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Urinary Assessment - PP1
Terms in this set (16)
A patient was admitted 2 weeks ago after multiple traumatic injuries in a motor vehicle collision. The patient now has a serum creatinine at 3.9 mg/dL and blood urea nitrogen (BUN) of 100 mg/dL. Which medication, if ordered by the health care provider, should the nurse question?
d) Morphine sulfate
A: Elevated serum creatinine and BUN indicate renal insufficiency or acute kidney injury. All medications should be evaluated for nephrotoxic potential. Many drugs are known to be nephrotoxic (see Table 44.3-Lewis, et. all); gentamicin is a potential nephrotoxic agent.
A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. What teaching point should the nurse emphasize before the procedure?
a) "You might have pink-tinged urine and burning after your cystoscopy."
b) "You'll need to refrain from eating or drinking after midnight the day before the test."
c) "The morning of the test, you will drink some water that contains a contrast solution."
d) "You'll need a urinary catheter before the cystoscopy, and it will be in place for a few days."
A: Pink-tinged urine, burning, and frequency are common after a cystoscopy. The patient does not need to be NPO before the test, and contrast media is not needed. A cystoscopy does not always necessitate catheterization before or after the procedure.
The nurse is caring for a patient after a right kidney biopsy. Which position would be the mostappropriate for this patient immediately after the procedure?
a) Right lateral side-lying position
b) Reverse Trendelenburg position
c) Supine with lower extremities elevated
d) High Fowler's position with arms supported
A: After a renal biopsy, a pressure dressing should be applied. The patient should be kept on the affected side for 30 to 60 minutes to apply additional pressure from the patient's own body weight and then on bed rest for 24 hours. High Fowler's position with arms supported is a position for a patient in respiratory distress. Reverse Trendelenburg position is used to maintain circulation to the legs in peripheral artery insufficiency. Supine with legs elevated puts excessive pressure on the diaphragm and should generally be avoided.
A patient in the intensive care unit is receiving gentamicin for treatment of pneumonia from Pseudomonas aeruginosa. What assessment results should the nurse report to the health care provider?
a) Decreased weight
b) Increased appetite
c) Increased urinary output
d) Elevated creatinine level
D: Gentamicin can be toxic to the kidneys and the auditory system. The elevated creatinine level must be reported to the provider because it probably indicates renal damage. Other factors that may occur with renal damage would include increased weight and decreased urinary output. Many medications have side effects of anorexia.
The nurse obtained a urine specimen from a patient. What result should the nurse recognize as an abnormal finding?
a) pH of 6.0
b) Amber yellow color
c) Specific gravity of 1.025
d) White blood cells (WBCs) 9/hpf
D: Normal WBC levels in urine are below 5/hpf, with levels exceeding this indicative of inflammation or urinary tract infection. A urine pH of 6.0 is average; amber yellow is normal coloration, and the reference range for specific gravity is 1.003 to 1.030.
The nurse is performing an assessment for a patient and preparing to palpate the kidneys. How should the nurse position the patient for this assessment?
c) Seated at the edge of the bed
d) Standing, facing away from the nurse
B: To palpate the right kidney, the patient is positioned supine, and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney. The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it.
In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to maintaining homeostasis. Which physiologic processes are performed by the kidneys? (Select all that apply.)
a) Release of renin
b) Activation of vitamin D
c) Carbohydrate metabolism
d) Erythropoietin production
e) Hemolysis of old red blood cells (RBCs)
A, B, D: In addition to urine formation, the kidneys release renin to maintain blood pressure, activate vitamin D to maintain calcium levels, and produce erythropoietin to stimulate RBC production. Carbohydrate metabolism and hemolysis of old RBCs are not physiologic functions that are associated with the kidneys
When a patient reports acute, severe, renal colic pain in the lower abdomen, the nurse suspects that the patient is most likely to have an obstruction at which area?
d) Ureterovesical junction
D: The ureterovesical junction is the narrowest part of the urethra and easily obstructed by urinary calculi. With a stone in the kidney or at the ureteropelvic junction, the pain may be dull costovertebral flank pain. Stones in the bladder do not cause obstruction or symptoms unless they are staghorn stones. The urethra seldom has obstruction related to stones.
A patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. How should the nurse document this abnormal assessment finding?
B: Painful and difficult urination is characterized as dysuria. Whereas anuria is an absence of urine production, oliguria is diminished urine production. Enuresis is involuntary nocturnal urination.
The nurse is preparing a patient for an intravenous pyelogram (IVP). What is a priority action by the nurse?
a) Administer a cathartic or enema.
b) Assess patient for allergies to penicillin.
c) Keep the patient NPO for 4 hours preprocedure.
d) Tell the patient a metallic taste be present during the procedure.
A: Nursing responsibilities in caring for a patient undergoing an IVP include administration of a cathartic or enema to empty the colon of feces and gas. The nurse will also assess the patient for iodine sensitivity; keep the patient NPO for 8 hours before the procedure; and advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur.
A patient with suspected renal insufficiency is scheduled for a creatinine clearance diagnostic test. Which instructions would be appropriate for the nurse to provide to the patient?
a) "Empty your bladder and discard the urine; then save all urine for 24 hours."
b) "Your blood creatinine level will be tested after you eat a high-protein meal."
c) "This test should not be performed if you have allergies to iodine or shellfish."
d) "A sterile container must be used to store the urine during the collection period.
A: The patient should discard the first urination when this test is started. Urine should be saved from all subsequent urinations for 24 hours. Creatinine clearance testing does not involve the injection of contrast dye. A serum creatinine is determined during the 24-hour period and used in the calculation to determine creatinine clearance. Consumption of a high-protein meal is not indicated. Sterile containers would be indicated if cultures are performed to determine the presence of microorganisms.
A postoperative patient had a urinary catheter. Eight hours after catheter removal and drinking fluids, the patient has not been able to void. What is the nurse's first action to assess for urinary retention?
a) Bladder scan
c) Residual urine test
d) Kidneys, ureters, bladder (KUB) x-ray
A: If the patient is unable to void, the bladder may be palpated for distention or percussed for dullness if it is full, or a bladder scan may be done to determine the approximate amount of urine in the bladder. A cystometrogram visualizes the bladder and evaluates vesicoureteral reflux. A KUB x-ray delineates size, shape, and positions of kidneys and possibly a full bladder. Neither of these would be useful in this situation. A residual urine test requires urination before catheterizing the patient to determine the amount of urine left in the bladder, so this assessment would not be helpful for this patient.
The nurse is caring for an older adult patient taking bumetanide. What age-related changes does the nurse inform the patient may be experienced?
a) Benign enlargement of prostatic tissues
b) Decreased sensation of bladder capacity
c) Decreased function of the loop of Henle
d) Less absorption in the Bowman's capsule
C: Bumetanide (Bumex) is a loop diuretic that acts in the loop of Henle to decrease reabsorption of sodium and chloride. Because the loop of Henle loses function with aging, the excretion of drugs becomes less and less efficient. Thus, the circulating levels of drugs are increased and their effects prolonged. The benign enlargement of prostatic tissue, decreased sensation of bladder capacity, and loss of concentrating ability do not directly affect the action of loop diuretics.
A patient tells the nurse that they are having burning on urination, dysuria, and frequency. What is the best response by the nurse?
a) "Drink less fluid so you don't have to void so often."
b) "Take some acetaminophen to decrease the discomfort."
c) "Come in so we can check a clean-catch urine specimen."
d) "Avoid caffeine and spicy food to decrease inflammation."
C: The patient's symptoms are typical of a urinary tract infection. To verify this, a clean-catch urine specimen must be obtained for a specimen of urine to culture. Drinking less fluid will not improve the symptoms. Acetaminophen would not decrease the discomfort; an antibiotic would be needed. Avoiding caffeine and spicy food may decrease bladder inflammation but will not affect these symptoms.
A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) admitted for pneumonia. What laboratory finding would be consistent with decreased kidney function?
a) Serum uric acid of 5.2 mg/dL
b) Serum creatinine 2.3 of mg/dL
c) Urine specific gravity of 1.040
d) Blood urea nitrogen (BUN) of 10 mg/dL
B: An expected assessment finding related to decreased kidney function in the aging process is an increased serum creatinine. Other expected assessments include an elevated BUN and inability to concentrate urine (with urine specific gravity fixed at 1.010). Uric acid is used as a screening test for disorders of purine metabolism or kidney disease; values depend on renal function, rate of purine metabolism, and dietary intake of food rich in purines. Normal reference intervals: serum creatinine, 0.6 to 1.3 mg/dL; BUN, 6 to 20 mg/dL; urine specific gravity, 1.003 to 1.030; and serum uric acid, 2.3 to 6.6 mg/dL (female) or 4.4 to 7.6 mg/dL (male).
The nurse prepares a patient for discharge after a cystoscopy. It is most important for the nurse to provide additional information in response to which patient statement?
a) "I should drink plenty of fluids to prevent complications."
b) "If my urine is cloudy, I should contact my health care provider."
c) "Bright red bleeding is normal for a few days after the procedure."
d) "Sitz baths and acetaminophen will help to reduce my discomfort."
C: Bright red bleeding after a cystoscopy is not normal and should be reported immediately. Other complications include urinary retention, bladder infection, and perforation of the bladder. Patients should drink plenty of fluids and expect burning on urination, pink-tinged urine, and urinary frequency. Warm sitz baths, heat, and mild analgesics may be used to relieve discomfort.
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