Flashcards in Ch 53 Assessment of Kidney and Urinary Function Deck (40)
The care team is considering the use of dialysis in a patient whose renal function is progressively declining. Renal replacement therapy is indicated in which of the following situations?
A) When the patient's creatinine level drops below 1.2 mg/dL (110 mmol/L)
B) When the patient's blood urea nitrogen (BUN) is above 15 mg/dL
C) When approximately 40% of nephrons are not functioning
D) When about 80% of the nephrons are no longer functioning
When the total number of functioning nephrons is less than 20%, renal replacement
therapy needs to be considered. Dialysis is an example of a renal replacement therapy. Prior to the loss of about 80% of the nephron functioning ability, the patient may have mild symptoms of compromised renal function, but symptom management is often obtained through dietary modifications and drug therapy. The listed creatinine and BUN levels are within reference ranges.
A nurse knows that specific areas in the ureters have a propensity for obstruction.
Prompt management of renal calculi is most important when the stone is located where?
A) In the ureteropelvic junction
B) In the ureteral segment near the sacroiliac junction
C) In the ureterovesical junction
D) In the urethra
The three narrowed areas of each ureter are the ureteropelvic junction, the ureteral
segment near the sacroiliac junction, and the ureterovescial junction. These three areas of the ureters have a propensity for obstruction by renal calculi or stricture. Obstruction of the ureteropelvic junction is most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction. The urethra is not part of the ureter.
A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has been ordered. The nurse should facilitate collection of what samples?
A) A fasting serum potassium level and a random urine sample
B) A 24-hour urine specimen and a serum creatinine level midway through the urine
C) A BUN and serum creatinine level on three consecutive mornings
D) A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values
To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection, the serum creatinine level is measured.
The nurse is assessing a patient's bladder by percussion. The nurse elicits dullness after the patient has voided. How should the nurse interpret this assessment finding?
A) The patient's bladder is not completely empty.
B) The patient has kidney enlargement.
C) The patient has a ureteral obstruction.
D) The patient has a fluid volume deficit.
Dullness to percussion of the bladder following voiding indicates incomplete bladder emptying. Enlargement of the kidneys can be attributed to numerous conditions such as polycystic kidney disease or hydronephrosis and is not related to bladder fullness. Dehydration and ureteral obstruction are not related to bladder fullness; in fact, these conditions result in decreased flow of urine to the bladder.
The nurse is providing pre-procedure teaching about an ultrasound. The nurse informs the patient that in preparation for an ultrasound of the lower urinary tract the patient will require what?
A) Increased fluid intake to produce a full bladder
B) IV administration of radiopaque contrast agent
C) Sedation and intubation
D) Injection of a radioisotope
Ultrasonography requires a full bladder; therefore, fluid intake should be encouraged before the procedures. The administration of a radiopaque contrast agent is required to perform IV urography studies, such as an IV pyelogram. Ultrasonography is a quick
and painless diagnostic test and does not require sedation or intubation. The injection of
a radioisotope is required for nuclear scan and ultrasonography is not in this category of diagnostic studies.
The nurse is caring for a patient who has a fluid volume deficit. When evaluating this patient's urinalysis results, what should the nurse anticipate?
A) A fluctuating urine specific gravity
B) A fixed urine specific gravity
C) A decreased urine specific gravity
D) An increased urine specific gravity
Urine specific gravity depends largely on hydration status. A decrease in fluid intake will lead to an increase in the urine specific gravity. With high fluid intake, specific gravity decreases. In patients with kidney disease, urine specific gravity does not vary with fluid intake, and the patient's urine is said to have a fixed specific gravity.
A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse should be aware of what age-related change affecting the renal or urinary system?
A) Increased ability to concentrate urine
B) Increased bladder capacity
C) Urinary incontinence
D) Decreased glomerular filtration rate
Many age-related changes in the renal and urinary systems should be taken into
consideration when taking a health history of the older adult. One change includes a decreased glomerular surface area resulting in a decreased glomerular filtration rate. Other changes include the decreased ability to concentrate urine and a decreased bladder capacity. It also should be understood that urinary incontinence is not a normal age-related change, but is common in older adults, especially in women because of the loss of pelvic muscle tone.
A nurse is preparing a patient diagnosed with benign prostatic hypertrophy (BPH) for a lower urinary tract cystoscopic examination. The nurse informs the patient that the most common temporary complication experienced after this procedure is what?
A) Urinary retention
B) Bladder perforation
Ans: A Feedback:
After a cystoscopic examination, the patient with obstructive pathology may experience
urine retention if the instruments used during the examination caused edema. The nurse will carefully monitor the patient with prostatic hyperplasia for urine retention. Post- procedure, the patient will experience some hematuria, but is not at great risk for hemorrhage. Unless the condition is associated with another disorder, nausea is not commonly associated with this diagnostic study. Bladder perforation is rare.
A patient with renal failure secondary to diabetic nephropathy has been admitted to the medical unit. What is the most life-threatening effect of renal failure for which the nurse should monitor the patient?
A) Accumulation of wastes
B) Retention of potassium
C) Depletion of calcium
D) Lack of BP control
Retention of potassium is the most life-threatening effect of renal failure.
Aldosterone causes the kidney to excrete potassium, in contrast to aldosterone's effects on sodium described previously. Acidñbase balance, the amount of dietary potassium intake, and the flow rate of the filtrate in the distal tubule also influence the amount of potassium secreted into the urine. Hypocalcemia, the accumulation of wastes, and lack of BP control are complications associated with renal failure, but do not have same level of threat to the patient's well-being as hyperkalemia.
A kidney biopsy has been scheduled for a patient with a history of acute renal failure.
The patient asks the nurse why this test has been scheduled. What is the nurse's best
A) A biopsy is routinely ordered for all patients with renal disorders.
B) A biopsy is generally ordered following abnormal x-ray findings of the renal pelvis.
C) A biopsy is often ordered for patients before they have a kidney transplant.
D) A biopsy is sometimes necessary for diagnosing and evaluating the extent of
Biopsy of the kidney is used in diagnosing and evaluating the extent of kidney disease.
Indications for biopsy include unexplained acute renal failure, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.
The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, the nurse interprets the presence of which substances in the urine as most suggestive of pathology?
A) Potassium and sodium
B) Bicarbonate and urea
C) Glucose and protein
D) Creatinine and chloride
The various substances normally filtered by the glomerulus, reabsorbed by the tubules,
and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that it is not excreted in the urine.
The nurse caring for a patient with suspected renal dysfunction calculates that the patient's weight has increased by 5 pounds in the past 24 hours. The nurse estimates that the patient has retained approximately how much fluid?
A) 1,300 mL of fluid in 24 hours
B) 2,300 mL of fluid in 24 hours
C) 3,100 mL of fluid in 24 hours
D) 5,000 mL of fluid in 24 hours
An increase in body weight commonly accompanies edema. To calculate the
approximate weight gain from fluid retention, remember that 1 kg of weight gain equals approximately 1,000 mL of fluid. Five lbs = 2.27 kg = 2,270 mL.
The nurse is performing a focused genitourinary and renal assessment of a patient.
Where should the nurse assess for pain at the costovertebral angle?
A) At the umbilicus and the right lower quadrant of the abdomen
B) At the suprapubic region and the umbilicus
C) At the lower border of the 12th rib and the spine
D) At the 7th rib and the xyphoid process
The costovertebral angle is the angle formed by the lower border of the 12th rib and the spine. Renal dysfunction may produce tenderness over the costovertebral angle.
The staff educator is giving a class for a group of nurses new to the renal unit. The educator is discussing renal biopsies. In what patient would the educator tell the new nurses that renal biopsies are contraindicated?
A) A 64-year-old patient with chronic glomerulonephritis
B) A 57-year-old patient with proteinuria
C) A 42-year-old patient with morbid obesity
D) A 16-year-old patient with signs of kidney transplant rejection
There are several contraindications to a kidney biopsy, including bleeding tendencies,
uncontrolled hypertension, a solitary kidney, and morbid obesity. Indications for a renal biopsy include unexplained acute renal failure, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.
The nurse is caring for a patient who describes changes in his voiding patterns. The patient states, "I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesn't seem to be a great deal of urine flow." What would the nurse expect this patient's physical assessment to reveal?
B) Urine retention
D) Renal failure
Increased urinary urgency and frequency coupled with decreasing urine volumes strongly suggest urine retention. Hematuria may be an accompanying symptom, but is likely related to a urinary tract infection secondary to the retention of urine. Dehydration and renal failure both result in a decrease in urine output, but the patient with these conditions does not have normal urine production and decreased or minimal flow of urine to the bladder. The symptoms of urgency and frequency do not accompany renal failure and dehydration due to decreased urine production.
The nurse is caring for a patient with a nursing diagnosis of deficient fluid volume. The nurse's assessment reveals a BP of 98/52 mm Hg. The nurse should recognize that the patient's kidneys will compensate by secreting what substance?
A) Antidiuretic hormone (ADH)
Ans: C Feedback:
When the vasa recta detect a decrease in BP, specialized juxtaglomerular cells near the
afferent arteriole, distal tubule, and efferent arteriole secrete the hormone renin. Renin converts angiotensinogen to angiotensin I, which is then converted to angiotensin II. The vasoconstriction causes the BP to increase. The adrenal cortex secretes aldosterone in response to stimulation by the pituitary gland, which in turn is in response to poor perfusion or increasing serum osmolality. The result is an increase in BP.
A nurse is caring for a 73-year-old patient with a urethral obstruction related to prostatic enlargement. When planning this patient's care, the nurse should be aware of the consequent risk of what complication?
A) Urinary tract infection
An obstruction of the bladder outlet, such as in advanced benign prostatic hyperplasia, results in abnormally high voiding pressure with a slow, prolonged flow of urine. The urine may remain in the bladder, which increases the potential of a urinary tract infection. Older male patients are at risk for prostatic enlargement, which causes urethral obstruction and can result in hydronephrosis, renal failure, and urinary tract infections.
A patient with elevated BUN and creatinine values has been referred by her primary physician for further evaluation. The nurse should anticipate the use of what initial diagnostic test?
C) Computed tomography (CT)
D) Nuclear scan
Ultrasonography is a noninvasive procedure that passes sound waves into the body
through a transducer to detect abnormalities of internal tissues and organs. Structures of the urinary system create characteristic ultrasonographic images. Because of its sensitivity, ultrasonography has replaced many other diagnostic tests as the initial diagnostic procedure.
A patient admitted to the medical unit with impaired renal function is complaining of severe, stabbing pain in the flank and lower abdomen. The patient is being assessed for renal calculi. The nurse recognizes that the stone is most likely in what anatomic location?
Ans: C Feedback:
Ureteral pain is characterized as a dull continuous pain that may be intense with voiding. The pain may be described as sharp or stabbing if the bladder is full. This type of pain is inconsistent with a stone being present in the bladder. Stones are not normally situated in the urethra or meatus.
The nurse is caring for a patient who had a brush biopsy 12 hours ago. The presence of what assessment finding should prompt the nurse to notify the physician?
A) Scant hematuria
B) Renal colic
C) Temperature 100.2∞F orally
D) Infiltration of the patient's intravenous catheter
Hematuria and renal colic are common and expected findings after the performance of a renal brush biopsy. The physician should be notified of the patient's body temperature, which likely indicates the onset of an infectious process. IV infiltration does not
warrant notification of the primary care physician.
A patient with recurrent urinary tract infections has just undergone a cystoscopy and complains of slight hematuria during the first void after the procedure. What is the nurse's most appropriate action?
A) Administer a STAT dose of vitamin K, as ordered.
B) Reassure the patient that this is not unexpected and then monitor the patient for further bleeding.
C) Promptly inform the physician of this assessment finding.
D) Position the patient supine and insert a Foley catheter, as ordered.
Some burning on voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected after cystoscopy. The nurse should explain this to the patient and ensure that the bleeding resolves. No clear need exists to report this finding and it does not warrant insertion of a Foley catheter or vitamin K
A patient is complaining of genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform?
A) Encourage mobilization.
B) Apply topical lidocaine to the patient's meatus, as ordered.
C) Apply moist heat to the patient's lower abdomen.
D) Apply an ice pack to the patient's perineum.
Following cystoscopy, moist heat to the lower abdomen and warm sitz baths are helpful
in relieving pain and relaxing the muscles. Ice, lidocaine, and mobilization are not recommended interventions.
The nurse is caring for a patient who is going to have an open renal biopsy. What would be an important nursing action in preparing this patient for the procedure?
A) Discuss the patient's diagnosis with the family.
B) Bathe the patient before the procedure with antiseptic skin wash.
C) Administer antivirals before sending the patient for the procedure.
D) Keep the patient NPO prior to the procedure.
Preparation for an open biopsy is similar to that for any major abdominal surgery. When preparing the patient for an open biopsy you would keep the patient NPO. You may discuss the diagnosis with the family, but that is not a preparation for the procedure. A pre-procedure wash is not normally ordered and antivirals are not administered in anticipation of a biopsy.
The nurse is caring for a patient scheduled for renal angiography following a motor vehicle accident. What patient preparation should the nurse most likely provide before this test?
A) Administration of IV potassium chloride
B) Administration of a laxative
C) Administration of Gastrografin
D) Administration of a 24-hour urine test
Before the procedure, a laxative may be prescribed to evacuate the colon so that
unobstructed x-rays can be obtained. A 24-hour urine test is not necessary prior to the procedure. Gastrografin and potassium chloride are not administered prior to renal angiography.
Diagnostic testing of an adult patient reveals renal glycosuria. The nurse should recognize the need for the patient to be assessed for what health problem?
A) Diabetes insipidus
B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C) Diabetes mellitus
D) Renal carcinoma
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.
A patient with a diagnosis of respiratory acidosis is experiencing renal compensation.
What function does the kidney perform to assist in restoring acid base balance?
A) Sequestering free hydrogen ions in the nephrons
B) Returning bicarbonate to the body's circulation
C) Returning acid to the body's circulation
D) Excreting bicarbonate in the urine
The kidney performs two major functions to assist in acidñbase balance. The first is to
reabsorb and return to the body's circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine. Retaining bicarbonate will counteract an acidotic state. The nephrons do not sequester free hydrogen ions.
A patient's most recent laboratory findings indicate a glomerular filtration rate (GFR) of
58 mL/min. The nurse should recognize what implication of this diagnostic finding?
A) The patient is likely to have a decreased level of blood urea nitrogen (BUN).
B) The patient is at risk for hypokalemia.
C) The patient is likely to have irregular voiding patterns.
D) The patient is likely to have increased serum creatinine levels.
The adult GFR can vary from a normal of approximately 125 mL/min (1.67 to 2.0 mL/sec) to a high of 200 mL/min. A low GFR is associated with increased levels of BUN, creatinine, and potassium.
A patient has experienced excessive losses of bicarbonate and has subsequently developed an acid base imbalance. How will this lost bicarbonate be replaced?
A) The kidneys will excrete increased quantities of acid.
B) Bicarbonate will be released from the adrenal medulla.
C) Alveoli in the lungs will synthesize new bicarbonate.
D) Renal tubular cells will generate new bicarbonate.
To replace any lost bicarbonate, the renal tubular cells generate new bicarbonate
through a variety of chemical reactions. This newly generated bicarbonate is then reabsorbed by the tubules and returned to the body. The lungs and adrenal glands do
not synthesize bicarbonate. Excretion of acid compensates for a lack of bicarbonate, but it does not actively replace it.
A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult?
A) If possible, try to drink at least 4 liters of fluid daily.
B) Ensure that you avoid replacing water with other beverages.
C) Remember to drink frequently, even if you don't feel thirsty.
D) Make sure you eat plenty of salt in order to stimulate thirst.
The nurse emphasizes the need to drink throughout the day even if the patient does not feel thirsty, because the thirst stimulation is decreased. Four liters of daily fluid intake is excessive and fluids other than water are acceptable in most cases. Additional salt intake is not recommended as a prompt for increased fluid intake.