Chapter 57: Introduction to Urinary System
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: a. confirm all of the medications and supplements normally taken. b. assess the client's usual intake of sodium. c. confirm which beverages the client normally consumes. d. palpate the client's bladder before and after voiding.
a 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 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 After a cystoscopic examination, the client with obstructive pathology may experience urine retention if the instruments used during the examination caused edema. The nurse will carefully monitor the client with prostatic hyperplasia for urine retention. Postprocedure, the client will experience some hematuria, but is not at great risk for hemorrhage. Unless the condition is associated with another disorder, nausea is not commonly associated with this diagnostic study. Bladder perforation is rare.
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? a. Assess the patient's back and shoulder areas for signs of internal bleeding. b. Distract the client's attention from the pain. c. Provide analgesics to the client. d. Enable the client to sit up and ambulate.
a 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.
A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? a. glucose b. potassium c. creatinine d. chloride
a 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 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 An obstruction of the bladder outlet, such as in advanced benign prostatic hyperplasia, results in abnormally high voiding pressure with a slow, prolonged flow of urine. The urine may remain in the bladder, which increases the potential of a urinary tract infection. Older male clients are at risk for prostatic enlargement, which causes urethral obstruction and can result in hydronephrosis, kidney injury, and urinary tract infections.
A client is having a blood urea nitrogen (BUN) test. BUN level is: a. increased in renal disease and urinary obstruction. b. decreased in nephrotic syndrome. c. decreased in renal disease and urinary obstruction. d. unchanged in renal disease.
a BUN is increased in renal disease and urinary obstruction.
Which value does the nurse recognize as the best clinical measure of renal function? a. Creatinine clearance b. Circulating ADH concentration c. Volume of urine output d. Urine-specific gravity
a 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.
Urodynamic studies evaluate bladder and urethral function and are performed to assess causes of reduced urine flow, urinary retention, and urinary incontinence. Which is the urodynamic study that evaluates bladder tone and capacity? a. cystometrography b. uroflowmetry c. cystography d. cystoscopy
a Cystometrography evaluates the bladder tone and capacity. Uroflowmetry, which is a urodynamic study that determines urinary flow rate, is performed to evaluate bladder and sphincter function. Cystography is not a urodynamic study. Cystography evaluates abnormalities in bladder structure and filling through the instillation of contrast dye and radiography. Cystoscopy, a urological endoscopic procedure, is the direct visual examination of the inside of the urethra and bladder using a cystoscope.
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 Drinking fluids can help to clear hematuria. Diuretics are not used for this purpose. Activity limitation and massage are unlikely to resolve this expected consequence of testing.
A nurse is reviewing guidelines for the care of clients undergoing intravenous or retrograde pyelography. Which would not be included in the guidelines for postprocedural and discharge care? a. Limit fluid intake for 24 hours. b. Encourage adequate fluid intake postprocedure and voiding within 8 hours postprocedure. c. Advise the use of warm tub baths to decrease urethral discomfort or spasms after a retrograde pyelography. These reactions should disappear within 24 hours. d. Abstain from alcohol for 48 hours postprocedure to avoid irritating the bladder.
a Encourage adequate fluid intake postprocedure and voiding within 8 hours postprocedure. Burning sensation on voiding and small amounts of blood-tinged urine are normal and should disappear after the third voiding. Advise the use of warm tub baths to decrease urethral discomfort or spasms after a retrograde pyelography. These reactions should disappear within 24 hours. Instruct the client to abstain from alcohol 48 hours postprocedure to avoid irritating the bladder.
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. Specific gravity compares the density of urine to the density of distilled water. Which is an example of how urine concentration is affected? a. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. b. On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. c. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has scant urine output with a high specific gravity. d. When the kidneys are diseased, the ability to concentrate urine may be impaired, and the specific gravity may vary widely.
a Specific gravity is altered by the presence of blood, protein, and casts in the urine and is normally influenced primarily by hydration status. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has copious urine output with a low specific gravity. When the kidneys are diseased, the ability to concentrate urine may be impaired, and the specific gravity remains relatively constant.
The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: a. Specific gravity 1.035 b. Creatinine 0.7 mg/dL c. Protein 15 mg/dL d. Bright yellow urine
a 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 multiple 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.
The nurse is preparing the procedure room for a client who will undergo an intravenous pyelogram. Which item(s) should the nurse include? a. Suction equipment b. Antihypertensive agents c. Padded tongue blades d. Dressings and tape
a The contrast agent injected into the client for an intravenous pyelogram is allergenic and nephrotoxic. Emergency supplies and equipment should be readily available in case the client experiences an anaphylactic reaction, including airway and suction equipment, oxygen, epinephrine, corticosteroids, and vasopressors.
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: a. ureteral stones. b. pyelonephritis. c. cystitis. d. Urethral infection.
a The findings are constant with ureteral stones, edema or stricture, or a blood clot. The other answers do not apply.
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? a. The left kidney usually is slightly higher than the right one. b. The kidneys are situated just above the adrenal glands. c. The average kidney is approximately 5 cm (2 in.) long and 2 to 3 cm (0.8 to 1.2 in.) wide. d. The kidneys lie between the 10th and 12th thoracic vertebrae.
a 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.
A client with elevated BUN and creatinine values has been referred by her primary physician for further evaluation. The nurse should anticipate the use of what initial diagnostic test? a. Ultrasound b. X-ray c. Computed tomography (CT) d. Nuclear scan
a Ultrasonography is a noninvasive procedure that passes sound waves into the body through a transducer to detect abnormalities of internal tissues and organs. Structures of the urinary system create characteristic ultrasonographic images. Because of its sensitivity, ultrasonography has replaced many other diagnostic tests as the initial diagnostic procedure.
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? 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 Ultrasonography requires a full bladder; therefore, fluid intake should be encouraged before the procedure. The administration of a radiopaque contrast agent is required to perform IV urography studies, such as an IV pyelogram. Ultrasonography is a quick and painless diagnostic test and does not require sedation or intubation. The injection of a radioisotope is required for nuclear scan and ultrasonography is not in this category of diagnostic studies.
A client has been asked to provide a clean-catch midstream urine specimen. It is important that the instructions are clear and that things are done in the proper order. Select the proper sequence of events for obtaining a specimen from a client. a. Wash hands and remove the lid from the specimen container without touching the inside of the lid. Open the antiseptic towelette package and cleanse the urethral area. Begin voiding into the toilet. Void 30 to 50 mL of the midstream urine into the collection container, taking care not to contaminate the container. Carefully replace the lid, dry the container if necessary, and wash hands. b. Wash hands and remove the lid from the specimen container without touching the inside of the lid. Begin voiding into the toilet. Void 30 to 50 mL of the midstream urine into the collection container, taking care not to contaminate the container. Open the antiseptic towelette package and cleanse the urethral area. Carefully replace the lid, dry the container if necessary, and wash hands. c. Wash hands and remove the lid from the specimen container without touching the inside of the lid. Begin voiding into the toilet. Open the antiseptic towelette package and cleanse the urethral area. Void 30 to 50 mL of the midstream urine into the collection container, taking care not to contaminate the container. Carefully replace the lid, dry the container if necessary, and wash hands. d. Wash hands and remove the lid from the specimen container without touching the inside of the lid. Begin voiding into the toilet. Void 30 to 50 mL of the midstream urine into the collection container, taking care not to contaminate the container. Carefully replace the lid, dry the container if necessary, and wash hands. Open the antiseptic towelette package and cleanse the urethral area.
a Wash hands and remove the lid from the specimen container without touching the inside of the lid. Open the antiseptic towelette package and cleanse the urethral area. Begin voiding into the toilet. Void 30 to 50 mL of the midstream urine into the collection container, taking care not to contaminate the container. Carefully replace the lid, dry the container if necessary, and wash hands.
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.
Which is an effect of aging on upper and lower urinary tract function? a. Increased glomerular filtration rate b. Susceptibility to develop hypernatremia c. Increased blood flow to the kidney d. Acid-base balance
b 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.
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 To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection, the serum creatinine level is measured.
The nurse observes that the client's urine is orange. Which additional assessment would be important for this client? a. Bleeding b. Intake of medication such as phenazopyridine hydrochloride c. Intake of multiple vitamin preparations d. Infection
b Urine that is orange may be caused by intake of phenazopyridine hydrochloride 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 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: a. keep the client's knee on the affected side bent for 6 hours. b. apply pressure to the puncture site for 30 minutes. c. check the client's pedal pulses frequently. d. remove the dressing on the puncture site after vital signs stabilize.
c 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.
During a routine assessment, the client states; "I wake up all night long to go the bathroom." The nurse documents this finding as which condition? a. Polyuria b. Oliguria c. Nocturia d. Dysuria
c Nocturia is awakening at night to urinate. Oliguria is urine output less than 0.5 mL/kg/hr Polyuria is increased urine output. Dysuria is painful or difficult urination.
Diagnostic testing of an adult client reveals renal glycosuria. The nurse should recognize the need for the client to be assessed for what health problem? a. Diabetes insipidus b. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) c. Diabetes mellitus d. Renal carcinoma
c Renal glycosuria can occur on its own as a benign condition. It also occurs in poorly controlled diabetes, the most common condition that causes the blood glucose level to exceed the kidney's reabsorption capacity. Glycosuria is not associated with SIADH, diabetes insipidus, or renal carcinoma.
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 costovertebral angle is the angle formed by the lower border of the 12th rib and the spine. Renal dysfunction may produce tenderness over the costovertebral angle.
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 of the following situations? a. When the client's creatinine level drops below 1.2 mg/dL (110 mmol/L) b. When the client's blood urea nitrogen (BUN) is above 15 mg/dL c. When approximately 40% of nephrons are not functioning d. When about 80% of the nephrons are no longer functioning
d When the total number of functioning nephrons is less than 20%, renal replacement therapy needs to be considered. Dialysis is an example of a renal replacement therapy. Prior to the loss of about 80% of the nephron functioning ability, the client may have mild symptoms of compromised renal function, but symptom management is often obtained through dietary modifications and drug therapy. The listed creatinine and BUN levels are within reference ranges.
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? a. When the urine output is less than 30 mL/h b. When the urine output is about 100 mL/h c. When the urine output is between 300 and 500 mL/h d. When the urine output is between 500 and 1,000 mL/h
a Oliguria is defined as urine output <0.5 mL/kg/h
The nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration? a. phenazopyridine hydrochloride b. infection c. phenytoin d. metronidazole
a Orange to amber-colored urine is caused by concentrated urine due to dehydration, fever, bile, excess bilirubin or carotene, and the medications phenazopyridine 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 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? a. After discarding the 8:00 am specimen b. At 8:00 am, with or without a specimen c. 6 hours after the urine is discarded d. With the first specimen voided after 8:00 am
a 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 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 is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? a. Decreased fluid intake b. Increased fluid intake c. Glomerulonephritis d. Diabetes insipidus
a 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.
In a diagnosis of an upper urinary tract infection, which structures could be affected? Select all that apply. A. ureter B. kidney C. bladder D. urethra
a, b The upper urinary tract is composed of the kidneys, renal pelvis, and ureters.
A client is undergoing a renal angiogram after a traumatic accident. What post-procedural assessments would the nurse perform on the client? Select all that apply. a. Monitor hypersensitivity response. b. Palpates the pulses in the legs and feet. c. Monitor site condition. d. Apply a warm compress to site. e. Administer an enema.
a, b, c After the procedure, the healthcare provider applies a pressure dressing to the femoral area, which remains in place for several hours. The nurse palpates the pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Monitoring the pressure dressing is important to note frank bleeding or hematoma formation. If either condition occurs, the nurse immediately notifies the health care provider. Another important assessment is for hypersensitivity responses to contrast material. The nurse also monitors and documents intake and output. The client may have an enema pre procedure and application of a cold compress may reduce pain and swelling.
A client reports "bloody" urine to the nurse. What causes would the nurse relate the hematuria? Select all that apply. a. acute glomerulonephritis b. hypertension c. renal stones d. extreme exercise e. lithium toxicity
a, c, d 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 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 The deep tendon reflexes of the knee are examined for quality and symmetry. This is an important part of testing for neurologic causes of bladder dysfunction, because the sacral area, which innervates the lower extremities, is in the same peripheral nerve area responsible for urinary continence. Neurologic function does not directly influence the course of renal calculi, BPH or UTIs.
A nurse, when caring for a client, notes that the specific gravity of the client's urine is low. What could have led to the low specific gravity of urine? a. Frequent vomiting b. Excess fluid intake c. Repeated diarrhea d. Urine retention
b Excess fluid intake results in low specific gravity of urine. Excessive fluid intake will result in formation of dilute urine. When the urine is diluted, it results in low specific gravity of urine. Frequent vomiting, repeated diarrhea, and urine retention will result in high specific gravity of urine.
A client with a history of incontinence will undergo urodynamic testing in the health care provider's office. Because voiding in the presence of others can cause situational anxiety, the nurse should perform what action? a. Administer diuretics as prescribed. b. Push fluids for several hours prior to the test. c. Discuss possible test results as the client voids. d. Help the client to relax before and during the test.
d Voiding in the presence of others can frequently cause guarding, a natural reflex that inhibits voiding due to situational anxiety. Because the outcomes of these studies determine the plan of care, the nurse must help the client relax by providing as much privacy and explanation about the procedure as possible. Diuretics and increased fluid intake would not address the client's anxiety. It would be inappropriate and anxiety-provoking to discuss test results during the performance of the test.
Which value represents a normal BUN-to-creatinine ratio? a. 4:1 b. 6:1 c. 8:1 d. 10:1
d A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect.
The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure? a. Cortisol b. Vasopressin c. Albumin d. Renin
d 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 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.
The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? a. "I will feel a warm sensation as the dye is injected." b. "I should remove all jewelry before the test." c. "I should let the staff know if I feel claustrophobic." d. "I will need to drink all of the dye as quickly as possible."
a A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected.
Which nursing assessment finding indicates the client has not met expected outcomes? a. The client voids 75 cc four hours post cystoscopy. b. The client reports a pain rating of 3 two hours post-kidney biopsy. c. The client has blood-tinged urine following brush biopsy. d. The client consumes 75% of lunch following an intravenous pyelogram.
a Urinary retention is an undesirable outcome following cystoscopy. A pain rating of 3 is an achievable 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.
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.
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.
A patient had a renal angiography and is being brought back to the hospital room. What nursing interventions should the nurse carry out after the procedure to detect complications? Select all that apply. a. Assess peripheral pulses. b. Compare color and temperature between the involved and uninvolved extremities. c. Examine the puncture site for swelling and hematoma formation. d. Apply warm compresses to the insertion site to decrease swelling. e. Increase the amount of IV fluids to prevent clot formation.
a, b, c After the procedure, vital signs are monitored until stable. If the axillary artery was the injection site, blood pressure measurements are taken on the opposite arm. The injection site is examined for swelling and hematoma. Peripheral pulses are palpated, and the color and temperature of the involved extremity are noted and compared with those of the uninvolved extremity. Cold compresses may be applied to the injection site to decrease edema and pain.
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.
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? a. Blood urea nitrogen level b. Creatinine clearance level c. Serum potassium level d. Uric acid level
b 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.
A client with kidney injury secondary to diabetic nephropathy has been admitted to the medical unit. What is the most life-threatening effect of kidney injury for which the nurse should monitor the client? a. Accumulation of wastes b. Retention of potassium c. Depletion of calcium d. Lack of BP control
b Retention of potassium is the most life-threatening effect of kidney injury. Aldosterone causes the kidney to excrete potassium, in contrast to aldosterone's effects on sodium described previously. Acid-base balance, the amount of dietary potassium intake, and the flow rate of the filtrate in the distal tubule also influence the amount of potassium secreted into the urine. Hypocalcemia, the accumulation of wastes, and lack of BP control are complications associated with kidney injury, but do not have same level of threat to the client's well-being as hyperkalemia.
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? a. Kidney stone formation b. Proteinuria c. Chronic kidney disease d. Neurogenic bladder
c 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 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 physician? a. Scant hematuria b. Renal colic c. Temperature 37.9°C (100.2°F) orally d. Infiltration of the client's intravenous catheter
c Hematuria and renal colic are common and expected findings after the performance of a renal brush biopsy. The physician should be notified of the client's body temperature, which likely indicates the onset of an infectious process. IV infiltration does not warrant notification of the primary physician.
A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram? a. Increased alertness b. Hypoventilation c. Pruritus d. Unusually smooth skin
c The nurse should be alert for pruritus and urticaria, which may indicate a mild anaphylactic reaction to the arteriogram dye. Decreased (not increased) alertness may occur as well as dyspnea (not hypoventilation). Unusually smooth skin isn't a sign of anaphylaxis.
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 various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that they are not excreted in the urine.
A client admitted to the medical unit with impaired renal function is complaining of 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 Ureteral pain is characterized as a dull continuous pain that may be intense with voiding. The pain may be described as sharp or stabbing if the bladder is full. This type of pain is inconsistent with a stone being present in the bladder. Stones are not normally situated in the urethra or meatus.
A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 mL. Urine output that's less than 50 ml in 24 hours is known as: a. oliguria. b. polyuria. c. anuria. d. hematuria.
c Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine.
A geriatric nurse is performing an assessment of body systems on an 85-year-old client. The nurse should be aware of what age-related change affecting the renal or urinary system? a. Increased ability to concentrate urine b. Increased bladder capacity c. Urinary incontinence d. Decreased glomerular filtration rate
d Many age-related changes in the renal and urinary systems should be taken into consideration when taking a health history of the older adult. One change includes a decreased glomerular surface area resulting in a decreased glomerular filtration rate. Other changes include the decreased ability to concentrate urine and a decreased bladder capacity. It also should be understood that urinary incontinence is not a normal age-related change, but is common in older adults, especially in women because of the loss of pelvic muscle tone.
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 Biopsy of the kidney is used in diagnosing and evaluating the extent of kidney disease. Indications for biopsy include unexplained acute kidney injury, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.
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 The adult GFR can vary from a normal of approximately 125 mL/min (1.67 to 2.0 mL/sec) to a high of 200 mL/min. A low GFR is associated with increased levels of BUN, creatinine, and potassium.
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 his or her medical diagnosis after reviewing the results. d. Assess the client's understanding of the test results after their completion.
d The nurse should ensure that the client understands the results that are presented by the health care provider. Informing the client of a diagnosis is normally the primary provider's responsibility. Withholding fluids or medications is not normally required after testing.
Retention of which electrolyte is the most life-threatening effect of renal failure? a. Calcium b. Sodium c. Potassium d. Phosphorous
c Retention of potassium is the most life-threatening effect of renal failure.
The nurse is caring for a client who has a fluid volume deficit. When evaluating this client's urinalysis results, what should the nurse anticipate? a. A fluctuating urine specific gravity b. A fixed urine specific gravity c. A decreased urine specific gravity d. An increased urine specific gravity
d Urine specific gravity depends largely on hydration status. A decrease in fluid intake will lead to an increase in the urine specific gravity. With high fluid intake, specific gravity decreases. In clients with kidney disease, urine specific gravity does not vary with fluid intake, and the client's urine is said to have a fixed specific gravity.
