Ch 26 Assessment of the Renal System

15. A client needs some labwork prior to a test the next day. The client is having a study that allows the visualization of the urinary system including the renal pelvis, the ureters and the bladder. The client cannot have the test completed if the BUN is greater than 40 mg/dL. This test is called a(n): a. intravenous pyelogram (IVP) b. kidney-ureter-bladder x-ray c. renal angiography d. renal ultrasound

ANS: A An intravenous pyelogram (IVP) is a study that allows for the visualization of the urinary system including the renal pelvis, the ureters and the bladder. This test requires the infusion of radiopaque dye into a vein. If the BUN is over 40 mg/dL, the test may not be performed as the dye may harm the kidneys.

1. The kidneys are responsible for which of the following functions? a. removal of waste products b. removal of drugs and medications c. balancing the body's fluids d. releasing hormones to regulate blood pressure e. produce an inactive form of Vitamin D f. assist in the production of red blood cells

ANS: A, B, C, D, F The kidneys are responsible for the removal of waste products, removal drugs and medications, balancing the body's fluids, the release of hormones to regulate blood pressure, produce an active form of vitamin D, and to assist in the production of red blood cells.

2. Which are changes found in the urinary system as a result of aging? a. ability to conserve sodium is decreased b. glomerular filtration rate increases c. stress incontinence increases in females d. enlarged prostate by cause frequency or dribbling e. BUN decreases

ANS: A, C, D The following changes are found in the urinary system as a result of aging: nephrons decrease, resulting in decreased filtration and gradual decrease in excretory and reabsorptive functions of renal tubules, glomerular filtration rate decreases, resulting in decreased renal clearance of drugs, blood urea nitrogen (BUN) increases 20% by age 70, sodium-conserving ability is diminished, bladder capacity decreases, causing increased frequency of urination and nocturia, bladder and perineal muscles weaken, resulting in inability to empty the bladder, incidence of stress incontinence increases in females and the prostate may enlarge, causing frequency or dribbling in males.

17. The lab has called the nurse to report the completion of the urinalysis. The physician suspects the client has acute glomerulonephritis. What would be present in the urine in acute glomerulonephritis? a. nitrites b. proteniuria c. leukocyte esterase d. casts

ANS: B A client with acute glomerulonephritis will show proteinuria in urinalysis. Nitrites, casts and leukocyte esterase are all negative in a normal urinalysis.

19. A nurse has just assisted a client to the bathroom to void. Upon returning to the bed, the client reports that the bladder still feels somewhat full. The nurse reports this client's concern to the physician who orders a test. Which study will determine if there is urine remaining in the client's bladder? a. uroflowmetry b. postvoid residual (PVR) c. bladder x-ray d. bladder CT scan

ANS: B A postvoid residual (PVR) urinary catheterization would be completed to quantify the amount of urine retained by the client after voiding. Uroflowmetry is a noninvasive assessment of urination using an electronic device connected to a funneled commode to calculate the urine flow, volume voided and time to void. Bladder x-ray and CT scan are not indicated to determine postvoid residual.

7. What anatomical feature puts women more at risk for urinary tract infections? a. a larger bladder b. a shorter urethra c. thinner ureters d. larger kidneys

ANS: B Females have a shorter urethra than males, thus increasing the risk for urinary tract infections. Bacteria have a shorter distance to travel to the kidneys.

20. The nurse is teaching a client about the procedures involved for an upcoming a voiding cystourethrography. The client understands that the bladder is filled with dye and then x-rays are taken. The nurse informs the client of the purpose of this radiographic procedure, which is: a. to detect between cystic and solid masses in the bladder b. to observe bladder filling and emptying c. to show the blood vessels from the kidney to the bladder d. identify the cause of urinary system disorders like acute renal failure

ANS: B The bladder is filled with dye, and X-rays are taken for the purpose of observing the bladder filling and emptying. This test detects structural abnormalities of the bladder and urethra and reflux into the ureters.

10. Which client may require a more in-depth assessment for renal disease? a. a client on corticosteroids b. a client with history of nephrotoxin exposure c. a client with mild high blood pressure d. a pregnant client with no history of renal disease

ANS: B The client with the history of nephrotoxin exposure would require a more in-depth assessment for renal disease as exposure may have caused harm to the client's renal system. Clients on medication with mild high blood pressure and pregnancy may require a more thorough assessment.

11. The nurse is preparing a room for a client about to be admitted for oliguria. The nurse knows the definition of oliguria to be: a. excessive urination at night b. diminished capacity to form and excrete urine (<500 mL/day) c. painful urination d. cessation of urine production or urine output <100 mL/day

ANS: B The definition of oliguria is the diminished capacity to form and excrete urine (<500 mL/day). Anuria is the cessation of urine production or urine output <100mL/day. Nocturia is excessive urination at night while dysuria is painful urination.

5. The kidneys have a capability to process about 200 quarts of blood a day. How many quarts of waste products and extra water as urine do the kidneys produce? a. .5 quart b. 2 quarts c. 5 quarts d. 10 quarts

ANS: B The kidneys have a capability to process about 200 quarts of blood a day and to eliminate 2 quarts of waste products and extra water as urine.

16. The color of a client's urine in a normal urinalysis would be: a. orange tinged b. clear amber c. slightly cloudy yellow d. pale yellow with red flecks

ANS: B The normal of color of urine in a urinalysis is clear amber. Differing colors may indicate the presence of blood in the urine, client's level of hydration/dehydration, and/or presence of infection.

9. The nurse is reviewing a client's recent labwork conducted during a recent annual physical. The nurse notices an elevated serum creatinine. What does this mean clinically? a. This is a normal lab value. b. The kidneys are failing to excrete waste products. c. The client may have bladder cancer. d. The client was dehydrated at the time of the labwork.

ANS: B The serum creatinine level is a byproduct of protein and muscle metabolism and it is a good indicator of renal functioning. As the kidneys fail to excrete the waste products, the serum creatinine level increases.

1. A primary care physician has been treating a client for repeated urinary tract infections. Despite several courses of antibiotics, the infection remains. The primary care physician decides to refer his client to a physician specializing in urinary tract disorders. This type of physician is a(n): a. nephrologist b. urologist c. internist d. gynecologist

ANS: B Urologists specialize in the care of clients with urinary tract disorders. Nephrologists specialize in the structure, function and diseases of the kidney. Physicians in the internal medicine and gynecology fields could provide care for a client with a urinary tract infection but are not specialists in the field.

12. An client is admitted to the hospital after a round of chemotherapy with a BUN of 22. A normal blood urea nitrogen (BUN) is: a. 0-3 mg/dL b. 5-10 mg/dL c. 5-20 mg/dL d. 20-30 mg?dL

ANS: C The Blood Urea Nitrogen is an expression of the amount of urea nitrogen buildup in the body. An elevated BUN can result from dehydration, infection, cancer treatment, or steroid use. A normal BUN is 5-20 mg/dL.

2. The location of the kidneys can best be described as: a. inside the peritoneal cavity b. at the front of the abdominal cavity c. in the retroperitoneal space d. just adjacent to the diaphragm

ANS: C The kidneys are bean shaped organs about the size of a fist that are located just beneath the false ribs, in the retroperitoneal space (behind the peritoneum outside the peritoneal cavity).

4. The hollow tube that connects the kidney to the urinary bladder and is responsible for the passage of urine from the kidney to the bladder is called the: a. urethra b. efferent arteriole c. ureter d. proximal convoluted tubule

ANS: C The ureter is a hollow tube that connects the kidney to the urinary bladder and responsible for the passage of urine from the kidney to the bladder. The urethra is a small narrow tube responsible for the passage of urine out of the urinary bladder. The efferent arteriole is responsible for the transport of blood from the glomerulus and supplies blood to the renal tubules. The proximal convoluted tubule is the beginning of the renal tubule responsible for the reabsorption and secretion of fluids, electrolytes, and waste products.

18. The nurse is performing a physical assessment on a client and see signs and symptoms of uremic frost. Where would these be visible on a client? a. on the client's conjuctiva b. under the client's finger nails c. on the client's skin d. on the client's oral mucous membranes

ANS: C Uremic frost is white powdery crystal-like deposits of urea and uric acid salts on the skin.

13. Why would a physician order a urine culture and sensitivity (C & S)? a. to identify the presence of glucose in the urine b. to determine if sodium is elevated in urine c. to determine the presence of ketones in the urine d. to determine the presence of microorganisms in urine and to identify the appropriate antibiotic to kill microorganisms

ANS: D A urine culture and sensitivity is ordered to determine the presence of microoganisms in the urine as well as to identify the antibiotic sensitivity It is important to assure specimen collected prior to initiation of antibiotic therapy.

6. After urine is produced in the kidneys, by which method is the urine moved through the ureters into the urinary bladder? a. bladder suction b. gravity c. retrograde pressure d. peristalsis

ANS: D After urine is produced in the kidneys, it moves steadily by peristalsis through the ureters into the urinary bladder.

14. Which test is the best to determine renal function in the elderly? a. urinalysis b. glomerular filtration rate c. BUN d. creatinine clearance

ANS: D The creatinine clearance test is a better index than the BUN of renal function in the elderly.

8. An accurate measure of the functioning status of the kidneys and the amount of fluid filtered from the blood into the Bowman's capsule per minute is: a. micturition b. renal perfusion rate c. retroperitoneal perfusion rate d. glomerular filtration rate

ANS: D The glomerular filtration rate (GFR) is the amount of fluid filtered from the blood into the capsule per minute and an accurate measure of the functioning status of the kidneys.

3. A tuft of capillaries in the kidney that is responsible for filtering the blood is called the: a. Bowman's capsule b. Loop of henle c. afferent arteriole d. glomerulus

ANS: D The glomerulus is a tuft of capillaries that is responsible for filtering the blood. Bowman's Capsule is a funnel-like structure that surrounds the glomerulus and is responsible for the collection of the filtered products. The Loop of Henle is the middle section of the renal tubule that contains a hair-pin turn and is responsible for the concentrating ability of the nephron. The afferent arteriole is responsible for the transport of blood from the renal artery to the glomerulus.