Patho Chapter 24

A client in 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 two 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 patient in a 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. He asks the nurse why the test is necessary since he provided a single urine sample two days ago. How could the nurse best respond to the patient's question?

"Often why an abnormal substance shows up in urine test, a 24-hour urine collection is needed to determine exactly how much is present in your urine." p. 615.

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

** Blood urea nitrogen: 26 mg/dL ** Creatinine: 2.6 mg/dL **Potassium: 6.5 mEq/L **Calcium: 4.1 mg/dL pH: 7.23

The renal clearance of any given substance (glucose, urea, creatinine, etc.) that is present in the filtrate is measured independently. What are the factors that determine renal clearance of a substance? (Select all that apply.)

**The ability of the substance to be filtered in the glomeruli **The capacity of the renal tubules to reabsorb or secrete the substance p. 611

The health care provider has ordered a urinalysis for a normally healthy client admitted to the hospital with dehydration. The client has been vomiting for the past 3 days and has had minimal oral intake. Upon analysis of the results, the urine specific gravity reflects:

1.040

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.

Following an automobile accident where the patient had a traumatic amputation of their lower leg and lost >40% of their blood volume, they are currently not producing any urine output. The nurse bases this phenomena on which of the following humoral substances responsible for causing severe vasoconstriction of the renal vessels?

Angiotensin II and ADH. Explanation: The Renin-angiotensin-aldosterone mechanism regulates hort and long term blood pressure. Renin is an enzyme that is tsored and secreted by the juxtaglomerular cells of the kidney, and is released in response to a decrease in renal blood flow or a change in the composition in the distal tubular fluid, or sympathetic nervous system stimulation. Renin acts by converting angiotensinogen to angiotensin I. Angiotensin I (some vasocontrictor properties) leaves the kidneys and enters the circulation. There it is converted to Angiotensin II by the angiotensin-converting enzyme. ANgiotensin II is a potent vasoconstrictor and acts directly on the kidneys to decrease SALT and WATER excretion, this enzyme also stimualtes the secretion of aldosterone by the adrenal gland which exerts a long-term effect on maintenance of blood pressure by increasing the reabsorption of Na in the distal tubule. Renin also acts via Angiotensin II to prodoce constriction of the efferent arteriole as a means of preventing a serious decrease in Glomerular filtration pressure. The glomerular filtration pressure is 2-3 times higher than other cap beds in the body. Relaxation of the afferent arteriole increases the filtration pressure and GFR by increasing glomerular blood flow; relaxation of the efferent arteriole decreases resistance to outflow of blood, decreasing glomerular pressure and GFR. The symapthetic nervous system innervate both the afferent and efferent arterioles which are also sensitive to vasoactive hormones like ANgiotensin II. When sympathetic system is stimulated (shock) the constriction of the afferent arteriole causes a decrease in renal BL flow and thus one in GFR, Therefore urine output can fall to almost 0. p. 604.

Which substance, released by the atria, causes vasodilation of the afferent and efferent arterioles, which results in an increase in renal blood flow and glomerular filtration rate (GFR)?

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 to creatinine 1 mg/dL Explanation: Blood Urea Nitrogen (BUN) is related to GFR but is also influenced by protien intake, GI bleeding, and hydration status. Urea is formed as a by-product of protein metabolism is mainly eliminated by the kidneys. In GI bleeding the BL is broken down by intestinal flora, and the nitogenous waster is absorbed into the portal vein and transported to the liver where it is converted to urea. During dehydration elevated BUN results from an increased concentration. About 2/3rds of renal function must be lost before sign. rise in BUN level occurs. A BUN-creatine ratio is a useful diagnostic for renal insufficiency, anything from 15:1 and greater respresents prerenal conditions like congestive heart failure and upper GI bleeding that increase BUN but NOT creatinine. A ratio less than 10:1 occurs in peaple with liver disease who eat a low-protein diet or chronic dialysis because BUN is more readily dialyzable then creatinine. p. 614.

Select the action of renin in the renin-angiotensin-aldosterone mechanism.

Converts angiotensin to angiotensin I

A nurse is evaluating a patient's morning laboratory values. Which of the following results requires that the nurse notify the health care provider?

Creatinine: 10.6 mg/dL

The nurse is assessing a client who has come to the family practice clinic for an annual checkup. The nurse performs a dip stick of the client's urine for screening, which reveals glucose in the urine. The nurse recognizes this may occur with which of the following medical problems?

Diabetes

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

Excessive urine output Explanation: ADH helps maintain ECF by controlling the permeability of the medullary colelcting tubules. Osmopreceptors in the hypothalamus sense an increase in osmolality of ECF and stimulate the release of ADH (aka vasopressin) from the posterior pituitary galnds. Adh then binds to receptors on tubular celss causes the water channels to move into the luminal side of the tubular membrance, produncung an increase in water permeability. At the basolateral side the water exits the tubular cells into the hyperosmotic interstitium of the medullary area, where it then enters the peritubular capillaries for return to the vascular syste,.The water channels may play a role in inherited and acquired disorders if water reaborption by the kidney, such as diabetes insipidus. p. 607.

Select the option that identifies the function of the kidneys in maintaining normal composition of internal body fluids.

Filtration and reabsorption of physiologically essential substances p. 599

Urine specific gravity is normally 1.010 to 1.025 with adequate hydration. When there is loss of renal concentrating ability due to impaired renal function, low concentration levels are exhibited. When would the nurse consider the low levels of concentration to be significant?

First void in morning p. 615.

The nurse is caring for a client with a disease causing excess antidiuretic hormone. When performing the assessment, the nurse should focus on which of these consequences of excess ADH?

Fluid volume excess Explanation:p. 608.

Which condition causes an elevation in the level of blood urea nitrogen (BUN)?

Gastrointestinal bleeding p. 612

A patient is hospitalized and being treated for an acute kidney injury. Which information is most useful to the nurse while evaluating for improvement in kidney function?

Glomerular filtration rate (GFR)

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

Glomerulus Explanation: This a condition in which alot protein is excreted in the urine. In healthy people less than 150 mg/dL is lost a day. Microalbuminuria occurs long before this condition, and a dipstick test can be done for this. A 24-hour test is recommended for both. p. 615

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

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 most likely?

It removes water from the filtrate and returns it to the vascular compartment. Explanation p. 607.

The nurse recognizes that ADH, antidiuretic hormone, exerts its effects in which of these locations?

Loop of Henle

When explaining the role of the proximal tubule in terms of medication administration, the nursing instructor will emphasize that which of the following medications are bound to plasma proteins and require the proximal tubule secretion of exogenous organic compounds to help with filtration? Select all that apply.

Penicillin. Aspirin. Morphine sulfate.

The nurse and nursing student are caring for a client with a condition causing deficiency of ADH. The nurse recognizes that the student understands the origin of this process when the student states ADH is produced in which of these areas?

Pituitary gland

A nursing student studying pharmacology is learning how angiotensin converting enzyme inhibitors (ACE) work. The student is correct when the student states the mechanism of action of ACE inhibitors is which of these?

Prevent conversion of angiotensin I to II

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 Explanation: About 85-95% of erythropoietin is is formed in the kidneys, and its synthesis is stimulated by hypoxia which can be from anemia, high-altitudes, cardiac pulmonary disease, or impaired oxygenation of tissues. Thus those with chronic kidney disease have anemia because they cannot make eythropoientin and need a recombinant drug to stimulate erythropoiesis. p. 613.

The nurse is teaching a group of nursing students about the physiologic consequences of hypotension and reduced perfusion to the kidney. Which of these compensatory mechanisms occurs immediately after renin release from the kidney?

Production of angiotensin I

Damage to which of the following areas of a nephron would most likely result in impaired secretion and reabsorption?

Proximal tubule Explanation: This drains Bowman's capsule. About 65% of all reabsorpative and secretory processes occur here. There is complete reabsorption of glucose, amino acids, lactate, and water-soluble vitamins here, as well as most of the electrolytes Na+,K+, and Cl-. When blood glucose is elevated in uncontrolled diabetes mellitus the amount that is secreted is surpassing what is being reaborbed (about 320mg/min). p. 603.

When teaching a pharmacology class the nurse relates that 65 percent of all reabsorptive and secretory processes that occur in the tubular system take place in which of these areas?

Proximal tubules p. 605

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 of the following way?

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

Which function of the kidneys helps to maintain the pH balance in the body?

The kidneys conserve base bicarbonate and eliminate hydrogen ions.

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 liters of urine each day.

While assessing a patient with urosepsis, the ICU nurse notes the patient's BP is 80/54; HR 132; RR 24; pulse Ox 89% on 6 lpm O2. Over the last hour, the patients urine output is 15 mL. When explaining to a new graduate nurse, the nurse will emphasize that the patients status may relate to:

The patients sympathetic nervous system has been stimulated which has resulted in vasoconstriction of the afferent arteriole which causes a decrease in renal blood flow.

The nurse is teaching a group of nursing students about the mechanism of action of common diuretics. Which of these best reflects the mechanism of these drugs?

They block the reabsorption of sodium and chloride in the nephron

A client is admitted to the hospital with a diagnosis of gout in the right foot and a kidney stone in the left ureter. The nurse recognizes that these conditions may have resulted from accumulation of:

Uric Acid

The nurse is caring for a client who is diagnosed with gout. Which of these laboratory studies does the nurse monitor to monitor this condition?

Uric acid levels

The nurse is teaching a group of nursing students about the formation of urine in the nephron. Which of these components does the nurse teach are components of the nephron? Select all that apply.

• Collecting tubule • Proximal convoluted tubule • Distal convoluted tubule • Loop of Henle

The nurse is teaching a group of nursing students about the major functions of the kidney. Which of these should the nurse include in the discussion? Select all that apply.

• Elimination of water • Removal of waste products • Removal of excess electrolytes

Select the percentage of cardiac output that perfuses the kidneys.

20% to 25% p. 607

When explaining to a class of nursing students enrolled in pathophysiology, the instructor states, "the majority of energy used by the kidney is for:

Active sodium transport mechanisms." Explanation: p. 604.

When administering a thiazide diuretic the nurse recognizes these medications exert their effects in which of these areas of the kidney?

Distal and collecting tubules p. 606

A client has just been admitted to the emergency department after sustaining severe injuries and massive blood loss following a motor vehicle accident. The nurse predicts that the client's glomerular filtration rate will:

Decrease

The nurse is caring for a client with suspected dehydration. Which of these results does the nurse recognize will help confirm this diagnosis?

Elevated urine specific gravity

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

Increased levels of uric acid in the blood cause gout. p. 612.

The nurse is caring for a client with profound dehydration. The nurse recognizes the body should release ADH in this situation based on which of these types of feedback from the body?

Increased serum osmolarity

The nurse is instructing a client on the procedure for obtaining a voided urine specimen to bring the laboratory for analysis. Which is the most important information for the nurse to tell the client?

Obtain the first-voided morning specimen

An elderly 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

The nurse teaches the client with end-stage kidney disease who has developed anemia that the reason anemia has developed is which of these?

The damaged kidney is unable to produce erythropoietin. p. 613.

The nurse would be most concerned when the glomerular filtrate contains:

Protein

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

"This test provides a gauge of renal function."

When explaining the function of the cells of the proximal tubule, the pathophysiology instructor will emphasize their role in: Select all that apply.

*supporting active transport processes. *increasing the surface area for reabsorption. p. 603

What is the average amount of urine (in liters) produced daily by a man of average height and weight and in good health. (Round your answer off to the nearest half of a liter.)

1.5

A client is experiencing an increase in urinary output. The nurse determines this is a result of:

A decrease in antidiuretic hormone

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 in to the tubular fluid, thereby reducing uric acid secretion?

Aspirin

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

Blood urea nitrogen

Which of the following occurrences is most likely to cause increased urination?

Decrease in anti-diuretic hormone Explanation: p. 608

Select the option that identifies the function of the kidneys in maintaining normal composition of internal body fluids.

Filtration and reabsorption of physiologically essential substance

A 62-year-old woman with high blood pressure is to begin long-term treatment with a thiazide diuretic that she thinks she'll need to take for some time. What should the nurse expect to happen to her potassium and calcium levels?

Her potassium level will drop, but her calcium level may rise. Explanation: p. 606.

Which type of nephron is primarily responsible for concentrating urine?

Juxtamedullary nephrons p. 601-602.

A nurse educator is explaining the importance of maintaining GFR for the maintenance of homeostasis. Which play an essential role in maintaining a constant GFR?

Macula densa Explanation: p. 610.

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. Explanation: The kidneys can eliminate drugs that are weak acids or bases, aka not bound to a protein. p. 612.

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. p. 615.

porth patho chapt 24

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Chapter 24 patho

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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.

A client with Addison disease has been admitted to regulate fluid and electrolyte imbalances. The nurse can anticipate that the client's blood work will show:

serum potassium levels have increased. Explanation :Aldosterone is absent in this disease, and so potassium secretion is deacreased thus the blood levels of it fall. Aldosterone works by secreting potassium. p. 612.