Chapter 57 Introduction to the Urinary System

The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following? A) Kidney stones B) Neurogenic bladder C) Chronic renal failure D) Fistula

A Feedback: A client with hyperparathyroidism is at risk for kidney stones. The client with diabetes mellitus is a risk factor for developing chronic renal failure and neurogenic bladder. A client with radiation to the pelvis is at risk for urinary tract fistula.

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 Feedback: 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 nurse is caring for clients at a long-term care facility. When considering activities in the summer heat, which physiologic change of renal aging can also result in geriatric dehydration? A) Decreased ability to concentrate urine B) Decreased renal blood flow C) Thickening of the renal tubules D) Double voiding

A Feedback: A gerontologic consideration of aging is the decreased ability to concentrate urine. This consideration leads to an increased susceptibility to dehydration further complicated by a deficit in thirst. Other age-related changes include a decrease in renal blood flow and a thickening of the renal tubules. These changes lead to an alteration in the excretion of drugs in older adults, increasing the risk of drug toxicity. Double voiding is remaining at the toilet after voiding to allow time for additional urine to be excreted.

Which of the following urine characteristics would the nurse anticipate when caring for a client whose lab work reveals a high urine specific gravity related to dehydration? A) Dark amber urine B) Clear or light yellow urine C) Red urine D) Turbid urine

A Feedback: Concentrated urine (one with a high specific gravity) is a dark amber color due to the solutes in the urine. Clear or yellow urine indicates a flushing of the urinary system. Red urine indicates hematuria. A turbid urine may indicate bacteriuria.

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? A) Maintain the client on bedrest B) Assist the client for bathroom privileges C) Ambulate the client in the hall D) Activity as tolerated

A Feedback: 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 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? A) Bleeding B) Infection C) Dehydration D) Allergic reaction

A Feedback: 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.

The client tells the nurse of the feeling of always needing to void. The nurse instructs on normal urine elimination. At which amount of urine accumulation in the bladder is the nerve reflex triggered to signal the need to void? A) 150 mL B) 300 mL C) 500 mL D) 750 mL

A Feedback: The nerve reflex is triggered when approximately 150 mL of urine accumulates.

The nurse is caring for a client with oliguria. When instructing the client on the process of urine formation, place the following in correct sequence. Use all options. A) Products enter the Bowman's capsule B) Drains from the collecting tubules C) Filtration of plasma by glomerulus D) Moves through the nephrons and is absorbed or excreted E) Flows into the renal pelvis and down the ureter F) Drains into the bladder then out the urethra

A, B, C, D, E, F Feedback: There are three main steps with substeps in the complex process of forming urine. The glomerular filtration begins with filtering of the blood plasma by the glomerulus. Next, the filtrate enters Bowman's capsule and moves through the tubular system of the nephron and is either absorbed into circulation or excreted as urine. The formed urine drains from the collecting tubules into the renal pelvis and down each ureter to the bladder and out through the urethra.

A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? A) Monitor the client for signs of electrolyte and water imbalance. B) Monitor the client for an allergy to iodine contrast material. C) Assess the client's mental changes. D) Evaluate the client for periorbital edema.

B Feedback: 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.

Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys? A) Radiography B) Angiography C) Computed tomography (CT scan) D) Cystoscopy

B Feedback: 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 bladder.

A client has a full bladder. Which sound would the nurse expect to hear on percussion? A) Tympany B) Dullness C) Resonance D) Flatness

B Feedback: 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.

The nurse is caring for a client prescribed gentamicin 110 mg every 8 hours for 10 days. Which laboratory study is anticipated to monitor medication side effects? A) Blood chemistry B) BUN and serum creatinine C) Creatinine clearance test D) Urine osmolality

B Feedback: The client who is on a therapeutic regimen of gentamicin is ordered laboratory studies of a BUN and serum creatinine to monitor for signs of nephrotoxicity related to medication therapy. Nephrotoxicity from the use of an aminoglycoside is reversible if the medication is discontinued. The other laboratory studies do not focus on nephrotoxicity.

The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client assess for an allergy to shellfish? A) Radiography B) Computed tomography with contrast C) Cystoscopy D) Bladder ultrasonography

B Feedback: The nurse is correct to assess for an allergy to shellfish most times when a contrast medium is ordered. The other options do not necessarily have a contrast medium.

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? A) Nephron B) Renal pelvis C) Parenchyma D) Glomerulus

B Feedback: 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.

A client who is suspected of urinary tract infection is asked to collect a 24-hour urine specimen for culture. Which of the following measures can the nurse suggest to the client that may help prevent the entire urine specimen from becoming contaminated? A) Collect the voided urine sample primarily before 5 AM. B) Refrigerate the specimen until it is taken to the laboratory. C) Use the same receptacle for voiding and defecation. D) Store the collected urine away from sunlight.

B Feedback: To prevent the entire urine specimen from becoming contaminated, the urine specimen should be refrigerated until it can be taken to the laboratory. The nurse should ask the client to use separate receptacles for voiding and defecation to prevent any part of the specimen from being lost or contaminated. Urinating and collecting the urine sample only before 5 AM and collecting and storing the urine away from sunlight will not help prevent the urine specimen from becoming contaminated.

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? A) Tenderness over the kidneys B) Bruits noted over the abdominal area C) A dull sound when percussing over the bladder D) The ingestion of 8 oz of water

C Feedback: 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.

The nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client's symptoms and urine specific gravity is anticipated? A) The specific gravity will be inversely proportional. B) The specific gravity will equal to one. C) The specific gravity will be high. D) The specific gravity will be low.

C Feedback: The nurse assesses all of the data to make an informed decision on client status. On a hot day, the client found outside will be perspiring. When dehydration occurs, a client will have low urine output and increased specific gravity of urine. Normal specific gravity is inversely proportional. The density of distilled water is one. A low specific gravity is noted in a client with high fluid intake and who is not losing systemic fluid.

The nurse has received morning lab work on a client with chronic renal disease. Which finding indicates renal disease? A) Urine pH of 6.5 B) Urine nitrate: negative C) Protein level of 400 mg/dL D) Specific gravity: 1.002

C Feedback: The nurse must analyze components of a urinalysis to determine abnormal results. Protein at a level of 400 mg/dL is high and indicates renal disease. The other results are normal.

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? A) Bladder B) Urethra C) Ureters D) Pelvic floor muscles

C Feedback: 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.

The nurse is reviewing urine tests to obtain client baseline information. Which of the following urine tests is preferred to identify characteristics of normal and abnormal urine? A) A 24-hour urine kept in the bathroom on ice B) A catheterized specimen obtained at no particular time C) A clean-catch midstream specimen from the first voiding of the morning D) A specimen obtained from an indwelling Foley catheter's bag

C Feedback: When obtaining urine for baseline information, the preferred test is a clean-catch midstream specimen obtained from the first voiding of the morning. Specialized testing is not done until a baseline test is completed to identify abnormal readings. It is best to obtain data from the least invasive method. Specimens from a Foley catheter are obtained from the port not from the bag.

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 the enzyme renin

C, D Feedback: 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.

During the physical examination of a client, the nurse monitors for signs that may indicate a urinary tract disorder. Which of the following would suggest that the client may have a urinary tract disorder? A) Light-headedness B) Malaise C) Periorbital edema D) Flank pain

C, D Feedback: Periorbital edema, among other signs, such as edema of the extremities, cardiac failure, and mental changes may indicate a urinary tract disorder. Light-headedness and flank pain may suggest urinary bleeding. Malaise is a sign of systemic infection. Flank pain and malaise could occur after a biopsy, and if they occur, the physician is to be notified immediately.

The nurse is caring for clients on a medical urinary unit. Which client, scheduled for a urinary procedure, will be prescribed antibiotics following the procedure? A) The client scheduled for a voiding cystourethrography B) The client scheduled for a cystoscopy C) The client scheduled for a retrograde pyelography D) The client scheduled for a cystometrography

D Feedback: A cystometrography evaluates bladder tone and capacity. Because solution is instilled into the client's bladder, antibiotics may be prescribed for a day or two. The other options do not regularly have antibiotics prescribed.

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? A) Encourage voiding following the procedure. B) Assess renal blood work. C) Assess cognitive status. D) Complete a pulse assessment of the legs and feet.

D Feedback: 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 postprocedural period. Assessing cognitive status is completed due to the sedative that is administered in the preprocedural period.

The nurse is caring for a client who has a history of urine reflux. To assess the client for this urinary complication, which nursing action is best? A) Ask the client if voiding sufficient quantities has been a problem. B) Monitor the client's intake and output for inconsistency. C) Have the client void into a collection device. D) Palpate the client's bladder for distension.

D Feedback: Normally, urine flows in one direction because of peristaltic action and because the ureters enter the bladder at an oblique angle. The reflux of urine (urine that flows backward) can occur secondary to a distended bladder. By palpating for bladder distension, the nurse is able to determine that reflux urine traveled back to the bladder instead of traveling from the bladder down the urethra. All of the other options provide data that can be helpful, but actually feeling for the distension is best. Using a bladder scanner would also provide an amount of urine in the bladder.