Brunner's Ch 53: Assessment of Kidney and Urinary Function Flashcards
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 patients creatinine level drops below 1.2 mg/dL (110 mmol/L)
B) When the patients 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
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
A) In the ureteropelvic junction
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 collection process
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
B) A 24-hour urine specimen and a serum creatinine level midway through the urine collection process
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 patients bladder by percussion. The nurse elicits dullness after the patient has voided. How should the nurse interpret this assessment finding?
A) The patients 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
A) The patients bladder is not completely empty.
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
A) Increased fluid intake to produce a full bladder
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 patients 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
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 patients 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
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
c. Hemorrhage
d. Nausea
a. Urinary retention
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
b. Retention of potassium
Retention of potassium is the most life-threatening effect of renal failure.
Aldosterone causes the kidney to excrete potassium, in contrast to aldosterones effects on sodium described previously. Acidbase 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 patients 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 nurses best response?
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 kidney disease.
D) A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease.
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
C) Glucose and protein
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 patients 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
B) 2,300 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
C) At the lower border of the 12th rib and the spine
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
C) A 42-year-old patient with morbid obesity
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 doesnt seem to be a great deal of urine flow. What would the nurse expect this patients physical assessment to reveal? A) Hematuria B) Urine retention C) Dehydration D) Renal failure
B) Urine retention
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 nurses assessment reveals a BP of 98/52 mm Hg. The nurse should recognize that the patients kidneys will compensate by secreting what substance? A) Antidiuretic hormone (ADH) B) Aldosterone C) Renin D) Angiotensin
C) Renin
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.
