PREP U Ch. 53

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? A. "Do you urinate while sleeping?" B. "Is it painful when you urinate?" C. "Does it burn when you urinate?" D. "Do you have strong desire to void?"

A. "Do you urinate while sleeping?" Enuresis is defined as involuntary voiding during sleep. The remaining questions do not relate to this problem associated with changes in the client's voiding pattern.

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? A. Creatinine clearance B. BUN C. Hgb D. Osmolality

A. Creatinine clearance To calculate creatinine clearance, a 24-hour urine specimen is collected. The serum creatinine concentration is measured midway through the collection. The other concentrations are not measured during this test.

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? A. 10% B. 20% C. 30% D. 40%

B. 20% 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.

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: A. Palpate the client's bladder before and after voiding B. Confirm all of the meds and supplements normally taken C. Confirm which beverages the client normally consumes D. Assess the client's usual intake of sodium

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

The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to A. Maintain bed rest for 2 hours B. Drink liberal amounts of fluid C. Carefully handle urine because it is radioactive D. Notify the HCP if bloody urine is noted

B. Drink liberal amounts of fluid 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.

When the bladder contains 400 to 500 mL of urine, this is referred to as A. Renal clearance B. Functional capacity C. Specific gravity D. Anuria

B. Functional capacity 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.

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 contrast dye C. Assess the client's mental changes D. Evaluate the client for preorbital edema

B. Monitor the client for an allergy to contrast dye 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.

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

D. "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.

A nurse is caring for a client with a fluid and electrolyte balance. What urine specific gravity would the nurse expect to measure? A. 1.028 B. 1.000 C. 1.008 D. 1.018

D. 1.008 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.

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: A. Interstitial cystitis B. An overdistended bladder C. Acute prostatitis D. Renal caliculi

D. Renal caliculi 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.

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 between 300-500 mL B. When the urine output is about 100 mL/hr C. When the urine output is between 500-1,000 mL D. When the urine output is less 30 mL/hr

Oliguria is defined as urine output <0.5 mL/kg/h

Which of the following describes awakening at night to urinate? A. Dysuria B. Nocturia C. Polyuria D. Oliguria

B. Nocturia Nocturia is awakening at night to urinate. Oliguria is a urine output of less than 400 mL in 24 hours. Polyuria is increased urine output. Dysuria is painful or difficult urination.

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? A. "Do you take multiple vitamin preparations?" B. "Do you take phenytoin daily?" C. "Have you had a recent urinary tract infections?" D. "Have you noticed any vaginal bleeding?"

A. "Do you take multiple vitamin preparations?" 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 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? A. Creatinine clearance level B. Uric acid level C. BUN level D. Serum potassium level

A. Creatinine clearance level 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 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? A. Pruritus B. Hypoventilation C. Increased alertness D. Unusually smooth skin

A. Pruritis 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.

When describing the functions of the kidney to a client, which of the following would the nurse include? Select all that apply. A. Secretion of the enzyme renin B. Control of water balance C. Synthesis of vitamin K D. Regulation of WBC production

A. Secretion of enzyme renin B. Control of water balance 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 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 costovertebral angle B. Above the symphysis pubis C. Around the umbilicus D. The upper abdominal quadrants on the left and right side

A. The costovertebral angle The nurse is correct to assess the kidneys for tenderness at the costovertebral angle. The other options are incorrect.

In a diagnosis of an upper urinary tract infection, which structures could be affected? Select all that apply. A. Ureter B. Kidney C. Urethra D. Bladder

A. Ureter B. Kidney The upper urinary tract is composed of the kidneys, renal pelvis, and ureters.

A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? A. Chloride B. Glucose C. Creatinine D. Potassium

B. Glucose 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.

The nurse is performing a renal assessment on a client with prostate cancer. Which clinical manifestation suggests prostate cancer? Select all that apply. A. Chills B. Hesistancy C. Dyspnea D. Palpitations E. Nocturia

B. Hesitancy E. Nocturia Clinical manifestations of prostate cancer include urinary hesitancy and nocturia. Palpitations, chills, and dyspnea are not suggestive of prostate cancer.

A client reports having to get up frequently to void in the night, or nocturia. What is not a probable cause of his problem? A. Heart failure B. Neurogenic bladder C. Decreased renal concentrating ability D. Diabetes mellitus

B. Neurogenic bladder Neurogenic bladder will cause a delay, or difficulty in initiating voiding, called hesitancy. Nocturia may be caused by decreased renal concentrating ability, heart failure, diabetes mellitus, incomplete bladder emptying, excessive fluid intake at bedtime, nephrotic syndrome, or cirrhosis with ascites.

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. 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 B. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity C. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity may vary widely D. On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with low specific gravity

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

A 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. Ureters C. Pelvic floor muscles D. Urethra

B. Ureters 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 most frequent reason for admission to skilled care facilities includes which of the following? A. MI B. Urinary incontinence C. Stroke D. CHF

B. Urinary incontinence Urinary incontinence is the most common reason for admission to skilled nursing facilities.

The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? A. "I should remove all jewelry before the test." B. "I should let staff know if I feel claustrophobic." C. "I will feel a warm sensation as the dye is injected." D. "I will need to drink all of the dye as quickly as possible."

C. "I will feel a warm sensation as the dye is injected." 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.

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

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

The nurse is 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. Infection B. Dehydration C. Bleeding D. Allergic reaction

C. Bleeding 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.

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? A. Place a bed board under the mattress to add support B. Apply moist heat, every 4 hours for the first 48 hours to aid in healing C. Check the patient's urine for hematuria D. Keep the patient on bed rest for 72 hours

C. Check the patient's urine for hematuria The kidneys are located from the 12th thoracic vertebrae to the third lumbar vertebrae. Therefore, the accident may have caused blunt force trauma damage to the kidneys. Ice is always applied for the first 24 hours, then heat, if not contraindicated. Activity will be restricted but bed rest is not necessary.

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

C. Decreased fluid intake 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.

A client has a full bladder. Which sound would the nurse expect to hear on percussion? A. Tympany B. Flatness C. Dullness D. Resonance

C. Dullness 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.

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. Fistula B. Neurogenic bladder C. Kidney stones D. Chronic renal failure

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

A creatinine level has been ordered. The nurse prepares to: A. Obtain a clean catch urine B. Straight cath for a specimen C. Obtain a blood specimen D. Collect client's urine for 24 hours

C. Obtain a blood specimen A creatinine level is determined from a blood sample. It is used to assess renal function.

The term used to describe total urine output less than 0.5 mL/kg/hour is A. Anuria B. Dysuria C. Oliguria D. Nocturia

C. Oliguria 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. Reference:

Which of the following hormones is secreted by the juxtaglomerular apparatus? A. ADH B. Calcitonin C. Renin D. Aldosterone

C. Renin 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 completing a full exam of the renal system. Which assessment finding best documents the need to offer the use of the bathroom? A. Bruits over the abdominal area B. The ingestion of 8 oz. of water C. Tenderness over the kidneys D. A dull sound when percussing over the bladder

D. A dull sound when percussing over the bladder 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.

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? A. Provide analgesics to the patient B. Distract the patient's attention from the pain C. Enable the patient to sit up and ambulate D. Assess the patient's back and shoulder areas for signs of internal bleeding

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

Which value does the nurse recognize as the best clinical measure of renal function? A. Urine specific gravity B. Volume of urine output C. Circulating ADH concentration D. Creatinine clearance

D. Creatinine clearance 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 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. Activity as tolerated B. Ambulate the client in the hall C. Assist the client the client for bathroom privileges D. Maintain the client on bed rest

D. Maintain the client on bed rest 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 term used to describe total urine output less than 0.5 mL/kg/hour is A. Dysuria B. Anuria C. Nocturia D. Oliguria

D. Oliguria 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.

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 pelvis B. Renal papilla C. Renal medulla D. Renal cortex

D. Renal cortex The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex.

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 reports a pain rating of 3 two hours post-kidney biopsy C. The client has blood tinged urine following brush biopsy D. The client voids 75 cc four hours post cystoscopy

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

The nurse is 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? A. Urinary incontinence B. Urinary frequency C. Urinary stasis D. Urinary urgency

D. Urinary urgency The nurse would document urinary urgency. Urinary frequency is urinating more frequently than normal often times due to inadequate emptying of the bladder.

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

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