NUR 240 PrepU Chapter 47: Assessment of Kidney and Urinary Function
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
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.
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 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."
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?
Creatinine clearance
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."
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."
A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client?
"You don't need to do any fasting before this noninvasive test."
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
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.
As women age, many experience an increased sense of urgency to void, as well as an increased risk of incontinence. This is usually the result of age-related changes in which part of the renal system?
Bladder
The nurse is caring for a client with a history of sickle cell anemia. The nurse understands that this predisposes the client to which renal or urologic disorder?
Chronic kidney disease
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?
Computed tomography with contrast
The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find?
Costovertebral angle tenderness
A creatinine clearance test is ordered for a client with possible renal insufficiency. The nurse must collect which serum concentration midway through the 24-hour urine collection?
Creatinine
An appropriate nursing intervention for the client following a nuclear scan of the kidney is to:
Encourage high fluid intake.
The nurse is instructing a health class of high school seniors on the function of the kidney. The nurse is correct to highlight which information? Select all that apply.
Excretes waste products Controls blood pressure Regulate calcium and the synthesis of vitamin D Regulates red blood cell production
The nurse observes that the client's urine is orange. Which additional assessment would be important for this client?
Intake of medication such as phenazopyridine hydrochloride
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
The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following?
Kidney stones
A 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?
Lie still on the table for approximately 35 minutes.
A client is undergoing a renal angiogram after a traumatic accident. What post-procedural assessments would the nurse perform on the client? Select all that apply.
Monitor hypersensitivity response. Palpates the pulses in the legs and feet. Monitor site condition.
A creatinine level has been ordered. The nurse prepares to:
Obtain a blood specimen.
A client undergoes renal angiography. Which postprocedure care intervention should the nurse provide to the client?
Palpate the pulses in the legs and feet.
A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram?
Pruritus
Which of the following is an age-related change associated with the renal system?
Renal arteries thicken
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?
Renal pelvis
Which of the following hormones is secreted by the juxtaglomerular apparatus?
Renin
Which is an effect of aging on upper and lower urinary tract function?
Susceptibility to develop hypernatremia
The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness?
The costovertebral angle
A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact?
The left kidney usually is slightly higher than the right one.
The client presents with nausea and vomiting, absent bowel sounds, and colicky flank pain. The nurse interprets these findings as consistent with:
Ureteral colic
The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document?
Urinary urgency
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
When the bladder contains 400 to 500 mL of urine, this is referred to as
functional capacity.
Approximately what percentage of blood passing through the glomeruli is filtered into the nephron?
20%
Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys?
Angiography
A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 mL. Urine output that's less than 50 ml in 24 hours is known as:
anuria.
A client 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.
Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal?
50%
A female client presents to the health clinic for a routine physical examination. The nurse observes that the client's urine is bright yellow. Which question is most appropriate for the nurse to ask the client?
"Do you take multiple vitamin preparations?"
While reviewing a client's chart, the nurse notes the client has been experiencing enuresis. To assess whether this remains an ongoing problem for the client, the nurse asks which question?
"Do you urinate while sleeping?"
When fluid intake is normal, the specific gravity of urine should be:
1.010 to 1.025
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?
10:1
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?
A dull sound when percussing over the bladder
Following a voiding cystogram, the client has a nursing diagnosis of risk for infection related to the introduction of bacterial following manipulation of the urinary tract. An appropriate nursing intervention for the client is to:
Encourage high fluid intake.
