Nurs. 107 Chapter 47: Assessment of Kidney and Urinary Function

The nurse is preparing the client for magnetic resonance imaging (MRI) of the kidney. Which statement by the client requires action by the nurse? A) "I took my blood pressure medication with my morning coffee an hour ago." B) "I had my last cigarette 3 hours ago with my morning coffee." C) "I did not take my multivitamin this morning." D) "I do not have a pacemaker, artificial heart valve, or artificial joints."

"A) I took my blood pressure medication with my morning coffee an hour ago." Explanation: The client should not eat for at least 1 hour before an MRI. Alcohol, caffeine-containing beverages, and smoking should be avoided for at least 2 hours before an MRI. The client can take his or her usual medications except for iron supplements prior to the procedure.

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

A) "Do you urinate while sleeping?" Explanation: 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 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 prevents urinary incontinence." C) "This medication will treat the blood in your urine." D) "This medication prevents infection in your urinary tract"

A) "This medication will relieve your pain." Explanation: 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."

A) "You don't need to do any fasting before this noninvasive test." Explanation: 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.

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) Assess peripheral pulses in the left leg. B) Assess for anaphylaxis. C) Place cool compresses on the calf. D) Exercise the leg and foot.

A) Assess peripheral pulses in the left leg. Explanation: 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.

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) Enable the client to sit up and ambulate. C) Distract the client's attention from the pain. D) Provide analgesics to the client.

A) Assess the patient's back and shoulder areas for signs of internal bleeding. Explanation: 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 Explanation: 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.

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? A) Decreased fluid intake B) Increased fluid intake C) Glomerulonephritis D) Diabetes insipidus

A) Decreased fluid intake Explanation: When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases. Disorders or conditions that cause decreased urine-specific gravity include diabetes insipidus, glomerulonephritis, and severe renal damage. Disorders that can cause increased specific gravity include diabetes, nephritis, and fluid deficit.

Diagnostic testing of an adult client reveals renal glycosuria. The nurse should recognize the need for the client to be assessed for what health problem? A) Diabetes insipidus B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) C) Diabetes mellitus D) Renal carcinoma

A) Diabetes mellitus Explanation: Renal glycosuria can occur on its own as a benign condition. It also occurs in poorly controlled diabetes, the most common condition that causes the blood glucose level to exceed the kidney's reabsorption capacity. Glycosuria is not associated with SIADH, diabetes insipidus, or renal carcinoma.

The nurse observes that the client's urine is orange. Which additional assessment would be important for this client? A) Intake of medication such as phenazopyridine hydrochloride B) Intake of multiple vitamin preparations C) Infection D) Bleeding

A) Intake of medication such as phenazopyridine hydrochloride Explanation: Urine that is orange may be caused by intake of phenazopyridine hydrochloride 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. Urine that is bright yellow is an anticipated abnormal finding in the client taking a multiple vitamin preparation. Yellow to milky white urine may indicate infection, pyuria, or, in the female client, the use of vaginal creams.

To obtain information about the chief complaint and medical history of an older client, the nurse asks the client about any medication history. Why is obtaining a medication history important? A) It may indicate drugs that should not be prescribed to the client. B) It may indicate multiple medications taken by the client. C) It may reflect the client's childhood and family illnesses. D) It may indicate the client's general health.

A) It may indicate multiple medications taken by the client. Explanation: The nurse should obtain information about a client's medication history because the older client, in particular, may be taking multiple medications that may affect their renal function. The medication history in general indicates the probable risk factors of renal or urologic disorders. The medication history of an older client is not used to obtain information about the client's general health, childhood and family illnesses, or drugs that are contraindicated for use by the client.

A client is undergoing a renal angiogram after a traumatic accident. What post-procedural assessments would the nurse perform on the client? Select all that apply. A) Monitor site condition. B) Palpates the pulses in the legs and feet. C) Administer an enema. D) Monitor hypersensitivity response. E) Apply a warm compress to site.

A) Monitor site condition. B) Palpates the pulses in the legs and feet. D) Monitor hypersensitivity response. Explanation: After the procedure, the healthcare provider applies a pressure dressing to the femoral area, which remains in place for several hours. The nurse palpates the pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Monitoring the pressure dressing is important to note frank bleeding or hematoma formation. If either condition occurs, the nurse immediately notifies the health care provider. Another important assessment is for hypersensitivity responses to contrast material. The nurse also monitors and documents intake and output. The client may have an enema pre procedure and application of a cold compress may reduce pain and swelling.

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.

A) Monitor the client for an allergy to iodine contrast material. Explanation: 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.

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? A) Mucosal B) Adventitia C) Detrusor D) Connective tissue

A) Mucosal Explanation: Beneath the detrusor is a submucosal layer of loose connective tissue that serves as an interface between the detrusor and the innermost layer, a mucosal lining. This inner layer contains specialized transitional cell epithelium, a membrane that is impermeable to water and prevents reabsorption of urine stored in the bladder.

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? A) On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. B) On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. C) When the kidneys are diseased, the ability to concentrate urine may be impaired, and the specific gravity may vary widely. D) 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.

A) On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. Explanation: Specific gravity is altered by the presence of blood, protein, and casts in the urine and is normally influenced primarily by hydration status. 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 of the following hormones is secreted by the juxtaglomerular apparatus? A) Renin B) Aldosterone C) Antidiuretic hormone (ADH) D) Calcitonin

A) Renin Explanation: 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) Protein 15 mg/dL D) Bright yellow urine

A) Specific gravity 1.035 Explanation: 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 multiple 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.

Which is an effect of aging on upper and lower urinary tract function? A) Susceptibility to develop hypernatremia B) Acid-base balance C) Increased blood flow to the kidney D) Increased glomerular filtration rate

A) Susceptibility to develop hypernatremia Explanation: The elderly are more susceptible to developing hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidney, and acid-base imbalances.

Which nursing assessment finding indicates the client has not met expected outcomes? A) The client voids 75 cc four hours post cystoscopy. B) The client reports a pain rating of 3 two hours post-kidney biopsy. C) The client has blood-tinged urine following brush biopsy. D) The client consumes 75% of lunch following an intravenous pyelogram.

A) The client voids 75 cc four hours post cystoscopy. Explanation: Urinary retention is an undesirable outcome following cystoscopy. A pain rating of 3 is an achievable and expected outcome following kidney biopsy. Blood-tinged urine is an expected finding following cystoscopy due to trauma of the procedure. A client would be expected to eat and retain a meal following an intravenous pyelogram.

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 Explanation: Oliguria is defined as urine output <0.5 mL/kg/h

A client is experiencing some renal secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed in urine? A) glucose B) chloride C) potassium D) creatinine

A) glucose Explanation: 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.

A client is having a blood urea nitrogen (BUN) test. BUN level is: A) increased in renal disease and urinary obstruction. B) decreased in nephrotic syndrome. C) decreased in renal disease and urinary obstruction. D) unchanged in renal disease.

A) increased in renal disease and urinary obstruction. Explanation: BUN is increased in renal disease and urinary obstruction.

A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 mL. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of: A) microorganism transfer. B) prostate irritation. C) client discomfort. D) incorrect urine output values.

A) microorganism transfer. Explanation: Bladder ultrasonic scanning, a noninvasive way of calculating the amount of urine in the bladder, reduces the risk of transferring microorganisms into the bladder. Use of a straight catheter to measure residual urine increases the transfer of microorganisms into the bladder, and increases, rather than reduces, client discomfort. A bladder ultrasonic scan doesn't reduce the risk of prostate irritation or incorrect urine output values.

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. Explanation: 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.

A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is: A) renal calculi. B) an overdistended bladder. C) interstitial cystitis. D) acute prostatitis.

A) renal calculi. Explanation: Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void. The client with acute prostatitis presents with a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria.

A client presents to the ED reporting left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The client has also experienced nausea and emesis. The nurse suspects the client is experiencing: A) Urethral infection. B) cystitis. C) pyelonephritis. D) ureteral stones.

A) ureteral stones. Explanation: The findings are constant with ureteral stones, edema or stricture, or a blood clot. The other answers do not apply.

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 multiple vitamin preparations?" C) "Do you take phenytoin daily?" D) "Have you had a recent urinary tract infection?"

B) "Do you take multiple vitamin preparations?" Explanation: 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.

The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions? A) "I should increase my fluid intake for the rest of the day." B) "I can resume my usual activities without restriction." C) "It is normal for my urine to be blood-tinged." D) "If I have difficulty urinating, I should contact my physician."

B) "I can resume my usual activities without restriction." Explanation: A bladder ultrasound is a non-invasive procedure. The client can resume usual activities without restriction.

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 Explanation: 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) Serum potassium level B) Creatinine clearance level C) Blood urea nitrogen level D) Uric acid level

B) Creatinine clearance level Explanation: 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.

Which substance stimulates the bone marrow to produce red blood cells? A) Renin B) Erythropoietin C) Prostacyclin D) Prostaglandin E

B) Erythropoietin Explanation: Erythropoietin stimulates the bone marrow to produce red blood cells, thereby increasing the amount of hemoglobin available to carry oxygen. The kidneys produce prostaglandin E and prostacyclin, which have vasodilatory effect and are important in maintaining renal blood flow. Renin is involved in controlling arterial blood pressure.

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? A) Decreased blood urea nitrogen (BUN) B) Increased serum albumin C) Increased serum creatinine D) Decreased potassium

B) Increased serum creatinine Explanation: In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.

The nurse recognizes that a referral for genetic counseling is inappropriate for the client with: A) Alport syndrome B) Renal calculi C) Polycystic kidney disease D) Wilms' tumor

B) Renal calculi Explanation: Wilms' tumor, polycystic disease, and Alport are conditions that have a genetic influence. Renal calculi are not influenced by genetic factors.

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? A) Glomerulus B) Renal pelvis C) Nephron D) Parenchyma

B) Renal pelvis Explanation: The renal pelvis empties into the ureter which carries urine to the bladder for storage. The nephron consists of the glomerulus, afferent arteriole, efferent arteriole, Bowman's capsule, distal and proximal convoluted tubules, the loop of Henle, and collecting tubule. The nephron is located in the cortex and carries out the functions of the kidney. The parenchyma is made up of the cortex and medulla.

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

B) Ureters Explanation: 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) Congestive heart failure B) Urinary incontinence C) Myocardial infarction D) Stroke

B) Urinary incontinence Explanation: Urinary incontinence is the most common reason for admission to skilled nursing facilities.

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: A) confirm which beverages the client normally consumes. B) confirm all of the medications and supplements normally taken. C) palpate the client's bladder before and after voiding. D) assess the client's usual intake of sodium.

B) confirm all of the medications and supplements normally taken. Explanation: Adverse effects of medications are a common cause of decreased renal function in older adults. Quantity, rather than type, of beverages is relevant. Sodium intake does not normally cause decreased renal function. Bladder palpation can be used to confirm urinary retention, but this does not normally affect renal function as much as medications.

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? A) stimulating RBC production B) excreting protein C) excreting nitrogen waste products D) regulating blood pressure

B) excreting protein Explanation: Although the kidneys excrete excess water and nitrogen-based waste products of protein metabolism, persistent renal excretion of protein is not the function of kidneys, which are in the state of homeostasis. The kidneys assist in maintenance of acid-base and electrolyte balance; produce the enzyme renin, which helps regulate blood pressure; and produce the hormone erythropoietin.

A client reports "bloody" urine to the nurse. What causes would the nurse relate the hematuria? Select all that apply. A) hypertension B) renal stones C) extreme exercise D) lithium toxicity E) acute glomerulonephritis

B) renal stones C) extreme exercise E) acute glomerulonephritis Explanation: Hematuria may be caused by cancer of the genitourinary tract, acute glomerulonephritis, renal stones, renal tuberculosis, blood dyscrasias, trauma, extreme exercise, rheumatic fever, hemophilia, leukemia, or sickle cell trait or disease. Lithium toxicity and hypertension are not related causes of hematuria.

The nurse is completing a full exam of the client's renal system. Which assessment finding best documents the need to offer the use of the bathroom? A) Tenderness over the kidneys B) Bruits noted over the abdominal area C) A dull sound when percussing over the bladder D) The ingestion of 8 oz of water

C) A dull sound when percussing over the bladder Explanation: A dull sound when percussing over the bladder indicates a full bladder. Because the bladder is full, the nurse would offer for the client to use the bathroom. Tenderness over the kidney can indicate an infection or stones. Bruits are an abnormal vascular sound that does not indicate the need to use the bathroom. Ingesting water does not mean that the client has to void at this time.

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. Explanation: 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 client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? A) Perineal pain B) Suprapubic pain C) Costovertebral angle tenderness D) Pain after voiding

C) Costovertebral angle tenderness Explanation: Acute pyelonephritis is characterized by costovertebral angle tenderness. Suprapubic pain is suggestive of bladder distention or infection. Urethral trauma and irritation of the bladder neck can cause pain after voiding. Perineal pain is experienced by male clients with prostate cancer or prostatitis.

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? A) Blood urea nitrogen B) Osmolality C) Creatinine D) Hemoglobin

C) Creatinine Explanation: To calculate creatinine clearance, a 24-hour urine specimen is collected. The serum creatinine concentration is measured midway through the collection. The other concentrations are not measured during this test.

The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition? A) Submucosal layer of connective tissue B) Adventitia (connective tissue) C) Detrusor muscle D) Inner layer of epithelium

C) Detrusor muscle Explanation: The bladder wall contains four layers. The smooth muscle layer beneath the adventitia is known as the detrusor layer. When this muscle contracts, urine is released from the bladder. When the bladder is relaxed, the muscle fibers are closed and act as a sphincter.

A client has a full bladder. Which sound would the nurse expect to hear on percussion? A) Resonance B) Tympany C) Dullness D) Flatness

C) Dullness Explanation: Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very dense tissue, such as the bone or muscle.

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

C) Infection Explanation: 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 Explanation: 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 nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: A) Bright yellow urine B) Protein 15 mg/dL C) Specific gravity 1.035 D) Creatinine 0.7 mg/dL

C) Specific gravity 1.035 Explanation: 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 multiple 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.

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. Explanation: 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.

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? A) 4:1 B) 6:1 C) 8:1 D) 10:1

D) 10:1 Explanation: A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect.

A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? A) At 8:00 am, with or without a specimen B) With the first specimen voided after 8:00 am C) 6 hours after the urine is discarded D) After discarding the 8:00 am specimen

D) After discarding the 8:00 am specimen Explanation: A 24-hour collection of urine is the primary test of renal clearance used to evaluate how well the kidney performs this important excretory function. The client is initially instructed to void and discard the urine. The collection bottle is marked with the time the client voided. Thereafter, all the urine is collected for the entire 24 hours. The last urine is voided at the same time the test originally began.

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? A) Proteinuria B) Kidney stone formation C) Neurogenic bladder D) Chronic kidney disease

D) Chronic kidney disease Explanation: A history of sickle cell anemia predisposes the client to the development of chronic kidney disease. The other disorders are not associated with the development of sickle cell anemia.

The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? A) Perineal pain B) Pain after voiding C) Suprapubic pain D) Costovertebral angle tenderness

D) Costovertebral angle tenderness Explanation: Acute pyelonephritis is characterized by costovertebral angle tenderness. Suprapubic pain is suggestive of bladder distention or infection. Urethral trauma and irritation of the bladder neck can cause pain after voiding. Perineal pain is experienced by male clients with prostate cancer or prostatitis.

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) Red urine B) Turbid urine C) Clear or light yellow urine D) Dark amber urine

D) Dark amber urine Explanation: 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.

A client with a history of incontinence will undergo urodynamic testing in the health care provider's office. Because voiding in the presence of others can cause situational anxiety, the nurse should perform what action? A) Administer diuretics as prescribed. B) Push fluids for several hours prior to the test. C) Discuss possible test results as the client voids. D) Help the client to relax before and during the test.

D) Help the client to relax before and during the test. Explanation: Voiding in the presence of others can frequently cause guarding, a natural reflex that inhibits voiding due to situational anxiety. Because the outcomes of these studies determine the plan of care, the nurse must help the client relax by providing as much privacy and explanation about the procedure as possible. Diuretics and increased fluid intake would not address the client's anxiety. It would be inappropriate and anxiety-provoking to discuss test results during the performance of the test.

Which is an effect of aging on upper and lower urinary tract function? A) Increased glomerular filtration rate B) Acid-base balance C) Increased blood flow to the kidneys D) More prone to develop hypernatremia

D) More prone to develop hypernatremia Explanation: The elderly are more prone to develop hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidneys, and acid-base imbalances.

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 Explanation: 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 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? A) Provide ondansetron intravenously. B) Repeat the portable bladder ultrasound. C) Place a urinary cathether. D) Provide intravenous hydromorphone.

Place a urinary cathether. Explanation: Increased urinary urgency and frequency coupled with decreasing urine volume strongly suggest urinary retention depending on the acuity of the onset of the symptoms, immediate bladder emptying via catheterization and evaluation may be necessary to prevent kidney dysfunction. The combination of pain, sudden oliguria, nausea, vomiting and post-ressidual results are suggestive of an acute condition. Therefore, a second bladder scan is not warranted and may delay care. The pain, nausea, and vomiting may be the result of urinary retention and a full bladder. Placement of a urinary cathether may alleviate those conditions. After placing the urinary cathether, a reassessment and treatment of those conditions can occur.