H&C Ch 53. Assess Kidney and Urinary Function

Which part of the kidney contains the nephrons?

Cortex The cortex is located farthest from the center of the kidney and around the outermost edges. It contains the nephrons (the functional units of the kidney).

The nurse notes that the client's urine is blood-tinged following cystoscopy. Which of the following nursing actions should the nurse do next?

Document the finding in the health record R: should document and continue to monitor. Fluids can be encouraged.

Which term describes painful or difficult urination?

Dysuria

Which hormone causes the kidneys to reabsorb sodium?

Aldosterone R: Aldosterone is a hormone synthesized and released by the adrenal cortex

Serum sodium plays a major role in maintaining fluid and electrolyte balance. Choose all the correct statements that apply.

Aldosterone causes renal reabsorption of sodium. Angiotensin II controls the release of aldosterone. Renin, an enzyme released by the kidneys, activates the RAS system to ensure adequate filtration. R: The renin-angiotensin system (RAS) maintains the balance of fluid volume. Refer to Figure 26-4 in the text.

A group of students is reviewing the process of urine elimination. The students demonstrate understanding of the process when they identify which amount of urine as triggering the reflex?

150 mL The desire to urinate comes from the feeling of bladder fullness. A nerve reflex is triggered when approximately 150 to 200 mL of urine accumulates.

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron?

20% R:

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal?

50

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal?

50%

The nurse is monitoring a client who has undergone cystoscopy because the client's history indicates urinary infection. Which of the following would the nurse need to report to the physician?

Chills and fever R:The nurse should monitor for chills, fever, and septicemia in a client who has a history of urinary infection after cystoscopy. These symptoms should be observed and the physician should be notified of the findings. Hematoma formation and frank bleeding would be indications to notify the physician after a renal angiography. The nurse should inform the client who is discharged after a renal biopsy to report dysuria, discolored or malodorous urine, flank pain, and rapid pulse to the physician.

The nurse is educating a patient about preparation for an IV urography. What should the nurse be sure to include in the preparation instructions?

Fluids may be had before the test. R: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.

To assess circulating oxygen concentration, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommends the use of which diagnostic test?

Hemo globin R:Although hematocrit has always been the blood test of choice to assess for anemia, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommend that anemia be quantified using hemoglobin rather than hematocrit measurements. Hemoglobin is recommended because it more accurately assesses circulating oxygen than does hematocrit. Serum iron concentration measures iron storage in the body. Arterial blood gases assess the adequacy of oxygenation, ventilation, and acid-base status.

A nurse is preparing an education program about renal disease. Which risk factor should the nurse include when teaching? Select all that apply.

Immobility Spinal cord injury Sickle-cell anemia 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.

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 multiple medications taken by the client.

A client has been experiencing severe pain and hematuria and is hardly able to ambulate into the physician's office. The physician suspects kidney stones and orders diagnostic tests to confirm. What test would physician order?

KUB Xray of kidney, ureters, bladder

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 R: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 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 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 nurse is preparing the procedure room for a client who will undergo an intravenous pyelogram. Which item(s) should the nurse include?

Suction equipment R:The contrast agent injected into the client for an intravenous pyelogram is allergenic and nephrotoxic. Emergency supplies and equipment should be readily available in case the client experiences an anaphylactic reaction, including airway and suction equipment, oxygen, epinephrine, corticosteroids, and vasopressors.

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

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 R: hypertension is a risk factor for kidney disease