the point chapter 53 renal/urinary function

A nurse measures a patient's urinary output every 8 hours. The nurse weighs the importance of these results by comparing the normal 24-hour urinary output with the patient's condition and medication. The normal 24-hour output should be:

1 to 2 L/day Explanation: The normal output of urine every 24 hours is 800 to 1,500 mL. The significance of the 24-hour result will depend on the patient's medical condition.

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 Explanation: Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries.

The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find?

Costovertebal angle tenderness

The nurse observes that the client's urine is orange. Which additional assessment would be important for this client?

Intake of medication such as phenytoin Explanation: 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.

Frequency, urgency, and dysuria are commonly associated with

UTI

Urine that is bright yellow is an anticipated abnormal finding in the client taking

a multiple vitamin preparation.

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.

Anuria is:

a total urine output less than 50 mL in 24 hours.

Oliguria or anuria and proteinuria might suggest

acute renal failure

Suprapubic pain is suggestive of

bladder distention or infection

A CT scan is useful in identifying

calculi, congenital abnormalities, obstruction, infections, and polycystic diseases.

The client with diabetes mellitus is a risk factor for developing

chronic renal failure and neurogenic bladder.

Disorders or conditions that cause decreased urine-specific gravity include

diabetes insipidus, glomerulonephritis, and severe renal damage.

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. Explanation: After the procedure is completed, the client is encouraged to drink fluids to promote excretion of the radioisotope by the kidneys

When the bladder contains 400 to 500 mL of urine, this is referred to as:

functional capacity.

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

Urine that is pink to red may indicate

lower urinary tract bleeding.

Nocturia is associated with

nephrotic syndrome

Urethral trauma and irritation of the bladder neck can cause

pain after voiding

Yellow to milky white urine may indicate

pyuria, infection, vaginal cream

Renal clearance refers to

the ability of the kidneys to clear solutes from the plasma.

The lower urinary tract consists of

the bladder, urethra, and pelvic floor muscles.

A client with radiation to the pelvis is at risk for

urinary tract fistula.

The filtrate that is secreted as urine usually contains

water, sodium, chloride, bicarbonate, potassium, urea, creatinine, and uric acid.

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?"

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 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 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 Explanation: Renal biopsy carries the risk of post procedure 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.

Which value does the nurse recognize as the best clinical measure of renal function?

Creatinine clearance Explanation: 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.

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. 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.

Retention of which electrolyte is the most life-threatening effect of renal failure?

Potassium

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?

Pruritus 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 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 Usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor.

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

The most frequent reason for admission to skilled care facilities is?

Urinary incontinence

The client with acute prostatitis presents with:

a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria.

Hesitancy and enuresis may indicate

an obstruction

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.

Disorders that can cause increased specific gravity include

diabetes, nephritis, and fluid deficit.

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. 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.

Perineal pain is experienced by male clients with

prostate cancer or prostatitis.

Cystoscopy is used for

providing a visual examination of the internal bladder.

When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity remains

relatively constant.

A client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. What postprocedural assessment will the nurse perform on the client?

After the procedure, the physician 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 physician. Another important assessment is for hypersensitivity responses to contrast material. The client remains on bed rest for 4 to 8 hours. The nurse also monitors and documents intake and output.

Nephrotoxicity can occur as a result of the use of aminoglycosides such as gentamicin. Why?

Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity. Signs of nephrotoxicity may not occur until the client has received 5 or more days of therapy. Nephrotoxicity from the use of the aminoglycosides is reversible if the drug is discontinued as soon as the symptoms appear.

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. 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.

A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse?

Asses the patient's back and shoulder areas for signs of internal bleeding. Explanation: After a renal biopsy, the patient is on bed rest. It is important to assess the dressing frequently for signs of bleeding 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. Distracting the patient's attention, helping the patient to sit up or ambulate, and providing analgesics may only aggravate the patient's pain and, therefore, should not be performed by the nurse.

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?

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.

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:

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.

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." Explanation: A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected.

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."

Which intervention would the nurse expect to implement following urologic endoscopy? Select all that apply.

Administer an antispasmodic agent. Provide privacy to promote bladder emptying. Explanation: The nurse would expect to administer an antispasmodic agent, such as flavoxate (Urispas), and provide privacy to promote bladder emptying. The nurse verifies the client's understanding prior to the procedure. Assisting with coughing and deep breathing and teaching leg exercises and range of motion are not specific interventions post-urologic endoscopy.

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

Dullness Explanation: Dullness on percussion indicates a full bladder; tympany indicates an empty bladder.

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

What is enuresis?

the involuntary voiding during sleep or commonly called "wetting the bed," is a normal finding in a pediatric client younger than 5 years old.

The upper urinary tract is composed of

the kidneys, renal pelvis, and ureters.

Renal angiography involves

the passage of a catheter up the femoral artery into the aorta to the level of the renal vessels.

Cystoscopy is

the visual examination of the inside of the bladder using an instrument called a cystoscope, a lighted tube with a telescopic lens.

Specific gravity reflects

the weight of particles dissolved in the urine