is the best response from the nurse?
"Inflammation from the stone can block the flow of urine." ✓
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?
"It is appropriate to warm the dialysate in a microwave." ✓
A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult?
"Remember to drink frequently, even if you don't feel thirsty."
A nursing student asks the nurse why older adults are at risk for renal disease. The best response by the nurse is:
"The glomerular filtration rate decreases as we age."
A nurse is caring for a client who is being prescribed phenazopyridine. The client is distressed on seeing that the urine is exhibiting a reddish-orange discoloration. Which response by the nurse would be most appropriate?
"This discoloration is a normal result of the medication. Nothing is wrong."
An investment banker, with chronic renal failure, informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse?
"This type of dialysis will provide more independence." ✓
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse?
"Very few symptoms are associated with renal cancer." ✓
The nurse is caring for a 37-year-old female client with potential interstitial cystitis. Which question, asked by the nurse, is helpful in suggesting the disease?
"When was your last menstrual period?" ✓
In a diagnosis of an upper urinary tract infection, which structures could be affected? Select all that apply.
-ureter -kidney
A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in:
1 min
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?
150 mL 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.
The client tells the nurse of the feeling of always needing to void. The nurse instructs on normal urine elimination. At which amount of urine accumulation in the bladder is the nerve reflex triggered to signal the need to void?
150mL ✓
The nurse caring for a patient with suspected renal dysfunction calculates that the patient's weight has increased by 5 pounds in the past 24 hours. The nurse estimates that the patient has retained approximately how much fluid?
2,300 mL of fluid in 24 hours
The nurse caring for a patient with suspected renal dysfunction calculates that the patients weight has increased by 5 pounds in the past 24 hours. The nurse estimates that the patient has retained approximately how much fluid?
2,300 mL of fluid in 24 hours
You are examining a urinalysis laboratory report of a client who is undergoing a diagnostic workup. You know that the normal urine pH range should be
4.5 to 7.5.
The normal urine pH range should be:
4.6 to 8.0.
The nurse is evaluating the urinary system of an older adult male client who reports that his stream seems to have decreased. The nurse educates the client that urine flow rate decreases with age, and that the average flow rate in older men is? (Fill in the blank with a number.)
9
The client presents with nausea and vomiting, absent bowel sounds, and colicky flank pain. The nurse interprets these findings as consistent with: A. Ureteral colic B. Acute prostatitis C. Urethritis D. Interstitial cystitis
A
The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions? A. "I can resume my usual activities without restriction." B. "I should increase my fluid intake for the rest of the day." C. "If I have difficulty urinating, I should contact my physician." D. "It is normal for my urine to be blood-tinged."
A A bladder ultrasound is a non-invasive procedure. The client can resume usual activities without restriction.
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? Kidney stones Chronic renal failure Fistula Neurogenic bladder
A 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.
A client asks the nurse why a creatinine clearance test is accurate. The nurse is most correct to reply which of the following? A. "Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." B. "Creatinine is metabolized in the liver and excreted by the kidney at a regular rate." C. "Creatinine is a stress-related response that is excreted by the kidney." D. "Creatinine is found in the urine to make the urine acidic and can be measured."
A A creatinine clearance test is used to determine kidney function and creatinine excretion. Creatinine results from a breakdown of phosphocreatine. It is filtered by the glomeruli and excreted at a consistent rate by the kidney.
A creatinine level has been ordered. The nurse prepares to: A. Obtain a blood specimen. B. Collect the client's urine for 24 hours. C. Obtain a clean catch urine. D. Straight cath for a specimen.
A A creatinine level is determined from a blood sample. It is used to assess renal function.
The nurse is reviewing the results of renal function studies of a patient. The nurse understands that which of the following is a normal BUN-to-creatinine ratio? a) 10:1 b) 8:1 c) 4:1 d) 6:1
A A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect.
Which of the following is used to identify vesicoureteral reflux? A. Voiding cystourethrography B. IV urography C. Renal angiography D. Bladder ultrasonography
A A voiding cystourethrography is used as a diagnostic tool to identify vesicoureteral reflux. An IV urography may be used as the initial assessment of various suspected urologic problems, especially lesions in the kidneys and ureters, and it provides an approximate estimate of renal function. Renal angiography is used to evaluate renal blood flow, to differentiate renal cysts from tumors, to evaluate hypertension, and preoperatively for renal transplantation.
To assess circulating oxygen concentration, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommends the use of which diagnostic test? A. Hemoglobin B. Hematocrit C. Serum iron concentration D. Arterial blood gases
A Although hematocrit has always been the blood test of choice to assess for anemia, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommend that anemia be quantified using hemoglobin rather than hematocrit measurements. Hemoglobin is recommended because it more accurately assesses circulating oxygen than does hematocrit. Serum iron concentration measures iron storage in the body. Arterial blood gases assess the adequacy of oxygenation, ventilation, and acid-base status.
Although the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which is NOT a function of the kidneys? A. excreting protein B. excreting nitrogen waste products C. regulating blood pressure D. stimulating RBC production
A Although the kidneys excrete excess water and nitrogen-based waste products of protein metabolism, persistent renal excretion of protein is not the function of kidneys, which are in the state of homeostasis. The kidneys assist in maintenance of acid-base and electrolyte balance; produce the enzyme renin, which helps regulate blood pressure; and produce the hormone erythropoietin.
A client has been experiencing severe pain and hematuria and is hardly able to ambulate into the physician's office. The physician suspects kidney stones and orders diagnostic tests to confirm. What test would physician order? A. KUB B. ultrasound C. CT D. MRI
A An x-ray study of the abdomen includes x-rays of the kidneys, ureters, and bladder (KUB). It is performed to show the size and position of the kidneys, ureters, and bony pelvis as well as any radiopaque urinary calculi (stones), abnormal gas patterns (indicative of renal mass), and anatomic defects of the bony spinal column (indicative of neuropathic bladder dysfunction). Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. A computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen and pelvis may be obtained to diagnose renal pathology, determine kidney size, and evaluate tissue densities with or without contrast.
A patient has an increase in blood osmolality when the nurse reviews the laboratory work. What can this increase indicate for the patient? A. ADH stimulation B. An increase in urine volume C. Diuresis D. Less reabsorption of water
A Antidiuretic hormone (ADH), also known as vasopressin, is a hormone that is secreted by the posterior portion of the pituitary gland in response to changes in osmolality of the blood. With decreased water intake, blood osmolality tends to increase, stimulating ADH release.
The wall of the bladder has four layers. Which of the following layers contains a membrane that prevents reabsorption of urine stored in the bladder? A. Mucosal B. Adventitia C. Detrusor D. Connective tissue
A Beneath the detrusor is a submucosal layer of loose connective tissue that serves as an interface between the detrusor and the innermost layer, a mucosal lining. This inner layer contains specialized transitional cell epithelium, a membrane that is impermeable to water and prevents reabsorption of urine stored in the bladder.
Which term refers to casts in the urine? A. Cylindruria B. Crystalluria C. Pyuria D. Bacteriuria
A Casts may be identified through microscopic examination of the urine sediment after centrifuging. Crystalluria refers to crystals in the urine. Pyuria refers to pus in the urine. Bacteriuria refers to a bacterial count higher than 100,000 colonies/mL in the urine.
Which nursing assessment finding indicates the client with renal dysfunction has not met expected outcomes? a) Client reports increasing fatigue. b) Urine output is 100 ml/hr. c) Client rates pain at a 3 on a scale of 0 to 10. d) Client denies frequency and urgency.
A Fatigue, shortness of breath, and exercise intolerance are consistent with unexplained anemia, which can be secondary to gradual renal dysfunction.
A client is prescribed flavoxate (Urispas) following cystoscopy. Which of the following instructions would the nurse give the client? A. "This medication will relieve your pain." B. "This medication prevents urinary incontinence." C. "This medication will treat the blood in your urine." D. "This medication prevents infection in your urinary tract"
A Flavoxate (Urispas) is a antispasmodic agent used for the treatment of burning and pain of the urinary tract.
A client is prescribed flavoxate (Urispas) following cystoscopy. Which of the following instructions would the nurse give the client? a) "This medication will relieve your pain." b) "This medication will treat the blood in your urine." c) "This medication prevents infection in your urinary tract" d) "This medication prevents urinary incontinence."
A Flavoxate (Urispas) is a antispasmodic agent used for the treatment of burning and pain of the urinary tract.
A client with a history of chronic renal infections is to undergo CT with contrast. Before the procedure, the nurse should complete which action? A. Place emergency medical equipment in the procedure room. B. Instruct the client to maintain a full bladder for the diagnostic test. C. Hold the client's iron supplement until after the diagnostic test. D. Keep the client NPO for 1 hour before the scan.
A For some clients, contrast agents are nephrotoxic and allergenic. Emergency equipment and medications should be available in case of an anaphylactic reaction to the contrast agent. Emergency supplies include epinephrine, corticosteroids, vasopressors, oxygen, and airway and suction equipment. The client is instructed to maintain a full bladder for an ultrasonography. The other instructions/interventions relate to magnetic resonance imaging.
The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program? A. Hypotension B. Diabetes mellitus C. Neuromuscular disorders D. Pregnancy
A Hypertension, not hypotension, is a risk factor for kidney disease.
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? A. Maintain the client on bedrest B. Assist the client for bathroom privileges C. Ambulate the client in the hall D. Activity as tolerated
A 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.
An older client is experiencing an increasingly troublesome need to urinate several times through the night. The client's prostate is within normal limits, and the physician prescribes limiting fluid intake after the evening meal. What is another important intervention to keep the client safe? A. Increase fluid intake throughout the day. B. Decrease overall fluid intake. C. Decrease salt intake. D. Increase protein intake.
A Older persons may need to drink more fluids throughout the day to allow for limiting their intake after the evening meal. Urine formation increases during the night, when leg elevation promotes blood return to the heart and kidneys, and may interrupt sleep patterns. Salt is secreted. Filtrate that is secreted as urine usually contains sodium and chloride. Protein molecules, except for periodic small amounts of globulins and albumin, also are reabsorbed.
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? A. When the urine output is less than 30 mL/h B. When the urine output is about 100 mL/h C. When the urine output is between 300 and 500 mL/h D. When the urine output is between 500 and 1,000 mL/h
A Oliguria is defined as urine output <0.5 mL/kg/h
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Which is an example of how urine concentration is affected? A. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. B. On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. C. 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. D. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity may vary widely.
A 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.
The nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration? phenazopyridine hydrochloride Infection Metronidazole Phenytoin
A 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 caring for a client after a cystoscopic examination. Following the procedure, the nurse informs the client that which effect may occur? A. Blood-tinged urine B. Nausea and emesis C. Diarrhea D. Severe abdominal pain
A Postprocedural management is directed at relieving any discomfort resulting from the examination. Some burning upon voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected. Moist heat to the lower abdomen and warm Sitz baths are helpful in relieving pain and relaxing the muscles. Not eating and diarrhea are not expected following a cystoscopic examination. The client should not experience severe abdominal pain.
Which is the correct term for the ability of the kidneys to clear solutes from the plasma? A. Renal clearance B. Glomerular filtration rate C. Specific gravity D. Tubular secretion
A Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. Glomerular filtration rate is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.
A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client? a) "You don't need to do any fasting before this noninvasive test." b) "You'll have a pressure dressing on your groin after the test." c) "A contrast medium will be used to help see the structures better." d) "An x-ray will be done to view your kidneys, ureters, and bladder."
A Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. It is not invasive, does not require the injection of a radiopaque dye, and does not require fasting or bowel preparation. An x-ray of the abdomen to view the kidneys, ureters, and bladder is called a KUB. A contrast medium is used for computed tomography of the abdomen and pelvis. A pressure dressing is applied to the groin after a renal arteriogram.
The health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator? A. Creatinine clearance level B. Uric acid level C. Blood urea nitrogen (BUN) D. BUN to creatinine ratio
A The creatinine clearance measures the volume of blood cleared of endogenous creatinine in 1 minute. This serves as a measure of the glomerular filtration rate. Therefore the creatinine clearance test is a sensitive indicator of renal disease progression.
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: A. ureteral stones. B. pyelonephritis. C. cystitis. D. Urethral infection.
A The findings are constant with ureteral stones, edema or stricture, or a blood clot. The other answers do not apply.
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? A. The left kidney usually is slightly higher than the right one. B. The kidneys are situated just above the adrenal glands. C. The average kidney is approximately 5 cm (2 in.) long and 2 to 3 cm (0.8 to 1.2 in.) wide. D. The kidneys lie between the 10th and 12th thoracic vertebrae.
A The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4??) long, 5 to 5.8 cm (2? to 2¼?) wide, and 2.5 cm (1?) thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae.
The nurse is monitoring a client who has undergone cystoscopy because the client's history indicates urinary infection. Which of the following would the nurse need to report to the physician? A. Chills and fever B. Dysuria and discolored or malodorous urine C. Hematoma and frank bleeding D. Flank pain and rapid pulse
A The nurse should monitor for chills, fever, and septicemia in a client who has a history of urinary infection after cystoscopy. These symptoms should be observed and the physician should be notified of the findings. Hematoma formation and frank bleeding would be indications to notify the physician after a renal angiography. The nurse should inform the client who is discharged after a renal biopsy to report dysuria, discolored or malodorous urine, flank pain, and rapid pulse to the physician.
The nurse notes that the client's urine is blood-tinged following cystoscopy. Which nursing action should the nurse take next? A. Document the finding in the health record. B. Notify the physician of the finding. C. Instruct the client to increase fluid intake. D. Inspect the client's urinary meatus.
A The physician does not need to be contacted as blood-tinged urine is an expected finding following cystoscopy due to trauma of the procedure. The nurse should document the finding and continue to monitor the client. The client should be encouraged to increase fluid intake to help flush the urinary tract of microorganisms. The urinary meatus does not need to be inspected.
A patient is having an MAG3 renogram and is informed that radioactive material will be injected to determine kidney function. What should the nurse instruct the patient to do during the procedure? A. Lie still on the table for approximately 35 minutes. B. Drink contrast material at various intervals during the procedure. C. Turn from side to side to get a variety of views during the procedure. D. Take deep breaths and hold them at various times throughout the procedure.
A This relatively new scan is used to further evaluate kidney function in some centers. The patient is given an injection containing a small amount of radioactive material, which will show how the kidneys are functioning. The patient needs to lie still for about 35 minutes while special cameras take images (Albala, Gomelia, Morey, et al., 2010).
A nurse is caring for a client with a fluid and electrolyte balance. What urine specific gravity would the nurse expect to measure? A. 1.018 B. 1.000 C. 1.008 D. 1.028
A Urine specific gravity is a measurement of the kidney's ability to concentrate urine; levels between 1.010-1.025 are considered normal. The specific gravity of water is 1.000. A urine specific gravity less than 1.010 may indicate overhydration. A urine specific gravity greater than 1.025 may indicate dehydration.
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? A) Kidney stones B) Neurogenic bladder C) Chronic renal failure D) Fistula
A Feedback: 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.
A client asks the nurse why a creatinine clearance test is accurate. The nurse is most correct to reply which of the following? A) "Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." B) "Creatinine is metabolized in the liver and excreted by the kidney at a regular rate." C) "Creatinine is a stress-related response that is excreted by the kidney." D) "Creatinine is found in the urine to make the urine acidic and can be measured."
A Feedback: A creatinine clearance test is used to determine kidney function and creatinine excretion. Creatinine results from a breakdown of phosphocreatine. It is filtered by the glomeruli and excreted at a consistent rate by the kidney.
The nurse is caring for clients at a long-term care facility. When considering activities in the summer heat, which physiologic change of renal aging can also result in geriatric dehydration? A) Decreased ability to concentrate urine B) Decreased renal blood flow C) Thickening of the renal tubules D) Double voiding
A Feedback: A gerontologic consideration of aging is the decreased ability to concentrate urine. This consideration leads to an increased susceptibility to dehydration further complicated by a deficit in thirst. Other age-related changes include a decrease in renal blood flow and a thickening of the renal tubules. These changes lead to an alteration in the excretion of drugs in older adults, increasing the risk of drug toxicity. Double voiding is remaining at the toilet after voiding to allow time for additional urine to be excreted.
Which of the following urine characteristics would the nurse anticipate when caring for a client whose lab work reveals a high urine specific gravity related to dehydration? A) Dark amber urine B) Clear or light yellow urine C) Red urine D) Turbid urine
A Feedback: Concentrated urine (one with a high specific gravity) is a dark amber color due to the solutes in the urine. Clear or yellow urine indicates a flushing of the urinary system. Red urine indicates hematuria. A turbid urine may indicate bacteriuria.
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? A) Maintain the client on bedrest B) Assist the client for bathroom privileges C) Ambulate the client in the hall D) Activity as tolerated
A Feedback: 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.
The nurse is providing care to a client who has had a renal biopsy. The nurse would need to be alert for signs and symptoms of which of the following? A) Bleeding B) Infection C) Dehydration D) Allergic reaction
A Feedback: 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 client tells the nurse of the feeling of always needing to void. The nurse instructs on normal urine elimination. At which amount of urine accumulation in the bladder is the nerve reflex triggered to signal the need to void? A) 150 mL B) 300 mL C) 500 mL D) 750 mL
A Feedback: The nerve reflex is triggered when approximately 150 mL of urine accumulates.
A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has been ordered. The nurse should facilitate collection of what samples?
A 24-hour urine specimen and a serum creatinine level midway through the urine collection process
The staff educator is giving a class for a group of nurses new to the renal unit. The educator is discussing renal biopsies. In what patient would the educator tell the new nurses that renal biopsies are contraindicated?
A 42-year-old patient with morbid obesity
The nursing instructor is talking about monitoring laboratory tests in renal and urinary tract dysfunction. What is monitored to assess for anemia?
Hemoglobin
The nurse is caring for a client who has a fluid volume deficit. When evaluating this client's urinalysis results, what should the nurse anticipate?
An increased urine specific gravity
Which is an effect of aging on upper and lower urinary tract function? More prone to develop hypernatremia Acid-base balance Increased blood flow to the kidneys Increased glomerular filtration rate
A. The elderly are more prone to develop hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidneys, and acid-base imbalances.
In a diagnosis of a lower urinary tract infection, which structures could be affected? Select all that apply. A. bladder B. urethra C. ureter D. kidney
A, B The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.
In a diagnosis of an upper urinary tract infection, which structures could be affected? Select all that apply. A. ureter B. kidney C. bladder D. urethra
A, B The upper urinary tract is composed of the kidneys, renal pelves, and ureters.
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. A. Assess peripheral pulses. B. Compare color and temperature between the involved and uninvolved extremities. C. Examine the puncture site for swelling and hematoma formation. D. Apply warm compresses to the insertion site to decrease swelling. E. Increase the amount of IV fluids to prevent clot formation.
A, B, C After the procedure, vital signs are monitored until stable. If the axillary artery was the injection site, blood pressure measurements are taken on the opposite arm. The injection site is examined for swelling and hematoma. Peripheral pulses are palpated, and the color and temperature of the involved extremity are noted and compared with those of the uninvolved extremity. Cold compresses may be applied to the injection site to decrease edema and pain.
Common tests of renal function include which of the following? Select all that apply. A. Renal concentration test B. Creatinine clearance C. Serum creatinine D. Blood urea nitrogen (BUN) E. Arterial blood gas analysis
A, B, C, D Common tests of renal function include BUN, serum creatinine, creatinine clearance, and renal concentration tests. Arterial blood gas analysis is a test of respiratory function.
Enlargement of the prostate causes which of the following to occur? Select all that apply. A. Frequency B. Oliguria C. Anuria D. Obstruction of urine flow E. Polyuria
A, B, C, D Enlargement of the prostate gland causes obstruction of urine flow, resulting in frequency, oliguria, and anuria. Polyuria does not occur.
The nurse is caring for a client with oliguria. When instructing the client on the process of urine formation, place the following in correct sequence. Use all options. A) Products enter the Bowman's capsule B) Drains from the collecting tubules C) Filtration of plasma by glomerulus D) Moves through the nephrons and is absorbed or excreted E) Flows into the renal pelvis and down the ureter F) Drains into the bladder then out the urethra
A, B, C, D, E, F Feedback: There are three main steps with substeps in the complex process of forming urine. The glomerular filtration begins with filtering of the blood plasma by the glomerulus. Next, the filtrate enters Bowman's capsule and moves through the tubular system of the nephron and is either absorbed into circulation or excreted as urine. The formed urine drains from the collecting tubules into the renal pelvis and down each ureter to the bladder and out through the urethra.
The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply. A. Secretion of prostaglandins B. Vitamin B production C. Regulation of blood pressure D. Vitamin D synthesis E. Secretion of insulin
A, C, D Functions of the kidney include secretion of prostaglandins, regulation of blood pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body does not produce Vitamin B.
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. Evaluate the client for periorbital edema. Assess the client's mental changes. Monitor the client for signs of electrolyte and water imbalance.
A. A renal angiography procedure will be contraindicated if the client is allergic to iodine contrast material. Therefore, it is important for the nurse to monitor the client for an allergy to iodine contrast material. The nurse monitors the client for the signs of electrolyte and water imbalance, mental changes, and periorbital edema at any time regardless of the test being done.
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? Creatinine clearance level Serum potassium level Blood urea nitrogen level Uric acid level
A. Creatinine 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 client has a full bladder. Which sound would the nurse expect to hear on percussion? Dullness Tympany Flatness Resonance
A. Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very dense tissue, such as the bone or muscle.
When describing the functions of the kidney to a client, which of the following would the nurse include? Control of water balance Regulation of white blood cell production Synthesis of vitamin K Secretion of enzymes
A. Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins.
The nurse is providing care to a client who has had a renal biopsy. The nurse would need to be alert for signs and symptoms of which of the following? Bleeding Dehydration Infection Allergic reaction
A. 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 reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: a) Specific gravity 1.035 b) Creatinine 0.7 mg/dL c) Bright yellow urine d) Protein 15 mg/dL
A. 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 mulitiple 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.
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 Unusually smooth skin Hypoventilation Increased alertness
A. The nurse should be alert for pruritus and urticaria, which may indicate a mild anaphylactic reaction to the arteriogram dye. Decreased (not increased) alertness may occur as well as dyspnea (not hypoventilation). Unusually smooth skin isn't a sign of anaphylaxis.
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? Creatinine clearance GI absorption rate Liver function studies Therapeutic index
A. The 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.
The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions? "I can resume my usual activities without restriction." "It is normal for my urine to be blood-tinged." "I should increase my fluid intake for the rest of the day." "If I have difficulty urinating, I should contact my physician."
A. A bladder ultrasound is a non-invasive procedure. The client can resume usual activities without restriction.
The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? "I will feel a warm sensation as the dye is injected." "I will need to drink all of the dye as quickly as possible." "I should remove all jewelry before the test." "I should let the staff know if I feel claustrophobic."
A. A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected.
When the bladder contains 400 to 500 mL of urine, this is referred to as functional capacity. anuria. renal clearance. specific gravity.
A. A marked sense of fullness and discomfort with a strong desire to void usually occurs when the bladder contains 400 to 500 mL of urine, referred to as the "functional capacity." Anuria is a total urine output less than 50 mL in 24 hours. Specific gravity reflects the weight of particles dissolved in the urine. Renal clearance refers to the ability of the kidneys to clear solutes from the plasma.
The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to drink liberal amounts of fluids. maintain bed rest for 2 hours. notify the health care team if bloody urine is noted. carefully handle urine because it is radioactive.
A. After the procedure is completed, the client is encouraged to drink fluids to promote excretion of the radioisotope by the kidneys. The remaining instructions are not associated with a nuclear scan.
A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 mL. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of: microorganism transfer. incorrect urine output values. client discomfort. prostate irritation.
A. Bladder ultrasonic scanning, a noninvasive way of calculating the amount of urine in the bladder, reduces the risk of transferring microorganisms into the bladder. Use of a straight catheter to measure residual urine increases the transfer of microorganisms into the bladder, and increases, rather than reduces, client discomfort. A bladder ultrasonic scan doesn't reduce the risk of prostate irritation or incorrect urine output values.
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? Increased serum creatinine Increased serum albumin Decreased potassium Decreased blood urea nitrogen (BUN)
A. In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.
A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is: renal calculi. interstitial cystitis. an overdistended bladder. acute prostatitis.
A. Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void. The client with acute prostatitis presents with a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria.
A nurse measures a patient's urinary output every 8 hours. The nurse weighs the importance of these results by comparing the normal 24-hour urinary output with the patient's condition and medication. The normal 24-hour output should be: 1 to 2 L/day 2.5 to 3 L/day 3.5 to 4 L/day 0.4 to 0.8 L/day
A. The normal output of urine every 24 hours is 800 to 1,500 mL. Refer to Table 26-1 in the text. The significance of the 24-hour result will depend on the patient's medical condition.
When fluid intake is normal, the specific gravity of urine should be which of the following? 1.010 to 1.025. >1.025. 1.000. <1.010.
A. Urine specific gravity is a measurement of the kidney's ability to concentrate urine. The specific gravity of water is 1.000. A urine specific gravity of <1.010 may indicate overhydration. A urine specific gravity >1.025 may indicate dehydration.
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? "Do you take multiple vitamin preparations?" "Have you had a recent urinary tract infection?" "Do you take phenytoin daily?" "Have you noticed any vaginal bleeding?"
A. 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.
A patient has an increase in blood osmolality when the nurse reviews the laboratory work. What can this increase indicate for the patient?
ADH stimulation
The nurse is caring for a client who diagnosed with renal failure. which of the following is a characteristic of this disease?
Abnormal levels of potassium, calcium, and phosphate are found in the blood.
A routine urinalysis is performed on a 59-year-old female client diagnosed with kidney disease and electrolyte imbalances. Which abnormality would the nurse suspect to be documented?
Abnormal specific gravity
A nurse is caring for a client who reports frequent urination. When assessing the urinalysis report, the nurse should look for what component to confirm a normal urinalysis?
Absence of glucose in the urine
A 28 year old female client presents at the emergency department with a rapid onset of fever and chills, as well as flank pain, pyuria, nausea, vomiting, and headache. Laboratory results indicate bacteriuria, WBC's and casts. These symptoms and lab results support which medical diagnosis?
Acute Pyelonephritis
The nurse is caring for a patient scheduled for renal angiography following a motor vehicle accident. What patient preparation should the nurse most likely provide before this test?
Administration of a laxative
A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure?
After discarding the 8:00 am specimen
A 32-year-old client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure and post-procedural assessments. What post-procedural assessment will you perform on the client?
All options are correct
A client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. What postprocedural assessment will the nurse perform on the client?
All options are correct.
The nurse is checking the laboratory results of a 76 year old woman who had a urinalysis performed. The nurse notes that there is calcium in her urine. What condition does this abnormal substance in the urine signify?
Bone degeneration
Which of the following is an effect of aging on upper and lower urinary tract function?
Susceptibility to develop hypernatremia
The nurse is reviewing the electronic health record of a client with a history of incontinence. The nurse reads that the health care provider assessed the client's deep tendon reflexes. What condition of the urinary/renal system does this assessment address?
Bladder dysfunction
The nurse is reviewing the electronic health record of a patient with a history of incontinence. The nurse reads that the physician assessed the patients deep tendon reflexes. What condition of the urinary/renal system does this assessment address?
Bladder dysfunction
A client has a full bladder. Which sound would the nurse expect to hear on percussion? A) Tympany B) Dullness C) Resonance D) Flatness
B Feedback: Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very dense tissue, such as the bone or muscle.
An ileal conduit is created for a client after a radical cystectomy. Which of the following would the nurse expect to include in the client's plan of care?
Application of an ostomy pouch ✓
A client is reporting genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform?
Apply moist heat to the client's lower abdomen.
A patient is complaining of genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform?
Apply moist heat to the patient's lower abdomen.
A patient is complaining of genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform?
Apply moist heat to the patients lower abdomen.
Following identification of a mass by imaging studies, a client undergoes a needle biopsy of the kidney for a specific diagnosis. Which should the nurse consider for this procedure?
Apply pressure to the site to minimize bleeding
The nurse is providing instruction in stoma care with temporary bag following an ileal conduit surgery. Which of the following instructions are accurate? Select all that apply.
Ascorbic acid suppresses urine odors. ✓ Apply an appliance deodorant to decrease odors. ✓ Change the pouch every 4 to 7 days if it is a two-piece pouch. ✓
A client has undergone a renal biopsy. After the test, while the client is resting, the client complains of severe pain in the back, the arms, and the shoulders. In such a case, which of the following appropriate nursing interventions should be offered by the nurse?
Asses the patient's back and shoulder areas for signs of internal bleeding.
A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse?
Asses the patient's back and shoulder areas for signs of internal bleeding.
The nurse is caring for an 84-year-old client who is being admitted for diagnostic studies for a potential renal disorder. The nurse planning care has initiated a care plan of "Knowledge Deficit related to poor understanding of diagnostic studies as manifested by client statements of not understanding diagnostic procedures and elevated anxiety." Which nursing interventions does the nurse include in the plan of care? Select all that apply.
Assess client's level of understanding. ✓ Use simple language. ✓. Remain with client and answer questions. ✓
A client has undergone a renal biopsy. After the test, while the client is resting, the client complains of severe pain in the back, the arms, and the shoulders. In such a case, which of the following appropriate nursing interventions should be offered by the nurse?
Assess the patient's back and shoulder areas for signs of internal bleeding.
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?
Assess the patient's back and shoulder areas for signs of internal bleeding.
What nursing action should the nurse perform when caring for a patient undergoing diagnostic testing of the renal-urologic system?
Assess the patient's understanding of the test results after their completion.
What nursing action should the nurse perform when caring for a patient undergoing diagnostic testing of the renal-urologic system?
Assess the patients understanding of the test results after their completion.
The nurse is performing a focused genitourinary and renal assessment of a client. Where should the nurse assess for pain at the costovertebral angle?
At the lower border of the 12th rib and the spine
The nurse is performing a focused genitourinary and renal assessment of a patient. Where should the nurse assess for pain at the costovertebral angle?
At the lower border of the 12th rib and the spine
The nursing instructor is teaching the students assessment skills in the lab. Where would the instructor teach the students to assess for pain at the costovertebral angle?
At the lower border of the 12th rib and the spine
A client undergoes dialysis as a part of treatment for kidney failure, and is administered heparin during dialysis to achieve therapeutic levels. Which step should the nurse take to allow heparin to be metabolized and excreted in the client?
Avoid administering injections for 2 to 4 hours after heparin administration.
The most frequent reason for admission to skilled care facilities includes which of the following? a) Stroke b) Urinary incontinence c) Congestive heart failure d) Myocardial infarction
B
The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness? A. The upper abdominal quadrants on the left and right side B. The costovertebral angle C. Above the symphysis pubis D. Around the umbilicus
B
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: A. chronic, excessive acetaminophen use. B. recent streptococcal infection. C. childhood asthma. D. family history of pernicious anemia.
B A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction.
The nurse is educating a patient about preparation for an IV urography. What should the nurse be sure to include in the preparation instructions? A. A liquid restriction for 8 to 10 hours before the test is required B. The patient may have liquids before the test. C. The patient will have enemas until the urine is clear. D. The patient is restricted from eating or drinking from midnight until after the test.
B IV urography may be used as the initial assessment of many suspected urologic conditions, especially lesions in the kidneys and ureters. The patient preparation is the same as for excretory urography, except fluids are not restricted.
The nurse observes the color of the client's urine, which appears pale blue-green. The nurse obtains a drug history from the client based on the understanding that drugs used by the client may affect which of the following? A. Size of the urinary bladder B. Urinary tract tests C. Urine specific gravity D. Amount of urine produced
B It is important to inquire about drugs because some drugs may affect the outcome of urinary tract tests as well as the color and odor of the urine. Dietary intake may affect urine characteristics as well as urinary tract disorders and their management. Drugs do not directly affect the size of the urinary bladder or the amount of urine produced.
A patient who complains of a dull, continuous pain in the suprapubic area that occurs with and at the end of voiding would most likely be diagnosed with which of the following? a) A kidney stone b) Interstitial cystitis c) Prostatic cancer d) Acute pyelonephritis
B Pain over the suprapubic area is most likely related to the bladder. Pain intensity would increase with fullness. Pain at the end of voiding is one of the symptoms associated with interstitial cystitis.
A patient who complains of a dull, continuous pain in the suprapubic area that occurs with, and at the end of, voiding would most likely be diagnosed with which of the following? A. A kidney stone B. Interstitial cystitis C. Acute pyelonephritis D. Prostatic cancer
B Pain over the suprapubic area is most likely related to the bladder. Pain intensity would increase with fullness. Pain at the end of voiding is one of the symptoms associated with interstitial cystitis.
A group of students is reviewing the process of urine elimination. The students demonstrate understanding of the process when they identify which amount of urine as triggering the reflex? A. 50 mL B. 150 mL C. 250 mL D. 350 mL
B The desire to urinate comes from the feeling of bladder fullness. A nerve reflex is triggered when approximately 150 to 200 mL of urine accumulates.
Which is an effect of aging on upper and lower urinary tract function? A. Increased glomerular filtration rate B. More prone to develop hypernatremia C. Increased blood flow to the kidneys D. Acid-base balance
B The elderly are more prone to develop hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidneys, and acid-base imbalances.
The nephrons are the functional units of the kidney, responsible for the initial formation of urine. The nurse knows that damage to the area of the kidney where the nephrons are located will affect urine formation. Identify that area. A. Renal medulla B. Renal cortex C. Renal pelvis D. Renal papilla
B The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex.
The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client assess for an allergy to shellfish? a) Bladder ultrasonography b) Computed tomography with contrast c) Cystoscopy d) Radiography
B The nurse is correct to assess for an allergy to shellfish most times when a contrast medium is ordered. The other options do not necessarily have a contrast medium.
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? A. Nephron B. Renal pelvis C. Parenchyma D. Glomerulus
B The renal pelvis empties into the ureter which carries urine to the bladder for storage. The nephron consists of the glomerulus, afferent arteriole, efferent arteriole, Bowman's capsule, distal and proximal convoluted tubules, the loop of Henle, and collecting tubule. The nephron is located in the cortex and carries out the functions of the kidney. The parenchyma is made up of the cortex and medulla.
Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? A. 10 B. 20 C. 30 D. 40
B Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 L/day of filtrate.
A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? A) Monitor the client for signs of electrolyte and water imbalance. B) Monitor the client for an allergy to iodine contrast material. C) Assess the client's mental changes. D) Evaluate the client for periorbital edema.
B Feedback: A renal angiography procedure will be contraindicated if the client is allergic to iodine contrast material. Therefore, it is important for the nurse to monitor the client for an allergy to iodine contrast material. The nurse monitors the client for the signs of electrolyte and water imbalance, mental changes, and periorbital edema at any time regardless of the test being done.
Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys? A) Radiography B) Angiography C) Computed tomography (CT scan) D) Cystoscopy
B Feedback: Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the bladder.
The nurse is caring for a client prescribed gentamicin 110 mg every 8 hours for 10 days. Which laboratory study is anticipated to monitor medication side effects? A) Blood chemistry B) BUN and serum creatinine C) Creatinine clearance test D) Urine osmolality
B Feedback: The client who is on a therapeutic regimen of gentamicin is ordered laboratory studies of a BUN and serum creatinine to monitor for signs of nephrotoxicity related to medication therapy. Nephrotoxicity from the use of an aminoglycoside is reversible if the medication is discontinued. The other laboratory studies do not focus on nephrotoxicity.
The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client assess for an allergy to shellfish? A) Radiography B) Computed tomography with contrast C) Cystoscopy D) Bladder ultrasonography
B Feedback: The nurse is correct to assess for an allergy to shellfish most times when a contrast medium is ordered. The other options do not necessarily have a contrast medium.
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? A) Nephron B) Renal pelvis C) Parenchyma D) Glomerulus
B Feedback: The renal pelvis empties into the ureter, which carries urine to the bladder for storage. The nephron consists of the glomerulus, afferent arteriole, efferent arteriole, Bowman's capsule, distal and proximal convoluted tubules, the loop of Henle, and collecting tubule. The nephron is located in the cortex and carries out the functions of the kidney. The parenchyma is made up of the cortex and medulla.
A client who is suspected of urinary tract infection is asked to collect a 24-hour urine specimen for culture. Which of the following measures can the nurse suggest to the client that may help prevent the entire urine specimen from becoming contaminated? A) Collect the voided urine sample primarily before 5 AM. B) Refrigerate the specimen until it is taken to the laboratory. C) Use the same receptacle for voiding and defecation. D) Store the collected urine away from sunlight.
B Feedback: To prevent the entire urine specimen from becoming contaminated, the urine specimen should be refrigerated until it can be taken to the laboratory. The nurse should ask the client to use separate receptacles for voiding and defecation to prevent any part of the specimen from being lost or contaminated. Urinating and collecting the urine sample only before 5 AM and collecting and storing the urine away from sunlight will not help prevent the urine specimen from becoming contaminated.
The nurse is caring for a client after a cystoscopic examination. Following the procedure, the nurse informs the client that which effect may occur?
Blood-tinged urine
The nephrons are the functional units of the kidney, responsible for the initial formation of urine. The nurse knows that damage to the area of the kidney where the nephrons are located will affect urine formation. Identify that area. Renal papilla Renal cortex Renal medulla Renal pelvis
B. The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex.
The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? Glomerulonephritis Decreased fluid intake Increased fluid intake Diabetes insipidus
B. When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases. Disorders or conditions that cause decreased urine-specific gravity include diabetes insipidus, glomerulonephritis, and severe renal damage. Disorders that can cause increased specific gravity include diabetes, nephritis, and fluid deficit.
The nurse is caring for a patient following a cystoscopic examination. Following the procedure, the nurse informs the patient that which of the following may occur?
Blood-tinged urine
A 30-year-old male patient presents to the clinic for an employment physical. The nurse notes protein in the patient's urine. The nurse understands that transient proteinuria can be caused by which of the following? Select all that apply. a) NSAIDs b) Strenuous exercise c) Prolonged standing d) Diabetes mellitus e) Fever
B, C, E Proteinuria may be a benign finding, or it may signify serious disease. Common benign causes of transient proteinuria are fever, strenuous exercise, and prolonged standing. Causes of persistent proteinuria include glomerular diseases, malignancies, collagen diseases, diabetes, preeclampsia, hypothyroidism, heart failure, exposure to heavy metals, and use of medications, such as drugs, NSAIDs, and angiotensin-converting enzyme (ACE) inhibitors.
The nurse is performing a renal assessment on a client with prostate cancer. Which clinical manifestation suggests prostate cancer? Select all that apply. A. Palpitations B. Hesitancy C. Chills D. Dyspnea E. Nocturia
B, E
A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? chloride glucose potassium creatinine
B. Amino acids and glucose typically are reabsorbed and not excreted in the urine. The filtrate that is secreted as urine usually contains water, sodium, chloride, bicarbonate, potassium, urea, creatinine, and uric acid.
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? a) Excretory urogram b) Cystoscopy c) Intravenous pyelography d) Renal angiography
B. Cystoscopy is the visual examination of the inside of the bladder using an instrument called a cystoscope, a lighted tube with a telescopic lens. Renal angiography involves the passage of a catheter up the femoral artery into the aorta to the level of the renal vessels. Intravenous pyelography or excretory urography is a radiologic study that involves the use of a contrast medium to evaluate the kidneys' ability to excrete it.
The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition? Inner layer of epithelium Detrusor muscle Submucosal layer of connective tissue Adventitia (connective tissue)
B. The bladder wall contains four layers. The smooth muscle layer beneath the adventitia is known as the detrusor layer. When this muscle contracts, urine is released from the bladder. When the bladder is relaxed, the muscle fibers are closed and act as a sphincter.
A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? 6 hours after the urine is discarded After discarding the 8:00 am specimen With the first specimen voided after 8:00 am At 8:00 am, with or without a specimen
B. 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.
Following a voiding cystogram, the client has a nursing diagnosis of risk for infection related to the introduction of bacterial following manipulation of the urinary tract. An appropriate nursing intervention for the client is to: Strain all urine for 48 hours. Encourage high fluid intake. Monitor for hematuria. Apply moist heat to the flank area.
B. A voiding cystogram involves the insertion of a urinary catheter, which can result in the introduction of microorganism into the urinary tract. Fluid intake is encouraged to flush the urinary tract and promote removal of microorganisms. Monitoring for hematuria, applying heat, and straining urine do not address the nursing diagnosis of risk for infection.
The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness? Around the umbilicus The costovertebral angle Above the symphysis pubis The upper abdominal quadrants on the left and right side
B. The nurse is correct to assess the kidneys for tenderness at the costovertebral angle. The other options are incorrect.
The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document? Urinary incontinence Urinary urgency Urinary stasis Urinary frequency
B. The nurse would document urinary urgency. Urinary frequency is urinating more frequently than normal often times due to inadequate emptying of the bladder. Urinary incontinence is the involuntary loss of urine. Urinary stasis is a stoppage or diminution of flow.
Which assessment finding is most important in determining nursing care for a client with acute glomerulonephritis?
Blurred vision ✓
The nurse is caring for a client prescribed gentamicin 110 mg every 8 hours for 10 days. Which laboratory study is anticipated to monitor medication side effects?
BUN and serum creatinine
The nurse is caring for a client prescribed gentamicin 110 mg every 8 hours for 10 days. Which laboratory study is anticipated to monitor medication side effects?
BUN and serum creatinine the client who is on a therapeutic regimen of gentamicin is ordered laboratory studies of a BUN and serum creatinine to monitor for signs of nephrotoxicity related to medication therapy. Nephrotoxicity from the use of an aminoglycoside is reversible if the medication is discontinued. The other laboratory studies do not focus on nephrotoxicity.
Your client is having a blood urea nitrogen (BUN) test run. What do you recall from your studies that is true about BUN levels?
BUN is increased in renal disease and urinary obstruction.
To obtain information about the chief complaint and medical history of an older male client, the nurse asks the client about his medication history. Why is it important to obtain medication history from the client?
Because the medication history may indicate multiple medications administered by the client
Retention of which electrolyte is the most life-threatening effect of renal failure? A. Calcium B. Sodium C. Potassium D. Phosphorous
C
When the bladder contains 400 to 500 mL of urine, this is referred to as A. anuria. B. specific gravity. C. functional capacity. D. renal clearance.
C A marked sense of fullness and discomfort, with a strong desire to void, usually occurs when the bladder contains 400 to 500 mL of urine, referred to as the "functional capacity." Anuria is a total urine output less than 50 mL in 24 hours. Specific gravity reflects the weight of particles dissolved in the urine. Renal clearance refers to the ability of the kidneys to clear solutes from the plasma.
The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? a) Pain after voiding b) Suprapubic pain c) Costovertebal angle tenderness d) Perineal pain
C 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.
When describing the functions of the kidney to a client, which of the following would the nurse include? A. Regulation of white blood cell production B. Synthesis of vitamin K C. Control of water balance D. Secretion of enzymes
C Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins.
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? A. Decreased blood urea nitrogen (BUN) B. Increased serum albumin C. Increased serum creatinine D. Decreased potassium
C In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.
Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? a) 20% b) 40% c) 50% d) 30%
C 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.
Which of the following is the priority nursing diagnosis for the client preparing for a voiding cystourethrography? A. Risk for infection: urinary tract B. Acute pain C. Deficient knowledge: procedure D. Urinary retention
C The client needs adequate information before experiencing the procedure. Information about its purpose, the actual steps of the procedure, and the client's role during and after the procedure is essential. Appropriate nursing diagnoses following the procedure would include risk for infection: urinary tract, acute pain, and urinary retention.
To obtain information about the chief report and medical history of an older client, the nurse asks the client about any medication history. Why is obtaining a medication history important? A. It may indicate the client's general health. B. It may reflect the client's childhood and family illnesses. C. It may indicate multiple medications taken by the client. D. It may indicate drugs that should not be prescribed to the client.
C The nurse should obtain information about a client's medication history because older clients, in particular, may be taking multiple medications that may affect their renal function. The medication history in general indicates the probable risk factors of renal or urologic disorders. The medication history of an older client is not used to obtain information about the client's general health, childhood and family illnesses, or drugs that are contraindicated for use by the client.
A client undergoes renal angiography. The nurse prepares the client for the test and provides postprocedure care. Which intervention should the nurse provide to the client after renal angiography? A. Encourage the client to void B. Monitor the client for signs and symptoms of pyelonephritis C. Palpate the pulses in the legs and feet D. Assess for signs of electrolyte and water imbalance
C To observe for signs of arterial occlusion in a client who has undergone renal angiography, the nurse should palpate the pulses in the legs and feet. While preparing the client for renal angiography, the nurse asks the client to void. The nurse assesses for signs of electrolyte and water imbalances during the physical examination of a client. The nurse should monitor for signs and symptoms of pyelonephritis in a client who has undergone retrograde pyelography.
A client undergoes renal angiography. Which postprocedure care intervention should the nurse provide to the client? A. Encourage the client to void. B. Monitor the client for signs and symptoms of pyelonephritis. C. Palpate the pulses in the legs and feet. D. Assess for signs of electrolyte and water imbalances.
C To observe for signs of arterial occlusion in a client who has undergone renal angiography, the nurse should palpate the pulses in the legs and feet. While preparing the client for renal angiography, the nurse asks the client to void. The nurse assesses for signs of electrolyte and water imbalances during the physical examination of a client. The nurse should monitor for signs and symptoms of pyelonephritis in a client who has undergone retrograde pyelography.
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: A. oliguria. B. polyuria. C. anuria. D. hematuria.
C 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.
The nurse recognizes that a referral for genetic counseling is inappropriate for the client with: A. Alport syndrome B. Polycystic kidney disease C. Renal calculi D. Wilms' tumor
C Wilms' tumor, polycystic disease, and Alport are conditions that have a genetic influence. Renal calculi are not influenced by genetic factors.
The nurse is completing a full exam of the renal system. Which assessment finding best documents the need to offer the use of the bathroom? A) Tenderness over the kidneys B) Bruits noted over the abdominal area C) A dull sound when percussing over the bladder D) The ingestion of 8 oz of water
C Feedback: 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.
The nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client's symptoms and urine specific gravity is anticipated? A) The specific gravity will be inversely proportional. B) The specific gravity will equal to one. C) The specific gravity will be high. D) The specific gravity will be low.
C Feedback: The nurse assesses all of the data to make an informed decision on client status. On a hot day, the client found outside will be perspiring. When dehydration occurs, a client will have low urine output and increased specific gravity of urine. Normal specific gravity is inversely proportional. The density of distilled water is one. A low specific gravity is noted in a client with high fluid intake and who is not losing systemic fluid.
The nurse has received morning lab work on a client with chronic renal disease. Which finding indicates renal disease? A) Urine pH of 6.5 B) Urine nitrate: negative C) Protein level of 400 mg/dL D) Specific gravity: 1.002
C Feedback: The nurse must analyze components of a urinalysis to determine abnormal results. Protein at a level of 400 mg/dL is high and indicates renal disease. The other results are normal.
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? A) Bladder B) Urethra C) Ureters D) Pelvic floor muscles
C Feedback: 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.
The nurse is reviewing urine tests to obtain client baseline information. Which of the following urine tests is preferred to identify characteristics of normal and abnormal urine? A) A 24-hour urine kept in the bathroom on ice B) A catheterized specimen obtained at no particular time C) A clean-catch midstream specimen from the first voiding of the morning D) A specimen obtained from an indwelling Foley catheter's bag
C Feedback: When obtaining urine for baseline information, the preferred test is a clean-catch midstream specimen obtained from the first voiding of the morning. Specialized testing is not done until a baseline test is completed to identify abnormal readings. It is best to obtain data from the least invasive method. Specimens from a Foley catheter are obtained from the port not from the bag.
The nurse is encouraging the client with recurrent urinary tract infections to increase his fluid intake to 8 large glasses of fluids daily. The client states he frequently drinks water and all of the following. Which of the following would the nurse discourage for this client?
Coffee in the morning ✓
As the nurse comes from morning report, the nurse is instructed to use a bladder scanner on a client following a client's attempt at urination. The client is able to void 300 mL. The client denies any pain on urination. The nurse scans 250 mL of remaining urine in the bladder. Which entry is most correct when documenting the intervention?
Client voided 300 mL with 250 mL residual volume ✓
A female client who is diagnosed with a malignant tumor in her bladder is advised to undergo cystectomy followed by a urinary diversion procedure. Which of the following would be most important for the nurse to assess preoperatively?
Client's manual dexterity and vision ✓
When describing the functions of the kidney to a client, which of the following would the nurse include? Select all that apply. A. Regulation of white blood cell production B. Synthesis of vitamin K C. Control of water balance D. Secretion of the enzyme renin
C, D Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins. They also produce the enzyme renin.
The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable?
Clients have chronic renal failure. ✓
When describing the functions of the kidney to a client, which of the following would the nurse include? A) Regulation of white blood cell production B) Synthesis of vitamin K C) Control of water balance D) Secretion of the enzyme renin
C, D Feedback: Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins. They also produce the enzyme renin.
During the physical examination of a client, the nurse monitors for signs that may indicate a urinary tract disorder. Which of the following would suggest that the client may have a urinary tract disorder? A) Light-headedness B) Malaise C) Periorbital edema D) Flank pain
C, D Feedback: Periorbital edema, among other signs, such as edema of the extremities, cardiac failure, and mental changes may indicate a urinary tract disorder. Light-headedness and flank pain may suggest urinary bleeding. Malaise is a sign of systemic infection. Flank pain and malaise could occur after a biopsy, and if they occur, the physician is to be notified immediately.
The nurse is caring for a client with oliguria. When instructing the client on the process of urine formation, place the following in correct sequence. Use all options. A) Products enter the Bowman's capsule B) Drains from the collecting tubules C) Filtration of plasma by glomerulus D) Moves through the nephrons and is absorbed or excreted E) Flows into the renal pelvis and down the ureter F) Drains into the bladder then out the urethra
C,A,D,B,E,F ✓
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? Provide analgesics to the client. Distract the client's attention from the pain. Assess the patient's back and shoulder areas for signs of internal bleeding. Enable the client to sit up and ambulate.
C.
The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure? Vasopressin Cortisol Renin Albumin
C. 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).
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." "You may resume consuming caffeinated, carbonated, and alcoholic beverages." "Contact the primary provider if you experience fever, chills, or lower back pain." "You can stop taking the prescribed antibiotic."
C. 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 health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator? Uric acid level Blood urea nitrogen (BUN) Creatinine clearance level BUN to creatinine ratio
C. The creatinine clearance measures the volume of blood cleared of endogenous creatinine in 1 minute. This serves as a measure of the glomerular filtration rate. Therefore the creatinine clearance test is a sensitive indicator of renal disease progression.
Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? a) 10 b) 30 c) 20 d) 40
C. Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 liters per day of filtrate.
A client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. What postprocedural assessment will the nurse perform on the client? Palpate pedal pulses. Monitor site condition. All options are correct. Monitor hypersensitivity response.
C. After the procedure, the physician applies a pressure dressing to the femoral area, which remains in place for several hours. The nurse palpates the pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Monitoring the pressure dressing is important to note frank bleeding or hematoma formation. If either condition occurs, the nurse immediately notifies the physician. Another important assessment is for hypersensitivity responses to contrast material. The client remains on bed rest for 4 to 8 hours. The nurse also monitors and documents intake and output.
-Which of the following hormones is secreted by the juxtaglomerular apparatus? Calcitonin Antidiuretic hormone (ADH) Renin Aldosterone
C. Renin is a hormone directly involved in the control of arterial blood pressure; it is essential for proper functioning of the glomerulus. ADH, also known as vasopressin, plays a key role in the regulation of extracellular fluid by excreting or retaining water. Calcitonin regulates calcium and phosphorous metabolism.
The nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client's symptoms and urine specific gravity is anticipated? The specific gravity will be low The specific gravity will equal to one The specific gravity will be high. The specific gravity will be inversely proportional
C. The nurse assesses all of the data to make an informed decision on client status. On a hot day, the client found outside will be perspiring. When dehydration occurs, a client will have low urine output and increased specific gravity of urine. Normal specific gravity is inversely proportional. The density of distilled water is one. A low specific gravity is noted in a client with high fluid intake and who is not losing systemic fluid.
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? Urethra Bladder Ureters Pelvic floor muscles
C. 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.
The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client assess for an allergy to shellfish?
CT with contrast ✓
The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important?
Catheterize the client immediately after the client voids.
The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important?
Catheterize the client immediately after the client voids. ✓
When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?
Check for thrill or bruit over the access site.
When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?
Check for thrill or bruit over the access site. ✓
A 24-year-old patient was admitted to the emergency room after a water skiing accident. The X-rays revealed two fractured vertebrae, T-12 and L1. Based on this information, the nurse would know to perform which of the following actions?
Check the patient's urine for hematuria.
The nurse is caring for a client with a history of sickle cell anemia. The nurse understands that this predisposes the client to which renal or urologic disorder?
Chronic kidney disease
As the nurse comes from morning report, the nurse is instructed to use a bladder scanner on a client following a client's attempt at urination. The client is able to void 300 mL. The client denies any pain on urination. The nurse scans 250 mL of remaining urine in the bladder. Which entry is most correct when documenting the intervention?
Client voided 300 mL with 250 mL residual volume
A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication?
Decrease in the blood flow through the kidneys
The nurse is caring for a patient with a medical history of sickle cell anemia. The nurse understands this predisposes the patient to which of the following possible renal or urologic disorders? a) Kidney stone formation b) Neurogenic bladder c) Proteinuria d) Chronic kidney disease
D A medical history of sickle cell anemia predisposes the patient to the development of chronic kidney disease. The other disorders are not associated with the development of sickle cell anemia.
A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication?
Decrease in the blood flow through the kidneys ✓
The nurse is caring for clients at a long-term care facility. When considering activities in the summer heat, which physiologic change of renal aging can also result in geriatric dehydration?
Decreased ability to concentrate urine ✓
The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition?
Decreased fluid intake
The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which of the following?
Decreased fluid intake
The health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator?
Creatinine clearance level
A 48 year old client is undergoing testing to confirm kidney disease. which test uses a collected urine specimen to indicate glomerular filtration rate and renal insufficiency?
Creatinine clearance test
The nurse is caring for a client who has a urinary diversion in which the ureters are brought to the abdominal wall as a stoma. This is known as what type of diversion?
Cutaneous ureterostomy
Urodynamic studies evaluate bladder and urethral function and are performed to assess causes of reduced urine flow, urinary retention, and urinary incontinence. Of the following tests, which is the urodynamic study that evaluates the bladder tone and capacity?
Cystometrography
Which value represents a normal BUN-to-creatinine ratio? A. 4:1 B. 6:1 C. 8:1 D. 10:1
D
A creatinine clearance test is ordered for a client with possible renal insufficiency. The nurse must collect which serum concentration midway through the 24-hour urine collection?
Creatinine
A creatinine clearance test is ordered for a patient with possible renal insufficiency. It is necessary for the nurse to collect which of the following serum levels midway through the 24-hour urine collection?
Creatinine
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?
Creatinine clearance
Which of the following does the nurse recognize is the best clinical measure of renal function?
Creatinine clearance
Which value does the nurse recognize as the best clinical measure of renal function?
Creatinine clearance
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?
Creatinine clearance level
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: A. Administer prescribed antibiotics. B. Monitor for urinary retention. C. Apply moist heat to the flank area. D. Assist with warm sitz baths.
D 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.
The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable? A. Clients have frequent urinary tract infections. B. Clients develop a neurogenic bladder. C. Clients have urinary frequency. D. Clients have chronic renal failure.
D Although all of the options may occur in the client with diabetes mellitus, the option which is most notable, and potentially life threatening, is chronic renal failure.
A male client, scheduled for a renal angiography, expresses his fear and anxiety to the nurse about the use of intravenous contrast medium substances in the test. Which of the following would be most appropriate for the nurse to do to help him overcome his apprehension? A. Distract the client's attention from the test. B. Discuss the client's anxiety with the physician. C. Arrange for a radioactive expert to have a talk with the client. D. Offer assurance about the safety of contrast media substances.
D Because the client is anxious about the use of intravenous contrast media for a renal angiography, the nurse should offer him assurance about the safety of these substances which are iodine based. The nurse can do this by confirming that the substances are safe and ordinarily pose no danger to the client or others. The test would be contraindicated if the client had an allergy to iodine or seafood. It is not necessary to discuss the client's anxiety with the physician or ask an expert to talk with the client. More important than the technical details, the client requires assurance and comforting words about the test experience that will help him gain confidence.
Which value does the nurse recognize as the best clinical measure of renal function? Volume of urine output Circulating ADH concentration Urine-specific gravity Creatinine clearance
D 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.
The term used to describe painful or difficult urination is which of the following? a) Oliguria b) Anuria c) Nocturia d) Dysuria
D Dysuria refers to painful or difficult urination. Oliguria is urine output less than 0.5 mL/kg/hr. Anuria is used to describe total urine output of less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate.
The nurse analyzes a urinalysis report. He is aware that the presence of this substance in the urine indicates a blood level that exceeds the kidney's reabsorption capacity. Select the substance. A. Sodium B. Bicarbonate C. Creatinine D. Glucose
D Glucose is usually filtered at the level of the glomerulus. It does not normally appear in the urine. Renal glycosuria occurs if the glucose in the blood exceeds the amount that is able to be reabsorbed. The other substances are normally excreted in the urine.
Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? A. 20% B. 30% C. 40% D. 50%
D 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) concentrations.
The nurse is caring for clients on a medical urinary unit. Which client, scheduled for a urinary procedure, will be prescribed antibiotics following the procedure? A) The client scheduled for a voiding cystourethrography B) The client scheduled for a cystoscopy C) The client scheduled for a retrograde pyelography D) The client scheduled for a cystometrography
D Feedback: A cystometrography evaluates bladder tone and capacity. Because solution is instilled into the client's bladder, antibiotics may be prescribed for a day or two. The other options do not regularly have antibiotics prescribed.
The nurse caring for a client is providing instructions for an upcoming renal angiography. Which nursing action, explained in the preoperative instructions, is essential in the postprocedure period? A) Encourage voiding following the procedure. B) Assess renal blood work. C) Assess cognitive status. D) Complete a pulse assessment of the legs and feet.
D Feedback: A renal angiography provides details about the arterial blood supply to the kidney. A catheter is passed up the femoral artery into the aorta in the area of the renal artery. After the procedure, a pressure dressing remains in place for several hours. It is essential that the nurse palpates pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Reviewing lab work is completed in the preoperative period. Voiding assesses renal status that provides additional data in the postprocedural period. Assessing cognitive status is completed due to the sedative that is administered in the preprocedural period.
The nurse is caring for a client who has a history of urine reflux. To assess the client for this urinary complication, which nursing action is best? A) Ask the client if voiding sufficient quantities has been a problem. B) Monitor the client's intake and output for inconsistency. C) Have the client void into a collection device. D) Palpate the client's bladder for distension.
D Feedback: Normally, urine flows in one direction because of peristaltic action and because the ureters enter the bladder at an oblique angle. The reflux of urine (urine that flows backward) can occur secondary to a distended bladder. By palpating for bladder distension, the nurse is able to determine that reflux urine traveled back to the bladder instead of traveling from the bladder down the urethra. All of the other options provide data that can be helpful, but actually feeling for the distension is best. Using a bladder scanner would also provide an amount of urine in the bladder.
A geriatric nurse is performing an assessment of body systems on an 85-year-old client. The nurse should be aware of what age-related change affecting the renal or urinary system?
Decreased glomerular filtration rate
A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse? Distract the patient's attention from the pain. Enable the patient to sit up and ambulate. Provide analgesics to the patient. Assess the patient's back and shoulder areas for signs of internal bleeding.
D. 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.
A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? Obstruction of the lower urinary tract Nephrotic syndrome Acute renal failure Infection
D. 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 nurse is caring for a client after a cystoscopic examination. Following the procedure, the nurse informs the client that which effect may occur? Severe abdominal pain Diarrhea Nausea and emesis Blood-tinged urine
D. Postprocedural management is directed at relieving any discomfort resulting from the examination. Some burning upon voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected. Moist heat to the lower abdomen and warm Sitz baths are helpful in relieving pain and relaxing the muscles. Not eating and diarrhea are not expected following a cystoscopic examination. The client should not experience severe abdominal pain.
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? Dehydration Infection Allergic reaction Bleeding
D. Renal biopsy carries the risk of post procedure 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.
Retention of which electrolyte is the most life-threatening effect of renal failure? Phosphorous Calcium Sodium Potassium
D. Retention of potassium is the most life-threatening effect of renal failure.
Which nursing assessment finding indicates the client has not met expected outcomes? a) The client consumes 75% of lunch following an intravenous pyelogram. b) The client has blood-tinged urine following brush biopsy. c) The client reports a pain rating of 3 two hours post-kidney biopsy. d) The client voids 75 cc four hours post cystoscopy.
D. 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.
When fluid intake is normal, the specific gravity of urine should be: 1.000 Less than 1.010 Greater than 1.025 1.010 to 1.025
D. Urine-specific gravity is a measurement of the kidneys' ability to concentrate urine. The specific gravity of water is 1.000. A urine-specific gravity less than 1.010 may indicate inadequate fluid intake. A urine-specific gravity greater than 1.025 may indicate overhydration.
The term used to describe total urine output less than 0.5 mL/kg/hr is anuria. dysuria. nocturia. oliguria.
D. Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Dysuria refers to painful or difficult urination.
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Which is an example of how urine concentration is affected? A. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity may vary widely. B. 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. C. On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. D. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity.
D. 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 patient is scheduled for a test with contrast to determine kidney function. What statement made by the patient should the nurse inform the physician about prior to testing? "I don't like needles." "I take medication to help me sleep at night." "I have had a test similar to this one in the past." "I am allergic to shrimp."
D. The nurse should obtain the patient's allergy history with emphasis on allergy to iodine, shellfish, and other seafood, because many contrast agents contain iodine.
The nurse is instructing a 3-year-old's mother regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as a normal finding for this age group? Hematuria Anuria Dysuria Enuresis
D. The nurse would be most correct to document that enuresis, the involuntary voiding during sleep or commonly called "wetting the bed," is a normal finding in a pediatric client younger than 5 years old. Dysuria (pain on urination), hematuria (red blood cells in urine), and anuria (urine output less than 50 mL/day) are all abnormal findings needing further investigation.
Which of the following urine characteristics would the nurse anticipate when caring for a client whose lab work reveals a high urine specific gravity related to dehydration?
Dark yellow or orange urine ✓
The nurse notes that the client's urine is blood-tinged following cystoscopy. Which of the following nursing actions should the nurse do next?
Document the finding in the health record.
The nurse is caring for a client with cystitis. Which adjunct therapy is the nurse most correct to suggest to keep bacteria from adhering to the wall of the bladder?
Drinking cranberry juice ✓
A nurse is educating a client undergoing treatment for genitourinary tract bacterial infections on an outpatient basis. What instructions should the nurse offer the client as part of the client teaching plan?
During antibiotic treatment increase fluid intake to at least 3-4 L/day unless contraindicated.
The term used to describe painful or difficult urination is which of the following?
Dysuria
Which term describes painful or difficult urination?
Dysuria
The client with glomerulonephritis is exhibiting gross periorbital edema. Which is the best nursing intervention to relieve this symptom?
Elevate the head of the bed. ✓
Which substance stimulates the bone marrow to produce red blood cells?
Erythropoietin
A nurse, when caring for a client, notes that the specific gravity of the client's urine is low. What could have lead to the low specific gravity of urine?
Excess fluid intake
A nurse, when caring for a client, notes that the specific gravity of the client's urine is low. What could have led to the low specific gravity of urine?
Excess fluid intake
In starting your new job as a nurse with a group of renal specialists, you begin your orientation with a thorough review of renal function. Although the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which of the following is NOT a function of the kidneys?
Excreting protein
In starting your new job as a nurse with a group of renal specialists, you begin your orientation with a thorough review of renal function. While the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which of the following is NOT a function of the kidneys?
Excreting protein
An older adult male client is participating in a bladder retraining program as part of the treatment for urinary incontinence. The nurse advises him to wear barrier garments, such as liners and protective pants. Which suggestion would be most appropriate to help the client maintain skin integrity?
Exposing the affected area to air ✓
A client with chronic glomerulonephritis has generalized edema. Which response by the nurse best describes why anasarca occurs with this disorder?
Fluid shifting occurs due to loss of serum protein. ✓
When describing the adverse reactions associated with anti-infectives for UTIs, which of the following would the nurse explain as being most common?
Gastrointestinal
A 42-year-old client is being seen by a urologist in the group where you practice nursing. She is experiencing some secretion abnormalities, for which diagnostics are being performed. Which of the following substances are typically reabsorbed and not secreted in urine?
Glucose
A 42-year-old client is being seen by an urologist in the group where you practice nursing. She is experiencing some secretion abnormalities, for which diagnostics are being performed. Which of the following substances are typically reabsorbed and not secreted in urine?
Glucose
The nurse analyzes a urinalysis report. He is aware that the presence of this substance in the urine indicates a blood level that exceeds the kidney's reabsorption capacity. Select the substance.
Glucose
The nurse is caring for a client suspected of having renal dysfunction. When reviewing laboratory results for this client, the nurse interprets the presence of which substances in the urine as most suggestive of pathology?
Glucose and protein
The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient the nurse recalls that several substances are filtered from the blood by the glomerulus and these substances are then excreted in the urine. The nurse identifies the presence of which substances in the urine as abnormal findings?
Glucose and protein
The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, the nurse interprets the presence of which substances in the urine as most suggestive of pathology?
Glucose and protein
A client with a history of incontinence will undergo urodynamic testing in the health care provider's office. Because voiding in the presence of others can cause situational anxiety, the nurse should perform what action?
Help the client to relax before and during the test.
A client is scheduled for cystoscopy to determine which of her kidneys is diseased. Which should the nurse consider when caring for this client?
Help the client with sitz baths to ease voiding
A patient with a history of incontinence will undergo urodynamic testing in the physicians office. Because voiding in the presence of others can cause situational anxiety, the nurse should perform what action?
Help the patient to relax before and during the test.
The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder?
Hematuria
A patient with a history of progressively worsening fatigue is undergoing a comprehensive assessment which includes test of renal function relating to erythropoiesis. When assessing the oxygen transport ability of the blood, the nurse should prioritize the review of what blood value?
Hemoglobin
Regulation of electrolyte balance is a management goal for patients suffering from renal disease. Which of the following lab results is considered the most life-threatening effect of renal failure?
Hyperkalemia
A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values?
Hyperkalemia ✓
A chronic renal failure client complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?
Hyperphosphatemia ✓
A client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. What postprocedural assessment will the nurse perform on the client?
Hypersensitivity response Monitor site condition. Palpate pedal pulses.
A nurse knows that specific areas in the ureters have a propensity for obstruction. Prompt management of renal calculi is most important when the stone is located where?
In the ureteropelvic junction
The nurse is assessing a patient's bladder by percussion. The nurse elicits dullness after voiding. What does this finding indicate?
Incomplete bladder emptying
A 76-year-old client is visiting the urologist because of an increasingly troublesome need to urinate several times through the night. After checking his prostate (which was within normal limits), the physician prescribes limiting fluid intake after the evening meal. What is another important intervention to keep the client safe?
Increase fluid intake throughout the day.
A nurse is working with a client who will undergo invasive urologic testing. The nurse has informed the client that slight hematuria may occur after the testing is complete. The nurse should recommend what action to help resolve hematuria?
Increased fluid intake following the test
A nurse is working with a patient who will undergo invasive urologic testing. The nurse has informed the patient that slight hematuria may occur after the testing is complete. The nurse should recommend what action to help resolve hematuria?
Increased fluid intake following the test
The nurse is providing pre-procedure teaching about an ultrasound. The nurse informs the patient that in preparation for an ultrasound of the lower urinary tract the patient will require what?
Increased fluid intake to produce a full bladder
A client is administered dialysate solution through an abdominal catheter. The nurse notices that the return flow rate is slow, so the nurse advises the client to move to the other side. However, even after changing the client's position, the nurse does not observe an increase in return flow. Which of the following actions should the nurse perform to help accelerate the return flow rate?
Inform the physician that catheter may need repositioning. ✓
The nurse is caring for a male client who has a significant urinary narrowing secondary to an enlarged prostate. Which nursing action is best to relieve his urinary retention?
Insert a coudé catheter to remove urine from the bladder. ✓
A nurse is caring for a female client with recurrent urinary tract infection (UTI). What intervention should the nurse implement with this client?
Instruct the client to void before and after intercourse
The nurse observes that the client's urine is orange. Which additional assessment would be important for this client?
Intake of medication such as phenytoin
The nurse observes the patient's urine to be orange. Which additional assessment would be important for this patient?
Intake of medication such as phenytoin (Dilantin)
To obtain information about the chief report and medical history of an older client, the nurse asks the client about any medication history. Why is obtaining a medication history important?
It may indicate multiple medications taken by the client.
A 54-year-old machinist is being seen by a physician within the urology group where you practice nursing. He has been experiencing severe pain and hematuria, hardly able to ambulate into the physician's office. The physician orders diagnostic tests to confirm his suspicion of kidney stones. What test would you expect the physician to order?
KUB
A 37 year old male client presents at the emergency department reporting excruciating pain that comes in waves, along with nausea, vomiting, and chills. The nurse suspects the client has kidney stones. What test would be ordered to confirm or rule out this condition?
KUB flat plate of the abdomen
The nurse is caring for a client who is going to have an open renal biopsy. What nursing action should the nurse prioritize when preparing this client for the procedure?
Keep the client NPO prior to the procedure.
A 32 year old female client has come to your clinic with a complaint of hematuria, or the presence of red blood cells in the urine. Of the following, which is not a cause of hematuria?
Lithium toxicity
The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following?
Location of discomfort ✓
Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?
Low purine
A nephrostomy tube is inserted in a client with a large ureteral calculus. Which is the most important consideration in providing nursing care for this client?
Maintain free, continuous urine drainage. ✓
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?
Maintain the client on bed rest ✓
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. ✓
Which is an effect of aging on upper and lower urinary tract function?
More prone to develop hypernatremia
When teaching a client about a diagnostic procedure, which teaching philosophy provides the best manner to present the information to the client?
Move from general details of the procedure to specifics. ✓
The licensed practical nurse is employed as a charge nurse at a long-term care facility. A resident is ordered a catheterization schedule of every 6 hours due to chronic urinary retention. The LPN reports daily catheterization amounts from the previous day ranging from 450 to 800 mL. Which nursing action is most correct?
Obtain an order to increase the frequency of the catheterizations. ✓
The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated?
Obtaining a blood pressure reading from the right arm
Which problem with voiding is described by urine output of <400ml/day?
Oliguria
Which term best describes a total urine output less than 500 mL in 24 hours?
Oliguria
Which term best describes a total urine output of less than 500 mL in 24 hours?
Oliguria
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Select the correct example of how urine concentration is affected from among the following statements.
On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity.
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with 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 low urine output with a high specific gravity.
The nurse is assisting the physician in completing a cystoscopy. In which position would the nurse place the client when preparing for the procedure?
On the client's back with feet in the stirrups ✓
The office nurse is providing information to a client who has experienced recurrent renal calculi. Which of the following jobs would place a client at greatest risk for calculi formation?
Over-the-road truck driver ✓
A patient is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all that apply.
Pain Gastrointestinal symptoms Changes in voiding
You are caring for a patient with renal dysfunction. The patient tells you that the pain in their right flank has gotten worse. Why would you notify the physician of the increased pain?
Pain may indicate progression or recurrence of dysfunction, or untoward signs.
A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom?
Painless hematuria
The nurse is caring for a client who has a history of urine reflux. To assess the client for this urinary complication, which nursing action is best?
Palpate the client's bladder for distension. ✓
The nurse is caring for a client who has a history of urine reflux. To assess the client for this urinary complication, which nursing action is best?
Palpate the clients bladder for distension.
A client undergoes renal angiography. The nurse prepares the client for the test and provides postprocedure care. Which intervention should the nurse provide to the client after renal angiography?
Palpate the pulses in the legs and feet
A male patient undergoes a renal angiogram. The nurse prepares the patient for the test and provides postprocedure care to the patient. Which of the following postprocedure care interventions should the nurse provide to the patient who has already undergone a renal angiogram?
Palpate the pulses in the legs and feet
The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client?
Permanent drainage with a urethral catheter ✓
The nurse is preparing a client for cystoscope. What is the meaning of the prefix "cysto"?
Pertaining to the bladder
A client with a UTI is experiencing dysuria. The nurse would expect which of the following to be prescribed?
Phenazopyridine
Retention of which electrolyte is the most life-threatening effect of renal failure?
Potassium
A 30-year-old client presents to the clinic for an employment physical. The nurse notes protein in the client's urine. The nurse understands that transient proteinuria can be caused by which factor(s)? Select all that apply.
Prolonged standing Fever Strenuous exercise
The nurse has received morning lab work on a client with chronic renal disease. Which finding indicates renal disease?
Protein level of 400 mg/dL ✓
Which nursing action is best to comfort the client prior to urologic testing?
Provide for privacy and allow verbalization of concerns. ✓
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
The nurse is caring for a patient complaining of orange-colored urine. The nurse suspects which of the following as the cause of the urine discoloration?
Pyridium (phenazopyridium HCl)
A patient with elevated BUN and creatinine values has been referred by her primary physician for further evaluation. The nurse should anticipate the use of what initial diagnostic test?
Ultrasound
A client with recurrent urinary tract infections has just undergone a cystoscopy and reports slight hematuria during the first void after the procedure. What is the nurse's most appropriate action?
Reassure the client that this is not unexpected and then monitor the client for further bleeding.
A patient with recurrent urinary tract infections has just undergone a cystoscopy and complains of slight hematuria during the first void after the procedure. What is the nurses most appropriate action?
Reassure the patient that this is not unexpected and then monitor the patient for further bleeding.
A client who is suspected of urinary tract infection is asked to collect a 24 hour urine specimen for culture. Which of the following measures can the nurse suggest to the client that may help prevent the entire urine specimen from being contaminated?
Refrigerate the specimen until it is taken to the laboratory.
A client who is suspected of urinary tract infection is asked to collect a 24-hour urine specimen for culture. Which of the following measures can the nurse suggest to the client that may help prevent the entire urine specimen from becoming contaminated?
Refrigerate the specimen until it is taken to the laboratory. ✓
The nurse is instructing a senior high health class on the function of the kidney. The nurse is correct to highlight which information? Select all that apply.
Regulate calcium and the synthesis of vitamin D ✓ Activates growth hormone ✓ Regulates red blood cell production ✓ Controls blood pressure ✓ Excretes waste products ✓
A patient is scheduled for a diagnostic MRI of the lower urinary system. What pre-procedure education should the nurse include?
Relaxation techniques to apply during the test
A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult?
Remember to drink frequently, even if you dont feel thirsty.
Which of the following is an age-related change associated with the renal system?
Renal arteries thicken
A 32-year-old flight attendant is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure. The client asks what the angiography will reveal. What is your response as her nurse?
Renal circulation
A 32-year-old flight attendant is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure. The client asks what the angiography will reveal. What is your response, as her nurse?
Renal circulation
Which is the correct term for the ability of the kidneys to clear solutes from the plasma?
Renal clearance
The nephrons are the functional units of the kidney, responsible for the initial formation of urine. The nurse knows that damage to the area of the kidney where the nephrons are located will affect urine formation. Identify that area.
Renal cortex
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?
Renal pelvis
A patient has experienced excessive losses of bicarbonate and has subsequently developed an acidbase imbalance. How will this lost bicarbonate be replaced?
Renal tubular cells will generate new bicarbonate.
The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure?
Renin
The nurse is caring for a patient with a nursing diagnosis of deficient fluid volume. The nurse's assessment reveals a BP of 98/52 mm Hg. The nurse should recognize that the patient's kidneys will compensate by secreting what substance?
Renin
The nurse evaluates the client as experiencing symptoms of disequilibrium syndrome, following an initial hemodialysis treatment. Which is the best action to be taken by the nurse?
Slow the dialysis process during future treatment. ✓
A child is brought into the clinic with symptoms of periorbital edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem?
Sore throat 2 weeks ago ✓
Following a nephrectomy, which assessment finding is most important in determining nursing care for the client?
SpO2 at 90% with fine crackles in the lung bases ✓
The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is:
Specific gravity 1.035
The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply.
Specific gravity of the patients urine Testing for the presence of glucose in the patients urine Microscopic examination of urine sediment for RBCs Microscopic examination of urine sediment for casts
Which is a function of the lower urinary tract?
Store urine until micturition occurs.
A nurse is caring for a client with renal calculi. What measure should the nurse employ for this client?
Strain all urine through a piece of gauze, cheesecloth, or strainer.
The nurse is caring for a client diagnosed with bladder stones. The client is scheduled for a litholapaxy. Which nursing action is most important to complete prior to the procedure?
Strain all urine ✓
A nurse is caring for a client experiencing urge incontinence. What should the nurse include in the client education?
Tell the client to preform Kegel exercises daily.
The nurse is caring for a patient who had a brush biopsy 12 hours ago. The presence of what assessment finding should prompt the nurse to notify the physician?
Temperature 100.2F orally
The nurse is caring for a client who had a brush biopsy 12 hours ago. The presence of what assessment finding should prompt the nurse to notify the physician?
Temperature 37.9°C (100.2°F) orally
The nurse is caring for a client who is following a treatment plan to decrease urinary tract infections. Which of the following indicates the need to change the treatment plan?
The client exhibits continued symptoms. ✓
The nurse is caring for four clients on a urinary medical unit. For which client does the nurse need no further medical interventions?
The client has a residual urine of 90 mL on a bedside ultrasound bladder scan. ✓
The nurse is caring for clients on a medical urinary unit. Which client, scheduled for a urinary procedure, will be prescribed antibiotics following the procedure?
The client scheduled for a cystometrography ✓
You are reviewing the guidelines for the care of clients undergoing intravenous or retrograde pyelography. All of the following are guidelines for postprocedural and discharge care except one. Choose the incorrect choice.
The client should limit fluid intake for 24 hours.
The nurse is obtaining a history on a client stating nocturia. When evaluating the client's evening behaviors, which may be the cause of the problem?
The client takes a furosemide (Lasix) with the evening medications.
The nurse is obtaining a history on a client stating nocturia. When evaluating the client's evening behaviors, which may be the cause of the problem?
The client takes a furosemide with the evening medications. ✓
Which nursing assessment finding indicates the client has not met expected outcomes?
The client voids 75 cc four hours post cystoscopy.
The nurse is caring for several clients on a urinary medical unit. Which client is at an increased risk for bladder stones?
The client who is paraplegic ✓
The nurse is completing a plan of care for a client with chronic urinary incontinence. Which of the following outcomes is a priority?
The client will maintain perineal skin integrity. ✓
The nurse is assessing a client's bladder by percussion. The nurse elicits dullness after the client has voided. How should the nurse interpret this assessment finding?
The client's bladder is not completely empty.
The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness?
The costovertebral angle ✓
The nurse is assisting in the transport of a client with an indwelling catheter to the diagnostic studies unit. Which action made by the nursing assistant would require instruction?
The nursing assistant places the drainage bag on the client's abdomen for transport.
The nurse is assisting in the transport of a client with an indwelling catheter to the diagnostic studies unit. Which action, made by the nursing assistant, would require instruction?
The nursing assistant places the drainage bag on the client's abdomen for transport. ✓
A patient's most recent laboratory findings indicate a glomerular filtration rate (GFR) of 58 mL/min. The nurse should recognize what implication of this diagnostic finding?
The patient is likely to have increased serum creatinine levels.
A patients most recent laboratory findings indicate a glomerular filtration rate (GFR) of 58 mL/min. The nurse should recognize what implication of this diagnostic finding?
The patient is likely to have increased serum creatinine levels.
The nurse is educating a patient about preparation for an IV urography. What should the nurse be sure to include in the preparation instructions?
The patient may have liquids before the test.
The nurse is assessing a patients bladder by percussion. The nurse elicits dullness after the patient has voided. How should the nurse interpret this assessment finding?
The patients bladder is not completely empty.
Results of a patients 24-hour urine sample indicate osmolality of 510 mOsm/kg, which is within reference range. What conclusion can the nurse draw from this assessment finding?
The patients kidneys can produce sufficiently concentrated urine.
A patient asks the nurse why kidney problems can cause gastrointestinal disturbances. What relationship should the nurse describe?
The right kidneys proximity to the pancreas, liver, and gallbladder
The nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client's symptoms and urine specific gravity is anticipated?
The specific gravity will be high. ✓
A client with several calculi in the ureter is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which teaching statement by the nurse best describes the procedure?
The stone is identified via fluoroscopy and then shock waves are used to shatter the stones. ✓
The nurse is caring for a client with a urinary tract infection and a urethral stricture. Which complication of the condition is the primary cause of infection?
There is a backflow of urine causing a diverticulum. ✓
Dipstick testing of an older adult patients urine indicates the presence of protein. Which of the following statements is true of this assessment finding? Select all that apply.
This finding is a risk factor for urinary incontinence. This finding is likely the result of an age-related physiologic change. This result confirms that the patient has diabetes.
The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse?
Turn the client from side to side.
The nurse is reviewing the client's lab results. Which lab result requires follow up by the nurse? Select all that apply.
Urine: RBC 20 BUN 28 mg/dL Hematuria (> 3RBCs) and an elevated BUN are both suggestive of a problem within the genitourinary tract. A serum creatinine of 0.8 mg/dL and a urine specific gravity of 1.020 are within normal limits. A rare white blood cell is not clinically significant.
The nurse is preparing a client for urodynamic tests. Which component of this series is a noninvasive assessment of the status of micturition and generally the first test done in a urodynamic evaluation?
Uroflowmetry
A nurse is caring for a client with an ileal conduit for urinary diversion following bladder removal. What intervention should the nurse be prepared to implement when caring for this client?
Use a solvent to loosen the appliance during removal
The nurse is caring for a client who has chronic urinary retention and discussing the options. When discussing care, which intervention is considered first?
Using the Credé's maneuver ✓
A client has been asked to provide a clean-catch midstream urine specimen. It is important that the instructions are clear and that things are done in the proper order. Select the proper sequence of events for obtaining a specimen from a client.
Wash hands and remove the lid from the specimen container without touching the inside of the lid. Open the antiseptic towelette package and cleanse the urethral area. Begin voiding into the toilet. Void 30 to 50 mL of the midstream urine into the collection container, taking care not to contaminate the container. Carefully replace the lid, dry the container if necessary, and wash hands.
The client in your clinic has been asked to bring you a clean-catch midstream urine specimen. It is important that the instructions are clear and that things are done in the proper order. Select the proper sequence of events for obtaining a specimen from a client.
Wash your hands and remove the lid from the specimen container without touching the inside of the lid. Open the antiseptic towelette package and cleanse the urethral area. Begin voiding into the toilet. Void 30 to 50 mL of the midstream urine into the toilet, taking care not to contaminate the container. Carefully replace the lid, dry the container if necessary, and wash your hands.
Which of the following is the most accurate indicator of fluid loss or gain?
Weight
The care team is considering the use of dialysis in a client whose renal function is progressively declining. Renal replacement therapy is indicated in which of the following situations?
When about 80% of the nephrons are no longer functioning
The care team is considering the use of dialysis in a patient whose renal function is progressively declining. Renal replacement therapy is indicated in which of the following situations?
When about 80% of the nephrons are no longer functioning
The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time?
With each meal
The nurse is caring for a client with chronic bladder infections and inflammation. The physician has ruled out several medical diagnoses and is considering interstitial cystitis. The nurse is most correct to anticipate which diagnostic test to confirm the disorder?
a bladder biopsy ✓
A 176-lb client with pyelonephritis has been instructed to drink at least 30 mL of water for each kilogram of body weight. The client prefers to drink bottled water and asks the nurse to calculate the number of 16-oz bottles needed to fulfill the daily intake required. Fill in the blank with the total number of 16-oz bottles of water that should be consumed each day.
a. 5 bottles b. 6 botlles ✘ c. 7 bottles d. 8 bottles NO ANSWER
A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom?
a. painless hematuria b. urinary retention ✘ c. frequency d. fever NO ANSWER
A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection?
abdominal pain ✓
When assessing a client with chronic glomerulonephritis, the nurse notes that the client has generalized edema. The nurse documents this as which of the following?
anasarca ✓
Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys?
angiography ✓
The nurse is employed in an urologist office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence?
anticholinergic ✓
The nurse is providing care to a client who has had a renal biopsy. The nurse would need to be alert for signs and symptoms of which of the following?
bleeding ✓
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:
check the client's pedal pulses frequently.
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:
confirm all of the medications and supplements normally taken.
A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 mL. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of:
microorganism transfer.
A client reports having to get up frequently to void in the night, or nocturia. What is not a probable cause of his problem?
neurogenic bladder
During the physical examination of a client, the nurse monitors for signs that may indicate a urinary tract disorder. Which of the following would suggest that the client may have a urinary tract disorder? Select all that apply.
periorbital edema ✓ edema of the extremities ✓
The nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration?
phenazopyridine hydrochloride
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.
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?
renal pelvis ✓
The nurse is caring for a client with recurrent urinary tract infections. Which of the following body structures would the nurse instruct as the most frequent cause of women's urinary tract infections?
the urethra ✓
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?
ureters ✓
A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate, I can't control it and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence?
urge ✓
A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?
urinary calculi ✓
The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document?
urinary urgency ✓
Within the urology group where you practice nursing, clients with urinary tract infections are frequently seen by physicians. In a diagnosis of a lower urinary tract infection, which structures could be affected? Choose all correct options.
• Bladder • Urethra
The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply.
• Secretion of prostaglandins • Regulation of blood pressure • Vitamin D synthesis
Within the urology group where you practice nursing, clients with urinary tract infections are frequently seen by physicians. In a diagnosis of an upper urinary tract infection, which structures could be affected? Choose all correct options.
• Ureter • Kidney
The nurse is reviewing the client's lab results. Which lab result requires follow up by the nurse? Select all that apply.
• Urine: RBC 20 • BUN 28 mg/dL
