CH 43: assessment of Renal and Urinary Tract Functions
A nurse is caring for a 73-year-old male patient with a urethral obstruction related to prostatic enlargement. The nurse is aware this may result in what?
"A urinary tract infection "
Voiding is activated by interaction between the sympathetic and parasympathetic nervous systems causing a coordinated sequence of events. This interaction between the sympathetic and parasympathetic nervous systems is called what?
"Micturition reflex arc "
The nurse is caring for a patient who had a brush biopsy 12 hours ago. What will the nurse notify the physician of?
"Renal colic "
The pathophysilolgy instructor is talking to the pre-nursing students about hypovolemia and the kidneys. The instructor points out that when the blood pressure is low due to dehydration the body will compensate by secreting what?
"Renin "
A diabetic patient with renal failure has been admitted to your unit. What is the most life-threatening effect of renal failure you will monitor for?
"Retention of potassium "
What function does the kidney perform to assist in maintaining acid–base balance within the necessary normal range?
"Return bicarbonate to the body's circulation "
A patient you are caring for is having a diagnostic MRI of the lower urinary system. How would you prepare the patient for this test?
"Teaching relaxation to the patient "
A patient admitted to your unit with impaired renal function is complaining of severe, sharp, stabbing pain that is colicky in nature in the flank and lower abdomen. The patient is being assessed for renal calculi. The nurse recognizes that the stone is most likely located where in the patient?
"Ureter "
A nurse is preparing a patient diagnosed with benign prostatic hypertrophy 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 "
A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has been ordered. The nurse is aware that the specimens needed for the calculation of the patient's creatinine clearance will include what?
A 24-hour urine specimen collection and a serum creatinine level midway through the urine collection process
The nurse caring for a patient with suspected renal dysfunction is assessing ankle and sacral edema and the presence of crackles in the bases of the lungs bilaterally. A daily weight indicates that the patient's weight has increased by 5 pounds in the past 24 hours. The nurse notes that evaluation of the patient's intake and output records for the prior 24 hours indicate greater fluid intake than urine output. Based upon the assessment findings and the daily weight information, the nurse estimates that the patient has retained how much fluid?
2273 mL of fluid in 24 hours
"You are caring for a patient with renal dysfunction. The patient tells you that the pain in their right flank has gotten worse. Why would you notify the physician of the increased pain
" Pain may indicate progression or recurrence of dysfunction, or untoward signs.
A patient is admitted for renal dysfunction. The nurse knows that the kidneys receive 20% to 25% of the total cardiac output. This means that all of the body's blood circulates through the kidneys how many times an hour?
"12 "
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 42-year-old patient with morbid obesity "
The pituitary gland, in response to increasing serum osmolality, stimulates what to secrete aldosterone?
"Adrenal cortex "
The nursing instructor is teaching the students assessment skills in the lab. Where would the instructor teach the students to assess for pain at the costovertebral angle?
"At the lower border of the 12th rib and the spine "
When fluids are filtered by the glomerular membrane of Bowman's capsule where does the filtrate go?
"Fills the space in Bowman's capsule "
The nurse is caring for a patient scheduled for an infusion drip pyelography. What patient preparation is necessary for this test?
"Fluids are not restricted "
The nursing instructor is talking about monitoring laboratory tests in renal and urinary tract dysfunction. What is monitored to assess for anemia?
"Hemoglobin "
The nurse is providing pre-procedure teaching about an ultrasound. The nurse informs the patient that in preparation for an ultrasound of the lower urinary tract the patient will require what?
"Increased fluid intake to produce a full bladder "
The nurse is caring for a patient who describes his changes in 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 does not seem to be a great deal of urine flow." What would the nurse expect this patient's physical assessment will likely reveal?
"Urine retention "
The nurse is assessing the deep tendon reflexes on a patient with incontinence. What condition of the urinary/renal system does the nurse expect to illicit specific information on?
"bladder dysfunction"
A student asks the pathophysiology instructor what the function of rennin is in the body. What is the instructor's best response to the student's question?
"“Renin is directly involved in the control of arterial blood pressure and it is essential for proper functioning of the glomerulus.” "
A patient asks her nurse why kidney problems can cause gastrointestinal disturbances. What would be the nurse's best answer?
"“The right kidney's proximity to the pancreas, liver and gallbladder” "
What is the largest number of pyramids that a healthy kidney has?
18
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 sometimes necessary for diagnosing and evaluating the extent of kidney disease.”
The nurse is caring for a patient who is not allowed oral intake of fluid or food. When evaluating this patient's urinalysis, what would the nurse anticipate?
An increased urine specific gravity
What nursing diagnosis would be a priority when caring for a patient undergoing diagnostic testing of the renal-urologic system?
Assess patient's understanding of test results after their completion.
A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse realizes that what particular change is an age-related change affecting the renal or urinary system?
Decreased glomerular filtration rate
Urodynamic testing is carried out in the urologist's office to study incontinence. Because voiding in the presence of others can cause a situational anxiety, the nurse must do what?
Help the patient relax.
There are three areas of the ureters that have a propensity for obstruction. Prompt management of renal calculi is most important when the stone is located where?
In the ureteropelvic junction
The nurse is assessing a patient's bladder by percussion. The nurse elicits dullness after voiding. What does this finding indicate?
Incomplete bladder emptying
You are 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?
Keep the patient NPO.
In a patient who loses bicarbonate from the body, how does it get replaced?
Renal tubular cells generate new bicarbonate.
A patient with elevated BUN and creatinine values has been sent to the emergency department by her primary physician for further evaluation. Based upon the physician's orders, the nurse caring for this patient in the emergency department prepares the patient for what commonly used diagnostic test?
Ultrasound
A patient with renal insufficiency has been hospitalized on your unit. The patient knows that renal function depends upon the functional status of nephrons. The patient asks you when she will need to start dialysis based upon loss of nephron function. What would you respond?
When about 80% of the nephrons are no longer functioning."
The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient the nurse recalls that several substances are filtered from the blood by the glomerulus and these substances are then excreted in the urine. The nurse identifies the presence of which substances in the urine as abnormal findings?
protein and glucose