Assessment of Kidney and Urinary Function 53 PrepU

Urine output <50 mL/day

anuria

Urine output <0.5 mL/kg/hr

oliguria

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

Correct response: 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 dehydration.

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. Distract the patient's attention from the pain. Provide analgesics to the patient. Enable the patient to sit up and ambulate.

Correct response: Assess 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.

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 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.

When describing the functions of the kidney to a client, which of the following would the nurse include? Regulation of white blood cell production Synthesis of vitamin K Control of water balance Secretion of enzymes

Correct response: Control of water balance Explanation: 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.

Biopsy extra info

The patient may be prescribed a fasting regimen 6 to 8 hours before the test. An IV line is established. A urine specimen is obtained and saved for comparison with the post biopsy specimen. If a needle biopsy is to be performed, the patient is instructed to breathe in and hold that breath (to prevent the kidney from moving) while the needle is being inserted. The sedated patient is placed in a prone position with a sandbag under the abdomen. The skin at the biopsy site is infiltrated with a local anesthetic agent. The biopsy needle is introduced just inside the renal capsule of the outer quadrant of the kidney. The location of the needle may be confirmed by fluoroscopy or by ultrasound, in which case a special probe is used.

Specific gravity is an expression of the degree of concentration of the urine that measures the density of a solution compared to the density of water, which is 1.000. Specific gravity is altered by the presence of blood, protein, and casts in the urine. The normal range of urine-specific gravity is 1.010 to 1.025 Urine-specific gravity depends largely on hydration status. When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases.

specific gravity

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

Correct response: increased in renal disease and urinary obstruction. Explanation: BUN is increased in renal disease and urinary obstruction.

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 Creatinine clearance level Serum potassium level Uric acid level

Correct response: Creatinine clearance level Explanation: 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.

The nurse is instructing a 3-year-old's mother regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as a normal finding for this age group? Dysuria Enuresis Hematuria Anuria

Correct response: Enuresis Explanation: The nurse would be most correct to document that enuresis, the involuntary voiding during sleep or commonly called "wetting the bed," is a normal finding in a pediatric client younger than 5 years old. Dysuria (pain on urination), hematuria (red blood cells in urine), and anuria (urine output less than 50 mL/day) are all abnormal findings needing further investigation

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? Decreased blood urea nitrogen (BUN) Increased serum albumin Increased serum creatinine Decreased potassium

Correct response: Increased serum creatinine Explanation: 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.

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 low urine output with a high specific gravity. On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low 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. When the kidneys are diseased, the ability to concentrate urine may be impaired, and the specific gravity may vary widely.

Correct response: On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. Explanation: Specific gravity is altered by the presence of blood, protein, and casts in the urine and is normally influenced primarily by hydration status. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has copious urine output with a low specific gravity. When the kidneys are diseased, the ability to concentrate urine may be impaired, and the specific gravity remains relatively constant.

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

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

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

The nurse is reviewing the client's lab results. Which lab result requires follow up by the nurse? Select all that apply. Urine: RBC 20 BUN 28 mg/dL Urine: WBC 1 Serum creatinine 0.8 mg/dL Urine specific gravity 1.020

Correct response: Urine: RBC 20 BUN 28 mg/dL Explanation: Hematuria (> 3RBCs) and an elevated BUN are both suggestive of a problem within the genitourinary tract. A serum creatinine of 0.8 mg/dL and a urine specific gravity of 1.020 are within normal limits. A rare white blood cell is not clinically significant.

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: oliguria. polyuria. anuria. hematuria.

Correct response: anuria. Explanation: 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.