NUR240 WK. 2 CH. 60 Assessment of Renal/Urinary System

When assessing a patient suspected of having a kidney disorder, the nurse would ask which question to help confirm the diagnosis? Select all that apply. One, some, or all responses may be correct.

*** A: "Do you have a history of hypertension?" *** B: "Do you have a history of kidney stones?" C: "Do you have a family history of diabetes mellitus?" D: "Do you have a family history of cardiovascular disease?" E: "Do you have a family history of any autoimmune diseases?"

When explaining a scheduled bedside sonography procedure to a patient, which statement indicates patient understanding of the procedure? Select all that apply. One, some, or all responses may be correct.

*** A: "The technician will place the ultrasound gel pad above the pubic bone." B: "Overweight patients require the use of a gel over the scanning area." *** C: "The ultrasound projects toward my coccyx area." *** D: "Placement of the probe's midline will be over my abdomen and above the pubic bone." E: "I need to sign an informed consent form prior to the procedure." Rationale: Bedside sonography is a noninvasive method used to estimate bladder volume. The technician should place the ultrasound gel pad above the pubic bone and aim the toward the patient's coccyx. Placement of the probe's midline should be over the abdomen about 4 cm above the pubic bone to obtain accurate results. During bedside sonography, the technician should use the gel on the scanner head rather than on the scanning area in the case of obese patients to visualize the images clearly. The procedure is noninvasive and does not require a signed consent form or patient preparation beyond an explanation of what to expect during the procedure.

Which urine abnormality would the nurse expect for a patient who consumes a protein-rich diet?

*** A: Acidic urine B: Glucose in urine C: Foul-smelling urine D: High bilirubin levels in urine Rationale: A protein-rich diet is high in purines, which may increase the levels of uric acid in the urine, resulting in acidic urine. The presence of glucose in the urine indicates renal failure, which is not a finding associated with a protein-rich diet. The presence of foul-smelling urine is associated with infection or the ingestion of certain foods. A patient with jaundice will have high bilirubin levels in the urine because of the excess breakdown of red blood cells.

A nurse assesses a client recovering from a cystoscopy. Which assessment findings would alert the nurse to urgently contact the primary health care provider? (Select all that apply)

*** A: Decrease in urine output B: Tolerating oral fluids C: Prescription for metformin *** D: Blood clots present in the urine E: Burning sensation when urinating

Which description would the nurse associate with urine turbidity on a urinalysis report?

*** A: Presence of proteins B: Highly concentrated urine C: Presence of red blood cells D: Increased urinary bilirubin level Rationale: Turbid urine indicates the presence of proteins in the urine. Increased amounts of protein indicate stress, infection, recent strenuous exercise, or glomerular disorders. Dark red or brown urine indicates the presence of red blood cells in the urine. Highly concentrated urine is dark amber in color, generally occurring because of dehydration or after long hours of restricted fluid intake. Brown urine indicates an increased urinary bilirubin level.

For the older-adult patient in the emergency department with a distended bladder and an inability to void, which priority intervention would the nurse implement?

*** A: Privacy B: IV fluids C: Increased oral fluids D: Health history forms

The nurse delegates completing a bladder scan to assistive personnel (AP). Which action by the AP indicates that the nurse must provide additional instructions when delegating this task?

*** A: Selecting the female icon for all female patients and male icon for all male patients B: Telling the client, "This test measures the amount of urine in your bladder" C: Applying ultrasound gel to the scanning head and removing it when finished D: Taking at least two readings using the aiming icon to place the scanning head

When discussing urinary and sexual hygiene with adult patients, the nurse would use which terms when referring to the patient's reproductive body parts?

*** A: Words that the patient uses B: Technical and medical terminology C: Easily understood children's terms D: "Socially" heard terms and slang words

A nurse reviews the urinalysis of a client and notes the presence of glucose. What action would the nurse take?

A: Document the findings and continue to monitor the client. B: Contact the primary health care provider and recommend a 24-hour urine test. C: Review the client's recent dietary selections over 3 days. *** D: Perform a finger stick blood glucose assessment

Which urinalysis finding indicates the presence of a urinary tract infection (UTI)? Select all that apply. One, some, or all responses may be correct.

*** A: Casts *** B: Red blood cells *** C: White blood cells *** D: Combination of a positive leukocyte esterase and nitrate E: Presence of more than 20 epithelial cells/high-power field Rationale: The presence of casts, red blood cells, white blood cells, and the combination of a positive leukocyte esterase and nitrate are all indicative of a UTI. The presence of more than 20 epithelial cells/high-power field suggests contamination; in this case, the nurse should collect a new specimen.

When suspecting a urinary obstruction in a patient with renal colic and an increased bilirubin level, the nurse would associate which diagnostic test with identifying the obstruction?

*** A: Cystoscopy B: Renal arteriography C: Cystometrography D: Electromyography Rationale: A cystoscopy examines for bladder trauma and helps identify the causes of a urinary tract obstruction. Renal arteriography is a test used to determine blood vessel size and abnormalities. Cystometrography evaluates bladder capacity, bladder pressure, and voiding reflexes. Electromyography tests the strength of the muscles used in voiding.

When a patient's urinalysis reports a high specific gravity, which problem would the nurse associate with the probable cause?

*** A: Dehydration B: High fluid intake C: High renal blood flow D: Low vasopressin level Rationale: Specific gravity reflects the concentration of particles in the urine. An adult's normal urine specific gravity is 1.005 to 1.030. Dehydration results in concentrated urine that increases the specific gravity of urine, while high fluid intake decreases the specific gravity of urine. Vasopressin stimulates reabsorption of water, and reduced vasopressin results in low specific gravity. Decreased blood flow to the kidneys results in high specific gravity.

Which action would the nurse implement first when planning an assessment of a patient's urethra?

*** A: Don gloves. B: Examine the meatus. C: Note any unusual discharge. D: Record the presence of abnormalities. Rationale: Before examination begins, the nurse should implement body fluid precautions (don gloves) first. Examining the meatus, noting unusual discharge, or recording the presence of abnormalities are actions the nurse should perform after putting on gloves.

A nurse plans care for an older adult patient. Which interventions should the nurse include in this client's plan of care to promote kidney health? (Select all that apply)

*** A: Ensure adequate fluid intake *** B: Leave the bathroom light on at night C: Encourage use of the toilet every 6 hours D: Delegate bladder training instructions to the assistive personnel (AP) *** E: Provide thorough perineal care after each voiding *** F: Assess for urinary retention and urinary tract infection

The nurse is preparing a client for a percutaneous kidney biopsy. Which laboratory tests results would the nurse review prior to the procedure? (Select all that apply)

*** A: Hemoglobin *** B: Hematocrit C: Sodium D: Potassium *** E: Platelet count *** F: Prothrombin time

After ruling out kidney disease, the nurse would suspect which additional condition as a potential cause of a patient's elevated blood urea nitrogen (BUN)? Select all that apply. One, some, or all responses may be correct.

*** A: Infection *** B: Dehydration C: Fluid overload D: Increased blood pressure *** E: Decreased cardiac output Rationale: Conditions other than kidney disease may increase the patient's BUN level. Rapid cell destruction from infection may increase the BUN level. Additionally, dehydration and decreased cardiac output may increase the patient's BUN level. Fluid overload decreases rather than increases the BUN level. Increased blood pressure by itself does not affect the patient's BUN level.

A nurse contacts the primary health care provider after reviewing a client's laboratory results and noting a blood urea nitrogen (BUN) of 35mg/dL and a serum creatinine of 1.0 mg/dL. What collaborative care measure would the nurse recommend?

*** A: Intravenous fluids B: Hemodialysis C: Fluid restriction D: Urine culture and sensitivity

A nurse prepares a client for a percutaneous kidney biopsy. What actions should the nurse take prior to this procedure? (Select all that apply)

*** A: Keep the client NPO for 4 to 6 hours *** B: Review coagulation study results C: Maintain strict bedrest in a supine position D: Assess for blood in the client's urine *** E: Administer client's antihypertensive medications

Which component on a patient's urinalysis report leads the nurse to suspect the patient has a urinary tract infection?

*** A: Nitrites B: Crystals C: Ketones D: Red blood cells Rationale: The presence of nitrites in the urine is indicative of a urinary tract infection. When the laboratory does not receive a urine specimen immediately, or if there is failure to refrigerate the specimen if a delay is anticipated in sending the specimen, urinary crystals may develop. The presence of ketones in the urine indicates diabetic ketoacidosis, prolonged fasting, or anorexia nervosa. The presence of red blood cells in the urine can occur normally with catheterization, stones, or glomerular disorders.

Which assessment finding would the nurse associate with a very low erythropoietin level for a patient with chronic kidney disease? Select all that apply. One, some, or all responses may be correct.

*** A: Pale skin B: Dilute urine C: Bradycardia D: Jaundiced skin *** E: Reduced oxygen level Rationale: Kidney disease often causes a decrease in erythropoietin, causing anemia. Anemia, or a decrease in red blood cells, may manifest as pale skin and reduced oxygen levels. Increased fluid intake or an alteration in the concentration of urine causes diluted urine. Anemia would cause tachycardia (increased heart rate), not bradycardia (decreased heart rate). Jaundiced skin is an increased amount of bilirubin in the blood, often caused by liver disease, not renal disease.

When reviewing the laboratory reports of four assigned patients, the nurse understands that which patient most likely has kidney impairment?

*** A: Patient A The normal range of serum creatinine in adult men and women is 0.6 to 1.2 mg/dL and 0.5 to 1.1 mg/dL, respectively. The normal BUN range is 10 to 20 mg/dL. The increased level of serum creatinine may indicate kidney impairment. For Patient A, the obtained laboratory values for both serum creatinine and BUN are above the normal range. Therefore this patient is more prone to have impaired kidneys. Patient B's values are borderline. Patients C and D have values in the normal range.

Of the patients scheduled for CT with contrast, which patient would prompt the nurse to communicate safety concerns to the health care provider? Select all that apply. One, some, or all responses may be correct.

*** A: Patient with an allergy to shrimp *** B: Patient with a history of asthma *** C: Patient who took metformin 4 hours ago D: Patient who requests morphine sulfate every 3 hours *** E: Patient with a blood urea nitrogen (BUN) of 62 mg/dL and a creatinine level of 2.0 mg/dL Rationale: The nurse should ask the patient scheduled for a CT about known hay fever or food or drug allergies, especially to seafood, eggs, milk, or chocolate. Reported contrast reactions have been as high as 15% in these patients. Patients with asthma have a greater risk for contrast reactions than the general public. When reactions do occur, they are more likely to be severe. The risk for contrast-induced nephropathy increases in patients who have pre-existing renal insufficiency (e.g., serum creatinine levels greater than 1.5 mg/dL or estimated glomerular filtration rate [GFR] less than 45 mL/min). Metformin should be temporarily discontinued at least 24 hours before and for at least 48 hours after any study using contrast media because the life-threatening complication of lactic acidosis, though rare, could occur. There are no contraindications to undergo CT with contrast while taking morphine sulfate. CT with contrast may help identify the underlying cause of pain.

Which rationale would the nurse associate with a patient's urinalysis report reflecting a pH value of 4?

*** A: The patient is on a high-protein diet. B: The patient has a high intake of citrus fruits. C: The patient's urine has multiple bacteria, indicating an infection. D: The patient's urine specimen remained uncovered after collection. Rationale: The pH value of urine is the measure of urine acidity or alkalinity. The pH of less than 7 indicates acidic urine. A high protein diet causes metabolic acidosis and decreases the pH of the urine. A high intake of citrus fruits produces alkaline urine. Infection with bacteria increases the pH of urine because the bacteria split the urea into ammonia, making the urine alkaline. If the specimen of urine remained uncovered after collection, the carbon dioxide (acid) of the urine lost in the air increases the pH, and the pH of the urine rises (alkalotic).

For which purpose would a patient with a kidney disorder have a diagnostic renal scan performed?

*** A: To evaluate renal perfusion B: To detect the backward flow of urine C: To examine the structure of the urethra D: To identify abnormalities of the bladder wall Rationale: A renal scan is the diagnostic test used to evaluate renal perfusion in patients with kidney disorders. Cystography and cystourethrography examine the structure of the urethra and also to detect the backward flow of urine. Cystoscopy is the diagnostic test used to identify abnormalities of the bladder wall in patients with disorders of the kidneys.

When assessing urinary incontinence in a patient with kidney dysfunction, the nurse would use which diagnostic test?

*** A: Urine stream testing B: Electromyography (EMG) C: Cystometrography (CMG) D: Urethral pressure profilometry (UPP) Rationale: Urine stream testing evaluates the effectiveness of pelvic muscles in stopping urinary flow; therefore the test assesses urinary incontinence in patients with kidney dysfunction. EMG of the perineal muscles tests the strength of the muscles used for voiding. CMG determines the bladder wall muscle functions and sensitivity of the bladder when stretched. UPP provides information about the nature of urinary incontinence or retention.

A nurse reviews a client's laboratory results. Which results from the client's urinalysis would the nurse identify as normal? (Select all that apply)

*** A: pH 6 *** B: Specific gravity: 1.015 C: Protein: 1.2 mg/dL *** D: Glucose: negative E: Nitrate: small F: Leukocyte esterase: positive

Which urinalysis finding would the nurse recognize as normal? Select all that apply. One, some, or all responses may be correct.

*** A: pH of 6.0 B; Foul smell *** C: Clear urine *** D: Pale yellow urine E: 4 to 5 red blood cells (RBCs) per high-power field (HPF) Rationale: Normal urine is pale yellow, clear, and has a pH of 6.0. Changes in color could be due to the concentration of urine or from diet or drugs. Cloudy urine indicates the presence of infection, sediment, or high levels of urinary protein. Diet or drugs can affect the urinary pH. Urine normally has an ammonic odor. A foul smell indicates the presence of infection, dehydration, or certain foods or drugs. Normally, there can be 0 to 2 RBCs per HPF. Increased numbers of RBCs indicate trauma or bleeding disorders.

A nurse reviews the urinalysis results of a client and notes a urine osmolality of 1200mOsm/kg. Which action would the nurse take?

A: Contact the primary health care provider to recommend a low-sodium diet B: Prepare to administer an intravenous diuretic *** C: Encourage the client to drink more fluids D: Obtain a suction device and implement seizure precautions

Which statement would the nurse make to a patient upon return from a captopril renal scan?

A: "I must measure your intake and output." B: "I must attach you to this cardiac monitor." C: "We must save your urine because it is radioactive." *** D: "Arise slowly and call for assistance when ambulating." Rationale: Captopril can cause severe hypotension during and after the procedure, so the nurse should warn the patient to avoid rapid position changes and about the risk for falling as a result of orthostatic (positional) hypotension. Intake and output measurements are not necessary after this procedure, unless they are requested before the procedure. A renal scan uses a small amount of radionuclide; the urine is not radioactive, although the nurse should practice Standard Precautions, as always, and wear gloves. The nurse does not need to initiate cardiac monitoring, although the nurse should monitor for hypotension secondary to captopril.

A nurse assesses a client with renal insufficiency and a low red blood cell count. The client asks, "Is my anemia related to my kidney problem?" How would the nurse respond?

A: "Red blood cells produce erythropoietin, which increases blood flow to the kidneys." B: "Your anemia and kidney problem are related to inadequate vitamin D and a loss of bone density" *** C: Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow" D: "kidney insufficiency inhibits active transportation of red blood cells throughout the blood"

Which intervention would the nurse implement for a patient after a retrograde cystography?

A: Administer analgesics as prescribed. B: Monitor for systemic allergic response. *** C: Monitor for manifestations of infection. D: Monitor for dye-induced acute kidney injury. Rationale: The nurse should monitor the patient for manifestations of infection potentially caused by placing instruments in the urinary tract. Administer analgesics to provide comfort to patients after an electromyography. Retrograde examination of the bladder or cystography involves instilling dye into the lower urinary tract. The dye does not enter the bloodstream; therefore the patient is not at risk for a systemic allergic response or dye-induced acute kidney injury.

A nurse reviews the health history of a client with an over-secretion of renin. Which disorder would the nurse correlate with this assessment finding?

A: Alzheimer disease *** B: Hypertension C: Diabetes mellitus D: Viral hepatits

Which term would the nurse use to document a patient's report of discomfort and pain when voiding?

A: Anuria *** B: Dysuria C: Oliguria 4: Polyuria Rationale: Discomfort and pain associated with voiding is known as dysuria and is associated with urinary retention or urinary tract infection. The condition in which the total urine output is less than 100 mL in 24 hours is known as anuria. When total urine output is between 100 and 400 mL in 24 hours, the condition is known as oliguria. Polyuria is increased urine output, usually greater than 2000 mL in 24 hours.

Which action would the nurse implement when providing care for a patient who has a urinary catheter after undergoing a cystoscopy to remove an enlarged prostate gland?

A: Ask the patient to avoid oral fluids. B: Tell the patient to expect urinary frequency. *** C: Report any fever to the health care provider. D: Tell the patient to expect blood clots in the urine. Rationale: Fever with or without chills is suggestive of infection and should be reported by the nurse. The patient without an indwelling catheter will have urinary urgency after irritation from the procedure. The nurse should expect pink-tinged urine after a cystoscopy because of the presence of traces of blood but does not expect gross bleeding and blood clots. The nurse should urge the patient to consume oral fluids to increase urine output to prevent clotting.

When preparing to assess a patient with a portable bladder scanner, which explanation would the nurse provide the patient regarding the purpose of the sonography?

A: Assesses for obstruction B: Detects tumors and cysts C: Evaluates kidney blood flow *** D: Measures postvoid residual urine Rationale: A bladder scanner measures postvoid residual urine and determines the need for intermittent catheterization. A renal scan evaluates kidney blood flow. Ultrasonography of the kidneys helps detect the presence of tumors and cysts. Ultrasonography also assesses for obstruction in the kidneys or lower urinary tract.

Which laboratory finding leads the nurse to conclude a female patient has a decreased muscle mass?

A: Blood glucose level of 200 mg/dL *** B: Serum creatinine level of 0.2 mg/dL C: Blood urea nitrogen level of 7 mg/dL D: Blood urea nitrogen-to-creatinine ratio of 12:1 Rationale: A normal serum creatinine level in women is between 0.5 and 1.1 mg/dL. A serum creatinine level of 0.2 mg/dL indicates reduced muscle mass. Blood glucose levels are not associated with decreased muscle mass. A normal blood urea nitrogen level is between 10 and 20 mg/dL. The patient has a blood urea nitrogen level of 7 mg/dL, indicating malnutrition, but not reduced muscle mass. The ratio of blood urea nitrogen to creatinine is not associated with decreased muscle mass.

When reviewing the urinalysis report of a patient, which finding indicates the presence of a urinary tract infection (UTI) for this patient?

A: Casts B: Crystals *** C: Leukocyte esterase D: Red blood cells Rationale: Leukocyte esterase (leukoesterase) is an enzyme found in some white blood cells (WBCs), especially neutrophils. When lysis of these WBCs occurs, the urine contains leukoesterase. The presence of leukoesterase indicates a UTI. Minerals form casts; sticky materials in the urine clump around cells, bacteria, or proteins. Crystals in the urine come from mineral salts as a result of diet, drugs, or disease. Red blood cells in the urine can indicate injury to the urinary tract resulting from a catheterization or trauma.

Which information would the nurse teach a patient about obtaining a voided urine specimen for a urinalysis?

A: Collect urine at any time of the day. B: Obtain at least 5 mL of the urine specimen. C: Add a preservative to the container if delay is inevitable. *** D: Send the specimen to the laboratory as soon as possible. Rationale: The nurse should instruct the patient about the importance of sending the specimen to the laboratory as soon as possible. After the urine is collected, cellular breakdown results in more alkaline urine, and bacteria are more likely to multiply. A voided specimen is generally the first specimen voided in the morning because this urine is more concentrated. The patient should collect the entire specimen for urinalysis. The culture and sensitivity tests require at least 5 mL of urine specimen. An added preservative helps prevent breakdown of the elements in the container if the patient is collecting a 24-hour urine specimen. Refrigerate the specimen if a delay is unavoidable.

For a patient with a kidney disorder, which potential identifiable complication would the nurse associate with a urinalysis indicating the presence of ketones?

A: Cystitis *** B: Anorexia nervosa C: Bleeding disorders D: Glomerular disorders Rationale: The liver produces ketones, which are normally absent in the urine, because of incomplete fatty acid metabolism. During starvation, the body cannot get enough glucose and utilizes body fats. This utilization of body fats results in increased ketone production, which are detectable in the urine. Anorexia nervosa is an eating disorder that involves self-starvation and binge eating, resulting in the presence of ketone bodies in the patient's urine. Increased red blood cells in a patient with kidney dysfunction indicates cystitis and bleeding disorders. The urinalysis reports of patients with glomerular disorders would show proteins in the urine (proteinuria).

Which diagnostic test would the nurse associate with evaluation of a patient's pelvic muscle strength?

A: Cystometrography *** B: Urine stream testing C: CT D: Urethral pressure profile Rationale: Urine stream testing evaluates pelvic muscle strength and effectiveness of the pelvic muscles in stopping urine flow. Cystometrography helps evaluate the bladder's capacity, bladder pressure, and voiding reflexes. CT measures the size of the kidneys. A urethral pressure profile obtains information about the type of urinary incontinence or urinary retention.

When the nurse is assessing a pregnant female patient suspected of having a kidney disease, which finding by the nurse would assist in confirming a problem with the patient's kidneys?

A: Decreased blood pressure B: Decreased blood glucose levels *** C: Increased protein levels in the urine D: Increased protein levels in the blood Rationale: Increased protein levels in the urine indicate proteinuria. This laboratory assessment indicates kidney disease. The patient's elevated blood pressure is secondary to hypertension in pregnancy. Similarly, pregnancy would elevate the patient's blood glucose levels. Patients with kidney disease would not have increased blood protein levels but would have increased urine proteins.

Which typical cause would the nurse associate with a patient's high urine specific gravity on a urinalysis report?

A: Diabetes insipidus B: Diuretic medications C: Increased fluid intake *** D: Antidiuretic hormone (ADH) Rationale: ADH production increases with stress, surgery, anesthetic agents, and commonly used oral antidiabetic drugs. In these situations, the normal kidney response is to reabsorb water and decrease urine output. This leads to an increase in the specific gravity of urine. A decrease in specific gravity occurs with increased fluid intake, use of diuretic drugs, and diabetes insipidus. In these situations, the normal kidney response is to excrete more water, thus increasing the urine output.

Which purpose statement would the nurse associate with a patient's scheduled electromyography?

A: Evaluation of pelvic muscle strength B: Identification of urinary incontinence *** C: Evaluation of the perineal muscle strength D: Determination of the renal blood vessel size and abnormalities Rationale: Electromyography on perineal muscles test the strength of muscles in voiding. A urine stream test evaluates pelvic muscle strength. A urethral pressure profile test provides information on urinary incontinence and urinary retention. Renal arteriography determines the renal blood vessel size and abnormalities.

When preparing to perform a bladder scan to detect residual urine in a female patient, the nurse must first assess which factor?

A: Hematuria B: Abdominal girth *** C: History of hysterectomy D: Presence of urinary infection Rationale: Before scanning, the nurse will select the male or female icon on the bladder scanner. Using the female icon allows the scanner software to subtract the volume of the uterus from any measurement. The male icon should be selected for all men and for women who have undergone a hysterectomy. The nurse performs this procedure in response to distention or pressure in the bladder; girth is not a factor. This procedure detects urine retained in the bladder, not infection. Assessment of the presence of retained urine in the bladder occurs regardless of hematuria.

Regarding a patient with chronic renal impairment, which potential rationale would the nurse associate with the patient's recent history of anorexia and a 15-lb unintentional weight loss?

A: Increased fluid clearance B: Increased protein clearance C: Decreased urea waste products *** D: Increased nitrogenous waste products Rationale: In chronic renal impairment, changes to taste and appetite may occur because of an increase in nitrogenous waste products. The patient with renal impairment has decreased rather than increased fluid and protein clearance and increased urea waste products.

When the nurse is reviewing the urinalysis report of a patient, which finding supports the nurse's interpretation that the patient may have cystitis?

A: Increased protein B: Increased glucose C: Increased ketones *** D: Increased red blood cells Rationale: Cystitis is the inflammation of the bladder, which can cause hematuria (presence of red blood cells in the urine).

The nurse is assessing a group of clients for their risk of kidney disease. Which racial/ethnic group is at the greatest risk as they age?

A: Latino Americans *** B: African Americans C: Jewish Americans D: Asian Americans

Which initial assessment finding would alarm the nurse when receiving a patient from the operating room after a cystoscopy performed under conscious sedation?

A: Lethargy B: Pink-tinged urine C: Urinary frequency *** D: Temperature of 100.8°F (38.2°C) Rationale: Fever, chills, or an elevated white blood cell (WBC) count after cystoscopy suggest infection after an invasive procedure; notify the health care provider immediately. Expect pink-tinged urine after a cystoscopy; gross hematuria would require notification of the surgeon. Note frequency as a result of irritation of the bladder. If sedation or anesthesia used for the procedure, lethargy would be an expected effect.

Which component on the urinalysis report would the nurse consider a normal finding? Select all that apply. One, some, or all responses may be correct.

A: Nitrites *** B: Protein *** C: Red blood cells **** D: White blood cells Rationale: Nitrites are not present in normal urine. The presence of nitrites indicates a urinary tract infection. In normal urine, 0 to 0.8 mg/dL of protein is present. In normal urine, 0 to 2 red blood cells are present per high-power field. In normal urine, 0 to 4 white blood cells are present per low-power field.

A nurse cares for a client with a urine specific gravity of 1.040. What action would the nurse take?

A: Obtain a urine culture and sensitivity B: Place the client on restricted fluids C: Assess the client's creatinine level *** D: Increase the client's fluid intake

Which pain characteristic would the nurse associate with a patient's renal colic pain?

A: Pain occurring with hypertension B: Pain that is mild and localized at the umbilicus C: Pain associated with an infection *** D: Pain radiating into the perineal area Rationale: Renal colic pain occurs with distension of the ureter and radiates into the perineal area. Renal colic pain occurs with hypotension. Renal colic pain is intermittent or continuous and is associated with spasms of the ureter. Pain commonly associated with infection is not associated with renal colic pain. Mild, localized pain at the umbilicus is not associated with renal colic pain.

Which urinalysis datum indicates the potential need to increase the patient's fluid intake?

A: Pale-colored urine B: Decreased sodium C: Increased creatinine *** D: Increased blood urea nitrogen (BUN) Rationale: Increased BUN can indicate dehydration. Increased creatinine indicates kidney impairment. Pale-colored urine signifies diluted urine, which indicates adequate fluid intake. Increased, not decreased, sodium indicates dehydration.

When preparing to assess four assigned patients, the nurse understands that which patient may incur harm if he or she palpates the urinary system?

A: Patient with a kidney infection *** B: Patient having a kidney aneurysm C: Patient having a kidney transplant D: Patient having severe bladder distension Rationale: Palpation is the examination of the abdomen to determine any tenderness and pain. Palpation may harm a patient having a kidney aneurysm because it may result in rupture and renal failure. Aneurysm is an excessive localized swelling of the wall of an artery. The nurse should easily palpate transplanted kidneys in the lower right or left abdominal quadrant without causing any harm to the patient. Costovertebral tenderness occurs with kidney infection, and the patient experiences dull pain. The outline of the bladder will be seen as high as the umbilicus in a patient with severe bladder distention during palpation.

For the patient with a kidney disorder, which possible color of urine would the nurse associate with the urinalysis indicating an increase in bilirubin levels?

A: Red *** B: Brown C: Very pale D: Dark amber Rationale: Patients with renal disorders may have a brown urine, and this color indicates increased bilirubin levels. Patients with kidney disorder may have red urine, and this color indicates the presence of myoglobin. Very pale-colored urine in patients with a kidney disorder indicates diluted urine. Dark amber urine in patients with a kidney disorder indicates concentrated urine.

A nurse cares for a client who is recovering from a closed percutaneous kidney biopsy. The client states, "My pain has suddenly increased from a 3 to a 10 on a scale of 0-10." Which action would the nurse take first?

A: Reposition the client on the operative side B: Administer the prescribed opioid analgesic *** C: Assess the client's pulse rate and blood pressure D: Examine the color of the client's urine

To prevent further patient complications, which precautionary test result would the nurse anticipate reviewing before proceeding with a patient's scheduled diagnostic test using high-osmolarity contrast agents?

A: Serum glucose B: Serum albumin C: Serum bilirubin *** D: Serum creatinine Rationale: Exposure to certain dyes during imaging can harm the kidneys. High-osmolarity contrast agents can also contribute to kidney function impairment. Therefore the patient should be tested for high levels of serum creatinine before performing a test using high-osmolarity contrast agents. High levels of serum glucose indicate diabetes. High levels of serum albumin indicate a problem in liver function. High levels of serum bilirubin indicate abnormal liver function.

Which medication would the nurse associate with contributing to a patient's urinary incontinence? Select all that apply. One, some, or all responses may be correct.

A: Statins *** B: Diuretics C: Beta blockers *** D: Opioid analgesics *** E: Anticholinergic drugs

Which urinary change would the nurse expect in a patient with an enlarged prostate?

A: Urinary incontinence B: Decreased bladder capacity C: Uncontrollable need to urinate *** D: Difficulty in starting the urine stream

To obtain information about the cause of a patient's urinary incontinence and retention, which test would the nurse expect the health care provider to prescribe?

A: Urine stream testing B: Retrograde pyelography C: Retrograde urethrography *** D: Urethral pressure profilometry (UPP) Rationale: UPP, or urethral pressure profile, provides information about the nature of urinary incontinence or urinary retention. The health care provider inserts a special catheter with pressure-sensing capabilities into the bladder. Urine stream testing evaluates pelvic muscle strength and the effectiveness of pelvic muscles in stopping the flow of urine. Retrograde examination of the ureters and pelvis is retrograde pyelography. Retrograde urethrography identifies structural problems such as fistulas, diverticula, and tumors.

A nurse reviews a client's laboratory results. Which results from the client's urinalysis would the nurse recognize as abnormal?

A: pH of 5.6 *** B: Ketone bodies present C: Specific gravity of 1.020 D: Clear and yellow color

In which order would the nurse obtain a urine specimen from an indwelling urinary catheter for a patient's prescribed culture and sensitivity test?

First, apply a clamp to the drainage tubing distal to the port, which allows urine to collect in the tubing. Clean the injection port cap of the catheter drainage tubing with povidone-iodine or alcohol, which prevents surface contamination. Attach a sterile 5-mL syringe to the port, and aspirate 5 mL of urine for the culture and sensitivity test. Then inject the urine sample into the sterile specimen container. Dispose of the syringe per hospital policy. Lastly, remove the clamp on the tubing to resume drainage.