Renal Modules

A patient is admitted to the critical care unit in congestive heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. A diagnosis of renal failure is made. The patient weight upon admission was 176 lb. The patient's weight the next day is 184 lb. What is the approximate amount of fluid retained with this weight gain? A) 3600 mL B) 2000 mL C) 8000 mL D) 800 mL

A) 3600 mL The patient has gained approximately 8 pounds since admission. Remember, the 1 kg is equal to 1 liter. Therefore, converting the weight gain from pounds to kilograms (8 divided 2.2 = 3.6) would reveal the patient has gained approximately 3.6 kilograms for 3.6 liters. Furthermore, there is 1000 mL in every liter, thus 3.6 kilograms would equal 3.6 L or 3600 mL.

Over what range of mean arterial pressure does glomerular filtration rate remain relatively stable due to intrinsic autoregulation? A) 80-180 mm Hg B) 70-120 mm Hg C) 55-110 mm Hg D) 50-150 mm Hg E) 80-100 mm Hg

A) 80-180 mm Hg

Which of the following is always present in acute kidney injury (AKI)? A) A decrease in glomerular filtration rate B) Urine output less than 400 mL/day C) Absence of urine output D) A decrease in metabolic waste products

A) A decrease in glomerular filtration rate By definition, acute kidney injury is a decreased glomerular filtration. Options B and C may be present in renal failure but are not always present. An increase in metabolic waste products, such as creatinine, usually occurs in AKI.

Which of the following can influence serum creatinine? (select all that apply) A) Age B) Gender C) Fluid volume status D) Increased muscle mass E) Time of day

A) Age B) Gender C) Fluid volume status D) Increased muscle mass

When renin eventually stimulates angiotensin II, the adrenal glands then secretes? A) Aldosterone B) Potassium C) Anti-diuretic Hormone (ADH) D) Vasopressin

A) Aldosterone

The primary waste product(s) that are measured to determine kidney function is/are? A) BUN and creatinine B) Creatinine only C) Urease and creatinine D) BUN and ammonia

A) BUN and creatinine

Functions of the kidneys include which of the following? (Select all that apply) Correct! A) Formation of urine B) Blood pressure regulation C) Erythrocyte destruction D) Breakdown of prostaglandins E) Regulation of acid-base balance

A) Formation of urine B) Blood pressure regulation E) Regulation of acid-base balance

Which of the following conditions have been reported in up to 35% of patients with AKI? A) Heart failure, arrhythmias, myocardial infarction B) COPD, heart failure, and previous CABG C) Myocardial infarction, heart failure, and end-stage renal disease D) Parkinson's disease, arrhythmias, and heart failure

A) Heart failure, arrhythmias, myocardial infarction

Where does the concentration and dilution of urine occur? A) In the juxtamedullary nephrons B) In the cortical nephrons C) In the peritubular capillaries D) In the internal nephron

A) In the juxtamedullary nephrons Remember, there are two types of nephrons. The majority (85%) are cortical nephrons located almost entirely within the cortex. Juxtamedullary nephrons (15%) are located in the cortex and extend deep into the medulla. One of the critical functions of the kidney is to keep concentration of substance in body fluids constant by regulating urine concentration and volume. The countercurrent mechanism involves interaction between filtrate flow through the loops of Henle (the countercurrent multiplier) of juxtamedullary nephrons and the flow of blood through the vasa recta (the countercurrent exchanger). This process critical to concentrating and diluting the filtrate (urine).

In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to the maintenance of homeostasis. Which physiologic processes are performed by the kidneys (select all that apply)? A) Production of renin B) Activation of vitamin D C) Carbohydrate metabolism D) Erythropoietin production E) Hemolysis of old red blood cells (RBCs)

A) Production of renin B) Activation of vitamin D D) Erythropoietin production

A patient with new onset acute renal failure reports all of the following during the medical history. Which is most likely to have precipitated the patient's acute renal failure? A) Recent computed tomography of the brain with intravenous (IV) contrast B) A history of congestive heart failure after an acute myocardial infarction C) Twice-daily prescription of Lasix 40 mg by mouth D) A recent bout of benign prostatic hypertrophy (BPH) and transurethral resection of the prostate

A) Recent computed tomography of the brain with intravenous (IV) contrast Intravenous contrast media can be nephrotoxic, especially with the patient's pre-existing cardiac disease. The other choices, although possible causes are less likely than the intravenous contrast media.

Common causes of acute kidney injury may result from? (select all that apply) A) Severe hypotension B) Hypovolemia C) Nephrotoxins (i.e. contrast media) D) I.V. antibiotics E) Chemical exposures F) Overhydration G) I.V. fluids (i.e. normal saline)

A) Severe hypotension B) Hypovolemia C) Nephrotoxins (i.e. contrast media) D) I.V. antibiotics E) Chemical exposures

Which of the following forms the filtration barrier? A) capillary endothelial cells, basement membrane, and podocytes B) basement membrane and podocytes only C) capillary endothelial cells only D) capillary endothelial cells and basement membrane only

A) capillary endothelial cells, basement membrane, and podocytes

The most important assessment parameters for evaluating an anuric patient's fluid status is to measure? A) daily weights B) urine and serum osmolality C) intake and output D) hemoglobin and hematocrit levels

A) daily weights

What is the process whereby molecules are selectively transported from the peritubular fluid to the lumen of the renal tubules? A) secretion B) glomerular filtration C) absorption D) excretion E) reabsorption

A) secretion

The nurse is caring for a client recently admitted for an acute kidney injury. The client's wife asks the nurse, "Are his kidneys going to stop working and will he need a kidney transplant? That's what happen to my friend." Which response by the nurse is the most appropriate? A) "No, don't think that will happen. He will be fine and recover completely." B) "His condition can be reversed with prompt treatment and usually will not cause kidney failure." C) "He will likely need a kidney transplant and it would be a good idea to start talking to family members." D) "When the provider comes to see you, we can talk about whether he will need a transplant."

B) "His condition can be reversed with prompt treatment and usually will not cause kidney failure."

What is the normal glomerular filtration rate (GFR)? A) 30 L/day B) 125 mL/min C) 1 gallon/day D) 625 mL/min E) 3 L/day

B) 125 mL/min

A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has been ordered. The nurse would facilitate the collection of which sample(s)? A) A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values. B) A 24-hour urine specimen and a serum creatinine level midway through the urine collection process. C) A BUN and serum creatinine level on three consecutive mornings. D) A fasting serum potassium level and a random urine sample.

B) A 24-hour urine specimen and a serum creatinine level midway through the urine collection process.

What two structures make up the renal corpuscle? A) nephron and collecting duct B) Bowman's capsule and glomerulus. C) afferent and efferent arterioles D) proximal straight and proximal convoluted tubules E) major and minor calyces

B) Bowman's capsule and glomerulus

The mobilization of calcium from bone stores is accomplished through the influence of which hormone? A) Antidiuretic hormone (ADH) B) Parathyroid hormone (PTH) C) Thyroid-stimulating hormone (TSH) D) Erythropoietin

B) Parathyroid hormone (PTH)

Which electrolytes pose the most potential hazard if not within normal limits for a person with renal failure? A) Phosphorous and calcium B) Potassium and calcium C) Magnesium and sodium D) Phosphorous and magnesium

B) Potassium and calcium Although most electrolytes, such as potassium, become increasingly elevated in patients with acute renal failure, calcium levels are reduced. In each case, these conditions produce life-threatening cardiac dysrhythmias.

Which structure or structures are responsible for the reabsorption of water within the kidney? A) Distal tubule, collecting tubule, vasa recta, peritubular capillaries B) Proximal, distal, and collecting tubules and descending Loop of Henle C) Proximal tubule, ascending limb of the Loop of Henle, and distal tubule D) Ascending and descending Loops of Henle and distal tubule

B) Proximal, distal, and collecting tubules and descending Loop of Henle

Which of the following urine values reflects a decreased ability of the kidneys to concentrate urine? A) pH of 5.0 B) a specific gravity of 1.000 C) No casts D) Urine sodium of 104 mEq / 24 hours

B) a specific gravity of 1.000

Changes in mean arterial pressure have the potential to alter glomerular filtration rate by directly altering which of the following? A) glomerular oncotic pressure B) glomerular capillary hydrostatic pressure C) Bowman's capsule hydrostatic pressure D) Bowman's capsule oncotic pressure E) efferent arteriole resistance

B) glomerular capillary hydrostatic pressure

When a patient's urine dipstick test indicates a small amount of protein, the nurse's next action should be to: A) Send a urine specimen to the laboratory to test for ketones. B) Obtain clean-catch urine for culture and sensitivity testing. C) Inquire about the patient's diet and recent levels of exercise. D) Ask the patient about any family history of chronic renal failure.

C) Inquire about the patient's diet and recent levels of exercise. The question is asking why there might be "protein" in the urine. Transient proteinuria can occur with fever and exercise as well as with symptomatic urinary tract infection. Ketonuria is a medical condition in which ketone bodies are present in the urine. It is seen in conditions in which the body produces excess ketones as an indication that it is using an alternative source of energy...think diabetes. There would be no indication for obtaining a clean-catch urine as it is used to determine the type of bacteria present (culture) and who sensitive the identified bacteria is to various antibiotics. There is no significant relationship between a patient's family history of chronic renal failure and there predisposing risk for developing it.

The functional unit of the kidney is known as the? A) Bowman's Capsule B) Glomerulus C) Nephron D) Distal Convoluting Tubule

C) Nephron

An elderly patient is in a motor vehicle accident and sustains a significant internal hemorrhage. Which category of renal failure is the patient at the greatest risk of developing? A) Intrinsic B) Postrenal C) Prerenal D) Acute tubular necrosis

C) Prerenal Any condition that decreases blood flow, blood pressure, or kidney perfusion before arterial blood reaches the renal artery that supplies the kidney may be anatomically described as prerenal acute kidney injury (AKI). When arterial hypoperfusion caused by low cardiac output, hemorrhage, vasodilation, thrombosis, or other cause reduces the blood flow to the kidney, glomerular filtration decreases, and consequently urine output decreases. Any condition that produces an ischemic or toxic insult directly at parenchymal nephron tissue places the patient at risk for development of intrarenal AKI. Any obstruction that hinders the flow of urine from beyond the kidney through the remainder of the urinary tract may lead to postrenal AKI. When the internal filtering structures are pathologically affected, the condition was previously known as acute tubular necrosis.

The initial filtering of the blood occurs in which structure? A) The distal convoluting tubule (DCT) B) The proximal convoluting tubule (PCT) C) The glomerulus D) The collecting tubule

C) The glomerulus Urine formation begins at the glomerulus, where blood is filtered. The glomerulus is a semipermeable membrane that allows filtration. The hydrostatic pressure of the blood within the glomerular capillaries causes a portion of blood to be filtered across the semipermeable membrane into Bowman's capsule, where the filtered portion of the blood (glomerular filtrate) begins to pass down to the tubule. Filtration is more rapid in the glomerulus than in ordinary tissue capillaries because the glomerular membrane is porous. ( pp. 1016-1017)

What is the process whereby protein-free plasma moves by bulk flow from the glomerulus into Bowman's capsules? A) absorption B) secretion C) glomerular filtration D) excretion E) reabsorption

C) glomerular filtration

In which renal process are molecules selectively removed from the tubule lumen, moved into the interstitial space, and removed from the kidneys by the peritubular capillaries and the vasa recta? A) absorption B) secretion C) reabsorption D) filtration E) excretion

C) reabsorption

Which of the following, if found in the urine, suggests damage to the glomerular membrane? A) Creatinine B) Bicarbonate ions C) Sodium D) Proteins

D) Proteins Large molecules such as proteins (albumin) and red blood cells are prevented from entering the filtrate. The presence of large molecules in the urine is a signal that the glomerular membrane is damaged or affected by disease.

Which of the following conditions would result in an increased release of renin? A) Increased release of angiotensin I B) Increased release of angiotensin II C) Increased amount of sodium in the distal convoluted tubule D) Reduced pressure entering in the glomerulus

D) Reduced pressure entering in the glomerulus

A hypertensive patient was placed on the diuretic Lasix (furosemide) to increase urinary output. Furosemide is a potent diuretic because of its actions in which of following tubular processes? A) Action in the proximal tubule affecting glucose reabsorption B) Action on the entire tubule system affecting sodium secretion C) Action on the collecting ducts blocking the effects of ADH D) Action on the thick ascending limb of the Loop of Henle inhibiting NaCl reabsorption

D) Action on the thick ascending limb of the Loop of Henle inhibiting NaCl reabsorption

Which of the following, if found in the urine, suggests damage to the glomerular membrane? A) Creatinine B) Bicarbonate ions C) Sodium D) Albumin

D) Albumin The ultrafiltrate is similar in composition to blood except that it lacks blood cells, platelets, and large plasma proteins. Under normal conditions, the capillary pores are too small to allow the loss of these large blood components. However, in many kidney diseases, capillary permeability is increased, which permits plasma proteins and blood cells to pass into the urine. ( p. 1017)

When a patient's blood pressure drops, which of the following will help maintain adequate glomerular pressure? A) Constriction of the afferent arteriole and dilation of the efferent arteriole. B) Dilation of both the afferent and efferent arteriole. C) Dilation of the afferent arteriole only. D) Constriction of the efferent arteriole.

D) Constriction of the efferent arteriole.

Which of the following is most indicative of renal failure? A) Elevated blood-urea-nitrogen B) Congestive heart failure C) Peripheral edema D) Elevated creatinine

D) Elevated creatinine Creatinine is used as a measure of the glomerular filtration rate (GFR) because it is a waste product produced at a fairly constant rate by the muscles, is freely filtered by the glomerulus, and is minimally resorbed or secreted by the tubules. Therefore, most of the creatinine produced by the body is excreted by the kidneys, making the creatinine clearance a good screening and follow-up test for estimating the GFR. A creatinine clearance less than 100 mL/min reflects a GFR of less than 100 mL/min and is a signal of decreased kidney function. A creatinine clearance (and GFR) less than 20 mL/min results in symptoms of kidney failure. Patients with and without kidney disease may have a variety of both similar as well as different clinical presentations. Some have symptoms that are a direct result of a kidney issue, such as gross hematuria and flank pain, or a non-kidney specific symptom such as edema or hypertension. Patients can also be asymptomatic and only on a routine examination is an elevated serum creatinine level discovered indicating a kidney condition is present. Edema is a non-specific assessment finding. Congestive heart failure may lead to future kidney issues but the diagnosis is not exclusively associated with kidney disease. Elevated blood-urea-nitrogen (BUN) is highly influenced by non-renal factors and therefore is exclusively specific to kidney dysfunction.

One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin. How do these agents lower potassium? A) They force potassium out of the cells and into the serum, lowering it on a cellular level. B) They promote higher excretion of potassium in the urine. C) They bind with resin in the bowel and are eliminated in the feces. D) They force potassium out of the serum and into the cells, thus causing potassium to lower.

D) They force potassium out of the serum and into the cells, thus causing potassium to lower. Acute hyperkalemia can be treated temporarily by intravenous administration of insulin and glucose. An infusion of 50 mL of 50% dextrose accompanied by 10 units of regular insulin forces potassium out of the serum and into the cells.

The patient complains of a metallic taste and loss of appetite. The nurse is concerned that the patient has developed? A) Glycosuria B) Proteinuria C) Myoglobinuria D) Uremia

D) Uremia

During myogenic regulation of glomerular filtration rate, an increase in mean arterial pressure will: A) cause the afferent arterioles to dilate and thereby maintain a relatively constant glomerular filtration pressure B) cause the afferent arterioles to dilate and thereby allow glomerular filtration pressure to increase C) cause the efferent arterioles to dilate and thereby maintain a relatively constant glomerular filtration pressure D) cause the afferent arterioles to constrict and thereby maintain a relatively constant glomerular filtration pressure E) cause the efferent arterioles to constrict and thereby maintain a relatively constant glomerular filtration pressure

D) cause the afferent arterioles to constrict and thereby maintain a relatively constant glomerular filtration pressure

What type of nephrons are located within the outer region of the kidney and comprise nearly 85% of the nephrons? A) peritubular B) juxtaglomerular C) juxtamedullary D) cortical E) medullary

D) cortical

Maintaining a normal range of serum potassium is important for: A) fluid regulation. B) acid-base buffering. C) triggering ADH release. D) nerve impulse conduction.

D) nerve impulse conduction.

Which of the following is NOT a function of the kidneys? (select all that apply) A) regulation of plasma osmolarity B) regulation of plasma hydrogen concentration C) regulation of plasma volume D) regulation of plasma temperature E) regulation of plasma ionic concentration

D) regulation of plasma temperature

Despite being less than 1% of body weight, the kidneys receive what percent of resting cardiac output? A) 15% B) 1% C) 35% D) 5% E) 20%

E) 20%

Blood leaves the ________ and enters the glomerulus. A) peritubular capillary B) Bowman's capsule C) efferent arteriole D) vasa recta E) afferent arteriole

E) afferent arteriole

The amount of a substance excreted from the kidneys is calculated by which of the following equations? A) filtration - secretion - reabsorption B) filtration + (secretion × reabsorption) C) filtration - (secretion × reabsorption) D) filtration + secretion + reabsorption E) filtration + secretion - reabsorption

E) filtration + secretion - reabsorption

In diabetes mellitus, why does polyuria occur? A) a lack of insulin decreases water reabsorption B) a lack of ADH decreases water reabsorption C) hypoglycemia causes increased permeability of the renal tubules to water D) hypoglycemia causes the excretion of a dilute urine E) hyperglycemia causes some glucose to remain in the renal tubules which pulls water with it by osmosis

E) hyperglycemia causes some glucose to remain in the renal tubules which pulls water with it by osmosis

The juxtaglomerular apparatus describes the unique region of the nephron where ________. A) the afferent and efferent arterioles are in contact with the proximal tubule B) the efferent arteriole is in contact with the proximal tubule C) the afferent arteriole is in contact with the proximal tubule D) the afferent arteriole is in contact with the collecting tubule E) the afferent and efferent arterioles are in contact with the distal tubule

E) the afferent and efferent arterioles are in contact with the distal tubule

The primary function of the kidneys involves regulating the ________ and the ________ of plasma and interstitial fluid. A) pressure : volume B) temperature : composition C) volume : temperature D) composition : osmolarity E) volume : composition

E) volume : composition