CH. 47: Kidney and Urinary Function

A nurse is caring for a 73-year-old client with a urethral obstruction related to prostatic enlargement. When planning this client's care, the nurse should be aware of the risk of what complication? A. Urinary tract infection B. Enuresis C. Polyuria D. Proteinuria

A

A client asks the nurse why kidney problems can cause gastrointestinal disturbances. What relationship should the nurse describe? A. The right kidney's proximity to the pancreas, liver, and gallbladder B. The indirect impact of digestive enzymes on renal function C. That the peritoneum encapsulates the GI system and the kidneys D. The left kidney's connection to the common bile duct

A

A client with difficulty voiding and elevated BUN and creatinine values has been referred by the health care provider for further evaluation. The nurse should anticipate the use of what initial diagnostic test? A. Portable bladder ultrasound B. X-ray C. Computed tomography (CT) D. Nuclear scan

A

A nurse is giving discharge instructions to a client following urodynamic testing. What are the priority topics to be addressed by the nurse? A. Beverage limitations, pain control, and urinary expectations B. Antibiotic adherence, carbohydrate restrictions, and urinary expectations C. Protein intake, mobility limitations, and urinary expectations D. Opioid usage, urinary expectations, fat and protein limitations

A

A nurse is preparing a client diagnosed with benign prostatic hyperplasia (BPH) for a lower urinary tract cystoscopic examination. The nurse should caution the client about what common temporary complication of this procedure? A. Urinary retention B. Bladder perforation C. Hemorrhage D. Nausea

A

A nurse is working with a client who will undergo invasive urologic testing. The nurse has informed the client that slight hematuria may occur after the testing is complete. The nurse should recommend what action to help resolve hematuria? A. Increased fluid intake following the test B. Use of an over-the-counter (OTC) diuretic after the test C. Gentle massage of the lower abdomen D. Activity limitation for the first 12 hours after the test

A

Dipstick testing of an older adult client's urine indicates the presence of protein. Which statement is true of this assessment finding? A. This finding needs to be considered in light of other forms of testing. B. This finding is a risk factor for urinary incontinence. C. This finding is likely the result of an age-related physiologic change. D. This result confirms that the client has diabetes.

A

The nurse is assessing a client's bladder by percussion. The nurse elicits dullness after the client has voided. How should the nurse interpret this assessment finding? A. The client's bladder is not completely empty. B. The client has kidney enlargement. C. The client has a ureteral obstruction. D. The client has a fluid volume deficit.

A

The nurse is caring for a client who has been diagnosed with renal calculi. Prompt management of renal calculi is most important when the stone is located where? A. In the ureteropelvic junction B. In the ureteral segment near the sacroiliac junction C. In the ureterovesical junction D. In the urethra

A

The nurse is providing preprocedure teaching about an ultrasound. The nurse informs the client that in preparation for an ultrasound of the lower urinary tract the client will require what action? A. Increased fluid intake to produce a full bladder B. IV administration of radiopaque contrast agent C. Sedation and intubation D. Injection of a radioisotope

A

The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply. A. Specific gravity of the client's urine B. Testing for the presence of glucose in the client's urine C. Microscopic examination of urine sediment for RBCs D. Microscopic examination of urine sediment for casts E. Testing for BUN and creatinine in the client's urine

A, B, C, D

A client is scheduled for a diagnostic MRI of the lower urinary system. What preprocedure education should the nurse include? A. The need to be NPO for 12 hours prior to the test B. Relaxation techniques to use during the test C. The need for conscious sedation prior to the test D. The need to limit fluid intake to 1 liter in the 24 hours before the test

B

A client with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid-base balance? A. Sequestering free hydrogen ions in the nephrons B. Returning bicarbonate to the body's circulation C. Retaining ammonium chloride D. Excreting bicarbonate in the urine

B

A client with recurrent urinary tract infections has just undergone a cystoscopy and reports slight hematuria during the first void after the procedure. What is the nurse's most appropriate action? A. Administer a STAT dose of vitamin K, as prescribed. B. Reassure the client that this is not unexpected and then monitor the client for further bleeding. C. Promptly inform the health care provider of this assessment finding. D. Position the client supine and insert a Foley catheter, as prescribed.

B

A nurse is caring for a client with impaired renal function. A creatinine clearance measurement has been ordered. The nurse should facilitate collection of what samples? A. A fasting serum potassium level and a random urine sample B. A 24-hour urine specimen and a serum creatinine level midway through the urine collection process C. A BUN and serum creatinine level on three consecutive mornings D. A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values

B

The nurse caring for a client with suspected renal dysfunction calculates that the client's weight has increased by 5 pounds (2.27 kg) in the past 24 hours. The nurse estimates that the client has retained approximately how much fluid? A. 1,300 mL/ 43.9 fl oz. of fluid in 24 hours B. 2,270 mL/76.7 fl oz. of fluid in 24 hours C. 3,100 mL/104.8 fl oz. of fluid in 24 hours D. 5,000 mL/169.0 fl oz. of fluid in 24 hours

B

The nurse is caring for a client scheduled for renal angiography following a motor vehicle accident. What client preparation should the nurse most likely provide before this test? A. Administration of IV potassium chloride B. Administration of a laxative C. Administration of Gastrografin D. Administration of a 24-hour urine test

B

The nurse is caring for a client who describes changes in voiding patterns. The client states, "I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesn't seem to be much urine flow." What would the nurse expect this client's physical assessment to reveal? A. Hematuria B. Urine retention C. Dehydration D. Kidney injury

B

The nurse is reviewing the electronic health record of a client with a history of incontinence. The nurse reads that the health care provider assessed the client's deep tendon reflexes. What condition of the urinary/renal system does this assessment address? A. Renal calculi B. Bladder dysfunction C. Benign prostatic hyperplasia (BPH) D. Recurrent urinary tract infections (UTIs)

B

A 52-year-old client is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all that apply. A. Petechiae B. Pain C. Gastrointestinal symptoms D. Changes in voiding E. Jaundice

B, C, D

A client with gross hematuria has been admitted to a surgical floor in preparation for an upper cystoscopy in the morning. What post-procedure interventions would the nurse anticipate for this client? Select all that apply. A. Nothing by mouth (NPO) B. Intermittent straight catheterization C. Sedative agent administration D. Moist heat to abdomen E. Monitor for urinary retention

B, D, E

A client admitted to the medical unit with impaired renal function reports severe, stabbing pain in the flank and lower abdomen. The client is being assessed for renal calculi. The nurse recognizes that the stone is most likely in what anatomic location? A. Meatus B. Bladder C. Ureter D. Urethra

C

A client is reporting genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform? A. Encourage mobilization. B. Apply topical lidocaine to the client's meatus, as prescribed. C. Apply moist heat to the client's lower abdomen. D. Apply an ice pack to the client's perineum.

C

A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult? A. "If possible, try to drink at least 4 liters of fluid daily." B. "Ensure that you avoid replacing water with other beverages." C. "Remember to drink frequently, even if you don't feel thirsty." D. "Make sure you eat plenty of salt in order to stimulate thirst."

C

Results of a client's 24-hour urine sample indicate osmolality of 510 mOsm/kg (510 mmol/kg), which is within reference range. What conclusion can the nurse draw from this assessment finding? A. The client's kidneys are capable of maintaining acid-base balance. B. The client's kidneys reabsorb most of the potassium that the client ingests. C. The client's kidneys can produce sufficiently concentrated urine. D. The client's kidneys are producing sufficient erythropoietin.

C

The nurse is caring for a client suspected of having renal dysfunction. When reviewing laboratory results for this client, the nurse interprets the presence of which substances in the urine as most suggestive of pathology? A. Potassium and sodium B. Bicarbonate and urea C. Glucose and protein D. Creatinine and chloride

C

The nurse is caring for a client who had a brush biopsy 12 hours ago. The presence of what assessment finding should prompt the nurse to notify the health care provider? A. Scant hematuria B. Renal colic C. Temperature 37.9°C (100.2°F) orally D. Infiltration of the client's intravenous catheter

C

The nurse is caring for a client with a nursing diagnosis of deficient fluid volume. The nurse's assessment reveals a blood pressure (BP) of 98/52 mm Hg. The nurse should recognize that the client's kidneys will compensate by secreting what substance? A. Antidiuretic hormone (ADH) B. Aldosterone C. Renin D. Angiotensin

C

The nurse is performing a focused genitourinary and renal assessment of a client. Where should the nurse assess for pain at the costovertebral angle? A. At the umbilicus and the right lower quadrant of the abdomen B. At the suprapubic region and the umbilicus C. At the lower border of the 12th rib and the spine D. At the 7th rib and the xiphoid process

C

The nurse on a nephrology unit is caring for a diverse group of clients. For which client would a kidney biopsy most likely be contraindicated? A. A 64-year-old client with chronic glomerulonephritis B. A 57-year-old client with proteinuria C. A 42-year-old client with morbid obesity D. A 16-year-old client with signs of kidney transplant rejection

C

A client has experienced excessive losses of bicarbonate and has subsequently developed an acid-base imbalance. How will this lost bicarbonate be replaced? A. The kidneys will excrete increased quantities of acid. B. Bicarbonate will be released from the adrenal medulla. C. Alveoli in the lungs will synthesize new bicarbonate. D. Renal tubular cells will generate new bicarbonate.

D

A client's most recent laboratory findings indicate a glomerular filtration rate (GFR) of 58 mL/min. The nurse should recognize what implication of this diagnostic finding? A. The client is likely to have a decreased level of blood urea nitrogen (BUN). B. The client is at risk for hypokalemia. C. The client is likely to have irregular voiding patterns. D. The client is likely to have increased serum creatinine levels.

D

A geriatric nurse is performing an assessment of body systems on an older adult client. The nurse should be aware of what age-related change affecting the renal and urinary systems? A. Increased ability to concentrate urine B. Increased bladder capacity C. Urinary incontinence D. Decreased glomerular filtration rate

D

A kidney biopsy has been scheduled for a client with a history of acute kidney injury. The client asks the nurse why this test has been scheduled. What is the nurse's best response? A. "A biopsy is routinely ordered for all clients with renal disorders." B. "A biopsy is generally ordered following abnormal x-ray findings of the renal pelvis." C. "A biopsy is often ordered for clients before they have a kidney transplant." D. "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."

D

The care team is considering the use of dialysis in a client whose renal function is progressively declining. Renal replacement therapy is indicated in which situation? A. creatinine level drops below 1.2 mg/dl (110mmol/L) B. blood urea nitrogen (BUN) is above 15 mg/dl C. urinalysis (dipstick test) reveals 140 mg/dl of protein D. functioning nephrons are less than 20%

D

The nurse is caring for a client who has a fluid volume deficit. When evaluating this client's urinalysis results, what should the nurse normally anticipate? A. Decrease in blood urea nitrogen (BUN) B. Less antidiuretic hormone (ADH) released C. Decreased urine osmolality D. Increased urine specific gravity

D

The nurse is caring for a client who is going to have an open renal biopsy. What nursing action should the nurse prioritize when preparing this client for the procedure? A. Discuss the client's diagnosis with the family. B. Bathe the client before the procedure with antiseptic skin wash. C. Administer antivirals before sending the client for the procedure. D. Keep the client NPO prior to the procedure.

D

What nursing action should the nurse perform when caring for a client undergoing diagnostic testing of the renal-urologic system? A. Withhold medications until 12 hours post-testing. B. Ensure that the client knows the importance of temporary fluid restriction after testing. C. Inform the client of the medical diagnosis after reviewing the results. D. Assess the client's understanding of the test results after their completion.

D