Chapter 47 Assessment of kidney and urinary function Flashcards
The nurse is caring for a postoperative client who has a Kock pouch. Nursing assessment findings reveal abdominal pain, absence of bowel sounds, fever, tachycardia, and tachypnea. The nurse suspects which of the following?
a. Stoma ischemia
b. Postoperative pneumonia
c. Stoma retraction
d. Peritonitis
d
Clinical manifestations of peritonitis include abdominal pain and distention, absence of bowel sounds, nausea and vomiting, fever, changes in vital signs.
The nurse is caring for an older client whose chart reveals that the client has a reversible cause of urinary incontinence. The nurse creates a plan of care for which condition?
a. Asthma
b, Bladder cancer
c. Constipation
d. Decreased progesterone levels
c
Constipation is a reversible cause of urinary incontinence in the older adult. Other reversible causes include acute urinary tract infection, infection elsewhere in the body, decreased fluid intake, a change in a chronic disease pattern, and decreased estrogen levels in menopausal woman.
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?
a. Urinary frequency
b. Urinary urgency
c. Urinary incontinence
d. Urinary stasis
b
The nurse would document urinary urgency.
Urinary frequency is urinating more frequently than normal often times due to inadequate emptying of the bladder.
Urinary incontinence is the involuntary loss of urine.
Urinary stasis is a stoppage or diminution of flow.
After teaching a group of students about malignant bladder tumors, the instructor determines that the teaching was successful when the students identify which of the following clients as having the greatest risk for developing a malignant bladder tumor?
a. Client with a history of untreated gonorrhea
b. Client with a history of bladder inflammation
c. Client with a history of cigarette smoking
d. Client with a history of a sexually transmitted disease
c
Environmental and occupational health hazards are associated with bladder tumors. Therefore, the client who smokes is at the greatest risk for a malignant tumor.
The client with a history of untreated gonorrhea is most vulnerable to urethral strictures, while the client with a history of bladder inflammation may be vulnerable to interstitial cystitis. Finally, the client with sexually transmitted disease may be vulnerable to acquiring urethritis.
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. ureteral stones.
b. pyelonephritis.
c. cystitis.
d. Urethral infection.
a
The findings are constant with ureteral stones, edema or stricture, or a blood clot.
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
Flavoxate (Urispas) is a antispasmodic agent used for the treatment of burning and pain of the urinary tract.
A patient had a renal angiography and is being brought back to the hospital room. What nursing interventions should the nurse carry out after the procedure to detect complications? Select all that apply.
a. Assess peripheral pulses.
b. Compare color and temperature between the involved and uninvolved extremities.
c. Examine the puncture site for swelling and hematoma formation.
d. Apply warm compresses to the insertion site to decrease swelling.
e. Increase the amount of IV fluids to prevent clot formation.
a, b, c
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.
A female client who suffers from urethral strictures undergoes a dilation procedure and experiences a burning sensation while voiding. Which nursing instruction would be most helpful?
a. Encourage a visit to a local ostomy support group.
b. Advise cleansing of the perineum frequently.
c. Urge the application of moisture sealants.
d. Instruct the use of warm sitz baths.
d
Taking warm sitz baths and non-narcotic analgesics can relieve the client’s discomfort while voiding.
A female client who is diagnosed with a malignant tumor in her bladder is advised to undergo cystectomy followed by a urinary diversion procedure. Which of the following would be most important for the nurse to assess preoperatively?
a. Client’s manual dexterity and vision
b. History of allergy to iodine and seafood
c. Dietary habits involving cholesterol-laden food
d. Menstrual history
a
It is essential to assess manual dexterity, vision, and level of understanding of a client who undergoes a urinary diversion procedure, because this information will determine the client’s ability to manage stoma care and self-catheterization following the urinary diversion procedure.
Which of the following is the procedure of choice for men with recurrent or complicated urinary tract infections (UTIs)?
a. Transrectal ultrasonography
b. IV urogram
c. Computed tomography (CT) scan
d. Magnetic resonance imaging (MRI)
a
A transrectal ultrasonography is the procedure of choice for men with recurrent or complicated UTIs. This allows visualization of the structure to rule out any etiology that possible causing obstruction that continuously leading to recurrent UTIs.
A patient is admitted to a hospital with a diagnosis of spastic, neurogenic bladder. The nurse is aware that the pathophysiology of this condition is primarily due to which of the following occurrences?
a. Bladder distended until overflow incontinence occurs
b. Patient’s inability to exert motor control
c. Presence of a lower motor neuron lesion
d. Inability of the bladder muscle to contract forcefully
b
Neurogenic bladder dysfunction results from a lesion of the nervous system that results in urinary incontinence.
Spastic bladder is caused by any spinal cord lesion above the voiding reflex.
There is a loss of conscious sensation and control.
A spastic bladder empties on reflex.
A nurse caring for a patient with a neurogenic bladder knows to assess for the major complication of:
a. Permanent distention
b. Infection
c. Consistent pain
d. Daily and painful spasms
b
Infection is caused by an increased urinary bacterial count that results from incomplete and delayed emptying of the bladder.
A client has been experiencing severe pain and hematuria and is hardly able to ambulate into the physician’s office. The physician suspects kidney stones and orders diagnostic tests to confirm. What test would the nurse expect the physician to order?
a. KUB
b. ultrasound
c. CT
d. MRI
An x-ray study of the abdomen includes x-rays of the kidneys, ureters, and bladder (KUB). It is performed to show the size and position of the kidneys, ureters, and bony pelvis as well as any radiopaque urinary calculi (stones), abnormal gas patterns (indicative of renal mass), and anatomic defects of the bony spinal column (indicative of neuropathic bladder dysfunction).
Renal ultrasonography identifies the kidney’s shape, size, location, collecting systems, and adjacent tissues. A computed tomography (CT) scan or magnetic resonance imaging (MRI) of the abdomen and pelvis may be obtained to diagnose renal pathology, determine kidney size, and evaluate tissue densities with or without contrast.
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
c
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.
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. Dark amber urine
b. Clear or light yellow urine
c. Red urine
d. Turbid urine
a
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 geriatric nurse is performing an assessment of body systems on an older adult client. The nurse should be aware of what age-related change affecting the renal and urinary systems?
a. Increased ability to concentrate urine
b, Increased bladder capacity
c, Urinary incontinence
d. Decreased glomerular filtration rate
d
Many age-related changes in the renal and urinary systems should be taken into consideration when taking a health history of an 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.
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. excreting protein
b, excreting nitrogen waste products
c, regulating blood pressure
d, stimulating RBC production
a
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 is scheduled for a diagnostic MRI of the lower urinary system. What preprocedure education should the nurse include?
a. The need to be NPO for 12 hours prior to the test
b. Relaxation techniques to use during the test
c, The need for conscious sedation prior to the test
d, The need to limit fluid intake to 1 liter in the 24 hours before the test
b
Client preparation should include teaching relaxation techniques because the client needs to remain still during an MRI. The client does not normally need to be NPO or fluid-restricted before the test and conscious sedation is not usually implemented.
A patient is scheduled for a test with contrast to determine kidney function. What statement made by the patient should the nurse inform the physician about prior to testing?
a. “I don’t like needles.”
b. “I am allergic to shrimp.”
c. “I take medication to help me sleep at night.”
d. “I have had a test similar to this one in the past.”
b
The nurse should obtain the patient’s allergy history with emphasis on allergy to iodine, shellfish, and other seafood, because many contrast agents contain iodine.
When fluid intake is normal, the specific gravity of urine should be
a. 1.000.
b. less than 1.010.
c. greater than 1.025.
d. 1.010 to 1.025.
d
Urine-specific gravity is a measurement of the kidneys’ ability to concentrate urine. The specific gravity of water is 1.000. A urine-specific gravity less than 1.010 may indicate inadequate fluid intake. A urine-specific gravity greater than 1.025 may indicate overhydration.
A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client?
a. “An x-ray will be done to view your kidneys, ureters, and bladder.”
b, “A contrast medium will be used to help see the structures better.”
c. “You don’t need to do any fasting before this noninvasive test.”
d, “You’ll have a pressure dressing on your groin after the test.”
c
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.
