MS 57 ***Urinary

A kidney biopsy has been scheduled for a patient with a history of acute renal failure. The patient asks the nurse why this test has been scheduled. What is the nurse's best response?

"A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."

A patient presents to the ED complaining of left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The patient has also experienced nausea and emesis. The nurse suspects the patient is experiencing which of the following?

Ureteral stones

A nurse is preparing a patient diagnosed with benign prostatic hypertrophy (BPH) for a lower urinary tract cystoscopic examination. The nurse informs the patient that the most common temporary complication experienced after this procedure is what?

Urinary retention

Within the urology group where you practice nursing, clients with urinary tract infections are frequently seen by physicians. In a diagnosis of a lower urinary tract infection, which structures could be affected? Choose all correct options.

• Bladder • Urethra

The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply.

• Secretion of prostaglandins • Regulation of blood pressure • Vitamin D synthesis

Within the urology group where you practice nursing, clients with urinary tract infections are frequently seen by physicians. In a diagnosis of an upper urinary tract infection, which structures could be affected? Choose all correct options.

• Ureter • Kidney

The nurse is reviewing the client's lab results. Which lab result requires follow up by the nurse? Select all that apply.

• Urine: RBC 20 • BUN 28 mg/dL

A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult?

"Remember to drink frequently, even if you don't feel thirsty."

A nursing student asks the nurse why older adults are at risk for renal disease. The best response by the nurse is:

"The glomerular filtration rate decreases as we age."

The nurse caring for a patient with suspected renal dysfunction calculates that the patient's weight has increased by 5 pounds in the past 24 hours. The nurse estimates that the patient has retained approximately how much fluid?

2,300 mL of fluid in 24 hours

You are examining a urinalysis laboratory report of a client who is undergoing a diagnostic workup. You know that the normal urine pH range should be

4.5 to 7.5.

The nurse is evaluating the urinary system of an older adult male client who reports that his stream seems to have decreased. The nurse educates the client that urine flow rate decreases with age, and that the average flow rate in older men is? (Fill in the blank with a number.)

9

A 42-year-old client is being seen by an 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?

Glucose

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

Oliguria

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

The client voids 75 cc four hours post cystoscopy.

Which of the following is a normal BUN to creatinine ratio?

10:1

The nurse observes the patient's urine to be orange. Which additional assessment would be important for this patient?

Intake of medication such as phenytoin (Dilantin)

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?"

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."

When fluid intake is normal, the specific gravity of urine should be which of the following?

1.010 to 1.025

An older female client reports that she feels like she does not urinate as strongly or quickly as she did when she was younger. The nurse educates the client that urinary flow rates do decline with aging, and that the average rate for older women is? (Fill in the blank with a number.)

10

A nurse is caring for a 73-year-old male patient with a urethral obstruction related to prostatic enlargement. The nurse is aware this may result in what?

A urinary tract infection

A 32-year-old client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure and post-procedural assessments. What post-procedural assessment will you perform on the client?

All options are correct

The nurse is caring for a patient who has a fluid volume deficit. When evaluating this patient's urinalysis results, what should the nurse anticipate?

An increased urine specific gravity

The nurse is caring for a patient who is not allowed oral intake of fluid or food. When evaluating this patient's urinalysis, what would the nurse anticipate?

An increased urine specific gravity

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

Renin

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?

Glucose

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

A patient is complaining of genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform?

Apply moist heat to the patient's lower abdomen.

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.

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

Assess the patient's back and shoulder areas for signs of internal bleeding.

What nursing action should the nurse perform when caring for a patient undergoing diagnostic testing of the renal-urologic system?

Assess the patient's understanding of the test results after their completion.

The nurse is performing a focused genitourinary and renal assessment of a patient. Where should the nurse assess for pain at the costovertebral angle?

At the lower border of the 12th rib and the spine

The nursing instructor is teaching the students assessment skills in the lab. Where would the instructor teach the students to assess for pain at the costovertebral angle?

At the lower border of the 12th rib and the spine

Your client is having a blood urea nitrogen (BUN) test run. What do you recall from your studies that is true about BUN levels?

BUN is increased in renal disease and urinary obstruction.

To obtain information about the chief complaint and medical history of an older male client, the nurse asks the client about his medication history. Why is it important to obtain medication history from the client?

Because the medication history may indicate multiple medications administered by the client

Which of the following does the nurse recognize is the best clinical measure of renal function?

Creatinine clearance

The nurse is caring for a patient following a cystoscopic examination. Following the procedure, the nurse informs the patient that which of the following may occur?

Blood-tinged urine

The nurse discusses a care plan with a male patient who is to be discharged after a biopsy. He is instructed to maintain limited activity and report signs of systemic infection, urinary tract infection, or bleeding. Which additional instructions should the nurse include in the care plan?

Complete the prophylactic antibiotic therapy.

A creatinine clearance test is ordered for a patient with possible renal insufficiency. It is necessary for the nurse to collect which of the following serum levels midway through the 24-hour urine collection?

Creatinine

Urodynamic studies evaluate bladder and urethral function and are performed to assess causes of reduced urine flow, urinary retention, and urinary incontinence. Of the following tests, which is the urodynamic study that evaluates the bladder tone and capacity?

Cystometrography

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

Decreased fluid intake

A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse should be aware of what age-related change affecting the renal or urinary system?

Decreased glomerular filtration rate

Diagnostic testing of an adult patient reveals renal glycosuria. The nurse should recognize the need for the patient to be assessed for what health problem?

Diabetes mellitus

The nurse notes that the client's urine is blood-tinged following cystoscopy. Which of the following nursing actions should the nurse do next?

Document the finding in the health record.

The term used to describe painful or difficult urination is which of the following?

Dysuria

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 nurse, when caring for a client, notes that the specific gravity of the client's urine is low. What could have lead to the low specific gravity of urine?

Excess fluid intake

In starting your new job as a nurse with a group of renal specialists, you begin your orientation with a thorough review of renal function. Although the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which of the following is NOT a function of the kidneys?

Excreting protein

In starting your new job as a nurse with a group of renal specialists, you begin your orientation with a thorough review of renal function. While the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which of the following is NOT a function of the kidneys?

Excreting protein

The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient the nurse recalls that several substances are filtered from the blood by the glomerulus and these substances are then excreted in the urine. The nurse identifies the presence of which substances in the urine as abnormal findings?

Glucose and protein

The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, the nurse interprets the presence of which substances in the urine as most suggestive of pathology?

Glucose and protein

A patient with a history of progressively worsening fatigue is undergoing a comprehensive assessment which includes test of renal function relating to erythropoiesis. When assessing the oxygen transport ability of the blood, the nurse should prioritize the review of what blood value?

Hemoglobin

The nursing instructor is talking about monitoring laboratory tests in renal and urinary tract dysfunction. What is monitored to assess for anemia?

Hemoglobin

The nurse is assessing a patient's bladder by percussion. The nurse elicits dullness after voiding. What does this finding indicate?

Incomplete bladder emptying

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.

A nurse is working with a patient who will undergo invasive urologic testing. The nurse has informed the patient that slight hematuria may occur after the testing is complete. The nurse should recommend what action to help resolve hematuria?

Increased fluid intake following the test

The nurse is providing pre-procedure teaching about an ultrasound. The nurse informs the patient that in preparation for an ultrasound of the lower urinary tract the patient will require what?

Increased fluid intake to produce a full bladder

A 54-year-old machinist is being seen by a physician within the urology group where you practice nursing. He has been experiencing severe pain and hematuria, hardly able to ambulate into the physician's office. The physician orders diagnostic tests to confirm his suspicion of kidney stones. What test would you expect the physician to order?

KUB

You are caring for a patient who is going to have an open renal biopsy. What would be an important nursing action in preparing this patient for the procedure?

Keep the patient NPO.

A 32 year old female client has come to your clinic with a complaint of hematuria, or the presence of red blood cells in the urine. Of the following, which is not a cause of hematuria?

Lithium toxicity

You are reviewing the guidelines for the care of clients undergoing intravenous or retrograde pyelography. All of the following are guidelines for postprocedural and discharge care except one. Choose the incorrect choice.

The client should limit fluid intake for 24 hours.

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. Select the correct example of how urine concentration is affected from among the following statements.

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

You are caring for a patient with renal dysfunction. The patient tells you that the pain in their right flank has gotten worse. Why would you notify the physician of the increased pain?

Pain may indicate progression or recurrence of dysfunction, or untoward signs.

A male patient undergoes a renal angiogram. The nurse prepares the patient for the test and provides postprocedure care to the patient. Which of the following postprocedure care interventions should the nurse provide to the patient who has already undergone a renal angiogram?

Palpate the pulses in the legs and feet

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

Potassium

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 is caring for a patient complaining of orange-colored urine. The nurse suspects which of the following as the cause of the urine discoloration?

Pyridium (phenazopyridium HCl)

A 32-year-old flight attendant is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure. The client asks what the angiography will reveal. What is your response as her nurse?

Renal circulation

A 32-year-old flight attendant is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure. The client asks what the angiography will reveal. What is your response, as her nurse?

Renal circulation

The nurse is caring for a patient with a nursing diagnosis of deficient fluid volume. The nurse's assessment reveals a BP of 98/52 mm Hg. The nurse should recognize that the patient's kidneys will compensate by secreting what substance?

Renin

A diabetic patient with renal failure has been admitted to your unit. What is the most life-threatening effect of renal failure you will monitor for?

Retention of potassium

A patient with renal failure secondary to diabetic nephropathy has been admitted to the medical unit. What is the most life-threatening effect of renal failure for which the nurse should monitor the patient?

Retention of 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

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

Susceptibility to develop hypernatremia

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.

A patient's most recent laboratory findings indicate a glomerular filtration rate (GFR) of 58 mL/min. The nurse should recognize what implication of this diagnostic finding?

The patient is likely to have increased serum creatinine levels.

A patient with elevated BUN and creatinine values has been referred by her primary physician for further evaluation. The nurse should anticipate the use of what initial diagnostic test?

Ultrasound

A patient admitted to the medical unit with impaired renal function is complaining of severe, stabbing pain in the flank and lower abdomen. The patient is being assessed for renal calculi. The nurse recognizes that the stone is most likely in what anatomic location?

Ureter

The client in your clinic has been asked to bring you a clean-catch midstream urine specimen. It is important that the instructions are clear and that things are done in the proper order. Select the proper sequence of events for obtaining a specimen from a client.

Wash your hands and remove the lid from the specimen container without touching the inside of the lid. Open the antiseptic towelette package and cleanse the urethral area. Begin voiding into the toilet. Void 30 to 50 mL of the midstream urine into the toilet, taking care not to contaminate the container. Carefully replace the lid, dry the container if necessary, and wash your hands.

The care team is considering the use of dialysis in a patient whose renal function is progressively declining. Renal replacement therapy is indicated in which of the following situations?

When about 80% of the nephrons are no longer functioning

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 frequently.