Chapter 53: Assessment of Kidney and Urinary Function (Exam 2)

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 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."

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

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

"Do you urinate while sleeping?" 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.

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 had my last cigarette 3 hours ago with my morning coffee." "I took my blood pressure medication with my morning coffee an hour ago." "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." 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.

The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? "I should remove all jewelry before the test." "I will need to drink all of the dye as quickly as possible." "I should let the staff know if I feel claustrophobic." "I will feel a warm sensation as the dye is injected."

"I will feel a warm sensation as the dye is injected." 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.

The nurse is explaining the steps for collecting a clean catch urine specimen to a client. Which statement by the client indicates effective teaching? "I need to use one antiseptic wipe to clean the sides and down the middle." "After I clean the area, I can let go of my labia to hold the container." "I'll start to urinate for a few seconds and then start to collect the specimen." "I need to collect at least 100 mL of urine for the specimen."

"I'll start to urinate for a few seconds and then start to collect the specimen." When collecting a clean catch urine specimen, the client would begin voiding for a few seconds and then collect 30 to 50 mL of the midstream urine into the container. The client would use one antiseptic towelette to clean the one side of the urethra, one to clean the other side of the urethra, and then a third to clean the center. The labia are held apart during the cleaning process and throughout the voiding until after the specimen is collected.

A client is prescribed flavoxate (Urispas) following cystoscopy. Which of the following instructions would the nurse give the client? "This medication will treat the blood in your urine." "This medication prevents urinary incontinence." "This medication prevents infection in your urinary tract" "This medication will relieve your pain."

"This medication will relieve your pain." Flavoxate (Urispas) is a antispasmodic agent used for the treatment of burning and pain of the urinary tract.

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

Collect the client's urine for 24 hours. A creatinine clearance test is a 24-hour urine test and is useful in evaluating renal disease.

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 Bladder ultrasonography Cystoscopy Radiography

Computed tomography with contrast The nurse is correct to assess for an allergy to shellfish most times when a contrast medium is ordered. The other options do not necessarily have a contrast medium.

Which part of the kidney contains the nephrons? Pelvis Medulla Glomerulus Cortex

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

Which of the following urine characteristics would the nurse anticipate when caring for a client whose lab work reveals a high urine specific gravity related to dehydration? Red urine Clear or light yellow urine Dark amber urine Turbid urine

Dark amber urine Concentrated urine (one with a high specific gravity) is a dark amber color due to the solutes in the urine. Clear or yellow urine indicates a flushing of the urinary system. Red urine indicates hematuria. A turbid urine may indicate bacteriuria.

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

Dullness 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.

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

Encourage high fluid intake. 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.

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

Enuresis 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.

To assess circulating oxygen concentration, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommends the use of which diagnostic test? Arterial blood gases Hematocrit Hemoglobin Serum iron concentration

Hemoglobin Although hematocrit has always been the blood test of choice to assess for anemia, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommend that anemia be quantified using hemoglobin rather than hematocrit measurements. Hemoglobin is recommended because it more accurately assesses circulating oxygen than does hematocrit. Serum iron concentration measures iron storage in the body. Arterial blood gases assess the adequacy of oxygenation, ventilation, and acid-base status.

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? Increased serum albumin Increased serum creatinine Decreased potassium Decreased blood urea nitrogen (BUN)

Increased serum creatinine In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.

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

Intake of medication such as phenazopyridine hydrochloride 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.

To obtain information about the chief report 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 reflect the client's childhood and family illnesses. It may indicate multiple medications taken by the client. It may indicate drugs that should not be prescribed to the client. It may indicate the client's general health.

It may indicate multiple medications taken by the client. The nurse should obtain information about a client's medication history because older clients, in particular, may be taking multiple medications that may affect their renal function. The medication history in general indicates the probable risk factors of renal or urologic disorders. The medication history of an older client is not used to obtain information about the client's general health, childhood and family illnesses, or drugs that are contraindicated for use by the client.

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

Urinary incontinence Urinary incontinence is the most common reason for admission to skilled nursing facilities.

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. A creatinine level is determined from a blood sample. It is used to assess renal function.

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

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

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

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.

The client presents with nausea and vomiting, absent bowel sounds, and colicky flank pain. The nurse interprets these findings as consistent with: Interstitial cystitis Ureteral colic Acute prostatitis Urethritis

Ureteral colic These clinical manifestations are consistent with ureteral colic.

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

Voiding cystourethrography 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.

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: hematuria. oliguria. polyuria. anuria.

anuria. 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.

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

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

A client 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. check the client's pedal pulses frequently. remove the dressing on the puncture site after vital signs stabilize. apply pressure to the puncture site for 30 minutes.

check the client's pedal pulses frequently. 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.

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

drink liberal amounts of fluids. 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.

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? stimulating RBC production excreting nitrogen waste products regulating blood pressure excreting protein

excreting protein 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.

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: cystitis. Urethral infection. pyelonephritis. ureteral stones.

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

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

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

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

oliguria. 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.

A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? With the first specimen voided after 8:00 am At 8:00 am, with or without a specimen 6 hours after the urine is discarded After discarding the 8:00 am specimen

After discarding the 8:00 am specimen 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.

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 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.

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? Infection Allergic reaction Bleeding Dehydration

Bleeding 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.

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

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

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

Control of water balance 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.

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

Renal calculi Wilms' tumor, polycystic disease, and Alport are conditions that have a genetic influence. Renal calculi are not influenced by genetic factors.

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 Perineal pain Suprapubic pain Pain after voiding

Costovertebral angle tenderness 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.

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? Blood urea nitrogen Hemoglobin Creatinine Osmolality

Creatinine To calculate creatinine clearance, a 24-hour urine specimen is collected. The serum creatinine concentration is measured midway through the collection. The other concentrations are not measured during this test.

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

Creatinine clearance 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.

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 Intravenous pyelography Renal angiography Excretory urogram

Cystoscopy Cystoscopy is the visual examination of the inside of the bladder using an instrument called a cystoscope, a lighted tube with a telescopic lens. Renal angiography involves the passage of a catheter up the femoral artery into the aorta to the level of the renal vessels. Intravenous pyelography or excretory urography is a radiologic study that involves the use of a contrast medium to evaluate the kidneys' ability to excrete it.

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? Increased fluid intake Diabetes insipidus Glomerulonephritis Decreased fluid intake

Decreased fluid intake 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.

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

Detrusor muscle 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.

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

Encourage high fluid intake. A voiding cystogram involves the insertion of a urinary catheter, which can result in the introduction of microorganism into the urinary tract. Fluid intake is encouraged to flush the urinary tract and promote removal of microorganisms. Monitoring for hematuria, applying heat, and straining urine do not address the nursing diagnosis of risk for infection.

Which substance stimulates the bone marrow to produce red blood cells? Prostaglandin E Erythropoietin Prostacyclin Renin

Erythropoietin Erythropoietin stimulates the bone marrow to produce red blood cells, thereby increasing the amount of hemoglobin available to carry oxygen. The kidneys produce prostaglandin E and prostacyclin, which have vasodilatory effect and are important in maintaining renal blood flow. Renin is involved in controlling arterial blood pressure.

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. Creatinine Glucose Bicarbonate Sodium

Glucose 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.

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

Infection 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. Oliguria is defined as a urine output that is less than 400 mL/24 h or less than 17 mL/h in adults. Anuria is defined as urine output that is less than 100 mL/24 h or 0 mL/12 h. Nocturia (is a condition in which you wake up during the night because you have to urinate) is associated with nephrotic syndrome.

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? Neurogenic bladder Chronic renal failure Kidney stones Fistula

Kidney stones 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.

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

Monitor the client for an allergy to iodine contrast material. 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.

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 Detrusor Adventitia Connective tissue

Mucosal 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.

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 pelvis Renal papilla Renal medulla Renal cortex

Renal cortex The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex.

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

Renin Renin is a hormone directly involved in the control of arterial blood pressure; it is essential for proper functioning of the glomerulus. ADH, also known as vasopressin, plays a key role in the regulation of extracellular fluid by excreting or retaining water. Calcitonin regulates calcium and phosphorous metabolism.

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

Renin Renin is directly involved in the control of arterial blood pressure. It is also essential for the proper functioning of the glomerulus and management of the body's renin-angiotensin system (RAS).

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

Specific gravity 1.035 Specific gravity is reflective of hydration status. A concentrated specific gravity, such as 1.035, is suggestive of dehydration. Bright yellow urine suggests ingestion of multiple vitamins. Proteinuria can be benign or be caused by conditions which alter kidney function. Creatinine measures the ability of the kidney to filter the blood. A level of 0.7 is within normal limits.

The nurse is preparing the procedure room for a client who will undergo an intravenous pyelogram. Which item(s) should the nurse include? Padded tongue blades Suction equipment Dressings and tape Antihypertensive agents

Suction equipment The contrast agent injected into the client for an intravenous pyelogram is allergenic and nephrotoxic. Emergency supplies and equipment should be readily available in case the client experiences an anaphylactic reaction, including airway and suction equipment, oxygen, epinephrine, corticosteroids, and vasopressors.

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

The costovertebral angle The nurse is correct to assess the kidneys for tenderness at the costovertebral angle. The other options are incorrect.

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

The left kidney usually is slightly higher than the right one. 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.

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? Urethra Bladder Ureters Pelvic floor muscles

Ureters 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 nurse observes the color of the client's urine, which appears pale blue-green. The nurse obtains a drug history from the client based on the understanding that drugs used by the client may affect which of the following? Amount of urine produced Size of the urinary bladder Urine specific gravity Urinary tract tests

Urinary tract tests It is important to inquire about drugs because some drugs may affect the outcome of urinary tract tests as well as the color and odor of the urine. Dietary intake may affect urine characteristics as well as urinary tract disorders and their management. Drugs do not directly affect the size of the urinary bladder or the amount of urine produced.

The nurse is reviewing the client's lab results. Which lab result requires follow up by the nurse? Select all that apply. BUN 28 mg/dL Urine: RBC 20 Urine specific gravity 1.020 Serum creatinine 0.8 mg/dL Urine: WBC 1

Urine: RBC 20 BUN 28 mg/dL Hematuria (> 3RBCs) and an elevated BUN are both suggestive of a problem within the genitourinary tract. A serum creatinine of 0.8 mg/dL and a urine specific gravity of 1.020 are within normal limits. A rare white blood cell is not clinically significant.

A client asks the nurse why a creatinine clearance test is accurate. The nurse is most correct to reply which of the following? "Creatinine is metabolized in the liver and excreted by the kidney at a regular rate." "Creatinine is a stress-related response that is excreted by the kidney." "Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." "Creatinine is found in the urine to make the urine acidic and can be measured."

"Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." A creatinine clearance test is used to determine kidney function and creatinine excretion. Creatinine results from a breakdown of phosphocreatine. It is filtered by the glomeruli and excreted at a consistent rate by the kidney.

A patient is scheduled for a test with contrast to determine kidney function. What statement made by the patient should the nurse inform the physician about prior to testing? "I don't like needles." "I take medication to help me sleep at night." "I am allergic to shrimp." "I have had a test similar to this one in the past."

"I am allergic to shrimp." The nurse should obtain the patient's allergy history with emphasis on allergy to iodine, shellfish, and other seafood, because many contrast agents contain iodine.

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." 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.

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

1.010 to 1.025 Urine-specific gravity is a measurement of the kidneys' ability to concentrate urine. The specific gravity of water is 1.000. A urine-specific gravity less than 1.010 may indicate inadequate fluid intake. A urine-specific gravity greater than 1.025 may indicate overhydration.

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

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

The nurse is caring for a patient who has been NPO for 2 days pending a diagnostic procedure that has been repeated cancelled. When evaluating this patient's urinalysis, what would the nurse anticipate? A fluctuating urine specific gravity A decreased urine specific gravity A fixed urine specific gravity An increased urine specific gravity

An increased urine specific gravity Urine specific gravity depends largely on hydration status. A decrease in fluid intake (such as a "nothing by mouth" status) will lead to an increase in the urine specific gravity. With high fluid intake, specific gravity decreases. In patients with kidney disease, urine specific gravity does not vary with fluid intake, and the patient's urine is said to have a fixed specific gravity.

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 Cystoscopy Computed tomography (CT scan)

Angiography 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.

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 financial status The ability of the patient to manage activities of daily living The patient's occupation The presence of hypertension or diabetes

Any voiding disorders 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.

Following a cystoscopy, the client has a nursing diagnosis of acute pain related to the trauma of the procedure to the urinary tract. An appropriate nursing intervention is to: Administer prescribed antibiotics. Apply moist heat to the flank area. Monitor for urinary retention. Assist with warm sitz baths.

Assist with warm sitz baths. Acute pain can be relieved with warm sitz baths. The nurse should monitor the client for urinary retention, which can help detect a potential cause of pain, but this nursing action does not relieve pain. Antibiotics may be prescribed to prevent infection. The pain associated with cystoscopy tends to be confined to the perineal area and lower abdomen not the flank area.

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? Dehydration Allergic reaction Bleeding Infection

Bleeding 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.

The nurse caring for a client is providing instructions for an upcoming renal angiography. Which nursing action, explained in the preoperative instructions, is essential in the postprocedure period? Assess cognitive status. Encourage voiding following the procedure. Assess renal blood work. Complete a pulse assessment of the legs and feet.

Complete a pulse assessment of the legs and feet. A renal angiography provides details about the arterial blood supply to the kidney. A catheter is passed up the femoral artery into the aorta in the area of the renal artery. After the procedure, a pressure dressing remains in place for several hours. It is essential that the nurse palpates pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Reviewing lab work is completed in the preoperative period. Voiding assesses renal status that provides additional data in the post procedural period. Assessing cognitive status is completed due to the sedative that is administered in the preprocedural period.

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

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.

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

Creatinine clearance 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.

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 Creatinine is an endogenous waste product of skeletal muscle that is filtered at the glomerulus, passed through the tubules with minimal change, and excreted in the urine. Hence, creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

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

Hesitancy Nocturia Clinical manifestations of prostate cancer include urinary hesitancy and nocturia. Palpitations, chills, and dyspnea are not suggestive of prostate cancer.

A male client, scheduled for a renal angiography, expresses his fear and anxiety to the nurse about the use of intravenous contrast medium substances in the test. Which of the following would be most appropriate for the nurse to do to help him overcome his apprehension? Arrange for a radioactive expert to have a talk with the client. Offer assurance about the safety of contrast media substances. Discuss the client's anxiety with the physician. Distract the client's attention from the test.

Offer assurance about the safety of contrast media substances. Because the client is anxious about the use of intravenous contrast media for a renal angiography, the nurse should offer him assurance about the safety of these substances which are iodine based. The nurse can do this by confirming that the substances are safe and ordinarily pose no danger to the client or others. The test would be contraindicated if the client had an allergy to iodine or seafood. It is not necessary to discuss the client's anxiety with the physician or ask an expert to talk with the client. More important than the technical details, the client requires assurance and comforting words about the test experience that will help him gain confidence.

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 between 300 and 500 mL/h When the urine output is about 100 mL/h When the urine output is between 500 and 1,000 mL/h When the urine output is less than 30 mL/h

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

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

bladder urethra The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.

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

functional capacity. 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 undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. This test will reveal details about: renal circulation. urine production. kidney structure. kidney function.

renal circulation. 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.

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. Exercise the leg and foot. Place cool compresses on the calf. Assess for anaphylaxis.

Assess peripheral pulses in the left leg. The nurse should begin by assessing peripheral pulses in the left leg to determine if blood flow was interrupted by the procedure. The client may also have thrombophlebitis. Cool compresses aren't used to relieve pain and inflammation in thrombophlebitis. The leg should remain straight after the procedure. Calf pain isn't a symptom of anaphylaxis.

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

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.

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? BUN to creatinine ratio Uric acid level Blood urea nitrogen (BUN) Creatinine clearance level

Creatinine clearance level 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.

An older client is experiencing an increasingly troublesome need to urinate several times through the night. The client's prostate is within normal limits, and the physician prescribes limiting fluid intake after the evening meal. What is another important intervention to keep the client safe? Increase fluid intake throughout the day. Decrease salt intake. Decrease overall fluid intake. Increase protein intake.

Increase fluid intake throughout the day. Older persons may need to drink more fluids throughout the day to allow for limiting their intake after the evening meal. Urine formation increases during the night, when leg elevation promotes blood return to the heart and kidneys, and may interrupt sleep patterns. Salt is secreted. Filtrate that is secreted as urine usually contains sodium and chloride. Protein molecules, except for periodic small amounts of globulins and albumin, also are reabsorbed.

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? Unusually smooth skin Pruritus Hypoventilation Increased alertness

Pruritus (itching) The nurse should be alert for pruritus and urticaria (hives), which may indicate a mild anaphylactic reaction to the arteriogram dye. Decreased (not increased) alertness may occur as well as dyspnea- shortness of breath (not hypoventilation). Unusually smooth skin isn't a sign of anaphylaxis.

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

Susceptibility to develop hypernatremia The elderly are more susceptible to developing hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidney, and acid-base imbalances.

The nurse is educating a patient about preparation for an IV urography. What should the nurse be sure to include in the preparation instructions? A liquid restriction for 8 to 10 hours before the test is required The patient will have enemas until the urine is clear. The patient may have liquids before the test. The patient is restricted from eating or drinking from midnight until after the test.

The patient may have liquids before the test. IV urography may be used as the initial assessment of many suspected urologic conditions, especially lesions in the kidneys and ureters. The patient preparation is the same as for excretory urography, except fluids are not restricted.

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 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.

A group of students is reviewing the process of urine elimination. The students demonstrate understanding of the process when they identify which amount of urine as triggering the reflex? 150 mL 350 mL 50 mL 250 mL

150 mL The desire to urinate comes from the feeling of bladder fullness. A nerve reflex is triggered when approximately 150 to 200 mL of urine accumulates.

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

20 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.

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 Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal.

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

Aldosterone 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.

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

Glucose and protein The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that it is not excreted in the urine.

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

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

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

glucose 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.

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. 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.

Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Which is an example of how urine concentration is affected? On a hot day, a person who is perspiring profusely and taking little fluid has low 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. 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. On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity.

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 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.

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 Glomerulus Parenchyma

Renal pelvis 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.

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 incontinence Urinary frequency Urinary urgency Urinary stasis

Urinary urgency The nurse would document urinary urgency. Urinary frequency is urinating more frequently than normal often times due to inadequate emptying of the bladder. Urinary incontinence is the involuntary loss of urine. Urinary stasis is a stoppage or diminution of flow.

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

confirm all of the medications and supplements normally taken. 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.

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

confirm all of the medications and supplements normally taken. 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.