EXAM 3 : Chapter 26 (Nursing Assessment: Renal and Urinary Tract Function)
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?
Decreased glomerular filtration rate
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
When the bladder contains 400 to 500 mL of urine, this is referred to as
functional capacity.
A client is experiencing some renal secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed in urine?
glucose
A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect?
Infection
Which of the following is an age-related change associated with the renal system?
Renal arteries thicken
Which is an effect of aging on upper and lower urinary tract function?
Susceptibility to develop hypernatremia
A patient had a renal angiography and is being brought back to the hospital room. What nursing interventions should the nurse carry out after the procedure to detect complications? Select all that apply.
Assess peripheral pulses. Compare color and temperature between the involved and uninvolved extremities. Examine the puncture site for swelling and hematoma formation.
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?
"Do you take multiple vitamin preparations?"
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."
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."
A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient reports severe pain in the back, arms, and shoulders. Which intervention should be offered by the nurse?
Assess the patient's back and shoulder areas for signs of internal bleeding.
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?
"Your kidneys are adept at compensating for diminished function, but it's still important to safeguard their health."
When fluid intake is normal, the specific gravity of urine should be:
1.010 to 1.025
When fluid intake is normal, the specific gravity of urine should be
1.010 to 1.025.
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?
10:1
Which hormone causes the kidneys to reabsorb sodium?
Aldosterone
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?
An increased urine specific gravity
Which value does the nurse recognize as the best clinical measure of renal function?
Creatinine clearance
The nurse is providing care to a client who has had a kidney biopsy. The nurse would need to be alert for signs and symptoms of which of the following?
Bleeding
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?
Chronic kidney disease
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?
Creatinine clearance level
A creatinine clearance test has been ordered. The nurse prepares to:
Collect the client's urine for 24 hours.
The nurse caring for a client is providing instructions for an upcoming renal angiography. Which nursing action, explained in the preoperative instructions, is essential in the postprocedure period?
Complete a pulse assessment of the legs and feet.
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 acid-base balance
The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find?
Costovertebral angle tenderness
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?
Creatinine
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?
Creatinine clearance
A client has a full bladder. Which sound would the nurse expect to hear on percussion?
Dullness
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:
Encourage high fluid intake.
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.
Glucose
Regulation of electrolyte balance is a management goal for patients suffering from renal disease. Which of the following lab results is considered the most life-threatening effect of renal failure?
Hyperkalemia
The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program?
Hypotension
The nurse is assessing a patient's bladder by percussion. The nurse elicits dullness after voiding. What does this finding indicate?
Incomplete bladder emptying
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
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find?
Increased serum creatinine
The nurse observes that the client's urine is orange. Which additional assessment would be important for this client?
Intake of medication such as phenazopyridine hydrochloride
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
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.
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.
Lower quadrant, about 2 cm to the right or left of the umbilicus
A nurse who works in a clinic is aware of the importance of thorough and thoughtful urologic assessments, despite the fact that these assessments have the potential to make patients uncomfortable. When interviewing patients about their urologic health, the nurse should:
Maintain a composed but empathic demeanor.
A client is scheduled for a renal angiography. Which of the following would be appropriate before the test?
Monitor the client for an allergy to iodine contrast material.
Which is an effect of aging on upper and lower urinary tract function?
More prone to develop hypernatremia
The wall of the bladder has four layers. Which of the following layers contains a membrane that prevents reabsorption of urine stored in the bladder?
Mucosal
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
A client in moderate pain is admitted for possible kidney stones. The client appears diaphoretic and has frequent periods of nausea and vomiting. The client reports sudden oliguria and initial portable bladder ultrasound shows 300 mL in the bladder after the client voided 50 mL. Which action should the nurse anticipate performing first for this client?
Place a urinary cathether.
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?
Reassure the client the urine color is related to the medication methylopa and no further action is needed at this time.
The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness?
The costovertebral angle
A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact?
The left kidney usually is slightly higher than the right one.
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?
Ureters
The most frequent reason for admission to skilled care facilities includes which of the following?
Urinary incontinence
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 urgency
The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to
drink liberal amounts of fluids.
Although the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which is NOT a function of the kidneys?
excreting protein
A client is having a blood urea nitrogen (BUN) test. BUN level is:
increased in renal disease and urinary obstruction.
The term used to describe total urine output less than 0.5 mL/kg/hour is
oliguria.
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
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:
recent streptococcal infection.
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.
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 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.
650 mL 850 mL 1,050 mL
A routine serum glucose analysis indicated the presence of renal glycosuria. The nurse knew that the serum glucose level was:
>180 mg/dL.
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?
Cystoscopy
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.
The nephrons are the functional units of the kidney, responsible for the initial formation of urine. The nurse knows that damage to the area of the kidney where the nephrons are located will affect urine formation. Identify that area.
Renal cortex
A nurse is describing the renal system to a client with a kidney disorder. Which structure would the nurse identify as emptying into the ureters?
Renal pelvis
The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure?
Renin
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
Which nursing assessment finding indicates the client has not met expected outcomes?
The client voids 75 cc four hours post cystoscopy.
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:
There will likely be 50 to 100 mL of residual urine in the woman's bladder.
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.
