RENAL- COURSEPOINT

The nurse is caring for a client scheduled for urodynamic testing. Following the procedure, which information does the nurse provide to the client?

"Contact the primary provider if you experience fever, chills, or lower back pain."

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?"

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?"

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 normal adult bladder capacity is ______ to ______ mL of urine

400-500

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?

Acute glomerulonephritis

Regulation of sodium volume excretion depends on _____, a hormone synthesized and released from the adrenal cortex.

Aldosterone

The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence?

Anticholinergic Pharmacologic agents that can improve bladder retention, emptying, and control include anticholinergic drugs. In this classification are medications such as Detrol, Ditropan, and Urecholine.

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?

Assessing present voiding patterns

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

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?

CVA

Which objective symptom of a UTI is most common in older adults, especially those with dementia?

Change in cognitive functioning The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these clients usually exhibit even more profound cognitive changes with the onset of a UTI.

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 has been asked to provide health information to a female patient diagnosed with a urinary tract infection. What appropriate instructions will the nurse provide? Select all that apply.

Cleanse around the perineum and urethral meatus after each bowel movement to reduce pathogens. Drink liberal amounts of fluid to flush out bacteria. Void every 2-3 hours to prevent overdistention of the bladder

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

Client reports increasing fatigue.

The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client be assessed for an allergy to iodine?

Computed tomography with contrast

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?

Start IV fluids with a normal saline solution bolus followed by a maintenance dose. The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize.

A patient has a suprapubic catheter inserted postoperatively. What would be the advantages of the suprapubic catheter versus a urethral catheter? Select all that apply.

The patient can void sooner than with a urethral catheter. The suprapubic catheter allows for more mobility. The suprapubic catheter permits measurement of residual urine without urethral instrumentation.

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 describing the types of bladder tumors that may occur, which type would the nurse identify as most common?

Transitional cell carcinoma

The angling of the ureterovesical junction is the primary factor preventing backward movement of urine from the bladder toward the kidney

True

The glomerular filtration rate decreases at a yearly decline of about 1 mL/min after age 40.

True

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

Urinary incontinence

Dull, continuous pain that is located over the suprapubic area is most likely pain involving the _____.

bladder

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 client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing post-procedure care, the nurse should:

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

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.

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

drink liberal amounts of fluids.

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 term used to describe total urine output less than 0.5 mL/kg/hour is

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.

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

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

Bladder _______ is a noninvasive method of measuring urine volume in the bladder that can be performed by the nurse at the bedside.

ultrasonography

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

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 nurse cares for an acutely ill client. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill client is:

weight

Enclosed in an epithelia structure called Bowman capsule, the ______ is a unique network of capillaries that form that part of the nephron through which filtration occurs.

Glomerulus

Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. Specific gravity compares the density of urine to the density of distilled water. Which is an example of how urine concentration is affected?

On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity.

When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic?

Penicillin

A client is concerned after noticing the color of their urine is dark brown. The nurse is aware that the client is prescribed senna, methyldopa, and acetaminophen. Which action is an appropriate response by the nurse?

Reassure the client the urine color is related to the medication methylopa and no further action is needed at this time.

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?

Recent history of streptococcal infection

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

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?

Cystoscopy

The nurse is instructing a 3-year-old's parent 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 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.

Urea is an abnormal constituent of urine

False

The medulla contains the nephrons, the structural and functional units of the kidney responsible for urine formation.

False It is the cortex that contains the nephrons

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

Functional Capacity

A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?

Hyperphosphatemia

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?

Hypovolemic shock caused by hemorrhage

Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications?

Iatrogenic Iatrogenic incontinence is the involuntary loss of urine due to extrinsic medical factors, predominantly medications.

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

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 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 with suspected renal dysfunction is scheduled for excretory urography. The nurse reviews his history for conditions that may warrant changes in client preparation. Normally, the client should be mildly hypovolemic (fluid depleted) before excretory urography. Which history finding calls for the client to be well hydrated?

Multiple myeloma Fluid depletion before excretory urography is contraindicated in clients with multiple myeloma, severe diabetes mellitus, and uric acid nephropathy — conditions that can seriously compromise renal function in fluid-depleted clients with reduced renal perfusion. If these clients must undergo excretory urography, they should be well hydrated before the test. Cystic fibrosis, gout, and myasthenia gravis don't necessitate changes in client preparation for excretory urography.