chapter 26 renal prepu
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. 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.
A 79-year-old female resident of a long-term care facility has reported urinary frequency to the nurse. As a result, the nurse has conducted a bladder ultrasound immediately following the woman's most recent void. When assessing the resident's urinary post-void residual, the nurse should understand that: > A post-void residual of ≤ 250 mL is considered normal. > The bladder should not contain any urine after voiding. > The volume of residual urine is dependent on the volume of the preceding void. > There will likely be 50 to 100 mL of residual urine in the woman's bladder.
There will likely be 50 to 100 mL of residual urine in the woman's bladder. Normally, residual urine amounts to no more than 50 mL in the middle-aged adult and less than 50 to 100 mL in the older adult. Residual urine volumes of greater than 100 mL are significantly associated with a risk of infection
The client presents with nausea and vomiting, absent bowel sounds, and colicky flank pain. The nurse interprets these findings as consistent with: > Ureteral colic > Acute prostatitis > Urethritis > Interstitial cystitis
Ureteral colic These clinical manifestations are consistent with ureteral colic.
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 Oliguria is defined as urine output <0.5 mL/kg/h
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 X-ray 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 sometimes necessary for diagnosing and evaluating the extent of kidney disease." 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 female client presents to the health clinic for a routine physical examination. The nurse observes that the client's urine is bright yellow. Which question is most appropriate for the nurse to ask the client? > "Have you noticed any vaginal bleeding?" > "Do you take phenytoin daily?" > "Do you take multiple vitamin preparations?" > "Have you had a recent urinary tract infection?"
"Do you take multiple vitamin preparations?" Urine that is bright yellow is an anticipated abnormal finding in the client taking a multivitamin preparation. Urine that is orange may be caused by intake of phenytoin 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. Yellow to milky white urine may indicate infection, pyuria, or, in the female client, the use of vaginal creams.
The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions? > "I can resume my usual activities without restriction." > "I should increase my fluid intake for the rest of the day." > "If I have difficulty urinating, I should contact my physician." > "It is normal for my urine to be blood-tinged."
"I can resume my usual activities without restriction." A bladder ultrasound is a non-invasive procedure. The client can resume usual activities without restriction.
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." Flavoxate (Urispas) is a antispasmodic agent used for the treatment of burning and pain of the urinary tract.
A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client? > "An x-ray will be done to view your kidneys, ureters, and bladder." > "A contrast medium will be used to help see the structures better." > "You don't need to do any fasting before this noninvasive test." > "You'll have a pressure dressing on your groin after the test."
"You don't need to do any fasting before this noninvasive test." Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. It is not invasive, does not require the injection of a radiopaque dye, and does not require fasting or bowel preparation. An x-ray of the abdomen to view the kidneys, ureters, and bladder is called a KUB. A contrast medium is used for computed tomography of the abdomen and pelvis. A pressure dressing is applied to the groin after a renal arteriogram.
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.
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 overhydration.
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% Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal. Renal function can be assessed most accurately if several tests are performed and their results are analyzed together. Common tests of renal function include renal concentration tests, creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein metabolism) concentrations.
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 > 1,050 mL
650 mL, 850 mL, 1,050 mL 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. The normal serum glucose level ranges from about 80 to 110 mg/dL. Renal glycosuria occurs if the amount of glucose in the blood and the glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Glycosuria is seen when the serum glucose level exceeds 180 mg/dL.
A nurse is completing a health history on a 62-year-old male client reporting urinary urgency, frequency, and nocturia. The client has no past medical issues. The nurse would anticipate which prescription for this client? > Voiding pressure of 15 cm H20 during micturition > Immediate placement of a urinary catheter > A portable bladder ultrasound is prescribed > Urinalysis result is positive for ketones
A portable bladder ultrasound is prescribed A portable bladder ultrasound is a noninvasive method of measuring urine volume and detecting urinary retention in the bladder. It may be indicated for urinary frequency, measurement of post residual urine volume or assessment of the need for catheterization. While a urinary catheter may be placed on this client, the priority intervention should be first identifying that the client is retaining urine. Bladder pressure is usually measured during urodynamic testing. The pressure generated in the bladder during micturition (act of urinating) is about 22 to 40 cm of H2O in females. It is somewhat higher and more variable in males 45 years and older due to the normal hyperplasia of the cells of the prostate gland. Any obstruction of the bladder outlet, such as advanced benign prostate hyperplastic, results in a higher voiding pressure, which makes it more difficult to start urine flow and maintain it. Therefore, the measurement of 15 cm of H20 is an unexpected finding. The urinalysis finding of ketones is more suggestive of diabetic ketoacidosis (DKA) and is also unexpected.
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 Renal biopsy carries the risk of postprocedure 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.
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.
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? > Radiography > Computed tomography with contrast > Cystoscopy > Bladder ultrasonography
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.
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 Acute pyelonephritis is characterized by costovertebral angle tenderness. Suprapubic pain is suggestive of bladder distention or infection. Urethral trauma and irritation of the bladder neck can cause pain after voiding. Perineal pain is experienced by male clients with prostate cancer or prostatitis.
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 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 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 Cystoscopy is the visual examination of the inside of the bladder using an instrument called a cystoscope, a lighted tube with a telescopic lens. Renal angiography involves the passage of a catheter up the femoral artery into the aorta to the level of the renal vessels. Intravenous pyelography or excretory urography is a radiologic study that involves the use of a contrast medium to evaluate the kidneys' ability to excrete it.
A client has a full bladder. Which sound would the nurse expect to hear on percussion? > Tympany > Dullness > Resonance > Flatness
Dullness Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very dense tissue, such as the bone or muscle.
Which term describes painful or difficult urination? > Oliguria > Anuria > Nocturia > Dysuria
Dysuria Dysuria refers to painful or difficult urination. Oliguria is urine output less than 0.5 mL/kg/hr. Anuria is used to describe total urine output less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate.
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 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 nurse is preparing an education program about renal disease. Which risk factor should the nurse include when teaching? Select all that apply. > Hypotension > Immobility > Spinal cord injury > Sickle-cell anemia > Seizures
Immobility, Spinal cord injury, Sickle-cell anemia Risk factors for renal disease include immobility, sickle-cell anemia, and spinal cord injury. Immobility promotes kidney stone formation. Sickle-cell anemia increases the risk for chronic kidney disease. Spinal cord injury can lead to neurogenic bladder, urinary tract infection, and urinary incontinence.
Three areas of 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 There are three narrowed areas of each ureter: the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovesical junction. These three areas of the ureters have a propensity for obstruction by renal calculi or stricture. Obstruction of the ureteropelvic junction is the most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction. The urethra is not part of the ureters.
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
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? > Obstruction of the lower urinary tract > Acute renal failure > Infection > Nephrotic syndrome
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.
A patient who complains of a dull, continuous pain in the suprapubic area that occurs with, and at the end of, voiding would most likely be diagnosed with which of the following? > A kidney stone > Interstitial cystitis > Acute pyelonephritis > Prostatic cancer
Interstitial cystitis Pain over the suprapubic area is most likely related to the bladder. Pain intensity would increase with fullness. Pain at the end of voiding is one of the symptoms associated with interstitial cystitis.
To obtain information about the chief complaint and medical history of an older client, the nurse asks the client about any medication history. Why is obtaining a medication history important? > It may indicate the client's general health. > It may reflect the client's childhood and family illnesses. > It may indicate multiple medications taken by the client. > It may indicate drugs that should not be prescribed to the client.
It may indicate multiple medications taken by the client. The nurse should obtain information about a client's medication history because the older client, in particular, may be taking multiple medications that may affect their renal function. The medication history in general indicates the probable risk factors of renal or urologic disorders. The medication history of an older client is not used to obtain information about the client's general health, childhood and family illnesses, or drugs that are contraindicated for use by the client.
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 client with hyperparathyroidism is at risk for kidney stones. The client with diabetes mellitus is a risk factor for developing chronic renal failure and neurogenic bladder. A client with radiation to the pelvis is at risk for urinary tract fistula.
The client is admitted to the nursing unit for a biopsy of the urinary tract tissue. When planning nursing care for the postoperative period, which nursing intervention documents the prescribed activity level? > Maintain the client on bedrest > Assist the client for bathroom privileges > Ambulate the client in the hall > Activity as tolerated
Maintain the client on bedrest In the postoperative period, the client remains on bed rest as the nurse assess for signs of bleeding. If the client is to be discharged on the following day, the client is to maintain limited activity for several days to avoid spontaneous bleeding. The client does not ambulate in the hall and should maintain limited activity for several days post discharge.
Which term best describes a total urine output less than 500 mL in 24 hours? > Polyuria > Oliguria > Nocturia > Dysuria
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.
A client with a history of chronic renal infections is to undergo CT with contrast. Before the procedure, the nurse should complete which action? > Place emergency medical equipment in the procedure room. > Instruct the client to maintain a full bladder for the diagnostic test. > Hold the client's iron supplement until after the diagnostic test. > Keep the client NPO for 1 hour before the scan.
Place emergency medical equipment in the procedure room. For some clients, contrast agents are nephrotoxic and allergenic. Emergency equipment and medications should be available in case of an anaphylactic reaction to the contrast agent. Emergency supplies include epinephrine, corticosteroids, vasopressors, oxygen, and airway and suction equipment. The client is instructed to maintain a full bladder for an ultrasonography. The other instructions/interventions relate to magnetic resonance imaging.
Retention of which electrolyte is the most life-threatening effect of renal failure? > Calcium > Sodium > Potassium > Phosphorous
Potassium Retention of potassium is the most life-threatening effect of renal failu
Which of the following is an age-related change associated with the renal system? > Renal arteries thicken > Kidney weight increases > Blood flow increase > Increased bladder capacity
Renal arteries thicken Age-related changes include thickening of the renal arteries, a decrease in the weight of the kidney, blood flow decrease by approximately 10% per decade, and decreased bladder capacity.
Common tests of renal function include which of the following? Select all that apply. > Renal concentration test > Creatinine clearance > Serum creatinine > Blood urea nitrogen (BUN) > Arterial blood gas analysis
Renal concentration test, Creatinine clearance, Serum creatinine, Blood urea nitrogen (BUN) 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.
A patient's vasa recta have detected a precipitous drop in the patient's blood pressure. In response to feedback from the vasa recta, the patient's kidneys will: > Increase the pH of the blood > Synthesize angiotensin > Increase water excretion > Secrete renin
Secrete renin Decreased blood pressure causes the secretion of renin, which causes a cascade that ultimately increases blood pressure. Angiotensin I and II are the effectors of this cascade, but these are not synthesized or secreted by the kidneys directly. Water excretion would exacerbate low blood pressure, and a change in pH would not resolve the problem.
The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply. > Secretion of prostaglandins > Vitamin B production > Regulation of blood pressure > Vitamin D synthesis > Secretion of insulin
Secretion of prostaglandins, Regulation of blood pressure Vitamin D synthesis Functions of the kidney include secretion of prostaglandins, regulation of blood pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body does not produce Vitamin B.
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 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.
The nurse is educating a patient about preparation for an IV urography. What should the nurse be sure to include in the preparation instructions? > A liquid restriction for 8 to 10 hours before the test is required. > The patient may have liquids before the test. > The patient will have enemas until the urine is clear. > The patient is restricted from eating or drinking from midnight until after the test.
The patient may have liquids before the test. IV urography may be used as the initial assessment of many suspected urologic conditions, especially lesions in the kidneys and ureters. The patient preparation is the same as for excretory urography, except fluids are not restricted.
An increase in the osmolality of a patient's blood has prompted the release of antidiuretic hormone (ADH) from the patient's posterior pituitary gland. What effect will result from the release of this hormone? > The patient's kidneys will resorb more water than usual. > The patient will retain more sodium than normal. > The patient's kidneys will reduce their filtration rate. > Excretion of water by the kidneys will increase.
The patient's kidneys will resorb more water than usual. ADH increases reabsorption of water and returns the osmolality of the blood to normal. It does not increase sodium retention or influence the overall rate of filtration.
Diagnostic testing of a patient with a history of chronic renal failure has been ordered. The care provider has ordered a test of the patient's creatinine clearance in an effort to gauge the progression of his disease. The nurse understands that this test reflects what aspect of the kidney structure and function? > The volume of blood that the kidneys are able to filter in a given time > The kidneys' ability to accommodate changes in blood pH > The locations in the renal tubules where excretion and resorption are occurring > The combined volume of the renal pelvises and the ureters
The volume of blood that the kidneys are able to filter in a given time A creatinine clearance test measures volume of blood cleared of endogenous creatinine in 1 minute, which provides an approximation of the glomerular filtration rate. It does not indicate the volume of the kidneys, accommodation of pH changes, or the functioning of specific locations within the kidneys.
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 Urinary incontinence is the most common reason for admission to skilled nursing facilities.
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 The nurse would document urinary urgency. Urinary frequency is urinating more frequently than normal often times due to inadequate emptying of the bladder. Urinary incontinence is the involuntary loss of urine. Urinary stasis is a stoppage or diminution of flow.
Which of the following is used to identify vesicoureteral reflux? > Voiding cystourethrography > IV urography > Renal angiography > Bladder ultrasonography
Voiding cystourethrography A voiding cystourethrography is used as a diagnostic tool to identify vesicoureteral reflux. An IV urography may be used as the initial assessment of various suspected urologic problems, especially lesions in the kidneys and ureters, and it provides an approximate estimate of renal function. Renal angiography is used to evaluate renal blood flow, to differentiate renal cysts from tumors, to evaluate hypertension, and preoperatively for renal transplantation.
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. Adverse effects of medications are a common cause of decreased renal function in older adults. Quantity, rather than type, of beverages is relevant. Sodium intake does not normally cause decreased renal function. Bladder palpation can be used to confirm urinary retention, but this does not normally affect renal function as much as medications.
When the bladder contains 400 to 500 mL of urine, this is referred to as > anuria. > specific gravity. > functional capacity. > renal clearance.
functional capacity A marked sense of fullness and discomfort with a strong desire to void usually occurs when the bladder contains 400 to 500 mL of urine, referred to as the "functional capacity." Anuria is a total urine output less than 50 mL in 24 hours. Specific gravity reflects the weight of particles dissolved in the urine. Renal clearance refers to the ability of the kidneys to clear solutes from the plasma.
A client is experiencing some renal secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed in urine? > glucose > potassium > creatinine > chloride
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.
The term used to describe total urine output less than 0.5 mL/kg/hour is > oliguria. > anuria. > nocturia. > dysuria.
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 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 Orange to amber-colored urine is caused by concentrated urine due to dehydration, fever, bile, excess bilirubin or carotene, and the medications phenazopyridine hydrochloride and nitrofurantoin. Infection would cause yellow to milky white urine. Phenytoin would cause the urine to become pink to red. Metronidazole would cause the urine to become brown to black.
A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about: > chronic, excessive acetaminophen use. > recent streptococcal infection. > childhood asthma. > family history of pernicious anemia.
recent streptococcal infection A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction.
A client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. This test will reveal details about: > renal circulation. > kidney function. > kidney structure. > urine production.
renal circulation A renal angiography (renal arteriography) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.
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 The findings are constant with ureteral stones, edema or stricture, or a blood clot. The other answers do not apply.
While reviewing a client's chart, the nurse notes the client has been experiencing enuresis. To assess whether this remains an ongoing problem for the client, the nurse asks which question? > "Do you have a strong desire to void?" > "Do you urinate while sleeping?" > "Does it burn when you urinate?" > "Is it painful when you urinate?"
"Do you urinate while sleeping?" Enuresis is defined as involuntary voiding during sleep. The remaining questions do not relate to this problem associated with changes in the client's voiding pattern.
The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? > "I will feel a warm sensation as the dye is injected." > "I should remove all jewelry before the test." > "I should let the staff know if I feel claustrophobic." > "I will need to drink all of the dye as quickly as possible."
"I will feel a warm sensation as the dye is injected." A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected.
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." The kidneys are vulnerable but are able to maintain homeostasis even in the loss of one kidney or up to 80% of normal function. Signs and symptoms of renal failure are often not apparent in early stages of failure, but they appear prior to complete failure.
The nurse is reviewing the results of a client's renal function study. The nurse understands that which value represent a normal BUN-to-creatinine ratio? > 4:1 > 6:1 > 8:1 > 10:1
10:1 A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect.
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 To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection, the serum creatinine level is measured.
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) 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 UTI. Older male patients are at risk for prostatic enlargement, which causes urethral obstruction and can result in hydronephrosis, renal failure, and UTIs.
The nurse is conducting a focused assessment of a male patient who has a history of poorly controlled hypertension. Which of the following findings would indicate the presence of renal artery bruits? > S1 and S2 sounds over the kidneys > A whooshing sound over the kidneys > A lack of audible sounds over the kidneys > Gurgles and clicks over the kidneys
A whooshing sound over the kidneys A whooshing sound is indicative of a bruit. Gurgles, clicks, heart sounds, and an absence of audible sounds are not associated with a bruit.
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.
Which hormone causes the kidneys to reabsorb sodium? > Antidiuretic hormone > Aldosterone > Growth hormone > Prostaglandins
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.
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 Urine specific gravity depends largely on hydration status. A decrease in fluid intake (such as a "nothing by mouth" status) 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.
The nurse has been closely monitoring the blood work of a patient who recently experienced nephrotoxic effects from an over-the-counter medication. In the course of providing care, the nurse has been teaching the patient about the various roles that the kidney plays in the maintenance of homeostasis. Which of the following functions is performed by the kidneys? > Control of protein synthesis > Regulation of metabolism > Control of acid-base balance > Regulation of digestion
Control of acid-base balance The kidneys perform several diverse physiological functions, including regulation of acid-base balance. However, the kidneys do not regulate protein synthesis, overall metabolism, or digestion.
A 24-year-old patient was admitted to the emergency room after a water skiing accident. The X-rays revealed two fractured vertebrae, T-12 and L1. Based on this information, the nurse would know to perform which of the following actions? > Keep the patient on bed rest for 72 hours. > Place a bed board under the mattress to add support. > Check the patient's urine for hematuria. > Apply moist heat, every 4 hours for the first 48 hours to aid healing.
Check the patient's urine for hematuria. The kidneys are located from the 12th thoracic vertebrae to the third lumbar vertebrae. Therefore, the accident may have caused blunt force trauma damage to the kidneys. Ice is always applied for the first 24 hours, then heat, if not contraindicated. Activity will be restricted but bed rest is not necessary.
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 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 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 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.
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 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 develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? > GI absorption rate > Therapeutic index > Creatinine clearance > Liver function studies
Creatinine clearance The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.
Which of the following urine characteristics would the nurse anticipate when caring for a client whose lab work reveals a high urine specific gravity related to dehydration? > Dark amber urine > Clear or light yellow urine > Red urine > Turbid urine
Dark amber urine Concentrated urine (one with a high specific gravity) is a dark amber color due to the solutes in the urine. Clear or yellow urine indicates a flushing of the urinary system. Red urine indicates hematuria. A turbid urine may indicate bacteriuria.
A geriatric nurse is performing an assessment of an 85-year-old patient. The nurse realizes that what particular change is an age-related effect on the renal or urinary system? > Increased ability to concentrate urine > Increased bladder capacity > Urinary incontinence > Decreased glomerular filtration rate
Decreased glomerular filtration rate Many age-related 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 age-related change, but is common in older adults, especially in women, because of the loss of pelvic muscle tone.
An appropriate nursing intervention for the client following a nuclear scan of the kidney is to: > Encourage high fluid intake. > Strain all urine for 48 hours. > Apply moist heat to the flank area. > Monitor for hematuria.
Encourage high fluid intake. A nuclear scan of the kidney involves the IV administration of a radioisotope. Fluid intake is encouraged to flush the urinary tract to promote excretion of the isotope. Monitoring for hematuria, applying heat, and straining urine do not address the potential renal complications associated with the radioisotope.
A patient is diagnosed with detrusor sphincter dyssynergia. The nurse understands that the patient would most likely experience which of the following voiding problems? > Frequency > Urgency > Hesitancy > Nocturia
Hesitancy Detrusor sphincter dyssynergia refers to a lack of coordination between the bladder and the sphincter, which results in delayed voiding or a difficulty in initiating voiding.
The nurse is performing a renal assessment on a client with prostate cancer. Which clinical manifestation suggests prostate cancer? Select all that apply. > Palpitations > Hesitancy > Chills > Dyspnea > Nocturia
Hesitancy, Nocturia Clinical manifestations of prostate cancer include urinary hesitancy and nocturia. Palpitations, chills, and dyspnea are not suggestive of prostate cancer.
A gerontological nurse is aware that older adults experience numerous age-related physiological changes that place them at risk of fluid and electrolyte imbalances. Age-related changes to kidney function and the thirst mechanism create a particular risk of what problem? > Hypermagnesemia > Hypokalemia > Fluid volume excess > Hypernatremia
Hypernatremia The elderly are more prone to developing hypernatremia and fluid volume deficit because increasing age is also associated with diminished osmotic stimulation of thirst. These changes are not associated with an increased risk of hypermagnesemia, hypokalemia, or fluid volume excess.
An older client is experiencing an increasingly troublesome need to urinate several times through the night. The client's prostate is within normal limits, and the physician prescribes limiting fluid intake after the evening meal. What is another important intervention to keep the client safe? > Decrease salt intake. > Increase protein intake. > Decrease overall fluid intake. > Increase fluid intake throughout the day.
Increase fluid intake throughout the day. Older persons may need to drink more fluids throughout the day to allow for limiting their intake after the evening meal. Urine formation increases during the night, when leg elevation promotes blood return to the heart and kidneys, and may interrupt sleep patterns. Salt is secreted. Filtrate that is secreted as urine usually contains sodium and chloride. Protein molecules, except for periodic small amounts of globulins and albumin, also are reabsorbed.
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 Ultrasonography requires a full bladder; therefore, fluid intake should be encouraged before the procedure. 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.
The nurse observes that the client's urine is orange. Which additional assessment would be important for this client? > Bleeding > Intake of medication such as phenazopyridine hydrochloride > Intake of multiple vitamin preparations > Infection
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.
To obtain information about the chief report and medical history of an older client, the nurse asks the client about any medication history. Why is obtaining a medication history important? > It may indicate the client's general health. > It may reflect the client's childhood and family illnesses. > It may indicate multiple medications taken by the client. > It may indicate drugs that should not be prescribed to the client.
It may indicate multiple medications taken by the client. The nurse should obtain information about a client's medication history because older clients, in particular, may be taking multiple medications that may affect their renal function. The medication history in general indicates the probable risk factors of renal or urologic disorders. The medication history of an older client is not used to obtain information about the client's general health, childhood and family illnesses, or drugs that are contraindicated for use by the client.
A patient is having an MAG3 renogram and is informed that radioactive material will be injected to determine kidney function. What should the nurse instruct the patient to do during the procedure? > Lie still on the table for approximately 35 minutes. > Drink contrast material at various intervals during the procedure. > Turn from side to side to get a variety of views during the procedure. > Take deep breaths and hold them at various times throughout the procedure.
Lie still on the table for approximately 35 minutes This relatively new scan is used to further evaluate kidney function in some centers. The patient is given an injection containing a small amount of radioactive material, which will show how the kidneys are functioning. The patient needs to lie still for about 35 minutes while special cameras take images (Albala, Gomelia, Morey, et al., 2010).
A patient with hypertension needs to be assessed for the presence of renal artery stenosis. Select the location that the nurse should use to auscultate for a renal bruit. > Midthoracic region about 10 cm above T12 > Lower quadrant, about 1 inch above the pubic area > Lower quadrant, about 2 cm to the right or left of the umbilicus > Upper sacral area, about 4 cm directly below the umbilicus
Lower quadrant, about 2 cm to the right or left of the umbilicus The renal arteries are best assessed in the lower thoracic and lumbar paravertebral region about 2 cm to the right or left of the umbilicus.
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 After the procedure, the healthcare provider applies a pressure dressing to the femoral area, which remains in place for several hours. The nurse palpates the pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Monitoring the pressure dressing is important to note frank bleeding or hematoma formation. If either condition occurs, the nurse immediately notifies the health care provider. Another important assessment is for hypersensitivity responses to contrast material. The nurse also monitors and documents intake and output. The client may have an enema pre procedure and application of a cold compress may reduce pain and swelling.
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. After the procedure, the healthcare provider applies a pressure dressing to the femoral area, which remains in place for several hours. The nurse palpates the pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Monitoring the pressure dressing is important to note frank bleeding or hematoma formation. If either condition occurs, the nurse immediately notifies the health care provider. Another important assessment is for hypersensitivity responses to contrast material. The nurse also monitors and documents intake and output. The client may have an enema pre procedure and application of a cold compress may reduce pain and swelling.
A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? > Monitor the client for signs of electrolyte and water imbalance. > Monitor the client for an allergy to iodine contrast material. > Assess the client's mental changes. > Evaluate the client for periorbital edema.
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? > Increased glomerular filtration rate > More prone to develop hypernatremia > Increased blood flow to the kidneys > Acid-base balance
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 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. A creatinine level is determined from a blood sample. It is used to assess renal function.
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.
On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. 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.
A patient with a history of type 1 diabetes is being assessed for possible diabetic nephropathy, and a component of the ordered diagnostic evaluation is a urinalysis. This patient's ability to concentrate urine would be reflected in what component of urinalysis? > Osmolality > Red blood cells > Glucose > White blood cells
Osmolality Measurement of urine osmolality indicates the patient's ability to concentrate urine. Assessing for the presence of glucose, red cells, and white cells are components of urinalysis but none is indicative of the kidneys' ability to produce concentrated urine.
A client undergoes renal angiography. The nurse prepares the client for the test and provides postprocedure care. Which intervention should the nurse provide to the client after renal angiography? > Encourage the client to void > Monitor the client for signs and symptoms of pyelonephritis > Palpate the pulses in the legs and feet > Assess for signs of electrolyte and water imbalance
Palpate the pulses in the legs and feet To observe for signs of arterial occlusion in a client who has undergone renal angiography, the nurse should palpate the pulses in the legs and feet. While preparing the client for renal angiography, the nurse asks the client to void. The nurse assesses for signs of electrolyte and water imbalances during the physical examination of a client. The nurse should monitor for signs and symptoms of pyelonephritis in a client who has undergone retrograde pyelography.
A client is concerned after noticing the color of their urine is dark brown. The nurse is aware that the client is prescribed senna, methyldopa, and acetaminophen. Which action is an appropriate response by the nurse? > Explain to the client that dehydration is likely the culprit and encourage an increase in fluid intake as tolerated. > Call the primary health care provider and request a urinalysis and a culture and sensitivity test. > Reassure the client the urine color is related to the medication methylopa and no further action is needed at this time. > Encourage the client to stop taking acetaminophen as the brown urine color is the first indication of liver toxicity.
Reassure the client the urine color is related to the medication methylopa and no further action is needed at this time. Some medications cause a change in the color of the urine. Methyldopa can cause urine to appear dark brown to black in color and is a normal findings. Senna products can cause the urine. to appear pink or red. Unless other signs and symptoms are present dark brown urine is not an indication to send a urinalysis or culture and sensitivity. Dark brown urine can be a indication of dehydration but without further information and/or signs and symptoms this is not the most likely reasoning for this occurrence. Nausea and vomiting are usually the first signs of acetaminophen toxicity and urine can be cloudy and bloody.
Which is the correct term for the ability of the kidneys to clear solutes from the plasma? > Renal clearance > Glomerular filtration rate > Specific gravity > Tubular secretion
Renal clearance Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. Glomerular filtration rate is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.
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.
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, extreme exercise Hematuria may be caused by cancer of the genitourinary tract, acute glomerulonephritis, renal stones, renal tuberculosis, blood dyscrasias, trauma, extreme exercise, rheumatic fever, hemophilia, leukemia, or sickle cell trait or disease. Lithium toxicity and hypertension are not related causes of hematuria.
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.
anuria 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.
