Assessment of the Renal/Urinary System
Assessment of the Renal/Urinary System
Terms in this set (21)
Confirmed by palpation and x-ray study, the client's right kidney is lower than the left
kidney. What is the nurse's interpretation of this finding?
A. The client has a problem involving the right kidney.
B. The client has a problem involving the left kidney.
C. The client has both kidneys in the normal position.
D. The client is at increased risk for kidney impairment.
Normally, the right kidney is positioned somewhat lower than the left kidney. This
anatomic difference in otherwise symmetric organs is caused by liver displacement. The
significance of this difference is that the right kidney is easier to palpate in an adult than
is the left kidney.
What would be the response if a person's nephrons were not able to filter normally
due to scarring of the proximal convoluted tubule leading to inhibition of
A. Increased urine output, fluid volume deficit
B. Decreased urine output, fluid volume deficit
C. Increased urine output, fluid volume overload
D. Decreased urine output, fluid volume overload
The nephrons filter about 120 mL/min. Most of this filtrate is reabsorbed in the proximal
convoluted tubule. If the tubule were not able to reabsorb the fluid that has been filtered,
urine output would greatly increase, leading to rapid and severe dehydration.
With a renal threshold for glucose of 220 mg/dL, what is the expected response when
a client has a blood glucose level of 400 mg/dL?
A. 400 mg/dL of excreted glucose in the urine
B. 220 mg/dL of excreted glucose in the urine
C. 180 mg/dL of glucose is excreted in the urine
D. No excreted glucose in the urine
Blood glucose is freely filtered at the glomerulus. Therefore, if a client has a blood sugar
level of 400 mg/dl, the filtrate in the proximal convoluted tubule will have a glucose
concentration of 400 mg/dL. With a renal threshold of 220 mg/dl, a total of 220 mg/dL of
the 400 mg/dL will be reabsorbed back into the systemic circulation, and the final urine
will have a glucose concentration of 180 mg/dL.
Which of the following conditions are associated with oversecretion of rennin?
A. Alzheimer's disease
C. Diabetes mellitus
D. Diabetes insipidus
Renin is secreted when special cells in the DCT, called the macula densa, sense changes
in blood volume and pressure. When the macula densa cells sense that blood volume is
low, blood pressure is low, 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
the 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.
The client is taking a medication for an endocrine problem that inhibits aldosterone
secretion and release. To what complications of this therapy should the nurse be alert?
A. Dehydration, hypokalemia
B. Dehydration, hyperkalemia
C. Overhydration, hyponatremia
D. Overhydration, hypernatremia
Aldosterone is a mineralocorticoid that increases the reabsorption of water and sodium in
the kidney at the same time that it promotes excretion of potassium. Any drug or
condition that disrupts aldosterone secretion or release increases the client's risk for
excessive water loss and potassium reabsorption.
6. What is the result of stimulation of erythropoietin production in the kidney tissue?
A. Increased blood flow to the kidney
B. Inhibition of vitamin D and loss of bone density
C. Increased bone marrow production of red blood cells
D. Inhibition of the active transport of sodium, leading to hyponatremi
Erythropoietin is produced in the kidney and released in response to decreased oxygen
tension in the renal blood supply. Erythropoietin stimulates red blood cell (RBC)
production in the bone marrow.
Which of the following muscle actions results in voluntary urination?
A. Detrusor contraction, external sphincter contraction
B. Detrusor contraction, external sphincter relaxation
C. Detrusor relaxation, external sphincter contraction
D. Detrusor relaxation, external sphincter relaxation
Voiding becomes a voluntary act as a result of learned responses controlled by the
cerebral cortex that cause contraction of the bladder detrusor muscle and simultaneous
relaxation of the external urethral sphincter muscle.
Which change in renal or urinary functioning as a result of the normal aging process
increases the older client's risk for infection?
A. Decreased glomerular filtration
B. Decreased filtrate reabsorption
C. Weakened sphincter muscles
D. Urinary retention
Incomplete bladder emptying for whatever reason increases the client's risk for urinary
tract infections as a result of urine stasis providing an excellent culture medium that
promotes the growth of microorganisms.
The client reports the regular use of all the following medications. Which one alerts
the nurse to the possibility of renal impairment when used consistently?
C. Antihistamine nasal sprays
D. Nonsteroidal anti-inflammatory drug
NSAIDs inhibit prostaglandin production and decrease blood flow to the nephrons. They
can cause an interstitial nephritis and renal impairment.
A nurse observes that the client's left flank region is larger than the right flank region.
What is the nurse's best action?
A. Ask the client if he or she participates in contact sports and has been recently injured.
B. Document the finding as the only action on the appropriate flowsheet.
C. Apply a heating pad to the left flank after inspecting the site for signs of infection.
D. Anticipate further diagnostic testing after sharing informing the physician of this
Asymmetry of the flank or a unilateral protrusion may indicate an enlargement of a
kidney. The enlargement may be benign or may be associated with a hydronephrosis or
mass on the kidney.
Which assessment maneuvers should the nurse perform first when assessing the renal
system at the same time as the abdomen?
A. Abdominal percussion
B. Abdominal auscultation
C. Abdominal palpation
D. Renal palpation
Auscultation precedes percussion and palpation because the nurse needs to auscultate for
abdominal bruits before palpation or percussion of the abdominal and renal components
of a physical assessment.
The client has an elevated blood urea nitrogen (BUN) level and an increased ratio of
blood urea nitrogen to creatinine. What is the nurse's interpretation of these
A. The client probably has a urinary tract infection.
B. The client may be overhydrated.
C. The kidney may be hypoperfused.
D. The kidney may be damaged.
When dehydration or renal hypoperfusion exist, the BUN level rises more rapidly than
the serum creatinine level, causing the ratio to be increased, even when no renal
dysfunction is present.
The client's urine specific gravity is 1.018. What is the nurse's best action?
A. Ask the client for a 24-hour recall of liquid intake.
B. Document the finding as the only action.
C. Obtain a specimen for culture.
D. Notify the physician.
This specific gravity is within the normal range for urine.
Which condition would trigger the release of antidiuretic hormone (ADH)?
A. Plasma osmolarity decreased secondary to overhydration.
B. Plasma osmolarity increased secondary to dehydration.
C. Plasma volume decreased secondary to hemorrhage.
D. Plasma volume increased with edema formation.
Antidiuretic hormone is triggered by a rising ECF osmolarity, especially hypernatremia.
The female client's urinalysis shows all the following characteristics. Which should
the nurse document as abnormal?
A. pH 5.6
B. Ketone bodies present
C. Specific gravity is 1.030
D. Two white blood cells per high-power field
Ketone bodies are byproducts of incomplete metabolism of fatty acids. Normally, there
are no ketones in urine. Ketone bodies are produced when fat sources are used instead of
glucose to provide cellular energy.
The client scheduled for intravenous urography informs the nurse of the following
allergies. Which one should the nurse report to the physician immediately?
C. Bee stings
D. Red food dye
Clients with seafood allergies often have severe allergic reactions to the standard dyes
used during intravenous urography.
The client scheduled to have an intravenous urogram is a diabetic and taking the
antidiabetic agent metformin. What should the nurse tell this client?
A. "Call your diabetes doctor and tell him or her that you are having an intravenous
urogram performed using dye."
B. "Do not take your metformin the morning of the test because you are not going to be
eating anything and could become hypoglycemic."
C. "You must start on an antibiotic before this test because your risk of infection is
greater as a result of your diabetes."
D. "You must take your metformin immediately before the test is performed because
the IV fluid and the dye contain a significant amount of sugar."
Metformin can cause a lactic acidosis and renal impairment as 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 client is going home after urography. Which instruction or precaution should the
nurse teach this client?
A. "Avoid direct contact with the urine for 24 hours until the radioisotope clears."
B. "You are likely to experience some dribbling of urine for several weeks after this
C. "Be sure to drink at least 3 L of fluids today to help eliminate the dye faster."
D. "Your skin may become slightly yellow-tinged from the dye used in this procedure."
Dyes used in urography are potentially nephrotoxic.
Two hours after a closed percutaneous kidney biopsy, the client reports a dramatic
increase in pain. What is the nurse's best first action?
A. Reposition the client on the operative side.
B. Administer prescribed opioid analgesic.
C. Assess pulse rate and blood pressure.
D. Check the Foley catheter for kinks.
An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of
The client is scheduled to have a renogram (kidney scan). She is concerned about
discomfort during the procedure. What is the nurse's best response?
A. "Before the test you will be given a sedative to reduce any pain."
B. "A local anesthetic agent will be used, so you might feel a little pressure but no
C. "Although this test is very sensitive, there is no more discomfort than you would
have with an ordinary x-ray."
D. "The only pain associated with this procedure is a small needle stick when you are
given the radioisotope
The test involves an intravenous injection of the radioisotope and the subsequent
recording of the emission by a scintillator.
Select the results (in italics) that are normal in a urinalysis.
A. pH 6
B. Specific gravity 1.015
C. Protein small
D. Sugar negative
E. Nitrate small
F. Leukocyte esterase positive
G. Bilirubin negative
A, B, D, G
Rationale: The abnormal values are indicative of a urinary tract infection. As a result of
protein, nitrates, and leukoesterase in the urine, the nurse can expect the laboratory to
analyze microscopic sediment including evaluating the sample for the presence of
crystals, casts, WBCs, and RBCs.
YOU MIGHT ALSO LIKE...
NCLEX-RN Exam | Mometrix Comprehensive Guide
MED-SURG_RENAL, ENDOCRINE, GI/LIVER/PANCREAS
Chapter 65: Assessment of the Renal/Urinary System
MedSurg Exam 1: Perioperative Care, GI, Diabetes
OTHER SETS BY THIS CREATOR
Prioritization, Delegation, and Assignment Practice Exercises for the NCLEX ® Examination
NCLEX head injury
THIS SET IS OFTEN IN FOLDERS WITH...
Chapter 65: Assessment of the Renal/Urinary System
Chapter 65 - Assessment of the Renal/Urinary System
Care of Patients with Renal Disorders
Chapter 67 - Care of Patients with Kidney Disorders