Adult Care I Exam 3 – Questions & Verified Solutions
Assessment of a patient with confirmed or potential renal/ urinary
dysfunction Right Ans - -Waste product build up
-F/E imbalance
Procedure for a urinalysis Right Ans - -Void urine (collect void in the
morning if possible)
-Clean-catch specimen (clean urethra before hand , 1oz is needed)
-Catheterized specimen (STERILE, apply clap to drainage tube, distal to
injection port for 15-30 min, clean injection port, attach syringe and pull out
amount needed, put in specimen container, remove clamp)
-24 hour urine collection
+Ask patient to void and discard then start time
+ collect urine for next 24 hours
+start over if any urine is discarded
+throughout either keep on ice, refrigerate, or use preservative
+at the end ask them to empty bladder one last time
What does a urinalysis look for? Right Ans - -Pregnancy
-Glucose
-Blood (glomerulonephritis)
-Protein (glomerulonephritis)
-Bacteria (infection)
-Nitrates (infection)
-WBC (infection)
Urine:
-turbidity (cloudy?)
-color
-odor (infection, food eaten, meds)
-sediment
BUN and Creatinine Right Ans - blood urea nitrogen
,-a byproduct of protein break down by the liver. It elevated because of
dehydration (has less fluid in blood making it look higher) or kidney
dysfunction (not filtering out that byproduct)
creatinine
-kidneys filter creatinine out so high levels mean kidney dysfunction
GFR- creatinine clearance Right Ans - -low creatinine clearance indicates
kidney dysfunction because glomerulus is not filtering (clearance) creatinine
as well
-high or normal levels mean its filtering good
-based on demographics
Ultrasound Right Ans - assess kidney size; images the ureters, bladder,
masses, cysts, calculi, and obstructions of lower urinary tract
Also can determine blood flow into and out of kidney using doppler color flow
imagining
Ultrasound procedure Right Ans - -Full bladder required
+drink 500-1000ml ab 2-3 hours before test
+don't void until after test is complete
-Prone position
-Gel applied to back and flank areas
Ultrasound patient education Right Ans - -Doesn't cause discomfort and is
without risk
-Fill bladder with 500-1000 ml of water 2-3 hrs before
-Don't void until test is complete
-Will be on prone position
Ultrasound nursing intervention Right Ans - -help to prone position
-after assist pt. to comfortable position and remove gel
CT scan Right Ans - provides three deminsional info about kidneys,
bladder, and surrounsing tissues
-assess kidney size and obstruction, cysts, or masses
-Preformed in radiology
CT scan procedure Right Ans - -might need to be NPO before
,-might need to have contrast medium (iodine) before hand
+may not have iodine if pt. has risk for contrast induced kidney injury, but
images will be less distinct
Nursing interventions- CT scan Right Ans - Pre-procedure
-Encourage increased fluids (to dilute contrast)
-NPO
-Determine allergies to iodine, seafood, eggs, milk, or chocolate
-Determine if they are taking nephrotoxic drufs
-Determine if client has asthma
-Assess hydration status (BP, HR, RR, mucous membranes, skin tugor, urine
concentration)
-Check creatinine and BUN levels
-Withhold metformin 24 hr before (risk for lactic acidosis)
Post-procedure
-Admin IV or oral fluids to flush out contrast (prevents complications)
-Diuretics can help excretion
-Check creatinine and BUN levels before resuming metformin
Patient education- CT scan Right Ans - -keep still during procedure
-drink 1L of fluid before
-dont take metformin 24 hrs before or 48 hrs after
Complications of CT scan Right Ans - Contrast-induced nephropathy
-onset acute kindey failure within 48 hrs
-signs of allergic reaction
High risk if:
-OA
-dehydrated
-pre-exisitng CKD
-Hypotension
-Taking nephrotoxic drugs
MRI Right Ans - similar to CT, provides improved imaging b/t normal and
abnormal tissue in the renal system
-useful for staging cancer
, MRI procedure Right Ans - -Gadolinium-based contrast used and given IV
-Put into machine
Nursing interventions- MRI Right Ans - -Check if they have metal implants
before test, if so they aren't eligible
-make sure their not allergic to contrast
+check renal impairment, serum creatinine >1.5, GFR <45mL/min, >60 yrs
old evaluate renal impairment
Patient education- MRI Right Ans - take off anything metal and inform if
you have anything metal in you
-lie down and remain still throughout
Complications of MRI Right Ans - -Serious injury if they go in with metal
-Nephrogenic systemic fibrosis from contrast
+should check if renal impairment, serum creatinine, GFR, and >60 yrs
Cystoscopy/ cystourethrography Right Ans - endoscopic procedures used
to evaluate bladder, urethra, and lower portion of ureters
-for diagnosis or treatment
-cystoscopy, used for bladder trauma
-cystourethroscopy, used for urethral trauma and to identify cause for urinary
tract obstruction
Also used for:
-remove bladder tumors
-plant radium seeds into tumors
-dilate urethra and ureters with or without stent
-stops areas of bleeding
-cut out enlarged prostate
Cystoscopy/ cystourethroscopy procedure Right Ans - -General anesthesia
might be used based on age, health, expected duration
-Preformed in clinics, ambulatory surgery, short procedure units, or urologist
office
-Pt. placed in lithotomy position (childbirth) after sedated
-Cleansed area and drape
-Cystoscope/ urethroscope through urethra into bladder
Assessment of a patient with confirmed or potential renal/ urinary
dysfunction Right Ans - -Waste product build up
-F/E imbalance
Procedure for a urinalysis Right Ans - -Void urine (collect void in the
morning if possible)
-Clean-catch specimen (clean urethra before hand , 1oz is needed)
-Catheterized specimen (STERILE, apply clap to drainage tube, distal to
injection port for 15-30 min, clean injection port, attach syringe and pull out
amount needed, put in specimen container, remove clamp)
-24 hour urine collection
+Ask patient to void and discard then start time
+ collect urine for next 24 hours
+start over if any urine is discarded
+throughout either keep on ice, refrigerate, or use preservative
+at the end ask them to empty bladder one last time
What does a urinalysis look for? Right Ans - -Pregnancy
-Glucose
-Blood (glomerulonephritis)
-Protein (glomerulonephritis)
-Bacteria (infection)
-Nitrates (infection)
-WBC (infection)
Urine:
-turbidity (cloudy?)
-color
-odor (infection, food eaten, meds)
-sediment
BUN and Creatinine Right Ans - blood urea nitrogen
,-a byproduct of protein break down by the liver. It elevated because of
dehydration (has less fluid in blood making it look higher) or kidney
dysfunction (not filtering out that byproduct)
creatinine
-kidneys filter creatinine out so high levels mean kidney dysfunction
GFR- creatinine clearance Right Ans - -low creatinine clearance indicates
kidney dysfunction because glomerulus is not filtering (clearance) creatinine
as well
-high or normal levels mean its filtering good
-based on demographics
Ultrasound Right Ans - assess kidney size; images the ureters, bladder,
masses, cysts, calculi, and obstructions of lower urinary tract
Also can determine blood flow into and out of kidney using doppler color flow
imagining
Ultrasound procedure Right Ans - -Full bladder required
+drink 500-1000ml ab 2-3 hours before test
+don't void until after test is complete
-Prone position
-Gel applied to back and flank areas
Ultrasound patient education Right Ans - -Doesn't cause discomfort and is
without risk
-Fill bladder with 500-1000 ml of water 2-3 hrs before
-Don't void until test is complete
-Will be on prone position
Ultrasound nursing intervention Right Ans - -help to prone position
-after assist pt. to comfortable position and remove gel
CT scan Right Ans - provides three deminsional info about kidneys,
bladder, and surrounsing tissues
-assess kidney size and obstruction, cysts, or masses
-Preformed in radiology
CT scan procedure Right Ans - -might need to be NPO before
,-might need to have contrast medium (iodine) before hand
+may not have iodine if pt. has risk for contrast induced kidney injury, but
images will be less distinct
Nursing interventions- CT scan Right Ans - Pre-procedure
-Encourage increased fluids (to dilute contrast)
-NPO
-Determine allergies to iodine, seafood, eggs, milk, or chocolate
-Determine if they are taking nephrotoxic drufs
-Determine if client has asthma
-Assess hydration status (BP, HR, RR, mucous membranes, skin tugor, urine
concentration)
-Check creatinine and BUN levels
-Withhold metformin 24 hr before (risk for lactic acidosis)
Post-procedure
-Admin IV or oral fluids to flush out contrast (prevents complications)
-Diuretics can help excretion
-Check creatinine and BUN levels before resuming metformin
Patient education- CT scan Right Ans - -keep still during procedure
-drink 1L of fluid before
-dont take metformin 24 hrs before or 48 hrs after
Complications of CT scan Right Ans - Contrast-induced nephropathy
-onset acute kindey failure within 48 hrs
-signs of allergic reaction
High risk if:
-OA
-dehydrated
-pre-exisitng CKD
-Hypotension
-Taking nephrotoxic drugs
MRI Right Ans - similar to CT, provides improved imaging b/t normal and
abnormal tissue in the renal system
-useful for staging cancer
, MRI procedure Right Ans - -Gadolinium-based contrast used and given IV
-Put into machine
Nursing interventions- MRI Right Ans - -Check if they have metal implants
before test, if so they aren't eligible
-make sure their not allergic to contrast
+check renal impairment, serum creatinine >1.5, GFR <45mL/min, >60 yrs
old evaluate renal impairment
Patient education- MRI Right Ans - take off anything metal and inform if
you have anything metal in you
-lie down and remain still throughout
Complications of MRI Right Ans - -Serious injury if they go in with metal
-Nephrogenic systemic fibrosis from contrast
+should check if renal impairment, serum creatinine, GFR, and >60 yrs
Cystoscopy/ cystourethrography Right Ans - endoscopic procedures used
to evaluate bladder, urethra, and lower portion of ureters
-for diagnosis or treatment
-cystoscopy, used for bladder trauma
-cystourethroscopy, used for urethral trauma and to identify cause for urinary
tract obstruction
Also used for:
-remove bladder tumors
-plant radium seeds into tumors
-dilate urethra and ureters with or without stent
-stops areas of bleeding
-cut out enlarged prostate
Cystoscopy/ cystourethroscopy procedure Right Ans - -General anesthesia
might be used based on age, health, expected duration
-Preformed in clinics, ambulatory surgery, short procedure units, or urologist
office
-Pt. placed in lithotomy position (childbirth) after sedated
-Cleansed area and drape
-Cystoscope/ urethroscope through urethra into bladder
