Ch. 44 Assessment of Urinary System
During physical assessment of the urinary system, the nurse a. cannot palpate the left kidney b. palpates an empty bladder as a small nodule c. finds a dull percussion sound when 100 mL of urine is present in the bladder d. palpates above the symphysis pubis to determine the level of urine in the bladder
a. cannot palpate the left kidney Rationale: The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it. Occasionally the lower pole of the right kidney is palpable. The urinary bladder is normally not palpable unless it is distended with urine. If the bladder is full, it may be felt as a smooth, round, firm organ and is sensitive to palpation.
Normal findings expected by the nurse on physical assessment of the urinary system include (select all that apply) a. nonpalpable left kidney b. auscultation of renal artery bruit c. CVA tenderness elicited by a kidney punch d. no CVA tenderness elicited by a kidney punch e. palpable bladder to the level of the pubic symphysis
a. nonpalpable left kidney d. no CVA tenderness elicited by a kidney punch Rationale: In the physical assessment of the urinary system, normal findings include no CVA tenderness, non palpable kidneys and bladder, and no palpable masses.
A patient with kidney disease has oliguria and a creatinine clearance of 40 mL/min. These findings most directly reflect abnormal function of a. tubular secretion b. glomerular filtration c. capillary permeability d. concentration of filtrate
b. glomerular filtration Rationale: The amount of blood filtered each minute by the glomeruli is expressed as the glomerular filtration rate (GFR). The normal GFR is about 125 mL/min.
A diagnostic study that indicates renal blood flow, glomerular filtration, tubular function, and excretion is a(n) a. IVP b. VCUG c. renal scan d. loopogram
c. renal scan Rationale: A renal scan is used to evaluate the anatomic structures, perfusion, and function of kidneys. The scan shows the location, size, and shape of the kidneys and helps assess blood flow, glomerular filtration, tubular function, and urinary excretion. In some facilities, a numerical value ("split" renal function) may be assigned (i.e., percent contributed by each kidney).
Diminished ability to concentrate urine, associated with aging of the urinary system, is attributed to a. a decrease in bladder sensory receptors b. a decrease in the number of functioning nephrons c. decreased function of the loop of Henle and tubules d. thickening of the basement membrane of Bowman's capsule
c. thickening of the basement membrane of Bowman's capsule Rationale: Older adults have decreased function of the loop of Henle and tubules, which results in the loss of normal diurnal excretory pattern because of a decreased ability to concentrate urine and because of less concentrated urine.
A renal stone in the pelvis of the kidney will alter the function of the kidney by interfering with the a. structural support of the kidney b. regulation of the concentration of urine c. entry and exit of blood vessels at the kidney d. collection and drainage of urine from the kidney
d. collection and drainage of urine from the kidney Rationale: the outer layer of the kidney is the cortex, and the inner layer is the medulla. The medulla consists of a number of pyramids. The apices (tops) of these pyramids are called papillae, through which urine passes to enter the calyces. The minor calyces widen and merge to form major calyces, which form a funnel-shaped sac called the renal pelvis. The minor and major calyces transport urine to the renal pelvis, from which it drains through the ureter to the bladder.
The nurse identifies a risk for urinary calculi in a patient who relates a past health history that includes a. hyperaldosteronism b. serotonin deficiency c. adrenal insufficiency d. hyperparathyroidism
d. hyperparathyroidism Rationale: Excessive levels of circulating parathyroid hormone (PTH) usually lead to hypercalcemia and hypophosphatemia. In the kidneys, the excess calcium cannot be reabsorbed, so the calcium levels in the urine increase (i.e., hypercalciuria). This excess urinary calcium, along with a large amount of urinary phosphate, can lead to calculi formation.
On reading the urinalysis results of a dehydrated patient, the nurse would expect to find a. a pH of 8.4 b. RBCs of 4/hpf c. color: yellow, cloudy d. specific gravity of 1.035
d. specific gravity of 1.035 Rationale: Normal specific gravity of urine is 1.003 to 1.030; the concentrating ability of the kidneys is maximal in producing morning urine (1.025 to 1.030). A high urinary specific gravity value indicates dehydration.
