Honan-Chapter 26: Nursing Assessment: Renal and Urinary Tract Function

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

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

A client presents at the testing center for an intravenous pyelogram. What question should the nurse ask to ensure the safety of the client? A. "Do you have any allergies?" B. "Who has come with you today?" C. "Have you any artificial joints?" D. "Do you have a pacemaker?"

A. "Do you have any allergies?" RATIONALE Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood. Reference:

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? A. 150 B. 250 C. 200 D. 100

A. 150 RATIONALE: 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.

A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse? A. Asses the patient's back and shoulder areas for signs of internal bleeding. B. Distract the patient's attention from the pain. C. Provide analgesics to the patient. D. Enable the patient to sit up and ambulate.

A. Asses the patient's back and shoulder areas for signs of internal bleeding. RATIONALE After a renal biopsy, the patient is on bed rest. It is important to assess the dressing frequently for signs of bleeding and evaluate the type and severity of pain. Severe pain in the back, shoulder, or abdomen may indicate bleeding. In such a case, the nurse should notify the physician about these signs and symptoms. Distracting the patient's attention, helping the patient to sit up or ambulate, and providing analgesics may only aggravate the patient's pain and, therefore, should not be performed by the nurse.

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? A. Assess the patient's back and shoulder areas for signs of internal bleeding. B. Distract the client's attention from the pain. C. Provide analgesics to the client. D. Enable the client to sit up and ambulate.

A. Assess the patient's back and shoulder areas for signs of internal bleeding. RATIONALE: After a renal biopsy, the client should be on bed rest. The nurse observes the urine for signs of hematuria. It is important to assess the dressing frequently for signs of bleeding, monitor vital signs, and evaluate the type and severity of pain. Severe pain in the back, shoulder, or abdomen may indicate bleeding. In such a case, the nurse should notify the physician about these signs and symptoms. The nurse should also assess the client for difficulty voiding and encourage adequate fluid intake.

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? A. Bleeding B. Infection C. Dehydration D. Allergic reaction

A. Bleeding RATIONALE 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.

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? A. Cystoscopy B. Ureteral brush biopsy C. Urinalysis D. Renal biopsy

A. Cystoscopy RATIONALE: A cystoscopy can be used to directly visualize the urethra and bladder, as well as the urethral orifices and prostatic urethra. Biopsies and urinalysis do not facilitate direct visualization.

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? A. Dark amber urine B. Clear or light yellow urine C. Red urine D. Turbid urine

A. Dark amber urine RATIONALE: 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.

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

A. Diabetes insipidus B. Glomerulonephritis C. Severe renal damage

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. Strain all urine for 48 hours. C. Apply moist heat to the flank area. D. Monitor for hematuria.

A. Encourage high fluid intake. RATIONALE: 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.

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? A. Increased fluid intake to produce a full bladder B. IV administration of radiopaque contrast agent C. In-and-out urinary catheterization D. The injection of a radioisotope

A. Increased fluid intake to produce a full bladder RATIONALE: 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 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. Kidney stones B. Neurogenic bladder C. Chronic renal failure D. Fistula

A. Kidney stones RATIONALE 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.

Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Which is an example of how urine concentration is affected? A. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. B. On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. C. 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. D. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity may vary widely.

A. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. RATIONALE: 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.

Which is the correct term for the ability of the kidneys to clear solutes from the plasma? A. Renal clearance B. Glomerular filtration rate C. Specific gravity D. Tubular secretion

A. Renal clearance RATIONALE: 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.

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? A. When the urine output is less than 30 mL/h B. When the urine output is about 100 mL/h C. When the urine output is between 300 and 500 mL/h D. When the urine output is between 500 and 1,000 mL/h

A. When the urine output is less than 30 mL/h RATIONALE: Oliguria is defined as urine output <0.5 mL/kg/h

The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to A. drink liberal amounts of fluids. B. maintain bed rest for 2 hours. C. carefully handle urine because it is radioactive. D. notify the health care team if bloody urine is noted.

A. drink liberal amounts of fluids. RATIONALE: After the procedure is completed, the client is encouraged to drink fluids to promote excretion of the radioisotope by the kidneys. The remaining instructions are not associated with a nuclear scan.

A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? A. glucose B. potassium C. creatinine D. chloride

A. glucose RATIONALE: 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 A. oliguria. B. anuria. C. nocturia. D. dysuria.

A. oliguria. RATIONALE: 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.

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? A. "Do you have a strong desire to void?" B. "Do you urinate while sleeping?" C. "Does it burn when you urinate?" D. "Is it painful when you urinate?"

B. "Do you urinate while sleeping?" RATIONALE: 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.

A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address? A. "I've had diabetes for 4 years." B. "I'm allergic to shellfish." C. "I haven't eaten since midnight." D. "My physician diagnosed me with hypertension 3 months ago."

B. "I'm allergic to shellfish." RATIONALE An allergy to iodine, shellfish, or other seafood should immediately be investigated because the contrast agent used in the procedure may contain iodine, which can cause a severe allergic reaction. Although contrast agents should be used cautiously in clients with diabetes mellitus, investigating this isn't the nurse's priority if the client also has a shellfish allergy. It's appropriate for the client to not eat after midnight before the procedure. The client's hypertension isn't a priority because this condition is the likely reason the renal angiography was ordered.

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? A. S1 and S2 sounds over the kidneys B. A whooshing sound over the kidneys C. A lack of audible sounds over the kidneys D. Gurgles and clicks over the kidneys

B. A whooshing sound over the kidneys RATIONALE A whooshing sound is indicative of a bruit. Gurgles, clicks, heart sounds, and an absence of audible sounds are not associated with a bruit.

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

B. Angiography RATIONALE: Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the internal bladder.

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. Blood urea nitrogen level B. Creatinine clearance level C. Serum potassium level D. Uric acid level

B. Creatinine clearance level RATIONALE: 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 is scheduled for a renal angiography. Which of the following would be appropriate before the test? A. Monitor the client for signs of electrolyte and water imbalance. B. Monitor the client for an allergy to iodine contrast material. C. Assess the client's mental changes. D. Evaluate the client for periorbital edema.

B. Monitor the client for an allergy to iodine contrast material. RATIONALE: 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.

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? A. "Have you noticed any vaginal bleeding?" B. "Do you take phenytoin daily?" C. "Do you take multiple vitamin preparations?" D. "Have you had a recent urinary tract infection?"

C. "Do you take multiple vitamin preparations?" RATIONALE: 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.

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? A. Keep the patient on bed rest for 72 hours. B. Place a bed board under the mattress to add support. C. Check the patient's urine for hematuria. D. Apply moist heat, every 4 hours for the first 48 hours to aid healing.

C. Check the patient's urine for hematuria. RATIONALE: 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 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? A. Control of protein synthesis B. Regulation of metabolism C. Control of acid-base balance D. Regulation of digestion

C. Control of acid-base balance RATIONALE 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.

When describing the functions of the kidney to a client, which of the following would the nurse include? A. Regulation of white blood cell production B. Synthesis of vitamin K C. Control of water balance D. Secretion of enzymes

C. Control of water balance RATIONALE Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins.

A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect? A. Obstruction of the lower urinary tract B. Acute renal failure C. Infection D. Nephrotic syndrome

C. Infection RATIONALE 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 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. Increased alertness B. Hypoventilation C. Pruritus D. Unusually smooth skin

C. Pruritus RATIONALE: 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.

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. Bladder B. Urethra C. Ureters D. Pelvic floor muscles

C. Ureters RATIONALE 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.

When the bladder contains 400 to 500 mL of urine, this is referred to as: A. anuria. B. specific gravity. C. functional capacity. D. renal clearance.

C. functional capacity. RATIONALE 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. Reference:

When the bladder contains 400 to 500 mL of urine, this is referred to as A. anuria. B. specific gravity. C. functional capacity. D. renal clearance.

C. functional capacity. RATIONALE 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 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. "A biopsy is routinely ordered for all patients with renal disorders." B. "A biopsy is generally ordered following abnormal X-ray findings of the renal pelvis." C. "A biopsy is often ordered for patients before they have a kidney transplant." D. "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."

D. "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease." RATIONALE 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 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. "A biopsy is routinely ordered for all patients with renal disorders." B. "A biopsy is generally ordered following abnormal X-ray findings of the renal pelvis." C. "A biopsy is often ordered for patients before they have a kidney transplant." D. "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."

D. "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease." RATIONALE: 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.

When fluid intake is normal, the specific gravity of urine should be: A. 1.000 B. Less than 1.010 C. Greater than 1.025 D. 1.010 to 1.025

D. 1.010 to 1.025 RATIONALE: 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? A. 20% B. 30% C. 40% D. 50%

D. 50% RATIONALE: 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.

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

D. >180 mg/dL. RATIONALE: 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.

Following a cystoscopy, the client has a nursing diagnosis of acute pain related to the trauma of the procedure to the urinary tract. An appropriate nursing intervention is to: A. Administer prescribed antibiotics. B. Monitor for urinary retention. C. Apply moist heat to the flank area. D. Assist with warm sitz baths.

D. Assist with warm sitz baths. RATIONALE Acute pain can be relieved with warm sitz baths. The nurse should monitor the client for urinary retention, which can help detect a potential cause of pain, but this nursing action does not relieve pain. Antibiotics may be prescribed to prevent infection. The pain associated with cystoscopy tends to be confined to the perineal area and lower abdomen not the flank area.

As women age, many experience an increased sense of urgency to void, as well as an increased risk of incontinence. This is usually the result of age-related changes in which part of the renal system? A. Kidney B. Nephron C. Tubule system D. Bladder

D. Bladder RATIONALE: With increased age, bladder tone and capacity is decreased. In women, this is compounded by a decrease in estrogen, which causes changes to the urethral sphincter.

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? A. Renal angiography B. Intravenous pyelography C. Excretory urogram D. Cystoscopy

D. Cystoscopy RATIONALE: 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.

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? A. Enuresis B. Polyuria C. Dysuria D. Oliguria

D. Oliguria RATIONALE Oliguria is urine output of less than 500 mL/day. Enuresis is bedwetting, and polyuria is output of more than 2.5 L/day. Dysuria is painful urination.

The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure? A. Cortisol B. Vasopressin C. Albumin D. Renin

D. Renin RATIONALE: 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).