Chapter 53: Assessment of Kidney and Urinary Function

A female patient presents to the health clinical for a routine physical examination. The nurse observes that the patient's urine is bright yellow in color. Which of the following questions is most appropriate for the nurse to ask the patient? a) "Do you take phenytoin (Dilantin) daily?" b) "Do you take multiple vitamin preparations?" c) "Have you noticed any vaginal bleeding?" d) "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 patient taking a multiple vitamin preparation. Urine that is orange may be caused by intake of Dilantin 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 patient, the use of vaginal creams.

A patient is scheduled for a test with contrast to determine kidney function. What statement made by the patient should the nurse inform the physician about prior to testing? a) "I have had a test similar to this one in the past." b) "I take medication to help me sleep at night." c) "I am allergic to shrimp." d) "I don't like needles."

"I am allergic to shrimp." The nurse should obtain the patient's allergy history with emphasis on allergy to iodine, shellfish, and other seafood, because many contrast agents contain iodine.

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

"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? a) "You don't need to do any fasting before this noninvasive test." b) "You'll have a pressure dressing on your groin after the test." c) "A contrast medium will be used to help see the structures better." d) "An x-ray will be done to view your kidneys, ureters, and bladder."

"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 which of the following? a) >1.025. b) 1.000. c) <1.010. d) 1.010 to 1.025.

1.010 to 1.025. Urine specific gravity is a measurement of the kidney's ability to concentrate urine. The specific gravity of water is 1.000. A urine specific gravity of <1.010 may indicate overhydration. A urine specific gravity >1.025 may indicate dehydration.

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.

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

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) levels.

After undergoing renal arteriogram, in which the left groin was accessed, a client complains of left calf pain. Which intervention should the nurse perform first? a) Exercise the leg and foot. b) Assess for anaphylaxis. c) Place cool compresses on the calf. d) Assess peripheral pulses in the left leg.

Assess peripheral pulses in the left leg. The nurse should begin by assessing peripheral pulses in the left leg to determine if blood flow was interrupted by the procedure. The client may also have thrombophlebitis. Cool compresses aren't used to relieve pain and inflammation in thrombophlebitis. The leg should remain straight after the procedure. Calf pain isn't a symptom of anaphylaxis.

The nurse is caring for a patient with a medical history of sickle cell anemia. The nurse understands this predisposes the patient to which of the following possible renal or urologic disorders? a) Kidney stone formation b) Neurogenic bladder c) Proteinuria d) Chronic kidney disease

Chronic kidney disease A medical history of sickle cell anemia predisposes the patient to the development of chronic kidney disease. The other disorders are not associated with the development of sickle cell anemia.

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

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 term used to describe painful or difficult urination is which of the following? a) Oliguria b) Anuria c) Nocturia d) 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 of less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate.

Following a voiding cystogram, the client has a nursing diagnosis of risk for infection related to the introduction of bacterial following manipulation of the urinary tract. An appropriate nursing intervention for the client is to: a) Encourage high fluid intake. b) Apply moist heat to the flank area. c) Monitor for hematuria. d) Strain all urine for 48 hours.

Encourage high fluid intake. A voiding cystogram involves the insertion of a urinary catheter, which can result in the introduction of microorganism into the urinary tract. Fluid intake is encouraged to flush the urinary tract and promote removal of microorganisms. Monitoring for hematuria, applying heat, and straining urine do not address the nursing diagnosis of risk for infection.

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) A kidney stone b) Interstitial cystitis c) Prostatic cancer d) Acute pyelonephritis

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.

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? a) Neurogenic bladder b) Kidney stones c) Fistula d) Chronic renal failure

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 nurse is aware, when caring for patients with renal disease, that which of the following substances, made in the glomeruli, directly controls blood pressure? a) Renin b) Vasopressin c) Cortisol d) Albumin

Renin Renin is directly involved in the control of arterial blood pressure. It is also essential for the proper functioning of the glomerulus and management of the body's renin-angiotensin system (RAS).

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? a) Unusually smooth skin b) Pruritus c) Increased alertness d) Hypoventilation

Pruritus The nurse should be alert for pruritus and urticaria, which may indicate a mild anaphylactic reaction to the arteriogram dye. Decreased (not increased) alertness may occur as well as dyspnea (not hypoventilation). Unusually smooth skin isn't a sign of anaphylaxis.

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. a) Renal papilla b) Renal medulla c) Renal pelvis d) Renal cortex

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.

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

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: a) Specific gravity 1.035 b) Creatinine 0.7 mg/dL c) Bright yellow urine d) Protein 15 mg/dL

Specific gravity 1.035

The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: a) Specific gravity 1.035 b) Creatinine 0.7 mg/dL c) Bright yellow urine d) Protein 15 mg/dL

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 mulitiple 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 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? a) The specific gravity will be high. b) The specific gravity will be inversely proportional c) The specific gravity will be low d) The specific gravity will equal to one

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 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? a) Ureters b) Pelvic floor muscles c) Bladder d) Urethra

Ureters The upper urinary tract is composed of the kidneys, renal pelvis, and ureters. The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.

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

Urinary incontinence Urinary incontinence is the most common reason for admission to skilled nursing facilities.

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? a) Creatinine clearance level b) Uric acid level c) Blood urea nitrogen level d) Serum potassium level

a) 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 client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should: a) check the client's pedal pulses frequently. b) remove the dressing on the puncture site after vital signs stabilize. c) keep the client's knee on the affected side bent for 6 hours. d) apply pressure to the puncture site for 30 minutes.

check the client's pedal pulses frequently. After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the client's knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse should leave this dressing in place for several hours — and only remove it if instructed to do so.

The term used to describe total urine output of less than 400 mL in 24 hours is a) oliguria. b) dysuria. c) anuria. d) nocturia.

oliguria. Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output of less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Dysuria refers to painful or difficult urination.