Chapter 26 - Renal & Urinary Tract Function

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? Creatinine clearance level Uric acid level Blood urea nitrogen (BUN) BUN to creatinine ratio

Creatinine clearance level

The nurse is completing a full exam of the client's renal system. Which assessment finding best documents the need to offer the use of the bathroom? Tenderness over the kidneys Bruits noted over the abdominal area A dull sound when percussing over the bladder The ingestion of 8 oz of water

A dull sound when percussing over the bladder

Which value does the nurse recognize as the best clinical measure of renal function? Creatinine clearance Circulating ADH concentration Volume of urine output Urine-specific gravity

Creatinine clearance

Which is an effect of aging on upper and lower urinary tract function? Increased glomerular filtration rate Susceptibility to develop hypernatremia Increased blood flow to the kidney Acid-base balance

Susceptibility to develop hypernatremia

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

Decreased fluid intake

The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition? Adventitia (connective tissue) Detrusor muscle Submucosal layer of connective tissue Inner layer of epithelium

Detrusor muscle

The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document? Urinary frequency Urinary urgency Urinary incontinence Urinary stasis

Urinary urgency

In a diagnosis of a lower urinary tract infection, which structures could be affected? Select all that apply. bladder urethra ureter kidney

bladder urethra

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 fasting serum potassium level and a random urine sample A 24-hour urine specimen collection and a serum creatinine level midway through the urine collection process A blood, urea, nitrogen (BUN) level and a serum creatinine level on three consecutive mornings A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values

A 24-hour urine specimen collection and a serum creatinine level midway through the urine collection process

The nurse is caring for a client scheduled for urodynamic testing. Following the procedure, which information does the nurse provide to the client? "Contact the primary provider if you experience fever, chills, or lower back pain." "You will be sent home with a urinary catheter." "You may resume consuming caffeinated, carbonated, and alcoholic beverages." "You can stop taking the prescribed antibiotic."

"Contact the primary provider if you experience fever, chills, or lower back pain."

A client is prescribed flavoxate (Urispas) following cystoscopy. Which of the following instructions would the nurse give the client? "This medication will relieve your pain." "This medication prevents urinary incontinence." "This medication will treat the blood in your urine." "This medication prevents infection in your urinary tract"

"This medication will relieve your pain."

The nurse is conducting health education regarding kidney health with a female patient who has recently been diagnosed with type 2 diabetes. What should the nurse teach this individual about the normal functioning of her kidneys? "If you lose even 10% of your kidneys' normal function, it can radically affect your overall health." "Your kidneys are adept at compensating for diminished function, but it's still important to safeguard their health." "It's vital that you have two functioning kidneys in order to maintain a regular lifestyle." "You need to protect your kidneys because you won't know that they're unhealthy until they've nearly shut down."

"Your kidneys are adept at compensating for diminished function, but it's still important to safeguard their health."

A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in: 1 minute. 30 minutes. 1 hour. 24 hours.

1 minute.

Which value represents a normal BUN-to-creatinine ratio? 4:1 6:1 8:1 10:1

10:1

A nurse is assisting the physician conducting a cystogram. The client has an intravenous (IV) infusion of D5W at 40 ml/hr. The physician inserts a urinary catheter into the bladder and instills a total of 350 ml of a contrast agent. The nurse empties 500 ml from the urinary catheter drainage bag at the conclusion of the procedure. How many milliliters does the nurse record as urine?

150 The urinary drainage bag contains both the contrast agent and urine at the conclusion of the procedure. Total contents (500 ml) in the drainage bag consist of 350 ml of contrast agent and 150 ml of urine.

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? 10% 20% 30% 40%

20%

The nurse received report on a hospitalized patient who was being evaluated for renal disease. The nurse was told that the patient had oliguria. Select the output record that would be consistent with that diagnosis. 600 mL/24 hr 350 mL/24 hr 800 mL/24 hr 2,000 mL/24 hr

350 mL/24 hr

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

50

The nurse is preparing to conduct intermittent catheterization of an older adult who has been retaining urine due to benign prostatic hyperplasia (BPH). The nurse would understand that the patient's bladder was filled beyond its normal capacity if catheterization yielded how many mL of urine? Select all that apply. 250 mL 450 mL 650 mL 850 mL 1050ml

650 mL 850 mL 1050ml Normal bladder capacity is around 30 to 500 mL of urine.

A routine serum glucose analysis indicated the presence of renal glycosuria. The nurse knew that the serum glucose level was: 60 to 80 mg/dL. 80 to 100 mg/dL. 120 to 150 mg/dL. >180 mg/dL.

>180 mg/dL.

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 (UTI) Enuresis Polyuria Proteinuria

A urinary tract infection (UTI)

A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? After discarding the 8:00 am specimen At 8:00 am, with or without a specimen 6 hours after the urine is discarded With the first specimen voided after 8:00 am

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.

The nurse is caring for a patient who has been NPO for 2 days pending a diagnostic procedure that has been repeated cancelled. When evaluating this patient's urinalysis, what would the nurse anticipate? A fluctuating urine specific gravity A fixed urine specific gravity A decreased urine specific gravity An increased urine specific gravity

An increased urine specific gravity

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

Angiography

A patient had a renal angiography and is being brought back to the hospital room. What nursing interventions should the nurse carry out after the procedure to detect complications? Select all that apply. Assess peripheral pulses. Compare color and temperature between the involved and uninvolved extremities. Examine the puncture site for swelling and hematoma formation. Apply warm compresses to the insertion site to decrease swelling. Increase the amount of IV fluids to prevent clot formation.

Assess peripheral pulses. Compare color and temperature between the involved and uninvolved extremities. Examine the puncture site for swelling and hematoma formation.

Following a renal biopsy, a client reports severe pain in the back, the arms, and the shoulders. Which intervention should be offered by the nurse? Assess the patient's back and shoulder areas for signs of internal bleeding. Distract the client's attention from the pain. Provide analgesics to the client. Enable the client to sit up and ambulate.

Assess the patient's back and shoulder areas for signs of internal bleeding.

The nurse is providing care to a client who has had a renal biopsy. The nurse would need to be alert for signs and symptoms of which of the following? Bleeding Infection Dehydration Allergic reaction

Bleeding

The nurse is caring for a client after a cystoscopic examination. Following the procedure, the nurse informs the client that which effect may occur? Blood-tinged urine Nausea and emesis Diarrhea Severe abdominal pain

Blood-tinged urine

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? Kidney stone formation Proteinuria Chronic kidney disease Neurogenic bladder

Chronic kidney disease

Which nursing assessment finding indicates the client with renal dysfunction has not met expected outcomes? Client reports increasing fatigue. Client rates pain at a 3 on a scale of 0 to 10. Client denies frequency and urgency. Urine output is 100 ml/hr.

Client reports increasing fatigue. Fatigue, shortness of breath, and exercise intolerance are consistent with unexplained anemia, which can be secondary to gradual renal dysfunction.

A creatinine clearance test has been ordered. The nurse prepares to: Collect the client's urine for 24 hours. Obtain a clean catch urine. Obtain a blood specimen. Insert a straight catheter for a specimen.

Collect the client's urine for 24 hours.

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

Control of water balance

The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? Costovertebral angle tenderness Suprapubic pain Pain after voiding Perineal pain

Costovertebral angle tenderness

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? Blood urea nitrogen Creatinine Osmolality Hemoglobin

Creatinine

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

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 68-year-old woman has experienced multiple urinary tract infections over the past several months, and her care provider suspects a structural problem with her bladder or urethra. To directly visualize these structures, what diagnostic test may be ordered? Cystoscopy Ureteral brush biopsy Urinalysis Renal biopsy

Cystoscopy

A client has undergone diagnostic testing that involved the insertion of a lighted tube with a telescopic lens. The nurse identifies this test as which of the following? Renal angiography Intravenous pyelography Excretory urogram Cystoscopy

Cystoscopy

In which of the following renal disorders would one suspect a decreased urine specific gravity? Select all that apply Diabetes insipidus Glomerulonephritis Severe renal damage Diabetes Fluid deficits

Diabetes insipidus Glomerulonephritis Severe renal damage Disorders or conditions that cause decreased urine specific gravity (i.e., dilute urine) include diabetes insipidus, glomerulonephritis, and severe renal damage that may cause a fixed specific gravity of 1.010. Etiologies associated with increased urine specific gravity include diabetes mellitus, patients who have recently received high density radiopaque dyes, and fluid deficit.

A client has a full bladder. Which sound would the nurse expect to hear on percussion? Tympany Dullness Resonance Flatness

Dullness

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. Sodium Bicarbonate Creatinine Glucose

Glucose

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? Potassium and sodium Bicarbonate and urea Glucose and protein Creatinine and chloride

Glucose and protein

Regulation of electrolyte balance is a management goal for patients suffering from renal disease. Which of the following lab results is considered the most life-threatening effect of renal failure? Hyperkalemia Hypocalcemia Hypernatremia Hyperphosphatemia

Hyperkalemia

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 In-and-out urinary catheterization The injection of a radioisotope

Increased fluid intake to produce a full bladder

The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following? Kidney stones Neurogenic bladder Chronic renal failure Fistula

Kidney stones

A nurse who works in a clinic is aware of the importance of thorough and thoughtful urologic assessments, despite the fact that these assessments have the potential to make patients uncomfortable. When interviewing patients about their urologic health, the nurse should: Use lighthearted or slang terminology to help put the patient at ease. Emphasize the dangers of neglecting urologic health. Maintain a composed but empathic demeanor. Forego a urologic assessment if the patient is visibly uncomfortable.

Maintain a composed but empathic demeanor.

A client is undergoing a renal angiogram after a traumatic accident. What post-procedural assessments would the nurse perform on the client? Select all that apply. Monitor hypersensitivity response. Palpates the pulses in the legs and feet. Monitor site condition. Apply a warm compress to site. Administer an enema.

Monitor hypersensitivity response. Palpates the pulses in the legs and feet. Monitor site condition.

During a routine assessment, the client states; "I wake up all night long to go the bathroom." The nurse documents this finding as which condition? Polyuria Oliguria Nocturia Dysuria

Nocturia

A creatinine level has been ordered. The nurse prepares to: Obtain a blood specimen. Collect the client's urine for 24 hours. Obtain a clean catch urine. Straight cath for a specimen.

Obtain a blood specimen.

The nurse has paged a hospital patient's primary care provider because the patient's urine output over the past 12 hours is approximately 140 mL. The nurse would recognize that this patient is experiencing what health problem? Enuresis Polyuria Dysuria Oliguria

Oliguria

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? Provide intravenous hydomorphone. Repeat the portable bladder ultrasound. Place a urinary cathether. Provide ondansetron intravenously.

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-residual 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? Calcium Sodium Potassium Phosphorous

Potassium

A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram? Increased alertness Hypoventilation Pruritus Unusually smooth skin

Pruritus

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. Renal medulla Renal cortex Renal pelvis Renal papilla

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.

A nurse is describing the renal system to a client with a kidney disorder. Which structure would the nurse identify as emptying into the ureters? Nephron Renal pelvis Parenchyma Glomerulus

Renal pelvis

Which of the following hormones is secreted by the juxtaglomerular apparatus? Renin Aldosterone Antidiuretic hormone (ADH) Calcitonin

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: Specific gravity 1.035 Creatinine 0.7 mg/dL Protein 15 mg/dL Bright yellow urine

Specific gravity 1.035

The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness? The upper abdominal quadrants on the left and right side The costovertebral angle Above the symphysis pubis Around the umbilicus

The costovertebral angle

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

The specific gravity will be high.

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? Bladder Urethra Ureters Pelvic floor muscles

Ureters

The most frequent reason for admission to skilled care facilities includes which of the following? Urinary incontinence Congestive heart failure Stroke Myocardial infarction

Urinary incontinence

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

Urine: RBC 20 BUN 28 mg/dL 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.

The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse understand that oliguria is said to be present? When the urine output is less than 30 mL/h When the urine output is about 100 mL/h When the urine output is between 300 and 500 mL/h When the urine output is between 500 and 1,000 mL/h

When the urine output is less than 30 mL/h

A client reports "bloody" urine to the nurse. What causes would the nurse relate the hematuria? Select all that apply. acute glomerulonephritis hypertension renal stones extreme exercise lithium toxicity

acute glomerulonephritis renal stones

An older adult's most recent laboratory findings indicate a decrease in creatinine clearance. When performing an assessment related to potential causes, the nurse should: confirm all of the medications and supplements normally taken. assess the client's usual intake of sodium. confirm which beverages the client normally consumes. palpate the client's bladder before and after voiding.

confirm all of the medications and supplements normally taken.

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? excreting protein excreting nitrogen waste products regulating blood pressure stimulating RBC production

excreting protein

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.

increased in renal disease and urinary obstruction.

The nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration? phenazopyridine hydrochloride infection phenytoin metronidazole

phenazopyridine hydrochloride

A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is: renal calculi. an overdistended bladder. interstitial cystitis. acute prostatitis.

renal calculi. Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void. The client with acute prostatitis presents with a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria.

In a diagnosis of an upper urinary tract infection, which structures could be affected? Select all that apply. ureter kidney bladder urethra

ureter kidney

A client presents to the ED reporting left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The client has also experienced nausea and emesis. The nurse suspects the client is experiencing: ureteral stones. pyelonephritis. cystitis. Urethral infection.

ureteral stones.