Podcast
Questions and Answers
What is the first step in collecting a catheter specimen of urine?
What is the first step in collecting a catheter specimen of urine?
Which of the following is an accurate indicator of overall kidney function?
Which of the following is an accurate indicator of overall kidney function?
What is an essential nursing intervention to prepare a patient before intravenous urography?
What is an essential nursing intervention to prepare a patient before intravenous urography?
During which procedure is a radiopaque dye injected to outline the kidneys, ureter, and bladder?
During which procedure is a radiopaque dye injected to outline the kidneys, ureter, and bladder?
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What monitoring should be prioritized post-procedure for renal angiography?
What monitoring should be prioritized post-procedure for renal angiography?
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What action should be taken to relieve discomfort for a patient recovering from a urinary procedure?
What action should be taken to relieve discomfort for a patient recovering from a urinary procedure?
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What is one primary indication for performing a renal biopsy?
What is one primary indication for performing a renal biopsy?
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Which of the following should not be included in pre-procedural nursing interventions for renal biopsies?
Which of the following should not be included in pre-procedural nursing interventions for renal biopsies?
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What is the purpose of instructing a client to self-clean before voiding in a clean catch specimen collection?
What is the purpose of instructing a client to self-clean before voiding in a clean catch specimen collection?
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Which of the following is NOT a normal result in a urinalysis?
Which of the following is NOT a normal result in a urinalysis?
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What does a BUN-to-Creatinine ratio of 10:1 indicate about a patient’s hydration status?
What does a BUN-to-Creatinine ratio of 10:1 indicate about a patient’s hydration status?
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What should the nurse advise the patient about exercising before renal function tests?
What should the nurse advise the patient about exercising before renal function tests?
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Which of the following indicates a potential need for a renal biopsy?
Which of the following indicates a potential need for a renal biopsy?
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Which diagnostic imaging method is most suitable for evaluating renal abnormalities?
Which diagnostic imaging method is most suitable for evaluating renal abnormalities?
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What is the minimum normal value for serum creatinine?
What is the minimum normal value for serum creatinine?
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In a renal concentration test, what does a fixed specific gravity indicate?
In a renal concentration test, what does a fixed specific gravity indicate?
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Which step is crucial when collecting a 24-hour urine specimen?
Which step is crucial when collecting a 24-hour urine specimen?
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What does a renal biopsy help to diagnose?
What does a renal biopsy help to diagnose?
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Which nursing intervention is appropriate after renal angiography?
Which nursing intervention is appropriate after renal angiography?
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What is monitored as part of post-procedural care for intravenous urography?
What is monitored as part of post-procedural care for intravenous urography?
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Which is a reason to assess for allergy before performing intravenous urography?
Which is a reason to assess for allergy before performing intravenous urography?
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What key factor must be maintained while collecting urine for creatinine clearance?
What key factor must be maintained while collecting urine for creatinine clearance?
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What is the significance of conducting a cystourethrography?
What is the significance of conducting a cystourethrography?
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What nursing activity is indicated prior to renal angiography?
What nursing activity is indicated prior to renal angiography?
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What does a serum creatinine level of 1.5 mg/dl indicate about kidney function?
What does a serum creatinine level of 1.5 mg/dl indicate about kidney function?
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Which of the following factors can affect the accuracy of urine specific gravity measurements?
Which of the following factors can affect the accuracy of urine specific gravity measurements?
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What could a finding of >3 RBCs/hpf in a urinalysis indicate?
What could a finding of >3 RBCs/hpf in a urinalysis indicate?
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Which measure is most reliable for assessing the kidney's ability to concentrate urine?
Which measure is most reliable for assessing the kidney's ability to concentrate urine?
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In a clean catch specimen, which step is NOT part of the collection process?
In a clean catch specimen, which step is NOT part of the collection process?
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Which parameter, when above normal levels, indicates potential diabetic nephropathy?
Which parameter, when above normal levels, indicates potential diabetic nephropathy?
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Which of the following strategies can help a patient relax before renal function testing?
Which of the following strategies can help a patient relax before renal function testing?
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What is the normal value range for urine osmolality?
What is the normal value range for urine osmolality?
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What is an important consideration for the 24-hour urine collection process?
What is an important consideration for the 24-hour urine collection process?
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Which of the following is a critical nursing action prior to renal angiography?
Which of the following is a critical nursing action prior to renal angiography?
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During intravenous urography, which positioning of the patient is required?
During intravenous urography, which positioning of the patient is required?
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What is the primary purpose of performing a renal biopsy?
What is the primary purpose of performing a renal biopsy?
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Which nursing intervention is important after a renal biopsy?
Which nursing intervention is important after a renal biopsy?
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What should be done to ensure a sterile urine collection from a catheter specimen?
What should be done to ensure a sterile urine collection from a catheter specimen?
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For the renal clearance test, what is a key measurement to assess?
For the renal clearance test, what is a key measurement to assess?
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What condition is assessed by cystography?
What condition is assessed by cystography?
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What should be the first voided urine specimen collection done to ensure accuracy?
What should be the first voided urine specimen collection done to ensure accuracy?
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In a urinalysis, what would a result of >3 RBCs/hpf most likely indicate?
In a urinalysis, what would a result of >3 RBCs/hpf most likely indicate?
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Which method is considered the most accurate for measuring urine concentration?
Which method is considered the most accurate for measuring urine concentration?
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What is the normal range for serum creatinine levels?
What is the normal range for serum creatinine levels?
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What does a BUN (Blood Urea Nitrogen) level of 30 mg/dl suggest about renal function?
What does a BUN (Blood Urea Nitrogen) level of 30 mg/dl suggest about renal function?
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Which of the following conditions is monitored through the BUN-to-Creatinine ratio?
Which of the following conditions is monitored through the BUN-to-Creatinine ratio?
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What should a patient avoid 24 hours prior to undergoing renal function tests?
What should a patient avoid 24 hours prior to undergoing renal function tests?
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What is the significance of performing a clean catch specimen collection?
What is the significance of performing a clean catch specimen collection?
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Study Notes
Responses to Altered Elimination: Diagnostic Examinations
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Role of Nurses:
- Educate patients before testing; explain the purpose, what to expect, possible side effects, and how to note trends in results.
- Help patients relax and ensure privacy.
Renal Function Tests
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Renal Concentration:
- Measures urine concentration.
- Concentrating ability decreases early in kidney disease.
- This test can detect early kidney defects.
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Specific Gravity:
- Measures the degree of urine concentration
- Normal range: 1.010-1.025
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Urine Osmolality:
- Measures the concentration of solutes in urine
- Normal range: 250-900 mOsm/kg/24 hr, 50-1200 mOsm/kg random sample
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24-Hour Urine:
- Measures volume of creatinine cleared in one minute.
- Approximates glomerular filtration rate (GFR).
- Helpful to detect and monitor kidney disease progression.
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Creatinine Clearance:
- Measures creatinine cleared from blood by kidneys in 1 minute.
- Provides an estimate of GFR.
- Normal values vary by patient age and sex.
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Serum Creatinine:
- Measures renal function effectiveness.
- Normal values: 0.6-1.2 mg/dL (50-110 mmol/L).
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BUN (Blood Urea Nitrogen):
- Measures renal excretion of urea.
- Normal values: 10-25 mg/dL.
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BUN-to-Creatinine Ratio:
- Evaluates hydration status.
- Helps assess kidney disease.
- Normal ratio: approximately 10:1.
Urinalysis
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Kidney Function:
- Urinalysis assists in diagnosing kidney function and other diseases, including diabetes.
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Components:
- Color, clarity, and odor: check for abnormalities.
- pH and specific gravity.
- Protein, glucose, and ketones: test for presence or absence of abnormalities.
- RBCs, WBCs, casts, crystals, and bacteria: check for presence or absence of infection or other issues.
- Normal RBC count: 0-3/hpf
- Hematuria: greater than 3/hpf and often indicative of a larger problem
Urine Culture & Sensitivity
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Bacterial Presence:
- Determines bacterial presence in urine samples.
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Antimicrobial Therapy:
- Identifies appropriate antibiotics based on bacterial sensitivities.
Protein
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Dipstick Examination, and Proteinuria:
- Quantifies protein in urine.
- Normal values range from 30-1000 mg/dL.
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Microalbuminuria:
- Measures Albumin in urine
- Normal values range from 20-200 mg/dL.
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Protein excretion gm/24 hours:
- Measures protein excretion in a 24-hour period
- Measurements vary based on results.
Urine Collection Methods
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Voided Specimen:
- Collect early morning specimen (first voided specimen).
- Place in clean container and send to lab immediately.
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Clean Catch Specimen:
- Instruct client to clean genital area prior to urine collection.
- Collect midstream specimen.
- Place in sterile container and send to lab immediately.
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Catheter Specimen:
- Apply clamp to drainage tubing away from the injection port.
- Clean injection port with antiseptic.
- Use a 5cc syringe to collect specimen.
- Place in sterile container and send to lab immediately.
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24-Hour Urine Collection:
- Collect all urine for a 24-hour period.
- Urine specimens are placed in appropriate container and must be stored in a cool place.
- Normal urine volume varies based on age and sex.
Diagnostic Imaging
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Kidney, Ureter, Bladder Studies:
- Evaluates size, shape, position, and detects abnormalities in kidneys, ureters, and bladder.
Intravenous Urography
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Procedure:
- Dye is injected to visualize the kidneys, ureters, and bladder.
- X-ray is performed to visualize images
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Precautions:
- Assess for allergies, perform bowel preparation, place patient in supine position, and monitor renal function.
- Increase fluid intake.
Cystography
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Evaluates:
- Vesicoureteral reflux, bladder injury.
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Simultaneous Pressure Recordings:
- Can be recorded during the study assessing bladder function.
Nursing Interventions
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Pre-procedure:
- Explain procedure and assess for allergies.
- Prepare for any possible sensations the patient may feel (n/v/etc).
- Perform bowel preparation.
- Injection site may be shaved.
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Post-procedure:
- Monitor vital signs, injection site, peripheral pulses, and assess extremities for color, temperature changes, etc.
- Maintain cold compress if needed.
- Increase oral fluid intake (OFI).
Renal Biopsy
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Indications:
- Unexplained acute kidney injury, persistent proteinuria, hematuria.
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Procedure:
- Removes small piece of renal cortex for analysis.
- Can be percutaneous or open.
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Contraindications:
- Bleeding, uncontrolled hypertension, sepsis, solitary kidneys, large polycystic kidneys, neoplasm and/or UTI and renal failure
Renal Angiography/Arteriography
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Uses:
- Assess renal arteries, blood flow, renal trauma, cysts, tumors, and pre-op assessment for renal transplant.
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Site of Access:
- Femoral artery is the usual site for access and catheter insertion.
Renography (Kidney Scan)
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Procedure:
- Radioactive dye is injected to image renal blood flow and function.
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Precautions:
- Assess for allergies, remain motionless, increase oral fluid intake in order to help clear out the dye from the body.
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Description
This quiz explores the role of nurses in educating patients about renal function tests, including the methods of testing and the importance of results. It covers renal concentration, specific gravity, urine osmolality, and creatinine clearance, providing insight into monitoring kidney health.
