Chapter 47: Assessment of Kidney and Urinary Function

Question 1

1. The care team is considering the use of dialysis in a client whose renal function is
   progressively declining. Renal replacement therapy is indicated in which situation?
   A. creatinine level drops below 1.2 mg/dl (110mmol/L)
   B. blood urea nitrogen (BUN) is above 15 mg/dl
   C. urinalysis (dipstick test) reveals 140 mg/dl of protein
   D. functioning nephrons are less than 20%

Answer 1

ANS: D
Rationale: When the total number of functioning nephrons is less than 20%, renal
replacement therapy needs to be considered. Dialysis is an example of renal replacement therapy. Prior to the loss of greater than 80% of the nephron’s functioning ability, the client may have mild symptoms of compromised renal function, but symptom management is often obtained through dietary modifications and drug therapy. The listed creatinine level is within normal range for men and slightly elevated for women. The BUN levels are within normal ranges. Proteinuria up to 150 mg/dl, as an occasional finding, is considered normal. Persistent proteinuria can indicate several medical problems including glomerular disease.

Question 2

2. The nurse is caring for a client who has been diagnosed with renal calculi. 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

Answer 2

ANS: A
Rationale: The three narrowed areas of each ureter are the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovesical 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.

Question 3

3. A nurse is caring for a client 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

Answer 3

ANS: B
Rationale: To calculate creatinine clearance, a 24-hour urine specimen is collected.
Midway through the collection, the serum creatinine level is measured.

Question 4

4. The nurse is assessing a client’s bladder by percussion. The nurse elicits dullness after
   the client has voided. How should the nurse interpret this assessment finding?
   A. The client’s bladder is not completely empty.
   B. The client has kidney enlargement.
   C. The client has a ureteral obstruction.
   D. The client has a fluid volume deficit.

Answer 4

ANS: A
Rationale: 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.

Question 5

5. The nurse is providing preprocedure teaching about an ultrasound. The nurse informs
   the client that in preparation for an ultrasound of the lower urinary tract the client will
   require what action?
   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

Answer 5

ANS: A
Rationale: Ultrasonography requires a full bladder; therefore, fluid intake should be
encouraged before the procedure. 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.

Question 6

6. The nurse is caring for a client who has a fluid volume deficit. When evaluating this
   client’s urinalysis results, what should the nurse normally anticipate?
   A. Decrease in blood urea nitrogen (BUN)
   B. Less antidiuretic hormone (ADH) released
   C. Decreased urine osmolality
   D. Increased urine specific gravity

Answer 6

ANS: D
Rationale: 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. Blood urea nitrogen (BUN) levels are usually elevated with volume deficits related to dehydration. With decreased water intake as seen in a client with fluid volume deficit, blood osmolality increases, which stimulates antidiuretic hormone (ADH) release. ADH acts on the kidney, increasing water reabsorption and returning the blood
osmolality to a normal level. Normally, urine osmolality increases (urine is concentrated)
with fluid volume deficits.

Question 7

7. 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

Answer 7

ANS: D
Rationale: 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.

Question 8

8. A nurse is preparing a client diagnosed with benign prostatic hyperplasia (BPH) for a
   lower urinary tract cystoscopic examination. The nurse should caution the client about
   what common temporary complication of this procedure?
   A. Urinary retention
   B. Bladder perforation
   C. Hemorrhage
   D. Nausea

Answer 8

ANS: A
Rationale: After a cystoscopic examination, the client with obstructive pathology may
experience urine retention if the instruments used during the examination cause edema. The nurse will carefully monitor the client with prostatic hyperplasia for urine retention. Postprocedure, the client 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.

Question 9

9. A client with gross hematuria has been admitted to a surgical floor in preparation for an
   upper cystoscopy in the morning. What post-procedure interventions would the nurse
   anticipate for this client? Select all that apply.
   A. Nothing by mouth (NPO)
   B. Intermittent straight catheterization
   C. Sedative agent administration
   D. Moist heat to abdomen
   E. Monitor for urinary retention

Answer 9

ANS: B, D, E
Rationale: Post-procedural management is directed at relieving any discomfort from the procedure. Moist heat to the lower abdomen and warm sitz baths are helpful in relieving pain and relaxing muscles. The client may experience urinary retention, so intermittent straight catheterization may be necessary for a few hours after the procedure. The nurse would also monitor the client for signs of urinary tract infection and obstruction. NPO and sedative agent administration is accomplished before the procedure. A cystoscope examination/procedure is used to directly visualize the urethra and bladder.

Question 10

10. A kidney biopsy has been scheduled for a client with a history of acute kidney injury.
    The client asks the nurse why this test has been scheduled. What is the nurse’s best
    response?
    A. “A biopsy is routinely ordered for all clients 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 clients before they have a kidney transplant.”
    D. “A biopsy is sometimes necessary for diagnosing and evaluating the extent of
    kidney disease.”

Answer 10

ANS: D
Rationale: Biopsy of the kidney is used in diagnosing and evaluating the extent of kidney disease. Indications for biopsy include unexplained acute kidney injury, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.

Question 11

11. The nurse is caring for a client suspected of having renal dysfunction. When reviewing
    laboratory results for this client, 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

Answer 11

ANS: C
Rationale: 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 they are not excreted in the urine.

Question 12

12. The nurse caring for a client with suspected renal dysfunction calculates that the
    client’s weight has increased by 5 pounds (2.27 kg) in the past 24 hours. The nurse
    estimates that the client has retained approximately how much fluid?
    A. 1,300 mL/ 43.9 fl oz. of fluid in 24 hours
    B. 2,270 mL/76.7 fl oz. of fluid in 24 hours
    C. 3,100 mL/104.8 fl oz. of fluid in 24 hours
    D. 5,000 mL/169.0 fl oz. of fluid in 24 hours

Answer 12

ANS: B
Rationale: An increase in body weight commonly accompanies edema. To calculate the approximate weight gain from fluid retention, the nurse should remember that 1 kg of weight gain equals approximately 1,000 mL of fluid. Five pounds = 2.27 kg = 2,270 mL.

Question 13

13. The nurse is performing a focused genitourinary and renal assessment of a client.
    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 xiphoid process

Answer 13

ANS: C
Rationale: 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.

Question 14

14. The nurse on a nephrology unit is caring for a diverse group of clients. For which client
    would a kidney biopsy most likely be contraindicated?
    A. A 64-year-old client with chronic glomerulonephritis
    B. A 57-year-old client with proteinuria
    C. A 42-year-old client with morbid obesity
    D. A 16-year-old client with signs of kidney transplant rejection

Answer 14

ANS: C
Rationale: There are several contraindications to a kidney biopsy, including bleeding tendencies, uncontrolled hypertension, a solitary kidney, and morbid obesity. Indications for a kidney biopsy include unexplained acute kidney injury, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.

Question 15

15. The nurse is caring for a client who describes changes in voiding patterns. The client
    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 much urine flow.” What would the nurse expect this client’s physical
    assessment to reveal?
    A. Hematuria
    B. Urine retention
    C. Dehydration
    D. Kidney injury

Answer 15

ANS: B
Rationale: Increased urinary urgency and frequency coupled with decreasing urine
volume 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 kidney injury both result in a decrease in urine output, but the client 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 kidney injury and dehydration due to decreased urine production.

Question 16

16. The nurse is caring for a client with a nursing diagnosis of deficient fluid volume. The
    nurse’s assessment reveals a blood pressure (BP) of 98/52 mm Hg. The nurse should
    recognize that the client’s kidneys will compensate by secreting what substance?
    A. Antidiuretic hormone (ADH)
    B. Aldosterone
    C. Renin
    D. Angiotensin

Answer 16

ANS: C
Rationale: The kidneys have an important function in the autoregulation of BP. When the vasa recta detects 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. Aldosterone and angiotensin are part of this complex process but renin is required to start this process. ADH is a hormone and vasopressin can increase the BP but is secreted by the pituitary gland, not the kidneys.

Question 17

17. A nurse is caring for a 73-year-old client with a urethral obstruction related to
    prostatic enlargement. When planning this client’s care, the nurse should be aware of the
    risk of what complication?
    A. Urinary tract infection
    B. Enuresis
    C. Polyuria
    D. Proteinuria

Answer 17

ANS: A
Rationale: 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 clients are at risk for prostatic enlargement, which causes urethral obstruction and can result in hydronephrosis, kidney injury, and urinary tract infections.

Question 18

18. A client with difficulty voiding and elevated BUN and creatinine values has been
    referred by the health care provider for further evaluation. The nurse should anticipate
    the use of what initial diagnostic test?
    A. Portable bladder ultrasound
    B. X-ray
    C. Computed tomography (CT)
    D. Nuclear scan

Answer 18

ANS: A
Rationale: Portable bladder ultrasound is a method of detecting urinary retention.
These devices provide a three-dimensional image of the bladder and should be used after voiding to detect urine retention. Researchers have reported a decrease in urinary tract infections and a shorter hospital stay when this device is used. A portable bladder ultrasound can be done quickly and frequently at the bedside by the nurse to detect urinary retention. There is no ionizing radiation exposure with a portable ultrasound. X-ray, CT and nuclear scans all use a certain amount of ionizing radiation.

Question 19

19. A client admitted to the medical unit with impaired renal function reports severe,
    stabbing pain in the flank and lower abdomen. The client is being assessed for renal
    calculi. The nurse recognizes that the stone is most likely in what anatomic location?
    A. Meatus
    B. Bladder
    C. Ureter
    D. Urethra

Answer 19

ANS: C
Rationale: 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.

Question 20

20. The nurse is caring for a client who had a brush biopsy 12 hours ago. The presence of
    what assessment finding should prompt the nurse to notify the health care provider?
    A. Scant hematuria
    B. Renal colic
    C. Temperature 37.9°C (100.2°F) orally
    D. Infiltration of the client’s intravenous catheter

Answer 20

ANS: C
Rationale: Hematuria and renal colic are common and expected findings after the
performance of a renal brush biopsy. The health care provider should be notified of the client’s body temperature, which likely indicates the onset of an infectious process. IV infiltration does not warrant notification of the primary care provider.

Question 21

21. A client with recurrent urinary tract infections has just undergone a cystoscopy and
    reports 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 prescribed.
    B. Reassure the client that this is not unexpected and then monitor the client for
    further bleeding.
    C. Promptly inform the health care provider of this assessment finding.
    D. Position the client supine and insert a Foley catheter, as prescribed.

Answer 21

ANS: B
Rationale: 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 client 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 administration.

Question 22

22. A client is reporting 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 client’s meatus, as prescribed.
    C. Apply moist heat to the client’s lower abdomen.
    D. Apply an ice pack to the client’s perineum.

Answer 22

ANS: C
Rationale: 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.

Question 23

23. The nurse is caring for a client who is going to have an open renal biopsy. What
    nursing action should the nurse prioritize when preparing this client for the procedure?
    A. Discuss the client’s diagnosis with the family.
    B. Bathe the client before the procedure with antiseptic skin wash.
    C. Administer antivirals before sending the client for the procedure.
    D. Keep the client NPO prior to the procedure.

Answer 23

ANS: D
Rationale: Preparation for an open biopsy is similar to that for any major abdominal
surgery. When preparing the client for an open biopsy, the nurse would keep the client NPO. The nurse may discuss the diagnosis with the family, but that is not a
preparation for the procedure. A preprocedure wash is not normally ordered and antivirals are not given in anticipation of a biopsy.

Question 24

24. The nurse is caring for a client scheduled for renal angiography following a motor
    vehicle accident. What client 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

Answer 24

ANS: B
Rationale: 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 given prior to renal
angiography.

Question 25

25. A client 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. Retaining ammonium chloride
    D. Excreting bicarbonate in the urine

Answer 25

ANS: B
Rationale: The kidney performs two major functions to assist in acid–base 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. Other functions include synthesizing ammonia and excreting ammonium chloride

Question 26

26. A client’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 client is likely to have a decreased level of blood urea nitrogen (BUN).
    B. The client is at risk for hypokalemia.
    C. The client is likely to have irregular voiding patterns.
    D. The client is likely to have increased serum creatinine levels.

Answer 26

ANS: D
Rationale: The adult GFR can vary from a normal of approximately 125 mL/min (1.67 to2.0 mL/sec) to a high of 200 mL/min. A low GFR is associated with increased levels of BUN, creatinine, and potassium.

Question 27

27. A client 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.

Answer 27

ANS: D
Rationale: 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.

Question 28

28. 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.”

Answer 28

ANS: C
Rationale: The nurse emphasizes the need to drink throughout the day even if the client 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.

Question 29

29. 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

Answer 29

ANS: B
Rationale: 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.

Question 30

30. Results of a client’s 24-hour urine sample indicate osmolality of 510 mOsm/kg (510
    mmol/kg), which is within reference range. What conclusion can the nurse draw from this
    assessment finding?
    A. The client’s kidneys are capable of maintaining acid–base balance.
    B. The client’s kidneys reabsorb most of the potassium that the client ingests.
    C. The client’s kidneys can produce sufficiently concentrated urine.
    D. The client’s kidneys are producing sufficient erythropoietin.

Answer 30

ANS: C
Rationale: Osmolality is the most accurate measurement of the kidney’s ability to dilute and concentrate urine. Osmolality is not a direct indicator of renal function as it relates to erythropoietin synthesis or maintenance of acid–base balance. It does not indicate the maintenance of healthy levels of potassium, the vast majority of which is excreted.

Question 31

31. A 52-year-old client is scheduled for diagnostic testing to address prolonged signs
    and symptoms of genitourinary dysfunction. What signs and symptoms are particularly
    suggestive of urinary tract disease? Select all that apply.
    A. Petechiae
    B. Pain
    C. Gastrointestinal symptoms
    D. Changes in voiding
    E. Jaundice

Answer 31

ANS: B, C, D
Rationale: Dysfunction of the kidney can produce a complex array of symptoms
throughout the body. Pain, changes in voiding, and gastrointestinal symptoms are
particularly suggestive of urinary tract disease. Petechiae is not associated with
genitourinary health problems. Jaundice is not a sign of urinary tract infection in an adult; it is seen typically in newborns.

Question 32

32. A client asks the nurse why kidney problems can cause gastrointestinal disturbances.
    What relationship should the nurse describe?
    A. The right kidney’s proximity to the pancreas, liver, and gallbladder
    B. The indirect impact of digestive enzymes on renal function
    C. That the peritoneum encapsulates the GI system and the kidneys
    D. The left kidney’s connection to the common bile duct

Answer 32

ANS: A
Rationale: The proximity of the right kidney to the colon, duodenum, head of the
pancreas, common bile duct, liver, and gallbladder may cause GI disturbances. The
proximity of the left kidney to the colon (splenic flexure), stomach, pancreas, and spleen may also result in intestinal symptoms. Digestive enzymes do not affect renal function, and the left kidney is not connected to the common bile duct.

Question 33

33. A nurse is giving discharge instructions to a client following urodynamic testing. What
    are the priority topics to be addressed by the nurse?
    A. Beverage limitations, pain control, and urinary expectations
    B. Antibiotic adherence, carbohydrate restrictions, and urinary expectations
    C. Protein intake, mobility limitations, and urinary expectations
    D. Opioid usage, urinary expectations, fat and protein limitations

Answer 33

ANS: A
Rationale: After the procedure, the client should avoid caffeinated, carbonated, and
alcoholic beverages because they can further irritate the bowel and cause pain. The client is encouraged to drink fluids that are not restricted to help clear any hematuria. No other dietary restrictions or limitations are needed. Symptoms of urinary pain and frequency should decrease or subside within a day after the procedure. A further recommendation for pain control is a sitz bath, not opioid use. Clients after this procedure should have instruction about urinary frequency, urgency, dysuria, hematuria, and signs of a urinary tract infection. If an antibiotic was given to the client before the procedure, then the client
is encouraged to continue taking the medication.

Question 34

34. The nurse is reviewing the electronic health record of a client with a history of
    incontinence. The nurse reads that the health care provider assessed the client’s deep
    tendon reflexes. What condition of the urinary/renal system does this assessment
    address?
    A. Renal calculi
    B. Bladder dysfunction
    C. Benign prostatic hyperplasia (BPH)
    D. Recurrent urinary tract infections (UTIs)

Answer 34

ANS: B
Rationale: The deep tendon reflexes of the knee are examined for quality and symmetry. This is an important part of testing for neurologic causes of bladder dysfunction because the sacral area, which innervates the lower extremities, is in the same peripheral nerve area responsible for urinary continence. Neurologic function does not directly influence the course of renal calculi, BPH or UTIs.

Question 35

35. A nurse is working with a client who will undergo invasive urologic testing. The nurse
    has informed the client that slight hematuria may occur after the testing is complete. The
    nurse should recommend what action to help resolve hematuria?
    A. Increased fluid intake following the test
    B. Use of an over-the-counter (OTC) diuretic after the test
    C. Gentle massage of the lower abdomen
    D. Activity limitation for the first 12 hours after the test

Answer 35

ANS: A
Rationale: Drinking fluids can help to clear hematuria. Diuretics are not used for this
purpose. Activity limitation and massage are unlikely to resolve this expected
consequence of testing.

Question 36

36. The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse
    should be aware that this test will include what assessment parameters? Select all that
    apply.
    A. Specific gravity of the client’s urine
    B. Testing for the presence of glucose in the client’s urine
    C. Microscopic examination of urine sediment for RBCs
    D. Microscopic examination of urine sediment for casts
    E. Testing for BUN and creatinine in the client’s urine

Answer 36

ANS: A, B, C, D
Rationale: Urine testing includes testing for specific gravity, glucose, RBCs, and casts.
BUN and creatinine are components of serum, not urine.

Question 37

37. What nursing action should the nurse perform when caring for a client undergoing
    diagnostic testing of the renal-urologic system?
    A. Withhold medications until 12 hours post-testing.
    B. Ensure that the client knows the importance of temporary fluid restriction after
    testing.
    C. Inform the client of the medical diagnosis after reviewing the results.
    D. Assess the client’s understanding of the test results after their completion.

Answer 37

ANS: D
Rationale: The nurse should ensure that the client understands the results that are
presented by the health care provider. Informing the client of a diagnosis is normally the primary provider’s responsibility. Withholding fluids or medications is not normally required after testing.

Question 38

38. Dipstick testing of an older adult client’s urine indicates the presence of protein.
    Which statement is true of this assessment finding?
    A. This finding needs to be considered in light of other forms of testing.
    B. This finding is a risk factor for urinary incontinence.
    C. This finding is likely the result of an age-related physiologic change.
    D. This result confirms that the client has diabetes.

Answer 38

ANS: A
Rationale: A dipstick examination should be used as a screening test only, because urine
concentration, pH, hematuria, and radiocontrast materials all affect the results.
Proteinuria is not diagnostic of diabetes, and it is neither an age-related change nor a risk factor for incontinence.