Ch. 65 Assessment of the Renal/Urinary System
A nurse contacts the health care provider after reviewing a clients laboratory results and noting a blood urea nitrogen (BUN) of 35 mg/dL and a creatinine of 1.0 mg/dL. For which action should the nurse recommend a prescription? a. Intravenous fluids b. Hemodialysis c. Fluid restriction d. Urine culture and sensitivity
ANS: A Normal BUN is 10 to 20 mg/dL. Normal creatinine is 0.6 to 1.2 mg/dL (males) or 0.5 to 1.1 mg/dL (females). Creatinine is more specific for kidney function than BUN, because BUN can be affected by several factors (dehydration, high-protein diet, and catabolism). This clients creatinine is normal, which suggests a non-renal cause for the elevated BUN. A common cause of increased BUN is dehydration, so the nurse should anticipate giving the client more fluids, not placing the client on fluid restrictions. Hemodialysis is not an appropriate treatment for dehydration. The lab results do not indicate an infection; therefore, a urine culture and sensitivity is not appropriate.
After delegating to an unlicensed assistive personnel (UAP) the task of completing a bladder scan examination for a client, the nurse evaluates the UAPs performance. Which action by the UAP indicates the nurse must provide additional instructions when delegating this task? a. Selecting the female icon for all female clients and male icon for all male clients b. Telling the client, This test measures the amount of urine in your bladder. c. Applying ultrasound gel to the scanning head and removing it when finished d. Taking at least two readings using the aiming icon to place the scanning head
ANS: A The UAP should use the female icon for women who have not had a hysterectomy. This allows the scanner to subtract the volume of the uterus from readings. If a woman has had a hysterectomy, the UAP should choose the male icon. The UAP should explain the procedure to the client, apply gel to the scanning head and clean it after use, and take at least two readings.
A nurse prepares a client for a percutaneous kidney biopsy. Which actions should the nurse take prior to this procedure? (Select all that apply.) a. Keep the client NPO for 4 to 6 hours. b. Obtain coagulation study results. c. Maintain strict bedrest in a supine position. d. Assess for blood in the clients urine. e. Administer antihypertensive medications.
ANS: A, B, E Prior to a percutaneous kidney biopsy, the client should be NPO for 4 to 6 hours. Coagulation studies should be completed to prevent bleeding after the biopsy. Blood pressure medications should be administered to prevent hypertension before and after the procedure. There is no need to keep the client on bedrest or assess for blood in the clients urine prior to the procedure; these interventions should be implemented after a percutaneous kidney biopsy.
A nurse plans care for an older adult client. Which interventions should the nurse include in this clients plan of care to promote kidney health? (Select all that apply.) a. Ensure adequate fluid intake. b. Leave the bathroom light on at night. c. Encourage use of the toilet every 6 hours. d. Delegate bladder training instructions to the unlicensed assistive personnel (UAP). e. Provide thorough perineal care after each voiding. f. Assess for urinary retention and urinary tract infection.
ANS: A, B, E, F The nurse should ensure that the client receives adequate fluid intake and has adequate lighting to ambulate safely to the bathroom at night, encourage the client to use the toilet every 2 hours, provide thorough perineal care after each voiding, and assess for urinary retention and urinary tract infections. The nurse should not delegate any teaching to the UAP, including bladder training instructions. The UAP may participate in bladder training activities, including encouraging and assisting the client to the bathroom at specific times.
A nurse assesses a client recovering from a cystoscopy. Which assessment findings should alert the nurse to urgently contact the health care provider? (Select all that apply.) a. Decrease in urine output b. Tolerating oral fluids c. Prescription for metformin d. Blood clots present in the urine e. Burning sensation when urinating
ANS: A, D The nurse should monitor urine output and contact the provider if urine output decreases or becomes absent. The nurse should also assess for blood in the clients urine. The urine may be pink-tinged, but gross bleeding or blood clots should not be present. If bleeding is present, the nurse should urgently contact the provider. Tolerating oral fluids is a positive outcome and does not need intervention. Metformin would be a concern if the client received dye; no dye is used in a cystoscopy procedure. The client may experience a burning sensation when urinating after this procedure; this would not require a call to the provider.
A nurse cares for a client with an increased blood urea nitrogen (BUN)/creatinine ratio. Which action should the nurse take first? a. Assess the clients dietary habits. b. Inquire about the use of nonsteroidal anti-inflammatory drugs (NSAIDs). c. Hold the clients metformin (Glucophage). d. Contact the health care provider immediately.
ANS: AAn elevated BUN/creatinine ratio is often indicative of dehydration, urinary obstruction, catabolism, or a high- protein diet. The nurse should inquire about the clients dietary habits. Kidney damage related to NSAID use most likely would manifest with elevations in both BUN and creatinine, but no change in the ratio. The nurse should obtain more assessment data before holding any medications or contacting the provider.
A nurse cares for a client who has elevated levels of antidiuretic hormone (ADH). Which disorder should the nurse identify as a trigger for the release of this hormone? a. Pneumonia b. Dehydration c. Renal failure d. Edema
ANS: B ADH increases tubular permeability to water, leading to absorption of more water into the capillaries. ADH is triggered by a rising extracellular fluid osmolarity, as occurs in dehydration. Pneumonia, renal failure, and edema would not trigger the release of ADH.
A nurse reviews a female clients laboratory results. Which results from the clients urinalysis should the nurse recognize as abnormal? a. pH 5.6 b. Ketone bodies present c. Specific gravity of 1.020 d. Clear and yellow color
ANS: B Ketone bodies are by-products of incomplete metabolism of fatty acids. Normally no ketones are present in urine. Ketone bodies are produced when fat sources are used instead of glucose to provide cellular energy. A pH between 4.6 and 8, specific gravity between 1.005 and 1.030, and clear yellow urine are normal findings for a female clients urinalysis.
A nurse reviews the health history of a client with an oversecretion of renin. Which disorder should the nurse correlate with this assessment finding a. Alzheimers disease b. Hypertension c. Diabetes mellitus d. Viral hepatitis
ANS: B Renin is secreted when special cells in the distal convoluted tubule, called the macula densa, sense changes in blood volume and pressure. When the macula densa cells sense that blood volume, blood pressure, or blood sodium levels are low, renin is secreted. Renin then converts angiotensinogen into angiotensin I. This leads to a series of reactions that cause secretion of the hormone aldosterone. This hormone increases kidney reabsorption of sodium and water, increasing blood pressure, blood volume, and blood sodium levels. Inappropriate or excessive renin secretion is a major cause of persistent hypertension. Renin has no impact on Alzheimers disease, diabetes mellitus, or viral hepatitis.
A nurse reviews the health history of a client with an oversecretion of renin. Which disorder should the nurse correlate with this assessment finding? a. Alzheimers disease b. Hypertension c. Diabetes mellitus d. Viral hepatitis
ANS: B Renin is secreted when special cells in the distal convoluted tubule, called the macula densa, sense changes in blood volume and pressure. When the macula densa cells sense that blood volume, blood pressure, or blood sodium levels are low, renin is secreted. Renin then converts angiotensinogen into angiotensin I. This leads to a series of reactions that cause secretion of the hormone aldosterone. This hormone increases kidney reabsorption of sodium and water, increasing blood pressure, blood volume, and blood sodium levels. Inappropriate or excessive renin secretion is a major cause of persistent hypertension. Renin has no impact on Alzheimers disease, diabetes mellitus, or viral hepatitis.
A nurse cares for a client with a urine specific gravity of 1.018. Which action should the nurse take? a. Evaluate the clients intake and output for the past 24 hours. b. Document the finding in the chart and continue to monitor. c. Obtain a specimen for a urine culture and sensitivity. d. Encourage the client to drink more fluids, especially water.
ANS: B This specific gravity is within the normal range for urine. There is no need to evaluate the clients intake and output, obtain a urine specimen, or increase fluid intake.
A nurse assesses clients on the medical-surgical unit. Which clients are at risk for kidney problems? (Select all that apply.) a. A 24-year-old pregnant woman prescribed prenatal vitamins b. A 32-year-old bodybuilder taking synthetic creatine supplements c. A 56-year-old who is taking metformin for diabetes mellitus d. A 68-year-old taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) for chronic back pain e. A 75-year-old with chronic obstructive pulmonary disease (COPD) who is prescribed an albuterol nebulizer
ANS: B, C, D Many medications can affect kidney function. Clients who take synthetic creatine supplements, metformin, and high-dose or long-term NSAIDs are at risk for kidney dysfunction. Prenatal vitamins and albuterol nebulizers do not place these clients at risk.
A nurse teaches a client who is recovering from a urography. Which instruction should the nurse include in this clients discharge teaching? a. Avoid direct contact with your urine for 24 hours until the radioisotope clears. b. You may have some dribbling of urine for several weeks after this procedure. c. Be sure to drink at least 3 liters of fluids today to help eliminate the dye faster. d. Your skin may become slightly yellow from the dye used in this procedure.
ANS: C Dyes used in urography are potentially nephrotoxic. A large fluid intake will help the client eliminate the dye rapidly. Dyes used in urography are not radioactive, the client should not experience any dribbling of urine, and the dye should not change the color of the clients skin.
A nurse assesses a client with renal insufficiency and a low red blood cell count. The client asks, Is my anemia related to the renal insufficiency? How should the nurse respond? a. Red blood cells produce erythropoietin, which increases blood flow to the kidneys. b. Your anemia and renal insufficiency are related to inadequate vitamin D and a loss of bone density. c. Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow. d. Kidney insufficiency inhibits active transportation of red blood cells throughout the blood.
ANS: C Erythropoietin is produced in the kidney and is released in response to decreased oxygen tension in the renal blood supply. Erythropoietin stimulates red blood cell production in the bone marrow. Anemia and renal insufficiency are not manifestations of vitamin D deficiency. The kidneys do not play a role in the transportation of red blood cells or any other cells in the blood.
A nurse obtains a sterile urine specimen from a clients Foley catheter. After applying a clamp to the drainage tubing distal to the injection port, which action should the nurse take next? a. Clamp another section of the tube to create a fixed sample section for retrieval. b. Insert a syringe into the injection port and aspirate the quantity of urine required. c. Clean the injection port cap of the drainage tubing with povidone-iodine solution. d. Withdraw 10 mL of urine and discard it; then withdraw a fresh sample of urine.
ANS: C It is important to clean the injection port cap of the catheter drainage tubing with an appropriate antiseptic, such as povidone-iodine solution or alcohol. This will help prevent surface contamination before injection of the syringe. The urine sample should be collected directly from the catheter; therefore, a second clamp to create a sample section would not be appropriate. Every sample from the catheter is usable; there is no need to discard the first sample.
A nurse reviews the urinalysis results of a client and notes a urine osmolality of 1200 mOsm/L. Which action should the nurse take? a. Contact the provider and recommend a low-sodium diet. b. Prepare to administer an intravenous diuretic. c. Obtain a suction device and implement seizure precautions. d. Encourage the client to drink more fluids.
ANS: D Normal urine osmolality ranges from 300 to 900 mOsm/L. This clients urine is more concentrated, indicating dehydration. The nurse should encourage the client to drink more water. Dehydration can be associated with elevated serum sodium levels. Although a low-sodium diet may be appropriate for this client, this diet change will not have a significant impact on urine osmolality. A diuretic would increase urine output and decrease urine osmolality further. Low serum sodium levels, not elevated serum levels, place the client at risk for seizure activity. These options would further contribute to the clients dehydration or elevate the osmolality.
A nurse cares for a client who is having trouble voiding. The client states, I cannot urinate in public places. How should the nurse respond? a. I will turn on the faucet in the bathroom to help stimulate your urination. b. I can recommend a prescription for a diuretic to improve your urine output. c. Ill move you to a room with a private bathroom to increase your comfort. d. I will close the curtain to provide you with as much privacy as possible.
ANS: D The nurse should provide privacy to clients who may be uncomfortable or have issues related to elimination or the urogenital area. Turning on the faucet and administering a diuretic will not address the clients concern. Although moving the client to a private room with a private bathroom would be nice, this is not realistic. The nurse needs to provide as much privacy as possible within the clients current room.
For which clients scheduled for a computed tomography (CT) scan with contrast does the nurse communicate safety concerns to the health care provider (HCP)? Select all that apply. a. Client with an allergy to shrimp b. Client with a history of asthma c. Client who requests morphine sulfate every 3 hours d. Client with a blood urea nitrogen of 62 mg/dL (22.1 mmol/L) and a creatinine of 2.0 mg/dL (177 umol/L) e. Client who took metformin (Glucophage) 4 hours ago
a, b, d, and e The nurse would communicate to the HCP CT scan contrast safety concerns about a client with an allergy to shrimp, a client with an asthma history, a client with an elevated BUN and creatinine, and a client who took Metformin 4 hours ago. All clients undergoing a CT scan with contrast would be asked about known hay fever or food or drug allergies, especially to seafood, eggs, milk, or chocolate. Contrast reactions have been reported to be as high as 15% in these clients. Clients with asthma have been shown to be at greater risk for contrast reactions than the general public. When reactions do occur, they are more likely to be severe. The risk for contrast-induced nephropathy is also increased in clients who have pre-existing renal insufficiency (e.g., serum creatinine levels greater than 1.5 mg/dL (133 umol/L) or estimated glomerular filtration rate less than 45 mL/min). Metformin must be discontinued at least 24 hours before and for at least 48 hours after any study using contrast media because the life-threatening complication of lactic acidosis, although rare, could occur.There are no contraindications to undergo CT scan with contrast while taking morphine sulfate. CT with contrast may help to identify the underlying cause of pain.
A client has returned from a captopril renal scan. Which teaching does the nurse provide when the client returns to the unit? a. "Arise slowly and call for assistance when ambulating." b. "I must measure your intake and output." c. "We must save your urine because it is radioactive." d. "I must attach you to this cardiac monitor."
a. "Arise slowly and call for assistance when ambulating." When a client returns to the unit from a captopril retinal scan, the nurse needs to teach the client to rise slowly and call for help when ambulating. Captopril can cause severe hypotension during and after the procedure. The client would be warned to avoid rapid position changes and about the risk for falling as a result of orthostatic (positional) hypotension.Intake and output measurement is not necessary after this procedure, unless it had been requested previously. The urine is not radioactive, because only a small amount of radioisotope is used in a renal scan. Standard Precautions need to be implemented and the nurse must wear gloves. Cardiac monitoring is not needed, although the nurse would monitor for hypotension secondary to captopril.
An older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the nurse's best response? a. "Have you tried using the toilet at least every couple of hours?" b. "How does that make you feel?" c. "We can fix that." d. "That happens when we get older."
a. "Have you tried using the toilet at least every couple of hours?" The nurse's best response to a client who states, "I feel like a child who sometimes pees her pants," is to ask the client if she uses the toilet at least every couple of hours. By emptying the bladder on a regular basis, urinary incontinence from overflow may be avoided, which may give the client some sense of control.The client has already stated how she feels. Asking her again does not address her concern, nor does it allow for nursing education. The nurse cannot assert that the problem can be fixed because this may be untrue. Suggesting that the problem occurs as we get older does not address the client's concern and does not provide for any client teaching.
A client with these assessment data is preparing to undergo a computed tomography (CT) scan with contrast Assessment Data: BUN 54 mg/dL Creatinine 2.4 mg/dL Ca 8.5 mg/dL Which medication does the nurse plan to administer before the procedure? a. Acetylcysteine (Mucomyst) b. Metformin (Glucophage) c. Captopril (Capoten) d. Acetaminophen (Tylenol)
a. Acetylcysteine (Mucomyst) Before a CT scan with contrast, the nurse needs to administer acetylcysteine to the client. This client has kidney impairment demonstrated by increased creatinine. Acetylcysteine (an antioxidant) would be used to prevent contrast-induced nephrotoxic effects.Metformin is held at least 24 hours before and for at least 48 hours after procedures using contrast. Although captopril and acetaminophen may be administered with a sip of water with permission of the provider, this is not essential before the procedure.
Which client being managed for dehydration does the nurse consider at greatest risk for possible reduced kidney function? a. An 80-year-old man who has benign prostatic hyperplasia b. A 62-year-old woman with a known allergy to contrast media c. A 48-year-old woman with established urinary incontinence d. A 45-year-old man receiving oral and intravenous fluid therapy
a. An 80-year-old man who has benign prostatic hyperplasia Older adults have fewer nephrons and about half of the glomerular filtration rate of younger adults. This change increases their risk for kidney dysfunction more profoundly and persistently after dehydration of other conditions that can impair the renal system. Although an allergy to contrast media can cause problems, the adult must be exposed to it first. Tests requiring contrast media are not used to diagnose or manage dehydration. Urinary incontinence can lead to poor quality of life and skin problems but does not reduce kidney function. The client receiving hydration therapy with both oral and intravenous fluids is at risk for overhydration (fluid overload), not dehydration-induced kidney damage.
Which age-related change can cause nocturia? a. Decreased ability to concentrate urine b. Decreased production of antidiuretic hormone c. Increased production of erythropoietin d. Increased secretion of aldosterone
a. Decreased ability to concentrate urine Nocturia may result from decreased kidney-concentrating ability associated with aging.Increased production of antidiuretic hormone, decreased production of erythropoietin, and decreased secretion of aldosterone are age-related changes.
The client admitted to a surgical unit following a TURP, has a CBI running. The nurse assesses the client's urine and finds dark red urine containing several small clots. Which intervention should the nurse implement? a. Increase the flow of the bladder irrigation fluid. b. Immediately stop the bladder irrigation fluid. c. Irrigate the urinary catheter manually. d. Deflate the balloon on the urinary catheter.
a. Increase the flow of the bladder irrigation fluid. A- Keep irrigation going to flush out the clots , if this does not work, we have to manually irrigate
When obtaining a health history from a 22-year-old female client who has new onset urinary incontinence, which findings or factors does the nurse consider significant? (Select all that apply.) a. Chemical exposure in the workplace b. A burning sensation occurring on urination c. Urinating 10 times daily although fluid intake remains unchanged d. A recent change in the client's oral contraceptive prescription e. A new inability to hold urine (urgency) f. A "stinky" odor from the urine
b, c, e, and f Burning on urination, frequent urination without increasing fluid intake, urgency, and malodorous urine are concerning changes in urine elimination. Although chemical exposure in the workplace may cause kidney damage, it is not associated with new onset incontinence in a young adult. Oral contraceptives do not contribute to problems with urination.
The nurse is admitting a client who has type 2 diabetes (T2D) and is scheduled for surgery. Which laboratory findings from this client's admission panel does the nurse report as indicating possible abnormal kidney function? (Select all that apply.) a. Presence of ammonia in the urine b. Urine microalbumin 240 mcg/24 hour (0.240 g/24 hour) c. Urine specific gravity of 1.028 d. Blood urea nitrogen of 38 mg/dL (13.5 mmol/L) f. Serum creatinine 2.2 mg/dL (294.3 mcmol/L) g. Blood osmolarity 290 mOsm/kg (290 mmol/kg)
b, d, and f Urine normally has a small amount of ammonia in it as a breakdown product of nitrogen. Other normal values include the urine specific gravity (normal range of 1.005 to 1.030) and the blood osmolarity (280 to 300 mOsm/kg; 280 to 300 mmol/kg). The urine microalbumin is much higher than the normal levels (30 to 80 mcg/24 hour; 0.03 to 0.08 g/24 hour) and indicates abnormal kidney function. Blood urea nitrogen is high (normal ranges 10 to 120 mg/dL; 3.6 to 7.1 mmol/L) as is the serum creatinine (normal ranges 0.5 to 1.2 mg/dL; 44 to 106 mcmol/L). Both of these values indicate abnormal kidney function.
The charge nurse is making client assignments for the day shift. Which client is best to assign to an LPN/LVN? a. Client who has just returned from having a kidney artery angioplasty b. Client with polycystic kidney disease who is having a kidney ultrasound c. Client who is going for a cystoscopy and cystourethroscopy d. Client with glomerulonephritis who is having a kidney biopsy
b. Client with polycystic kidney disease who is having a kidney ultrasound The best client to assign to an LPN/LVN is the client with polycystic kidney disease who is having a kidney ultrasound. Kidney ultrasounds are noninvasive procedures without complications, and the LPN/LVN can provide this care.A kidney artery angioplasty is an invasive procedure that requires post procedure monitoring for complications, especially hemorrhage. A registered nurse is needed for this client. Cystoscopy and cystourethroscopy are procedures that are associated with potentially serious complications such as bleeding and infection. These clients must be assigned to RN staff members. Kidney biopsy is associated with potentially serious complications such as bleeding, and this client would also be assigned to RN staff members.
Which percussion technique does the nurse use to assess a client who reports flank pain? a. Place outstretched fingers over the flank area and percuss with the fingertips. b. Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank. c. Place one hand with the palm up over the flank area and cup the other hand to percuss the hand on the flank. d. Quickly tap the flank area with cupped hands.
b. Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank. When performing percussion of a client's flank, the nurse needs to place one hand with the palm down flat over the costovertebral angle (CVA) of the flank area and, with the other fisted hand, thump the hand on the flank.Placing outstretched fingers, one hand palm up, and/or using cupped hands and quickly tapping the flank are incorrect techniques.
The RN is caring for a client who has just had a kidney biopsy. Which action does the nurse perform first? a. Obtain blood urea nitrogen (BUN) and creatinine. b. Position the client supine. c. Administer pain medications. d. Check urine for hematuria.
b. Position the client supine. When caring for a client after a kidney biopsy, the nurse first needs to position the client in a supine position. The client is positioned supine with a back roll for several hours after a kidney biopsy to decrease the risk for hemorrhage.BUN and creatinine would be obtained before the procedure is performed. Only local discomfort would be noted around the procedure site. Severe pain could indicate hematoma. Although pink urine may develop, the nurse would position the client to prevent bleeding first. The other actions are appropriate after this procedure, but do not need to be done immediately after the biopsy.
Which instruction does the nurse give a client who needs a clean-catch urine specimen? a. "Save all urine for 24 hours." b. "Use the sponges to cleanse the urethra, and then initiate voiding directly into the cup." c. "Do not touch the inside of the container." d. "You will receive an isotope injection, then I will collect your urine."
c. "Do not touch the inside of the container." Before obtaining a clean-catch urine specimen, the nurse instructs the client not to touch the inside of the container. A clean-catch specimen is used to obtain urine for culture and sensitivity of organisms present. Contamination by any part of the client's anatomy will render the specimen invalid and alter results.Saving urine for 24 hours is not necessary for a midstream clean-catch urine specimen. After cleaning, the client needs to initiate voiding into the commode, then stop and resume voiding into the container. Only 1 ounce (30 mL) is needed. The remainder of the urine may be discarded into the commode. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra. A clean-catch specimen for culture does not require injection of an isotope before urine is collected.
The female nurse is preparing to empty the urostomy bag of a female client of a Muslim. Which statement would be most respectful of the client? a. "Do you want your spouse in the room when I empty the urine from the bag." b. "You need to increase you fluid intake. What beverages do you like to drink?" c. "I need to move the covers to the side in order to empty the bag. Can I do this now." d. "You didn't eat any lunch, and you need protein for healing. What foods can you eat?"
c. "I need to move the covers to the side in order to empty the bag. Can I do this now."
The nurse is teaching a client how to provide a clean-catch urine specimen. Which statement by the client indicates that teaching was effective? a. "I must clean with the wipes and then urinate directly into the cup." b. "I will have to drink 2 liters of fluid before providing the sample." c. "I'll start to urinate in the toilet, stop, and then urinate into the cup." d. "It is best to provide the sample while I am bathing."
c. "I'll start to urinate in the toilet, stop, and then urinate into the cup." Teaching is demonstrated to be effective when the client says, "I'll start to urinate in the toilet, stop, and then urinate into the cup." A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra.Although cleaning with wipes before providing a clean-catch urine sample is proper procedure, a step is missing. It is not necessary to drink 2 liters of fluid before providing a clean-catch urine sample. Providing a clean-catch urine sample does not involve bathing.
When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which factor? a. Abdominal girth b. Presence of urinary infection c. History of hysterectomy d. Hematuria
c. History of hysterectomy Before performing bladder scanning to detect residual urine in a female client, the nurse must first determine if the client has had a hysterectomy. The scanner must be in the scan mode for female clients in order to ensure the scanner subtracts the volume of the uterus from the measurement.The nurse performs this procedure in response to distention or pressure in the bladder; girth is not a factor. This procedure detects urine retained in the bladder, not infection. The presence of retained urine in the bladder is assessed, regardless of hematuria.
The nurse is reviewing the medical record for a client with polycystic kidney disease who is scheduled for computed tomographic angiography with contrast: Assessment Data: BUN 26 mg/dL Creatinine 1.0 mg/dL) HbA1c 6.9% Glucose 132 mg/dL Which intervention is essential for the nurse to perform? a. Obtain a thyroid-stimulating hormone (TSH) level. b. Report the blood urea nitrogen (BUN) and creatinine. c. Hold the metformin 24 hours before and on the day of the procedure. d. Notify the provider regarding blood glucose and glycosylated hemoglobin (HbA1c) values.
c. Hold the metformin 24 hours before and on the day of the procedure. The essential intervention for the nurse to perform is to withhold metformin at least 24 hours before the time of a contrast media study and for at least 48 hours after the procedure because metformin may cause lactic acidosis.The focus of this scenario is the client with polycystic kidneys. A TSH level is not essential at this time. BUN and creatinine are normal. The glucose is only mildly elevated (if fasting), and the HbA1c is in an appropriate range.
When a client with diabetes returns to the medical unit after a computed tomography (CT) scan with contrast dye, all of these interventions are prescribed. Which intervention does the nurse implement first? a. Give lispro (Humalog) insulin, 12 units subcutaneously. b. Request a breakfast tray for the client. c. Infuse 0.45% normal saline at 125 mL/hr. d. Administer captopril (Capoten).
c. Infuse 0.45% normal saline at 125 mL/hr. After a diabetic client returns to the unit after a CT scan, the first intervention implemented by the nurse is to infuse 0.45% normal saline at 125 mL/hour. Fluids are needed because the iodinated dye used in a CT scan with contrast has an osmotic effect, causing dehydration and potential kidney failure. Lispro is not administered until the breakfast tray arrives. A breakfast tray will be requested, but preventing complications of the procedure is done first. Because the client may be hypovolemic, the nurse needs to monitor blood pressure and administer IV fluids before deciding whether administration of captopril is appropriate.
When caring for a client with uremia, the nurse assesses for which symptom? a. Tenderness at the costovertebral angle (CVA) b. Cyanosis of the skin c. Nausea and vomiting d. Insomnia
c. Nausea and vomiting The signs and symptoms the nurse needs to assess for are nausea and vomiting. Other manifestations of uremia include anorexia, nausea, vomiting, muscle cramps, pruritus, fatigue, and lethargy.CVA tenderness is a sign of inflammation or infection in the renal pelvis. Cyanosis is related to poor tissue perfusion. Insomnia is nonspecific and may be caused by psychoemotional factors, medications, or other problems.
The nurse visualizes blood clots in a client's urinary catheter after a cystoscopy. What nursing intervention does the nurse perform first? a. Administer heparin intravenously. b. Remove the urinary catheter. c. Notify the health care provider (HCP). d. Irrigate the catheter with sterile saline.
c. Notify the health care provider (HCP). The nurse first notifies the HCP after visualizing a blood clot in a postoperative cystoscopy client's urinary catheter. Bleeding and/or blood clots are potential complications of cystoscopy and may obstruct the catheter and decrease urine output. In addition, the nurse must monitor urine output and notify the HCP of obvious blood clots or a decreased or absent urine output.Heparin would not be administered due to bleeding. The urinary catheter is allowing close monitoring of the urinary system and would not be removed at this time. The Foley catheter may be irrigated with sterile saline if prescribed by the HCP.
A client is in the emergency department for an inability to void and for bladder distention. What is most important for the nurse to provide to the client? a. Increased oral fluids b. IV fluids c. Privacy d. Health history forms
c. Privacy It is most important for the nurse to provide privacy for this client. Besides privacy, the nurse also needs to help this client with assistance and voiding stimulants, such as warm water over the perineum, as needed.Increased oral fluids and IV fluids would exacerbate the client's problem. Obtaining a health history is not the priority for this client's care.
Which assessment finding alarms the nurse immediately after a client returns from the operating room for cystoscopy performed under conscious sedation? a. Pink-tinged urine b. Urinary frequency c. Temperature of 100.8°F (38.2°C) d. Lethargy
c. Temperature of 100.8°F (38.2°C) The nurse is immediately concerned when a postoperative cystoscopy client who had conscious sedation returns to the unit with a temperature of 100.8°F (38.2°C). Fever, chills, or an elevated white blood cell count after cystoscopy suggest infection after an invasive procedure. The provider must be notified immediately.Pink-tinged urine is expected after a cystoscopy. Frequency may be noted as a result of irritation of the bladder. Gross hematuria would require notification of the surgeon. If sedation or anesthesia was used, lethargy is an expected effect.
The nurse is reviewing hospital admission orders for the client diagnosed with acute prostatitis. Which prescription should the nurse verify with the HCP? a. Give trimethoprim/sulfamethoxazole 1 gram IV q6h. b. Administer ibuprofen 600 mg orally q6h prn. c. Increase fluid intake to 3 L daily; have client void often. d. Insert an indwelling urinary drainage catheter now.
d catheterization is contraindicated with acute prostatitis; they do suprapubic catheter in this case; and it so painful and the patient would not let you do this
Which technique does the nurse use to obtain a sterile urine specimen from a client with a Foley catheter? a. Disconnect the Foley catheter from the drainage tube and collect urine directly from the Foley. b. Remove the existing catheter and obtain a sample during the process of inserting a new Foley. c. Use a sterile syringe to withdraw urine from the urine collection bag. d. Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine.
d. Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine. The nurse will employ the technique of clamping the tubing, attaching a syringe to the specimen, and withdrawing at least 5 mL of urine when obtaining a sterile urine specimen from a client with a Foley catheter.Disconnecting the Foley catheter from the drainage tube and collecting urine directly from the Foley increases the risk for microbe exposure. A Foley catheter would not be removed to get a urine sample. Microbes may be in the urine collection bag from standing urine, so using a sterile syringe to withdraw urine from the urine collection bag is not the proper technique to obtain a sterile urine specimen. Question 25 of 25
The nurse has these client assignments. Which client does the nurse encourage to consume 2 to 3 liters of fluid each day? a. Client with chronic kidney disease b. Client with heart failure c. Client with complete bowel obstruction d. Client with hyperparathyroidism
d. Client with hyperparathyroidism The nurse encourages the client with hyperparathyroidism to drink 2 to 3 liters of fluid each day. A major feature of hyperparathyroidism is hypercalcemia, which predisposes a client to kidney stones. This client must remain hydrated.A client with chronic kidney disease would not consume 2 to 3 liters of water because the kidneys are not functioning properly. Consuming that much fluid could lead to fluid retention. People with heart failure typically have fluid volume excess. A client with complete bowel obstruction may experience vomiting and would be NPO.
A client had a computed tomography (CT) scan with contrast dye 8 hours ago. Which nursing intervention is the priority for this client? a. Maintaining bedrest b. Medicating for pain c. Monitoring for hematuria d. Promoting fluid intake
d. Promoting fluid intake The priority nursing intervention for this client is to promote fluid intake. The nurse must ensure that the client has adequate hydration to dilute and excrete the contrast media. The nurse urges the client to take oral fluid or, if needed, administers IV fluids to the client. Hydration reduces the risk for kidney damage.Bedrest is not indicated for the client who has undergone a CT scan with contrast dye. CT with contrast dye is not a painful procedure, so pain medication is not indicated. The client who has undergone CT with contrast dye is not at risk for hematuria.
Which symptom(s) in a client during the first 12 hours after a kidney biopsy indicates to the nurse a possible complication from the procedure? a. The client experiences nausea and vomiting after drinking juice. b. The biopsy site is tender to light palpation. c. The abdomen is distended and the client reports abdominal discomfort. d. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready.
d. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready. The most serious complication after a kidney biopsy is excessive bleeding. Nausea and vomiting are not signs of bleeding. Some discomfort at the biopsy site is expected and not considered a complication unless there is swelling and a large amount of bruising/discoloration in the flank area. The kidneys are not in the abdomen. Bleeding from the kidney would cause flank pain and swelling, not abdominal pain and swelling. The elevated pulse rate, thready peripheral pulses, and low diastolic blood pressure are consistent with excessive bleeding.
One of the nurse's roles is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body areas? a. Children's terms that are easily understood b. Slang words and terms that are heard "socially" c. Technical and medical terminology d. Words that the client uses
d. Words that the client uses When talking to an adult client about urinary and sexual hygiene, the nurse uses words that the client uses. The nurse would use the terms with which the client is most familiar, so there is no chance for the client to misunderstand information. Using the client's language ensures the comfort level for the client.The use of children's terms is demeaning to adult clients. The use of slang terms is unprofessional. Technical terms would not be used because the client may not know what they mean.
The nurse is caring for the female client experiencing recurrent UTIs. Which statement would best help the client reduce her risk for another UTI? a. "Eliminate caffeine and tea from your diet." b. "Take tub baths rather than showering." c. "Wear good-quality synthetic underwear." d. "Abstain from having sexual intercourse."
A- bladder irritants
The nurse is caring for a client with poor urine output. The nurse would report to the health care provider if the client had a urine output less than how many milliliters per hour for 2 consecutive hours? Provide a numerical response.
30 ml the question is asking per hour, so even if the question would be for three or four consecutive hours, the answer is still 30 ml per hour
Laboratory analysis reveals that the client passed a calcium oxalate stone. To prevent the formation of future stones, the nurse instruct the client to avoid consuming which foods? a. Cheese b. Lettuce c. Chocolate d. Beans
a. Chocolate
The nurse is caring for the client following a TRUP. At the end of an 8 hour shift, the nurse determines that the client received 3050 mL of CBI fluid and that 4030 mL of output was emptied from the urinary drainage bag. How many milliliters (mL) should the nurse document for the client's actual urine output for 8 hours? Record your answer in whole numbers.
980 ml (subtract 4030 from 3050
The nurse is caring for the client diagnosed with obstructing left ureterolithiasis. The nurse evaluates that the client may have passed the calculi in the urine when which outcome has been achieved? a. Voiding clear amber urine greater than 30 mL per hour. b. No evidence of hematemesis or urinary tract infection. c. Absence of epigastric pain, nausea, and vomiting. d. Absence of colicky pain in the left lateral flank and groin.
D
The nurse is caring for the client experiencing a possible hospital-acquired bladder infection. Which nursing action should the nurse perform first? a. Obtain a urine specimen for culture and sensitivity. b. Administer the prescribed antibiotic medication. c. Teach the client to wipe the perineum front to back. d. Prepare the client for removal of the urinary catheter.
A Non-treated UTI can get up and case pielonephritis
The mother of a child at the renal clinic asks why a radiological evaluation is performed on all children who have had one documented UTI. The best explanation by the nurse will include the information that the x-ray; a. Rules out structural abnormalities b. Confirms the absence of bacterial colonies after antimicrobial therapy c. Determines which kidney was infected d. Determines the probability of the infection recurring
A- Because statistic says 1-2 % of girls and 10 % of boys with UTI have structural abnormalities In addition, the procedure is not invasive
The nurse is planning for the client who is to undergo extracorporeal shock wave lithotripsy (ESWL). Which actions should the nurse include in the plan of care immediately following the procedure? SELECT ALL THAT APPLY a. Instruct on the need to measure and strain all urine. b. Give no fluids or foods for 24 hours post ESWL. c. Check for flank ecchymosis on the affected side. d. Assess the incision for clean, dry, and intactness. e. Remove the stent that was placed during ESWL.
A, C
The female client, being treated for stress incontinence with vaginal cone therapy, calls a clinic to report that she is experiencing burning on urination , chills, and fever. Which is the best instruction by the nurse? a. "Take acetaminophen to relieve the pain and reduce your fever." b. "Come to the clinic. We need to complete a urine culture and sensitivity." c. "Discontinue the use of the vaginal weights to see if the symptoms subside." d. "Drink cranberry juice and increase you fluid intake for the next 48 hours."
B -
A client with renal calculi is advised to restrict calcium in his diet. The nurse determines that the client understands the restrictions when he states he will avoid which of the following? a. Chicken, beef, and salmon b. Green vegetables, fruit, and legumes c. Chocolate, smoked fish, and low-fat milk d. Eggs, meat, and poultry
C
The nurse is completing an admission assessment of the client with a possible obstructing struvite calculus of the right ureter. Which is the best question for the nurse to ask? a. "Are you experiencing any pain in your left flank?" b. "Do you like to drink cranberry, prune, or tomato juice?" c. "Have you had a history of chronic urinary tract infectious?" d. "How often do you eat organ meats, poultry, fish, and sardines?"
C D would be true if the question was asking about uric acid stones stones; because organ meats are rich in uric acid
The nurse caring for a group of clients on a hospital unit with the assistance of the LPN. Which aspect of the client care would be most appropriate for the nurse to delegate to the LPN? a. Competing the admission for the client who has flank pain. b. Preparing the client for a newly prescribed renal biopsy. c. Administering sevelamer hydrochloride to the client with CRF. d. Observing the client self-catheterize a continent ideal reservoir.
C D - Is not because if something goes wrong, you have to teach them
The nurse is preparing to admit a client with urge incontinence. In writing the nursing care plan, the nurse writes interventions that target the client's? a. Involuntary loss of urine without warning or stimulus. b. Loss of urine when coughing or sneezing. c. Inability to empty bladder. d. Inability to stop urine flow long enough to reach the toilet.
D. Inability to stop urine flow long enough to reach the toilet.
The nurse is obtaining a hospital admission history for the client. Which statement should prompt the nurse to consider that the client has had chronic prostatitis? a. "I am having difficulty sustaining an erection." b. "I have pain with ejaculation during intercourse." c. "I have been feeling pressure around my rectum." d. I don't think I am emptying my bladder."
b- Pain with ejaculation because of chronic bacterial infection
Which laboratory test is the best indicator of kidney function? a. Blood urea nitrogen (BUN) b. Creatinine c. Aspartate aminotransferase (AST) d. Alkaline phosphatase
b. Creatinine The laboratory test that is the best indicator of kidney function is creatinine excretion. Creatinine excretion, the end product of muscle metabolism, remains relatively steady and therefore is the best laboratory marker of renal function.BUN may be affected by protein, fluid intake, rapid cell destruction, cancer treatment, steroid therapy, and hepatic damage. AST and alkaline phosphatase are measures of hepatic function.
When planning an assessment of the urethra, what does the nurse do first? a. Examine the meatus. b. Note any unusual discharge. c. Record the presence of abnormalities. d. Don gloves.
d. Don gloves. The nurse will first put on a pair of gloves. When assessing the urethra, the nurse needs to implement body fluid precautions before any other steps are taken.Examining the meatus, noting unusual discharge, and recording the presence of abnormalities are actions the nurse needs to perform after putting on gloves.
A client with a urinary diversion device has the nursing diagnosis risk for impaired skin integrity. Which of the following instructions would the nurse give the client? a. Change urine collection device every other day. b. Teach self-catheterization technique. c. Empty the bag reservoir every 2 hours. d. Monitor for foul-smelling urine.
C - empty the bag every often to prevent further skin break down
The nurse is planning care for the client, who is scheduled for an IVP. Which intervention should the nurse plan to implement? a. Teach that a warm, flushing sensation may occur as the dye is injected. b. Prepare the client for urinary catheterization before the procedure. c. Keep the client NPO after the procedure until test results are obtained. d. Ambulate the client in the hall to promote excretion of the dye.
A- We also have to ask the patient about allergies to dye, shell fish, or hey allergy IVP- intravenous insertion also may give a metallic taste
A nurse reviews a clients laboratory results. Which results from the clients urinalysis should the nurse identify as normal? (Select all that apply.) a. pH: 6 b. Specific gravity: 1.015 c. Protein: 1.2 mg/dL d. Glucose: negative e. Nitrate: small f. Leukocyte esterase: positive
ANS: A, B, D The pH, specific gravity, and glucose are all within normal ranges. A pH between 4.6 and 8, specific gravity between 1.005 and 1.030. The other values are abnormal.
A nurse reviews the urinalysis of a client and notes the presence of glucose. Which action should the nurse take? a. Document findings and continue to monitor the client. b. Contact the provider and recommend a 24-hour urine test. c. Review the clients recent dietary selections. d. Perform a capillary artery glucose assessment.
ANS: D Glucose normally is not found in the urine. The normal renal threshold for glucose is about 220 mg/dL, which means that a person whose blood glucose is less than 220 mg/dL will not have glucose in the urine. A positive finding for glucose on urinalysis indicates high blood sugar. The most appropriate action would be to perform a capillary artery glucose assessment. The client needs further evaluation for this abnormal result; therefore, documenting and continuing to monitor is not appropriate. Requesting a 24-hour urine test or reviewing the clients dietary selections will not assist the nurse to make a clinical decision related to this abnormality.
A nurse cares for a client with a urine specific gravity of 1.040. Which action should the nurse take? a. Obtain a urine culture and sensitivity. b. Place the client on restricted fluids. c. Assess the clients creatinine level. d. Increase the clients fluid intake.
ANS: D Normal specific gravity for urine is 1.005 to 1.030. A high specific gravity can occur with dehydration, decreased kidney blood flow (often because of dehydration), and the presence of antidiuretic hormone. Increasing the clients fluid intake would be a beneficial intervention. Assessing the creatinine or obtaining a urine culture would not provide data necessary for the nurse to make a clinical decision.
The nurse is caring for the female client experiencing new-onset urge urinary incontinence. Which interventions should the nurse implement? SELECT ALL THAT APPLY a. Ensure that the client is taken to the bathroom every 4 hours. b. Give diuretics at supper time so the bladder is empty at night. c. Turn on the water or flush the toilet to assist the client to void. d. Avoid caffeine and foods or beverages that contain aspartame. e. Instruct the client on inserting vaginal weights for daytime use.
C, d , e
The nurse is admitting a hospitalized client who has a renal calculi. Which should be the nurse's priority? a. Encourage the client to increase the amount of oral fluids. b. Obtain necessary supplies to measure and strain all urine. c. Assess the location and the severity of the client's pain. d. Obtain consent for extracorporeal shock wave lithotripsy (ESWL).
a. Assess the location and the severity of the client's pain.
A nurse reviews the allergy list of a client who is scheduled for an intravenous urography. Which client allergy should alert the nurse to urgently contact the health care provider? a. Seafood b. Penicillin c. Bee stings d. Red food dye
ANS: A Clients with seafood allergies often have severe allergic reactions to the standard dyes used during intravenous urography. The other allergies have no impact on the clients safety during an intravenous urography.
A nurse cares for a client with diabetes mellitus who is prescribed metformin (Glucophage) and is scheduled for an intravenous urography. Which action should the nurse take first? a. Contact the provider and recommend discontinuing the metformin. b. Keep the client NPO for at least 6 hours prior to the examination. c. Check the clients capillary artery blood glucose and administer prescribed insulin. d. Administer intravenous fluids to dilute and increase the excretion of dye.
ANS: A Metformin can cause lactic acidosis and renal impairment as the result of an interaction with the dye. This drug must be discontinued for 48 hours before the procedure and not started again after the procedure until urine output is well established. The clients health care provider needs to provide alternative therapy for the client until the metformin can be resumed. Keeping the client NPO, checking the clients blood glucose, and administering intravenous fluids should be part of the clients plan of care, but are not the priority, as the examination should not occur while the client is still taking metformin.
A nurse reviews laboratory results for a client who was admitted for a myocardial infarction and cardiogenic shock 2 days ago. Which laboratory test result should the nurse expect to find? a. Blood urea nitrogen (BUN) of 52 mg/dL b. Creatinine of 2.3 mg/dL c. BUN of 10 mg/dL d. BUN/creatinine ratio of 8:1
ANS: A Shock leads to decreased renal perfusion. An elevated BUN accompanies this condition. The creatinine should be normal because no kidney damage occurred. A low BUN signifies overhydration, malnutrition, or liver damage. A low BUN/creatinine ratio indicates fluid volume excess or acute renal tubular acidosis.
A nurse cares for a client who is recovering from a closed percutaneous kidney biopsy. The client states, My pain has suddenly increased from a 3 to a 10 on a scale of 0 to 10. Which action should the nurse take first? a. Reposition the client on the operative side. b. Administer the prescribed opioid analgesic. c. Assess the pulse rate and blood pressure. d. Examine the color of the clients urine.
ANS: C An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of internal hemorrhage. A change in vital signs can indicate that hemorrhage is occurring. Before other actions, the nurse must assess the clients hemodynamic status.
Which of the following statements by a female client indicates that instruction in ways to prevent urinary tract infection (UTI) was understood? a. "I should limit intake of water so I won't need to urinate so often." b. "I should drink 8 to 10 glasses of fluid per day." c. "I should only wear nylon underpants." d. "I should void every 6 hours while I am awake."
B - flush out bacteria from the system
Which urinary assessment information for a client indicates the potential need for increased fluids? a. Increased blood urea nitrogen b. Increased creatinine c. Pale-colored urine d. Decreased sodium
a. Increased blood urea nitrogen Potential for increased fluids are needed for a client with increased blood urea nitrogen. Increased blood urea nitrogen can indicate dehydration.Increased creatinine indicates kidney impairment. Pale-colored urine signifies diluted urine, which indicates adequate fluid intake. Increased, not decreased, sodium indicates dehydration.
The client with known benign prostatic hyperplasia (BPH), telephones the clinic nurse with concerns of increased urinary frequency and urgency after having a cold that started a few days ago. Which question should the nurse immediately ask the client? a. "Have you been drinking large amounts of water?" b. "Have you been exercising more than usual?" c. "Have you been taking any over-the-counter cold remedies?" d. "Have you increased the amount of dairy products in you diet?"
c. "Have you been taking any over-the-counter cold remedies?" C - tignthen the muscles and the bladder neck
Client who requires diuretic therapy has a creatinine clearance less than 30mL/min. The nurse checks the physician order sheet, expecting to find an order for which of the following types of medications? a. Mannitol (Osmitrol) b. Spironolactone (Aldacrtone) c. Chlorothiazide (Diuril) d. Furosimide (Lasix)
d- the most common one to use in the hospital
A client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the health care provider (HCP) visited the client the day before. What action does the nurse take? a. Asks the client to sign the informed consent b. Cancels the procedure c. Asks the client's spouse to sign the form d. Notifies the department and the HCP
d. Notifies the department and the HCP The nurse notifies both the HCP and the department to ensure effective communication across the continuum of care. This nursing action makes it less likely that essential information will be omitted. The client may be asked to sign the consent form in the department. The HCP gives the client a complete description of and reasons for the procedure and explains complications. The nurse reinforces this information.The procedure would not be cancelled without an attempt to correct the situation. The client has not received sedation, so nothing suggests that the client is not competent to consent and that the spouse needs to sign the form.
