CH 32
A client is experiencing an increase in urinary output. Which physiologic response by the body is responsible for how the kidney concentrates urine?
Decrease in antidiuretic hormone
The nurse is assigned multiple clients with anemia. Which client may be experiencing a failure of the body to produce erythropoietin and thus may require supplemental injections of this hormone?
Client with history of chronic kidney failure
Clients with CKD are at risk for demineralization of their bones since they are no longer able to:
transform vitamin D to its active form.
A nurse is teaching a client scheduled for a cystoscopy about the procedure. Which statement made by the client verifies that the teaching has been successful?
"The doctor will insert a lighted tube through my urethra into my bladder in order to inspect the inside of the bladder."
A client is scheduled for a creatinine clearance test to measure the glomerular filtration rate (GFR). The client asks the nurse what this test is used for. What 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.
The nurse is educating a client about renal disease. Which percentage of cardiac output perfuses the kidneys?
22% to 25%
The nurse is preparing the client with suspected bladder cancer for a biopsy via cystoscopy. What does the nurse teach the client about cystoscopy?
A flexible, lighted tube will be inserted into the bladder and a tissue sample will be taken
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:
Abnormal glomerular filtration
The nurse is performing palpation of the kidney during assessment of the client on the urology unit. The nurse plans to palpate in which area?
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 substance in the blood?
Blood urea nitrogen
Which diagnostic study would be effective in determining direct visualization of the bladder and ureters?
Cystoscope
When the urologist wants to directly visualize the bladder, urethra, and ureteral orifices, what diagnostic test would he use?
Cystoscopy
Which occurrence is most likely to cause increased urination?
Decrease in antidiuretic hormone
A client's most recent blood work reveals a blood urea nitrogen (BUN) level of 36 mg/dL (12.85 mmol/L). Which factor may have contributed to this finding?
Dehydration
A nurse is caring for a client with end-stage renal failure who has symptoms of anemia. The nurse anticipates administering which intervention to increase red blood cell production?
Epoetin alfa
The nurse is caring for a client with a condition of deficiency of antidiuretic hormone (ADH). When assessing the client, which finding does the nurse anticipate?
Excessive urine output
Which option 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 that dysfunction in which structure of the kidney allows protein to leak into the urine?
Glomerulus
The client with chronic kidney disease asks the nurse why he must take active vitamin D (calcitriol) as a medication. What is the most appropriate response by the nurse?
In renal disease, vitamin D is unable to be transformed to its active form.
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.
The nurse recognizes that antidiuretic hormone (ADH) exerts its effects in which location?
Loop of Henle
The nurse has delegated obtaining a urine specimen for testing to the nursing assistant. What does the nurse emphasize the assistant should do to ensure accuracy of testing?
Obtain a freshly voided specimen.
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 would be most concerned when the glomerular filtrate contains:
Protein
When teaching a pharmacology class the nurse relates that 65% of all reabsorptive and secretory processes that occur in the tubular system take place in which area?
Proximal tubules
Many substances are both filtered out of the blood and reabsorbed into the blood in the kidneys. What is the plasma level at which a specific substance can be found in the urine?
Renal threshold
The kidney assists in blood pressure regulation by releasing which substance from the juxtaglomerular cells in response to decreased renal blood flow, causing efferent arteriole vasoconstriction?
Renin
An older adult 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
Which blood test reflects the glomerular filtration rate (GFR) and is used to estimate renal function?
Serum creatinine
Which factor is likely to result in decreased renal blood flow?
Stimulation of the sympathetic nervous system
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
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 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 L of urine each day.
The nephrologist is evaluating the renal function of an older adult client. Which changes, related to aging, does the nephrologist expect to see?
The urine specific gravity will decrease.
The nurse is administering the diuretic furosemide to a client with heart failure. The nurse recognizes that this exerts its action in which area in the kidney?
Thick ascending loop of Henle
The nurse is caring for a client who is diagnosed with gout. Which laboratory study does the nurse monitor to monitor this condition?
Uric acid levels
A client has a routine urine sample during an annual checkup. Which result is an expected finding in a healthy individual?
Urine specific gravity of 1.020
The nurse administers the drug vasopressin to a client with a pituitary disorder. Based on knowledge of pathophysiology, the nurse anticipates the client will react in which way?
Water will be retained and decreased urine output will result.
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 health care 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].
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.
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.
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:
significant decrease in urine output due to decrease in renal blood flow.