Ignatavicius Ch 65: Assessment of the Renal/Urinary System Flashcards
A nurse reviews the urinalysis of a client and notes the presence of glucose. Which action should the nurse take?
a. Document findings and continue to monitor the client.
b. Contact the provider and recommend a 24-hour urine test.
c. Review the clients recent dietary selections.
d. Perform a capillary artery glucose assessment.
d. Perform a capillary artery glucose assessment.
Glucose normally is not found in the urine. The normal renal threshold for glucose is about 220 mg/dL, which means that a person whose blood glucose is less than 220 mg/dL will not have glucose in the urine. A positive finding for glucose on urinalysis indicates high blood sugar. The most appropriate action would be to perform a capillary artery glucose assessment. The client needs further evaluation for this abnormal result; therefore, documenting and continuing to monitor is not appropriate. Requesting a 24-hour urine test or reviewing the clients dietary selections will not assist the nurse to make a clinical decision related to this abnormality.
A nurse reviews the health history of a client with an oversecretion of renin. Which disorder should the nurse correlate with this assessment finding?
a. Alzheimers disease
b. Hypertension
c. Diabetes mellitus
d. Viral hepatitis
b. Hypertension
Renin is secreted when special cells in the distal convoluted tubule, called the macula densa, sense changes in blood volume and pressure. When the macula densa cells sense that blood volume, blood pressure, or blood sodium levels are low, renin is secreted. Renin then converts angiotensinogen into angiotensin I. This leads to a series of reactions that cause secretion of the hormone aldosterone. This hormone increases kidney reabsorption of sodium and water, increasing blood pressure, blood volume, and blood sodium levels. Inappropriate or excessive renin secretion is a major cause of persistent hypertension. Renin has no impact on Alzheimers disease, diabetes mellitus, or viral hepatitis.
A nurse reviews the urinalysis results of a client and notes a urine osmolality of 1200 mOsm/L. Which action should the nurse take?
a. Contact the provider and recommend a low-sodium diet.
b. Prepare to administer an intravenous diuretic.
c. Obtain a suction device and implement seizure precautions.
d. Encourage the client to drink more fluids.
d. Encourage the client to drink more fluids.
Normal urine osmolality ranges from 300 to 900 mOsm/L. This clients urine is more concentrated, indicating dehydration. The nurse should encourage the client to drink more water. Dehydration can be associated with elevated serum sodium levels. Although a low-sodium diet may be appropriate for this client, this diet change will not have a significant impact on urine osmolality. A diuretic would increase urine output and decrease urine osmolality further. Low serum sodium levels, not elevated serum levels, place the client at risk for seizure activity. These options would further contribute to the clients dehydration or elevate the osmolality.
A nurse assesses a client with renal insufficiency and a low red blood cell count. The client asks, Is my anemia related to the renal insufficiency? How should the nurse respond?
a. Red blood cells produce erythropoietin, which increases blood flow to the kidneys.
b. Your anemia and renal insufficiency are related to inadequate vitamin D and a loss of bone density.
c. Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow.
d. Kidney insufficiency inhibits active transportation of red blood cells throughout the blood.
c. Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow.
Erythropoietin is produced in the kidney and is released in response to decreased oxygen tension in the renal blood supply. Erythropoietin stimulates red blood cell production in the bone marrow. Anemia and renal insufficiency are not manifestations of vitamin D deficiency. The kidneys do not play a role in the transportation of red blood cells or any other cells in the blood.
A nurse contacts the health care provider after reviewing a clients laboratory results and noting a blood urea nitrogen (BUN) of 35 mg/dL and a creatinine of 1.0 mg/dL. For which action should the nurse recommend a prescription?
a. Intravenous fluids
b. Hemodialysis
c. Fluid restriction
d. Urine culture and sensitivity
a. Intravenous fluids
Normal BUN is 10 to 20 mg/dL. Normal creatinine is 0.6 to 1.2 mg/dL (males) or 0.5 to 1.1 mg/dL (females). Creatinine is more specific for kidney function than BUN, because BUN can be affected by several factors (dehydration, high-protein diet, and catabolism). This clients creatinine is normal, which suggests a non-renal cause for the elevated BUN. A common cause of increased BUN is dehydration, so the nurse should anticipate giving the client more fluids, not placing the client on fluid restrictions. Hemodialysis is not an appropriate treatment for dehydration. The lab results do not indicate an infection; therefore, a urine culture and sensitivity is not appropriate.
A nurse cares for a client with an increased blood urea nitrogen (BUN)/creatinine ratio. Which action should the nurse take first?
a. Assess the clients dietary habits.
b. Inquire about the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
c. Hold the clients metformin (Glucophage).
d. Contact the health care provider immediately.
a. Assess the clients dietary habits.
An elevated BUN/creatinine ratio is often indicative of dehydration, urinary obstruction, catabolism, or a high- protein diet. The nurse should inquire about the clients dietary habits. Kidney damage related to NSAID use most likely would manifest with elevations in both BUN and creatinine, but no change in the ratio. The nurse should obtain more assessment data before holding any medications or contacting the provider.
A nurse cares for a client with a urine specific gravity of 1.040. Which action should the nurse take?
a. Obtain a urine culture and sensitivity.
b. Place the client on restricted fluids.
c. Assess the clients creatinine level.
d. Increase the clients fluid intake.
d. Increase the clients fluid intake.
Normal specific gravity for urine is 1.005 to 1.030. A high specific gravity can occur with dehydration, decreased kidney blood flow (often because of dehydration), and the presence of antidiuretic hormone. Increasing the clients fluid intake would be a beneficial intervention. Assessing the creatinine or obtaining a urine culture would not provide data necessary for the nurse to make a clinical decision.
A nurse reviews laboratory results for a client who was admitted for a myocardial infarction and cardiogenic shock 2 days ago. Which laboratory test result should the nurse expect to find?
a. Blood urea nitrogen (BUN) of 52 mg/dL
b. Creatinine of 2.3 mg/dL
c. BUN of 10 mg/dL
d. BUN/creatinine ratio of 8:1
a. Blood urea nitrogen (BUN) of 52 mg/dL
Shock leads to decreased renal perfusion. An elevated BUN accompanies this condition. The creatinine should be normal because no kidney damage occurred. A low BUN signifies overhydration, malnutrition, or liver damage. A low BUN/creatinine ratio indicates fluid volume excess or acute renal tubular acidosis.
A nurse cares for a client with a urine specific gravity of 1.018. Which action should the nurse take?
a. Evaluate the clients intake and output for the past 24 hours.
b. Document the finding in the chart and continue to monitor.
c. Obtain a specimen for a urine culture and sensitivity.
d. Encourage the client to drink more fluids, especially water.
b. Document the finding in the chart and continue to monitor.
This specific gravity is within the normal range for urine. There is no need to evaluate the clients intake and output, obtain a urine specimen, or increase fluid intake.
A nurse cares for a client who has elevated levels of antidiuretic hormone (ADH). Which disorder should the nurse identify as a trigger for the release of this hormone?
a. Pneumonia
b. Dehydration
c. Renal failure
d. Edema
b. Dehydration
ADH increases tubular permeability to water, leading to absorption of more water into the capillaries. ADH is triggered by a rising extracellular fluid osmolarity, as occurs in dehydration. Pneumonia, renal failure, and edema would not trigger the release of ADH.
A nurse reviews a female clients laboratory results. Which results from the clients urinalysis should the nurse recognize as abnormal?
a. pH 5.6
b. Ketone bodies present
c. Specific gravity of 1.020
d. Clear and yellow color
b. Ketone bodies present
Ketone bodies are by-products of incomplete metabolism of fatty acids. Normally no ketones are present in urine. Ketone bodies are produced when fat sources are used instead of glucose to provide cellular energy. A pH between 4.6 and 8, specific gravity between 1.005 and 1.030, and clear yellow urine are normal findings for a female clients urinalysis.
A nurse reviews the allergy list of a client who is scheduled for an intravenous urography. Which client allergy should alert the nurse to urgently contact the health care provider?
a. Seafood
b. Penicillin
c. Bee stings
d. Red food dye
a. Seafood
Clients with seafood allergies often have severe allergic reactions to the standard dyes used during intravenous urography. The other allergies have no impact on the clients safety during an intravenous urography.
A nurse cares for a client with diabetes mellitus who is prescribed metformin (Glucophage) and is scheduled for an intravenous urography. Which action should the nurse take first?
a. Contact the provider and recommend discontinuing the metformin.
b. Keep the client NPO for at least 6 hours prior to the examination.
c. Check the clients capillary artery blood glucose and administer prescribed insulin.
d. Administer intravenous fluids to dilute and increase the excretion of dye.
a. Contact the provider and recommend discontinuing the metformin.
Metformin can cause lactic acidosis and renal impairment as the result of an interaction with the dye. This drug must be discontinued for 48 hours before the procedure and not started again after the procedure until urine output is well established. The clients health care provider needs to provide alternative therapy for the client until the metformin can be resumed. Keeping the client NPO, checking the clients blood glucose, and administering intravenous fluids should be part of the clients plan of care, but are not the priority, as the examination should not occur while the client is still taking metformin.
A nurse teaches a client who is recovering from a urography. Which instruction should the nurse include in this clients discharge teaching?
a. Avoid direct contact with your urine for 24 hours until the radioisotope clears.
b. You may have some dribbling of urine for several weeks after this procedure.
c. Be sure to drink at least 3 liters of fluids today to help eliminate the dye faster.
d. Your skin may become slightly yellow from the dye used in this procedure.
c. Be sure to drink at least 3 liters of fluids today to help eliminate the dye faster.
Dyes used in urography are potentially nephrotoxic. A large fluid intake will help the client eliminate the dye rapidly. Dyes used in urography are not radioactive, the client should not experience any dribbling of urine, and the dye should not change the color of the clients skin.
A nurse cares for a client who is recovering from a closed percutaneous kidney biopsy. The client states, My pain has suddenly increased from a 3 to a 10 on a scale of 0 to 10. Which action should the nurse take first?
a. Reposition the client on the operative side.
b. Administer the prescribed opioid analgesic.
c. Assess the pulse rate and blood pressure.
d. Examine the color of the clients urine.
c. Assess the pulse rate and blood pressure.
An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of internal hemorrhage. A change in vital signs can indicate that hemorrhage is occurring. Before other actions, the nurse must assess the clients hemodynamic status.
