Chapter 53: Assessment of Kidney and Urinary Function

In a diagnosis of a lower urinary tract infection, which structures could be affected? Select all that apply.

bladder urethra

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 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."

A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client?

"You don't need to do any fasting before this noninvasive test."

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?"

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:

1-2 L/day

When fluid intake is normal, the specific gravity of urine should be which of the following?

1.010 to 1.025.

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

10:1

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

Which hormone causes the kidneys to reabsorb sodium?

Aldosterone

As women age, many experience an increased sense of urgency to void, as well as an increased risk of incontinence. This is usually the result of age-related changes in which part of the renal system?

Bladder

A patient is having a problem with retention of urine in the bladder. Which of the following diagnostic tests measures the amount of residual urine in the bladder?

Bladder ultrasonography

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

Bleeding

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.

A client is having a blood urea nitrogen (BUN) test. BUN level is:

increased in renal disease and urinary obstruction.

The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition?

Detrusor muscle

A client has a full bladder. Which sound would the nurse expect to hear on percussion?

Dullness

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?

Increase fluid intake throughout the day.

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

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect?

Infection

Which is an effect of aging on upper and lower urinary tract function?

More prone to develop hypernatremia

The nurse recognizes that a referral for genetic counseling is inappropriate for the client with:

Renal calculi

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

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 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.

When the bladder contains 400 to 500 mL of urine, this is referred to as

functional capacity

Which substance stimulates the bone marrow to produce red blood cells?

Erythropoietin

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

glucose

An appropriate nursing intervention for the client following a nuclear scan of the kidney is to:

Encourage high fluid intake

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 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 client with a history of chronic renal infections is to undergo CT with contrast. Before the procedure, the nurse should complete which action?

Place emergency medical equipment in the procedure room.

Retention of which electrolyte is the most life-threatening effect of renal failure?

Potassium

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 a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to

drink liberal amounts of fluids.

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 reports having to get up frequently to void in the night, or nocturia. What is not a probable cause of his problem?

neurogenic bladder

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 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.

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

In a diagnosis of an upper urinary tract infection, which structures could be affected? Select all that apply.

ureter kidney

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:

ureteral stones

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

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.

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.

Which nursing assessment finding indicates the client with renal dysfunction has not met expected outcomes?

Client reports increasing fatigue.

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

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.

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

A creatinine clearance test has been ordered. The nurse prepares to:

Collect the client's urine for 24 hours.

When describing the functions of the kidney to a client, which of the following would the nurse include? Select all that apply.

Control of water balance Secretion of the enzyme renin

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

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 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?

Cytoscopy

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 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?

Enuresis

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

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?

Pruritits

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 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 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

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.

The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find?

Costovertebal angle tenderness

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 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.

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 aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure?

Renin

Which of the following hormones is secreted by the juxtaglomerular apparatus?

Renin

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

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.

The most frequent reason for admission to skilled care facilities includes which of the following?

Urinary incontinence

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.

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

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.