Complex - Renal Chapter 53

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." Explanation: 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.

While reviewing a patient's chart, the nurse notes the patient has been experiencing enuresis. To assess if this remains an ongoing problem for the patient, the nurse will ask which of the following questions?

"Do you urinate while sleeping?" Explanation: Enuresis is defined as involuntary voiding during sleep.

A nurse measures a patient's urinary output every 8 hours. The nurse weighs the importance of these results by comparing the normal 24-hour urinary output with the patient's condition and medication. The normal 24-hour output should be:

1 to 2 L/day Explanation: The normal output of urine every 24 hours is 800 to 1,500 mL.

The nurse is reviewing the results of renal function studies of a patient. The nurse understands that which of the following is a normal BUN-to-creatinine ratio?

10:1

When the bladder contains 350 mL or more of urine, this is referred to as which of the following?

A marked sense of fullness and discomfort, with a strong desire to void, usually occurs when the bladder contains 350 mL or more of urine, referred to as the "functional capacity."

The nurse is caring for a patient with a medical history of sickle cell anemia. The nurse understands this predisposes the patient to which of the following possible renal or urologic disorders

A medical history of sickle cell anemia predisposes the patient to the development of chronic kidney disease.

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 Explanation: 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.

Which hormone causes the kidney to reabsorb sodium?

Aldosterone

A 42-year-old client is being seen by a urologist in the group where you practice nursing. She is experiencing some secretion abnormalities, for which diagnostics are being performed. Which of the following substances are typically reabsorbed and not secreted in urine?

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.

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).

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

Client reports increasing fatigue. Explanation: Fatigue, shortness of breath, and exercise intolerance are consistent with unexplained anemia, which can be secondary to gradual renal dysfunction.

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

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.

To assess circulating oxygen levels, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommends the use of which of the following diagnostic tests?

Hemoglobin Explanation: Although hematocrit has always been the blood test of choice to assess for anemia, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines, recommend that anemia be quantified using hemoglobin rather than hematocrit measurements. Hemoglobin is recommended as it is more accurate in the assessment of circulating oxygen than hematocrit.

A 76-year-old client is visiting the urologist because of an increasingly troublesome need to urinate several times through the night. After checking his prostate (which was within normal limits), 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. Explanation: 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.

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

Potassium

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

Renal Clearance

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) levels.

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?

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.

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

The elderly are more prone to develop hypernatremia. These patients typically have a decreased GFR, decreased blood flow to the kidney, and acid-base imbalances.

The nephrons are the functional units of the kidney, responsible for the initial formation of urine. The nurse knows that damage to the area of the kidney where the nephrons are located will affect urine formation. Identify that area.

The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex.

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

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.

A creatinine clearance test has been ordered. The nurse prepares to:

Urine test for 24 hours followed by a blood test

Arterial blood gases

assess the adequacy of oxygenation, ventilation, and acid-base status

Oliguria

defined as urine output <0.5 mL/kg/h

Intravenous pyelography

excretory urography is a radiologic study that involves the use of a contrast medium to evaluate the kidneys' ability to excrete it. Emergency Supplies: Suctinon equipment in case of allergy, O2, epinephrine, corticosteriords and vasopressors

Renal angiography

involves the passage of a catheter up the femoral artery into the aorta to the level of the renal vessels. This test measures renal circulation. Provides details about arterial supply to the kidneys, specifically the number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery

Tubular Secretion

is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.

GFR

is the volume of plasma filtered at the glomerulus into the kidney tubules each minute.

Serum iron levels

measure iron storage in the body.

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about:

recent streptococcal infection. Explanation: A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis.

Cystoscopy

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