Ch 47 Assessment of Kidney and Urinary Function
The client presents with nausea and vomiting, absent bowel sounds, and colicky flank pain. The nurse interprets these findings as consistent with: A. Ureteral colic B. Acute prostatitis C. Urethritis D. Interstitial cystitis
A
A creatinine level has been ordered. The nurse prepares to: A. Obtain a blood specimen. B. Collect the client's urine for 24 hours. C. Obtain a clean catch urine. D. Straight cath for a specimen.
A A creatinine level is determined from a blood sample. It is used to assess renal function.
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? A. Increase fluid intake throughout the day. B. Decrease overall fluid intake. C. Decrease salt intake. D. Increase protein intake.
A 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.
Which is the correct term for the ability of the kidneys to clear solutes from the plasma? A. Renal clearance B. Glomerular filtration rate C. Specific gravity D. Tubular secretion
A Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. Glomerular filtration rate is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.
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? A. Size of the urinary bladder B. Urinary tract tests C. Urine specific gravity D. Amount of urine produced
B 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.
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. A kidney stone B. Interstitial cystitis C. Acute pyelonephritis D. Prostatic cancer
B 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.
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? A. 50 mL B. 150 mL C. 250 mL D. 350 mL
B 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.
Which is an effect of aging on upper and lower urinary tract function? A. Increased glomerular filtration rate B. More prone to develop hypernatremia C. Increased blood flow to the kidneys D. Acid-base balance
B 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.
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. A. Renal medulla B. Renal cortex C. Renal pelvis D. Renal papilla
B The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex.
When describing the functions of the kidney to a client, which of the following would the nurse include? A. Regulation of white blood cell production B. Synthesis of vitamin K C. Control of water balance D. Secretion of enzymes
C 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.
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? A. Decreased blood urea nitrogen (BUN) B. Increased serum albumin C. Increased serum creatinine D. Decreased potassium
C 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.
When describing the functions of the kidney to a client, which of the following would the nurse include? Select all that apply. A. Regulation of white blood cell production B. Synthesis of vitamin K C. Control of water balance D. Secretion of the enzyme renin
C, D 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.
The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable? A. Clients have frequent urinary tract infections. B. Clients develop a neurogenic bladder. C. Clients have urinary frequency. D. Clients have chronic renal failure.
D Although all of the options may occur in the client with diabetes mellitus, the option which is most notable, and potentially life threatening, is chronic renal failure.
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. A. Sodium B. Bicarbonate C. Creatinine D. Glucose
D 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.
The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions? A. "I can resume my usual activities without restriction." B. "I should increase my fluid intake for the rest of the day." C. "If I have difficulty urinating, I should contact my physician." D. "It is normal for my urine to be blood-tinged."
A A bladder ultrasound is a non-invasive procedure. The client can resume usual activities without restriction.
A client asks the nurse why a creatinine clearance test is accurate. The nurse is most correct to reply which of the following? A. "Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." B. "Creatinine is metabolized in the liver and excreted by the kidney at a regular rate." C. "Creatinine is a stress-related response that is excreted by the kidney." D. "Creatinine is found in the urine to make the urine acidic and can be measured."
A 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.
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? A. Mucosal B. Adventitia C. Detrusor D. Connective tissue
A 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.
Which term refers to casts in the urine? A. Cylindruria B. Crystalluria C. Pyuria D. Bacteriuria
A Casts may be identified through microscopic examination of the urine sediment after centrifuging. Crystalluria refers to crystals in the urine. Pyuria refers to pus in the urine. Bacteriuria refers to a bacterial count higher than 100,000 colonies/mL in the urine.
A client is prescribed flavoxate (Urispas) following cystoscopy. Which of the following instructions would the nurse give the client? A. "This medication will relieve your pain." B. "This medication prevents urinary incontinence." C. "This medication will treat the blood in your urine." D. "This medication prevents infection in your urinary tract"
A Flavoxate (Urispas) is a antispasmodic agent used for the treatment of burning and pain of the urinary tract.
A client with a history of chronic renal infections is to undergo CT with contrast. Before the procedure, the nurse should complete which action? A. Place emergency medical equipment in the procedure room. B. Instruct the client to maintain a full bladder for the diagnostic test. C. Hold the client's iron supplement until after the diagnostic test. D. Keep the client NPO for 1 hour before the scan.
A For some clients, contrast agents are nephrotoxic and allergenic. Emergency equipment and medications should be available in case of an anaphylactic reaction to the contrast agent. Emergency supplies include epinephrine, corticosteroids, vasopressors, oxygen, and airway and suction equipment. The client is instructed to maintain a full bladder for an ultrasonography. The other instructions/interventions relate to magnetic resonance imaging.
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? A. Hypotension B. Diabetes mellitus C. Neuromuscular disorders D. Pregnancy
A Hypertension, not hypotension, is a risk factor for kidney disease.
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? A. Creatinine clearance level B. Uric acid level C. Blood urea nitrogen (BUN) D. BUN to creatinine ratio
A 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.
A nurse is caring for a client with a fluid and electrolyte balance. What urine specific gravity would the nurse expect to measure? A. 1.018 B. 1.000 C. 1.008 D. 1.028
A Urine specific gravity is a measurement of the kidney's ability to concentrate urine; levels between 1.010-1.025 are considered normal. The specific gravity of water is 1.000. A urine specific gravity less than 1.010 may indicate overhydration. A urine specific gravity greater than 1.025 may indicate dehydration.
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? A. The upper abdominal quadrants on the left and right side B. The costovertebral angle C. Above the symphysis pubis D. Around the umbilicus
B
The nurse is performing a renal assessment on a client with prostate cancer. Which clinical manifestation suggests prostate cancer? Select all that apply. A. Palpitations B. Hesitancy C. Chills D. Dyspnea E. Nocturia
B, E
Which of the following is the priority nursing diagnosis for the client preparing for a voiding cystourethrography? A. Risk for infection: urinary tract B. Acute pain C. Deficient knowledge: procedure D. Urinary retention
C The client needs adequate information before experiencing the procedure. Information about its purpose, the actual steps of the procedure, and the client's role during and after the procedure is essential. Appropriate nursing diagnoses following the procedure would include risk for infection: urinary tract, acute pain, and urinary retention.
The nurse recognizes that a referral for genetic counseling is inappropriate for the client with: A. Alport syndrome B. Polycystic kidney disease C. Renal calculi D. Wilms' tumor
C Wilms' tumor, polycystic disease, and Alport are conditions that have a genetic influence. Renal calculi are not influenced by genetic factors.
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? A. excreting protein B. excreting nitrogen waste products C. regulating blood pressure D. stimulating RBC production
A 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 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? A. KUB B. ultrasound C. CT D. MRI
A 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.
The nurse is monitoring a client who has undergone cystoscopy because the client's history indicates urinary infection. Which of the following would the nurse need to report to the physician? A. Chills and fever B. Dysuria and discolored or malodorous urine C. Hematoma and frank bleeding D. Flank pain and rapid pulse
A The nurse should monitor for chills, fever, and septicemia in a client who has a history of urinary infection after cystoscopy. These symptoms should be observed and the physician should be notified of the findings. Hematoma formation and frank bleeding would be indications to notify the physician after a renal angiography. The nurse should inform the client who is discharged after a renal biopsy to report dysuria, discolored or malodorous urine, flank pain, and rapid pulse to the physician.
The nurse notes that the client's urine is blood-tinged following cystoscopy. Which nursing action should the nurse take next? A. Document the finding in the health record. B. Notify the physician of the finding. C. Instruct the client to increase fluid intake. D. Inspect the client's urinary meatus.
A The physician does not need to be contacted as blood-tinged urine is an expected finding following cystoscopy due to trauma of the procedure. The nurse should document the finding and continue to monitor the client. The client should be encouraged to increase fluid intake to help flush the urinary tract of microorganisms. The urinary meatus does not need to be inspected.
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? A. Lie still on the table for approximately 35 minutes. B. Drink contrast material at various intervals during the procedure. C. Turn from side to side to get a variety of views during the procedure. D. Take deep breaths and hold them at various times throughout the procedure.
A 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).
In a diagnosis of a lower urinary tract infection, which structures could be affected? Select all that apply. A. bladder B. urethra C. ureter D. kidney
A, B The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.
Common tests of renal function include which of the following? Select all that apply. A. Renal concentration test B. Creatinine clearance C. Serum creatinine D. Blood urea nitrogen (BUN) E. Arterial blood gas analysis
A, B, C, D Common tests of renal function include BUN, serum creatinine, creatinine clearance, and renal concentration tests. Arterial blood gas analysis is a test of respiratory function.
Enlargement of the prostate causes which of the following to occur? Select all that apply. A. Frequency B. Oliguria C. Anuria D. Obstruction of urine flow E. Polyuria
A, B, C, D Enlargement of the prostate gland causes obstruction of urine flow, resulting in frequency, oliguria, and anuria. Polyuria does not occur.
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. A. Secretion of prostaglandins B. Vitamin B production C. Regulation of blood pressure D. Vitamin D synthesis E. Secretion of insulin
A, C, D 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.
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? A. It may indicate the client's general health. B. It may reflect the client's childhood and family illnesses. C. It may indicate multiple medications taken by the client. D. It may indicate drugs that should not be prescribed to the client.
C 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.
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? A. Distract the client's attention from the test. B. Discuss the client's anxiety with the physician. C. Arrange for a radioactive expert to have a talk with the client. D. Offer assurance about the safety of contrast media substances.
D 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.