NURS 405 Tests of Renal Function

A kidney biopsy has been scheduled for a client with a history of acute kidney injury. The client asks the nurse why this test has been scheduled. What is the nurse's best response? "A biopsy is routinely ordered for all clients with renal disorders." "A biopsy is generally ordered following abnormal x-ray findings of the renal pelvis." "A biopsy is often ordered for clients before they have a kidney transplant." "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."

"A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease." Explanation: Biopsy of the kidney is used in diagnosing and evaluating the extent of kidney disease. Indications for biopsy include unexplained acute kidney injury, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.

A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client? "An x-ray will be done to view your kidneys, ureters, and bladder." "A contrast medium will be used to help see the structures better." "You don't need to do any fasting before this noninvasive test." "You'll have a pressure dressing on your groin after the test."

"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.

Nursing interventions after renal angiography

- After the procedure, vital signs are monitored until stable. - If the axillary artery was the injection site, blood pressure measurements are taken on the opposite arm. - The injection site is examined for swelling and hematoma. - Peripheral pulses are palpated, and the color and temperature of the involved extremity are noted and compared with those of the uninvolved extremity. - Cold compresses may be applied to the injection site to decrease edema and pain.

Preparation for renal angiography

- a laxative may be prescribed to evacuate the colon so that unobstructed x-rays can be obtained. - Injection sites (groin for femoral approach or axilla for axillary approach) may be shaved. - The peripheral pulse sites (radial, femoral, and dorsalis pedis) are marked for easy access during postprocedural assessment

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

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 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? Renal angiography Intravenous pyelography Excretory urogram Cystoscopy

Cystoscopy Explanation: 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.

Creatinine clearance

Detects and evaluates progression of kidney disease. Test measures volume of blood cleared of endogenous creatinine in 1 minute, which provides an approximation of the glomerular filtration rate. Sensitive indicator of kidney disease used to follow progression of kidney disease.

An appropriate nursing intervention for the client following a nuclear scan of the kidney is to: Encourage high fluid intake. Strain all urine for 48 hours. Apply moist heat to the flank area. Monitor for hematuria.

Encourage high fluid intake. Explanation: A nuclear scan of the kidney involves the IV administration of a radioisotope. Fluid intake is encouraged to flush the urinary tract to promote excretion of the isotope. Monitoring for hematuria, applying heat, and straining urine do not address the potential renal complications associated with the radioisotope.

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

Encourage high fluid intake. Explanation: 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.

BUN-to-creatinine ratio

Evaluates hydration status. An elevated ratio is seen in hypovolemia; a normal ratio with an elevated BUN and creatinine is seen with intrinsic kidney disease.

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

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.

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? Increased alertness Hypoventilation Pruritus Unusually smooth skin

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.

A client has just completed a renal biopsy. Which manifestation should be given priority attention? The sterile dressing needs changing. The child is still. The child is not voiding. The child is sleeping.

The child is not voiding. Explanation: The presence of voiding is a priority after a renal biopsy to prevent blood clotting and blocked urine flow. The other choices are not of a priority nature.

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

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

Voiding cystogram

The cystoscope, which is inserted through the urethra into the bladder, has an optical lens system that provides a magnified, illuminated view of the bladder

What care should be provided after a nuclear scan?

The patient is encouraged to drink fluids to promote excretion of the radioisotope by the kidneys.

Preparation for ultrasonography

Ultrasonography requires a full bladder; therefore, fluid intake is encouraged before the procedure.

Voiding Cystourethrography

a diagnostic procedure in which a fluoroscope is used to examine the flow of urine from the bladder and through the urethra

Cystography

a radiographic examination of the bladder after instillation of a contrast medium via a urethral catheter

A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should: keep the client's knee on the affected side bent for 6 hours. apply pressure to the puncture site for 30 minutes. check the client's pedal pulses frequently. remove the dressing on the puncture site after vital signs stabilize.

check the client's pedal pulses frequently. Explanation: After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the client's knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse should leave this dressing in place for several hours — and only remove it if instructed to do so.

Possible complications of retrograde pyelography

infection, hematuria, and perforation of the ureter

Intravenous urography indications

may be used as the initial assessment of many suspected urologic conditions, especially lesions in the kidneys and ureters. It also provides an approximate estimate of renal function.

Retrograde Pyelography

radiographic imaging in which a contrast medium is introduced through a cystoscope directly into the bladder and ureters using small-caliber catheters usually performed if IV urography provides inadequate visualization of the collecting systems.

Nuclear scans

require injection of a radioisotope (a technetium 99m-labeled compound or iodine 123 [123I] hippurate) into the circulatory system; the isotope is then monitored as it moves through the blood vessels of the kidneys.

Intravenous Urography

the radiographic visualization of the urinary tract with the use of a contrast medium A radiopaque contrast agent is given IV. An IVP shows the kidneys, ureter, and bladder via x-ray imaging as the dye moves through the upper and then the lower urinary syste

Indications for bladder ultrasonography

urinary frequency, inability to void after removal of an indwelling urinary catheter, measurement of postvoiding residual urine volume, inability to void postoperatively, or assessment of the need for catheterization during the initial stages of an intermittent catheterization training program.

Nuclear scan indications

used to evaluate acute and chronic kidney injury, renal masses, and blood flow before and after kidney transplantation. evaluates GFR

Renal angiography indications

used to evaluate renal blood flow in suspected renal trauma, to differentiate renal cysts from tumors, and to evaluate hypertension. It is used preoperatively for renal transplantation.

Renal Angiography

x-ray examination (with contrast) of the blood vessels of the kidney provides an image of the renal arteries. The femoral (or axillary) artery is pierced with a needle, and a catheter is threaded up through the femoral and iliac arteries into the aorta or renal artery. A contrast agent is injected to opacify the renal arterial supply.