o   Prerenal causes are factors external to the kidneys (e.g., hypovolemia) that reduce renal blood flow and lead to decreased glomerular perfusion and filtration.

o   Intrarenal causes include conditions that cause direct damage to the renal tissue, resulting in impaired nephron function. Acute tubular necrosis accounts for most cases of intrarenal failure.

o   Postrenal causes involve mechanical obstruction of urinary outflow. Common causes are benign prostatic hyperplasia, prostate cancer, calculi, trauma, and extrarenal tumors.

accumulation of nitrogenous waste products, such as urea nitrogen, creatine, etc., in the blood.

a reduction in urine output to less than 400 mL per day

syndrome in which kidney function declines to the point that symptoms develop in multiple body systems.

Decrease in the amount of renal tissue

decrease in the number of nephrons and renal blood vessels; thickened basement membrane of Bowman's capsule and glomeruli

decrease in the function of loop of Henle and tubules

6 - 20 mg/dL

creatinine clearance

creatinine clearance

In order to obtain a specimin for creatinine clearance, the nurse would do the following except:

a) collect a 36-hour urine specimen

b) discard first urine sample when test is started

c) save all samples from subsequent urinations for 24 hours

d) instruct the patient to urinate at the end of 24 hours and add specimin to collection

a) collect a 36-hour urine specimen

The nurse would want to collect a 24-hour urine specimen.

70 - 135 mL/min

amber yellow

Which of the following would indicate to the nurse that there is an abnormality with a patient's UA?

a) the urine has an aromatic odor

b) an absence of ketones, glucose and bilirubin

c) 10³ organisms/mL

d) pH of 8.3

d) pH of 8.3

the pH of urine is normally 4.0-8.0, with an average of 6.0

a) the urine has an aromatic odor - this is normal

b) an absence of ketones, glucose and bilirubin - this is normal

c) 10³ organisms/mL - <10⁴ organisms/mL result of normal urethral flora

a) ascertain coagulation studies through patient history, medication history, CBC, Hct, PTT, and INR.

b) determine whether patient has taken aspirin or Warfarin

c) inform patient that no pain or discomfort should be felt during the test, and there are no dietary or activity restrictions

d) inform the patient that they will be asked about sensations of bladder filling, usually including the first desire to void, a strong urge to void, and perception of bladder fullness.

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Indications for renal biopsy include all except which of the following?

a) to diagnose the cause of inflammation

b) to detect primary and metastatic malignancy of the kidney in patients who may not be candidates for surgery

c) to evaluate kidney transplantation rejection

d) to enable the physician to determine the appropriate dose of immunosuppresive drugs following transplantation

renal biopsy

Which of the following is contraindicated for renal biopsy?

a) bleeding disorders

b) presence of 2 kidneys

c) controlled hypertension

d) incontinence

False. Absolute contraindications of renal biopsy include single kidney-patients.

Post-renal biopsy, VS should be taken how often?

a) 15-30 min for first hour

b) 5-15 min for two hours

c) 5-10 min for first hour

d) 5-10 min for first day

Nursing responsibilities for renal biopsies include (select all that apply):

a) pre-op: type and crossmatch patient for blood, ensure consent form is signed

b) administer ordered Coumadin or aspirin

c) ascertain coagulation status through patient hx, medication hx, CBC, Hct, PTT, and bleeding/clotting time

d) ambulate patient within 4 hours post-op to prevent constipation and urinary stasis

e) instruct patient not to lift heavy items for 5-7 days post-op

f) instruct patient to resume anticoagulant therapy immediately following discharge

g) assess for post op pain

a) pre-op: type and crossmatch patient for blood, ensure consent form is signed

c) ascertain coagulation status through patient hx, medication hx, CBC, Hct, PTT, and bleeding/clotting time

e) instruct patient not to lift heavy items for 5-7 days post-op

abcesses, cysts and tumors. They show as cold spots because of nonfunctioning tissue.

renal scan

Bilirubin in the urine indicates

a) nothing; it is a normal finding

b) liver disorders

c) jaundice

Normal findings of bacteria in the urine would be

a) <10⁹ organisms/mL

b) <10⁴ organisms/mL

c) >10⁴ organisms/mL

d) <10⁵ organisms/mL

cystoscopy

KUB (Kidneys, ureters, bladder)

intravenous pyelogram (IVP)

contrast media can be nephrotoxic and worsen renal function

1.003 - 1.030

renal scan

Which of the following is the least invasive procedure?

a) renal scan

b) renal ultrasound

c) renal biopsy

d) renal arteriogram

Which of the following is a nursing responsibility regarding a patient undergoing a renal ultrasound?

a) a bowel preparation is not required

b) asking the patient about iodine sensitivity

c) ensure the patient does not have a pacemaker or prosthesis

d) forcing fluids post-test

If the urine specific gravity is increased, then the excreted urine would be

a) concentrated

b) dilute

In a dehydrated patient, the nurse would expect urine specific gravity to be

a) increased

b) decreased

The urine specific gravity would be increased.

Specific gravity is used to

a) detect the presence of leukocytes in the urine

b) evaluate the concentrating and excretory power of the kidneys

c) evaluation of kidney disease

d) none of the above

1.000

Which is a contraindication for kidney, ureter, and bladder (KUB) x-ray?

a) patients with abdominal pain

b) patients with abdominal trauma

c) patients who are pregnant

d) patients needing rapid evaluation of the abdomen and GU system

Your patient is scheduled for a barium study at 0900 and a KUB x-ray at 1200. What is the nurses responsibility?

a) reschedule the barium study for after the KUB x-ray

b) tell the patient that no fasting or sedation is required

c) tell the patient to not eat or drink 3 hours before the KUB

d) none of the above

True.

Nursing responsibilities for KUB x-rays for females include which of the following?

a) shielding the ovaries to prevent irradiation

b) determining iodine sensitivity before contrast media is given

c) determining if patient is pregnant

d) performing the KUB and interpreting the results

Which of the following would be a test to determine the presence of ureteral calculi?

a) renal biopsy

b) KUB

c) IVP

d) renal arteriogram

Your patient's post-void residual is 225 mL as indicated on the bladder scanner. You suspect urinary retention. What information would confirm this?

a) The patient has consumed 3 cups of coffee with breakfast.

b) The patient had a cystoscopy at 0800.

c) The patient had a KUB at 0600.

d) The patient refused a straight catheter.

Before a patient undergoes a cystoscopy, the nurse should

a) withhold fluids if general anesthesia is to be used

b) ensure the consent form is signed

c) give prophylactic antibiotics

d) determine patient's condition to establish need for local or general anesthesia

Which of the following is correct regarding patient teaching for what to expect after a cystoscopy?

a) "You may have bright red bleeding which is normal."

b) "You may get up and walk around without assistance after the procedure."

c) "You should avoid warm sitz baths and heat after the procedure."

d) "You may feel burning upon urination after the procedure, which is normal."

Which of the following is incorrect regarding patient teaching for what to expect after a cystoscopy?

a) "Let someone know right away if you experience bright red blood in your underwear."

b) "You may experience burning upon urination, pink-tinged urine and urinary frequency, which are all normal."

c) "If you feel discomfort, I can bring you a warm sitz bath, heat-pad, or mild pain medicine."

d) "You won't need to call for help up to the bathroom, because it's normal for you to feel like you have to go a lot."

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