Chapter 53 Test 2

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: anuria

Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine.

A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? After discarding the 8am 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. The collection bottle is marked with the time the client voided. Thereafter, all the urine is collected for the entire 24 hours. The last urine is voided at the same time the test originally began.

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

Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output less than 50 mL in 24 hours

A patient who complains of a dull, continuous pain in the suprapubic area that occurs with, and at the end of, voiding would most likely be diagnosed with which of the following? intersitial cystitis

Pain over the suprapubic area is most likely related to the bladder. Pain intensity would increase with fullness. Pain at the end of voiding is one of the symptoms associated with interstitial cystitis.

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.

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

Retention of potassium is the most life-threatening effect of renal failure.

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

The bladder wall contains four layers. The smooth muscle layer beneath the adventitia is known as the detrusor layer. When this muscle contracts, urine is released from the bladder. When the bladder is relaxed, the muscle fibers are closed and act as a sphincter

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.

A group of students is reviewing the process of urine elimination. The students demonstrate understanding of the process when they identify which amount of urine as triggering the reflex? 150 ml

The desire to urinate comes from the feeling of bladder fullness. A nerve reflex is triggered when approximately 150 to 200 mL of urine accumulates.

The client presents with nausea and vomiting, absent bowel sounds, and colicky flank pain. The nurse interprets these findings as consistent with: Ureteral colic

These clinical manifestations are consistent with ureteral colic.

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.

A creatinine level has been ordered. The nurse prepares to: obtain blood specimen

A creatinine level is determined from a blood sample. It is used to assess renal function.

Which term refers to casts in the urine? cylindruria

Casts may be identified through microscopic examination of the urine sediment after centrifuging. Crystalluria refers to crystals in the urine.

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.

The client is admitted to the nursing unit for a biopsy of the urinary tract tissue. When planning nursing care for the postoperative period, which nursing intervention documents the prescribed activity level? Maintain the client on bedrest

In the postoperative period, the client remains on bed rest as the nurse assess for signs of bleeding. If the client is to be discharged on the following day, the client is to maintain limited activity for several days to avoid spontaneous bleeding.

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. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

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

Although the kidneys excrete excess water and nitrogen-based waste products of protein metabolism, persistent renal excretion of protein is not the function of kidneys, which are in the state of homeostasis. The kidneys assist in maintenance of acid-base and electrolyte balance; produce the enzyme renin, which helps regulate blood pressure; and produce the hormone erythropoietin.

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.

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

Acute pyelonephritis is characterized by costovertebral 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.

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 undergoes renal angiography. Which postprocedure care intervention should the nurse provide to the client? Palpate the pulses in the legs and feet.

To observe for signs of arterial occlusion in a client who has undergone renal angiography, the nurse should palpate the pulses in the legs and feet. While preparing the client for renal angiography, the nurse asks the client to void. The nurse assesses for signs of electrolyte and water imbalances during the physical examination of a client. The nurse should monitor for signs and symptoms of pyelonephritis in a client who has undergone retrograde pyelography.

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

A marked sense of fullness and discomfort, with a strong desire to void, usually occurs when the bladder contains 400 to 500 mL of urine, referred to as the "functional capacity." Anuria is a total urine output less than 50 mL in 24 hours. Specific gravity reflects the weight of particles dissolved in the urine. Renal clearance refers to the ability of the kidneys to clear solutes from the plasma.

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.

Following a cystoscopy, the client has a nursing diagnosis of acute pain related to the trauma of the procedure to the urinary tract. An appropriate nursing intervention is to: assist with warm sitz bath

Acute pain can be relieved with warm sitz baths. The nurse should monitor the client for urinary retention, which can help detect a potential cause of pain, but this nursing action does not relieve pain. Antibiotics may be prescribed to prevent infection. The pain associated with cystoscopy tends to be confined to the perineal area and lower abdomen not the flank area.

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 clients pedal pulses frequently

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

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 chronic renal failure

Although all of the options may occur in the client with diabetes mellitus, the option which is most notable, and potentially life threatening, is chronic renal failure

A client has been experiencing severe pain and hematuria and is hardly able to ambulate into the physician's office. The physician suspects kidney stones and orders diagnostic tests to confirm. What test would physician order? KUB

An x-ray study of the abdomen includes x-rays of the kidneys, ureters, and bladder (KUB). It is performed to show the size and position of the kidneys, ureters, and bony pelvis as well as any radiopaque urinary calculi (stones), abnormal gas patterns (indicative of renal mass), and anatomic defects of the bony spinal column (indicative of neuropathic bladder dysfunction). Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. A computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen and pelvis may be obtained to diagnose renal pathology, determine kidney size, and evaluate tissue densities with or without contrast.

The wall of the bladder has four layers. Which of the following layers contains a membrane that prevents reabsorption of urine stored in the bladder? Mucosal

Beneath the detrusor is a submucosal layer of loose connective tissue that serves as an interface between the detrusor and the innermost layer, a mucosal lining. This inner layer contains specialized transitional cell epithelium, a membrane that is impermeable to water and prevents reabsorption of urine stored in the bladder.

The nurse analyzes a urinalysis report. He is aware that the presence of this substance in the urine indicates a blood level that exceeds the kidney's reabsorption capacity. Select the substance. glucose

Glucose is usually filtered at the level of the glomerulus. It does not normally appear in the urine. Renal glycosuria occurs if the glucose in the blood exceeds the amount that is able to be reabsorbed. The other substances are normally excreted in the urine.

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 levels

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. Reference:

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. Renal angiography involves the passage of a catheter up the femoral artery into the aorta to the level of the renal vessels. Intravenous pyelography or excretory urography is a radiologic study that involves the use of a contrast medium to evaluate the kidneys' ability to excrete it.

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

Fatigue, shortness of breath, and exercise intolerance are consistent with unexplained anemia, which can be secondary to gradual renal dysfunction.

A client with a history of chronic renal infections is to undergo CT with contrast. Before the procedure, the nurse should complete which action? Place emergency medical equipment in the procedure room

For some clients, contrast agents are nephrotoxic and allergenic. Emergency equipment and medications should be available in case of an anaphylactic reaction to the contrast agent. Emergency supplies include epinephrine, corticosteroids, vasopressors, oxygen, and airway and suction equipment. The client is instructed to maintain a full bladder for an ultrasonography. The other instructions/interventions relate to magnetic resonance imaging.

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 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.

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.

Which is the correct term for the ability of the kidneys to clear solutes from the plasma? Renal clearance

Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. Glomerular filtration rate is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal?

Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal. Renal function can be assessed most accurately if several tests are performed and their results are analyzed together. Common tests of renal function include renal concentration tests, creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein metabolism) concentrations.

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).

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 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? 150ml

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.

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? 20

Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 L/day of filtrate.

A nurse is caring for a client with a fluid and electrolyte imbalance. What urine specific gravity would the nurse expect to measure? 1.018

Urine specific gravity is a measurement of the kidney's ability to concentrate urine; levels between 1.010-1.025 are considered normal. The specific gravity of water is 1.000. A urine specific gravity less than 1.010 may indicate overhydration. A urine specific gravity greater than 1.025 may indicate dehydration.

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

When 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.

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? Decrease 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 recognizes that a referral for genetic counseling is inappropriate for the client with: Renal clculi

Wilms' tumor, polycystic disease, and Alport are conditions that have a genetic influence. Renal calculi are not influenced by genetic factors.

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

term for wetting the bed