Brunner and Suddarth's Textbook of Medical Surgical Nursing; Chapter 53: Assessment of Kidney and Urinary Function
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 nurse's best response? "A biopsy is routinely ordered for all patients with renal disorders." "A biopsy is generally ordered following abnormal xray findings of the renal pelvis." "A biopsy is often ordered for patients before they have a kidney transplant." "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."
"A biopsy is routinely ordered for all patients with renal disorders." "A biopsy is generally ordered following abnormal xray findings of the renal pelvis." "A biopsy is often ordered for patients before they have a kidney transplant." "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."**** 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.
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? "If possible, try to drink at least 4 liters of fluid daily." "Ensure that you avoid replacing water with other beverages." "Remember to drink frequently, even if you don't feel thirsty." "Make sure you eat plenty of salt in order to stimulate thirst."
"If possible, try to drink at least 4 liters of fluid daily." "Ensure that you avoid replacing water with other beverages." "Remember to drink frequently, even if you don't feel thirsty."***** "Make sure you eat plenty of salt in order to stimulate thirst." 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.
The nurse caring for a patient with suspected renal dysfunction calculates that the patient's weight has increased by 5 pounds in the past 24 hours. The nurse estimates that the patient has retained approximately how much fluid? 1,300 mL of fluid in 24 hours 2,300 mL of fluid in 24 hours 3,100 mL of fluid in 24 hours 5,000 mL of fluid in 24 hours
1,300 mL of fluid in 24 hours 2,300 mL of fluid in 24 hours******** 3,100 mL of fluid in 24 hours 5,000 mL of fluid in 24 hours 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.
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? When the patient's creatinine level drops below 1.2 mg/dL (110 mmol/L) When the patient's blood urea nitrogen (BUN) is above 15 mg/dL When approximately 40% of nephrons are not functioning When about 80% of the nephrons are no longer functioning
When the patient's creatinine level drops below 1.2 mg/dL (110 mmol/L) When the patient's blood urea nitrogen (BUN) is above 15 mg/dL When approximately 40% of nephrons are not functioning When about 80% of the nephrons are no longer functioning*** 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.
What nursing action should the nurse perform when caring for a patient undergoing diagnostic testing of the renalurologic system? Withhold medications until 12 hours posttesting. Ensure that the patient knows the importance of temporary fluid restriction after testing. Inform the patient of his or her medical diagnosis after reviewing the results. Assess the patient's understanding of the test results after their completion.
Withhold medications until 12 hours posttesting. Ensure that the patient knows the importance of temporary fluid restriction after testing. Inform the patient of his or her medical diagnosis after reviewing the results. Assess the patient's understanding of the test results after their completion.*** 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 provider's responsibility. Withholding fluids or medications is not normally required after testing.
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 64yearold patient with chronic glomerulonephritis A 57yearold patient with proteinuria A 42yearold patient with morbid obesity A 16yearold patient with signs of kidney transplant rejection
A 64yearold patient with chronic glomerulonephritis A 57yearold patient with proteinuria A 42yearold patient with morbid obesity***** A 16yearold patient with signs of kidney transplant rejection 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.
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 fasting serum potassium level and a random urine sample A 24hour urine specimen and a serum creatinine level midway through the urine collection process A BUN and serum creatinine level on three consecutive mornings A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values
A fasting serum potassium level and a random urine sample A 24hour urine specimen and a serum creatinine level midway through the urine collection process***** A BUN and serum creatinine level on three consecutive mornings A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values Feedback: To calculate creatinine clearance, a 24hour urine specimen is collected. Midway through the collection, the serum creatinine level is measured.
The nurse is caring for a patient who has a fluid volume deficit. When evaluating this patient's urinalysis results, what should the nurse anticipate? A fluctuating urine specific gravity A fixed urine specific gravity A decreased urine specific gravity An increased urine specific gravity
A fluctuating urine specific gravity A fixed urine specific gravity A decreased urine specific gravity An increased urine specific gravity**** 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 patient's urine is said to have a fixed specific gravity.
A patient with renal failure secondary to diabetic nephropathy has been admitted to the medical unit. What is the most lifethreatening effect of renal failure for which the nurse should monitor the patient? Accumulation of wastes Retention of potassium Depletion of calcium Lack of BP control
Accumulation of wastes Retention of potassium*** Depletion of calcium Lack of BP control Feedback: Retention of potassium is the most lifethreatening effect of renal failure. Aldosterone causes the kidney to excrete potassium, in contrast to aldosterone's effects on sodium described previously. Acid-base balance, the amount of dietary potassium intake, and the flow rate of the filtrate in the distal tubule also influence the amount of potassium secreted into the urine. Hypocalcemia, the accumulation of wastes, and lack of BP control are complications associated with renal failure, but do not have same level of threat to the patient's wellbeing as hyperkalemia.
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 nurse's most appropriate action? Administer a STAT dose of vitamin K, as ordered. Reassure the patient that this is not unexpected and then monitor the patient for further bleeding. Promptly inform the physician of this assessment finding. Position the patient supine and insert a Foley catheter, as ordered.
Administer a STAT dose of vitamin K, as ordered. Reassure the patient that this is not unexpected and then monitor the patient for further bleeding.***** Promptly inform the physician of this assessment finding. Position the patient supine and insert a Foley catheter, as ordered. Feedback: Some burning on voiding, bloodtinged 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.
A patient with a history of incontinence will undergo urodynamic testing in the physician's office. Because voiding in the presence of others can cause situational anxiety, the nurse should perform what action? Administer diuretics as ordered. Push fluids for several hours prior to the test. Discuss possible test results as the patient voids. Help the patient to relax before and during the test.
Administer diuretics as ordered. Push fluids for several hours prior to the test. Discuss possible test results as the patient voids. Help the patient to relax before and during the test.*** 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 patient's anxiety. It would be inappropriate and anxietyprovoking to discuss test results during the performance of the test.
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? Administration of IV potassium chloride Administration of a laxative Administration of Gastrografin Administration of a 24hour urine test
Administration of IV potassium chloride Administration of a laxative**** Administration of Gastrografin Administration of a 24hour urine test Feedback: Before the procedure, a laxative may be prescribed to evacuate the colon so that unobstructed xrays can be obtained. A 24hour urine test is not necessary prior to the procedure. Gastrografin and potassium chloride are not administered prior to renal angiography.
The nurse is caring for a patient with a nursing diagnosis of deficient fluid volume. The nurse's assessment reveals a BP of 98/52 mm Hg. The nurse should recognize that the patient's kidneys will compensate by secreting what substance? Antidiuretic hormone (ADH) Aldosterone Renin Angiotensin
Antidiuretic hormone (ADH) Aldosterone Renin***** Angiotensin 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.
The nurse is performing a focused genitourinary and renal assessment of a patient. Where should the nurse assess for pain at the costovertebral angle? At the umbilicus and the right lower quadrant of the abdomen At the suprapubic region and the umbilicus At the lower border of the 12th rib and the spine At the 7th rib and the xyphoid process
At the umbilicus and the right lower quadrant of the abdomen At the suprapubic region and the umbilicus At the lower border of the 12th rib and the spine**** At the 7th rib and the xyphoid process 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.
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? Diabetes insipidus Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Diabetes mellitus Renal carcinoma
Diabetes insipidus Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Diabetes mellitus**** Renal carcinoma 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 kidney's reabsorption capacity. Glycosuria is not associated with SIADH, diabetes insipidus, or renal carcinoma.
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? Discuss the patient's diagnosis with the family. Bathe the patient before the procedure with antiseptic skin wash. Administer antivirals before sending the patient for the procedure. Keep the patient NPO prior to the procedure.
Discuss the patient's diagnosis with the family. Bathe the patient before the procedure with antiseptic skin wash. Administer antivirals before sending the patient for the procedure. Keep the patient NPO prior to the procedure.*** 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 preprocedure wash is not normally ordered and antivirals are not administered in anticipation of a biopsy.
A patient is complaining of genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform? Encourage mobilization. Apply topical lidocaine to the patient's meatus, as ordered. Apply moist heat to the patient's lower abdomen. Apply an ice pack to the patient's perineum.
Encourage mobilization. Apply topical lidocaine to the patient's meatus, as ordered. Apply moist heat to the patient's lower abdomen.*** Apply an ice pack to the patient's perineum. 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.
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? Hematocrit Hemoglobin Erythrocyte sedimentation rate (ESR) Serum creatinine
Hematocrit Hemoglobin**** Erythrocyte sedimentation rate (ESR) Serum creatinine 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.
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 doesn't seem to be a great deal of urine flow." What would the nurse expect this patient's physical assessment to reveal? Hematuria Urine retention Dehydration Renal failure
Hematuria Urine retention*** Dehydration Renal failure 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.
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? In the ureteropelvic junction In the ureteral segment near the sacroiliac junction In the ureterovesical junction In the urethra
In the ureteropelvic junction**** In the ureteral segment near the sacroiliac junction In the ureterovesical junction In the urethra 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.
A geriatric nurse is performing an assessment of body systems on an 85yearold patient. The nurse should be aware of what agerelated change affecting the renal or urinary system? Increased ability to concentrate urine Increased bladder capacity Urinary incontinence Decreased glomerular filtration rate
Increased ability to concentrate urine Increased bladder capacity Urinary incontinence Decreased glomerular filtration rate***** Feedback: Many agerelated 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 agerelated change, but is common in older adults, especially in women because of the loss of pelvic muscle tone.
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? Increased fluid intake following the test Use of an OTC diuretic after the test Gentle massage of the lower abdomen Activity limitation for the first 12 hours after the test
Increased fluid intake following the test**** Use of an OTC diuretic after the test Gentle massage of the lower abdomen Activity limitation for the first 12 hours after the test 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.
The nurse is providing preprocedure 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? Increased fluid intake to produce a full bladder IV administration of radiopaque contrast agent Sedation and intubation Injection of a radioisotope
Increased fluid intake to produce a full bladder**** IV administration of radiopaque contrast agent Sedation and intubation Injection of a radioisotope 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.
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? Meatus Bladder Ureter Urethra
Meatus Bladder Ureter**** Urethra 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.
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. Petechiae Pain Gastrointestinal symptoms Changes in voiding Jaundice
Petechiae Pain*** Gastrointestinal symptoms*** Changes in voiding**** Jaundice 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 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? Potassium and sodium Bicarbonate and urea Glucose and protein Creatinine and chloride
Potassium and sodium Bicarbonate and urea Glucose and protein**** Creatinine and chloride 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.
The nurse is reviewing the electronic health record of a patient with a history of incontinence. The nurse reads that the physician assessed the patient's deep tendon reflexes. What condition of the urinary/renal system does this assessment address? Renal calculi Bladder dysfunction Benign prostatic hyperplasia (BPH) Recurrent urinary tract infections (UTIs)
Renal calculi Bladder dysfunction*** Benign prostatic hyperplasia (BPH) Recurrent urinary tract infections (UTIs) 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.
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? Scant hematuria Renal colic Temperature 100.2°F orally Infiltration of the patient's intravenous catheter
Scant hematuria Renal colic Temperature 100.2°F orally*** Infiltration of the patient's intravenous catheter 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 patient's body temperature, which likely indicates the onset of an infectious process. IV infiltration does not warrant notification of the primary care physician.
A patient with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid-base balance? Sequestering free hydrogen ions in the nephrons Returning bicarbonate to the body's circulation Returning acid to the body's circulation Excreting bicarbonate in the urine
Sequestering free hydrogen ions in the nephrons Returning bicarbonate to the body's circulation**** Returning acid to the body's circulation Excreting bicarbonate in the urine Feedback: The kidney performs two major functions to assist in acid-base balance. The first is to reabsorb and return to the body's 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.
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. Specific gravity of the patient's urine Testing for the presence of glucose in the patient's urine Microscopic examination of urine sediment for RBCs Microscopic examination of urine sediment for casts Testing for BUN and creatinine in the patient's urine
Specific gravity of the patient's urine**** Testing for the presence of glucose in the patient's urine*** Microscopic examination of urine sediment for RBCs*** Microscopic examination of urine sediment for casts**** Testing for BUN and creatinine in the patient's urine Feedback: Urine testing includes testing for specific gravity, glucose, RBCs, and casts. BUN and creatinine are components of serum, not urine.
A patient has experienced excessive losses of bicarbonate and has subsequently developed an acid-base imbalance. How will this lost bicarbonate be replaced? The kidneys will excrete increased quantities of acid. Bicarbonate will be released from the adrenal medulla. Alveoli in the lungs will synthesize new bicarbonate. Renal tubular cells will generate new bicarbonate.
The kidneys will excrete increased quantities of acid. Bicarbonate will be released from the adrenal medulla. Alveoli in the lungs will synthesize new bicarbonate. Renal tubular cells will generate new bicarbonate.**** 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.
A patient is scheduled for a diagnostic MRI of the lower urinary system. What preprocedure education should the nurse include? The need to be NPO for 12 hours prior to the test Relaxation techniques to apply during the test The need for conscious sedation prior to the test The need to limit fluid intake to 1 liter in the 24 hours before the test
The need to be NPO for 12 hours prior to the test Relaxation techniques to apply during the test**** The need for conscious sedation prior to the test The need to limit fluid intake to 1 liter in the 24 hours before the test 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 fluidrestricted before the test and conscious sedation is not usually implemented.
A patient's most recent laboratory findings indicate a glomerular filtration rate (GFR) of 58 mL/min. The nurse should recognize what implication of this diagnostic finding? The patient is likely to have a decreased level of blood urea nitrogen (BUN). The patient is at risk for hypokalemia. The patient is likely to have irregular voiding patterns. The patient is likely to have increased serum creatinine levels.
The patient is likely to have a decreased level of blood urea nitrogen (BUN). The patient is at risk for hypokalemia. The patient is likely to have irregular voiding patterns. The patient is likely to have increased serum creatinine levels.***** 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.
The nurse is assessing a patient's bladder by percussion. The nurse elicits dullness after the patient has voided. How should the nurse interpret this assessment finding? The patient's bladder is not completely empty. The patient has kidney enlargement. The patient has a ureteral obstruction. The patient has a fluid volume deficit.
The patient's bladder is not completely empty.***** The patient has kidney enlargement. The patient has a ureteral obstruction. The patient has a fluid volume deficit. 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.
Results of a patient's 24hour urine sample indicate osmolality of 510 mOsm/kg, which is within reference range. What conclusion can the nurse draw from this assessment finding? The patient's kidneys are capable of maintaining acid-base balance. The patient's kidneys reabsorb most of the potassium that the patient ingests. The patient's kidneys can produce sufficiently concentrated urine. The patient's kidneys are producing sufficient erythropoietin.
The patient's kidneys are capable of maintaining acid-base balance. The patient's kidneys reabsorb most of the potassium that the patient ingests. The patient's kidneys can produce sufficiently concentrated urine.**** The patient's kidneys are producing sufficient erythropoietin. Feedback: Osmolality is the most accurate measurement of the kidney's ability to dilute and concentrate urine. Osmolality is not a direct indicator of renal function as it relates to erythropoietin synthesis or maintenance of acid-base balance. It does not indicate the maintenance of healthy levels of potassium, the vast majority of which is excreted.
A patient asks the nurse why kidney problems can cause gastrointestinal disturbances. What relationship should the nurse describe? The right kidney's proximity to the pancreas, liver, and gallbladder The indirect impact of digestive enzymes on renal function That the peritoneum encapsulates the GI system and the kidneys The left kidney's connection to the common bile duct
The right kidney's proximity to the pancreas, liver, and gallbladder***** The indirect impact of digestive enzymes on renal function That the peritoneum encapsulates the GI system and the kidneys The left kidney's connection to the common bile duct 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.
Dipstick testing of an older adult patient's urine indicates the presence of protein. Which of the following statements is true of this assessment finding? select all that apply. This finding needs to be considered in light of other forms of testing. This finding is a risk factor for urinary incontinence. This finding is likely the result of an agerelated physiologic change. This result confirms that the patient has diabetes. Select all that apply.
This finding needs to be considered in light of other forms of testing. This finding is a risk factor for urinary incontinence.*** This finding is likely the result of an agerelated 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 agerelated change nor a risk factor for incontinence.
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? Ultrasound Xray Computed tomography (CT) Nuclear scan
Ultrasound**** Xray Computed tomography (CT) Nuclear scan 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.
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? Urinary retention Bladder perforation Hemorrhage Nausea
Urinary retention*** Bladder perforation Hemorrhage Nausea 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. Postprocedure, 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 nurse is caring for a 73yearold patient with a urethral obstruction related to prostatic enlargement. When planning this patient's care, the nurse should be aware of the consequent risk of what complication? Urinary tract infection Enuresis Polyuria Proteinuria
Urinary tract infection*** Enuresis Polyuria Proteinuria 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.
