Chapter 53: Assessment of Kidney and Urinary Function
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? Renal angiography Intravenous pyelography Excretory urogram Cystoscopy
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When describing the functions of the kidney to a client, which of the following would the nurse include? Regulation of white blood cell production Synthesis of vitamin K Control of water balance Secretion of enzymes
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A nurse is caring for a client with a fluid and electrolyte balance. What urine specific gravity would the nurse expect to measure? 1.018 1.000 1.008 1.028
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A nurse is assisting the physician conducting a cystogram. The client has an intravenous (IV) infusion of D5W at 40 ml/hr. The physician inserts a urinary catheter into the bladder and instills a total of 350 ml of a contrast agent. The nurse empties 500 ml from the urinary catheter drainage bag at the conclusion of the procedure. How many milliliters does the nurse record as urine?
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A creatinine clearance test is ordered for a client with possible renal insufficiency. The nurse must collect which serum concentration midway through the 24-hour urine collection? Blood urea nitrogen Creatinine Osmolality Hemoglobin
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A nurse is describing the renal system to a client with a kidney disorder. Which structure would the nurse identify as emptying into the ureters? Nephron Renal pelvis Parenchyma Glomerulus
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The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document? Urinary frequency Urinary urgency Urinary incontinence Urinary stasis
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The term used to describe total urine output less than 0.5 mL/kg/hr is oliguria. anuria. nocturia. dysuria.
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Which hormone causes the kidneys to reabsorb sodium? Antidiuretic hormone Aldosterone Growth hormone Prostaglandins
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The most frequent reason for admission to skilled care facilities includes which of the following? Urinary incontinence Congestive heart failure Stroke Myocardial infarction
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The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse understand that oliguria is said to be present? When the urine output is less than 30 mL/h When the urine output is about 100 mL/h When the urine output is between 300 and 500 mL/h When the urine output is between 500 and 1,000 mL/h
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An appropriate nursing intervention for the client following a nuclear scan of the kidney is to: Encourage high fluid intake. Strain all urine for 48 hours. Apply moist heat to the flank area. Monitor for hematuria.
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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." "You will be sent home with a urinary catheter." "You may resume consuming caffeinated, carbonated, and alcoholic beverages." "You can stop taking the prescribed antibiotic."
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Which of the following hormones is secreted by the juxtaglomerular apparatus? Renin Aldosterone Antidiuretic hormone (ADH) Calcitonin
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The nurse is educating a patient about preparation for an IV urography. What should the nurse be sure to include in the preparation instructions? A liquid restriction for 8 to 10 hours before the test is required The patient may have liquids before the test. The patient will have enemas until the urine is clear. The patient is restricted from eating or drinking from midnight until after the test.
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The nurse observes that the client's urine is orange. Which additional assessment would be important for this client? Bleeding Intake of medication such as phenazopyridine hydrochloride Intake of multiple vitamin preparations Infection
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Which is an effect of aging on upper and lower urinary tract function? Increased glomerular filtration rate More prone to develop hypernatremia Increased blood flow to the kidneys Acid-base balance
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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 Uric acid level Blood urea nitrogen (BUN) BUN to creatinine ratio
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The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? Costovertebal angle tenderness Suprapubic pain Pain after voiding Perineal pain
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A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? GI absorption rate Therapeutic index Creatinine clearance Liver function studies
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A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? glucose potassium creatinine chloride
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A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact? The left kidney usually is slightly higher than the right one. The kidneys are situated just above the adrenal glands. The average kidney is approximately 5 cm (2 in.) long and 2 to 3 cm (0.8 to 1.2 in.) wide. The kidneys lie between the 10th and 12th thoracic vertebrae.
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Although the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which is NOT a function of the kidneys? excreting protein excreting nitrogen waste products regulating blood pressure stimulating RBC production
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The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions? "I can resume my usual activities without restriction." "I should increase my fluid intake for the rest of the day." "If I have difficulty urinating, I should contact my physician." "It is normal for my urine to be blood-tinged."
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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." "I had my last cigarette 3 hours ago with my morning coffee." "I did not take my multivitamin this morning." "I do not have a pacemaker, artificial heart valve, or artificial joints."
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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 Infection Dehydration Allergic reaction
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The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? "I will feel a warm sensation as the dye is injected." "I should remove all jewelry before the test." "I should let the staff know if I feel claustrophobic." "I will need to drink all of the dye as quickly as possible."
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The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: Specific gravity 1.035 Creatinine 0.7 mg/dL Protein 15 mg/dL Bright yellow urine
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The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following? Kidney stones Neurogenic bladder Chronic renal failure Fistula
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Which nursing assessment finding indicates the client with renal dysfunction has not met expected outcomes? Client reports increasing fatigue. Client rates pain at a 3 on a scale of 0 to 10. Client denies frequency and urgency. Urine output is 100 ml/hr.
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Which of the following is used to identify vesicoureteral reflux? Voiding cystourethrography IV urography Renal angiography Bladder ultrasonography
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Enlargement of the prostate causes which of the following to occur? Select all that apply. Frequency Oliguria Anuria Obstruction of urine flow Polyuria
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A client reports "bloody" urine to the nurse. What causes would the nurse relate the hematuria? Select all that apply. acute glomerulonephritis hypertension renal stones extreme exercise lithium toxicity
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A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? After discarding the 8:00 am specimen At 8:00 am, with or without a specimen 6 hours after the urine is discarded With the first specimen voided after 8:00 am
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A client has a full bladder. Which sound would the nurse expect to hear on percussion? Tympany Dullness Resonance Flatness
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A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? Monitor the client for signs of electrolyte and water imbalance. Monitor the client for an allergy to iodine contrast material. Assess the client's mental changes. Evaluate the client for periorbital edema.
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The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition? Adventitia (connective tissue) Detrusor muscle Submucosal layer of connective tissue Inner layer of epithelium
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Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys? Radiography Angiography Computed tomography (CT scan) Cystoscopy
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A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client? "An x-ray will be done to view your kidneys, ureters, and bladder." "A contrast medium will be used to help see the structures better." "You don't need to do any fasting before this noninvasive test." "You'll have a pressure dressing on your groin after the test."
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A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 mL. Urine output that's less than 50 ml in 24 hours is known as: oliguria. polyuria. anuria. hematuria.
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A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? Decreased blood urea nitrogen (BUN) Increased serum albumin Increased serum creatinine Decreased potassium
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Retention of which electrolyte is the most life-threatening effect of renal failure? Calcium Sodium Potassium Phosphorous
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The nurse is assessing a patient upon admission to the hospital. What significant nursing assessment data is relevant to renal function? Select all that apply. Any voiding disorders The patient's occupation The presence of hypertension or diabetes The patient's financial status The ability of the patient to manage activities of daily living
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The nurse is caring for a client with a history of sickle cell anemia. The nurse understands that this predisposes the client to which renal or urologic disorder? Kidney stone formation Proteinuria Chronic kidney disease Neurogenic bladder
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As women age, many experience an increased sense of urgency to void, as well as an increased risk of incontinence. This is usually the result of age-related changes in which part of the renal system? Kidney Nephron Tubule system Bladder
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The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable? Clients have frequent urinary tract infections. Clients develop a neurogenic bladder. Clients have urinary frequency. Clients have chronic renal failure.
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The nurse is reviewing the results of a client's renal function study. The nurse understands that which value represent a normal BUN-to-creatinine ratio? 4:1 6:1 8:1 10:1
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When fluid intake is normal, the specific gravity of urine should be: 1.000 Less than 1.010 Greater than 1.025 1.010 to 1.025
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