CH 53 Urinary System Assessment

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 mL

A client presents to the ED reporting left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The client has also experienced nausea and emesis. The nurse suspects the client is experiencing: a. ureteral stones. b. pyelonephritis. c. cystitis. d. Urethral infection.

a. ureteral stones. Rationale: The findings are constant with ureteral stones, edema or stricture, or a blood clot. The other answers do not apply.

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? a. Kidney stones b. Neurogenic bladder c. Chronic renal failure d. Fistula

a. Kidney stones Rationale: 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.

Which part of the kidney contains the nephrons? a. Cortex b. Pelvis c. Medulla d. Glomerulus

a. Cortex Rationale: The cortex is located farthest from the center of the kidney and around the outermost edges. It contains the nephrons (the functional units of the kidney).

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? a. "Have you noticed any vaginal bleeding?" b. "Do you take phenytoin daily?" c. "Do you take multiple vitamin preparations?" d. "Have you had a recent urinary tract infection?"

c. "Do you take multiple vitamin preparations?" Rationale: 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. Orange- to amber-colored urine may also indicate concentrated urine due to dehydration or fever. Urine that is pink to red may indicate lower urinary tract bleeding. Yellow to milky white urine may indicate infection, pyuria, or, in the female client, the use of vaginal creams.

When describing the functions of the kidney to a client, which of the following would the nurse include? a. Regulation of white blood cell production b. Synthesis of vitamin K c. Control of water balance d. Secretion of enzymes

c. Control of water balance Rationale: Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins.

When fluid intake is normal, the specific gravity of urine should be: a. 1.000 b. Less than 1.010 c. Greater than 1.025 d. 1.010 to 1.025

d. 1.010 to 1.025 Rationale: 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 represents a normal BUN-to-creatinine ratio? a. 4:1 b. 6:1 c. 8:1 d. 10:1

d. 10:1 Rationale: A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect.

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? a. Renal angiography b. Intravenous pyelography c. Excretory urogram d. Cystoscopy

d. Cystoscopy Rationale: 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.

The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure? a. Cortisol b. Vasopressin c. Albumin d. Renin

d. Renin Rationale: 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 term used to describe total urine output less than 0.5 mL/kg/hour is a. oliguria. b. anuria. c. nocturia. d. dysuria.

a. oliguria. Rationale: 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.

The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions? a. "I can resume my usual activities without restriction." b. "I should increase my fluid intake for the rest of the day." c. "If I have difficulty urinating, I should contact my physician." d. "It is normal for my urine to be blood-tinged."

a. "I can resume my usual activities without restriction." Rationale: A bladder ultrasound is a non-invasive procedure. The client can resume usual activities without restriction.

The nurse is preparing the client for magnetic resonance imaging (MRI) of the kidney. Which statement by the client requires action by the nurse? a. "I took my blood pressure medication with my morning coffee an hour ago." b. "I had my last cigarette 3 hours ago with my morning coffee." c. "I did not take my multivitamin this morning." d. "I do not have a pacemaker, artificial heart valve, or artificial joints."

a. "I took my blood pressure medication with my morning coffee an hour ago." Rationale: 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 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? a. After discarding the 8:00 am specimen b. At 8:00 am, with or without a specimen c. 6 hours after the urine is discarded d. With the first specimen voided after 8:00 am

a. After discarding the 8:00 am specimen Rationale: 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.

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? a. Asses the patient's back and shoulder areas for signs of internal bleeding. b. Distract the patient's attention from the pain. c. Provide analgesics to the patient. d. Enable the patient to sit up and ambulate.

a. Asses the patient's back and shoulder areas for signs of internal bleeding. Rationale: 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. In such a case, the nurse should notify the physician about these signs and symptoms. Distracting the patient's attention, helping the patient to sit up or ambulate, and providing analgesics may only aggravate the patient's pain and, therefore, should not be performed by the nurse.

A patient had a renal angiography and is being brought back to the hospital room. What nursing interventions should the nurse carry out after the procedure to detect complications? Select all that apply. a. Assess peripheral pulses. b. Compare color and temperature between the involved and uninvolved extremities. c. Examine the puncture site for swelling and hematoma formation. d. Apply warm compresses to the insertion site to decrease swelling. e. Increase the amount of IV fluids to prevent clot formation.

a. Assess peripheral pulses. b. Compare color and temperature between the involved and uninvolved extremities. c. Examine the puncture site for swelling and hematoma formation. Rationale: After the procedure, vital signs are monitored until stable. If the axillary artery was the injection site, blood pressure measurements are taken on the opposite arm. The injection site is examined for swelling and hematoma. Peripheral pulses are palpated, and the color and temperature of the involved extremity are noted and compared with those of the uninvolved extremity. Cold compresses may be applied to the injection site to decrease edema and pain.

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? a. Bleeding b. Infection c. Dehydration d. Allergic reaction

a. Bleeding Rationale: 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. Dehydration and allergic reaction are not associated with a renal biopsy.

Which nursing assessment finding indicates the client with renal dysfunction has not met expected outcomes? a. Client reports increasing fatigue. b. Client rates pain at a 3 on a scale of 0 to 10. c. Client denies frequency and urgency. d. Urine output is 100 ml/hr.

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

Which value does the nurse recognize as the best clinical measure of renal function? a. Creatinine clearance b. Circulating ADH concentration c. Volume of urine output d. Urine-specific gravity

a. Creatinine clearance Rationale: 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? a. Decreased fluid intake b. Increased fluid intake c. Glomerulonephritis d. Diabetes insipidus

a. Decreased fluid intake Rationale: 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.

An appropriate nursing intervention for the client following a nuclear scan of the kidney is to: a. Encourage high fluid intake. b. Strain all urine for 48 hours. c. Apply moist heat to the flank area. d. Monitor for hematuria.

a. Encourage high fluid intake. Rationale: 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. Monitoring for hematuria, applying heat, and straining urine do not address the potential renal complications associated with the radioisotope.

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: a. Encourage high fluid intake. b. Strain all urine for 48 hours. c. Apply moist heat to the flank area. d. Monitor for hematuria.

a. Encourage high fluid intake. Rationale: 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.

A patient is having an MAG3 renogram and is informed that radioactive material will be injected to determine kidney function. What should the nurse instruct the patient to do during the procedure? a. Lie still on the table for approximately 35 minutes. b. Drink contrast material at various intervals during the procedure. c. Turn from side to side to get a variety of views during the procedure. d. Take deep breaths and hold them at various times throughout the procedure.

a. Lie still on the table for approximately 35 minutes. Rationale: This relatively new scan is used to further evaluate kidney function in some centers. The patient is given an injection containing a small amount of radioactive material, which will show how the kidneys are functioning. The patient needs to lie still for about 35 minutes while special cameras take images (Albala, Gomelia, Morey, et al., 2010).

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? a. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. b. On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. c. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has scant urine output with a high specific gravity. d. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity may vary widely.

a. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. Rationale: On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has copious urine output with a low specific gravity. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity remains relatively constant.

Which of the following hormones is secreted by the juxtaglomerular apparatus? a. Renin b. Aldosterone c. Antidiuretic hormone (ADH) d. Calcitonin

a. Renin Rationale: 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 reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: a. Specific gravity 1.035 b. Creatinine 0.7 mg/dL c. Protein 15 mg/dL d. Bright yellow urine

a. Specific gravity 1.035 Rationale: 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 multiple 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 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? a. When the urine output is less than 30 mL/h b. When the urine output is about 100 mL/h c. When the urine output is between 300 and 500 mL/h d. When the urine output is between 500 and 1,000 mL/h

a. When the urine output is less than 30 mL/h Rationale: Oliguria is defined as urine output <0.5 mL/kg/h

The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to a. drink liberal amounts of fluids. b. maintain bed rest for 2 hours. c. carefully handle urine because it is radioactive. d. notify the health care team if bloody urine is noted.

a. drink liberal amounts of fluids. Rationale: 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.

A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? a. glucose b. potassium c. creatinine d. chloride

a. glucose Rationale: 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 nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration? a. phenazopyridine hydrochloride b. infection c. phenytoin d. metronidazole

a. phenazopyridine hydrochloride Rationale: Orange to amber-colored urine is caused by concentrated urine due to dehydration, fever, bile, excess bilirubin or carotene, and the medications phenazopyridine hydrochloride and nitrofurantoin. Infection would cause yellow to milky white urine. Phenytoin would cause the urine to become pink to red. Metronidazole would cause the urine to become brown to black.

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: a. renal calculi. b. an overdistended bladder. c. interstitial cystitis. d. acute prostatitis.

a. renal calculi. Rationale: Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void. The client with acute prostatitis presents with a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria.

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: a. renal circulation. b. kidney function. c. kidney structure. d. urine production.

a. renal circulation. Rationale: 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 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? a. 50 mL b. 150 mL c. 250 mL d. 350 mL

b. 150 mL Rationale: 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.

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? a. Blood urea nitrogen level b. Creatinine clearance level c. Serum potassium level d. Uric acid level

b. Creatinine clearance level Rationale: 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 wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition? a. Adventitia (connective tissue) b. Detrusor muscle c. Submucosal layer of connective tissue d. Inner layer of epithelium

b. Detrusor muscle Rationale: 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.

A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? a. Monitor the client for signs of electrolyte and water imbalance. b. Monitor the client for an allergy to iodine contrast material. c. Assess the client's mental changes. d. Evaluate the client for periorbital edema.

b. Monitor the client for an allergy to iodine contrast material. Rationale: 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. The nurse monitors the client for the signs of electrolyte and water imbalance, mental changes, and periorbital edema at any time regardless of the test being done

Which is an effect of aging on upper and lower urinary tract function? a. Increased glomerular filtration rate b. More prone to develop hypernatremia c. Increased blood flow to the kidneys d. Acid-base balance

b. More prone to develop hypernatremia Rationale: 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.

A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client? a. "An x-ray will be done to view your kidneys, ureters, and bladder." b. "A contrast medium will be used to help see the structures better." c. "You don't need to do any fasting before this noninvasive test." d. "You'll have a pressure dressing on your groin after the test."

c. "You don't need to do any fasting before this noninvasive test." Rationale: 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. An x-ray of the abdomen to view the kidneys, ureters, and bladder is called a KUB. A contrast medium is used for computed tomography of the abdomen and pelvis. A pressure dressing is applied to the groin after a renal arteriogram.

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? a. GI absorption rate b. Therapeutic index c. Creatinine clearance d. Liver function studies

c. Creatinine clearance Rationale: 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.

During a routine assessment, the client states; "I wake up all night long to go the bathroom." The nurse documents this finding as which condition? a. Polyuria b. Oliguria c. Nocturia d. Dysuria

c. Nocturia Rationale: Nocturia is awakening at night to urinate. Oliguria is urine output less than 0.5 mL/kg/hr Polyuria is increased urine output. Dysuria is painful or difficult urination.

Retention of which electrolyte is the most life-threatening effect of renal failure? a. Calcium b. Sodium c. Potassium d. Phosphorous

c. Potassium Rationale: Retention of potassium is the most life-threatening effect of renal failure.

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: a. keep the client's knee on the affected side bent for 6 hours. b. apply pressure to the puncture site for 30 minutes. c. check the client's pedal pulses frequently. d. remove the dressing on the puncture site after vital signs stabilize.

c. check the client's pedal pulses frequently. Rationale: 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. Keeping the client's knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse should leave this dressing in place for several hours — and only remove it if instructed to do so.

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? a. Kidney b. Nephron c. Tubule system d. Bladder

d. Bladder Rationale: 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.