Prepu - Chapter 53: 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? "I did not take my multivitamin this morning." "I took my blood pressure medication with my morning coffee an hour ago." "I do not have a pacemaker, artificial heart valve, or artificial joints." "I had my last cigarette 3 hours ago with my morning coffee."

"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.

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

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? 250 mL 50 mL 150 mL 350 mL

150 mL Explanation: 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.

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? 20% 30% 40% 50%

50%

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

A dull sound when percussing over the bladder

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

After discarding the 8:00 am specimen

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

Angiography

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? Enable the client to sit up and ambulate. Provide analgesics to the client. Assess the patient's back and shoulder areas for signs of internal bleeding. Distract the client's attention from the pain.

Assess the patient's back and shoulder areas for signs of internal bleeding.

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? Dehydration Allergic reaction Infection Bleeding

Bleeding

The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client assess for an allergy to shellfish? Cystoscopy Bladder ultrasonography Radiography Computed tomography with contrast

Computed tomography with contrast

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

Detrusor muscle

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

Encourage high fluid intake.

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: Strain all urine for 48 hours. Monitor for hematuria. Encourage high fluid intake. Apply moist heat to the flank area.

Encourage high fluid intake.

The nurse is instructing a 3-year-old's mother regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as a normal finding for this age group? Anuria Dysuria Hematuria Enuresis

Enuresis

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

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? Chronic renal failure Fistula Kidney stones Neurogenic bladder

Kidney stones

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. Assess the client's mental changes. Monitor the client for signs of electrolyte and water imbalance. Evaluate the client for periorbital edema.

Monitor the client for an allergy to iodine contrast material.

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

More prone to develop hypernatremia

A creatinine level has been ordered. The nurse prepares to: Obtain a clean catch urine. Collect the client's urine for 24 hours. Straight cath for a specimen. Obtain a blood specimen.

Obtain a blood specimen.

Which nursing assessment finding indicates the client has not met expected outcomes? 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. The client reports a pain rating of 3 two hours post-kidney biopsy.

The client voids 75 cc four hours post cystoscopy.

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 average kidney is approximately 5 cm (2 in.) long and 2 to 3 cm (0.8 to 1.2 in.) wide. The left kidney usually is slightly higher than the right one. The kidneys lie between the 10th and 12th thoracic vertebrae. The kidneys are situated just above the adrenal glands.

The left kidney usually is slightly higher than the right one.

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? When the urine output is about 100 mL/h When the urine output is less than 30 mL/h When the urine output is between 300 and 500 mL/h When the urine output is between 500 and 1,000 mL/h

When the urine output is less than 30 mL/h

When the bladder contains 400 to 500 mL of urine, this is referred to as renal clearance. functional capacity. anuria. specific gravity.

functional capacity.

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

increased in renal disease and urinary obstruction.

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: renal calculi. an overdistended bladder. interstitial cystitis. acute prostatitis.

renal calculi. Explanation: Renal calculi usually presents as a dull, constant ache at the costovertebral angle.

In a diagnosis of an upper urinary tract infection, which structures could be affected? Select all that apply. ureter bladder urethra kidney

ureter kidney

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. confirm which beverages the client normally consumes. assess the client's usual intake of sodium. palpate the client's bladder before and after voiding.

confirm all of the medications and supplements normally taken.

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

"Do you urinate while sleeping?"

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? 4:1 6:1 8:1 10:1

10:1

When fluid intake is normal, the specific gravity of urine should be: 1.000 Less than 1.010 Greater than 1.025 1.010 to 1.025

1.010 to 1.025

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? 10 20 30 40

20

A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? glucose potassium creatinine chloride

glucose

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

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 Hemoglobin Osmolality Blood urea nitrogen

Creatinine

In which of the following renal disorders would one suspect a decreased urine specific gravity? Select all that apply Glomerulonephritis Fluid deficits Severe renal damage Diabetes Diabetes insipidus

Diabetes insipidus Glomerulonephritis Severe renal damage

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

Dullness

hich term best describes a total urine output less than 500 mL in 24 hours? Nocturia Dysuria Oliguria Polyuria

Oliguria Explanation: Oliguria is a urine output less than 500 mL in 24 hours. Polyuria is increased urine output. Nocturia is awakening at night to urinate. Dysuria is painful or difficult urination.

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 Glomerulus Parenchyma Nephron

Renal pelvis Explanation: The renal pelvis empties into the ureter which carries urine to the bladder for storage.

The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure? Albumin Renin Cortisol Vasopressin

Renin

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 Above the symphysis pubis The upper abdominal quadrants on the left and right side Around the umbilicus

The costovertebral angle

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 Bladder Pelvic floor muscles Urethra SUBMIT ANSWER

Ureters

The most frequent reason for admission to skilled care facilities includes which of the following? Stroke Urinary incontinence Myocardial infarction Congestive heart failure

Urinary incontinence

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: apply pressure to the puncture site for 30 minutes. remove the dressing on the puncture site after vital signs stabilize. keep the client's knee on the affected side bent for 6 hours. check the client's pedal pulses frequently.

check the client's pedal pulses frequently.

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? "Have you had a recent urinary tract infection?" "Do you take phenytoin daily?" "Do you take multiple vitamin preparations?" "Have you noticed any vaginal bleeding?"

"Do you take multiple vitamin preparations?"

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." "I should remove all jewelry before the test." "I will need to drink all of the dye as quickly as possible." "I should let the staff know if I feel claustrophobic."

"I will feel a warm sensation as the dye is injected."

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

"You don't need to do any fasting before this noninvasive test."

The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable? Clients have frequent urinary tract infections. Clients develop a neurogenic bladder. Clients have urinary frequency. Clients have chronic renal failure.

Clients have chronic renal failure.

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? Excretory urogram Renal angiography Intravenous pyelography Cystoscopy

Cystoscopy

Retention of which electrolyte is the most life-threatening effect of renal failure? Potassium Sodium Calcium Phosphorous

Potassium

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: microorganism transfer. client discomfort. incorrect urine output values. prostate irritation.

microorganism transfer.

The term used to describe total urine output less than 0.5 mL/kg/hour is anuria. dysuria. oliguria. nocturia.

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 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? Serum potassium level Blood urea nitrogen level Creatinine clearance level Uric acid level

Creatinine clearance level

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? Uric acid level BUN to creatinine ratio Creatinine clearance level Blood urea nitrogen (BUN)

Creatinine clearance level

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

Decreased fluid intake

Which of the following hormones is secreted by the juxtaglomerular apparatus? Calcitonin Antidiuretic hormone (ADH) Aldosterone Renin

Renin

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 Proteinuria Neurogenic bladder Kidney stone formation

Chronic kidney disease

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? GI absorption rate Therapeutic index Creatinine clearance Liver function studies

Creatinine clearance

Which value does the nurse recognize as the best clinical measure of renal function? Creatinine clearance Volume of urine output Urine-specific gravity Circulating ADH concentration

Creatinine clearance

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? Unusually smooth skin Increased alertness Hypoventilation Pruritus

Pruritus

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 nitrogen waste products regulating blood pressure stimulating RBC production excreting protein

excreting protein

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 Increased serum albumin Decreased blood urea nitrogen (BUN) Decreased potassium

Increased serum creatinine

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

Infection

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? Activity as tolerated Ambulate the client in the hall Maintain the client on bedrest Assist the client for bathroom privileges

Maintain the client on bedrest

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

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.

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

Specific gravity 1.035 Explanation: Specific gravity is reflective of hydration status.