Renal Function Tests: Nursing Roles and Procedures
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Questions and Answers

What is the first step in collecting a catheter specimen of urine?

  • Send the specimen to the laboratory
  • Use a 5cc syringe to collect the specimen
  • Clamp the drainage tubing (correct)
  • Clean the injection port with antiseptic

Which of the following is an accurate indicator of overall kidney function?

  • Urinary pH level
  • 24-hour urine volume
  • Blood urea nitrogen (BUN)
  • Creatinine clearance (correct)

What is an essential nursing intervention to prepare a patient before intravenous urography?

  • Encourage limited fluid intake
  • Instruct on deep breathing exercises
  • Administer pain medication
  • Perform bowel preparation (correct)

During which procedure is a radiopaque dye injected to outline the kidneys, ureter, and bladder?

<p>Intravenous urography (D)</p> Signup and view all the answers

What monitoring should be prioritized post-procedure for renal angiography?

<p>Monitor renal function (B)</p> Signup and view all the answers

What action should be taken to relieve discomfort for a patient recovering from a urinary procedure?

<p>Apply moist heat to the lower abdomen (B)</p> Signup and view all the answers

What is one primary indication for performing a renal biopsy?

<p>Diagnose and evaluate extent of kidney disease (A)</p> Signup and view all the answers

Which of the following should not be included in pre-procedural nursing interventions for renal biopsies?

<p>Monitor blood pressure (C)</p> Signup and view all the answers

What is the purpose of instructing a client to self-clean before voiding in a clean catch specimen collection?

<p>To provide a sterile specimen (D)</p> Signup and view all the answers

Which of the following is NOT a normal result in a urinalysis?

<p>Protein level greater than 150 mg/day (A)</p> Signup and view all the answers

What does a BUN-to-Creatinine ratio of 10:1 indicate about a patient’s hydration status?

<p>The patient is well-hydrated (A)</p> Signup and view all the answers

What should the nurse advise the patient about exercising before renal function tests?

<p>Avoid excessive exercise for at least 8 hours (B)</p> Signup and view all the answers

Which of the following indicates a potential need for a renal biopsy?

<p>Persistent proteinuria with unknown cause (A)</p> Signup and view all the answers

Which diagnostic imaging method is most suitable for evaluating renal abnormalities?

<p>CT scan (D)</p> Signup and view all the answers

What is the minimum normal value for serum creatinine?

<p>0.6 mg/dl (D)</p> Signup and view all the answers

In a renal concentration test, what does a fixed specific gravity indicate?

<p>Kidney disease (D)</p> Signup and view all the answers

Which step is crucial when collecting a 24-hour urine specimen?

<p>Discard first void and note the time (C)</p> Signup and view all the answers

What does a renal biopsy help to diagnose?

<p>Extent of kidney disease (B)</p> Signup and view all the answers

Which nursing intervention is appropriate after renal angiography?

<p>Increase oral fluid intake (B)</p> Signup and view all the answers

What is monitored as part of post-procedural care for intravenous urography?

<p>Renal function (C)</p> Signup and view all the answers

Which is a reason to assess for allergy before performing intravenous urography?

<p>To avoid adverse reactions to radiopaque dye (A)</p> Signup and view all the answers

What key factor must be maintained while collecting urine for creatinine clearance?

<p>Ensure the container is kept cool (C)</p> Signup and view all the answers

What is the significance of conducting a cystourethrography?

<p>To visualize urinary tract flow (D)</p> Signup and view all the answers

What nursing activity is indicated prior to renal angiography?

<p>Shaving the injection site (B)</p> Signup and view all the answers

What does a serum creatinine level of 1.5 mg/dl indicate about kidney function?

<p>Possible kidney impairment (C)</p> Signup and view all the answers

Which of the following factors can affect the accuracy of urine specific gravity measurements?

<p>Hydration status of the patient (B)</p> Signup and view all the answers

What could a finding of >3 RBCs/hpf in a urinalysis indicate?

<p>Possible hematuria (C)</p> Signup and view all the answers

Which measure is most reliable for assessing the kidney's ability to concentrate urine?

<p>Osmolality (B)</p> Signup and view all the answers

In a clean catch specimen, which step is NOT part of the collection process?

<p>Collecting urine immediately after the first void (C)</p> Signup and view all the answers

Which parameter, when above normal levels, indicates potential diabetic nephropathy?

<p>Protein levels in urine (B)</p> Signup and view all the answers

Which of the following strategies can help a patient relax before renal function testing?

<p>Ensuring privacy during the procedure (D)</p> Signup and view all the answers

What is the normal value range for urine osmolality?

<p>200 to 800 mOsm/kg (A)</p> Signup and view all the answers

What is an important consideration for the 24-hour urine collection process?

<p>The time of the first void should be noted. (B)</p> Signup and view all the answers

Which of the following is a critical nursing action prior to renal angiography?

<p>Assess for allergy to radiopaque dye. (D)</p> Signup and view all the answers

During intravenous urography, which positioning of the patient is required?

<p>Supine position. (B)</p> Signup and view all the answers

What is the primary purpose of performing a renal biopsy?

<p>To diagnose and evaluate the extent of kidney disease. (C)</p> Signup and view all the answers

Which nursing intervention is important after a renal biopsy?

<p>Monitor the patient's blood pressure and pulse. (D)</p> Signup and view all the answers

What should be done to ensure a sterile urine collection from a catheter specimen?

<p>Clean the injection port with antiseptic solution. (B)</p> Signup and view all the answers

For the renal clearance test, what is a key measurement to assess?

<p>Serum creatinine concentration. (B)</p> Signup and view all the answers

What condition is assessed by cystography?

<p>Vesicoureteral reflux. (A)</p> Signup and view all the answers

What should be the first voided urine specimen collection done to ensure accuracy?

<p>Early morning urine sample (D)</p> Signup and view all the answers

In a urinalysis, what would a result of >3 RBCs/hpf most likely indicate?

<p>Hematuria (D)</p> Signup and view all the answers

Which method is considered the most accurate for measuring urine concentration?

<p>Refractometer (C)</p> Signup and view all the answers

What is the normal range for serum creatinine levels?

<p>0.6 – 1.2 mg/dl (D)</p> Signup and view all the answers

What does a BUN (Blood Urea Nitrogen) level of 30 mg/dl suggest about renal function?

<p>Dehydration or increased protein breakdown (A), Possible kidney dysfunction (C)</p> Signup and view all the answers

Which of the following conditions is monitored through the BUN-to-Creatinine ratio?

<p>Hydration status (A)</p> Signup and view all the answers

What should a patient avoid 24 hours prior to undergoing renal function tests?

<p>Red meat (B)</p> Signup and view all the answers

What is the significance of performing a clean catch specimen collection?

<p>To minimize bacterial contamination (D)</p> Signup and view all the answers

Flashcards

Serum Creatinine

Waste product from muscle breakdown; measured to assess kidney function.

BUN (Blood Urea Nitrogen)

Measures kidney's ability to eliminate urea, a waste product.

BUN-to-Creatinine Ratio

Ratio of BUN to serum creatinine; helps assess hydration status.

Urinalysis

Examining urine to assess kidney and other body functions.

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Urine Culture & Sensitivity

Checks for bacteria in urine and identifies the best antibiotic.

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Hematuria

Presence of blood in the urine.

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Proteinuria

Presence of protein in the urine, greater than normal.

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Specific Gravity

Measures urine concentration; reflects hydration status.

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Catheter Specimen Collection

A method to collect urine using a catheter, clamping the tubing, cleaning the port, collecting using a syringe and placing into a sterile container

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24-Hour Urine Specimen

Collecting urine over a 24-hour period, discarding the first urine, and keeping the container cool.

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Creatinine Clearance

A measurement of kidney function, calculated from urine and blood tests.

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Intravenous Urography

X-ray imaging of the kidneys, ureters, and bladder after injecting a special dye.

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Cystography/Cystourethrography

Visualizing the lower urinary tract (bladder and urethra) using fluoroscopy, sometimes with pressure recordings.

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Renal Angiography/Arteriography

Visualizing the renal arteries and blood flow to the kidneys, useful for diagnosing problems.

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Renal Biopsy

Procedure used to diagnose and evaluate kidney disease by taking a tiny tissue sample from the kidney.

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Post-Procedure Nursing Interventions

Actions taken after a procedure to monitor patient recovery and address potential issues, including vital signs, pain relief, and infection prevention.

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What does a Urine Culture & Sensitivity test check for?

It checks for the presence of bacteria in the urine and identifies which antibiotics are most effective against the specific bacteria found.

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What does IVU stand for?

Intravenous Urography is a diagnostic imaging procedure that uses a contrast dye to visualize the kidneys, ureters, and bladder.

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What is the normal range for serum creatinine?

The normal range for serum creatinine is 0.6 – 1.2 mg/dl (50-110 mmol/L).

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What is the purpose of a voiding cystourethrography?

This procedure uses fluoroscopy to visualize the lower urinary tract, specifically the bladder and urethra, while the patient voids.

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What is the normal range for specific gravity?

The normal range for specific gravity is 1.010-1.025.

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What is a Renal Biopsy?

Taking a small sample of kidney tissue to diagnose and evaluate kidney disease.

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What is the normal range for RBCs in a urinalysis?

The normal range for red blood cells in a urinalysis is 0-3/hpf.

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What is the main indicator of overall kidney function?

Creatinine clearance is the best indicator of overall kidney function.

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What is a Cystography?

A diagnostic imaging procedure that uses a contrast dye to visualize the bladder.

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What does proteinuria indicate?

Proteinuria indicates a larger than normal amount of protein in the urine. It can be a sign of kidney disease.

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What is a 24-Hour Urine Specimen?

Collecting urine over a 24-hour period, discarding the first void, and keeping the container cool.

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What is the BUN-to-Creatinine ratio helpful for?

This ratio is helpful for assessing hydration status.

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What is the difference between a voided urine specimen and a clean catch specimen?

A voided urine specimen is collected by the patient without any special cleaning, while a clean catch specimen requires the patient to clean the genital area before collecting the midstream urine.

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What are the two main types of urine specimens?

The two main types of urine specimens are catheter specimens and 24-hour urine specimens.

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What is the purpose of the renal concentration tests?

These tests evaluate the kidney's ability to concentrate and dilute urine, which is crucial for maintaining electrolyte balance and fluid homeostasis.

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What are some nursing interventions after a renal procedure?

Post-procedure nursing interventions include monitoring vital signs, addressing discomfort with moist heat or warm baths, and preventing infection with antibiotics.

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Cystography

A diagnostic imaging procedure that uses contrast dye to visualize the bladder, often to assess for vesicoureteral reflux where urine backs up from the bladder into the ureters.

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Post-Procedure Nursing Interventions for Urinary Procedures

Actions taken after a urinary procedure to monitor and support the patient, including vital signs, pain management with moist heat or warm baths, and infection prevention.

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Study Notes

Responses to Altered Elimination: Diagnostic Examinations

  • 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

  • Renal Concentration:
    • Measures urine concentration.
    • Concentrating ability decreases early in kidney disease.
    • This test can detect early kidney defects.
  • Specific Gravity:
    • Measures the degree of urine concentration
    • Normal range: 1.010-1.025
  • Urine Osmolality:
    • Measures the concentration of solutes in urine
    • Normal range: 250-900 mOsm/kg/24 hr, 50-1200 mOsm/kg random sample
  • 24-Hour Urine:
    • Measures volume of creatinine cleared in one minute.
    • Approximates glomerular filtration rate (GFR).
    • Helpful to detect and monitor kidney disease progression.
  • 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.
  • Serum Creatinine:
    • Measures renal function effectiveness.
    • Normal values: 0.6-1.2 mg/dL (50-110 mmol/L).
  • BUN (Blood Urea Nitrogen):
    • Measures renal excretion of urea.
    • Normal values: 10-25 mg/dL.
  • BUN-to-Creatinine Ratio:
    • Evaluates hydration status.
    • Helps assess kidney disease.
    • Normal ratio: approximately 10:1.

Urinalysis

  • Kidney Function:
    • Urinalysis assists in diagnosing kidney function and other diseases, including diabetes.
  • 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

  • Bacterial Presence:
    • Determines bacterial presence in urine samples.
  • Antimicrobial Therapy:
    • Identifies appropriate antibiotics based on bacterial sensitivities.

Protein

  • Dipstick Examination, and Proteinuria:
    • Quantifies protein in urine.
    • Normal values range from 30-1000 mg/dL.
  • Microalbuminuria:
    • Measures Albumin in urine
    • Normal values range from 20-200 mg/dL.
  • Protein excretion gm/24 hours:
    • Measures protein excretion in a 24-hour period
    • Measurements vary based on results.

Urine Collection Methods

  • Voided Specimen:
    • Collect early morning specimen (first voided specimen).
    • Place in clean container and send to lab immediately.
  • 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.
  • 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.
  • 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

  • Kidney, Ureter, Bladder Studies:
    • Evaluates size, shape, position, and detects abnormalities in kidneys, ureters, and bladder.

Intravenous Urography

  • Procedure:
    • Dye is injected to visualize the kidneys, ureters, and bladder.
    • X-ray is performed to visualize images
  • Precautions:
    • Assess for allergies, perform bowel preparation, place patient in supine position, and monitor renal function.
    • Increase fluid intake.

Cystography

  • Evaluates:
    • Vesicoureteral reflux, bladder injury.
  • Simultaneous Pressure Recordings:
    • Can be recorded during the study assessing bladder function.

Nursing Interventions

  • 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.
  • 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

  • Indications:
    • Unexplained acute kidney injury, persistent proteinuria, hematuria.
  • Procedure:
    • Removes small piece of renal cortex for analysis.
    • Can be percutaneous or open.
  • Contraindications:
    • Bleeding, uncontrolled hypertension, sepsis, solitary kidneys, large polycystic kidneys, neoplasm and/or UTI and renal failure

Renal Angiography/Arteriography

  • Uses:
    • Assess renal arteries, blood flow, renal trauma, cysts, tumors, and pre-op assessment for renal transplant.
  • Site of Access:
    • Femoral artery is the usual site for access and catheter insertion.

Renography (Kidney Scan)

  • Procedure:
    • Radioactive dye is injected to image renal blood flow and function.
  • 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.

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