Pathophysiology - Ch 32
A client is experiencing an increase in urinary output. Which physiologic response by the body is responsible for how the kidney concentrates urine? Decrease in antidiuretic hormone Reduction in glomerular filtration rate Excessive secretion of aldosterone Activation of the angiotensin system
Decrease in antidiuretic hormone
Clients with CKD are at risk for demineralization of their bones since they are no longer able to: synthesize erythropoietin. excrete bicarbonate effectively. transform vitamin D to its active form. stimulate bone osteoclastic production.
transform vitamin D to its active form. Explanation: The kidneys aid in calcium metabolism by activating vitamin D after it is chemically converted by the liver. Bicarbonate buffering is unrelated to activation of vitamin D. Bone marrow is stimulated by the synthesis of erythropoietin to form red blood cells, which is unrelated to calcium levels.
In addition to regulating body fluids and electrolytes, the kidneys' endocrine function in maintaining bone calcium levels consists of what process? Synthesizing erythropoietin Activating vitamin D Stimulating bone marrow Excreting bicarbonate
Activating vitamin D Explanation: The kidneys aid in calcium metabolism by activating vitamin D after it is chemically converted by the liver. Bicarbonate buffering is unrelated to activation of vitamin D. Bone marrow is stimulated by the synthesis of erythropoietin to form red blood cells, which is unrelated to calcium levels.
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 who recently had surgery and is scheduled for a follow-up visit Client with a recent wound that bled a large amount but is now healing well Client living at a high altitude Client with history of chronic kidney failure Client with impaired oxygenation related to chronic obstructive pulmonary disease (COPD)
Client with history of chronic kidney failure
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? Low blood pressure Retention of sodium Excessive urine output Retention of chloride
Excessive urine output Explanation: ADH regulates the ability of the kidneys to concentrate urine. When ADH is present, the water that moved from the blood into the urine filtrate in the glomeruli is returned to the circulatory system, and when ADH is absent, the water is excreted in the urine. Pathologically, deficiency of ADH leads to polyuria and dehydration.
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 Renal pelvis Calyx Collecting tubule
Glomerulus Explanation: Alterations in the structure and function of the glomerular basement membrane are responsible for the leakage of proteins and blood cells into the filtrate that occurs in many forms of glomerular disease.
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 angiotensin Inactivate vitamin D Produce erythropoietin Produce renin
Produce erythropoietin Explanation: Persons with end-stage kidney disease often are anemic because of an inability of the kidneys to produce erythropoietin. This anemia usually is managed by the administration of a recombinant erythropoietin (epoetin alfa), produced through DNA technology, to stimulate erythropoiesis.
Which blood test reflects the glomerular filtration rate (GFR) and is used to estimate renal function? Serum ammonia Blood urea nitrogen Serum creatinine Blood protein
Serum creatinine Explanation: Serum creatinine level is used to estimate functional capacity of the kidneys. Increased creatinine level indicates decreased GFR and renal function. Blood urea nitrogen (BUN) levels are influenced by hydration status, protein intake, and bleeding, in addition to renal function. Serum ammonia is a metabolic by-product of urea and can be influenced by multiple factors unrelated to kidney function.
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 Low to moderate amount of glucose in the urine Presence of moderate amounts of albumin with the absence of other proteins Presence of urinary casts
Urine specific gravity of 1.020 Explanation: Normal urine specific gravity ranges from 1.010 to 1.025. Glucose and casts are normally absent, and albumin is normally present in only scant amounts.
It is known that high levels of uric acid in the blood can cause gout, while high levels in the urine can cause kidney stones. What medication competes with uric acid for secretion into the tubular fluid, thereby reducing uric acid secretion? Naproxen Ibuprofen Acetaminophen Aspirin
Aspirin Explanation: Small doses of aspirin compete with uric acid for secretion into the tubular fluid and reduce uric acid secretion. Large doses compete with uric acid for reabsorption and increase uric acid excretion in the urine.
Which substance released by atrial muscle cells will inhibit sodium and water reabsorption? Aldosterone B-type natriuretic peptide (BNP) Antidiuretic hormone (ADH) Atrial natriuretic peptide (ANP)
Atrial natriuretic peptide (ANP) Explanation: Atrial natriuretic peptide (ANP) is a hormone that is synthesized in the muscle cells of the atria of the heart and released when the atria are stretched. The primary effect of ANP is to inhibit sodium and water reabsorption, with action predominant in the collecting ducts. Angiotensin I, which has few vasoconstrictor properties, leaves the kidneys and enters the circulation. ADH and aldosterone would decrease blood flow and glomerular filtration rate.
Which diagnostic study would be effective in determining direct visualization of the bladder and ureters? Ultrasonography MRI Renal angiography Cystoscope
Cystoscope Explanation: Cystoscopic examinations can be used for direct visualization of the urethra, bladder, and ureters. Ultrasonography can be used to determine kidney size, and renal radionuclide imaging can be used to evaluate the kidney structures. Radiologic methods, such as excretory urography, provide a means by which kidney structures such as the renal calyces, pelvis, ureters, and bladder can be outlined. Other diagnostic tests include CT scans, MRI, radionuclide imaging, and renal angiography.
The nurse is caring for a client who has sustained a cervical spinal cord injury with resulting muscle wasting due to immobility. Which alteration in the laboratory tests does the nurse recognize is consistent with decreased muscle mass? Decreased creatinine levels Increased blood urea nitrogen levels Decreased calcium levels Increased phosphate levels
Decreased creatinine levels Explanation: Creatinine is a product of creatine metabolism in muscles; its formation and release are relatively constant and proportional to the amount of muscle mass present.
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? Parasympathetic nervous system stimulation Dehydration Increased salt intake Action of antidiuretic hormone
Dehydration Explanation: During periods of dehydration, the blood volume and glomerular filtration rate drop, and BUN levels increase. Increased salt intake, parasympathetic stimulation, and the action of antidiuretic hormone do not normally result in an increase in BUN.
Which factor is likely to result in decreased renal blood flow? Release of nitric oxide Action of prostaglandins Stimulation of the sympathetic nervous system Action of dopamine
Stimulation of the sympathetic nervous system Explanation: Sympathetic nervous system (SNS) stimulation results in decreased renal blood flow by vasoconstriction. Dopamine, nitric oxide, and prostaglandins are all vasodilators.
