Renal

A nurse educator is orientating new nurses to a renal unit of the hospital. Which of the following teaching points should the nurse include as part of a review of normal glomerular function?

"Glomerular filtrate is very similar in composition to blood plasma found elsewhere in circulation."

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."

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."

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.

Select the percentage of cardiac output that perfuses the kidneys.

20% to 25%

Urine is a amber, light-yellow fluid that is 5% dissolved solid. What percent of it is water?

95

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

A decrease in antidiuretic hormone

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

ANP

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."

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.

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

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

The nurse is performing palpation of the kidney during assessment of the client on the urology unit. The nurse plans to palpate in which of these areas?

Between the 12th thoracic and 3rd lumbar vertebrae

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

At which of the following locations in the nephron would a health care professional first expect blood to be largely free of plasma proteins?

Bowman's space

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

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

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

Decrease in anti-diuretic hormone

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

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

The nurse is caring for a client with Addision's disease. For which of these complications does the nurse monitor?

Elevations in potassium levels

A nurse is teaching a client about the functions of the kidney. Which would be the most appropriate information for the nurse to provide? Select all that apply.

Eliminates metabolic wastes Regulates calcium and phosphorus conservation and elimination Regulates blood pressure through the renin-aldosterone mechanism Regulates pH of body fluids through reabsorption and conservation

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

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

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

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

The nurse and nursing student are caring for a client with kidney dysfunction who requires a test to determine glomerular filtration rate. The nurse recognizes that the student understands the test when the student states which of these?

I will need to start a 24-hour urine collection.

Which of the following statements most accurately captures the function of the ascending loop of Henle?

Impermeability to water and absorption of solutes yields highly dilute filtrate.

The nurse is admitting to the hospital a 45-year-old woman with a presumptive diagnosis of diabetes mellitus. While taking her history, she mentions that she has been eating a lot of sweets lately. How would the nurse expect this diet to impact her renal system?

Increase renal blood flow

Which of the following lab results would be associated with abnormalities in kidney function? Select all that apply:

Increased creatinine levels Detectable levels of glucose in a urine sample Elevated cystatin-C level.

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.

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.

Which type of nephron is primarily responsible for concentrating urine?

Juxtamedullary nephrons

The health care provider has prescribed a diuretic to inhibit the Na+/K+/2Cl− cotransporters for a client. The nurse recognizes the medication as a:

Loop diuretic

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

Loop of Henle

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

The nurse in the cardiac clinic is teaching a client about his antihypertensive medications when he mentions he has strained his back and is taking over the counter ibuprofen for relief. Which information does the nurse need to relate to this client?

Non steroidal anti-inflammatory drugs cause fluid retention and should be avoided in those with hypertension.

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.

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

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.

Proximal convoluted tubule Loop of Henle Distal convoluted tubule Collecting tubule

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

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 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.

A medical client's routine urinalysis includes the following data: Casts: positive Red blood cells: negative Crystals: negative White blood cells: negative Epithelial cells: few Which interpretation of these findings is the most plausible?

The client's urine contains excessive protein

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.

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.

Which diuretic acts by preventing the reabsorption of sodium chloride in the distal convoluted tubule?

Thiazide diuretics

The nurse is administering the diuretic furosemide (Lasix) to a client with heart failure. The nurse recognizes that this exerts its action in which of these areas in the kidney?

Thick ascending loop of Henle

Gout and the development of kidney stones are often attributed to high levels of what compound?

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

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

Water will be retained and decreased urine output will result.

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?

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

A client arrives in the emergency department semi-comatose. Her breath has a "fruity" smell. Their initial blood glucose level is >600. Her mouth and mucous membranes are dry. The healthcare providers suspect the client may be experiencing hyperglycemic hyperosmolar syndrome. In this situation, the nurse can expect the client's lab results to reflect:

an increase in glomerular filtration rate [GFR].

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

bound to plasma proteins.

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

concentrate urine.

A client with a history of renal insufficiency is experiencing a flare-up of his arthritis and he has increased his daily dose of ibprofen (an NSAID). Knowing the effect that ibprofen has on prostaglandin synthesis, the nurse should anticipate:

decrease renal blood flow resulting in decrease in urine output.

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 a diagnosis of heart failure has begun showing signs of renal failure. This occurs because:

the kidneys receive a high proportion of cardiac output to maintain GFR and waste-product removal.