ch26: renal intro
Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? 10 20 30 40
20 Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 L/day of filtrate.
A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in: 1 minute. 30 minutes. 1 hour. 24 hours.
1 minute. The creatinine clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.
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? 350 mL 50 mL 250 mL 150 mL
150 mL 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.
The nurse is conducting health education regarding kidney health with a female patient who has recently been diagnosed with type 2 diabetes. What should the nurse teach this individual about the normal functioning of her kidneys? "If you lose even 10% of your kidneys' normal function, it can radically affect your overall health." "Your kidneys are adept at compensating for diminished function, but it's still important to safeguard their health." "It's vital that you have two functioning kidneys in order to maintain a regular lifestyle." "You need to protect your kidneys because you won't know that they're unhealthy until they've nearly shut down."
"Your kidneys are adept at compensating for diminished function, but it's still important to safeguard their health." The kidneys are vulnerable but are able to maintain homeostasis even in the loss of one kidney or up to 80% of normal function. Signs and symptoms of renal failure are often not apparent in early stages of failure, but they appear prior to complete failure.
Serum sodium plays a major role in maintaining fluid and electrolyte balance. Choose all the correct statements that apply. About 45% of sodium in the renal filtrate is absorbed. Angiotensin II controls the release of aldosterone. Renin, an enzyme released by the kidneys, activates the RAS system to ensure adequate filtration. The normal serum sodium level is 90 to 120 mmol/L. Aldosterone causes renal reabsorption of sodium.
Angiotensin II controls the release of aldosterone. Renin, an enzyme released by the kidneys, activates the RAS system to ensure adequate filtration. Aldosterone causes renal reabsorption of sodium.
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 Dehydration Infection Allergic reaction
Bleeding 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 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? Neurogenic bladder Proteinuria Kidney stone formation Chronic kidney disease
Chronic kidney disease A history of sickle cell anemia predisposes the client to the development of chronic kidney disease. The other disorders are not associated with the development of sickle cell anemia.
The nurse caring for a client is providing instructions for an upcoming renal angiography. Which nursing action, explained in the preoperative instructions, is essential in the postprocedure period? Encourage voiding following the procedure. Assess renal blood work. Assess cognitive status. Complete a pulse assessment of the legs and feet.
Complete a pulse assessment of the legs and feet. A renal angiography provides details about the arterial blood supply to the kidney. A catheter is passed up the femoral artery into the aorta in the area of the renal artery. After the procedure, a pressure dressing remains in place for several hours. It is essential that the nurse palpates pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Reviewing lab work is completed in the preoperative period. Voiding assesses renal status that provides additional data in the post procedural period. Assessing cognitive status is completed due to the sedative that is administered in the preprocedural period.
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 Blood urea nitrogen Hemoglobin Osmolality
Creatinine 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.
A client has a full bladder. Which sound would the nurse expect to hear on percussion? Tympany Resonance Flatness Dullness
Dullness 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.
Encourage high fluid intake. 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.
The nurse is performing a renal assessment on a client with prostate cancer. Which clinical manifestation suggests prostate cancer? Select all that apply. Hesitancy Dyspnea Chills Palpitations Nocturia
Hesitancy Nocturia Clinical manifestations of prostate cancer include urinary hesitancy and nocturia. Palpitations, chills, and dyspnea are not suggestive of prostate cancer.
The client is admitted to the nursing unit for a biopsy of the urinary tract tissue. When planning nursing care for the postoperative period, which nursing intervention documents the prescribed activity level? Activity as tolerated Maintain the client on bedrest Assist the client for bathroom privileges Ambulate the client in the hall
Maintain the client on bedrest In the postoperative period, the client remains on bed rest as the nurse assess for signs of bleeding. If the client is to be discharged on the following day, the client is to maintain limited activity for several days to avoid spontaneous bleeding. The client does not ambulate in the hall and should maintain limited activity for several days post discharge.
A client in moderate pain is admitted for possible kidney stones. The client appears diaphoretic and has frequent periods of nausea and vomiting. The client reports sudden oliguria and initial portable bladder ultrasound shows 300 mL in the bladder after the client voided 50 mL. Which action should the nurse anticipate performing first for this client? Repeat the portable bladder ultrasound. Provide intravenous hydomorphone. Place a urinary cathether. Provide ondansetron intravenously.
Place a urinary cathether. Increased urinary urgency and frequency coupled with decreasing urine volume strongly suggest urinary retention depending on the acuity of the onset of the symptoms, immediate bladder emptying via catheterization and evaluation may be necessary to prevent kidney dysfunction. The combination of pain, sudden oliguria, nausea, vomiting and post-ressidual results are suggestive of an acute condition. Therefore, a second bladder scan is not warranted and may delay care. The pain, nausea, and vomiting may be the result of urinary retention and a full bladder. Placement of a urinary cathether may alleviate those conditions. After placing the urinary cathether, a reassessment and treatment of those conditions can occur.
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 average kidney is approximately 5 cm (2 in.) long and 2 to 3 cm (0.8 to 1.2 in.) wide. The kidneys lie between the 10th and 12th thoracic vertebrae. The kidneys are situated just above the adrenal glands. The left kidney usually is slightly higher than the right one.
The left kidney usually is slightly higher than the right one. 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.
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. palpate the client's bladder before and after voiding. confirm all of the medications and supplements normally taken. confirm which beverages the client normally consumes.
confirm all of the medications and supplements normally taken. 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 is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. This test will reveal details about: urine production. kidney function. kidney structure. renal circulation.
renal circulation. A renal angiography (renal arteriography) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.
A client reports "bloody" urine to the nurse. What causes would the nurse relate the hematuria? Select all that apply. lithium toxicity renal stones acute glomerulonephritis extreme exercise hypertension
renal stones acute glomerulonephritis extreme exercise Hematuria may be caused by cancer of the genitourinary tract, acute glomerulonephritis, renal stones, renal tuberculosis, blood dyscrasias, trauma, extreme exercise, rheumatic fever, hemophilia, leukemia, or sickle cell trait or disease. Lithium toxicity and hypertension are not related causes of hematuria.
The nurse is preparing to conduct intermittent catheterization of an older adult who has been retaining urine due to benign prostatic hyperplasia (BPH). The nurse would understand that the patient's bladder was filled beyond its normal capacity if catheterization yielded how many mL of urine? Select all that apply. 650 mL 250 mL 850 mL 450 mL 1,050 mL
650 mL 850 1,050 Normal bladder capacity is around 30 to 500 mL of urine.
A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? With the first specimen voided after 8:00 am After discarding the 8:00 am specimen 6 hours after the urine is discarded At 8:00 am, with or without a specimen
After discarding the 8:00 am specimen 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.
Following a renal biopsy, a client reports severe pain in the back, the arms, and the shoulders. Which intervention should be offered by the nurse? Provide analgesics to the client. Enable the client to sit up and ambulate. Assess the patient's back and shoulder areas for signs of internal bleeding. Distract the client's attention from the pain.
Assess the patient's back and shoulder areas for signs of internal bleeding. After a renal biopsy, the client should be on bed rest. The nurse observes the urine for signs of hematuria. It is important to assess the dressing frequently for signs of bleeding, monitor vital signs, 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. The nurse should also assess the client for difficulty voiding and encourage adequate fluid intake.
Three areas of the ureters have a propensity for obstruction. Prompt management of renal calculi is most important when the stone is located where? In the urethra In the ureteral segment near the sacroiliac junction In the ureterovesical junction In the ureteropelvic junction
In the ureteropelvic junction There are three narrowed areas of each ureter: the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovesical junction. These three areas of the ureters have a propensity for obstruction by renal calculi or stricture. Obstruction of the ureteropelvic junction is the most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction. The urethra is not part of the ureters.
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? Decrease overall fluid intake. Increase fluid intake throughout the day. Increase protein intake. Decrease salt intake.
Increase fluid intake throughout the day. 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.
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. Take deep breaths and hold them at various times throughout the procedure. Turn from side to side to get a variety of views during the procedure. Drink contrast material at various intervals during the procedure.
Lie still on the table for approximately 35 minutes. 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).
A 79-year-old female resident of a long-term care facility has reported urinary frequency to the nurse. As a result, the nurse has conducted a bladder ultrasound immediately following the woman's most recent void. When assessing the resident's urinary post-void residual, the nurse should understand that: A post-void residual of ≤ 250 mL is considered normal. There will likely be 50 to 100 mL of residual urine in the woman's bladder. The volume of residual urine is dependent on the volume of the preceding void. The bladder should not contain any urine after voiding.
There will likely be 50 to 100 mL of residual urine in the woman's bladder. Normally, residual urine amounts to no more than 50 mL in the middle-aged adult and less than 50 to 100 mL in the older adult. Residual urine volumes of greater than 100 mL are significantly associated with a risk of infection
Which of the following is used to identify vesicoureteral reflux? Renal angiography Bladder ultrasonography IV urography Voiding cystourethrography
Voiding cystourethrography A voiding cystourethrography is used as a diagnostic tool to identify vesicoureteral reflux. An IV urography may be used as the initial assessment of various suspected urologic problems, especially lesions in the kidneys and ureters, and it provides an approximate estimate of renal function. Renal angiography is used to evaluate renal blood flow, to differentiate renal cysts from tumors, to evaluate hypertension, and preoperatively for renal transplantation.
