Urinary System Assessment

The nurse is caring for a patient who has undergone a cystoscopy. Which patient statement should be immediately reported to the primary health care provider?

A cystoscopy involves visualizing the interior of the bladder with a tubular lighted scope. The procedure may cause the urine to become pink in color due to procedure-related trauma, which is self-limiting and normal. However, a bright red color to the urine indicates major trauma and needs to be reported immediately. Increased frequency of urination, a burning sensation during urination, and passing large volumes of urine are normal symptoms after a cystoscopy.

The nurse reviews the assessment findings of a patient with a renal disorder who is scheduled for a renal biopsy. Which parameter will result in the cancellation of the procedure?

A renal biopsy is contraindicated in a patient with uncontrolled hypertension; therefore, the patient should be assessed for high blood pressure. Cholesterol levels are assessed for a patient with heart disease. Serum albumin levels are assessed in a patient with chronic kidney disease. Serum creatinine levels are assessed in a patient with renal disorders.

The nurse is caring for a patient who has undergone a renal biopsy. The nurse ensures that the patient lies on the affected area for 30 to 60 minutes, conducts urine serial urine tests using a dipstick, and measures the vital parameters frequently. The nurse performs the interventions to assess for and prevent which complication?

A renal biopsy may cause flank plain, an increase in body temperature, and internal bleeding. Therefore, to ensure safety the nurse should monitor the vital parameters frequently and perform the urine dipstick test to detect presence of blood in the urine. The nurse also ensures that the patient lies on the affected side for 30 to 60 minutes after the procedure. Asking the patient to lie in a side-lying position cannot prevent infection and urinary retention. Renal biopsy does not involve use of contrast media; therefore, hypersensitivity reaction might not occur.

The nurse observes a patient who is undergoing an intravenous pyelogram. Which patient reaction during the procedure should the nurse report to the primary health care provider immediately?

A tight feeling in the throat indicates the possible development of a severe allergic reaction to the dye used during intravenous pyelography, resulting in edema of the larynx and difficulty breathing. Flushing of the face, a salty taste in the mouth, and a feeling of warmth over the body are all possible and expected side effects during this procedure. They are usually transient and nondistressing.

The patient has undergone renal biopsy. After the procedure the nurse should:

After procedure: Apply pressure dressing and keep patient on affected side for 30 to 60 minutes. Bed rest for 24 hours. Vital signs every 5 to 10 minutes the first hour. Assess for flank pain, hypotension, decreasing hematocrit, elevated temperature, chills, urinary frequency, dysuria, and serial urine specimens (gross or microscopic hematuria). Urine dipstick can be used to test for bleeding in urine. Inspect biopsy site for bleeding. Instruct patient to avoid lifting heavy objects for five to seven days and to not take anticoagulant drugs until allowed by the health care provider.

What advice should the nurse give to the patient collecting a urine sample for urinalysis?

Although a specimen may be collected at any time of the day for a routine urinalysis, it is best to obtain the first specimen urinated in the morning. This concentrated specimen is more likely to contain abnormal constituents if they are present in the urine. The specimen should be examined within 1 hour of urinating. It is not necessary to collect the urine overnight.

The nurse has obtained an early morning urine specimen for a urinalysis, but is unable to get it to the laboratory within the one-hour time frame. The nurse should

Although a specimen may be collected at any time of the day for a routine urinalysis, it is best to obtain the first specimen urinated in the morning. This concentrated specimen is more likely to contain abnormal constituents if they are present in the urine. The specimen should be examined within one hour of urinating. Otherwise, bacteria multiply rapidly, red blood cells (RBCs) hemolyze, casts (molds of renal tubules) disintegrate, and the urine becomes alkaline as a result of urea-splitting bacteria. If it is not possible to send the specimen to the laboratory immediately, refrigerate it. However, to obtain the best results, coordinate specimen collection with routine laboratory hours.

When is an antegrade pyelogram recommended for a patient with urinary disorder?

An antegrade pyelogram is a procedure that uses a combination of contrast dye and X-rays to diagnose obstructions and other problems in the urinary tract. This procedure is used to evaluate the upper urinary tract when the patient has an allergy to the contrast medium or has abnormalities that prevent the passage of a urethral catheter. If the patient has an ileal conduit, the primary health care provider recommends a loopogram. If the patient has neurogenic bladder, the primary health care provider recommends a cystogram. If the patient has prostatic enlargement, a voiding cystourethrogram is appropriate.

The nurse is reviewing the medication history of four patients in a health care setting. What should the nurse include when providing education about each patient's medication?

Anticoagulants increase the risk of bleeding and may cause hematuria; therefore, the nurse should inform Patient C to watch for dark-colored, smoky urine to detect hematuria. For Patient D, antihistamines contract the bladder sphincter and cause urinary retention; the patient should watch for signs and symptoms of urinary retention instead of expecting to pass large amounts of urine. For Patient A, diuretics increase the elimination of fluids through the kidney; as the patient experiences diuresis, the urine will be become less concentrated, For Patient D, antidepressants relax the bladder sphincter; burning micturition is not a common side effect.

The patient is admitted with hypertension and severe headache. In performing the initial physical assessment, the nurse assesses for renal artery stenosis (narrowing of the renal artery) by

Auscultate the abdominal aorta and renal arteries for a bruit (an abnormal murmur), which indicates impaired blood flow to the kidneys. The kidneys are posterior organs protected by the abdominal organs, the ribs, and the heavy back muscles. The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it. Occasionally, the lower pole of the right kidney is palpable. Tenderness in the flank area may be detected by fist percussion (kidney punch). If costovertebral angle (CVA) tenderness and pain are present, it may indicate a kidney infection or polycystic kidney disease. A bladder is not normally percussible until it contains 150 mL of urine. If the bladder is full, dullness is heard above the symphysis pubis.

Because almost all creatinine in the blood is excreted normally by the kidneys, which is the most accurate indicator of renal function.

Because almost all creatinine in the blood is excreted normally by the kidneys, creatinine clearance is the most accurate indicator of renal function. It is a commonly used test to analyze renal function and urinary system disorders. The result of a creatinine clearance test closely approximates that of the glomerular filtration rate. Urinalysis is a general examination of urine to establish baseline information. Composite urine collection measures specific components, such as electrolytes, glucose, protein, 17-ketosteroids, catecholamines, creatinine, and minerals. BUN is used to detect renal problems, but is not as reliable as creatinine clearance.

A male patient is admitted with extreme left flank pain. During the admission interview, the nurse learns that the patient is training for a marathon and is on a high-protein diet consisting of a lot of chicken, beef, and seafood. He states he drinks a lot of milk and avoids sodas and caffeine. He states that he often gets up once a night to urinate, but denies incontinence. The nurse suspects that the patient's pain may be because of

Dehydration may contribute to UTIs, calculi formation, and kidney failure. Large intake of particular foods, such as dairy products or foods high in proteins, also may lead to calculi formation. Because the patient is athletic, muscle strain is probably not the primary cause of his symptoms. Caffeine, alcohol, carbonated beverages, some artificial sweeteners, or spicy foods often aggravate urinary inflammatory diseases. The patient avoids sodas so this would not be as great a concern. Up to one episode of nocturia is considered normal in younger adults, and up to two episodes are acceptable among adults ages 65 years or older.

A patient with chronic kidney failure has a hemoglobin (Hb) level of 8.0 g/dL. What should the nurse infer about the reason for this laboratory result?

Erythropoietin is a hormone produced by the kidneys that promotes red blood cell (RBC) production in the bone marrow. In kidney failure, the kidneys are unable to produce erythropoietin, resulting in a decreased production of RBCs and anemia. Patients with kidney failure may have renal hypertension; however, renal hypertension does not cause anemia. Patients with kidney failure have altered bone metabolism due to a lack of vitamin D, active metabolite, and tubule dysfunction. However, altered bone metabolism does not result in anemia. Excessive renin production in kidney failure causes hypertension but is unrelated to anemia.

A patient with facial edema, ascites, groin pain, and headache experiences an increase in body weight and blood pressure. The nurse anticipates that which body system will be tested further?

Facial edema, ascites, and groin pain are the specific manifestations observed in a patient with urinary system disorder. Headaches, along with an increase in body weight and blood pressure, are general manifestations of a patient with urinary system disorder. Autoimmune disorders may cause fever, fatigue, and malaise in a patient. Gastrointestinal disorders may cause bloating, constipation, heartburn, and ingestion in a patient. Nervous system disorders may affect motor function or cause symptoms of mental illness in a patient.

A patient reports waking up 5 to 6 times a night to urinate and urinating large amounts each time. The nurse anticipates that which diagnostic test will be prescribed?

High frequency of urination in the night is known as nocturia and the passage of a large volume of urine in a given time is called polyuria. Together, these reflect the symptoms of diabetes mellitus, and the health care provider may suggest that the patient undergo diagnostic tests for glucose levels. Alteration in amino acid levels may indicate malnutrition in the patient. A cholesterol level test is prescribed for an obese patient. A blood urea nitrogen test may be prescribed for a patient who is dehydrated.

A postoperative patient had a urinary catheter removed. Eight hours later and after drinking fluids, the patient is unable to void. What should the nurse do first to assess for urinary retention?

If the patient is unable to void, the bladder may be palpated for distention and percussed for dullness if it is full, or a bladder scan may be done to determine the approximate amount of urine in the bladder. A cystometrogram visualizes the bladder and evaluates vesicouretreral reflux. A KUB x-ray delineates size, shape, and positions of kidneys and possibly a full bladder. Neither of these would be useful in this situation. A residual urine test requires urination before catheterizing the patient to determine the amount of urine left in the bladder so this assessment would not be helpful for this patient.

A patient, who is taking aspirin, is scheduled for renal biopsy. What are the responsibilities of the nurse when preparing this patient for the procedure? Select all that apply.

It is the responsibility of a nurse to ensure that the consent form is signed, obtain a type and cross match from the patient, ascertain coagulation status through patient history, and ensure that the patient is not taking aspirin before a renal biopsy. A full bladder or preparation of the bowel is not required for renal biopsy.

Which urinalysis result should the nurse recognize as an abnormal finding?

Normal WBC levels in urine are below 5/hpf, with levels exceeding this indicative of inflammation or urinary tract infection. A urine pH of 6.0 is average, amber yellow is normal coloration, and the reference ranges for specific gravity are 1.003 to 1.030.

The night shift nurse notes that the patient's urine output has been 700 mL during the night shift while it was more than1500 mL of clear yellow urine during the day shift. The nurse should

Normal adult urine output is approximately 1500 mL/day, which varies with food and fluid intake. The volume of urine produced at night is less than half of that formed during the day because of hormonal influences (e.g., antidiuretic hormone [ADH]). This diurnal pattern of urination is normal. The nurse should continue to monitor urine output. There is no need to notify the patient health care provider or perform a catheterization. Fluid restriction is not warranted unless there are other conditions that require it.

What should the nurse expect to do to prepare a patient for an intravenous pyelogram (IVP)?

Nursing responsibilities in caring for a patient undergoing an IVP include administration of a cathartic or enema to empty the colon of feces and gas. The nurse also will assess the patient for iodine sensitivity, keep the patient NPO for eight hours preprocedure, and advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur.

A 70-year-old male patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. How should the nurse document this abnormal assessment finding?

Painful and difficult urination is characterized as dysuria. Anuria is an absence of urine production, whereas oliguria is diminished urine production. Enuresis is involuntary nocturnal urination.

A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. What teaching point should the nurse emphasize before the procedure?

Pink-tinged urine, burning, and frequency are common following a cystoscopy . The patient does not need to be nothing by mouth before the test and contrast media is not needed. A cystoscopy does not always necessitate catheterization before or after the procedure.

During the physical assessment of a patient, where should a nurse palpate to locate the kidneys?

The costovertebral angle (CVA) is the landmark to locate the kidneys. It is formed by the rib cage and the vertebral column. Pain and CVA tenderness may indicate a kidney infection or polycystic kidney disease. Kidneys are posterior organs and may not be palpated anteriorly, either below the rib cage or near the umbilicus. The angle formed by the first rib and the vertebral column is too high, as the kidneys are located at a lower position in the abdomen.

The nurse recognizes that which components, if present in a patient's urine, may indicate the need for further investigation? Select all that apply.

The glomeruli in the kidneys are porous structures that filter blood and contribute to urine. In normal conditions, the composition of ultrafiltrate produced by the glomeruli is similar to blood except it contains no blood cells, platelets, or large proteins. However, these components may pass the filtration membrane in certain renal diseases. Therefore, presence of blood cells, platelets, and large proteins in the urine indicate the need for further investigation. Sodium and calcium are normal constituents of urine.

The patient developed progressive renal failure 10 years ago and has been a dialysis patient for the last five years. The patient also has developed chronic anemia. There are many causes of anemia, but the most likely cause of anemia in this patient would be

The kidneys perform vital functions through participation in red blood cell (RBC) production and blood pressure regulation. Erythropoietin is a hormone produced in the kidneys and secreted in response to hypoxia and decreased renal blood flow. Erythropoietin stimulates RBC production in the bone marrow. A deficiency of erythropoietin occurs in kidney failure, leading to anemia. The patient with kidney failure (also called renal failure) has a deficiency of the active metabolite of vitamin D and manifests problems of altered calcium and phosphate balance. Renin is released into the bloodstream in response to decreased renal perfusion, decreased arterial blood pressure, decreased extracellular fluid (ECF), decreased serum Na+ concentration, and increased urinary Na+ concentration. It has no direct effect on blood cell production.

The patient called the clinic with manifestations of burning on urination, dysuria, and frequency. What is the best advice for the nurse to give the patient?

The patient's symptoms are typical of a urinary tract infection (UTI). To verify this, a clean catch urine specimen must be obtained for a specimen of urine to culture. Drinking less fluid will not improve the symptoms. Acetaminophen would not decrease the discomfort; an antibiotic would be needed. Avoiding caffeine and spicy food may decrease bladder inflammation but will not affect these symptoms.

Although urine formation is a result of kidney function, the primary functions of the kidneys are to filter blood and

The primary functions of the kidneys are to filter the blood and maintain the body's internal homeostasis. Urine formation begins at the glomerulus, where blood is filtered. The hydrostatic pressure of the blood within the glomerular capillaries causes a portion of blood to be filtered across the semipermeable membrane into Bowman's capsule, where the filtered portion of the blood (the glomerular filtrate) begins to pass down to the tubule. Filtration is more rapid in the glomerulus than in ordinary tissue capillaries because the glomerular membrane is porous. The ultrafiltrate is similar in composition to blood except that it lacks blood cells, platelets, and large plasma proteins. Under normal conditions, the capillary pores are too small to allow the loss of these large blood components. In many kidney diseases, capillary permeability is increased, which permits plasma proteins and blood cells to pass into the urine.

The patient is undergoing a 24-hour urine collection for creatinine clearance. The nurse realizes that

The result of a creatinine clearance test closely approximates that of the GFR.Creatinine levels remain remarkably constant for each person because they are not significantly affected by protein ingestion, muscular exercise, water intake, or rate of urine production. After age 40, the creatinine clearance rate decreases at a rate of about 1 mL/min/yr. Normal creatinine clearance values range from 70 to 135 mL/min.

As a component of the head-to-toe assessment of a patient who recently has been transferred to the clinical unit, the nurse is preparing to palpate the patient's kidneys. How should the nurse position the patient for this assessment?

To palpate the right kidney, the patient is positioned supine and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney. The normal-sized left kidney rarely is palpable because the spleen lies directly on top of it. The kidney is not palpable while the patient is prone, seated, or standing.

The nurse reviews a patient's medical record and notes that the urine output for the previous 24 hours is 200 mL. The nurse concludes that the likely reason for this output is the patient's history of what?

Urine output of 100 to 400 mL within 24 hours indicates severe dehydration. As body fluids decrease in the body, the kidneys will not be able to eliminate fluids from the body. Urethritis is an infection in the urinary tract and may cause pain in the patient. Heart failure may lead nocturia in the patient. Urethral irritation may cause burning upon urination.

What instructions should the nurse give to a patient who is about to have a renal computed tomography (CT) scan? Select all that apply.

When preparing the patient for a renal CT scan, the nurse should inform the patient that no dietary or activity restrictions are required. Also, no pain or discomfort should be felt during the test. The test does not require the patient to fast before the test or to restrict activities and rest.