COMBINED Ch 47 Assessment of Kidney and Urinary Function - 1
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 Renal angiography Cystoscopy Intravenous pyelography
Cystoscopy
The nurse is caring for a client with diabetic nephropathy who is scheduled for a right renal biopsy. Immediately after the biopsy, which of the following actions is essential? a. Monitor the blood urea nitrogen (BUN) and creatinine to assess renal function. b. Check blood glucose to assess for hyperglycemia or hypoglycemia. c. Insert a straight catheter to check for gross or microscopic hematuria. d. Apply a pressure dressing and keep the client prone for 30-60 minutes.
D
A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? creatinine glucose potassium chloride
glucose
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 which beverages the client normally consumes. confirm all of the medications and supplements normally taken.
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.
The test that most accurately reflects glomerular filtration and renal excretory function is: A) BUN B) Hematocrit C) Creatinine clearance D) Urine specific gravity
C) Creatinine clearance
The nurse is caring for a patient in the oliguric phase of AKI. Which does the nurse determine the daily urine output will be? A) 1.5 L B) 1.0 L C) Less than 400 mL D) Less than 50 mL
C) Less than 400 mL
The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? Increased fluid intake Glomerulonephritis Diabetes insipidus Decreased fluid intake
Decreased fluid intake
Enlargement of the prostate causes which of the following to occur? Select all that apply. A. Frequency B. Oliguria C. Anuria D. Obstruction of urine flow E. Polyuria
Frequency - Oliguria - Anuria - Obstruction of urine flow Enlargement of the prostate gland causes obstruction of urine flow, resulting in frequency, oliguria, and anuria. Polyuria does not occur.
The nurse is performing a renal assessment on a client with prostate cancer. Which clinical manifestation suggests prostate cancer? Select all that apply. A. Palpitations B. Hesitancy C. Chills D. Dyspnea E. Nocturia
Hesitancy - Nocturia
List the four phases of AKI
Initiation, Oliguria, Diuresis, and Recovery
A client with gross hematuria has been admitted to a surgical floor in preparation for an upper cystoscopy in the morning. What post-procedure interventions would the nurse anticipate for this client? Select all that apply. A. Nothing by mouth (NPO) B. Intermittent straight catheterization C. Sedative agent administration D. Moist heat to abdomenE. Monitor for urinary retention
Intermittent straight catheterization - Moist heat to abdomen - - Monitor for urinary retention Rationale: Post-procedural management is directed at relieving any discomfort from the procedure. Moist heat to the lower abdomen and warm sitz baths are helpful in relieving pain and relaxing muscles. The client may experience urinary retention, so intermittent straight catheterization may be necessary for a few hours after the procedure. The nurse would also monitor the client for signs of urinary tract infection and obstruction. NPO and sedative agent administration is accomplished before the procedure. A cystoscope examination/procedure is used to directly visualize the urethra and bladder.
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. Palpates the pulses in the legs and feet. Monitor hypersensitivity response. Monitor site condition. Administer an enema. Apply a warm compress to site.
Monitor hypersensitivity response. - Palpates the pulses in the legs and feet. - Monitor site condition.
What are some factors that influence mortality rate in patients with AKI?
Older in age Comorbid conditions Pre-existing kidney and vascular diseases Respiratory failure
Magnesium deficit
Positive Chvostek's Sign
Retention of which electrolyte is the most life-threatening effect of renal failure? Sodium Calcium Potassium Phosphorous
Potassium
The nurse is reviewing the results of a client's renal function study. The nurse understands that which value represent a normal BUN-to-creatinine ratio? 4:1 6:1 8:1 10:1
10:1
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
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.
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's urine dipstick indicates a small amount of protein in the urine. Which of the following actions should the nurse take next? a. Check which medications the client is currently taking. b. Obtain a clean-catch urine specimen for culture and sensitivity testing. c. Ask the client about any family history of chronic renal failure. d. Send a urine specimen to the laboratory to test for ketones and glucose.
A
A nurse is educating a patient about the dietary modifications that are necessary to decrease the amount of accumulated waste products. What will the nurse include in the education if the patient has ESKD? A) A diet high in protein B) A diet high in potassium C) A diet high in fat D) A diet high in sodium
A) A diet high in protein
What hormone regulates the amount of sodium excreted?
Aldosterone
A patient had a renal angiography and is being brought back to the hospital room. Which nursing actions will the nurse perform 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
Assess peripheral pulses - Compare color and temperature between the involved and uninvolved extremities - Examine the puncture site for swelling and hematoma formation
A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL. Which is the most effective intervention to reduce the risk of developing radiocontrast induced nephropathy? A) Performing the test without contrast B) Administering gentamicin sulfate prophylactically C) Hydrating with saline via IV before the test D) Administering sodium bicarbonate after the test
C) Hydrating with saline via IV before the test
The nurse is caring for a patient with end-stage kidney disease in the hospital and smells a fetid odor from the patients breath. Which major manifestation of uremia will be present? A) A decreased serum phosphorus level B) Hyperparathyroidism C) Hypocalcemia with bone changes D) Increased secretion of parathormone
C) Hypocalcemia with bone changes
The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client be assessed for an allergy to iodine? Radiography Computed tomography with contrast Bladder ultrasonography Cystoscopy
Computed tomography with contrast Explanation: The nurse is correct to assess for an allergy to iodine when a computed tomography with contrast medium is prescribed. Uroflowmetry, cystoscopy, and bladder ultrasonography are performed without the use of contrast medium.
When describing the functions of the kidney to a client, which of the following would the nurse include? Select all that apply. A. Regulation of white blood cell production B. Synthesis of vitamin K C. Control of water balance D. Secretion of the enzyme renin
Control of water balance - Secretion of the enzyme renin 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.
Fluid volume excess
Crackles and dyspnea
The two blood levels that are significantly increased in AKI are
Creatinine and BUN
What are the top 2 causes of approximately 70% of cases of CKD?
Diabetes and Hypertension
Which substance stimulates the bone marrow to produce red blood cells? Erythropoietin Prostaglandin E Prostacyclin Renin
Erythropoietin Explanation: Erythropoietin stimulates the bone marrow to produce red blood cells, thereby increasing the amount of hemoglobin available to carry oxygen. The kidneys produce prostaglandin E and prostacyclin, which have vasodilatory effect and are important in maintaining renal blood flow. Renin is involved in controlling arterial blood pressure.
Sodium deficit
Fingerprinting on the sternum
Which term best describes a total urine output less than 500 mL in 24 hours? Oliguria Nocturia Dysuria Polyuria
Oliguria
A nurse is preparing an education program about renal disease. Which risk factor should the nurse include when teaching? Select all that apply. Sickle-cell anemia Spinal cord injury Immobility Hypotension Seizures
Immobility - Spinal cord injury - Sickle-cell anemia Risk factors for renal disease include immobility, sickle-cell anemia, and spinal cord injury. Immobility promotes kidney stone formation. Sickle-cell anemia increases the risk for chronic kidney disease. Spinal cord injury can lead to neurogenic bladder, urinary tract infection, and urinary incontinence.
A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? Nephrotic syndrome Obstruction of the lower urinary tract Infection Acute renal failure
Infection 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.
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? Chronic renal failure Fistula Neurogenic bladder Kidney stones
Kidney stones [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.]
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 Assist the client for bathroom privileges Ambulate the client in the hall Maintain the client on bedrest
Maintain the client on bedrest Explanation: 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.
A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? Monitor the client for an allergy to iodine contrast material. Monitor the client for signs of electrolyte and water imbalance. Evaluate the client for periorbital edema. Assess the client's mental changes.
Monitor the client for an allergy to iodine contrast material.
Calcium excess
Muscle hypotonicity and flank pain
Fluid volume deficit
Oliguria and weight loss
What is the most common and serious complication of continuous ambulatory peritoneal dialysis?
Peritonitis
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? Pruritus Hypoventilation Increased alertness Unusually smooth skin
Pruritus
Common tests of renal function include which of the following? Select all that apply. A. Renal concentration test B. Creatinine clearance C. Serum creatinine D. Blood urea nitrogen (BUN) E. Arterial blood gas analysis
Renal concentration test - Creatinine clearance - Serum creatinine - Blood urea nitrogen (BUN) Common tests of renal function include BUN, serum creatinine, creatinine clearance, and renal concentration tests. Arterial blood gas analysis is a test of respiratory function.
Sodium excess
Rough, dry tongue and thirst
Potassium deficit
Soft, flabby muscles and weakness
Which nursing assessment finding indicates the client has not met expected outcomes? The client consumes 75% of lunch following an intravenous pyelogram. The client has blood-tinged urine following brush biopsy. The client reports a pain rating of 3 two hours post-kidney biopsy. The client voids 75 cc four hours post cystoscopy.
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 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 left kidney usually is slightly higher than the right one. The kidneys are situated just above the adrenal glands.
The left kidney usually is slightly higher than the right one.
What is the major waste product of metabolism?
Urea
In a diagnosis of an upper urinary tract infection, which structures could be affected? Select all that apply. Ureter Kidney Bladder Urethra
Ureter - Kidney Explanation: The upper urinary tract is composed of the kidneys, renal pelvis, and ureters.
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: Urethral infection. cystitis. ureteral stones. pyelonephritis.
Urethral stones.
A creatinine clearance test has been ordered. The nurse prepares to: a) Obtain a blood specimen. b) Collect the client's urine for 24 hours. c) Insert a straight catheter for a specimen. d) Obtain a clean catch urine.
b) Collect the client's urine for 24 hours. A creatinine clearance test is a 24-hour urine test and is useful in evaluating renal disease.
The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? Pain after voiding Perineal pain Costovertebral angle tenderness Suprapubic pain
costovertebral angle tenderness 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 client is having a blood urea nitrogen (BUN) test. BUN level is: decreased in nephrotic syndrome. decreased in renal disease and urinary obstruction. increased in renal disease and urinary obstruction. unchanged in renal disease.
increased in renal disease and urinary obstruction.
The term used to describe total urine output less than 0.5 mL/kg/hour is nocturia. dysuria. oliguria. anuria.
oliguria.
A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about: chronic, excessive acetaminophen use. childhood asthma. family history of pernicious anemia. recent streptococcal infection.
recent streptococcal infection.
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: renal circulation. kidney structure. urine production. kidney function.
renal circulation.
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 Ureters Bladder Urethra
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.
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." "Contact the primary provider if you experience fever, chills, or lower back pain." "You can stop taking the prescribed antibiotic." "You may resume consuming caffeinated, carbonated, and alcoholic beverages."
"Contact the primary provider if you experience fever, chills, or lower back pain." 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.
How long are patients instructed to allow the fluid to dwell during peritoneal dialysis?
10-15 minutes
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?
150mL 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.
Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? 20 30 40 50
50% Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal. Renal function can be assessed most accurately if several tests are performed and their results are analyzed together. Common tests of renal function include renal concentration tests, creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein metabolism) levels.
During assessment of a client with decreased renal function, which of the following medications taken by the client at home is of most concern to the nurse? a. Ibuprofen b. Warfarin c. Folic acid d. Penicillin
A
The client presents with nausea and vomiting, absent bowel sounds, and colicky flank pain. The nurse interprets these findings as consistent with: A. Ureteral colic B. Acute prostatitis C. Urethritis D. Interstitial cystitis
A
A client with a history of chronic renal infections is to undergo CT with contrast. Before the procedure, the nurse should complete which action? A. Place emergency medical equipment in the procedure room. B. Instruct the client to maintain a full bladder for the diagnostic test. C. Hold the client's iron supplement until after the diagnostic test. D. Keep the client NPO for 1 hour before the scan.
A For some clients, contrast agents are nephrotoxic and allergenic. Emergency equipment and medications should be available in case of an anaphylactic reaction to the contrast agent. Emergency supplies include epinephrine, corticosteroids, vasopressors, oxygen, and airway and suction equipment. The client is instructed to maintain a full bladder for an ultrasonography. The other instructions/interventions relate to magnetic resonance imaging.
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.
The nurse is completing a full exam of the client's renal system. Which assessment finding best documents the need to offer the use of the bathroom? Tenderness over the kidneys Bruits noted over the abdominal area The ingestion of 8 oz of water A dull sound when percussing over the bladder
A dull sound when percussing over the bladderExplanation: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. (less)
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) After discarding the 8:00 AM specimen
A patient with chronic kidney failure experiences decreased levels of erythropoietin. Which serious complication related to those levels will the nurse assess for when caring for this patient? A) Anemia B) Acidosis C) Hyperkalemia D) Pericarditis
A) Anemia
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. Which deficit does the nurse evaluate the patient for? A) Hypocalcemia B) Hypomagnesemia C) Hypophosphatemia D) Hyponatremia
A) Hypocalcemia
When a person is dehydrated, the urine osmolarity is... A) Increased B) Decreased C) Unaffected
A) Increased
A nurse is giving discharge instructions to a client following urodynamic testing. What are the priority topics to be addressed by the nurse? A. Beverage limitations, pain control, and urinary expectations B. Antibiotic adherence, carbohydrate restrictions, and urinary expectations C. Protein intake, mobility limitations, and urinary expectations D. Opioid usage, urinary expectations, fat and protein limitations
A. Beverage limitations, pain control, and urinary expectations
An appropriate nursing intervention for the client following a nuclear scan of the kidney is to: Apply moist heat to the flank area. Encourage high fluid intake. Monitor for hematuria. Strain all urine for 48 hours.
A. 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 caring for a client who has been diagnosed with renal calculi. Prompt management of renal calculi is most important when the stone is located where? A. In the ureteropelvic junction B. In the ureteral segment near the sacroiliac junction C. In the ureterovesical junction D. In the urethra
A. In the ureteropelvic junction
A patient has an increase in blood osmolality when the nurse reviews the laboratory work. What can this increase indicate for the patient? Diuresis Less reabsorption of water ADH stimulation An increase in urine volume
ADH stimulation
Which intervention would the nurse expect to implement following urologic endoscopy? Select all that apply. Assist with coughing and deep breathing. Teach leg and range-of-motion exercises. Administer an antispasmodic agent. Provide privacy to promote bladder emptying. Verify the client's understanding about procedure.
Administer an antispasmodic agent. - Provide privacy to promote bladder emptying. Explanation: The nurse would expect to administer an antispasmodic agent, such as flavoxate (Urispas), and provide privacy to promote bladder emptying. The nurse verifies the client's understanding prior to the procedure. Assisting with coughing and deep breathing and teaching leg exercises and range of motion are not specific interventions post-urologic endoscopy.
Serum sodium plays a major role in maintaining fluid and electrolyte balance. Choose all the correct statements that apply. 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. About 45% of sodium in the renal filtrate is absorbed. 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. R: The renin-angiotensin system (RAS) maintains the balance of fluid volume. Refer to Figure 26-4 in the text.
8. A nurse is preparing a patient diagnosed with benign prostatic hypertrophy (BPH) for a lower urinary tract cystoscopic examination. The nurse informs the patient that the most common temporary complication experienced after this procedure is what? A) Urinary retention B) Bladder perforation C) Hemorrhage D) Nausea
Ans: A Feedback: After a cystoscopic examination, the patient with obstructive pathology may experience urine retention if the instruments used during the examination caused edema. The nurse will carefully monitor the patient with prostatic hyperplasia for urine retention. Post-procedure, the patient 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.
A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient reports severe pain in the back, arms, and shoulders. Which intervention should be offered by the nurse? Assess the patient's back and shoulder areas for signs of internal bleeding. Provide analgesics to the patient. Distract the patient's attention from the pain. Enable the patient to sit up and ambulate.
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. 1552
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. Assess peripheral pulses. Compare color and temperature between the involved and uninvolved extremities. Examine the puncture site for swelling and hematoma formation. Apply warm compresses to the insertion site to decrease swelling. Increase the amount of IV fluids to prevent clot formation.
Assess peripheral pulses. - Compare color and temperature between the involved and uninvolved extremities. - Examine the puncture site for swelling and hematoma formation. Explanation: 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 nurse observes the color of the client's urine, which appears pale blue-green. The nurse obtains a drug history from the client based on the understanding that drugs used by the client may affect which of the following? A. Size of the urinary bladder B. Urinary tract tests C. Urine specific gravity D. Amount of urine produced
B It is important to inquire about drugs because some drugs may affect the outcome of urinary tract tests as well as the color and odor of the urine. Dietary intake may affect urine characteristics as well as urinary tract disorders and their management. Drugs do not directly affect the size of the urinary bladder or the amount of urine produced.
A patient who complains of a dull, continuous pain in the suprapubic area that occurs with, and at the end of, voiding would most likely be diagnosed with which of the following? A. A kidney stone B. Interstitial cystitis C. Acute pyelonephritis D. Prostatic cancer
B Pain over the suprapubic area is most likely related to the bladder. Pain intensity would increase with fullness. Pain at the end of voiding is one of the symptoms associated with interstitial cystitis.
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? A. 50 mL B. 150 mL C. 250 mL D. 350 mL
B 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.
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.
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. A. Renal medulla B. Renal cortex C. Renal pelvis D. Renal papilla
B 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 patient is scheduled for a test with contrast to determine kidney function. Which statement made by the patient should the nurse inform the health care provider about prior to testing? A) "I don't like needles" B) "I am allergic to shrimp" C) "I take medication to help me sleep at night" D) "I have had a test similar to this one time in the past"
B) "I am allergic to shrimp"
The nurse is educating a patient about preparation for an IV urography. Which will the nurse include in the preparation instructions? A) A liquid restriction for 8 to 10 hours before the test is required B) The patient may have liquids before the test C) The patient will have enemas until the urine is clear D) The patient is restricted from eating or drinking from midnight until after the test
B) The patient may have liquids before the test
As women age, many experience an increased sense of urgency to void, as well as an increased risk of incontinence. This is usually the result of age-related changes in which part of the renal system? Kidney Nephron Tubule system Bladder
Bladder Explanation: With increased age, bladder tone and capacity is decreased. In women, this is compounded by a decrease in estrogen, which causes changes to the urethral sphincter.
A client who had a cystoscopy the previous day calls the urology clinic and gives the nurse all the following information. Which of the following client statements should be reported immediately to the health care provider? a. "My urine still looks pink." b. "My IV site is still bruised." c. "I have a temperature of 38.3°C (100.9°F)." d. "I did not sleep well last night."
C
For which of the following purposes does the nurse use auscultation during assessment of the urinary system? a. Check for ureteral peristalsis. b. Assess for bladder distension. c. Identify renal artery or aortic bruits. d. Determine the position of the kidneys.
C
The nurse is reviewing a client's chart and notes that the client has dysuria. To assess whether there is any improvement, which of the following questions should the nurse ask? a. "Do you have any blood in your urine?" b. "Do you have to urinate very frequently?" c. "Do you have any pain when you urinate?" d. "Do you have to get up at night to urinate?"
C
The nurse is reviewing the results of a client's urinalysis. Which of the following information indicates that the nurse should notify the health care provider? a. pH 6.2 b. Trace protein c. WBC: 20-26/hpf d. Specific gravity: 1.021
C
Which of the following techniques should the nurse use to assess the flank area of a client with pyelonephritis for tenderness? a. Push gently into the two lowest intercostal spaces. b. Palpate along both sides of the lumbar vertebral column. c. Position one hand flat at the costovertebral angle (CVA) and strike it with the other fist. d. Use two fingers to percuss the area between the iliac crest and ribs along the midaxillary line.
C
A patient is placed on hemodialysis for the first time. The patient reports a headache with nausea and begins to vomit, and the nurse observes a decreased LOC. Which does the nurse identify has occurred with the patient? A) The dialysis was performed too quickly B) The patient is having an allergic reaction to the dialysate C) The patient is experiencing a cerebral fluid shift D) Too much fluid was pulled off during dialysis
C) The patient is experiencing a cerebral fluid shift
The most accurate indicator of fluid loss or gain in an acutely ill patient is A) Intake and output B) Electrolyte levels C) Weight D) Creatinine level
C) Weight
Calcium deficit
Carpopedal spasm and tetany
Protein deficit
Chronic weight loss and fatigue
The nurse is preparing to conduct annual health and physical examination on a client who is employed as a hairdresser and has a 10 pack-year history of cigarette smoking. Which of the following conditions should the nurse plan to teach the client about the increased risk based upon the client's history? a. Renal failure b. Kidney stones c. Pyelonephritis d. Bladder cancer
D
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 Infection Dehydration Allergic reaction
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 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. keep the client's knee on the affected side bent for 6 hours. apply pressure to the puncture site for 30 minutes. check the client's pedal pulses frequently.
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.
The nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration? infection metronidazole phenytoin 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 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? Blood urea nitrogen level Serum potassium level Uric acid level Creatinine clearance level
Creatinine clearance levelCreatinine 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.
The nurse is preparing a client for a cystoscopy. Which of the following postprocedural information should the nurse include in the teaching plan? a. NPO for 8 hours to prevent nausea and vomiting b. Strict bed rest for about 4-6 hours c. Request prescribed opioids as necessary for pain. d. May experience blood-tinged urine and urinary frequency.
D
The nurse is teaching a client scheduled for a cystoscopy about the procedure. Which of the following statements should the nurse include in the teaching plan? a. "Your health care provider will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidney." b. "Your health care provider will place a catheter into an artery in your groin and inject a dye that will visualize the blood supply to the kidneys." c. "Your health care provider will inject a radioactive solution into a vein in your arm and the distribution of the isotope in your kidneys and bladder will be checked." d. "Your health care provider will insert a lighted tube into the bladder through your urethra, inspect the bladder, and instill a dye that will outline your bladder on x-ray."
D
The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable? A. Clients have frequent urinary tract infections. B. Clients develop a neurogenic bladder. C. Clients have urinary frequency. D. Clients have chronic renal failure.
D Although all of the options may occur in the client with diabetes mellitus, the option which is most notable, and potentially life threatening, is chronic renal failure.
A male client, scheduled for a renal angiography, expresses his fear and anxiety to the nurse about the use of intravenous contrast medium substances in the test. Which of the following would be most appropriate for the nurse to do to help him overcome his apprehension? A. Distract the client's attention from the test. B. Discuss the client's anxiety with the physician. C. Arrange for a radioactive expert to have a talk with the client. D. Offer assurance about the safety of contrast media substances.
D Because the client is anxious about the use of intravenous contrast media for a renal angiography, the nurse should offer him assurance about the safety of these substances which are iodine based. The nurse can do this by confirming that the substances are safe and ordinarily pose no danger to the client or others. The test would be contraindicated if the client had an allergy to iodine or seafood. It is not necessary to discuss the client's anxiety with the physician or ask an expert to talk with the client. More important than the technical details, the client requires assurance and comforting words about the test experience that will help him gain confidence.
The care team is considering the use of dialysis in a client whose renal function is progressively declining. Renal replacement therapy is indicated in which situation? A. creatinine level drops below 1.2 mg/dl (110mmol/L) B. blood urea nitrogen (BUN) is above 15 mg/dl C. urinalysis (dipstick test) reveals 140 mg/dl of protein D. functioning nephrons are less than 20%
D. functioning nephrons are less than 20% Rationale: When the total number of functioning nephrons is less than 20%, renal replacement therapy needs to be considered. Dialysis is an example of renal replacement therapy. Prior to the loss of greater than 80% of the nephron's 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 level is within normal range for men and slightly elevated for women. The BUN levels are within normal ranges. Proteinuria up to 150 mg/dl, as an occasional finding, is considered normal. Persistent proteinuria can indicate several medical problems including glomerular disease.
32. A patient is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all that apply. A) Petechiae B) Pain C) Gastrointestinal symptoms D) Changes in voiding E) Jaundice
Pain - Gastrointestinal symptoms - Changes in voiding Feedback: Dysfunction of the kidney can produce a complex array of symptoms throughout the body. Pain, changes in voiding, and gastrointestinal symptoms are particularly suggestive of urinary tract disease. Jaundice and petechiae are not associated with genitourinary health problems.
The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure? Renin Cortisol Albumin Vasopressin
Renin 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 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
Secretion of prostaglandins - Regulation of blood pressure - Vitamin D synthesis 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.
The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: Protein 15 mg/dL Specific gravity 1.035 Creatinine 0.7 mg/dL Bright yellow urine
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 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.
38. The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply. A) Specific gravity of the patients urine B) Testing for the presence of glucose in the patients urine C) Microscopic examination of urine sediment for RBCs D) Microscopic examination of urine sediment for casts E) Testing for BUN and creatinine in the patients urine
Specific gravity of the patients urine - Testing for the presence of glucose in the patients urine - Microscopic examination of urine sediment for RBCs - Microscopic examination of urine sediment for casts Feedback: Urine testing includes testing for specific gravity, glucose, RBCs, and casts. BUN and creatinine are components of serum, not urine.
A 30-year-old male patient presents to the clinic for an employment physical. The nurse notes protein in the patient's urine. The nurse understands that transient proteinuria can be caused by which of the following? Select all that apply. a) Strenuous exercise b) Prolonged standing c) NSAIDs d) Diabetes mellitus e) Fever
Strenuous exercise - Prolonged standing - Fever Proteinuria may be a benign finding, or it may signify serious disease. Common benign causes of transient proteinuria are fever, strenuous exercise, and prolonged standing. Causes of persistent proteinuria include glomerular diseases, malignancies, collagen diseases, diabetes, preeclampsia, hypothyroidism, heart failure, exposure to heavy metals, and use of medications, such as drugs, NSAIDs, and angiotensin-converting enzyme (ACE) inhibitors.
The nurse is preparing the procedure room for a client who will undergo an intravenous pyelogram. Which item(s) should the nurse include? Antihypertensive agents Dressings and tape Suction equipment Padded tongue blades
Suction equipment R: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 nurse measures a patient's urinary output every 8 hours. The nurse weighs the importance of these results by comparing the normal 24-hour urinary output with the patient's condition and medication. The normal 24-hour output should be: a) 0.4 to 0.8 L/day b) 1 to 2 L/day c) 3.5 to 4 L/day d) 2.5 to 3 L/day
b) 1 to 2 L/day The normal output of urine every 24 hours is 800 to 1,500 mL. Refer to Table 26-1 in the text. The significance of the 24-hour result will depend on the patient's medical condition.
A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 mL. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of: microorganism transfer prostate irritation client discomfort incorrect urine output values
microorganism transfer Explanation: Bladder ultrasonic scanning, a noninvasive way of calculating the amount of urine in the bladder, reduces the risk of transferring microorganisms into the bladder. Use of a straight catheter to measure residual urine increases the transfer of microorganisms into the bladder, and increases, rather than reduces, client discomfort. A bladder ultrasonic scan doesn't reduce the risk of prostate irritation or incorrect urine output values.
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? Glomerulus Renal pelvis Nephron Parenchyma
renal pelvis
Which of the following hormones is secreted by the juxtaglomerular apparatus? Antidiuretic hormone (ADH) Renin Calcitonin Aldosterone
renin
Following a cystoscopy, the client has a nursing diagnosis of acute pain related to the trauma of the procedure to the urinary tract. An appropriate nursing intervention is to: Monitor for urinary retention. Administer prescribed antibiotics. Apply moist heat to the flank area. Assist with warm sitz baths.
warm sitz bath Acute pain can be relieved with warm sitz baths. The nurse should monitor the client for urinary retention, which can help detect a potential cause of pain, but this nursing action does not relieve pain. Antibiotics may be prescribed to prevent infection. The pain associated with cystoscopy tends to be confined to the perineal area and lower abdomen not the flank area.
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 took my blood pressure medication with my morning coffee an hour ago." "I do not have a pacemaker, artificial heart valve, or artificial joints." "I did not take my multivitamin this morning." "I had my last cigarette 3 hours ago with my morning coffee."
"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.
A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client? "An x-ray will be done to view your kidneys, ureters, and bladder." "A contrast medium will be used to help see the structures better." "You don't need to do any fasting before this noninvasive test." "You'll have a pressure dressing on your groin
"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.
The health care provider orders a clean-catch urine specimen for culture and sensitivity testing for a client with a suspected urinary tract infection (UTI). Which of the following actions should the nurse implement to obtain the specimen? a. Teach the client to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup. b. Have the client empty the bladder completely, and then obtain the next urine specimen that the client is able to void. c. Insert a short, small "mini" catheter attached to a collecting container into the urethra and bladder to obtain the specimen. d. Clean the area around the meatus with a povidone-iodine swab, and then have the client void into a sterile container.
A
The nurse is caring for a client with an elevated blood urea nitrogen (BUN) and serum creatinine who is scheduled for a renal arteriogram. Which of the following bowel preparation prescriptions should the nurse question? a. Fleet enema b. Tap-water enema c. Bisacodyl tablets d. Castor oil
A
The nurse is preparing a client for an intravenous pyelogram (IVP) and obtains the nurse the following information. Which information has the most immediate implications for the client's care? a. The client describes allergies to shellfish and penicillin. b. The client has not had anything to eat or drink for 8 hours. c. The client complains of costovertebral angle (CVA) tenderness. d. The client used a bisacodyl tablet the previous night.
A
The nurse is preparing a client with a decreased glomerular filtration rate for an intravenous pyelogram (IVP). Which of the following actions should be included in the plan of care? a. Monitor the urine output after the procedure. b. Assist with monitored anesthesia care (MAC). c. Give oral contrast solution before the procedure. d. Insert a large size urinary catheter before the IVP.
A
Which of the following actions should the nurse plan to take first when admitting a client who has a history of neurogenic bladder as a result of a spinal cord injury? a. Ask about the usual urinary pattern and any measures used for bladder control. b. Assist the client to the toilet at scheduled times to help ensure bladder emptying. c. Check the client for urinary incontinence every 2 hours to maintain skin integrity. d. Use intermittent catheterization on a regular schedule to avoid the risk of infection.
A
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.
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 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.
A creatinine level has been ordered. The nurse prepares to: A. Obtain a blood specimen. B. Collect the client's urine for 24 hours. C. Obtain a clean catch urine. D. Straight cath for a specimen.
A A creatinine level is determined from a blood sample. It is used to assess renal function.
The nurse is assessing a client's urinary system and is unable to palpate either kidney. Which of the following actions should the nurse take next? a. Obtain a urine specimen to check for hematuria. b. Document the information on the assessment form. c. Ask the client about any history of recent sore throat. d. Ask the health care provider about scheduling a renal ultrasound.
B
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.
A client has been experiencing severe pain and hematuria and is hardly able to ambulate into the physician's office. The physician suspects kidney stones and orders diagnostic tests to confirm. What test would physician order? A. KUB B. ultrasound C. CT D. MRI
A An x-ray study of the abdomen includes x-rays of the kidneys, ureters, and bladder (KUB). It is performed to show the size and position of the kidneys, ureters, and bony pelvis as well as any radiopaque urinary calculi (stones), abnormal gas patterns (indicative of renal mass), and anatomic defects of the bony spinal column (indicative of neuropathic bladder dysfunction). Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. A computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen and pelvis may be obtained to diagnose renal pathology, determine kidney size, and evaluate tissue densities with or without contrast.
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? A. Mucosal B. Adventitia C. Detrusor D. Connective tissue
A 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 term refers to casts in the urine? A. Cylindruria B. Crystalluria C. Pyuria D. Bacteriuria
A Casts may be identified through microscopic examination of the urine sediment after centrifuging. Crystalluria refers to crystals in the urine. Pyuria refers to pus in the urine. Bacteriuria refers to a bacterial count higher than 100,000 colonies/mL in the urine.
A client is prescribed flavoxate (Urispas) following cystoscopy. Which of the following instructions would the nurse give the client? A. "This medication will relieve your pain." B. "This medication prevents urinary incontinence." C. "This medication will treat the blood in your urine." D. "This medication prevents infection in your urinary tract"
A Flavoxate (Urispas) is a antispasmodic agent used for the treatment of burning and pain of the urinary tract.
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? A. Increase fluid intake throughout the day. B. Decrease overall fluid intake. C. Decrease salt intake. D. Increase protein intake.
A 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.
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 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? A. Creatinine clearance level B. Uric acid level C. Blood urea nitrogen (BUN) D. BUN to creatinine ratio
A 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.
The nurse is monitoring a client who has undergone cystoscopy because the client's history indicates urinary infection. Which of the following would the nurse need to report to the physician? A. Chills and fever B. Dysuria and discolored or malodorous urine C. Hematoma and frank bleeding D. Flank pain and rapid pulse
A The nurse should monitor for chills, fever, and septicemia in a client who has a history of urinary infection after cystoscopy. These symptoms should be observed and the physician should be notified of the findings. Hematoma formation and frank bleeding would be indications to notify the physician after a renal angiography. The nurse should inform the client who is discharged after a renal biopsy to report dysuria, discolored or malodorous urine, flank pain, and rapid pulse to the physician.
The nurse notes that the client's urine is blood-tinged following cystoscopy. Which nursing action should the nurse take next? A. Document the finding in the health record. B. Notify the physician of the finding. C. Instruct the client to increase fluid intake. D. Inspect the client's urinary meatus.
A The physician does not need to be contacted as blood-tinged urine is an expected finding following cystoscopy due to trauma of the procedure. The nurse should document the finding and continue to monitor the client. The client should be encouraged to increase fluid intake to help flush the urinary tract of microorganisms. The urinary meatus does not need to be inspected.
30. A patient is scheduled for a diagnostic MRI of the lower urinary system. What pre-procedure education should the nurse include? A) The need to be NPO for 12 hours prior to the test B) Relaxation techniques to apply during the test C) The need for conscious sedation prior to the test D) The need to limit fluid intake to 1 liter in the 24 hours before the test
Ans: B Feedback: Patient preparation should include teaching relaxation techniques because the patient needs to remain still during an MRI. The patient does not normally need to be NPO or fluid-restricted before the test and conscious sedation is not usually implemented.
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? A. Lie still on the table for approximately 35 minutes. B. Drink contrast material at various intervals during the procedure. C. Turn from side to side to get a variety of views during the procedure. D. Take deep breaths and hold them at various times throughout the procedure.
A 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 nurse is caring for a client with a fluid and electrolyte balance. What urine specific gravity would the nurse expect to measure? A. 1.018 B. 1.000 C. 1.008 D. 1.028
A Urine specific gravity is a measurement of the kidney's ability to concentrate urine; levels between 1.010-1.025 are considered normal. The specific gravity of water is 1.000. A urine specific gravity less than 1.010 may indicate overhydration. A urine specific gravity greater than 1.025 may indicate dehydration.
The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse document that oliguria is present? A) When the urine output is less than 30 mL/hr B) When the urine output is about 100 mL/hr C) When the urine output is between 300 and 500 mL/hr D) When the urine output is between 500 and 1000 mL/hr
A) When the urine output is less than 30 mL/hr
The nurse is administering calcium acetate to a patient with ESKD. When is the best time for the nurse to administer this medication? A) With food B) 2 hours before meals C) 2 hours after meals D) At bedtime with 8 oz of fluid
A) With food
Nephrotoxicity can occur as a result of the use of aminoglycosides such as gentamicin. Select all of the following statements which are true. a) Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity. b) Signs of nephrotoxicity may not occur until the client has received 5 or more days of therapy. c) All statements are true. d) Nephrotoxicity from the use of the aminoglycosides is reversible if the drug is discontinued as soon as the symptoms appear.
Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity. - Signs of nephrotoxicity may not occur until the client has received 5 or more days of therapy. - Nephrotoxicity from the use of the aminoglycosides is reversible if the drug is discontinued as soon as the symptoms appear. Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity. Signs of nephrotoxicity may not occur until the client has received 5 or more days of therapy. Nephrotoxicity from the use of the aminoglycosides is reversible if the drug is discontinued as soon as the symptoms appear.
17. A nurse is caring for a 73-year-old patient with a urethral obstruction related to prostatic enlargement. When planning this patients care, the nurse should be aware of the consequent risk of what complication? A) Urinary tract infection B) Enuresis C) Polyuria D) Proteinuria
Ans: A Feedback: 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 patients are at risk for prostatic enlargement, which causes urethral obstruction and can result in hydronephrosis, renal failure, and urinary tract infections.
37. A nurse is working with a patient who will undergo invasive urologic testing. The nurse has informed the patient 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 OTC diuretic after the test C) Gentle massage of the lower abdomen D) Activity limitation for the first 12 hours after the test
Ans: A Feedback: 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.
4. The nurse is assessing a patients bladder by percussion. The nurse elicits dullness after the patient has voided. How should the nurse interpret this assessment finding? A) The patients bladder is not completely empty. B) The patient has kidney enlargement. C) The patient has a ureteral obstruction. D) The patient has a fluid volume deficit.
Ans: A Feedback: Dullness to percussion of the bladder following voiding indicates incomplete bladder emptying. Enlargement of the kidneys can be attributed to numerous conditions such as polycystic kidney disease or hydronephrosis and is not related to bladder fullness. Dehydration and ureteral obstruction are not related to bladder fullness; in fact, these conditions result in decreased flow of urine to the bladder.
33. A patient asks the nurse why kidney problems can cause gastrointestinal disturbances. What relationship should the nurse describe? A) The right kidneys proximity to the pancreas, liver, and gallbladder B) The indirect impact of digestive enzymes on renal function C) That the peritoneum encapsulates the GI system and the kidneys D) The left kidneys connection to the common bile duct
Ans: A Feedback: The proximity of the right kidney to the colon, duodenum, head of the pancreas, common bile duct, liver, and gallbladder may cause GI disturbances. The proximity of the left kidney to the colon (splenic flexure), stomach, pancreas, and spleen may also result in intestinal symptoms. Digestive enzymes do not affect renal function and the left kidney is not connected to the common bile duct.
2. A nurse knows that specific areas in the ureters have a propensity for obstruction. Prompt management of renal calculi is most important when the stone is located where? A) In the ureteropelvic junction B) In the ureteral segment near the sacroiliac junction C) In the ureterovesical junction D) In the urethra
Ans: A Feedback: The three narrowed areas of each ureter are the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovescial junction. These three areas of the ureters have a propensity for obstruction by renal calculi or stricture. Obstruction of the ureteropelvic junction is most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction. The urethra is not part of the ureter.
18. A patient 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
Ans: A Feedback: 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.
5. The nurse is providing pre-procedure teaching about an ultrasound. The nurse informs the patient that in preparation for an ultrasound of the lower urinary tract the patient 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
Ans: A Feedback: Ultrasonography requires a full bladder; therefore, fluid intake should be encouraged before the procedures. 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.
34. A patient with a history of progressively worsening fatigue is undergoing a comprehensive assessment which includes test of renal function relating to erythropoiesis. When assessing the oxygen transport ability of the blood, the nurse should prioritize the review of what blood value? A) Hematocrit B) Hemoglobin C) Erythrocyte sedimentation rate (ESR) D) Serum creatinine
Ans: B Feedback: Although historically hematocrit has been the blood test of choice when assessing a patient for anemia, use of the hemoglobin level rather than hematocrit is currently recommended, because that measurement is a better assessment of the oxygen transport ability of the blood. ESR and creatinine levels are not indicative of oxygen transport ability.
12. The nurse caring for a patient with suspected renal dysfunction calculates that the patients weight has increased by 5 pounds in the past 24 hours. The nurse estimates that the patient has retained approximately how much fluid? A) 1,300 mL of fluid in 24 hours B) 2,300 mL of fluid in 24 hours C) 3,100 mL of fluid in 24 hours D) 5,000 mL of fluid in 24 hours
Ans: B Feedback: An increase in body weight commonly accompanies edema. To calculate the approximate weight gain from fluid retention, remember that 1 kg of weight gain equals approximately 1,000 mL of fluid. Five lbs = 2.27 kg = 2,270 mL.
24. The nurse is caring for a patient scheduled for renal angiography following a motor vehicle accident. What patient preparation should the nurse most likely provide before this test? A) Administration of IV potassium chloride B) Administration of a laxative C) Administration of Gastrografin D) Administration of a 24-hour urine test
Ans: B Feedback: Before the procedure, a laxative may be prescribed to evacuate the colon so that unobstructed x-rays can be obtained. A 24-hour urine test is not necessary prior to the procedure. Gastrografin and potassium chloride are not administered prior to renal angiography.
15. The nurse is caring for a patient who describes changes in his voiding patterns. The patient states, I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesnt seem to be a great deal of urine flow. What would the nurse expect this patients physical assessment to reveal? A) Hematuria B) Urine retention C) Dehydration D) Renal failure
Ans: B Feedback: Increased urinary urgency and frequency coupled with decreasing urine volumes strongly suggest urine retention. Hematuria may be an accompanying symptom, but is likely related to a urinary tract infection secondary to the retention of urine. Dehydration and renal failure both result in a decrease in urine output, but the patient with these conditions does not have normal urine production and decreased or minimal flow of urine to the bladder. The symptoms of urgency and frequency do not accompany renal failure and dehydration due to decreased urine production.
The nurse is admitting an older-adult client with benign prostatic hyperplasia. Which of the following actions should be included in the nursing plan of care? a. Limit fluid intake to no more than 1 500 mL/day. b. Leave a light on in the bathroom during the night. c. Pad the client's bed to accommodate overflow incontinence. d. Ask the client to use a urinal so that all urine can be measured.
B
9. A patient with renal failure secondary to diabetic nephropathy has been admitted to the medical unit. What is the most life-threatening effect of renal failure for which the nurse should monitor the patient? A) Accumulation of wastes B) Retention of potassium C) Depletion of calcium D) Lack of BP control
Ans: B Feedback: Retention of potassium is the most life-threatening effect of renal failure. Aldosterone causes the kidney to excrete potassium, in contrast to aldosterones effects on sodium described previously. Acidbase 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 renal failure, but do not have same level of threat to the patients well-being as hyperkalemia.
21. A patient with recurrent urinary tract infections has just undergone a cystoscopy and complains of slight hematuria during the first void after the procedure. What is the nurses most appropriate action? A) Administer a STAT dose of vitamin K, as ordered. B) Reassure the patient that this is not unexpected and then monitor the patient for further bleeding. C) Promptly inform the physician of this assessment finding. D) Position the patient supine and insert a Foley catheter, as ordered.
Ans: B Feedback: Some burning on voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected after cystoscopy. The nurse should explain this to the patient and ensure that the bleeding resolves. No clear need exists to report this finding and it does not warrant insertion of a Foley catheter or vitamin K administration.
35. The nurse is reviewing the electronic health record of a patient with a history of incontinence. The nurse reads that the physician assessed the patients 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)
Ans: B Feedback: 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.
26. A patient with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acidbase balance? A) Sequestering free hydrogen ions in the nephrons B) Returning bicarbonate to the bodys circulation C) Returning acid to the bodys circulation D) Excreting bicarbonate in the urine
Ans: B Feedback: The kidney performs two major functions to assist in acidbase balance. The first is to reabsorb and return to the bodys circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine. Retaining bicarbonate will counteract an acidotic state. The nephrons do not sequester free hydrogen ions.
3. A nurse is caring for a patient 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
Ans: B Feedback: To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection, the serum creatinine level is measured.
22. A patient is complaining of genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform? A) Encourage mobilization. B) Apply topical lidocaine to the patients meatus, as ordered. C) Apply moist heat to the patients lower abdomen. D) Apply an ice pack to the patients perineum.
Ans: C Feedback: Following cystoscopy, moist heat to the lower abdomen and warm sitz baths are helpful in relieving pain and relaxing the muscles. Ice, lidocaine, and mobilization are not recommended interventions.
20. The nurse is caring for a patient 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 100.2F orally D) Infiltration of the patients intravenous catheter
Ans: C Feedback: Hematuria and renal colic are common and expected findings after the performance of a renal brush biopsy. The physician should be notified of the patients body temperature, which likely indicates the onset of an infectious process. IV infiltration does not warrant notification of the primary care physician.
31. Results of a patients 24-hour urine sample indicate osmolality of 510 mOsm/kg, which is within reference range. What conclusion can the nurse draw from this assessment finding? A) The patients kidneys are capable of maintaining acidbase balance. B) The patients kidneys reabsorb most of the potassium that the patient ingests. C) The patients kidneys can produce sufficiently concentrated urine. D) The patients kidneys are producing sufficient erythropoietin.
Ans: C Feedback: Osmolality is the most accurate measurement of the kidneys ability to dilute and concentrate urine. Osmolality is not a direct indicator of renal function as it relates to erythropoietin synthesis or maintenance of acidbase balance. It does not indicate the maintenance of healthy levels of potassium, the vast majority of which is excreted.
25. Diagnostic testing of an adult patient reveals renal glycosuria. The nurse should recognize the need for the patient to be assessed for what health problem? A) Diabetes insipidus B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) C) Diabetes mellitus D) Renal carcinoma
Ans: C Feedback: 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 kidneys reabsorption capacity. Glycosuria is not associated with SIADH, diabetes insipidus, or renal carcinoma.
13. The nurse is performing a focused genitourinary and renal assessment of a patient. 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 xyphoid process
Ans: C Feedback: 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.
29. A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult? A) If possible, try to drink at least 4 liters of fluid daily. B) Ensure that you avoid replacing water with other beverages. C) Remember to drink frequently, even if you dont feel thirsty. D) Make sure you eat plenty of salt in order to stimulate thirst.
Ans: C Feedback: The nurse emphasizes the need to drink throughout the day even if the patient does not feel thirsty, because the thirst stimulation is decreased. Four liters of daily fluid intake is excessive and fluids other than water are acceptable in most cases. Additional salt intake is not recommended as a prompt for increased fluid intake.
11. The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, 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
Ans: C Feedback: 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 it is not excreted in the urine.
14. The staff educator is giving a class for a group of nurses new to the renal unit. The educator is discussing renal biopsies. In what patient would the educator tell the new nurses that renal biopsies are contraindicated? A) A 64-year-old patient with chronic glomerulonephritis B) A 57-year-old patient with proteinuria C) A 42-year-old patient with morbid obesity D) A 16-year-old patient with signs of kidney transplant rejection
Ans: C Feedback: There are several contraindications to a kidney biopsy, including bleeding tendencies, uncontrolled hypertension, a solitary kidney, and morbid obesity. Indications for a renal biopsy include unexplained acute renal failure, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.
19. A patient admitted to the medical unit with impaired renal function is complaining of severe, stabbing pain in the flank and lower abdomen. The patient 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
Ans: C Feedback: 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.
16. The nurse is caring for a patient with a nursing diagnosis of deficient fluid volume. The nurses assessment reveals a BP of 98/52 mm Hg. The nurse should recognize that the patients kidneys will compensate by secreting what substance? A) Antidiuretic hormone (ADH) B) Aldosterone C) Renin D) Angiotensin
Ans: C Feedback: When the vasa recta detect a decrease in BP, specialized juxtaglomerular cells near the afferent arteriole, distal tubule, and efferent arteriole secrete the hormone renin. Renin converts angiotensinogen to angiotensin I, which is then converted to angiotensin II. The vasoconstriction causes the BP to increase. The adrenal cortex secretes aldosterone in response to stimulation by the pituitary gland, which in turn is in response to poor perfusion or increasing serum osmolality. The result is an increase in BP.
10. A kidney biopsy has been scheduled for a patient with a history of acute renal failure. The patient asks the nurse why this test has been scheduled. What is the nurses best response? A) A biopsy is routinely ordered for all patients 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 patients before they have a kidney transplant. D) A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease.
Ans: D Feedback: Biopsy of the kidney is used in diagnosing and evaluating the extent of kidney disease. Indications for biopsy include unexplained acute renal failure, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.
7. A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. 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
Ans: D Feedback: 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.
23. The nurse is caring for a patient who is going to have an open renal biopsy. What would be an important nursing action in preparing this patient for the procedure? A) Discuss the patients diagnosis with the family. B) Bathe the patient before the procedure with antiseptic skin wash. C) Administer antivirals before sending the patient for the procedure. D) Keep the patient NPO prior to the procedure.
Ans: D Feedback: Preparation for an open biopsy is similar to that for any major abdominal surgery. When preparing the patient for an open biopsy you would keep the patient NPO. You may discuss the diagnosis with the family, but that is not a preparation for the procedure. A pre-procedure wash is not normally ordered and antivirals are not administered in anticipation of a biopsy.
27. A patients 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 patient is likely to have a decreased level of blood urea nitrogen (BUN). B) The patient is at risk for hypokalemia. C) The patient is likely to have irregular voiding patterns. D) The patient is likely to have increased serum creatinine levels.
Ans: D Feedback: 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.
40. What nursing action should the nurse perform when caring for a patient undergoing diagnostic testing of the renal-urologic system? A) Withhold medications until 12 hours post-testing. B) Ensure that the patient knows the importance of temporary fluid restriction after testing. C) Inform the patient of his or her medical diagnosis after reviewing the results. D) Assess the patients understanding of the test results after their completion.
Ans: D Feedback: The nurse should ensure that the patient understands the results that are presented by the physician. Informing the patient of a diagnosis is normally the primary care providers responsibility. Withholding fluids or medications is not normally required after testing
28. A patient has experienced excessive losses of bicarbonate and has subsequently developed an acidbase imbalance. How will this lost bicarbonate be replaced? A) The kidneys will excrete increased quantities of acid. B) Bicarbonate will be released from the adrenal medulla. C) Alveoli in the lungs will synthesize new bicarbonate. D) Renal tubular cells will generate new bicarbonate.
Ans: D Feedback: To replace any lost bicarbonate, the renal tubular cells generate new bicarbonate through a variety of chemical reactions. This newly generated bicarbonate is then reabsorbed by the tubules and returned to the body. The lungs and adrenal glands do not synthesize bicarbonate. Excretion of acid compensates for a lack of bicarbonate, but it does not actively replace it.
6. The nurse is caring for a patient who has a fluid volume deficit. When evaluating this patients 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
Ans: D Feedback: 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 patients with kidney disease, urine specific gravity does not vary with fluid intake, and the patients urine is said to have a fixed specific gravity.
36. A patient with a history of incontinence will undergo urodynamic testing in the physicians office. Because voiding in the presence of others can cause situational anxiety, the nurse should perform what action? A) Administer diuretics as ordered. B) Push fluids for several hours prior to the test. C) Discuss possible test results as the patient voids. D) Help the patient to relax before and during the test.
Ans: D Feedback: 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 patient relax by providing as much privacy and explanation about the procedure as possible. Diuretics and increased fluid intake would not address the patients anxiety. It would be inappropriate and anxiety-provoking to discuss test results during the performance of the test.
1. The care team is considering the use of dialysis in a patient whose renal function is progressively declining. Renal replacement therapy is indicated in which of the following situations? A) When the patients creatinine level drops below 1.2 mg/dL (110 mmol/L) B) When the patients 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
Ans: D Feedback: 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 patient 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.
Water is reabsorbed rather than excreted under the control of which hormone?
Antidiuretic Hormone
The nurse assesses a patient upon admission to the hospital. Which significant nursing assessment data is relevant to renal function? Select all that apply A) Any voiding disorders B) The patient's occupation C) The presence of hypertension or diabetes D) The patient's financial status E) The ability of the patient to manage activities of daily living
Any voiding disorders - The patient's occupation - The presence of hypertension or diabetes
The nurse is assessing a patient upon admission to the hospital. What significant nursing assessment data is relevant to renal function? Select all that apply. Any voiding disorders The presence of hypertension or diabetes The patient's occupation The ability of the patient to manage activities of daily living The patient's financial status
Any voiding disorders - The presence of hypertension or diabetes - The patient's occupation
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? Distract the client's attention from the pain. Assess the patient's back and shoulder areas for signs of internal bleeding. 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.
A client with a possible urinary tract infection (UTI) gives the nurse in the clinic a urine specimen that is a red-orange colour. Which of the following actions should the nurse take first? a. Notify the client's health care provider. b. Ask the client about use of any medications. c. Question the client about any UTI risk factors. d. Teach about the correct procedure for midstream urine collection.
B
A creatinine clearance test is ordered for a hospitalized client with possible renal insufficiency. Which of the following equipment will the nurse need to obtain? a. Sterile specimen cup b. Large container for urine c. Foley catheter and drainage bag d. Towelettes for perineal cleaning
B
The nurse is caring for a client following an intravenous pyelogram (IVP) and obtains all of the following assessment data. Which of the following findings require immediate action by the nurse? a. The heart rate is 58 beats/minute. b. The respiratory rate is 38 breaths/minute. c. The client complains of a dry mouth. d. The urine output is 400 mL in the first 2 hours.
B
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? A. The upper abdominal quadrants on the left and right side B. The costovertebral angle C. Above the symphysis pubis D. Around the umbilicus
B
The nurse is reviewing the result of a client's creatinine clearance test which is 60 mL/minute. Which of the following values is the client's glomerular filtration rate (GFR) in mL/minute? a. 30 b. 60 c. 120 d. 240
B
A patient with ESKD is scheduled to have an AV fistula created. The nurse explains that the patient will have a temporary dialysis catheter because the fistula has to mature. The nurse will explain that the patient will have to wait how long before using the fistula? A) 1 to 2 weeks B) 2 to 3 months C) 2 to 3 weeks D) 1 month
B) 2 to 3 months
The nurse is educating a patient who is required to restrict potassium intake. Which foods will the nurse suggest the patient eliminate that are rich in potassium? A) Butter B) Citrus fruits C) Cooked white rice D) Salad oils
B) Citrus fruits
A patient has stage 3 chronic kidney failure. What will the nurse expect the patient's GFR to be? A) GFR of 90 mL/min B) GFR of 30 to 59 mL/min C) GFR of 120 mL/min D) GFR of 85 mL/min
B) GFR of 30 to 59 mL/min
The nurse is caring for a patient after kidney surgery. Which major danger will the nurse closely monitor for? A) Abdominal distension owing to reflex cessation of intestinal peristalsis B) Hypovolemic shock caused by hemorrhage C) Paralytic ileus caused by manipulation of the colon during surgery D) Pneumonia caused by shallow breathing because of severe incisional pain
B) Hypovolemic shock caused by hemorrhage
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 enzymes
C 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.
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? A. Decreased blood urea nitrogen (BUN) B. Increased serum albumin C. Increased serum creatinine D. Decreased potassium
C 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.
4. A creatinine clearance test is ordered for a hospitalized patient with possible renal insufficiency. Which equipment will the nurse need to obtain? a. Foley catheter and drainage bag b. Towelettes for perineal cleaning c. Basin of ice d. Sterile specimen cup
C Rationale: Creatinine clearance testing involves a 24-hour urine specimen collection. The urine should be refrigerated or cooled, or a preservative should be used. Catheterization, cleaning of the perineum with antiseptic towelettes, and a sterile specimen cup are not needed for this test.
Which of the following is the priority nursing diagnosis for the client preparing for a voiding cystourethrography? A. Risk for infection: urinary tract B. Acute pain C. Deficient knowledge: procedure D. Urinary retention
C 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.
To obtain information about the chief report and medical history of an older client, the nurse asks the client about any medication history. Why is obtaining a medication history important? A. It may indicate the client's general health. B. It may reflect the client's childhood and family illnesses. C. It may indicate multiple medications taken by the client. D. It may indicate drugs that should not be prescribed to the client.
C The nurse should obtain information about a client's medication history because older clients, in particular, may be taking multiple medications that may affect their renal function. The medication history in general indicates the probable risk factors of renal or urologic disorders. The medication history of an older client is not used to obtain information about the client's general health, childhood and family illnesses, or drugs that are contraindicated for use by the client.
The nurse recognizes that a referral for genetic counseling is inappropriate for the client with: A. Alport syndrome B. Polycystic kidney disease C. Renal calculi D. Wilms' tumor
C Wilms' tumor, polycystic disease, and Alport are conditions that have a genetic influence. Renal calculi are not influenced by genetic factors.
The nurse analyzes a urinalysis report. He is aware that the presence of this substance in the urine indicates a blood level that exceeds the kidney's reabsorption capacity. Select the substance. A. Sodium B. Bicarbonate C. Creatinine D. Glucose
D Glucose is usually filtered at the level of the glomerulus. It does not normally appear in the urine. Renal glycosuria occurs if the glucose in the blood exceeds the amount that is able to be reabsorbed. The other substances are normally excreted in the urine.
If someone is using continuous ambulatory peritoneal dialysis, how often would they need to dialyze themselves per day? A) 1 time B) 2 times C) 2-3 times D) 4-5 times
D) 4-5 times with no night exchanges
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L and the nurse observes peaked T waves on the ECG. Which priority action will the nurse perform as prescribed to reduce potassium level? A) Administration of an insulin drip B) Administration of a loop diuretic (furosemide) C) Administration of sodium bicarbonate D) Administration of sodium polystyrene sulfonate
D) Administration of sodium polystyrene sulfonate
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? Therapeutic index Creatinine clearance Liver function studies GI absorption rate
D) Creatinine clearanceThe physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.
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? On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. When the kidneys are diseased, the ability to concentrate urine may be impaired, and the specific gravity may vary widely. 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 scant urine output with a high specific gravity.
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.
39. Dipstick testing of an older adult patients urine indicates the presence of protein. Which of the following statements is true of this assessment finding? A) This finding needs to be considered in light of other forms of testing. B) This finding is a risk factor for urinary incontinence. C) This finding is likely the result of an age-related physiologic change. D) This result confirms that the patient has diabetes. Select all that apply.
This finding is a risk factor for urinary incontinence. - This finding is likely the result of an age-related physiologic change. - This result confirms that the patient has diabetes. Feedback: A dipstick examination, which can detect from 30 to 1000 mg/dL of protein, should be used as a screening test only, because urine concentration, pH, hematuria, and radiocontrast materials all affect the results. Proteinuria is not diagnostic of diabetes and it is neither an age-related change nor a risk factor for incontinence.
The most frequent reason for admission to skilled care facilities includes which of the following? Urinary incontinence Congestive heart failure Stroke Myocardial infarction
Urinary incontinence Explanation: Urinary incontinence is the most common reason for admission to skilled nursing facilities.
Which of the following is used to identify vesicoureteral reflux? IV urography Bladder ultrasonography Renal angiography 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.
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 500 and 1,000 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 300 and 500 mL/h
When the urine output is less than 30 mL/h
The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to notify the health care team if bloody urine is noted. maintain bed rest for 2 hours. carefully handle urine because it is radioactive. drink liberal amounts of fluids.
drink liberal amounts of fluids.
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: anuria. oliguria. polyuria. hematuria.
anuria - 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.
When the bladder contains 400 to 500 mL of urine, this is referred to as renal clearance. functional capacity. specific gravity. anuria.
functional capacity.
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) BUN and serum creatinine 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.
In a diagnosis of a lower urinary tract infection, which structures could be affected? Select all that apply. A. bladder B. urethra C. ureter D. kidney
bladder - urethra The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.
The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? a) "I should remove all jewelry before the test." b) "I should let the staff know if I feel claustrophobic." c) "I will feel a warm sensation as the dye is injected." d) "I will need to drink all of the dye as quickly as possible."
c) "I will feel a warm sensation as the dye is injected." 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 statement by the client preparing for a voiding cystourethrography indicates further teaching by the nurse is needed? a) "My bladder will be filled with dye using a urinary catheter." b) "Pictures will be taken of my bladder as I urinate, using ultrasound." c) "The dye is injected through an IV." d) "I will need to drink all of the dye as quickly as possible."
c) "The dye is injected through an IV." A contrast agent is instilled into the bladder through a urinary catheter. Fluroroscopy is used to examine the lower urinary tract.
A patient has a history of multiple urinary tract infections. The nurse catheterized the patient and confirmed the presence of residual urine. Select the urine volume that is significantly associated with the risk of infection. a) 100 mL b) 50 mL c) 150 mL d) 25 mL
c) 150 mL Residual urine volume of more than 100 mL is significantly associated with the risk of infection. Amounts of less than 100 are within a normal range.
The nurse is caring for a patient with a medical history of sickle cell anemia. The nurse understands this predisposes the patient to which of the following possible renal or urologic disorders? a) Kidney stone formation b) Neurogenic bladder c) Chronic kidney disease d) Proteinuria
c) Chronic kidney disease A medical history of sickle cell anemia predisposes the patient to the development of chronic kidney disease. The other disorders are not associated with the development of sickle cell anemia.
The nurse observes the patient's urine to be orange. Which additional assessment would be important for this patient? a) Bleeding b) Intake of multiple vitamin preparations c) Infection d) Intake of medication such as phenytoin (Dilantin)
d) Intake of medication such as phenytoin (Dilantin) Urine that is orange may be caused by intake of Dilantin 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 patient taking a multiple vitamin preparation. Yellow to milky white urine may indicate infection, pyuria, or in the female patient, the use of vaginal creams.
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 Detrusor muscle Inner layer of epithelium Adventitia (connective tissue)
detrusor muscle
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?" "Do you take multiple vitamin preparations?" "Have you noticed any vaginal bleeding?" "Do you take phenytoin daily?"
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. 1548
