Chapter 32 Structure and Function of the Kidney - ML3

Which client is benefiting from the renin-angiotensin-aldosterone mechanism?

A college student admitted to the neurotrauma unit following traumatic brain injury requiring surgery to evacuate a large hematoma

The nurse is preparing the client with suspected bladder cancer for a biopsy via cystoscopy. What does the nurse teach the client about cystoscopy?

A flexible, lighted tube will be inserted into the bladder and a tissue sample will be taken.

The anemia that occurs with end-stage kidney disease is often caused by the kidneys themselves. What loss of function in the kidney results in anemia of end-stage kidney disease?

Produce erythropoietin

In the emergency department, a client arrives following a car accident. His pulse is 122; BP 88/60; respiration is 18 bpm. Urine output is 4 mL over the first hour on arrival. When in shock, this lower urine output is primarily due to:

innervation of the sympathetic nervous system causing constriction of the afferent arteriole.

Clients with CKD are at risk for demineralization of their bones since they are no longer able to:

transform vitamin D to its active form.

Which occurrence is most likely to cause increased urination?

Decrease in antidiuretic hormone

A client in the hospital is frustrated at the inconvenience of having to collect his urine for an entire day and night as part of an ordered 24-hour urine-collection test. The client asks the nurse why the test is necessary since the client provided a single urine sample 2 days prior. How could the nurse best respond?

"Often when an abnormal substance shows up in a urine test, a 24-hour urine collection is needed to determine exactly how much is present in your urine."

A nurse is teaching a client scheduled for a cystoscopy about the procedure. Which statement made by the client verifies that the teaching has been successful?

"The doctor will insert a lighted tube through my urethra into my bladder in order to inspect the inside of the bladder."

A client is scheduled for a creatinine clearance test to measure the glomerular filtration rate (GFR). The client asks the nurse what this test is used for. What is the nurse's best response?

"This test provides a gauge of renal function."

A new client on hemodialysis is watching his blood being filtered through a dialyzer. He asks the nurse how much blood typically passes through the kidney every minute? The nurse responds:

1000-1300 mL/minute.

The nurse is educating a client about renal disease. Which percentage of cardiac output perfuses the kidneys?

22% to 25%

A client asks the nurse what may have caused elevation in urinary protein levels (proteinuria) on a urine test. The best response by the nurse would be:

Abnormal glomerular filtration

A client with a history of previous myocardial infarction (MI) has symptomology indicating ineffective renal blood vessel dilation, resulting in increased sodium retention. Which hormone level may have been affected by the MI?

Atrial natriuretic peptide (ANP)

An adult has a serum sample taken to evaluate the BUN-creatinine ratio. Select the result that indicates a normal test.

BUN 10 mg/dL (3.57 mmol/L) to creatinine 1 mg/dL (88.40 µmol/L)

When caring for a client with dehydration, the nurse anticipates the client will have an alteration in which substance in the blood?

Blood urea nitrogen

The nurse is reviewing the most recent blood laboratory results of a client. The nurse would classify which lab results as abnormal? Select all that apply.

Blood urea nitrogen: 26 mg/dL (9.28 mmol/L) Creatinine: 2.6 mg/dL (229.84 µmol/L) Potassium: 6.5 mEq/L (6.5 mmol/L) Calcium: 4.1 mg/dL (1.02 mmol/L) pH: 7.23

The nurse is assigned multiple clients with anemia. Which client may be experiencing a failure of the body to produce erythropoietin and thus may require supplemental injections of this hormone?

Client with history of chronic kidney failure

What is the action of renin in the renin-angiotensin-aldosterone mechanism?

Converts angiotensinogen to angiotensin I

A nurse is evaluating a client's morning laboratory values. Which result requires that the nurse notify the health care provider?

Creatinine: 10.6 mg/dL (937.04 µmol/L)

When the urologist wants to directly visualize the bladder, urethra, and ureteral orifices, what diagnostic test would he use?

Cystoscopy

A client's most recent blood work reveals a blood urea nitrogen (BUN) level of 36 mg/dL (12.85 mmol/L). Which factor may have contributed to this finding?

Dehydration

The nurse is caring for a client with a condition of deficiency of antidiuretic hormone (ADH). When assessing the client, which finding does the nurse anticipate?

Excessive urine output

Which option identifies the function of the kidneys in maintaining normal composition of internal body fluids?

Filtration and reabsorption of physiologically essential substances

When caring for the client with proteinuria, the nurse recognizes that dysfunction in which structure of the kidney allows protein to leak into the urine?

Glomerulus

The client with chronic kidney disease asks the nurse why he must take active vitamin D (calcitriol) as a medication. What is the most appropriate response by the nurse?

In renal disease, vitamin D is unable to be transformed to its active form.

The nurse is reviewing the laboratory work of several medical clients. Which laboratory result is most suggestive of abnormalities in kidney function?

Increased creatinine and blood urea nitrogen (BUN) levels

When teaching the client with gout about the cause of the disease, which cause should the nurse relate?

Increased levels of uric acid in the blood cause gout.

To treat enuresis in a young girl, her pediatrician prescribes desmopressin, an antidiuretic hormone (ADH) nasal spray, before bedtime. Which rationale for this treatment is the mostlikely?

It removes water from the filtrate and returns it to the vascular compartment.

An athlete has become dehydrated during a long race in hot weather. Which physiologic process will occur in an attempt to protect the athlete's extracellular fluid volume?

Release of antidiuretic hormone from the posterior pituitary

An older adult man is brought into the clinic by his daughter, who states, "My father hasn't been himself lately. Now I think he looks a little yellow." What test would the nurse expect to have ordered to check this man's creatinine level?

Serum creatinine

When the glomerular transport maximum for blood glucose is exceeded and its renal threshold has been reached, what happens to the excess glucose?

Spills into the urine

Which factor is likely to result in decreased renal blood flow?

Stimulation of the sympathetic nervous system

The nurse is caring for a client with kidney disease who has an estimated glomerular filtration rate of 75 mL/minute. The nurse interprets this data in which way?

The client has reduced glomerular filtration, reflecting damage to the kidney.

The nurse is caring for a client who has produced an average of 20 mL/hour for the previous day. The nurse recognizes this compares in which way to the normal urine output?

The kidneys should produce about 1.5 L of urine each day.

A client has a routine urine sample during an annual checkup. Which result is an expected finding in a healthy individual?

Urine specific gravity of 1.020

The nurse administers the drug vasopressin to a client with a pituitary disorder. Based on knowledge of pathophysiology, the nurse anticipates the client will react in which way?

Water will be retained and decreased urine output will result.

A client has been prescribed a drug that is not removed quickly by renal filtration. The drug likely has this quality because it is:

bound to plasma proteins.

The nurse is reviewing the results of a renal client's laboratory results. This client's urine specific gravity allows the nurse to assess the kidneys' ability to:

concentrate urine.

A nursing student studying pharmacology is learning how angiotensin converting enzyme inhibitors (ACE) work. The student is correct when stating that the mechanism of action of ACE inhibitors is to:

prevent conversion of angiotensin I to II.

In the intensive care unit (ICU), the nurse is caring for a trauma client who has abdominal injuries, is beginning to have a decrease in BP and increased pulse rate, and is pale with diaphoretic skin. The nurse is assessing the client for hemorrhagic shock. If the client is in shock, the nurse would expect to find:

significant decrease in urine output due to decrease in renal blood flow.