Chapter 65: Assessment of the Renal/Urinary System

Question 1

ELIMINATION

Answer 1

is the excretion of waste from the body by the GI tract (as feces) and by the kidneys (as urine)

Question 2

renal system includes

Answer 2

the kidneys and the entire urinary tract.

Question 3

drainage route for the excretion of urine.

Answer 3

The ureters, bladder, and urethra

Question 4

The kidneys role:

Answer 4

maintain health by regulating body fluid volume and composition and filtering waste products for ELIMINATION.

also help regulate blood pressure and ACID–BASE BALANCE, produce erythropoietin for red blood cell (RBC) synthesis, and convert vitamin D to an active form.

Question 5

The regulatory functions control

Answer 5

FLUID AND ELECTROLYTE BALANCE and ACID–BASE BALANCE.

Question 6

The hormonal functions control

Answer 6

RBC formation, blood pressure, and vitamin D activation.

Question 7

The “working” units of the kidney consist of

Answer 7

1 million nephrons per kidney, each of which filters waste products and fluid from blood

Question 8

Normal glomerular filtration rate averages

Answer 8

125 mL/min, but only about 1 to 3 L are excreted each day as urine and the rest is reabsorbed back into the circulation.

Question 9

Tubular reabsorption involves

Answer 9

reabsorption of most of the water and electrolytes as the filtrate passes through the tubular parts of the nephron.

Question 10

kidneys and urine

Answer 10

regulate volume of urine depending upon the body needs

Question 11

bladder

Answer 11

provides temporary urine storage and continence and enables voiding

Question 12

urethral meatus,

Answer 12

or opening, is the exit point from the body.

Question 13

urethra

Answer 13

is a narrow tube that eliminates urine from the bladder.

Question 14

renal changes with aging, which may affect health:

Answer 14

There is an increased risk for dehydration and hypernatremia.

oBlood osmolarity is slightly higher in older adults and is a good indicator of hydration status.

oThe kidney loses cortical tissue and gets smaller by 80 years of age.

oMuscle mass and the amount of creatinine produced decrease with age.

oThe glomerular and tubular linings thicken, reducing filtrating ability.

oBlood flow to the kidney decreases by about 10% per decade as blood vessels thicken, resulting in less adaptive renal blood flow.

oThe combination of reduced kidney mass, reduced blood flow, and decreased glomerular filtration rate (GFR) contributes to reduced drug clearance and a greater risk for drug reactions and kidney damage from drugs and contrast dyes in older adults.

oTubular changes decrease the ability to concentrate urine, resulting in urgency and nocturnal polyuria.

Question 15

A high-protein intake can result in

Answer 15

temporary renal problems, and patients at risk for calculi formation who ingest large amounts of protein may form new stones.

Question 16

Ask about any change in appetite or in the ability to discriminate tastes because?

Answer 16

buildup of nitrogenous waste products can impact these.

Question 17

Assess FLUID BALANCE by

Answer 17

noting any edema (especially pedal,pretibial, sacral, and around the eyes), abnormal breath sounds (crackles), weight trends, and elevated blood pressure.

Question 18

Cognitive changes may be the result of

Answer 18

the buildup of waste products when kidney disease is present.

Question 19

distended bladder sounds ___ when percussed

Answer 19

dull

Question 20

No common pathologic condition other than ___ increases the serum creatinine level.

Answer 20

kidney disease

Question 21

why is the serum creatinine level a good indicator of kidney function

Answer 21

serum creatinine is produced when protein or muscle breaks down and is usually constant

Question 22

BUN

Answer 22

Urea nitrogen is filtered and excreted in the urine, so blood urea nitrogen (BUN) levels indicate renal clearance of this nitrogen waste product, but do not always reflect renal disease

8-21 mg/dL

Question 23

The ratio of BUN to serum creatinine

Answer 23

can help determine whether nonrenal factors, such as dehydration or poor renal perfusion, are causing the elevated BUN.

Question 24

urine specimens are collected when

Answer 24

at the morning’s first voiding.

Question 25

Culture and sensitivity is when the urine is analyzed for

Answer 25

the number and types of organisms present. A clean-catch urine sample is best for testing.

Question 26

Urine osmolarity measures the concentration of particles in solution and can range from

Answer 26

50 to 1400 mOsm/L, depending on hydration status and kidney function.

Question 27

Markers

Answer 27

are being used in investigation to identify early-onset kidney dysfunction, target therapy, and predict responsiveness to intervention. Markers for angiogenesis and kidney cell adhesion, regulation, and apoptosis will likely contribute to clinical diagnostics in the future.

Question 28

x-ray of the kidneys, ureters, and bladder shows

Answer 28

gross anatomic features and obvious stones, strictures, calcifications, or obstructions and identifies the shape, size, and relationship of the organs to other parts of the urinary tract.

Question 29

IV urogram

Answer 29

provides information about the kidneys,calices, pelves, ureters, and bladder and the adequacy of filling and rate of excretion.

Question 30

computed tomography (CT) scan

Answer 30

provides three-dimensional information about the kidneys, ureters, bladder, and surrounding tissue and can provide information about tumors, cysts, abscesses, other masses, obstruction, and renal blood vessels.

Question 31

Patients taking metformin

Answer 31

are at risk for lactic acidosis following a CT scan when they receive iodinated contrast media.

Question 32

Sodium bicarbonate in a liter of IV fluid or oral acetylcysteine may be used preprocedure to

Answer 32

prevent adverse reactions to dye.

Question 33

Evaluate risk for nephrotoxicity from diagnostic testing by

Answer 33

asking about allergy to radiopaque contrast dye, shellfish, or iodine or adverse reactions following the use of diagnostic agents such as gadolinium in magnetic resonance imaging.

Question 34

In both cystography and cystourethrography:

Answer 34

dye is instilled into the bladder via a urethral catheter and, after bladder filling, x-rays are taken.

Question 35

Kidney scans

Answer 35

are performed to provide general information about renal blood flow using a small amount of radioactive material.

Question 36

Ultrasonography

Answer 36

produces images to assess kidney size, cortical thickness, and status of the calices and identify obstructions without the use of contrast dye.

Question 37

Cystoscopy

Answer 37

may be performed to examine for trauma and identify causes of obstruction or to remove bladder tumors or an enlarged prostate gland.

Question 38

Urodynamic studies

Answer 38

examine bladder capacity, pressure, and tone; study urethral pressure and urine flow; and test perineal voluntary muscle function.

Question 39

Electromyography of the perineal muscles tests

Answer 39

the strength of the muscles used in voiding to help identify methods of improving continence.

Question 40

Percutaneous kidney biopsy

Answer 40

can assist in the diagnosis of renal problems and direct or alter treatment modalities.The patient should carefully be monitored for signs of bleeding post-procedure, coagulation studies such as platelet count, activated partial thromboplastin time (aPTT), prothrombin time (PT), and bleeding time are performed before surgery.

Question 41

after any procedure in which contrast dye is used:

Answer 41

Assess urine output closely

Question 42

after any invasive test:

Answer 42

Assess the patient for bleeding or manifestations of infection