Chapter 53

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect?

Infection

An older adult's most recent laboratory findings indicate a decrease in creatinine clearance. When performing an assessment related to potential causes, the nurse should:

confirm all of the medications and supplements normally taken.

The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to

drink liberal amounts of fluids.

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

functional capacity.

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:

ureteral stones.

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:

renal calculi.

The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document?

Urinary urgency

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?

When the urine output is less than 30 mL/h

A client is prescribed flavoxate (Urispas) following cystoscopy. Which of the following instructions would the nurse give the client?

"This medication will relieve your pain."

Which term refers to casts in the urine?

Cylindruria

The nurse is caring for a client scheduled for urodynamic testing. Following the procedure, which information does the nurse provide to the client?

"Contact the primary provider if you experience fever, chills, or lower back pain."

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?

"Do you take multiple vitamin preparations?"

While reviewing a client's chart, the nurse notes the client has been experiencing enuresis. To assess whether this remains an ongoing problem for the client, the nurse asks which question?

"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 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."

When fluid intake is normal, the specific gravity of urine should be:

1.010 to 1.025

Which value represents a normal BUN-to-creatinine ratio?

10:1

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

Which hormone causes the kidneys to reabsorb sodium?

Aldosterone

A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure?

After discarding the 8:00 am specimen

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

Costovertebral angle tenderness

A creatinine clearance test is ordered for a client with possible renal insufficiency. The nurse must collect which serum concentration midway through the 24-hour urine collection?

Creatinine

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

Which value does the nurse recognize as the best clinical measure of renal function?

Creatinine clearance

Enlargement of the prostate causes which of the following to occur? Select all that apply.

Frequency Oliguria Anuria Obstruction of urine flow

Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. Specific gravity compares the density of urine to the density of distilled water. Which is an example of how urine concentration is affected?

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

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

Potassium

A 30-year-old client presents to the clinic for an employment physical. The nurse notes protein in the client's urine. The nurse understands that transient proteinuria can be caused by which factor(s)? Select all that apply.

Prolonged standing Fever Strenuous exercise

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 reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is:

Specific gravity 1.035

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

Susceptibility to develop hypernatremia

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

The client voids 75 cc four hours post cystoscopy.

The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness?

The costovertebral angle

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.

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

The specific gravity will be high.

A group of students is reviewing for a test on the urinary and renal system. The students demonstrate understanding of the information when they identify which of the following as part of the upper urinary tract?

Ureters

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

oliguria.

A patient is being seen in the clinic for possible kidney disease. What major sensitive indicator of kidney disease does the nurse anticipate the patient will be tested for?

Creatinine clearance level

Following a renal biopsy, a client reports severe pain in the back, the arms, and the shoulders. Which intervention should be offered by the nurse?

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

A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client?

"You don't need to do any fasting before this noninvasive test."

The nurse is caring for a client with a history of sickle cell anemia. The nurse understands that this predisposes the client to which renal or urologic disorder?

Chronic kidney disease

After undergoing renal arteriogram, in which the left groin was accessed, a client complains of left calf pain. Which intervention should the nurse perform first?

Assess peripheral pulses in the left leg.

A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 mL. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of:

microorganism transfer.

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 describing the functions of the kidney to a client, which of the following would the nurse include?

Control of water balance

Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys?

Angiography

A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient reports severe pain in the back, arms, and shoulders. Which intervention should be offered by the nurse?

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

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.

Renal cortex

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?

Bladder

The nurse is providing care to a client who has had a kidney biopsy. The nurse would need to be alert for signs and symptoms of which of the following?

Bleeding

The nurse is providing care to a client who has had a renal biopsy. The nurse would need to be alert for signs and symptoms of which of the following?

Bleeding

The nurse is caring for a client after a cystoscopic examination. Following the procedure, the nurse informs the client that which effect may occur?

Blood-tinged urine

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

Client reports increasing fatigue.

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

Collect the client's urine for 24 hours.

The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client assess for an allergy to shellfish?

Computed tomography with contrast

A client has undergone diagnostic testing that involved the insertion of a lighted tube with a telescopic lens. The nurse identifies this test as which of the following?

Cystoscopy

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

Hemoglobin

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

Decreased fluid intake

Which of the following is an inappropriate nursing diagnosis for the client following a voiding cystourethrography?

Deficient knowledge: procedure

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

Detrusor muscle

An appropriate nursing intervention for the client following a nuclear scan of the kidney is to:

Encourage high fluid intake.

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.

The most frequent reason for admission to skilled care facilities includes which of the following?

Urinary incontinence

The nurse observes that the client's urine is orange. Which additional assessment would be important for this client?

Intake of medication such as phenazopyridine hydrochloride

To obtain information about the chief complaint and medical history of an older client, the nurse asks the client about any medication history. Why is obtaining a medication history important?

It may indicate multiple medications taken by the client.

The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following?

Kidney stones

A client is undergoing a renal angiogram after a traumatic accident. What post-procedural assessments would the nurse perform on the client? Select all that apply.

Monitor hypersensitivity response. Palpates the pulses in the legs and feet. Monitor site condition.

A client is scheduled for a renal angiography. Which of the following would be appropriate before the test?

Monitor the client for an allergy to iodine contrast material.

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

Oliguria

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

Renal clearance

The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure?

Renin

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

Renin

A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 mL. Urine output that's less than 50 ml in 24 hours is known as:

anuria.

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.

A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine?

glucose

A client is having a blood urea nitrogen (BUN) test. BUN level is:

increased in renal disease and urinary obstruction.

The nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration?

phenazopyridine hydrochloride