N406 Exam 2 PrepU Questions (KIDNEYS)

What is dwell time in peritoneal dialysis?

-fluid fills the peritoneal cavity and remains there for a prescribed amount of time - usually 4-6 hours

Which of the following is classified as a upper urinary tract infection (UTI)? Select all that apply: A. Acute pyelonephritis B. Renal abscess C. Cystitis D. Urethritis E. Prostatatis

A, B Upper UTIs include acute pyelonephritis, renal abscess, perineal abscess, chronic pyelonephritis, and interstitial nephritis. Lower UTIs include cystitis, urethritis, and prostatitis.

A client's renal failure has become chronic. Which signs and symptoms are associated with chronic renal failure? Select all that apply. A. lethargy B. muscle cramps C. bleeding of the oral mucous membranes D. enhanced cognition

A, B, C Lethargy, muscle cramps, and bleeding of the oral mucous membranes are some of the signs and symptoms of chronic renal failure. With chronic renal failure, mental processes progressively slow as electrolyte imbalances become marked and nitrogenous wastes accumulate.

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

A, B, C, D 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.

The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? Select all that apply. A. Red blood cells in the urine B. Polyuria C. Proteinuria D. White blood cell casts in the urine E. Hemoglobin of 12.8 g/dL

A, C The primary presenting features of an acute glomerular inflammation are hematuria, edema, azotemia (an abnormal concentration of nitrogenous wastes in the blood), and proteinuria (excess protein in the urine). The urine may appear cola colored because of red blood cells (RBCs) and protein plugs or casts; RBC casts may be present, indicating glomerular injury. Acute glomerulonephritis does not present with white blood cell (WBC) casts.

A client with chronic kidney disease (CKD) has been receiving erythropoietin injections as prescribed. Which outcome would indicate to the nurse that this medication has been effective? A. Absence of pallor B. Absence of a paradoxical pulse C. Blood pressure within normal limits D. Bowel movements solid and formed

A. Absence of pallor Erythropoietin stimulates the bone marrow to produce more red blood cells. The absence of pallor indicates that this treatment has been effective. Lack of a paradoxical pulse indicates the absence of a pericardial effusion. Blood pressure within normal limits indicates treatment for hypertension has been effective. Formed and solid bowel movements indicate the potassium level is within normal limits.

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 24-hour collection of urine is the primary test of renal clearance used to evaluate how well the kidney performs this important excretory function. The client is initially instructed to void and discard the urine. The collection bottle is marked with the time the client voided. Thereafter, all the urine is collected for the entire 24 hours. The last urine is voided at the same time the test originally began.

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? A. Azotemia B. Proteinuria C. Hematuria D. Bacteremia

A. Azotemia The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.

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? A. Bleeding B. Infection C. Dehydration D. Allergic reaction

A. Bleeding Renal biopsy carries the risk of post procedure bleeding, because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater. Dehydration and allergic reaction are not associated with a renal biopsy.

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? A. Calcium B. Magnesium C. Phosphorus D. Sodium

A. Calcium Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? A. Cola-colored urine B. Left upper quadrant pain C. Pyuria D. Low blood pressure

A. Cola-colored urine Cola-colored urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis.

Which part of the kidney contains the nephrons? A. Cortex B. Pelvis C. Medulla D. Glomerulus

A. Cortex The cortex is located farthest from the center of the kidney and around the outermost edges. It contains the nephrons (the functional units of the kidney).

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. Creatinine clearance level The creatinine clearance measures the volume of blood cleared of endogenous creatinine in 1 minute. This serves as a measure of the glomerular filtration rate. Therefore the creatinine clearance test is a sensitive indicator of renal disease progression.

A client who suffered hypovolemic shock during a cardiac incident has developed acute kidney injury. Which is the best nursing rationale for this complication? A. Decrease in the blood flow through the kidneys B. Obstruction of urine flow from the kidneys C. Blood clot formed in the kidneys interfered with the flow D. Structural damage occurred in the nephrons of the kidneys

A. Decrease in the blood flow through the kidneys Acute kidney injury can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? A. Decreased fluid intake B. Increased fluid intake C. Glomerulonephritis D. Diabetes insipidus

A. Decreased fluid intake When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases. Disorders or conditions that cause decreased urine-specific gravity include diabetes insipidus, glomerulonephritis, and severe renal damage. Disorders that can cause increased specific gravity include diabetes, nephritis, and fluid deficit.

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? A. Dehydration B. Hyperkalemia C. Crackles D. Hypertension

A. Dehydration The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.

Which substance stimulates the bone marrow to produce red blood cells? A. Erythropoietin B. Prostaglandin E C. Prostacyclin D. Renin

A. Erythropoietin 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.

Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? A. Glomerulonephritis B. Hypovolemia C. Ureteral calculus D. Dysrhythmia

A. Glomerulonephritis Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.

The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client? A. Hemodialysis B. Peritoneal dialysis C. Continuous arteriovenous hemofiltration (CAVH) D. Continuous venovenous hemofiltration (CVVH)

A. Hemodialysis The client is hemodynamically stable and hemodialysis would be most appropriate. Hemodialysis is used for clients who are acutely ill and require short-term dialysis for days to weeks until kidney function resumes and for clients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) who require long-term or permanent renal replacement therapy. Peritoneal dialysis (PD) may be the treatment of choice for clients with renal failure who are unable or unwilling to undergo hemodialysis or kidney transplantation. CAVH and CVVH are used for client who are hemodynamically unstable.

As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur? A. Hyperphosphatemia B. Hypercalcemia C. Hypokalemia D. Metabolic alkalosis

A. Hyperphosphatemia Changes include hyperphosphatemia due to its decreased renal excretion, hypocalcemia and decreased vitamin D activation, hyperkalemia due to decreased potassium excretion, and metabolic acidosis from decreased acid secretion by the kidney and inability to regenerate bicarbonate.

A client diagnosed with acute kidney injury (AKI) has developed congestive heart failure. The client has received 40 mg of intravenous push (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The client's vital signs are stable. Which health care order should the nurse anticipate? A. Lasix 80 mg IVP B. Normal saline bolus of 500 mL C. Chest x-ray D. Mannitol 12.5 g IVP

A. Lasix 80 mg IVP Diuretic agents are often used to control fluid volume in clients with acute kidney injury (AKI). The client's urine output indicates an inadequate response to the initial dosage of Lasix and the nurse should anticipate administering Lasix 80 mg IVP. Often in this situation, the initial dosage of Lasix is doubled. The client is experiencing fluid overload, thus, a 500-mL bolus of normal saline bolus would be contraindicated. There is no need to complete a chest x-ray. Mannitol is widely used in the management of cerebral edema and increased intracranial pressure from multiple causes.

Which of the following occurs late in chronic glomerulonephritis? A. Peripheral neuropathy B. Nosebleed C. Stroke D. Seizure

A. Peripheral neuropathy Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.

Which of the following hormones is secreted by the juxtaglomerular apparatus? A. Renin B. Aldosterone C. Antidiuretic hormone (ADH) D. Calcitonin

A. Renin Renin is a hormone directly involved in the control of arterial blood pressure; it is essential for proper functioning of the glomerulus. ADH, also known as vasopressin, plays a key role in the regulation of extracellular fluid by excreting or retaining water. Calcitonin regulates calcium and phosphorous metabolism.

The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: A. Specific gravity 1.035 B. Creatinine 0.7 mg/dL C. Protein 15 mg/dL D. Bright yellow urine

A. Specific gravity 1.035 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.

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. A. Tall, peaked T waves B. Shortened QRS complex C. Multiple spiked P waves D. Prolonged ST segment

A. Tall, peaked T waves Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.

Which nursing assessment finding indicates the client has not met expected outcomes? A. The client voids 75 cc four hours post cystoscopy. B. The client reports a pain rating of 3 two hours post-kidney biopsy. C. The client has blood-tinged urine following brush biopsy. D. The client consumes 75% of lunch following an intravenous pyelogram.

A. The client voids 75 cc four hours post cystoscopy. Urinary retention is an undesirable outcome following cystoscopy. A pain rating of 3 is an achievable and expected outcome following kidney biopsy. Blood-tinged urine is an expected finding following cystoscopy due to trauma of the procedure. A client would be expected to eat and retain a meal following an intravenous pyelogram.

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute kidney injury. Which statement from the nurse best reflects the ability of the kidneys to recover from acute kidney injury? A. The kidneys can improve over a period of months. B. Once on dialysis, the need will be permanent. C. Kidney function will improve with transplant. D. Acute kidney injury tends to turn to end-stage failure.

A. The kidneys can improve over a period of months. The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute kidney injury can progress to chronic renal failure.

The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to A. drink liberal amounts of fluids. B. maintain bed rest for 2 hours. C. carefully handle urine because it is radioactive. D. notify the health care team if bloody urine is noted.

A. drink liberal amounts of fluids. After the procedure is completed, the client is encouraged to drink fluids to promote excretion of the radioisotope by the kidneys. The remaining instructions are not associated with a nuclear scan.

Although the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which is NOT a function of the kidneys? A. excreting protein B. excreting nitrogen waste products C. regulating blood pressure D. stimulating RBC production

A. excreting protein 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 is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? A. glucose B. potassium C. creatinine D. chloride

A. glucose Amino acids and glucose typically are reabsorbed and not excreted in the urine. The filtrate that is secreted as urine usually contains water, sodium, chloride, bicarbonate, potassium, urea, creatinine, and uric acid.

A client is having a blood urea nitrogen (BUN) test. BUN level is: A. increased in renal disease and urinary obstruction. B. decreased in nephrotic syndrome. C. decreased in renal disease and urinary obstruction. D. unchanged in renal disease.

A. increased in renal disease and urinary obstruction. BUN is increased in renal disease and urinary obstruction.

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: A. microorganism transfer. B. prostate irritation. C. client discomfort. D. incorrect urine output values.

A. microorganism transfer. 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.

The term used to describe total urine output less than 0.5 mL/kg/hour is A. oliguria. B. anuria. C. nocturia. D. dysuria.

A. oliguria. Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Dysuria refers to painful or difficult urination.

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? A. pH 7.20, PaCO2 36, HCO3 14- B. pH 7.31, PaCO2 48, HCO3 24- C. pH 7.47, PaCO2 45, HCO3 33- D. pH 7.50, PaCO2 29, HCO3 22-

A. pH 7.20, PaCO2 36, HCO3 14- Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.

A client has been diagnosed with acute glomerulonephritis. This condition causes: A. proteinuria. B. pyuria. C. polyuria. D. No option is correct.

A. proteinuria. The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided.

One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: A. restricting sources of potassium. B. allowing liberal use of sodium. C. limiting iron and folic acid intake. D. eating protein liberally.

A. restricting sources of potassium. The nurse will teach the client to restrict sources of potassium, such as fresh fruits and vegetables, because hyperkalemia can cause life-threatening changes. The client will restrict sodium intake as ordered; doing so prevents fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken; iron and folic acid supplements are needed for red blood cell (RBC) production, and Epogen stimulates the bone marrow to produce RBCs. The client will restrict protein intake to foods that are complete proteins within prescribed limits; complete proteins provide positive nitrogen balance for healing and growth.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: A. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. B. a decreased serum phosphate level secondary to kidney failure. C. an increased serum calcium level secondary to kidney failure. D. metabolic alkalosis secondary to retention of hydrogen ions.

A. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

The nurse is instructing a health class of high school seniors on the function of the kidney. The nurse is correct to highlight which information? Select all that apply. A. Regulates estrogen and progesterone B. Excretes waste products C. Controls blood pressure D. Regulate calcium and the synthesis of vitamin D E. Activates growth hormone F. Regulates red blood cell production

B, C, D, F The nurse is correct to highlight all of the options except regulates estrogen and progesterone. The pituitary gland controls hormone secretion.

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? A. "It is important to use strict aseptic technique." B. "It is appropriate to warm the dialysate in a microwave." C. "The infusion clamp should be open during infusion." D. "The effluent should be allowed to drain by gravity."

B. "It is appropriate to warm the dialysate in a microwave." The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.

An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? A. "The risk of peritonitis is greater with this type of dialysis." B. "This type of dialysis will provide more independence." C. "Peritoneal dialysis will require more work for you." D. "Peritoneal dialysis does not work well for every client."

B. "This type of dialysis will provide more independence." Once a treatment choice has been selected by the client, the nurse should support the client in that decision. Continuous cyclic peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients.

Which hormone causes the kidneys to reabsorb sodium? A. Antidiuretic hormone B. Aldosterone C. Growth hormone D. Prostaglandins

B. Aldosterone Aldosterone is a hormone synthesized and released by the adrenal cortex. Antidiuretic hormone is secreted by the posterior pituitary gland. Growth hormone and prostaglandins do not cause the kidneys to reabsorb sodium.

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

B. Angiography Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the internal bladder.

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? A. Radiography B. Computed tomography with contrast C. Cystoscopy D. Bladder ultrasonography

B. Computed tomography with contrast 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.

A creatinine clearance test is ordered for a client with possible renal insufficiency. The nurse must collect which serum concentration midway through the 24-hour urine collection? A. Blood urea nitrogen B. Creatinine C. Osmolality D. Hemoglobin

B. Creatinine To calculate creatinine clearance, a 24-hour urine specimen is collected. The serum creatinine concentration is measured midway through the collection. The other concentrations are not measured during this test.

A patient is being seen in the clinic for possible kidney disease. What major sensitive indicator of kidney disease does the nurse anticipate the patient will be tested for? A. Blood urea nitrogen level B. Creatinine clearance level C. Serum potassium level D. Uric acid level

B. Creatinine clearance level Creatinine is an endogenous waste product of skeletal muscle that is filtered at the glomerulus, passed through the tubules with minimal change, and excreted in the urine. Hence, creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

A client with chronic kidney disease becomes confused and reports abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which lab value? A. Elevated urea levels B. Hyperkalemia C. Hypocalcemia D. Elevated white blood cells

B. Hyperkalemia Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.

What is a characteristic of the intrarenal category of acute renal failure? A. Decreased creatinine B. Increased BUN C. High specific gravity D. Decreased urine sodium

B. Increased BUN The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.

The nurse observes that the client's urine is orange. Which additional assessment would be important for this client? A. Bleeding B. Intake of medication such as phenazopyridine hydrochloride C. Intake of multiple vitamin preparations D. Infection

B. Intake of medication such as phenazopyridine hydrochloride Urine that is orange may be caused by intake of phenazopyridine hydrochloride or other medications. Orange to amber-colored urine may also indicate concentrated urine due to dehydration or fever. Urine that is pink to red may indicate lower urinary tract bleeding. Urine that is bright yellow is an anticipated abnormal finding in the client taking a multiple vitamin preparation. Yellow to milky white urine may indicate infection, pyuria, or, in the female client, the use of vaginal creams.

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

B. Monitor the client for an allergy to iodine contrast material. A renal angiography procedure will be contraindicated if the client is allergic to iodine contrast material. Therefore, it is important for the nurse to monitor the client for an allergy to iodine contrast material. The nurse monitors the client for the signs of electrolyte and water imbalance, mental changes, and periorbital edema at any time regardless of the test being done.

Which 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. More prone to develop hypernatremia 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.

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? A. Diuresis B. Oliguria C. Acute tubular necrosis D. Restored glomerular function

B. Oliguria During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.

Which term best describes a total urine output less than 500 mL in 24 hours? A. Polyuria B. Oliguria C. Nocturia D. Dysuria

B. Oliguria Oliguria is a urine output less than 500 mL in 24 hours. Polyuria is increased urine output. Nocturia is awakening at night to urinate. Dysuria is painful or difficult urination.

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI? A. Initiation B. Oliguria C. Diuresis D. Recovery

B. Oliguria The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.

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. Renal cortex The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? A. Blood glucose level of 200 mg/dl B. White blood cell (WBC) count of 20,000/mm3 C. Potassium level of 3.5 mEq/L D. Hematocrit (HCT) of 35%

B. White blood cell (WBC) count of 20,000/mm3 An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

The nurse monitors the client for potential complications during dialysis but recognizes NOT to monitor for A. muscle cramping. B. hypertension. C. dysrhythmias. D. air embolism.

B. hypertension. The nurse should monitor for hypotension, not hypertension, during the treatment related to the removal of fluid. Muscle cramping may occur late in dialysis as fluid and electrolytes rapidly leave the extracellular space. Dysrhythmias may result from electrolyte and pH changes or removal of antiarrhythmic medications. Air embolism is rare, but could occur if air enters the vascular system.

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: A. hematuria. B. weight loss. C. increased urine output. D. increased blood pressure.

B. weight loss. Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

A nurse cares for an acutely ill client. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill client is: A. blood pressure. B. weight. C. pulse rate. D. edema.

B. weight. The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. Blood pressure, pulse rate, and edema are not the most accurate indicator of fluid loss or gain.

A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? A. "Squamous cell carcinomas do not present with detectable symptoms." B. "You should have sought treatment earlier." C. "Very few symptoms are associated with renal cancer." D. "Painless gross hematuria is the first symptom in renal cancer."

C. "Very few symptoms are associated with renal cancer." Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease. Adenocarcinomas are the most common renal cancer (about 80%),whereas squamous cell renal cancers are rare. It is not therapeutic to place doubt or blame for delayed diagnosis.

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? A. Increased pH with decreased hydrogen ions B. Increased serum levels of potassium, magnesium, and calcium C. Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL D. Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75%

C. Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl. A BUN level of 100 mg/dl and a serum creatinine of 6.5 mg/dl are abnormally elevated results, reflecting CRF and the kidneys' decreased ability to remove nonprotein nitrogen waste from the blood. CRF causes decreased pH and increased hydrogen ions — not vice versa. CRF also increases serum levels of potassium, magnesium, and phosphorous, and decreases serum levels of calcium. A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls within the normal range of 60% to 75%.

The nurse is caring for a client with a history of sickle cell anemia. The nurse understands that this predisposes the client to which renal or urologic disorder? A. Kidney stone formation B. Proteinuria C. Chronic kidney disease D. Neurogenic bladder

C. Chronic kidney disease A history of sickle cell anemia predisposes the client to the development of chronic kidney disease. The other disorders are not associated with the development of sickle cell anemia.

A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? A. Elevated serum creatinine B. Hyperkalemia C. Hyperphosphatemia D. Elevated urea and nitrogen

C. Hyperphosphatemia Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.

A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? A. Increase fat intake and limit carbohydrates. B. Eliminate fat intake and increase protein intake. C. Increase carbohydrates and limit protein intake. D. Increase protein, carbohydrates, and fat intake.

C. Increase carbohydrates and limit protein intake. Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.

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. Increased serum creatinine 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.

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? A. Obstruction of the lower urinary tract B. Acute renal failure C. Infection D. Nephrotic syndrome

C. 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 helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client? A. Wear a mask while handling any dialysate solutions B. Keep the catheter stabilized to the abdomen, below the belt line C. Keep the dialysis supplies in a clean area, away from children and pets D. Clean the catheter insertion site daily with soap

C. Keep the dialysis supplies in a clean area, away from children and pets It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output? A. 1.5 L B. 1.0 L C. Less than 400 mL D. Less than 50 mL

C. Less than 400 mL The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The minimum amount of urine needed to rid the body of normal metabolic waste products is 400 mL. In this phase, uremic symptoms first appear and life-threatening conditions such as hyperkalemia develop.

A client in moderate pain is admitted for possible kidney stones. The client appears diaphoretic and has frequent periods of nausea and vomiting. The client reports sudden oliguria and initial portable bladder ultrasound shows 300 mL in the bladder after the client voided 50 mL. Which action should the nurse anticipate performing first for this client? A. Provide intravenous hydomorphone. B. Repeat the portable bladder ultrasound. C. Place a urinary cathether. D. Provide ondansetron intravenously.

C. Place a urinary cathether. Increased urinary urgency and frequency coupled with decreasing urine volume strongly suggest urinary retention depending on the acuity of the onset of the symptoms, immediate bladder emptying via catheterization and evaluation may be necessary to prevent kidney dysfunction. The combination of pain, sudden oliguria, nausea, vomiting and post-ressidual results are suggestive of an acute condition. Therefore, a second bladder scan is not warranted and may delay care. The pain, nausea, and vomiting may be the result of urinary retention and a full bladder. Placement of a urinary cathether may alleviate those conditions. After placing the urinary cathether, a reassessment and treatment of those conditions can occur.

Retention of which electrolyte is the most life-threatening effect of renal failure? A. Calcium B. Sodium C. Potassium D. Phosphorous

C. Potassium Retention of potassium is the most life-threatening effect of renal failure.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? A. Impaired urinary elimination B. Toileting self-care deficit C. Risk for infection D. Activity intolerance

C. Risk for infection The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

Based on her knowledge of the primary cause of ESRD, the nurse knows to assess the most important indicator. What is that indicator? A. pH and HCO3 B. Blood pressure C. Serum glucose D. Urine protein

C. Serum Glucose The nurse would evaluate serum and urine levels of glucose because diabetes is the primary cause of renal failure.

A group of students is reviewing for a test on the urinary and renal system. The students demonstrate understanding of the information when they identify which of the following as part of the upper urinary tract? A. Bladder B. Urethra C. Ureters D. Pelvic floor muscles

C. Ureters 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 instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? A. Wear a mask while handling any dialysate solutions. B. Keep the catheter stabilized to the abdomen, below the belt line. C. Use an aseptic technique during the procedure. D. Clean the catheter insertion site daily with soap.

C. Use an aseptic technique during the procedure. The client should be instructed to use an aseptic technique during the procedure. The client should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (clients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: A. nausea and vomiting. B. dyspnea and cyanosis. C. fatigue and weakness. D. thrush and circumoral pallor.

C. fatigue and weakness. RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.

A client requires hemodialysis. Which type of drug should be withheld before this procedure?

Cardiac glycosides Cardiac glycosides such as digoxin (Lanoxin) should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digoxin toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.

The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL? A. 250 mL B. 500 mL C. 750 mL D. 1,000 mL

D. 1,000 mL The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1-kg weight gain is equal to 1,000 mL of retained fluid.

When fluid intake is normal, the specific gravity of urine should be: A. 1.000 B. Less than 1.010 C. Greater than 1.025 D. 1.010 to 1.025

D. 1.010 to 1.025 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 dehydration.

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? A. 20 B. 30 C. 40 D. 50

D. 50 Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal.

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. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? A. Administration of an insulin drip B. Administration of a loop diuretic C. Administration of sodium bicarbonate D. Administration of sodium polystyrene sulfonate [Kayexalate])

D. Administration of sodium polystyrene sulfonate [Kayexalate]) The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.

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? A. Kidney B. Nephron C. Tubule system D. Bladder

D. Bladder 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 requires hemodialysis. Which type of drug should be withheld before this procedure? A. Phosphate binders B. Insulin C. Antibiotics D. Cardiac glycosides

D. Cardiac glycosides Cardiac glycosides such as digoxin (Lanoxin) should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digoxin toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.

The nurse caring for a client is providing instructions for an upcoming renal angiography. Which nursing action, explained in the preoperative instructions, is essential in the postprocedure period? A. Encourage voiding following the procedure. B. Assess renal blood work. C. Assess cognitive status. D. Complete a pulse assessment of the legs and feet.

D. Complete a pulse assessment of the legs and feet. A renal angiography provides details about the arterial blood supply to the kidney. A catheter is passed up the femoral artery into the aorta in the area of the renal artery. After the procedure, a pressure dressing remains in place for several hours. It is essential that the nurse palpates pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Reviewing lab work is completed in the preoperative period. Voiding assesses renal status that provides additional data in the post procedural period. Assessing cognitive status is completed due to the sedative that is administered in the preprocedural period.

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 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.

A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause? A. Acute pyelonephritis B. Osmotic dieresis. C. Dysrhythmias D. Renal calculi

D. Renal calculi Postrenal ARF is the result of an obstruction that develops anywhere from the collecting ducts of the kidney to the urethra. This results from ureteral blockage, such as from bilateral renal calculi or benign prostatic hypertrophy (BPH).

The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure? A. Cortisol B. Vasopressin C. Albumin D. Renin

D. Renin 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).

Which of the following would a nurse classify as a prerenal cause of acute renal failure? A. Polycystic disease B. Ureteral stricture C. Prostatic hypertrophy D. Septic shock

D. Septic shock Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias. Ureteral stricture and prostatic hypertrophy would be classified as postrenal causes. Polycystic disease is classified as an intrarenal cause of acute renal failure.

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? A. Encourage oral fluids. B. Administer furosemide (Lasix) 20 mg IV C. Start hemodialysis after a temporary access is obtained. D. Start IV fluids with a normal saline solution bolus followed by a maintenance dose.

D. Start IV fluids with a normal saline solution bolus followed by a maintenance dose. he client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.

A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? A. Hypotension B. Weight loss C. Polyuria D. Tenderness over transplant site

D. Tenderness over transplant site Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? A. Serum potassium level of 4.9 mEq/L B. Serum sodium level of 135 mEq/L C. Temperature of 99.2° F (37.3° C) D. Urine output of 20 ml/hour

D. Urine output of 20 ml/hour Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? A. Blood urea nitrogen (BUN) level of 22 mg/dl B. Serum creatinine level of 1.2 mg/dl C. Temperature of 100.2° F (37.8° C) D. Urine output of 250 ml/24 hours

D. Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

A client in acute renal failure receives an IV infusion of 10 percent dextrose in water with 20 units of regular insulin. The nurse understands that the rationale for this therapy is to:

Facilitate the intracellular movement of potassium. Dextrose with insulin helps move potassium into cells and is immediate management therapy for hyperkalemia due to acute renal failure. An exchange resin may also be employed. This type of infusion is often administered before cardiac surgery to stabilize irritable cells and prevent arrhythmias; in this case KCl is also added to the infusion.

The nurse is teaching the client who will undergo surgery for the creation of a nephrostomy. Which of the images best depicts this type of cutaneous urinary diversion?

Option D A cutaneous diversion involves the creation of an opening through the abdominal wall and skin to allow urine to drain. A nephrosostomy (Option D) allows urine to drain directly from the kidney through a percutaneous catheter through an opening in the flank. An ileal conduit (Option A) is the most common cutaneous diversion, whereby both ureters empty into an isolated section of the ileum. One end of the isolated segment is brought through the abdominal wall and allows urine to drain through a stoma. With a cutaneous ureterostomy (Option B), the ureter is detached from the bladder and brought through the abdominal wall and attached to an opening in the skin. The bladder is sutured to the abdominal wall and a stoma is created through the abdominal and bladder walls for drainage of urine in a vesicostomy (Option C)