RENAL Lewis Ch 44: Assessment of the Urinary System Flashcards
Which question should the nurse ask to assess a patient’s dysuria?
a. “Do you have to urinate at night?”
b. “Do you have blood in your urine?”
c. “Do you have to urinate frequently?”
d. “Do you have pain when you urinate?”
d. “Do you have pain when you urinate?”
Dysuria is painful urination. The alternate responses can be used to assess other urinary tract symptoms: hematuria, nocturia, and frequency.
What action should the nurse take first when a patient’s urine dipstick test indicates a small amount of protein?
a. Send a urine specimen to the laboratory to test for ketones.
b. Obtain a clean-catch urine for culture and sensitivity testing.
c. Inquire about which medications the patient is currently taking.
d. Ask the patient about any family history of chronic renal failure.
c. Inquire about which medications the patient is currently taking.
Normally the urinalysis will show zero to trace amounts of protein, but some medications may give false-positive readings. The other actions by the nurse may be appropriate but checking for medications that may affect the dipstick accuracy should be first.
A hospitalized patient who has possible renal insufficiency after coronary artery bypass surgery will have a creatinine clearance test. Which item will the nurse need to obtain?
a. Urinary catheter
b. Sterile specimen cup
c. Cleansing towelettes
d. Large urine container
d. Large urine container
Because creatinine clearance testing involves a 24-hour urine specimen, the nurse should obtain a large container for the urine collection. Catheterization, cleaning of the perineum with antiseptic towelettes, and a sterile specimen cup are not needed for this test.
A young adult employed as a hair stylist who has a 15 pack-year history of cigarette smoking arrives for an annual physical examination. Which area of increased risk should the nurse plan to teach the patient?
a. Renal failure
b. Kidney stones
c. Pyelonephritis
d. Bladder cancer
d. Bladder cancer
Exposure to the chemicals involved with working as a hair stylist and in smoking both increase the risk of bladder cancer, and the nurse should assess whether the patient understands this risk. The patient is not at increased risk for renal failure, pyelonephritis, or kidney stones.
Which medication taken by a patient with decreased renal function will be of most concern to the nurse?
a. ibuprofen (Motrin)
b. warfarin (Coumadin)
c. folic acid (vitamin B9)
d. penicillin (Bicillin C-R)
a. ibuprofen (Motrin)
Nonsteroidal antiinflammatory medications (NSAIDs) are nephrotoxic and should be avoided in patients with impaired renal function. The nurse should also ask about reasons the patient is taking the other medications, but the medication of most concern is the ibuprofen.
A 78-yr-old patient has been admitted with benign prostatic hyperplasia. What is most appropriate to include in the nursing plan of care?
a. Limit fluid intake to no more than 1000 mL/day.
b. Leave a light on in the bathroom during the night.
c. Ask the patient to use a urinal so that urine can be measured.
d. Pad the patient’s bed to accommodate overflow incontinence.
b. Leave a light on in the bathroom during the night.
The patient’s age and diagnosis indicate a likelihood of nocturia, so leaving the light on in the bathroom is appropriate. Fluids should be encouraged because dehydration is more common in older patients. The information in the question does not indicate that measurement of the patient’s output is necessary or that the patient has overflow incontinence.
The nurse completing a physical assessment for a newly admitted patient is unable to feel either kidney on palpation. Which action should the nurse take?
a. Obtain a urine specimen to check for hematuria.
b. Document the information on the assessment form.
c. Ask the patient about any history of recent sore throat.
d. Ask the health care provider about scheduling a renal ultrasound.
b. Document the information on the assessment form.
The kidneys are protected by the abdominal organs, ribs, and muscles of the back and may not be palpable under normal circumstances. No action is needed except to document the assessment information.
How will the nurse assess for flank tenderness in a patient with suspected pyelonephritis?
a. Palpate along both sides of the lumbar vertebral column.
b. Strike a flat hand covering the costovertebral angle (CVA).
c. Push fingers upward into the two lowest intercostal spaces.
d. Percuss between the iliac crest and ribs at the midaxillary line.
b. Strike a flat hand covering the costovertebral angle (CVA).
Checking for flank pain is performed by percussion of the CVA and asking about pain. The other techniques would not assess for flank pain.
What glomerular filtration rate (GFR) would the nurse estimate for a 30-yr-old patient with a creatinine clearance result of 60 mL/min?
a. 60 mL/min
b. 90 mL/min
c. 120 mL/min
d. 180 mL/min
a. 60 mL/min
The creatinine clearance approximates the GFR. The other responses are not accurate.
The nurse is examining an adult patient. For what purpose would the nurse use palpation?
a. Determining kidney function
b. Identifying renal artery bruits
c. Checking for bladder distention
d. Assessing for ureteral peristalsis
c. Checking for bladder distention
A distended bladder may be palpable above the symphysis pubis. Palpation would not be helpful in assessing for the other listed urinary tract information.
A patient gives the admitting nurse health information before a scheduled intravenous pyelogram (IVP). Which item requires the nurse to intervene before the procedure?
a. The patient has not had food or drink for 8 hours.
b. The patient lists allergies to shellfish and penicillin.
c. The patient reports costovertebral angle (CVA) tenderness.
d. The patient used a bisacodyl (Dulcolax) tablet the previous night.
b. The patient lists allergies to shellfish and penicillin.
Iodine-based contrast dye is used during IVP and for many CT scans. The nurse will need to notify the health care provider before the procedures so that the patient can receive medications such as antihistamines or corticosteroids before the procedures are started. The other information does not have immediate implications for the patient’s care during the procedures.
A patient passing bloody urine has scheduled a cystoscopy with cystogram. Which description of the procedure by the nurse is accurate?
a. “Your doctor will place a catheter into an artery in your groin and inject a dye to visualize the blood supply to the kidneys.”
b. “Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidneys.”
c. “Your doctor will insert a lighted tube in the bladder through your urethra, inspect the bladder, and instill dye to outline your bladder on x-ray.”
d. “Your doctor will inject a radioactive solution into a vein in your arm, then the isotope in your kidneys and bladder will be visible on a scanner.”
c. “Your doctor will insert a lighted tube in the bladder through your urethra, inspect the bladder, and instill dye to outline your bladder on x-ray.”
In a cystoscope and cystogram procedure, a cystoscope is inserted into the bladder for direct
visualization, and then contrast solution is injected through the scope so that x-rays can be
taken. The response beginning, “Your doctor will place a catheter” describes a renal arteriogram procedure. The response beginning, “Your doctor will inject a radioactive solution” describes a nuclear scan. The response beginning, “Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted” describes a retrograde pyelogram.
When caring for a patient after cystoscopy, what should the nurse include in the plan of care?
a. The patient learns to request narcotics for pain.
b. The patient understands to expect blood-tinged urine.
c. The patient restricts activity to bed rest for 4 to 6 hours.
d. The patient remains NPO for 8 hours to prevent vomiting.
b. The patient understands to expect blood-tinged urine.
Pink-tinged urine and urinary frequency are expected after cystoscopy. Burning on urination is common, but pain that requires opioids for relief is not expected. A good fluid intake is encouraged after this procedure. Bed rest is not required after cystoscopy.
A patient who has increased blood urea nitrogen (BUN) and serum creatinine levels is scheduled for a renal arteriogram. Which bowel preparation order would the nurse question for this patient?
a. Fleet enema
b. Tap-water enema
c. Senna/docusate (Senokot-S)
d. Bisacodyl (Dulcolax) tablets
a. Fleet enema
High-phosphate enemas, such as Fleet enemas, should be avoided in patients with elevated BUN and creatinine because phosphate cannot be excreted by patients with renal failure. The other medications for bowel evacuation are more appropriate.
A female patient with a suspected urinary tract infection is to provide a clean-catch urine specimen for culture and sensitivity testing. What should the nurse do to obtain the specimen?
a. Have the patient empty the bladder completely; then obtain the next urine
specimen that the patient is able to void.
b. Tell the patient to clean the urethral area, void a small amount into the toilet, then
void directly into a sterile container.
c. Insert a short sterile “mini” catheter attached to a collecting container into the
urethra and bladder to obtain the specimen.
d. Clean the area around the patient’s meatus with a povidone iodine (Betadine) swab
and then have the patient void into a sterile specimen cup.
b. Tell the patient to clean the urethral area, void a small amount into the toilet, then
This answer describes the technique for obtaining a clean-catch specimen. The answer
beginning, “insert a short, small, ‘mini’ catheter attached to a collecting container” describes a
technique that would result in a sterile specimen, but a health care provider’s order for a
catheterized specimen would be required. Using Betadine before obtaining the specimen might result in suppressing the growth of some bacteria. The technique described in the answer beginning “have the patient empty the bladder completely” would not result in a sterile specimen.
