Patho Test 4 - Renal/Kidney Disorders
Signs and Symptoms of Dialysis Disequilibrium Syndrome (DDS)?
1) Restlessness 2) Decreased LOC 3) Headache?
Priority nursing diagnosis for decreased calcium and vitamin D?
Risk for injury
Tell whether the following statement is true or false: CRF leads to decreased cardiac output (CO).
True Chronic renal failure leads to decreased cardiac output (CO) due to increased blood pressure, decreased oxygenation from anemia, and hypervolemia.
Skin manifestation of later stages of chronic kidney failure?
Uremic frost
A patient with a recent diagnosis of renal failure that will require hemodialysis is being educated in the dietary management of the disease. Which of the patient's following statements shows an accurate understanding of this component of treatment? A) "I've made a list of high-phosphate foods so that I can try to avoid them." B) "I'm making a point of trying to eat lots of bananas and other food rich in potassium." C) "I'm going to try a high-protein, low-carbohydrate diet." D) "I don't think I've been drinking enough, so I want to include 8 to 10 glasses of water each day."
A) "I've made a list of high-phosphate foods so that I can try to avoid them."
Tell whether the following statement is true or false: If GFR increases, urine output (UO) will decrease.
False If GFR increases, urine output (UO) will increase.
Low albumin levels in the blood may be due to?
Proteinuria (excreting protein in the urine)
A patient has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause? a) "Have you had any type of infection within the last 2 weeks?" b) "Do you have a history of heart failure?" c) "Have you ever been diagnosed with diabetes?" d) "Have you recently had kidney stones?"
a) "Have you had any type of infection within the last 2 weeks?" Acute post-infectious Glomerulonephritis usually occurs after infection with certain strains of group A β-hemolytic streptococci and is caused by deposition of immune complexes of antibody and bacterial antigens. Other organism can also cause this infection.
A 42 year-old male has been diagnosed with renal failure secondary to diabetes mellitus and is scheduled to begin dialysis soon. Which of the following statements by the client reflects an accurate understanding of the process of hemodialysis? a) "I won't be able to go about my normal routine during treatment." b) "It's stressful knowing that committing to dialysis means I can't qualify for a kidney transplant." c) "Changing my schedule to accommodate 3 or 4 hours of hemodialysis each day will be difficult." d) "I know I'll have to go to a hospital or dialysis center for treatment."
a) "I won't be able to go about my normal routine during treatment." Hemodialysis requires the client to remain connected to dialysis machinery, whereas peritoneal dialysis allows for activity during treatment. Dialysis does not disqualify an individual from receiving a transplant. Dialysis does not require attendance at a dialysis center, patients can be taught to perform the dialysis in their home with a family member in attendance. Hemodialysis is normally conducted 3 times weekly, not once per day.
In addition to regulating body fluids and electrolytes, the kidneys function in maintaining bone calcium levels by: a) Activating vitamin D. b) Excreting bicarbonate. c) Stimulating bone marrow. d) Synthesizing erythropoietin.
a) Activating vitamin D.
A patient with a diagnosis of chronic kidney disease (CKD) may require the administration of which of the following drugs to treat the consequences of CKD? a) Antihypertensive medications b) Antiarrhythmic medications c) Opioid analgesics d) Nonsteroidal anti-inflammatory drugs (NSAIDs)
a) Antihypertensive medications
The nurse is preparing to assess a client who has just been admitted to the hospital with a diagnosis of prerenal failure. Which would the nurse expect the client to manifest? (Select all that apply) a) BUN-to-serum creatinine ratio of greater than 20:1 b) Increased urinary output c) Decreased urinary output d) Increased BUN e) Decreased BUN f) BUN to serum creatinine ratio of 10:1
a) BUN-to-serum creatinine ratio of greater than 20:1 c) Decreased urinary output d) Increased BUN Prerenal injury is manifested by a sharp decrease in urine output and a disproportionate elevation of blood urea nitrogen (BUN) in relation to serum creatinine levels. Consequently, there also is a disproportionate elevation in the ratio of BUN to serum creatinine, from a normal value of 10:1 to a ratio greater than 20:1.
What are the most common indicators of ARF? (Select all that apply) a) Decreased GFR b) Increased GFR c) Oliguria d) Hypertension e) Azotemia
a) Decreased GFR c) Oliguria e) Azotemia
A client with chronic kidney disease (CKD) is anemic. The nurse will attempt to alleviate the anemia in order to prevent which of the following? (Select all that apply.) a) Decreased myocardial oxygen b) Increased blood viscosity c) Hypersomnia d) Tachycardia e) Fatigue
a) Decreased myocardial oxygen d) Tachycardia e) Fatigue Uncorrected anemia provokes fatigue and insomnia, a decrease in blood viscosity, a decrease in myocardial oxygen supply, and tachycardia as the heart attempts to supply sufficient oxygen to the heart and brain.
A patient is diagnosed with chronic kidney disease (CKD). The nurse recognizes that this patient will experience which of the following? (Select all that apply) a) Decreased tubular reabsorption b) Hypophospatemia c) Decreased glomerular filtration d) Proliferation of nephrons e) Decreased renal endocrine function
a) Decreased tubular reabsorption c) Decreased glomerular filtration e) Decreased renal endocrine function Chronic kidney disease results in loss of nephrons, with a decrease in tubular reabsorption, glomerular filtration, and endocrine function. Phosphate accumulates in the blood, as the kidneys lose their ability to excrete this electrolyte.
The nurse understands that which of the following disorders can lead to the development of chronic kidney disease (CKD)? (Select all that apply) a) Diabetes b) Polycycstic kidney disease c) Systemic lupus erythematosus d) Hyperlipidemia e) Glomerulonephritis
a) Diabetes b) Polycycstic kidney disease c) Systemic lupus erythematosus e) Glomerulonephritis Permanent renal damage can result from systemic lupus erythematosus, polycycstic kidney disease, glomerulonephritis, or diabetes. Hypertension also is a frequent cause for CKD. Hyperlipidemia does not cause CKD but may develop in clients with CKD.
Uremic pericarditis is a disorder that accompanies CKD. What are its presenting signs and symptoms? (Select all that apply) a) Pericardial friction rub b) Chest pain with respiratory accentuation c) Fever without infection d) Shortness of breath e) Thromboangiitis
a) Pericardial friction rub b) Chest pain with respiratory accentuation c) Fever without infection
The nurse is instructing a patient with advanced kidney disease (AKD) about a dietary regimen. Which of the following restrictions should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD? a) Dietary protein b) Fats c) Foods high in calcium d) Carbohydrates
a) Dietary protein Restriction of dietary proteins may decrease the progress of renal impairment in people with advanced renal disease. Proteins are broken down to form nitrogenous wastes, and reducing the amount of protein in the diet lowers the blood urea nitrogen and reduces symptoms.
Which of the following integumentary problems most often accompanies chronic kidney disease? a) Dry skin and pruritus b) Petechiae and purpura c) Hirsutism and psoriasis d) Alopecia
a) Dry skin and pruritus
A client is diagnosed with renal failure. The nurse must monitor for failure of which of the following functions? (Select all that apply) a) Electrolyte balance b) Removal of metabolic waste from blood c) Adrenal secretion d) Acid-base balance e) Maintenance of body water
a) Electrolyte balance b) Removal of metabolic waste from blood d) Acid-base balance e) Maintenance of body water Functions of the kidney include removal of metabolic end products and regulation of body water, electrolyte balance and acid-base balance. Although the adrenal glands are located above the kidneys, the kidneys are not directly involved in their regulation.
People with CKD have impaired immune responses to infection because of high levels of urea and metabolic wastes in the blood. What is one thing that is missing in an immune response in people with CKD? a) Failure to mount a fever with infection b) Failure of a phagocytic response with infection c) Decrease in granulocyte count d) Impaired humoral immunity response with infection
a) Failure to mount a fever with infection
A patient has developed chronic kidney disease (CKD). The nurse will advise the patient to be alert for the development of which hematologic signs and symptoms of this disorder? (Select all that apply) a) Fatigue b) Bradycardia c) Gastrointestinal bleeding d) Bruising e) Intravascular clotting
a) Fatigue c) Gastrointestinal bleeding d) Bruising In CKD, platelet function is impaired and bruising and gastrointestinal bleeding can occur. Intravascular clotting usually does not happen. Decreased renal production of erythropoietin results in decreased synthesis of red blood cells, resulting in anemia and fatigue. Decrease in red cells also decreases blood viscosity and decreases cerebral oxygen delivery, both of which contribute to tachycardia rather than bradycardia.
A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that which of the following statements regarding CKD are correct? (Select all that apply) a) Functioning nephrons compensate for those that are damaged. b) The rate of nephron destruction is the same in all clients. c) Signs and symptoms develop gradually. d) There is a reduction in glomerular filtration rate (GFR) as nephrons are destroyed. e) Nephron destruction takes place over many months.
a) Functioning nephrons compensate for those that are damaged. c) Signs and symptoms develop gradually. d) There is a reduction in glomerular filtration rate (GFR) as nephrons are destroyed. e) Nephron destruction takes place over many months. In CKD, the rate of nephron destruction occurs over many months and is different among clients. Signs and symptoms develop gradually as nephrons are destroyed and functioning nephrons gradually lose the ability to compensate for this. As nephrons are destroyed, GFR declines.
A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor this client for which of the following? (Select all that apply) a) Hyponatremia b) Hypocalcemia c) Hypophosphatemia d) Hyperkalemia e) Metabolic alkalosis
a) Hyponatremia b) Hypocalcemia d) Hyperkalemia The client will also have hyperphosphatemia and metabolic acidosis.
A nurse is assessing a client diagnosed with CKD for neuromuscular manifestation. Select the manifestations the nurse may expect to find. (Select all that apply) a) Loss of recent memory b) Restless leg syndrome c) Perceptual errors d) Muscle weakness e) Increased alertness f) Peripheral neuropathy
a) Loss of recent memory b) Restless leg syndrome c) Perceptual errors d) Muscle weakness f) Peripheral neuropathy Many persons with CKD have alterations in peripheral and central nervous system function. Restless leg syndrome is a manifestation of peripheral nerve involvement, and muscle weakness and atrophy are a manifestation of uremia. Reductions in alertness and awareness are the earliest and most significant indications of uremic encephalopathy. These often are followed by an inability to fix attention, loss of recent memory, and perceptual errors in identifying persons and objects.
What are some signs/symptoms of glomerulonephritis? (Select all that apply) a) Oliguria b) Increased creatinine c) Hematuria (blood in the urine) d) Proteinuria (protein in the urine) e) Hypotension f) Increased hemoglobin
a) Oliguria b) Increased creatinine c) Hematuria (blood in the urine) d) Proteinuria (protein in the urine) Other signs and symptoms include hypertension and decreased hemoglobin.
The nurse knows that a patient with chronic kidney disease (CKD) may experience which of the following changes in skin integrity? (Select all that apply) a) Pale skin b) Decreased perspiration c) Brittle fingernails d) Moist skin and mucous membranes e) Increased oil gland secretion
a) Pale skin b) Decreased perspiration c) Brittle fingernails In CKD, anemia due to loss of erythropoietin activity causes pale skin. Perspiration and oil secretion are decreased, leading to dry skin. Fingernails become brittle.
Which of the following patients does the nurse need to monitor for the development of intense intrarenal vasoconstriction that may induce prerenal failure? (Select all that apply) a) Patient taking cyclosporine to prevent rejection for a liver transplant b) Patient who is HIV positive c) Patient undergoing cardiac catheterization d) Patient with an elevated blood urea nitrogen who is taking ibuprofen every 6 hours for back pain e) Patient taking acetaminophen for fever
a) Patient taking cyclosporine to prevent rejection for a liver transplant c) Patient undergoing cardiac catheterization d) Patient with an elevated blood urea nitrogen who is taking ibuprofen every 6 hours for back pain Some vasoactive mediators, drugs, and diagnostic agents stimulate intense intrarenal vasoconstriction and can induce glomerular hypoperfusion and prerenal failure. Examples include endotoxins, radiocontrast agents such as those used for cardiac catheterization, cyclosporine, and nonsteroidal anti-inflammatory drugs. NSAIDs can reduce renal blood flow by inhibiting prostaglandin syntheses. In some persons with diminished renal perfusion, NSAIDs can precipitate prerenal failure. Acetaminophen for short-term use does not predispose a patient to prerenal failure. An HIV+ client is at no more risk than any other patient.
An 86-year-old female patient has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to prevent urinary incontinence. The patients most recent laboratory results are suggestive of acute renal failure. How would this patients renal failure be categorized? a) Prerenal b) Postrenal c) Intrinsic d) Intrarenal
a) Prerenal
As nitrogenous wastes increase in the blood, the CKD client may exhibit which of the following clinical manifestations? (Select all that apply) a) Pruritis b) Extremely low platelet counts c) Photophobia d) Numbness in lower extremities e) Restless leg syndrome
a) Pruritis d) Numbness in lower extremities e) Restless leg syndrome The uremic state is characterized by signs and symptoms of altered neuromuscular function (e.g., fatigue, peripheral neuropathy, restless leg syndrome, sleep disturbances, uremic encephalopathy); gastrointestinal disturbances such as anorexia and nausea; white blood cell and immune dysfunction, and dermatologic manifestations such as pruritus. Photophobia and thrombocytopenia are usually not associated with CKD.
A client with CKD is being treated for hyperphosphatemia and hypocalcemia. Select the most appropriate interventions. (Select all that apply) a) Restriction of food high in phosphate b) Activated vitamin D c) Oral phosphate supplements d) Phosphate-binding antacids e) Increased daily consumption of milk
a) Restriction of food high in phosphate b) Activated vitamin D d) Phosphate-binding antacids An example of a phosphate-binding antacid is calcium carbonate.
Acute tubular necrosis (ATN) is the most common cause of intrinsic/intrarenal failure. One of the causes of ATN is ischemia. What are the most common causes of ischemic ATN? (Select all that apply.) a) Severe hypovolemia b) Severe hypertension c) Burns d) Overwhelming sepsis e) Severe hypervolemia
a) Severe hypovolemia c) Burns d) Overwhelming sepsis
A chronic kidney disease client who has renal osteodystrophy should be assessed for which of the following complications? (Select all that apply) a) Stress fractures b) Bone pain c) Muscle weakness d) Urosepsis e) Kidney stones
a) Stress fractures b) Bone pain c) Muscle weakness Both types of renal osteodystrophy are manifested by abnormal absorption and defective bone remodeling. Renal osteodystrophy is typically accompanied by reductions in bone mass, alterations in bone microstructure, bone pain, and skeletal fracture. There are changes in bone turnover, mineralization, and bone volume, accompanied by bone pain and muscle weakness, risk of fractures, and other skeletal complications. Kidney stones and urosepsis are not associated with renal osteodystrophy.
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? a) The kidneys should produce about 1.5 liters of urine each day. b) The normal kidney produces an average 3000 ml of urine daily. c) The kidneys should produce a minimum of 10 ml/hour over one day. d) This represents normal urinary output for 24 hours.
a) The kidneys should produce about 1.5 liters of urine each day. Explanation: The kidneys normally produce approximately 1.5 L or 1500 ml of urine each day.
Impaired skin integrity and skin manifestations are common in persons with chronic kidney disease. Pale skin and subcutaneous bruising are often present as a result of: a) Thrombocytopenia b) Anticoagulant therapy c) Decreased vascular volume d) Impaired endocrine function
a) Thrombocytopenia
The client with chronic kidney disease asks the nurse why he must take active vitamin D (calcitriol) as a medication. Which of these is the most appropriate response by the nurse? a) With renal disease vitamin D is unable to be transformed to its active form. b) The skin is no longer able to activate vitamin D for use. c) Vitamin D can no longer be released from the exocrine glands. d) The bones no longer respond to vitamin D and demineralize.
a) With renal disease vitamin D is unable to be transformed to its active form. Explanation: Cholecalciferol and ergocalciferol must undergo chemical transformation to become active: first to 25-hydroxycholecalciferol in the liver and then to 1,25-dihydroxycholecalciferol in the kidneys. Individuals with end-stage renal disease are unable to transform vitamin D to its active form and may require pharmacologic preparations of the active vitamin (calcitriol) for maintaining mineralization of their bones.
A family physician is providing care for a 61 year-old obese male who has a history of diabetes and hypertension. Blood work has indicated that the man has a GFR of 51 mL/min with elevated serum creatinine levels. Which of the following statements will the physician most likely provide to the client in light of these results? a) "You're in kidney failure and I'll be starting dialysis treatment immediately." b) "Your chronic kidney disease has likely been caused by your diabetes and high blood pressure." c) "You likely have chronic kidney disease and there may be urine in your blood until it is controlled." d) "We will regularly monitor your kidney function, but most likely your kidneys will be able to compensate on their own and intervention is not required."
b) "Your chronic kidney disease has likely been caused by your diabetes and high blood pressure." Diabetes and hypertension are conditions that can cause chronic kidney disease (CKD). While the kidneys do have a remarkable ability to compensate for impaired function, this fact does not mean that treatment would not be undertaken. Hematuria is not a common manifestation of CKD and the clients GFR of 51 mL/min does not indicate kidney failure or the need for dialysis.
Select the percentage of cardiac output that perfuses the kidneys. a) 10% to 15% b) 20% to 25% c) 15% to 20% d) 25% to 30%
b) 20% to 25% In the adult, the kidneys are perfused with 1000 to 1300 mL of blood per minute, or 20% to 25% of the cardiac output; 10% to 15% and 15% to 20% represent a lower percentage; 25% to 30% is an increased percentage
A patient has prerenal failure. The nurse knows that this type of failure is characterized by which relationship of blood urea nitrogen (BUN) to serum creatinine levels? a) An elevated BUN level and decreased creatinine level b) A BUN to creatinine level ratio of 20:1 c) A BUN to creatinine level ratio of 10:1 d) An elevated creatinine level and decreased BUN level
b) A BUN to creatinine level ratio of 20:1 In prerenal failure, glomerular filtration rate (GFR) decreases, allowing more filtered urea to be reabsorbed into the circulatory system. Creatinine is filtered but remains in the forming urine. Thus the BUN to creatinine ratio rises to 20:1. A ratio of 10:1 is normal.
The nurse is reviewing the most recent lab results of a client. The nurse would classify which of the following as abnormal? (Select all that apply) a) Sodium: 140 mEq/L b) Calcium: 4.1 mg/dL c) Creatinine: 2.6 mg/dL d) pH: 7.23 e) BUN: 26 mg/dL f) Potassium: 6.5 mEq/L g) Phosphate: 4.5 h) Carbon dioxide: 27 mEq/L i) Chloride: 99 mEq/L
b) Calcium: 4.1 mg/dL c) Creatinine: 2.6 mg/dL d) pH: 7.23 e) BUN: 26 mg/dL f) Potassium: 6.5 mEq/L Calcium and pH are low and potassium, creatinine, and BUN are high.
An adult has a serum sample taken to evaluate the BUN-creatinine ratio. Select the result that indicates a normal test. a) BUN 25 mg/dL to creatinine 1 mg/dL b) BUN 40 mg/dL to creatinine 2 mg/dL c) BUN 10 mg/dL to creatinine 1 mg/dL d) BUN 30 mg/dL to creatinine 2.5 mg/dL
c) BUN 10 mg/dL to creatinine 1 mg/dL Normal BUN to creatinine ratio is 10:1.
A hospital client with a diagnosis of chronic renal failure has orders for measurement of her serum electrolyte levels three times per week. Which of the following statements best captures the relationship between renal failure and sodium regulation? a) Clients with renal failure often maintain high sodium levels because of decreased excretion. b) Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption. c) Renal clients often require a sodium-restricted diet to minimize the excretion load on remaining nephrons. d) Restricting sodium intake helps to preserve nephron function and has the additional benefit of lowering blood pressure.
b) Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption. The compromised ability of the tubular nephrons to reabsorb sodium predisposes renal clients to low serum sodium levels. A sodium restriction is thus not normally indicated.
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: a) Increase b) Decrease c) Remain unchanged d) Stop filtering
b) Decrease Although nearly all the blood that enters the kidney flows through the cortex, less than 10% passes into the medulla and only about 1% moves into the papillae. Under conditions of decreased perfusion or increased sympathetic nervous system stimulation, blood flow is redistributed away from the cortex toward the medulla. This redistribution of blood flow decreases glomerular filtration while maintaining the urine-concentrating ability of the kidneys, a factor that is important during conditions such as shock. With decreasing flow, the filtration rate will decrease to adapt perfusion and maintain function
Chronic kidney disease (CKD) can cause derangement of calcium and phosphate metabolism. The nurse will monitor a client with CKD for which of the following? (Select all that apply.) a) Decreased blood levels of phosphate b) Decreased blood levels of calcium c) Excess calcium deposits in bone d) Decreased release of parathyroid hormone (PTH) e) Impaired phosphate excretion
b) Decreased blood levels of calcium e) Impaired phosphate excretion In CKD, renal ability to excrete phosphate declines. As blood levels of phosphate increase, levels of calcium inversely related to phosphate, fall. This provokes an increase in PTH, which stimulates release of calcium from bone. The patient then becomes at risk for brittle bones and renal osteodystrophy due to the release of calcium from bone.
A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display? a) Terry nails b) Hypertension c) Asterixis d) Impotence
b) Hypertension Hypertension is commonly an early manifestation of CKD. The mechanisms that cause the hypertension are multifactorial; they include increased vascular volume, increased peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins, and increase activity of the renin-angiotensin-aldosterone system. Impotence occurs in as many as 56% of males on dialysis. Terry nails are dark band just behind the leading edge of a fingernail followed by a white band that occur in the late stages. Asterixis, a sign of hepatic encephalopathy, is due to the inability of the liver to metabolize ammonia to urea.
A client diagnosed with CKD has begun to experience periods of epistaxis and developed bruising of skin and subcutaneous tissue. The nurse recognizes these manifestations as? a) Increased erythropoietin b) Impaired platelet function c) Increased platelet production d) Decreased erythropoietin
b) Impaired platelet function Coagulation disorders of CKD are mainly caused by platelet dysfunction. Platelet counts may be slightly decreased, and the bleeding time is prolonged because of abnormal adhesiveness and aggregation.
In hemodialysis, access to the vascular system is most commonly through what? a) External arteriovenous shunt b) Internal arteriovenous fistula c) Internal arteriovenous shunt d) External arteriovenous fistula
b) Internal arteriovenous fistula
A client is diagnosed with acute renal injury. The nurse will evaluate the client for which of the following possible causes for this disorder? (Select all that apply) a) Hormonal imbalance b) Ischemic injury c) Obstruction of urinary outflow d) Nephrotoxic substances e) Nonischemic reduced renal blood flow
b) Ischemic injury c) Obstruction of urinary outflow d) Nephrotoxic substances e) Nonischemic reduced renal blood flow Acute renal injury can result from ischemia, reduced renal blood without ischemia, nephrotoxic substances including some drugs, and obstruction of urinary outflow. Hormonal imbalance usually does not cause renal injury.
The nurse knows that uremia or "urine in the blood" is often used to describe the clinical manifestations of chronic kidney disease (CKD). Which of the following are early signs and symptoms of uremia? (Select all that apply) a) Elevated blood glucose b) Nausea c) Apathy d) Fatigue e) Weakness
b) Nausea c) Apathy d) Fatigue e) Weakness As nitrogenous wastes accumulate in the circulatory system, symptoms of fatigue, nausea, apathy, and weakness will appear. CKD does not immediately affect blood glucose.
The client with acute renal failure has a serum potassium of 6.0 mEq/L. The nurse would plan which of the following as a priority action? a) Check the sodium level b) Place the client on a cardiac monitor c) Encourage increased vegetables in the diet d) Allow an extra 500 ml of fluid intake to dilute the electrolyte concentration
b) Place the client on a cardiac monitor
Which type of acute renal failure (ARF) would be most likely to accompany benign prostatic hypertrophy (BPH)? a) Prerenal b) Postrenal c) Intrinsic d) Extrinsic
b) Postrenal
Which of the following physiologic processes is performed by the kidneys and contributes to increased blood pressure? a) Catalysis of the conversion of angiotensin I to angiotensin II b) Production and release of renin c) Secretion of aldosterone d) Conversion of aldosterone to angiotensin
b) Production and release of renin
The nurse would be most concerned when the glomerular filtrate contains: a) Water b) Protein c) Potassium d) Sodium
b) Protein The glomerular filtrate has a chemical composition similar to plasma which contains sodium, potassium and water, but it contains no proteins because large molecules do not readily cross the glomerular wall.
A 56-year-old woman with type 2 diabetes mellitus and chronic kidney disease has a serum potassium level of 6.8 mEq/L. The nurse should assess the patient for: a) Fatigue b) Flank tenderness c) Cardiac dysrhythmias d) Elevated triglycerides
c) Cardiac dysrhythmias
Which symptom occurs in a client with chronic kidney disease (CKD) as a result of elevated serum phosphate levels and the development of phosphate crystals that occur with hyperparathyroidism? a) Azotemia b) Pruritis c) Asterixis d) Uremia
b) Pruritis Pruritus results from high phosphate levels and the development of phosphate crystals. Azotemia refers to elevated levels of nitrogenous wastes in the blood. Uremia is the accumulation of organic wastes in the blood. Asterixis is a sign of hepatic encephalopathy and is due to the inability of the liver to metabolize ammonia to urea.
The edema that develops in persons with glomerulonephritis and nephrotic syndrome reflects: a) Obstruction and reflux. b) Salt and water retention. c) Inability to concentrate urine. d) Decreased glomerular permeability.
b) Salt and water retention.
Which one of the following blood tests reflects the glomerular filtration rate (GFR) and is used to estimate renal function? a) Blood protein b) Serum creatinine c) Serum ammonia d) Blood urea nitrogen
b) Serum creatinine
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: a) Complaints of flank pain rotating around the abdominal muscles b) Significant decrease in urine output due to decrease in renal blood flow c) Excess output of blood-tinged urine d) An increase in GFR due to relaxation of the afferent arterioles
b) Significant decrease in urine output due to decrease in renal blood flow During periods of strong sympathetic stimulation, such as shock, constriction of the afferent arteriole causes a marked decrease in renal blood flow and thus glomerular filtration pressure. Consequently, urine output can fall almost to 0. Unless the injury is specific to the kidney, the client will not have blood in urine and urine production will not be excessive. Flank pain is associated with obstruction due to stone formation. The GFR will decrease rather than increase.
A nurse observes that a patient's urine is cola colored and considers which of the following as a possible reason? a) The patient has ingested a dark-colored drink. b) The patient's urine contains material from the degradation of red blood cells. c) The patient has an elevation of urine potassium. d) The patient's urine has a decrease in the specific gravity.
b) The patient's urine contains material from the degradation of red blood cells. When red blood cells degrade in the urine, urine may appear cola colored.
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: a) Decrease in antidiuretic hormone b) Urinary tract infection c) Abnormal glomerular filtration d) Poor fluid intake
c) Abnormal glomerular filtration
Which condition is often found in clients who have chronic renal disease? a) Elevated serum protein b) Liver disease c) Anemia d) Lung disease
c) Anemia
Glomerulonephritis is usually caused by: a) Vesicoureteral reflux. b) Catheter-induced infection. c) Antigen-antibody complexes. d) Glomerular membrane viruses.
c) Antigen-antibody complexes.
As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by: a) Decrease in GFR to 30 to 59 mL/min b) Diminished GFR to less than 15 mL/min c) Decrease in GFR of 60 to 89 mL/min d) GFR decrease to 15 to 29 mL/min
c) Decrease in GFR of 60 to 89 mL/min Diminished renal reserve is characteristic of renal insufficiency, when labs remain normal but there is renal insufficiency. Only the second stage, formerly known as renal insufficiency, is characterized by a decrease in GFR of 60 to 89 mL/min. The other choices represent stage 3, 4, and 5, respectfully.
If a CKD client is developing uremic encephalopathy, the earliest manifestations may include: (Select all that apply) a) Delirium and hallucinations b) New-onset seizures c) Diminished awareness d) Decreased alertness
c) Diminished awareness d) Decreased alertness Reductions in alertness and awareness are the earliest and most significant indications of uremic encephalopathy. Late in the disease process, the client may develop delirium, coma, and seizures.
Regardless of the cause, chronic kidney disease results in progressive permanent loss of nephrons, glomerular filtration and renal: a) Tubule dysplasia. b) Vascular pressure. c) Endocrine functions. d) Hypophosphatemia.
c) Endocrine functions.
The health care provider is reviewing lab results of a client. Select the test that is best measurement of overall kidney function? a) Urine albumin levels b) BUN c) GFR d) Serum creatinine levels
c) GFR GFR is usually estimated using the serum creatinine concentration. Creatinine is a by-product of muscle metabolism, is produced at a fairly constant rate, is freely filtered in the glomerulus, and is not reabsorbed in the renal tubules. Essentially, all of the creatinine filtered by the kidneys are lost in urine.
The nurse is providing care for a patient who has a diagnosis of kidney failure. Which of the following laboratory findings is consistent with this patients diagnosis? a) Metabolic alkalosis b) Hypophosphatemia c) Hypocalcemia d) Hypokalemia
c) Hypocalcemia
A client has acute pyelonephritis. The nurse will monitor the client for development of which of the following? a) Prerenal failure b) Post renal failure c) Intrarenal failure d) Chronic kidney disease
c) Intrarenal failure Acute pyelonephritis, an active bacterial infection, can cause tubular cell necrosis and intrarenal failure. Acute pyelonephritis does not cause prerenal or postrenal failure or chronic kidney disease unless it is not treated.
A 45-year-old client with chronic kidney disease (CKD) voices concern about her dialysis treatment. The client would like to work and spend time with her family. Which type of dialysis will best fit this client's lifestyle? a) Hemodialysis b) Continuous ambulatory peritoneal dialysis c) Nocturnal intermittent peritoneal dialysis (NIPD) d) Continuous cyclic peritoneal dialysis
c) Nocturnal intermittent peritoneal dialysis (NIPD) In NIPD, the client is given 10 hours of automatic cycling each night, with the abdomen left dry during the day. This is the most beneficial for this client. Individual preference, manual ability, lifestyle, knowledge of the procedure, and physiologic response to treatment are used to determine the type of dialysis that is used. Hemodialysis is generally three times a week for 3 to 4 hours a day. CAPD involves exchanging the dialysate four to six times per day. In CCPD, the last exchange remains in the abdomen during the day.
While assessing a peritoneal dialysis client in his or her home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as: a) Bladder erosion b) Bowel perforation c) Peritonitis d) Too much sugar in the dialysis solution
c) Peritonitis Potential problems with peritoneal dialysis include infection, catheter malfunction, dehydration, hyperglycemia, and hernia. Bowel perforation can occur, but the fluid would be stool colored. The client may develop hyperglycemia; however, this will not cause the fluid to be cloudy. If bladder erosion had occurred, the fluid would look like urine and not be cloudy and white.
What type of acute renal failure does hydronephrosis cause? a) Prerenal b) Intrarenal/Intrinsic c) Postrenal d) None of the above
c) Postrenal Hydronephrosis is the buildup of fluid in the kidneys due to an obstruction of urinary outflow.
A patient in renal failure has marked decrease in renal blood flow caused by hypovolemia, caused by gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which of the following forms of acute renal injury does this patient have? a) Postrenal failure b) Chronic renal failure c) Prerenal failure d) Intrarenal failure
c) Prerenal failure Prerenal failure, the most common form of acute renal failure, is characterized by a marked decrease in renal blood flow. It is reversible if the cause of the decreased renal blood flow can be identified and corrected before kidney damage occurs.
A client is diagnosed with chronic kidney disease (CKD). The nurse knows that which of the following statements regarding CKD are correct? (Select all that apply) a) Onset is abrupt. b) Symptoms appear with 50% of nephrons lost. c) Renal damage is irreversible. d) Hypertension is a major cause. e) Less than 1% of population is affected.
c) Renal damage is irreversible. d) Hypertension is a major cause. CKD usually develops slowly, often over many years. Irreversible damage occurs, as symptoms do not appear until 80% of the nephrons cease to function. Approximately 10% of the United States population has CKD. Hypertension and diabetes are major causes of CKD.
A 35-year-old client is diagnosed with acute kidney injury (AKI) and is started on hemodialysis. The client is concerned with the diagnosis and wants to know what to expect in the progression of this disorder. Which statement best addresses the client's concern? a) "You will need to have a renal transplant to live a productive, healthy life." b) "Once your condition improves you can be placed on peritoneal dialysis for the rest of your life." c) "The occurrence of acute kidney injury will always eventually result in chronic renal failure." d) "Acute kidney injury is abrupt in onset and often reversible if recognized early and treated appropriately."
d) "Acute kidney injury is abrupt in onset and often reversible if recognized early and treated appropriately." AKI is the result of a rapid decline in kidney function that increases blood levels of nitrogenous wastes. Once the underlying cause is treated, AKI is potentially reversible if the precipitating factors can be corrected or removed before permanent damage occurs.
Which of the following individuals likely faces the greatest risk for the development of chronic kidney disease? a) A first-time mother who recently lost 1.5 L of blood during a postpartum hemorrhage b) A patient whose diagnosis of thyroid cancer necessitated a thyroidectomy c) A patient who experienced a hemorrhagic stroke and now has sensory and motor deficits d) A patient with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet
d) A patient with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet
Which of the following renal disorders is characterized by increased BUN and creatinine levels? a) ARF b) CRF c) Uremia d) B & C e) All of the above
d) All of the above
The nurse is caring for a patient who has had acute blood loss from ruptured esophageal varices. Which of the following does the nurse recognize is an early sign of prerenal failure? a) Baseline blood pressure of 150/90 mm Hg that is now 130/80 mm Hg b) Baseline heart rate of 100 bpm that has increased to 120 bpm c) Foul smelling, cloudy urine d) Baseline urine output of 50 mL/hr that is now 10 mL/hr
d) Baseline urine output of 50 mL/hr that is now 10 mL/hr The kidney normally responds to a decrease in the glomerular filtration rate with a decrease in urine output. Thus, an early sign of prerenal failure is a sharp decrease in urine output.
A patient with a longstanding diagnosis of chronic kidney disease has been experiencing increasing fatigue, lethargy, and activity intolerance in recent weeks. His care team has established that his GFR remains at a low, but stable, level. Which of the following assessments is most likely to inform a differential diagnosis? a) Blood work for white cells and differential b) Cystoscopy and ureteroscopy c) Assessment of pancreatic exocrine and endocrine function d) Blood work for hemoglobin, red blood cells, and hematocrit
d) Blood work for hemoglobin, red blood cells, and hematocrit Decreased levels of hemoglobin, red blood cells, and hematocrit indicate anemia.
Which of the following data would a clinician consider as most indicative of acute renal failure? a) Decreased serum creatinine and blood urea nitrogen (BUN); decreased potassium and calcium levels b) Decreased urine output; hematuria; increased GFR c) Alterations in blood pH; peripheral edema d) Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR).
d) Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR). The hallmark of acute renal injury is azotemia, an accumulation of nitrogenous wastes such as creatinine, urea nitrogen, and uric acid plus a decrease in the GFR of the kidneys. While pH alterations, edema, electrolyte imbalances and decreased urine output may accompany acute renal failure, they are all potentially attributable to other pathologies. Creatinine, GFR and BUN would be unlikely to rise during renal failure.
The nurse is providing dietary instruction for a client with chronic kidney disease who is on hemodialysis. Which would the nurse encourage the client to restrict? a) Raw carrots b) Fresh apples c) Whole grains d) Lean meats
d) Lean meats Dietary proteins may be restricted as a means of decreasing the progress of renal impairment in people with advanced CKD. With protein restriction, adequate calories in the form of carbohydrates and fats are essential to meet energy needs.
The overall indicator of acute renal failure is: a) Anemia b) Increased GFR c) Anuria d) Oliguria
d) Oliguria
Neuromuscular disorders can be triggered by CKD. For those clients on dialysis, approximately two thirds suffer from what peripheral neuropathy? a) Raynaud syndrome b) Tingling and loss of sensation in lower limbs c) Burning hands and feet d) Restless legs syndrome
d) Restless legs syndrome Restless legs syndrome is a manifestation of peripheral nerve involvement and can be seen in as many as two thirds of clients on dialysis. The other answers are not correct.
A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which would be the best instruction for the nurse to provide? a) Restrict intake of dietary fat b) Increase intake of fruit juice c) Increase intake of carbohydrates d) Restrict intake of dietary protein
d) Restrict intake of dietary protein Early morning nausea is common in CKD. Nausea and vomiting often improve with the restriction of dietary protein and after initiation of dialysis and disappears after kidney transplant. The other options will not improve the symptoms.
Which of the following descriptions is true of peritoneal dialysis? a) Vascular access is achieved through an internal arteriovenous fistula or an external arteriovenous shunt. b) Treatments typically occur three times each week for three to four hours. c) The dialyzer is usually a hollow cylinder composed of bundles of capillary tubes. d) Treatment involves the introduction of a sterile dialyzing solution, which is drained after a specified time.
d) Treatment involves the introduction of a sterile dialyzing solution, which is drained after a specified time.
Select the body systems most commonly affected by chronic kidney disease in the elderly? (Select all that apply) a) Reproductive systems b) Immune c) GI system d) Integumentary system e) Cerebrovascular system f) Hematologic g) Skeletal h) Cardiovascular
e) Cerebrovascular system g) Skeletal h) Cardiovascular CKD can lead to congestive heart failure and hypertension. CKD also puts elderly at greater risk for bone fractures because of the decrease in calcium and increase in PTH secretion.
