Ch. 53: Assessment of Kidney & Urinary Function
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?
Correct response: 150 Explanation: 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.
Which value does the nurse recognize as the best clinical measure of renal function? Creatinine clearance Circulating ADH concentration Volume of urine output Urine-specific gravity
Correct response: Creatinine clearance Explanation: 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 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? Uric acid level BUN to creatinine ratio Blood urea nitrogen (BUN) Creatinine clearance level
Correct response: Creatinine clearance level Explanation: 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 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? Excretory urogram Cystoscopy Intravenous pyelography Renal angiography
Correct response: Cystoscopy Explanation: 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? Decreased fluid intake Diabetes insipidus Increased fluid intake Glomerulonephritis
Correct response: Decreased fluid intake Explanation: 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.
Which is an effect of aging on upper and lower urinary tract function? Increased glomerular filtration rate Acid-base balance Susceptibility to develop hypernatremia Increased blood flow to the kidney
Correct response: Susceptibility to develop hypernatremia Explanation: 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 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 Around the umbilicus Above the symphysis pubis The upper abdominal quadrants on the left and right side
Correct response: The costovertebral angle Explanation: The nurse is correct to assess the kidneys for tenderness at the costovertebral angle. The other options are incorrect.
The nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration? Phenytoin Infection Metronidazole phenazopyridine hydrochloride
Correct response: phenazopyridine hydrochloride Explanation: Orange to amber-colored urine is caused by concentrated urine due to dehydration, fever, bile, excess bilirubin or carotene, and the medications phenazopyridium 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 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. pyelonephritis. ureteral stones. Urethral infection.
Correct response: ureteral stones. Explanation: The findings are constant with ureteral stones, edema or stricture, or a blood clot. The other answers do not apply.
Retention of which electrolyte is the most life-threatening effect of renal failure? Potassium Sodium Calcium Phosphorous
Correct response: Potassium Explanation: Retention of potassium is the most life-threatening effect of renal failure.
When the bladder contains 400 to 500 mL of urine, this is referred to as anuria. renal clearance. specific gravity. functional capacity.
Correct response: functional capacity. Explanation: 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 experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? glucose potassium chloride creatinine
Correct response: glucose Explanation: 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.
A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? Nephrotic syndrome Infection Acute renal failure Obstruction of the lower urinary tract
Correct response: Infection Explanation: 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. Nocturia is associated with nephrotic syndrome.
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? Pelvic floor muscles Urethra Bladder Ureters
Correct response: Ureters Explanation: 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.
A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is: an overdistended bladder. renal calculi. acute prostatitis. interstitial cystitis.
Correct response: renal calculi. Explanation: Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void. The client with acute prostatitis presents with a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria.
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. confirm all of the medications and supplements normally taken. confirm which beverages the client normally consumes. palpate the client's bladder before and after voiding.
Correct response: confirm all of the medications and supplements normally taken. Explanation: 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.
A client presents at the testing center for an intravenous pyelogram. What question should the nurse ask to ensure the safety of the client? "Do you have a pacemaker?" "Who has come with you today?" "Have you any artificial joints?" "Do you have any allergies?"
Correct response: "Do you have any allergies?" Explanation: Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood.
Which hormone causes the kidneys to reabsorb sodium? Growth hormone Aldosterone Prostaglandins Antidiuretic hormone
Correct response: Aldosterone Explanation: 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.
Which nursing assessment finding indicates the client with renal dysfunction has not met expected outcomes? Client denies frequency and urgency. Client reports increasing fatigue. Urine output is 100 ml/hr. Client rates pain at a 3 on a scale of 0 to 10.
Correct response: Client reports increasing fatigue. Explanation: Fatigue, shortness of breath, and exercise intolerance are consistent with unexplained anemia, which can be secondary to gradual renal dysfunction.
The most frequent reason for admission to skilled care facilities includes which of the following? Myocardial infarction Stroke Congestive heart failure Urinary incontinence
Correct response: Urinary incontinence Explanation: Urinary incontinence is the most common reason for admission to skilled nursing facilities.
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: 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. keep the client's knee on the affected side bent for 6 hours.
Correct response: check the client's pedal pulses frequently. Explanation: 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.
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? Hemoglobin Blood urea nitrogen Osmolality Creatinine
Correct response: Creatinine Explanation: 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.
The nurse is caring for a client scheduled for urodynamic testing. Following the procedure, which information does the nurse provide to the client? "You will be sent home with a urinary catheter." "You may resume consuming caffeinated, carbonated, and alcoholic beverages." "You can stop taking the prescribed antibiotic." "Contact the primary provider if you experience fever, chills, or lower back pain."
Correct response: "Contact the primary provider if you experience fever, chills, or lower back pain." Explanation: The client must be made aware of the signs of a urinary tract infection after the procedure. The client should contact the primary provider if fever, chills, lower back pain, or continued dysuria and hematuria occur. The client will have catheters placed during the procedure but will not be sent home with one. The client should be told to avoid caffeinated, carbonated, and alcoholic beverages after the procedure because these can further irritate the bladder. These symptoms usually decrease or subside by the day after the procedure. If the client received an antibiotic medication before the procedure, they should be told to continue taking the complete course of medication after the procedure. This is a measure to prevent infection.
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? "Have you had a recent urinary tract infection?" "Have you noticed any vaginal bleeding?" "Do you take phenytoin daily?" "Do you take multiple vitamin preparations?"
Correct response: "Do you take multiple vitamin preparations?" Explanation: Urine that is bright yellow is an anticipated abnormal finding in the client taking a multivitamin preparation. Urine that is orange may be caused by intake of phenytoin 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. Yellow to milky white urine may indicate infection, pyuria, or, in the female client, the use of vaginal creams.
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? "Does it burn when you urinate?" "Is it painful when you urinate?" "Do you have a strong desire to void?" "Do you urinate while sleeping?"
Correct response: "Do you urinate while sleeping?" Explanation: 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 do not have a pacemaker, artificial heart valve, or artificial joints." "I took my blood pressure medication with my morning coffee an hour ago." "I had my last cigarette 3 hours ago with my morning coffee." "I did not take my multivitamin this morning."
Correct response: "I took my blood pressure medication with my morning coffee an hour ago." Explanation: 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 admitting a client who is to undergo an open renal biopsy. About which of the following comments by the client should the nurse be most concerned? "I took my usual dose of Coumadin last night." "I have not eaten since 8 pm last night." "I signed the consent form in the physician's office." "I brought a copy of my living will with me."
Correct response: "I took my usual dose of Coumadin last night." Explanation: A renal biopsy is an invasive procedure, whereby a small incision is made. Coumadin (warfarin) is an anticoagulant, and taking it places the client at increased risk for bleeding complications.
A client is prescribed flavoxate (Urispas) following cystoscopy. Which of the following instructions would the nurse give the client? "This medication will relieve your pain." "This medication will treat the blood in your urine." "This medication prevents urinary incontinence." "This medication prevents infection in your urinary tract"
Correct response: "This medication will relieve your pain." Explanation: Flavoxate (Urispas) is a antispasmodic agent used for the treatment of burning and pain of the urinary tract.
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 cortex Renal papilla Renal medulla Renal pelvis
Correct response: Renal cortex Explanation: The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex.
A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client? "You'll have a pressure dressing on your groin after the test." "You don't need to do any fasting before this noninvasive test." "A contrast medium will be used to help see the structures better." "An x-ray will be done to view your kidneys, ureters, and bladder."
Correct response: "You don't need to do any fasting before this noninvasive test." Explanation: 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
Correct response: 1.010 to 1.025 Explanation: 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 completing a full exam of the renal system. Which assessment finding best documents the need to offer the use of the bathroom? Tenderness over the kidneys The ingestion of 8 oz of water A dull sound when percussing over the bladder Bruits noted over the abdominal area
Correct response: A dull sound when percussing over the bladder Explanation: A dull sound when percussing over the bladder indicates a full bladder. Because the bladder is full, the nurse would offer for the client to use the bathroom. Tenderness over the kidney can indicate an infection or stones. Bruits are an abnormal vascular sound that does not indicate the need to use the bathroom. Ingesting water does not mean that the client has to void at this time.
A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? At 8:00 am, with or without a specimen With the first specimen voided after 8:00 am 6 hours after the urine is discarded After discarding the 8:00 am specimen
Correct response: After discarding the 8:00 am specimen Explanation: 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.
Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys? Computed tomography (CT scan) Radiography Angiography Cystoscopy
Correct response: Angiography Explanation: 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.
A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse? Asses the patient's back and shoulder areas for signs of internal bleeding. Provide analgesics to the patient. Enable the patient to sit up and ambulate. Distract the patient's attention from the pain.
Correct response: Asses the patient's back and shoulder areas for signs of internal bleeding. Explanation: After a renal biopsy, the patient is on bed rest. It is important to assess the dressing frequently for signs of bleeding 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. Distracting the patient's attention, helping the patient to sit up or ambulate, and providing analgesics may only aggravate the patient's pain and, therefore, should not be performed by the nurse.
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? Bleeding Allergic reaction Infection Dehydration
Correct response: Bleeding Explanation: 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.
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
Correct response: Bleeding Explanation: 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.
A 24-year-old patient was admitted to the emergency room after a water skiing accident. The X-rays revealed two fractured vertebrae, T-12 and L1. Based on this information, the nurse would know to perform which of the following actions? Check the patient's urine for hematuria. Place a bed board under the mattress to add support. Apply moist heat, every 4 hours for the first 48 hours to aid healing. Keep the patient on bed rest for 72 hours.
Correct response: Check the patient's urine for hematuria. Explanation: The kidneys are located from the 12th thoracic vertebrae to the third lumbar vertebrae. Therefore, the accident may have caused blunt force trauma damage to the kidneys. Ice is always applied for the first 24 hours, then heat, if not contraindicated. Activity will be restricted but bed rest is not necessary.
The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? Costovertebal angle tenderness Pain after voiding Perineal pain Suprapubic pain
Correct response: Costovertebal angle tenderness Explanation: Acute pyelonephritiis is characterized by costovertebal 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 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? Uric acid level Creatinine clearance level Serum potassium level Blood urea nitrogen level
Correct response: Creatinine clearance level Explanation: 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.
Which of the following is the priority nursing diagnosis for the client preparing for a voiding cystourethrography? Acute pain Deficient knowledge: procedure Risk for infection: urinary tract Urinary retention
Correct response: Deficient knowledge: procedure Explanation: 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 wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition? Submucosal layer of connective tissue Inner layer of epithelium Detrusor muscle Adventitia (connective tissue)
Correct response: Detrusor muscle Explanation: 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.
A client has a full bladder. Which sound would the nurse expect to hear on percussion? Resonance Flatness Dullness Tympany
Correct response: Dullness Explanation: 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: Apply moist heat to the flank area. Monitor for hematuria. Encourage high fluid intake. Strain all urine for 48 hours.
Correct response: Encourage high fluid intake. Explanation: 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.
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: Monitor for hematuria. Apply moist heat to the flank area. Strain all urine for 48 hours. Encourage high fluid intake.
Correct response: Encourage high fluid intake. Explanation: 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.
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? Decreased blood urea nitrogen (BUN) Increased serum creatinine Increased serum albumin Decreased potassium
Correct response: Increased serum creatinine Explanation: 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? Intake of multiple vitamin preparations Infection Bleeding Intake of medication such as phenytoin
Correct response: Intake of medication such as phenytoin Explanation: Urine that is orange may be caused by intake of phenytoin 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.
A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? Evaluate the client for periorbital edema. Monitor the client for an allergy to iodine contrast material. Monitor the client for signs of electrolyte and water imbalance. Assess the client's mental changes.
Correct response: Monitor the client for an allergy to iodine contrast material. Explanation: 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? Detrusor Adventitia Mucosal Connective tissue
Correct response: Mucosal Explanation: 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 of the following is an age-related change associated with the renal system? Increased bladder capacity Blood flow increase Kidney weight increases Renal arteries thicken
Correct response: Renal arteries thicken Explanation: Age-related changes include thickening of the renal arteries, a decrease in the weight of the kidney, blood flow decrease by approximately 10% per decade, and decreased bladder capacity.
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 Glomerulus Parenchyma Renal pelvis
Correct response: Renal pelvis Explanation: 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 aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure? Vasopressin Albumin Cortisol Renin
Correct response: Renin Explanation: 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: Bright yellow urine Specific gravity 1.035 Creatinine 0.7 mg/dL Protein 15 mg/dL
Correct response: Specific gravity 1.035 Explanation: 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 mulitiple 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.
Which nursing assessment finding indicates the client has not met expected outcomes? The client has blood-tinged urine following brush biopsy. The client consumes 75% of lunch following an intravenous pyelogram. The client reports a pain rating of 3 two hours post-kidney biopsy. The client voids 75 cc four hours post cystoscopy.
Correct response: The client voids 75 cc four hours post cystoscopy. Explanation: Urinary retention is an undesirable outcome following cystoscopy. A pain rating of 3 is an achieveable and expected outcome following kidney biopsy. Blood-tinged urine is an expected finding following cystoscopy due to trauma of the procedure. A client would be expected to eat and retain a meal following an intravenous pyelogram.
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 lie between the 10th and 12th thoracic vertebrae. 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 kidneys are situated just above the adrenal glands.
Correct response: The left kidney usually is slightly higher than the right one. Explanation: 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.
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 stasis Urinary urgency
Correct response: Urinary urgency Explanation: 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.
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 less than 30 mL/h When the urine output is about 100 mL/h When the urine output is between 500 and 1,000 mL/h
Correct response: When the urine output is less than 30 mL/h Explanation: Oliguria is defined as urine output <0.5 mL/kg/h
The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to drink liberal amounts of fluids. notify the health care team if bloody urine is noted. carefully handle urine because it is radioactive. maintain bed rest for 2 hours.
Correct response: drink liberal amounts of fluids. Explanation: 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? excreting nitrogen waste products stimulating RBC production excreting protein regulating blood pressure
Correct response: excreting protein Explanation: 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.
The term used to describe total urine output less than 0.5 mL/kg/hr is oliguria. dysuria. anuria. nocturia.
Correct response: oliguria. Explanation: 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.
