401 E2 Exam 2 Renal Outline & Key Concepts Summary | Comprehensive Kidney
1
Physiology Study Guide & Exam Prep 2026
Delegation:
Urine2 questions
collection
Exam 2 renal Chapter 66: 16 questions Chapter 67: 12 questions
Voided Urine: Med calculations: 2 questions SATA/other: 9
Chapter 65: 6 questions Chapter 72: 12 questions questions will be medication related
Collect the first specimen voided in the morning (more concentrated).
Send the specimen to the lab as soon as possible.
Refrigerate the specimen if a delay is unavoidable.
Most commonly done in pregnant mothers to look for protein & glucose. NOT sterile
Clean-Catch Specimen:
Instruct the patient to self-clean before voiding:
Instruct female pts to separate the labia & use the sponges/solution provided to wipe w/ 3 strokes over the urethra.
First 2 strokes are over each side of the urethra; 3rd is centered over the urethra (from front to back).
Instruct male pts to retract the foreskin of the penis and to similarly clean the urethra, using 3 wiping strokes w/ the
sponge/solution provided (from the head of the penis downward).
Surface cleaning is necessary to remove secretions or bacteria from the urethral meatus.
Instruct the patient to initiate voiding after cleaning then stop and resume voiding into the container.
Patient's anatomy should NEVER touch the lip or inner aspect of the container.
Only 1 oz (30 mL) is needed; the remainder may be discarded into the commode.
A midstream collection further removes secretions and bacteria b/c urine flushes the distal portion of the internal urethra.
Gerontologic and cultural considerations:
1. Decreased GFR: monitor hydration status (ability of the kidneys to regulate water balance decreases with age) ensure
adequate fluid intake (kidneys are less able to conserve water when necessary), and administer potentially nephrotoxic agents or
drugs carefully (Dehydration reduces kidney blood flow and increases the nephrotoxic potential of many agents. Acute or chronic
kidney failure may result).
2. Nocturia: ensure adequate nighttime lighting and a hazard-free environment (falls and injuries are common among patients
seeking bathroom facilities), ensure the availability of a bedside toilet, bedpan, or urinal (using these items instead of getting up to
go to the bathroom can help prevent falls), Discourage excessive fluid intake 2-4 hours before bed (Excessive fluid intake at night may
increase nocturia), evaluate drugs and timing (some drugs increase urine output and increase the risk for falling when toileting).
3. Decreased bladder capacity: Encourage the patient to use the toilet, bedpan, or urinal at least every 2 hr. (Emptying the
bladder on a regular basis may avoid overflow urinary incontinence), Respond as soon as possible to the patient's indication of the
need to void. (A quick response may alleviate episodes of urinary stress incontinence).
pg. 1
, 401 E2 Ex am 2 R enal Outline & Key Conc epts Summ ary | Com prehensiv e Kidney Phy siol ogy Study Gui de & Exam Prep 2026lOM oAR cPSD|22962964
4. Weakened urinary sphincters and shortened urethra in women: provide thorough perineal care after each voiding (The
shortened urethra increases the potential for bladder infections. Good perineal hygiene may prevent skin irritations and UTIs).
5. Tendency to retain urine: Observe the patient for urinary retention e.g., bladder distention or urinary tract infection e.g.,
dysuria, foul odor, confusion (Urinary stasis may result in a UTI, which may lead to bloodstream infections, urosepsis, or septic
shock), Provide privacy, assistance, and voiding stimulants such as warm water over the perineum as needed (Nursing interventions
can help initiate voiding), evaluate drugs for possible contribution to retention (anticholinergic drugs promote urinary retention).
Catheterized Specimen for Non-Indwelling (straight)Catheters: May be necessary to obtain an uncontaminated specimen for
analysis or to measure the volume of residual urine. Don't continuously give these -- risk for infection.
For Indwelling Catheters or Tubing: When patients have catheters for continence or long-term urinary drainage; Apply a clamp to
the drainage tubing, distal to the injection port. A sterile container is used for C&S specimens.
24-Hour Urine: Necessary to quantify or calculate the rate of clearance of a particular substance. Mostly for electrolyte levels
MUST BE ON ICE. Place signs appropriately (will have signs all over room).
Initiation of the collection, ask the patient to void, discard the urine, and note the time.
Inform all personnel or family caregivers of test in progress.
If a Foley catheter is in use, empty the tubing & drainage bag at the start time & discard the urine.
Collect all urine for the next 24 hrs. 24 hrs. after initiation, ask the patient to empty the bladder and add that urine to the container.
Proper techniques ensure that all urine formed within the 24-hr period is collected: Do not remove urine from the collection
container for other specimens; Urine in the container is not considered a "fresh" specimen and may be mixed with preservative.
Culture Considerations: African Americans have more rapid age-related decreases in GFR than do white adults. Kidney excretion of
sodium is less effective in hypertensive African Americans who have high sodium intake, and the kidneys have about 20% less blood
flow as a result of anatomic changes in small blood vessels and intrarenal responses to renin. Thus, African American patients are at
greater risk for kidney failure than are white patients. Yearly health examinations should include urinalysis, checking for
the presence of microalbuminuria, and evaluating serum creatinine.
Normal Urinalysis values
Urinalysis: Color- pale to deep yellow, clear. Casts- none. Phosphorus 2.5-4.5 mg/dl.
Odor: Aromatic. Crystals- none Normal lab Potassium 3.5-5 mEq.
values
Specific Gravity: 1.005-1.030. pH: 4.6-8.0. BUN 10-20mg/dl. Sodium 135-145mEq.
Protein: negative to trace.
Creatine 0.5-1.1 mg/dl. WBC 4,300 – 10,800.
Glucose and Ketones: negative.
BUN/creatine ratio 6-25. Hgb 10-15.5 g/dl.
Calcium 8.6-10.2 mg/dl. Hct 33-49%.
GFR >60
WBC’s & RBC’s- 0-4.
pg. 2
, 3
401 E2 Exam 2 Renal Outline & Key Concepts Summary | Comprehensive Kidney
Physiology Study Guide & Exam Prep 2026
Diagnostics:
Urine culture/gram stain Specific gravity
Creatine clearance: measure of glomerular filtration rate (GFR) and kidney function.
The patient's age, gender, height, weight, diet, and activity level influence the expected amount of excreted creatinine.
Thus these factors are considered when interpreting creatinine clearance test results.
Decreases in the creatinine clearance rate may require reducing drug doses and often signifies the need to further explore
the cause of kidney deterioration.
Serum labs:
BUN 10-20mg/dl. Phosphorus 2.5-4.5 mg/dl. Hgb 10-15.5 g/dl.
Creatine 0.5-1.1 mg/dl. Potassium 3.5-5 mEq. Hct 33-49%.
BUN/creatine ratio 6-25. Sodium 135-145mEq. GFR >60
Calcium 8.6-10.2 mg/dl. WBC 4,300 – 10,800.
Diagnostic tests
Bladder Scan: The bladder scan measures ultrasonic reflections within the patient's body to differentiate the urinary bladder from
the surrounding tissue. It is a noninvasive portable tool for diagnosing, managing, and treating urinary outflow dysfunction
KUB: kidneys, ureter, bladder. Sometimes so much bowel matter that you can’t see what you need to see. Used from basic plain film
for X-ray. Shows stones if there’s a mass, any kind of calcifications, and large obstructions.
A lot of times they need another test to completely diagnose a patient.
IVP: shows perfusion and structure of the kidneys, and obstructions. Doesn’t use iodine, they use a radioisotope contrast agent. Lied
prone/sitting. After they get furosemide or captopril
MRI: can be useful for staging cancers
Cystoscopy: To identify abnormalities of the bladder wall and urethral and ureteral occlusions. To treat small obstructions or lesions
via fulguration, lithotripsy, or removal with a stone basket
Angiography: to measure kidney size, to evaluate contour to assess for injury, masses, or obstruction in kidneys or the urinary tract,
and to assess renal blood flow.
Biopsy: can help determine a cause of unexplained kidney problems and help direct or change therapy.
Most are performed percutaneously (through skin and other tissues) using ultrasound or CT guidance.
The patient signs an informed consent. Patients are NPO for 4 to 6 hours before the procedure.
Because of the risk for bleeding after the biopsy, coagulation studies such as platelet count, activated partial thromboplastin
time (aPTT), prothrombin time (PT), and bleeding time are performed before surgery.
pg. 3
, 401 E2 Ex am 2 R enal Outline & Key Conc epts Summ ary | Com prehensiv e Kidney Phy siol ogy Study Gui de & Exam Prep 2026lOM oAR cPSD|22962964
Hypertension is aggressively managed before and after the procedure because high blood pressure can make stopping the
bleeding after the biopsy more difficult. Uremia also increases the risk for bleeding, and dialysis may be prescribed before a
biopsy. A blood transfusion may be needed to correct anemia before biopsy.
Stress incontinence
{most common type} Inability to retain urine when laughing, coughing, sneezing, jogging, or lifting.
Causes: occurs more in women (childbirth).
Childbirth ® pelvic muscles are stretched & weakened ® allows the urethra to move during exertion.
Low estrogen levels after menopause cause vaginal, urethral, & pelvic floor muscles to become thin and weak without
estrogen.
Interventions:
Keep a diary- patient records times of urine leakage, activities, and food eaten
Kegel exercises- most important to help the patient learn which muscles to exercise. Improves continence and quality of life
in women with urinary incontinence. Improvement may take several months but most patients notice a positive change
after 6 weeks. Teach patients to continue the exercises 10 times daily to improve and maintain pelvic floor strength.
Absorbent pads and undergarments may be used during the lengthy process of assessment/treatment/and by patients who
elect not to pursue further interventions.
Non-Surgical management :
Vaginal cone weight therapy- The patient begins her treatment with the heaviest cone she can comfortably hold in her
vagina for the 1- minute test period.
Treatment periods are 15 minutes twice a day. When the patient can comfortably hold the cone in her vagina for
15-minutes, she progresses to the next heaviest weight.
Treatment is completed with the cone labeled 5. Weighted vaginal cones can help strengthen the pelvic muscles
and decrease stress incontinence but may not help pelvic prolapse. Vaginal cones do not require a prescription
Pessary- (plastic device, often ring shaped, that helps hold internal organs in place) inserted into the vagina may help with a
prolapsed uterus or bladder when this condition is contributing to urinary incontinence.
A prolapse occurs when the supportive tissue in the vagina weakens and stretches, allowing pelvic organs to
protrude into the vaginal lumen. The pessary presses against the wall of the vagina to reposition pelvic organs.
Generally, a pessary is removed and cleaned with soap and water on a monthly basis by the patient, but the nurse
can do it for adults with cognitive or musculoskeletal impairment
Electrical stimulation- with either an intravaginal or intrarectal electrical stimulation device is available to treat both urge
and stress incontinence.
Treatment consists of stimulating sensory nerves to decrease the sensation of urgency. It is done as an office-based
procedure one to three times weekly for 6 to 8 weeks.
Magnetic resonance therapy- involves targeted urinary tract nerves and muscles for depolarization.
pg. 4
1
Physiology Study Guide & Exam Prep 2026
Delegation:
Urine2 questions
collection
Exam 2 renal Chapter 66: 16 questions Chapter 67: 12 questions
Voided Urine: Med calculations: 2 questions SATA/other: 9
Chapter 65: 6 questions Chapter 72: 12 questions questions will be medication related
Collect the first specimen voided in the morning (more concentrated).
Send the specimen to the lab as soon as possible.
Refrigerate the specimen if a delay is unavoidable.
Most commonly done in pregnant mothers to look for protein & glucose. NOT sterile
Clean-Catch Specimen:
Instruct the patient to self-clean before voiding:
Instruct female pts to separate the labia & use the sponges/solution provided to wipe w/ 3 strokes over the urethra.
First 2 strokes are over each side of the urethra; 3rd is centered over the urethra (from front to back).
Instruct male pts to retract the foreskin of the penis and to similarly clean the urethra, using 3 wiping strokes w/ the
sponge/solution provided (from the head of the penis downward).
Surface cleaning is necessary to remove secretions or bacteria from the urethral meatus.
Instruct the patient to initiate voiding after cleaning then stop and resume voiding into the container.
Patient's anatomy should NEVER touch the lip or inner aspect of the container.
Only 1 oz (30 mL) is needed; the remainder may be discarded into the commode.
A midstream collection further removes secretions and bacteria b/c urine flushes the distal portion of the internal urethra.
Gerontologic and cultural considerations:
1. Decreased GFR: monitor hydration status (ability of the kidneys to regulate water balance decreases with age) ensure
adequate fluid intake (kidneys are less able to conserve water when necessary), and administer potentially nephrotoxic agents or
drugs carefully (Dehydration reduces kidney blood flow and increases the nephrotoxic potential of many agents. Acute or chronic
kidney failure may result).
2. Nocturia: ensure adequate nighttime lighting and a hazard-free environment (falls and injuries are common among patients
seeking bathroom facilities), ensure the availability of a bedside toilet, bedpan, or urinal (using these items instead of getting up to
go to the bathroom can help prevent falls), Discourage excessive fluid intake 2-4 hours before bed (Excessive fluid intake at night may
increase nocturia), evaluate drugs and timing (some drugs increase urine output and increase the risk for falling when toileting).
3. Decreased bladder capacity: Encourage the patient to use the toilet, bedpan, or urinal at least every 2 hr. (Emptying the
bladder on a regular basis may avoid overflow urinary incontinence), Respond as soon as possible to the patient's indication of the
need to void. (A quick response may alleviate episodes of urinary stress incontinence).
pg. 1
, 401 E2 Ex am 2 R enal Outline & Key Conc epts Summ ary | Com prehensiv e Kidney Phy siol ogy Study Gui de & Exam Prep 2026lOM oAR cPSD|22962964
4. Weakened urinary sphincters and shortened urethra in women: provide thorough perineal care after each voiding (The
shortened urethra increases the potential for bladder infections. Good perineal hygiene may prevent skin irritations and UTIs).
5. Tendency to retain urine: Observe the patient for urinary retention e.g., bladder distention or urinary tract infection e.g.,
dysuria, foul odor, confusion (Urinary stasis may result in a UTI, which may lead to bloodstream infections, urosepsis, or septic
shock), Provide privacy, assistance, and voiding stimulants such as warm water over the perineum as needed (Nursing interventions
can help initiate voiding), evaluate drugs for possible contribution to retention (anticholinergic drugs promote urinary retention).
Catheterized Specimen for Non-Indwelling (straight)Catheters: May be necessary to obtain an uncontaminated specimen for
analysis or to measure the volume of residual urine. Don't continuously give these -- risk for infection.
For Indwelling Catheters or Tubing: When patients have catheters for continence or long-term urinary drainage; Apply a clamp to
the drainage tubing, distal to the injection port. A sterile container is used for C&S specimens.
24-Hour Urine: Necessary to quantify or calculate the rate of clearance of a particular substance. Mostly for electrolyte levels
MUST BE ON ICE. Place signs appropriately (will have signs all over room).
Initiation of the collection, ask the patient to void, discard the urine, and note the time.
Inform all personnel or family caregivers of test in progress.
If a Foley catheter is in use, empty the tubing & drainage bag at the start time & discard the urine.
Collect all urine for the next 24 hrs. 24 hrs. after initiation, ask the patient to empty the bladder and add that urine to the container.
Proper techniques ensure that all urine formed within the 24-hr period is collected: Do not remove urine from the collection
container for other specimens; Urine in the container is not considered a "fresh" specimen and may be mixed with preservative.
Culture Considerations: African Americans have more rapid age-related decreases in GFR than do white adults. Kidney excretion of
sodium is less effective in hypertensive African Americans who have high sodium intake, and the kidneys have about 20% less blood
flow as a result of anatomic changes in small blood vessels and intrarenal responses to renin. Thus, African American patients are at
greater risk for kidney failure than are white patients. Yearly health examinations should include urinalysis, checking for
the presence of microalbuminuria, and evaluating serum creatinine.
Normal Urinalysis values
Urinalysis: Color- pale to deep yellow, clear. Casts- none. Phosphorus 2.5-4.5 mg/dl.
Odor: Aromatic. Crystals- none Normal lab Potassium 3.5-5 mEq.
values
Specific Gravity: 1.005-1.030. pH: 4.6-8.0. BUN 10-20mg/dl. Sodium 135-145mEq.
Protein: negative to trace.
Creatine 0.5-1.1 mg/dl. WBC 4,300 – 10,800.
Glucose and Ketones: negative.
BUN/creatine ratio 6-25. Hgb 10-15.5 g/dl.
Calcium 8.6-10.2 mg/dl. Hct 33-49%.
GFR >60
WBC’s & RBC’s- 0-4.
pg. 2
, 3
401 E2 Exam 2 Renal Outline & Key Concepts Summary | Comprehensive Kidney
Physiology Study Guide & Exam Prep 2026
Diagnostics:
Urine culture/gram stain Specific gravity
Creatine clearance: measure of glomerular filtration rate (GFR) and kidney function.
The patient's age, gender, height, weight, diet, and activity level influence the expected amount of excreted creatinine.
Thus these factors are considered when interpreting creatinine clearance test results.
Decreases in the creatinine clearance rate may require reducing drug doses and often signifies the need to further explore
the cause of kidney deterioration.
Serum labs:
BUN 10-20mg/dl. Phosphorus 2.5-4.5 mg/dl. Hgb 10-15.5 g/dl.
Creatine 0.5-1.1 mg/dl. Potassium 3.5-5 mEq. Hct 33-49%.
BUN/creatine ratio 6-25. Sodium 135-145mEq. GFR >60
Calcium 8.6-10.2 mg/dl. WBC 4,300 – 10,800.
Diagnostic tests
Bladder Scan: The bladder scan measures ultrasonic reflections within the patient's body to differentiate the urinary bladder from
the surrounding tissue. It is a noninvasive portable tool for diagnosing, managing, and treating urinary outflow dysfunction
KUB: kidneys, ureter, bladder. Sometimes so much bowel matter that you can’t see what you need to see. Used from basic plain film
for X-ray. Shows stones if there’s a mass, any kind of calcifications, and large obstructions.
A lot of times they need another test to completely diagnose a patient.
IVP: shows perfusion and structure of the kidneys, and obstructions. Doesn’t use iodine, they use a radioisotope contrast agent. Lied
prone/sitting. After they get furosemide or captopril
MRI: can be useful for staging cancers
Cystoscopy: To identify abnormalities of the bladder wall and urethral and ureteral occlusions. To treat small obstructions or lesions
via fulguration, lithotripsy, or removal with a stone basket
Angiography: to measure kidney size, to evaluate contour to assess for injury, masses, or obstruction in kidneys or the urinary tract,
and to assess renal blood flow.
Biopsy: can help determine a cause of unexplained kidney problems and help direct or change therapy.
Most are performed percutaneously (through skin and other tissues) using ultrasound or CT guidance.
The patient signs an informed consent. Patients are NPO for 4 to 6 hours before the procedure.
Because of the risk for bleeding after the biopsy, coagulation studies such as platelet count, activated partial thromboplastin
time (aPTT), prothrombin time (PT), and bleeding time are performed before surgery.
pg. 3
, 401 E2 Ex am 2 R enal Outline & Key Conc epts Summ ary | Com prehensiv e Kidney Phy siol ogy Study Gui de & Exam Prep 2026lOM oAR cPSD|22962964
Hypertension is aggressively managed before and after the procedure because high blood pressure can make stopping the
bleeding after the biopsy more difficult. Uremia also increases the risk for bleeding, and dialysis may be prescribed before a
biopsy. A blood transfusion may be needed to correct anemia before biopsy.
Stress incontinence
{most common type} Inability to retain urine when laughing, coughing, sneezing, jogging, or lifting.
Causes: occurs more in women (childbirth).
Childbirth ® pelvic muscles are stretched & weakened ® allows the urethra to move during exertion.
Low estrogen levels after menopause cause vaginal, urethral, & pelvic floor muscles to become thin and weak without
estrogen.
Interventions:
Keep a diary- patient records times of urine leakage, activities, and food eaten
Kegel exercises- most important to help the patient learn which muscles to exercise. Improves continence and quality of life
in women with urinary incontinence. Improvement may take several months but most patients notice a positive change
after 6 weeks. Teach patients to continue the exercises 10 times daily to improve and maintain pelvic floor strength.
Absorbent pads and undergarments may be used during the lengthy process of assessment/treatment/and by patients who
elect not to pursue further interventions.
Non-Surgical management :
Vaginal cone weight therapy- The patient begins her treatment with the heaviest cone she can comfortably hold in her
vagina for the 1- minute test period.
Treatment periods are 15 minutes twice a day. When the patient can comfortably hold the cone in her vagina for
15-minutes, she progresses to the next heaviest weight.
Treatment is completed with the cone labeled 5. Weighted vaginal cones can help strengthen the pelvic muscles
and decrease stress incontinence but may not help pelvic prolapse. Vaginal cones do not require a prescription
Pessary- (plastic device, often ring shaped, that helps hold internal organs in place) inserted into the vagina may help with a
prolapsed uterus or bladder when this condition is contributing to urinary incontinence.
A prolapse occurs when the supportive tissue in the vagina weakens and stretches, allowing pelvic organs to
protrude into the vaginal lumen. The pessary presses against the wall of the vagina to reposition pelvic organs.
Generally, a pessary is removed and cleaned with soap and water on a monthly basis by the patient, but the nurse
can do it for adults with cognitive or musculoskeletal impairment
Electrical stimulation- with either an intravaginal or intrarectal electrical stimulation device is available to treat both urge
and stress incontinence.
Treatment consists of stimulating sensory nerves to decrease the sensation of urgency. It is done as an office-based
procedure one to three times weekly for 6 to 8 weeks.
Magnetic resonance therapy- involves targeted urinary tract nerves and muscles for depolarization.
pg. 4
