Chapter 53: Assessment of Kidney and Urinary Function

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." "You will be sent home with a urinary catheter." "You may resume consuming caffeinated, carbonated, and alcoholic beverages." "You can stop taking the prescribed antibiotic."

"Contact the primary provider if you experience fever, chills, or lower back pain." Explanation: The client must be made aware of the signs of a urinary tract infection after the procedure. The client should contact the primary provider if fever, chills, lower back pain, or continued dysuria and hematuria occur. The client will have catheters placed during the procedure but will not be sent home with one. The client should be told to avoid caffeinated, carbonated, and alcoholic beverages after the procedure because these can further irritate the bladder. These symptoms usually decrease or subside by the day after the procedure. If the client received an antibiotic medication before the procedure, they should be told to continue taking the complete course of medication after the procedure. This is a measure to prevent infection. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Chart 53-3, p. 1559.

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 Explanation: The urinary drainage bag contains both the contrast agent and urine at the conclusion of the procedure. Total contents (500 ml) in the drainage bag consist of 350 ml of contrast agent and 150 ml of urine. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Cystography, p. 1564.

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? 10 20 30 40

20 Explanation: Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 L/day of filtrate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1551.

The nurse is reviewing the results of a client's renal function study. The nurse understands that which value represent a normal BUN-to-creatinine ratio? 4:1 6:1 8:1 10:1

A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-5, p. 1562.

Which hormone causes the kidneys to reabsorb sodium? Antidiuretic hormone Aldosterone Growth hormone Prostaglandins

Aldosterone Explanation: Aldosterone is a hormone synthesized and released by the adrenal cortex. Antidiuretic hormone is secreted by the posterior pituitary gland. Growth hormone and prostaglandins do not cause the kidneys to reabsorb sodium. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1552.

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 Infection Dehydration Allergic reaction

Bleeding Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Nursing Interventions, p. 1565.

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? Kidney stone formation Proteinuria Chronic kidney disease Neurogenic bladder

Chronic kidney disease Explanation: A history of sickle cell anemia predisposes the client to the development of chronic kidney disease. The other disorders are not associated with the development of sickle cell anemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-1, p. 1555.

The nurse is performing a renal assessment on a client with prostate cancer. Which clinical manifestation suggests prostate cancer? Select all that apply. Palpitations Hesitancy Chills Dyspnea Nocturia

Nocturia Hesitancy Clinical manifestations of prostate cancer include urinary hesitancy and nocturia. Palpitations, chills, and dyspnea are not suggestive of prostate cancer. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Physical Assessment, p. 1558.

Retention of which electrolyte is the most life-threatening effect of renal failure? Calcium Sodium Potassium Phosphorous

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

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

"Do you take multiple vitamin preparations?" Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-4, p. 1561.

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 have a strong desire to void?" "Do you urinate while sleeping?" "Does it burn when you urinate?" "Is it painful when you urinate?"

"Do you urinate while sleeping?" Explanation: Enuresis is defined as involuntary voiding during sleep. The remaining questions do not relate to this problem associated with changes in the client's voiding pattern. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-3, p. 1556.

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." "I should increase my fluid intake for the rest of the day." "If I have difficulty urinating, I should contact my physician." "It is normal for my urine to be blood-tinged."

"I can resume my usual activities without restriction." Explanation: A bladder ultrasound is a non-invasive procedure. The client can resume usual activities without restriction. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, General Ultrasonography, p. 1562.

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." "I had my last cigarette 3 hours ago with my morning coffee." "I did not take my multivitamin this morning." "I do not have a pacemaker, artificial heart valve, or artificial joints."

"I took my blood pressure medication with my morning coffee an hour ago." Explanation: The client should not eat for at least 1 hour before an MRI. Alcohol, caffeine-containing beverages, and smoking should be avoided for at least 2 hours before an MRI. The client can take his or her usual medications except for iron supplements prior to the procedure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Nursing Interventions, p. 1563.

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." "I should remove all jewelry before the test." "I should let the staff know if I feel claustrophobic." "I will need to drink all of the dye as quickly as possible."

"I will feel a warm sensation as the dye is injected." Explanation: A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Chart 53-5, p. 1563.

A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address? "I've had diabetes for 4 years." "I'm allergic to shellfish." "I haven't eaten since midnight." "My physician diagnosed me with hypertension 3 months ago."

"I'm allergic to shellfish." Explanation: An allergy to iodine, shellfish, or other seafood should immediately be investigated because the contrast agent used in the procedure may contain iodine, which can cause a severe allergic reaction. Although contrast agents should be used cautiously in clients with diabetes mellitus, investigating this isn't the nurse's priority if the client also has a shellfish allergy. It's appropriate for the client to not eat after midnight before the procedure. The client's hypertension isn't a priority because this condition is the likely reason the renal angiography was ordered. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Chart 53-5, p. 1563.

A student asks the pathophysiology instructor what the function of renin is in the body? What is the instructor's best response to the student's question? "Renin is directly involved in the control of arterial blood pressure and it is essential for proper functioning of the glomerulus." "Renin is involved in venous blood pressure and controls the flow of blood through the tubules." Renin is directly involved in the control of arterial blood pressure and the flow of blood through the pyramids of the kidney." "Renin is involved in venous blood pressure and it is essential for proper functioning of the glomerulus."

"Renin is directly involved in the control of arterial blood pressure and it is essential for proper functioning of the glomerulus."

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

"You don't need to do any fasting before this noninvasive test." Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, General Ultrasonography, p. 1562.

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? 20% 30% 40% 50%

50% Explanation: Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal. Renal function can be assessed most accurately if several tests are performed and their results are analyzed together. Common tests of renal function include renal concentration tests, creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein metabolism) concentrations. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1562.

The nurse is completing a full exam of the client's renal system. Which assessment finding best documents the need to offer the use of the bathroom? Tenderness over the kidneys Bruits noted over the abdominal area A dull sound when percussing over the bladder The ingestion of 8 oz of water

A dull sound when percussing over the bladder Explanation: A dull sound when percussing over the bladder indicates a full bladder. Because the bladder is full, the nurse would offer for the client to use the bathroom. Tenderness over the kidney can indicate an infection or stones. Bruits are an abnormal vascular sound that does not indicate the need to use the bathroom. Ingesting water does not mean that the client has to void at this time. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Physical Assessment, p. 1558.

A patient has an increase in blood osmolality when the nurse reviews the laboratory work. What can this increase indicate for the patient? ADH stimulation An increase in urine volume Diuresis Less reabsorption of water

ADH stimulation Explanation: Antidiuretic hormone (ADH), also known as vasopressin, is a hormone that is secreted by the posterior portion of the pituitary gland in response to changes in osmolality of the blood. With decreased water intake, blood osmolality tends to increase, stimulating ADH release. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Antidiuretic Hormone, p. 1551.

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 At 8:00 am, with or without a specimen 6 hours after the urine is discarded With the first specimen voided after 8:00 am

After discarding the 8:00 am specimen Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Renal Clearance, p. 1553.

Serum sodium plays a major role in maintaining fluid and electrolyte balance. Choose all the correct statements that apply. The normal serum sodium level is 90 to 120 mmol/L. Aldosterone causes renal reabsorption of sodium. About 45% of sodium in the renal filtrate is absorbed. Angiotensin II controls the release of aldosterone. Renin, an enzyme released by the kidneys, activates the RAS system to ensure adequate filtration.

Aldosterone causes renal reabsorption of sodium. Angiotensin II controls the release of aldosterone. Renin, an enzyme released by the kidneys, activates the RAS system to ensure adequate filtration. The renin-angiotensin system (RAS) maintains the balance of fluid volume. Refer to Figure 26-4 in the text. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Regulation of Electrolyte Excretion, p. 1552.

Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys? Radiography Angiography Computed tomography (CT scan) Cystoscopy

Angiography Explanation: Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the internal bladder. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Renal Angiography, p. 1564.

The nurse is assessing a patient upon admission to the hospital. What significant nursing assessment data is relevant to renal function? Select all that apply. Any voiding disorders The patient's occupation The presence of hypertension or diabetes The patient's financial status The ability of the patient to manage activities of daily living

Any voiding disorders The patient's occupation The presence of hypertension or diabetes When obtaining the health history, the nurse should inquire about the following: dysuria (painful or difficult urination), as well as when during voiding (i.e., at initiation or at termination of voiding) this occurs; occupational, recreational, or environmental exposure to chemicals (plastics, pitch, tar, rubber); hypertension; or diabetes. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-1, p. 1555.

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. Assess peripheral pulses. Compare color and temperature between the involved and uninvolved extremities. Examine the puncture site for swelling and hematoma formation. Apply warm compresses to the insertion site to decrease swelling. Increase the amount of IV fluids to prevent clot formation.

Assess peripheral pulses. Compare color and temperature between the involved and uninvolved extremities. Examine the puncture site for swelling and hematoma formation. 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Nursing Interventions, p. 1564.

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. Distract the client's attention from the pain. Provide analgesics to the client. Enable the client to sit up and ambulate.

Assess the patient's back and shoulder areas for signs of internal bleeding. Explanation: After a renal biopsy, the client should be on bed rest. The nurse observes the urine for signs of hematuria. It is important to assess the dressing frequently for signs of bleeding, monitor vital signs, 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. The nurse should also assess the client for difficulty voiding and encourage adequate fluid intake. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, 1565.

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. Distract the patient's attention from the pain. Provide analgesics to the patient. Enable the patient to sit up and ambulate.

Assess the patient's back and shoulder areas for signs of internal bleeding. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Nursing Interventions, p. 1565.

A client is having a blood urea nitrogen (BUN) test. BUN level is: increased in renal disease and urinary obstruction. decreased in nephrotic syndrome. decreased in renal disease and urinary obstruction. unchanged in renal disease.

BUN is increased in renal disease and urinary obstruction. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-5, p. 1562.

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? Kidney Nephron Tubule system Bladder

Bladder Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Gerontologic Considerations, p. 1554.

A patient is having a problem with retention of urine in the bladder. Which of the following diagnostic tests measures the amount of residual urine in the bladder? Bladder ultrasonography Nuclear scan Cystography IV urography

Bladder ultrasonography Explanation: A bladder ultrasonography is a noninvasive method of measuring urine volume in the bladder; automatic calculations display the urine volume. A nuclear scan provides information about kidney perfusion and function. It is used to evaluate acute and chronic renal failure. Cystography aids in evaluating vesicourethral reflux and in assessing bladder injury. IV urography provides an approximate estimate of renal function and may be used as the initial assessment of many urologic problems. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Physical Assessment, p. 1558.

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 Infection Dehydration Allergic reaction

Bleeding Explanation: Renal biopsy carries the risk of post procedure 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Nursing Interventions, p. 1565.

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 Nausea and emesis Diarrhea Severe abdominal pain

Blood-tinged urine Explanation: Postprocedural management is directed at relieving any discomfort resulting from the examination. Some burning upon voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected. Moist heat to the lower abdomen and warm Sitz baths are helpful in relieving pain and relaxing the muscles. Not eating and diarrhea are not expected following a cystoscopic examination. The client should not experience severe abdominal pain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1565.

A creatinine level has been ordered. The nurse prepares to: Obtain a blood specimen. Collect the client's urine for 24 hours. Obtain a clean catch urine. Straight cath for a specimen.

Obtain a blood specimen. Explanation: A creatinine level is determined from a blood sample. It is used to assess renal function. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-5, p. 1562.

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

Client reports increasing fatigue. Explanation: Fatigue, shortness of breath, and exercise intolerance are consistent with unexplained anemia, which can be secondary to gradual renal dysfunction. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Unexplained Anemia, p. 1557.

A creatinine clearance test has been ordered. The nurse prepares to: Collect the client's urine for 24 hours. Obtain a clean catch urine. Obtain a blood specimen. Insert a straight catheter for a specimen.

Collect the client's urine for 24 hours. Explanation: A creatinine clearance test is a 24-hour urine test and is useful in evaluating renal disease. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Renal Clearance, p. 1553.

The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client be assessed for an allergy to iodine? Radiography Computed tomography with contrast Cystoscopy Bladder ultrasonography

Computed tomography with contrast Explanation: The nurse is correct to assess for an allergy to iodine when a computed tomography with contrast medium is prescribed. Uroflowmetry, cystoscopy, and bladder ultrasonography are performed without the use of contrast medium. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Chart 53-5: Patient Care During Urologic Testing With Contrast Agents, p. 1563.

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

Control of water balance Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Chart 53-1, p. 1549.

When describing the functions of the kidney to a client, which of the following would the nurse include? Select all that apply. Regulation of white blood cell production Synthesis of vitamin K Control of water balance Secretion of the enzyme renin

Control of water balance Secretion of the enzyme renin 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. They also produce the enzyme renin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Kidneys, p. 1548.

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 Suprapubic pain Pain after voiding Perineal pain

Costovertebral angle tenderness Explanation: Acute pyelonephritis is characterized by costovertebral angle tenderness. Suprapubic pain is suggestive of bladder distention or infection. Urethral trauma and irritation of the bladder neck can cause pain after voiding. Perineal pain is experienced by male clients with prostate cancer or prostatitis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-2, p. 1556.

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

Creatinine clearance Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1553.

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

Creatinine clearance Explanation: The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Renal Clearance, p. 1553.

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? Blood urea nitrogen level Creatinine clearance level Serum potassium level Uric acid level

Creatinine clearance level Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Renal Clearance, p. 1553.

The health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator? Creatinine clearance level Uric acid level Blood urea nitrogen (BUN) BUN to creatinine ratio

Creatinine clearance level Explanation: The creatinine clearance measures the volume of blood cleared of endogenous creatinine in 1 minute. This serves as a measure of the glomerular filtration rate. Therefore the creatinine clearance test is a sensitive indicator of renal disease progression. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-5, p. 1562.

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? Renal angiography Intravenous pyelography Excretory urogram Cystoscopy

Cystoscopy Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Urologic Endoscopic Procedures, p. 1564.

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 Increased fluid intake Glomerulonephritis Diabetes insipidus

Decreased fluid intake Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1561.

Which of the following is an inappropriate nursing diagnosis for the client following a voiding cystourethrography? Deficient knowledge: procedure Acute pain Risk for infection: urinary tract Urinary retention

Deficient knowledge: procedure Explanation: The client needs adequate information before experiencing the procedure. Appropriate nursing diagnoses following the procedure would include risk for infection: urinary tract, acute pain, and urinary retention. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Voiding Cystourethrography, p. 1564.

The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition? Adventitia (connective tissue) Detrusor muscle Submucosal layer of connective tissue Inner layer of epithelium

Detrusor muscle Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Ureters, Bladder, and Urethra, p. 1550.

A client has a full bladder. Which sound would the nurse expect to hear on percussion? Tympany Dullness Resonance Flatness

Dullness Explanation: Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very dense tissue, such as the bone or muscle. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Physical Assessment, p. 1558.

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

Encourage high fluid intake. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Nuclear Scans, p. 1564.

The nurse is instructing a 3-year-old's parent regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as a normal finding for this age group? Dysuria Enuresis Hematuria Anuria

Enuresis Explanation: The nurse would be most correct to document that enuresis, the involuntary voiding during sleep or commonly called "wetting the bed," is a normal finding in a pediatric client younger than 5 years old. Dysuria (pain on urination), hematuria (red blood cells in urine), and anuria (urine output less than 50 mL/day) are all abnormal findings needing further investigation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-3: Problems Associated With Changes in Voiding, p. 1556.

Enlargement of the prostate causes which of the following to occur? Select all that apply. Frequency Oliguria Anuria Obstruction of urine flow Polyuria

Frequency Oliguria Anuria Obstruction of urine flow Enlargement of the prostate gland causes obstruction of urine flow, resulting in frequency, oliguria, and anuria. Polyuria does not occur. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Gerontologic Considerations, p. 1554.

The nurse analyzes a urinalysis report. He is aware that the presence of this substance in the urine indicates a blood level that exceeds the kidney's reabsorption capacity. Select the substance. Sodium Bicarbonate Creatinine Glucose

Glucose Explanation: Glucose is usually filtered at the level of the glomerulus. It does not normally appear in the urine. Renal glycosuria occurs if the glucose in the blood exceeds the amount that is able to be reabsorbed. The other substances are normally excreted in the urine. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Urine Formation, p. 1551.

The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program? Hypotension Diabetes mellitus Neuromuscular disorders Pregnancy

Hypotension Explanation: Hypertension, not hypotension, is a risk factor for kidney disease. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-1, p. 1555.

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? Obstruction of the lower urinary tract Acute renal failure Infection Nephrotic syndrome

Infection Explanation: Frequency, urgency, and dysuria are commonly associated with urinary tract infection. Hesitancy and enuresis may indicate an obstruction. Oliguria or anuria and proteinuria might suggest acute renal failure. Nocturia is associated with nephrotic syndrome. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-3, p. 1556.

The nurse observes that the client's urine is orange. Which additional assessment would be important for this client? Bleeding Intake of medication such as phenazopyridine hydrochloride Intake of multiple vitamin preparations Infection

Intake of medication such as phenazopyridine hydrochloride Explanation: Urine that is orange may be caused by intake of phenazopyridine hydrochloride 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. Urine that is bright yellow is an anticipated abnormal finding in the client taking a multiple vitamin preparation. Yellow to milky white urine may indicate infection, pyuria, or, in the female client, the use of vaginal creams. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-4, p. 1561.

A patient who complains of a dull, continuous pain in the suprapubic area that occurs with, and at the end of, voiding would most likely be diagnosed with which of the following? A kidney stone Interstitial cystitis Acute pyelonephritis Prostatic cancer

Interstitial cystitis Explanation: Pain over the suprapubic area is most likely related to the bladder. Pain intensity would increase with fullness. Pain at the end of voiding is one of the symptoms associated with interstitial cystitis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-2, p. 1556.

A client has been experiencing severe pain and hematuria and is hardly able to ambulate into the physician's office. The physician suspects kidney stones and orders diagnostic tests to confirm. What test would physician order? KUB ultrasound CT MRI

KUB Explanation: An x-ray study of the abdomen includes x-rays of the kidneys, ureters, and bladder (KUB). It is performed to show the size and position of the kidneys, ureters, and bony pelvis as well as any radiopaque urinary calculi (stones), abnormal gas patterns (indicative of renal mass), and anatomic defects of the bony spinal column (indicative of neuropathic bladder dysfunction). Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. A computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen and pelvis may be obtained to diagnose renal pathology, determine kidney size, and evaluate tissue densities with or without contrast. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1562.

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 Neurogenic bladder Chronic renal failure Fistula

Kidney stones Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-1: Risk Factors for Selected Renal or Urologic Disorders, p. 1555.

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. Apply a warm compress to site. Administer an enema.

Monitor hypersensitivity response. Palpates the pulses in the legs and feet. Monitor site condition. After the procedure, the healthcare provider applies a pressure dressing to the femoral area, which remains in place for several hours. The nurse palpates the pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Monitoring the pressure dressing is important to note frank bleeding or hematoma formation. If either condition occurs, the nurse immediately notifies the health care provider. Another important assessment is for hypersensitivity responses to contrast material. The nurse also monitors and documents intake and output. The client may have an enema pre procedure and application of a cold compress may reduce pain and swelling. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1564.

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

Monitor the client for an allergy to iodine contrast material. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Renal Angiography, p. 1564.

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

More prone to develop hypernatremia Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1554.

The wall of the bladder has four layers. Which of the following layers contains a membrane that prevents reabsorption of urine stored in the bladder? Mucosal Adventitia Detrusor Connective tissue

Mucosal Explanation: Beneath the detrusor is a submucosal layer of loose connective tissue that serves as an interface between the detrusor and the innermost layer, a mucosal lining. This inner layer contains specialized transitional cell epithelium, a membrane that is impermeable to water and prevents reabsorption of urine stored in the bladder. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Ureters, Bladder, and Urethra, p. 1550.

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. On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. 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. When the kidneys are diseased, the ability to concentrate urine may be impaired, and the specific gravity may vary widely.

On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. Explanation: Specific gravity is altered by the presence of blood, protein, and casts in the urine and is normally influenced primarily by hydration status. 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1561.

A client undergoes renal angiography. Which postprocedure care intervention should the nurse provide to the client? Encourage the client to void. Monitor the client for signs and symptoms of pyelonephritis. Palpate the pulses in the legs and feet. Assess for signs of electrolyte and water imbalances.

Palpate the pulses in the legs and feet. Explanation: To observe for signs of arterial occlusion in a client who has undergone renal angiography, the nurse should palpate the pulses in the legs and feet. While preparing the client for renal angiography, the nurse asks the client to void. The nurse assesses for signs of electrolyte and water imbalances during the physical examination of a client. The nurse should monitor for signs and symptoms of pyelonephritis in a client who has undergone retrograde pyelography. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1564.

A client in moderate pain is admitted for possible kidney stones. The client appears diaphoretic and has frequent periods of nausea and vomiting. The client reports sudden oliguria and initial portable bladder ultrasound shows 300 mL in the bladder after the client voided 50 mL. Which action should the nurse anticipate performing first for this client? Provide intravenous hydomorphone. Repeat the portable bladder ultrasound. Place a urinary cathether. Provide ondansetron intravenously.

Place a urinary cathether. Explanation: Increased urinary urgency and frequency coupled with decreasing urine volume strongly suggest urinary retention depending on the acuity of the onset of the symptoms, immediate bladder emptying via catheterization and evaluation may be necessary to prevent kidney dysfunction. The combination of pain, sudden oliguria, nausea, vomiting and post-ressidual results are suggestive of an acute condition. Therefore, a second bladder scan is not warranted and may delay care. The pain, nausea, and vomiting may be the result of urinary retention and a full bladder. Placement of a urinary cathether may alleviate those conditions. After placing the urinary cathether, a reassessment and treatment of those conditions can occur.

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? Increased alertness Hypoventilation Pruritus Unusually smooth skin

Pruritus Explanation: The nurse should be alert for pruritus and urticaria, which may indicate a mild anaphylactic reaction to the arteriogram dye. Decreased (not increased) alertness may occur as well as dyspnea (not hypoventilation). Unusually smooth skin isn't a sign of anaphylaxis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Nursing Interventions, p. 1564.

Which of the following hormones is secreted by the juxtaglomerular apparatus? Renin Aldosterone Antidiuretic hormone (ADH) Calcitonin

Renin Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Nephrons, p. 1550.

The nurse recognizes that a referral for genetic counseling is inappropriate for the client with: Renal calculi Alport syndrome Polycystic kidney disease Wilms' tumor

Renal calculi Explanation: Wilms' tumor, polycystic disease, and Alport are conditions that have a genetic influence. Renal calculi are not influenced by genetic factors. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Chart 53-2, p. 1557.

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 medulla Renal cortex Renal pelvis Renal papilla

Renal cortex Explanation: The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Kidneys, p. 1549.

A nurse is describing the renal system to a client with a kidney disorder. Which structure would the nurse identify as emptying into the ureters? Nephron Renal pelvis Parenchyma Glomerulus

Renal pelvis Explanation: The renal pelvis empties into the ureter which carries urine to the bladder for storage. The nephron consists of the glomerulus, afferent arteriole, efferent arteriole, Bowman's capsule, distal and proximal convoluted tubules, the loop of Henle, and collecting tubule. The nephron is located in the cortex and carries out the functions of the kidney. The parenchyma is made up of the cortex and medulla. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Kidneys, p. 1549.

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

Renin Explanation: 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). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Nephrons, p. 1550.

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 Vitamin B production Regulation of blood pressure Vitamin D synthesis Secretion of insulin

Secretion of prostaglandins Regulation of blood pressure Vitamin D synthesis Functions of the kidney include secretion of prostaglandins, regulation of blood pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body does not produce Vitamin B. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Chart 53-1, p. 1549.

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 Creatinine 0.7 mg/dL Protein 15 mg/dL Bright yellow urine

Specific gravity 1.035 Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Components, p. 1561.

Which nursing assessment finding indicates the client has not met expected outcomes? The client voids 75 cc four hours post cystoscopy. The client reports a pain rating of 3 two hours post-kidney biopsy. The client has blood-tinged urine following brush biopsy. The client consumes 75% of lunch following an intravenous pyelogram.

The client voids 75 cc four hours post cystoscopy. Explanation: Urinary retention is an undesirable outcome following cystoscopy. A pain rating of 3 is an achievable and expected outcome following kidney biopsy. Blood-tinged urine is an expected finding following cystoscopy due to trauma of the procedure. A client would be expected to eat and retain a meal following an intravenous pyelogram. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Nursing Interventions, p. 1565.

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 upper abdominal quadrants on the left and right side The costovertebral angle Above the symphysis pubis Around the umbilicus

The costovertebral angle Explanation: The nurse is correct to assess the kidneys for tenderness at the costovertebral angle. The other options are incorrect. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-2: Identifying Characteristics of Genitourinary Pain, p. 1556.

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 kidneys are situated just above the adrenal glands. The average kidney is approximately 5 cm (2 in.) long and 2 to 3 cm (0.8 to 1.2 in.) wide. The kidneys lie between the 10th and 12th thoracic vertebrae.

The left kidney usually is slightly higher than the right one. Explanation: The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4??) long, 5 to 5.8 cm (2? to 2¼?) wide, and 2.5 cm (1?) thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Kidneys, p. 1548.

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 inversely proportional The specific gravity will equal to one The specific gravity will be high. The specific gravity will be low

The specific gravity will be high. Explanation: The nurse assesses all of the data to make an informed decision on client status. On a hot day, the client found outside will be perspiring. When dehydration occurs, a client will have low urine output and increased specific gravity of urine. Normal specific gravity is inversely proportional. The density of distilled water is one. A low specific gravity is noted in a client with high fluid intake and who is not losing systemic fluid. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Specific Gravity, p. 1561.

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? Bladder Urethra Ureters Pelvic floor muscles

Ureters Explanation: The upper urinary tract is composed of the kidneys, renal pelvis, and ureters. The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.

The most frequent reason for admission to skilled care facilities includes which of the following? Urinary incontinence Congestive heart failure Stroke Myocardial infarction

Urinary incontinence Explanation: Urinary incontinence is the most common reason for admission to skilled nursing facilities. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Gerontologic Considerations, p. 1554.

Which of the following is used to identify vesicoureteral reflux? Voiding cystourethrography IV urography Renal angiography Bladder ultrasonography

Voiding cystourethrography Explanation: A voiding cystourethrography is used as a diagnostic tool to identify vesicoureteral reflux. An IV urography may be used as the initial assessment of various suspected urologic problems, especially lesions in the kidneys and ureters, and it provides an approximate estimate of renal function. Renal angiography is used to evaluate renal blood flow, to differentiate renal cysts from tumors, to evaluate hypertension, and preoperatively for renal transplantation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Voiding Cystourethrography, p. 1564.

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 When the urine output is about 100 mL/h When the urine output is between 300 and 500 mL/h When the urine output is between 500 and 1,000 mL/h

When the urine output is less than 30 mL/h Explanation: Oliguria is defined as urine output <0.5 mL/kg/h Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-3, p. 1556.

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: oliguria. polyuria. anuria. hematuria.

anuria. Explanation: Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Acute Kidney Injury, p. 1576.

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

check the client's pedal pulses frequently. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Nursing Interventions, p. 1564.

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. assess the client's usual intake of sodium. confirm which beverages the client normally consumes. palpate the client's bladder before and after voiding.

confirm all of the medications and supplements normally taken. Explanation: Adverse effects of medications are a common cause of decreased renal function in older adults. Quantity, rather than type, of beverages is relevant. Sodium intake does not normally cause decreased renal function. Bladder palpation can be used to confirm urinary retention, but this does not normally affect renal function as much as medications. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Renal Clearance, p. 1553.

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. maintain bed rest for 2 hours. carefully handle urine because it is radioactive. notify the health care team if bloody urine is noted.

drink liberal amounts of fluids. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1564.

Although the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which is NOT a function of the kidneys? excreting protein excreting nitrogen waste products regulating blood pressure stimulating RBC production

excreting protein Explanation: Although the kidneys excrete excess water and nitrogen-based waste products of protein metabolism, persistent renal excretion of protein is not the function of kidneys, which are in the state of homeostasis. The kidneys assist in maintenance of acid-base and electrolyte balance; produce the enzyme renin, which helps regulate blood pressure; and produce the hormone erythropoietin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Chart 53-1, p. 1549.

When the bladder contains 400 to 500 mL of urine, this is referred to as anuria. specific gravity. functional capacity. renal clearance.

functional capacity. Explanation: A marked sense of fullness and discomfort, with a strong desire to void, usually occurs when the bladder contains 400 to 500 mL of urine, referred to as the "functional capacity." Anuria is a total urine output less than 50 mL in 24 hours. Specific gravity reflects the weight of particles dissolved in the urine. Renal clearance refers to the ability of the kidneys to clear solutes from the plasma.

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

glucose Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1551.

The term used to describe total urine output less than 0.5 mL/kg/hour is oliguria. anuria. nocturia. dysuria.

oliguria. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-3, p. 1556.

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about: chronic, excessive acetaminophen use. recent streptococcal infection. childhood asthma. family history of pernicious anemia.

recent streptococcal infection. Explanation: A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Health History, p. 1555.

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. an overdistended bladder. interstitial cystitis. acute prostatitis.

renal calculi. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Chart 53-4, p. 1560.

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: renal circulation. kidney function. kidney structure. urine production.

renal circulation. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, p. 1564.

In a diagnosis of an upper urinary tract infection, which structures could be affected? Select all that apply. ureter kidney bladder urethra

ureter kidney The upper urinary tract is composed of the kidneys, renal pelvis, and ureters.

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. pyelonephritis. cystitis. Urethral infection.

ureteral stones. Explanation: The findings are constant with ureteral stones, edema or stricture, or a blood clot. The other answers do not apply. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 53: Assessment of Kidney and Urinary Function, Table 53-2, p. 1556.