Chapter 53: Assessment of Kidney and Urinary Function H&I

A female client presents to the health clinic for a routine physical examination. The nurse observes that the client's urine is bright yellow. Which question is most appropriate for the nurse to ask the client?

"Do you take multiple vitamin preparations?" Urine that is bright yellow is an anticipated abnormal finding in the client taking a multivitamin preparation. Urine that is orange may be caused by intake of phenytoin or other medications.

A patient is scheduled for a test with contrast to determine kidney function. What statement made by the patient should the nurse inform the physician about prior to testing?

"I am allergic to shrimp." The nurse should obtain the patient's allergy history with emphasis on allergy to iodine, shellfish, and other seafood, because many contrast agents contain iodine.

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."

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." A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected.

A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client?

"You don't need to do any fasting before this noninvasive test." Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. It is not invasive, does not require the injection of a radiopaque dye, and does not require fasting or bowel preparation.

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?

Chronic kidney disease A history of sickle cell anemia predisposes the client to the development of chronic kidney disease. The other disorders are not associated with the development of sickle cell anemia.

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

Computed tomography with contrast

A client has undergone diagnostic testing that involved the insertion of a lighted tube with a telescopic lens. The nurse identifies this test as which of the following?

Cystoscopy Cystoscopy is the visual examination of the inside of the bladder using an instrument called a cystoscope, a lighted tube with a telescopic lens

Following a voiding cystogram, the client has a nursing diagnosis of risk for infection related to the introduction of bacterial following manipulation of the urinary tract. An appropriate nursing intervention for the client is to:

Encourage high fluid intake. A voiding cystogram involves the insertion of a urinary catheter, which can result in the introduction of microorganism into the urinary tract. Fluid intake is encouraged to flush the urinary tract and promote removal of microorganisms. Monitoring for hematuria, applying heat, and straining urine do not address the nursing diagnosis of risk for infection.

An older client is experiencing an increasingly troublesome need to urinate several times through the night. The client's prostate is within normal limits, and the physician prescribes limiting fluid intake after the evening meal. What is another important intervention to keep the client safe?

Increase fluid intake throughout the day. Older persons may need to drink more fluids throughout the day to allow for limiting their intake after the evening meal. Urine formation increases during the night, when leg elevation promotes blood return to the heart and kidneys, and may interrupt sleep patterns

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

A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram?

Pruritus The nurse should be alert for pruritus and urticaria, which may indicate a mild anaphylactic reaction to the arteriogram dye.

The nurse is educating a patient about preparation for an IV urography. What should the nurse be sure to include in the preparation instructions?

The patient may have liquids before the test. IV urography may be used as the initial assessment of many suspected urologic conditions, especially lesions in the kidneys and ureters. The patient preparation is the same as for excretory urography, except fluids are not restricted.

A client is having a blood urea nitrogen (BUN) test. BUN level is:

increased in renal disease and urinary obstruction. BUN is increased in renal disease and urinary obstruction.

A group of students is reviewing for a test on the urinary and renal system. The students demonstrate understanding of the information when they identify which of the following as part of the upper urinary tract?

Ureters The upper urinary tract is composed of the kidneys, renal pelvis, and ureters. The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.

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

Urinary incontinence

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

check the client's pedal pulses After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completelyrequently.

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

drink liberal amounts of fluids. After the procedure is completed, the client is encouraged to drink fluids to promote excretion of the radioisotope by the kidneys. The remaining instructions are not associated with a nuclear scan.

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

A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine?

glucose Amino acids and glucose typically are reabsorbed and not excreted in the urine. The filtrate that is secreted as urine usually contains water, sodium, chloride, bicarbonate, potassium, urea, creatinine, and uric acid.

A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 mL. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of:

microorganism transfer. Bladder ultrasonic scanning, a noninvasive way of calculating the amount of urine in the bladder, reduces the risk of transferring microorganisms into the bladder.

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

oliguria. Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Dysuria refers to painful or difficult urination.

A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is:

renal calculi.

A client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. This test will reveal details about:

renal circulation. A renal angiography (renal arteriography) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.

A patient has an increase in blood osmolality when the nurse reviews the laboratory work. What can this increase indicate for the patient?

ADH stimulation Antidiuretic hormone (ADH), also known as vasopressin, is a hormone that is secreted by the posterior portion of the pituitary gland in response to changes in osmolality of the blood. With decreased water intake, blood osmolality tends to increase, stimulating ADH release.

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 A 24-hour collection of urine is the primary test of renal clearance used to evaluate how well the kidney performs this important excretory function. The client is initially instructed to void and discard the urine.

Medications administered that are renal toxic should have frequent assessments of which blood values?

BUN and creatinine

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?

Bladder With increased age, bladder tone and capacity is decreased. In women, this is compounded by a decrease in estrogen, which causes changes to the urethral sphincter.

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 Renal biopsy carries the risk of post procedure bleeding, because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding

The nurse is providing care to a client who has had a renal biopsy. The nurse would need to be alert for signs and symptoms of which of the following?

Bleeding Renal biopsy carries the risk of postprocedure bleeding because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater.

A 24-year-old patient was admitted to the emergency room after a water skiing accident. The X-rays revealed two fractured vertebrae, T-12 and L1. Based on this information, the nurse would know to perform which of the following actions?

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

The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find?

Costovertebal angle tenderness Acute pyelonephritiis is characterized by costovertebal angle tenderness. Suprapubic pain is suggestive of bladder distention or infection. Urethral trauma and irritation of the bladder neck can cause pain after voiding. Perineal pain is experienced by male clients with prostate cancer or prostatitis.

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?

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

The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition?

Detrusor muscle

A client has a full bladder. Which sound would the nurse expect to hear on percussion?

Dullness Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very dense tissue, such as the bone or muscle.

The nurse is performing a renal assessment on a client with prostate cancer. Which clinical manifestation suggests prostate cancer? Select all that apply.

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

Which is an effect of aging on upper and lower urinary tract function?

More prone to develop hypernatremia The elderly are more prone to develop hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidneys, and acid-base imbalances.

Which term best describes a total urine output less than 500 mL in 24 hours?

Oliguria Oliguria is a urine output less than 500 mL in 24 hours. Polyuria is increased urine output. Nocturia is awakening at night to urinate. Dysuria is painful or difficult urination.

Retention of which electrolyte is the most life-threatening effect of renal failure?

Potassium

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

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 The creatinine clearance measures the volume of blood cleared of endogenous creatinine in 1 minute. This serves as a measure of the glomerular filtration rate. Therefore the creatinine clearance test is a sensitive indicator of renal disease progression.

The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness?

The costovertebral angle

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?

150 The urinary drainage bag contains both the contrast agent and urine at the conclusion of the procedure. Total contents (500 ml) in the drainage bag consist of 350 ml of contrast agent and 150 ml of urine

Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys?

Angiography Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the internal bladder.

An appropriate nursing intervention for the client following a nuclear scan of the kidney is to:

Encourage high fluid intake. A nuclear scan of the kidney involves the IV administration of a radioisotope. Fluid intake is encouraged to flush the urinary tract to promote excretion of the isotope.

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?

10:1

Which value represents a normal BUN-to-creatinine ratio?

10:1

The nurse is completing a full exam of the renal system. Which assessment finding best documents the need to offer the use of the bathroom?

A dull sound when percussing over the bladder A dull sound when percussing over the bladder indicates a full bladder. Because the bladder is full, the nurse would offer for the client to use the bathroom. Tenderness over the kidney can indicate an infection or stones.

A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse?

Asses the patient's back and shoulder areas for signs of internal bleeding. After a renal biopsy, the patient is on bed rest. It is important to assess the dressing frequently for signs of bleeding and evaluate the type and severity of pain. Severe pain in the back, shoulder, or abdomen may indicate bleeding.

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 urgency The nurse would document urinary urgency. Urinary frequency is urinating more frequently than normal often times due to inadequate emptying of the bladder. Urinary incontinence is the involuntary loss of urine. Urinary stasis is a stoppage or diminution of flow.

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

The nurse is preparing the client for magnetic resonance imaging (MRI) of the kidney. Which statement by the client requires action by the nurse?

"I took my blood pressure medication with my morning coffee an hour ago." The client should not eat for at least 1 hour before an MRI. Alcohol, caffeine-containing beverages, and smoking should be avoided for at least 2 hours before an MRI. The client can take his or her usual medications except for iron supplements prior to the procedure.

A patient is being seen in the clinic for possible kidney disease. What major sensitive indicator of kidney disease does the nurse anticipate the patient will be tested for?

Creatinine clearance level Creatinine is an endogenous waste product of skeletal muscle that is filtered at the glomerulus, passed through the tubules with minimal change, and excreted in the urine. Hence, creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition?

Decreased fluid intake When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases. Disorders or conditions that cause decreased urine-specific gravity include diabetes insipidus, glomerulonephritis, and severe renal damage. Disorders that can cause increased specific gravity include diabetes, nephritis, and fluid deficit.

The nurse is instructing a 3-year-old's mother regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as a normal finding for this age group?

Enuresis The nurse would be most correct to document that enuresis, the involuntary voiding during sleep or commonly called "wetting the bed," is a normal finding in a pediatric client younger than 5 years old. Dysuria (pain on urination), hematuria (red blood cells in urine), and anuria (urine output less than 50 mL/day) are all abnormal findings needing further investigation.

While reviewing a client's chart, the nurse notes the client has been experiencing enuresis. To assess whether this remains an ongoing problem for the client, the nurse asks which question?

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

Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Which is an example of how urine concentration is affected?

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

When fluid intake is normal, the specific gravity of urine should be:

1.010 to 1.025 Urine-specific gravity is a measurement of the kidneys' ability to concentrate urine. The specific gravity of water is 1.000. A urine-specific gravity less than 1.010 may indicate inadequate fluid intake. A urine-specific gravity greater than 1.025 may indicate overhydration.

Which value does the nurse recognize as the best clinical measure of renal function?

Creatinine clearance Creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?

Creatinine clearance The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys.

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find?

Increased serum creatinine In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect?

Infection Frequency, urgency, and dysuria are commonly associated with urinary tract infection. Hesitancy and enuresis may indicate an obstruction. Oliguria or anuria and proteinuria might suggest acute renal failure. Nocturia is associated with nephrotic syndrome.

A client is scheduled for a renal angiography. Which of the following would be appropriate before the test?

Monitor the client for an allergy to iodine contrast material. A renal angiography procedure will be contraindicated if the client is allergic to iodine contrast material. Therefore, it is important for the nurse to monitor the client for an allergy to iodine contrast material.

Which of the following hormones is secreted by the juxtaglomerular apparatus?

Renin Renin is a hormone directly involved in the control of arterial blood pressure; it is essential for proper functioning of the glomerulus. ADH, also known as vasopressin, plays a key role in the regulation of extracellular fluid by excreting or retaining water. Calcitonin regulates calcium and phosphorous metabolism.

The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure?

Renin Renin is directly involved in the control of arterial blood pressure. It is also essential for the proper functioning of the glomerulus and management of the body's renin-angiotensin system (RAS)

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

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

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 nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client's symptoms and urine specific gravity is anticipated?

The specific gravity will be high. The nurse assesses all of the data to make an informed decision on client status. On a hot day, the client found outside will be perspiring. When dehydration occurs, a client will have low urine output and increased specific gravity of urine. Normal specific gravity is inversely proportional. The density of distilled water is one. A low specific gravity is noted in a client with high fluid intake and who is not losing systemic fluid.