Ch 32 Kidney Function all

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 place a catheter into an artery in my groin and inject a dye that will visualize the blood supply to the kidneys." "The doctor will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into my kidney." "The doctor will insert a lighted tube through my urethra into my bladder in order to inspect the inside of the bladder." "The doctor will inject a radioactive solution into my vein. The dye will distribute through my body and can be monitored by x-ray as it travels through my kidneys to my bladder."

"The doctor will insert a lighted tube through my urethra into my bladder in order to inspect the inside of the bladder."

The nurse is caring for a critically ill client who requires measurement of hourly urine output. When assessing the urine output of the previous shift, the nurse recognizes that which volume reflects a minimum, normal urinary output? 10 mL/hour 20 mL/hour 60 mL/hour 125 mL/hour

60 mL/hour Under normal conditions, only approximately 1 mL of the 125 mL of glomerular filtrate that is formed each minute is excreted in the urine. The other 124 mL is reabsorbed in the tubules. This means that the average output of urine is approximately 60 mL/hour.

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

95% water

An adult has a serum sample taken to evaluate the BUN-creatinine ratio. Select the result that indicates a normal test. A. BUN 10 mg/dL (3.57 mmol/L) to creatinine 1 mg/dL (88.40 µmol/L) B. BUN 40 mg/dL (14.28 mmol/L) to creatinine 2 mg/dL C. BUN 30 mg/dL (10.71 mmol/L) to creatinine 2.5 mg/dL) C. BUN 25 mg/dL (8.92 mmol/L) to creatinine 1 mg/dL

A. BUN 10 mg/dL (3.57 mmol/L) to creatinine 1 mg/dL (88.40 µmol/L) The BUN-creatinine ratio is approximately 10:1. The other results, ratios greater than 15:1, represent prerenal conditions, such as congestive heart failure and upper gastrointestinal bleeding, that produce an elevation in BUN not creatinine.

When the urologist wants to directly visualize the bladder, urethra, and ureteral orifices, what diagnostic test would he use? A. Cystoscopy B. Ultrasonography C. Echocardiogram D, Laparoscopy

A. Cystoscopy Cystoscopy provides a means for direct visualization of the urethra, bladder, and ureteral orifices. It relies on the use of a cystoscope, an instrument with a lighted lens. None of the other tests provide direct visualization of the bladder, urethra, and ureteral orifices.

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: A. I will need to start a 24-hour urine collection. B. I will alert the laboratory to obtain blood for a blood urea nitrogen level. C. I will obtain a urine specimen for urine osmolality. D. I will teach the client to wipe the meatus and collect the specimen during the urine stream.

A. I will need to start a 24-hour urine collection. The test for glomerular filtration requires 24-hour urine collection, with blood being drawn when the urine collection is completed. In another method, two 1-hour urine specimens are collected, and a blood sample for creatinine is drawn in-between.

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? A. Proximal tubules B. Afferent arteriole C. Efferent arteriole D. Bowman's capsule

A. Proximal tubules Approximately 65% of all reabsorptive and secretory processes that occur in the tubular system take place in the proximal tubules. There is almost complete reabsorption of nutritionally important substances, such as glucose, amino acids, lactate, and water soluble vitamins.

An athlete has become dehydrated during a long race in hot weather. Which physiologic process will occur in an attempt to protect the athlete's extracellular fluid volume? A. Release of antidiuretic hormone from the posterior pituitary B. Increased water reabsorption in the distal convoluted tubule C. Increased water reabsorption in the ascending limb of the loop of Henle D. Dilation of the afferent and efferent arterioles

A. Release of antidiuretic hormone from the posterior pituitary Antidiuretic hormone (ADH) assists in the maintenance of the extracellular fluid volume by controlling the permeability of the medullary collecting tubules. Osmoreceptors in the hypothalamus sense an increase in osmolality of extracellular fluids and stimulate the release of ADH from the posterior pituitary gland. In exerting its effect, ADH, also known as vasopressin, binds to receptors on the basolateral side of the tubular cells. Binding of ADH to the vasopressin receptors causes water channels, known as aquaporin-2 channels, to move into the luminal side of the tubular cell membrane, producing a marked increase in water permeability. The ascending limb of the loop of Henle and the distal convoluted tubule are largely impermeable to water, and arteriole dilation does not directly increase the amount of water reabsorbed from glomerular filtrate.

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? A. Water will be retained and decreased urine output will result. B. Water will be lost through the kidney. C. Water loss with dehydration will result. D. Decreased renal blood flow and urine output will occur.

A. Water will be retained and decreased urine output will result. ADH, also known as vasopressin, acts at the level of the collecting tubule to increase water absorption, increasing blood volume and decreasing urine output.

A client is admitted with worsening heart failure. The client is reporting frequent urination recently. The nurse knows that the physiology behind the body's response to decreased vascular volume by increasing urine output is due to: A. release of atrial natriuretic peptide (ANP) from overstretched atria. B. renin secretion, resulting in angiotensin II formation. C. reabsorption of potassium from the proximal tubule. D. aldosterone secretion by the adrenal gland, which inhibits sodium absorption.

A. release of atrial natriuretic peptide (ANP) from overstretched atria. ANP plays an important role in salt and water excretion by the kidney. It is synthesized by muscle cells in the atria of the heart and released when the atria are stretched. Increased levels of this peptide directly inhibit the reabsorption of sodium and water in the renal tubules. ANP also inhibits renin secretion and therefore angiotensin II formation, which in turn reduces reabsorption of sodium. The decrease in sodium reabsorption increases urine output and helps return blood volume to normal. ANP levels, which become elevated when the atria are stretched in HF, help to decrease vascular volume by increasing urine output. Potassium reabsorption is not responsible for water excretion. Aldosterone secretion by the adrenal gland functions in the regulation of sodium and potassium elimination by the principal cells in the distal and collecting tubules.

An automobile accident client is brought to the emergency department in hypovolemic shock from internal bleeding. Nurses are closely monitoring urine output since a significant decrease signifies that: A. the SNS has caused afferent arteries to constrict to decrease blood flow. B. renal arteries are clogged with blood. C. the kidneys are probably injured. D. the vagus nerve has caused bradycardia, which decreases amount of blood reaching the kidneys.

A. the SNS has caused afferent arteries to constrict to decrease blood flow. The afferent and the efferent arterioles are innervated by the sympathetic nervous system and are sensitive to vasoactive hormones, such as angiotensin II. 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. There is not enough information to conclude the kidneys are injured, the renal arteries are clotted, or the vagus nerve has been innervated.

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: Urinary tract infection Abnormal glomerular filtration Decrease in antidiuretic hormone Poor fluid intake

Abnormal glomerular filtration

In addition to regulating body fluids and electrolytes, the kidneys' endocrine function in maintaining bone calcium levels consists of what process? Excreting bicarbonate Stimulating bone marrow Synthesizing erythropoietin Activating vitamin D

Activating vitamin D

Which client on a geriatric medical unit is most likely to require slow-release potassium supplements on a regular basis? A. A 90-year-old woman who is taking an aldosterone antagonist to treat pulmonary edema B. An 83-year-old woman who is taking an osmotic diuretic to address severe peripheral edema C. An 80-year-old man with congestive heart failure who is receiving a loop diuretic D. An 81-year-old man who takes a thiazide diuretic to control his hypertension

An 81-year-old man who takes a thiazide diuretic to control his hypertension A common side effect of thiazide diuretics is increased potassium losses in the urine, which may necessitate potassium supplementation. Aldosterone antagonists, loop diuretics, and osmotic diuretics are less likely to induce hypokalemia.

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? A. The client's low blood pressure is causing the reduced glomerular filtration rate. B. The client has reduced glomerular filtration, reflecting damage to the kidney. C. The rate is normal. D. The client's diabetes is causing the reduced glomerular filtration rate.

B. The client has reduced glomerular filtration, reflecting damage to the kidney. Approximately 125 mL of filtrate is formed each minute. This is called the glomerular filtration rate (GFR). This rate can vary from a few milliliters per minute to as high as 200 mL/minute.

The nurse is caring for a client with left-sided heart failure being treated with both a thiazide diuretic and an aldosterone antagonist. What effect on potassium will the nurse anticipate with this treatment? A. There is a high risk of interaction leading to hyperkalemia. B. The medications have the opposite effect on potassium levels. C. The client is most at risk for hypokalemia from this treatment. D. Potassium is not significantly affected by either medication.

B. The medications have the opposite effect on potassium levels. Because aldosterone antagonists block the effects of aldosterone there will be less reabsorption of sodium, leading to the diuretic effect. However, when less sodium is lost, more potassium is retained, hence the term potassium-sparing diuretics that is used for this class of medication. Thiazide diuretics, however, cause a loss of potassium, making the effects of the two medications on potassium opposite.

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 Bicarbonate Erythropoietin Uric acid

Blood urea nitrogen During periods of dehydration, the blood volume and GFR drop, and BUN levels increase. The renal tubules are permeable to urea, which means that the longer the tubular fluid remains in the kidneys, the greater the reabsorption of urea into the blood.

The elevated capillary hydrostatic pressure forces fluid and solutes out of the glomerular capillaries into what structure? Loop of Henle Distal tubule Proximal tubule Bowman capsule

Bowman capsule : The blood pressure in the glomerulus is extraordinarily high for the capillary bed. This elevated capillary hydrostatic pressure forces fluid and solutes out of the glomerular capillaries into the surrounding tubular structure, called the Bowman capsule. Filtrate flows from Bowman capsule to the proximal collecting tubule, the descending limb of the loop of Henle, the ascending limb of the loop of Henle, and then to the distal and collecting tubules.

The nurse is caring for a client with a disease causing excess antidiuretic hormone (ADH). When performing the assessment, the nurse should focus on which manifestation of excess ADH? A. Dehydration B. Increased urinary output C. Fluid volume excess D. Excess salivation

C. Fluid volume excess When ADH is present, the water that moved from the blood into the urine filtrate in the glomeruli is returned to the circulatory system, and when ADH is absent, the water is excreted in the urine. ADH assists in maintenance of the extracellular fluid volume by controlling the permeability of the medullary collecting tubules.

The kidney assists in blood pressure regulation by releasing which of the following from the juxtaglomerular cells in response to decreased renal blood flow, resulting in efferent arteriole vasoconstriction? a) Angiotensin I b) Aldosterone c) Angiotensin II d) Renin

D The kidney releases renin Renin enters the bloodstream to convert angiotensinogen to angiotensin I.

Which client is benefiting from the renin-angiotensin-aldosterone mechanism? A. A middle-aged adult with osteoarthritis requiring arthroscopic knee surgery to repair a torn meniscus B. A toddler who was recently diagnosed with cystic fibrosis C. A teenager who received an injury to the flank area during football practice D. A college student admitted to the neurotrauma unit following traumatic brain injury requiring surgery to evacuate a large hematoma

D. A college student admitted to the neurotrauma unit following traumatic brain injury requiring surgery to evacuate a large hematoma The kidney releases renin, which enters the blood stream to convert angiotensinogen to angiotensin I. The angiotensin I travels to the lungs, where it is converted to angiotensin II. Angiotensin II acts directly on the kidneys. Renin functions by means of angiotensin II to produce intrarenal vasoconstriction. This helps to regulate blood pressure, which could be a problem for the client having bleeding (hematoma) inside the brain.

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? A. Client with a recent wound that bled a large amount but is now healing well B. Client with impaired oxygenation related to chronic obstructive pulmonary disease (COPD) C. Client living at a high altitude D. Client with history of chronic kidney failure E. Client who recently had surgery and is scheduled for a follow-up visit

D. Client with history of chronic kidney failure Erythropoietin is a glycoprotein hormone that is produced by fibroblasts in the kidney and regulates the production of red blood cells in the bone marrow. Persons with end-stage kidney disease often are anemic because the kidneys can no longer produce erythropoietin.

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 Excessive secretion of aldosterone Activation of the angiotensin system Reduction in glomerular filtration rate

Decrease in antidiuretic hormone The ability of the kidney to respond to changes in the osmolality of the extracellular fluids by producing either a concentrated or dilute urine depends on the establishment of a high concentration of osmotically active particles in the interstitium of the kidney medulla and the action of the antidiuretic hormone (ADH) in regulating the water permeability of the surrounding medullary collecting tubules. Inhibition or reduction of antidiuretic hormone (ADH) release from the anterior pituitary increases excretion of water by the kidneys (increased urination). Activation of the angiotensin system, excessive secretion of aldosterone, and reduction in glomerular filtration rate would result in a decreased urinary output.

When administering a thiazide diuretic the nurse recognizes these medications exert their effects in which area of the kidney? Distal and collecting tubules Afferent arterioles Proximal tubules Loop of Henle

Distal and collecting tubules The thiazide diuretics exert their action by inhibiting sodium chloride reabsorption in the distal and collecting tubules.

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 Whole blood Oxygen Iron

Epoetin alfa Persons with end-stage kidney disease often are anemic because of an inability of the kidneys to produce erythropoietin. This anemia usually is managed by the administration of a recombinant erythropoietin (epoetin alfa) produced through DNA technology to stimulate erythropoiesis

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 Low blood pressure Retention of chloride Retention of sodium

Excessive urine output ADH regulates the ability of the kidneys to concentrate urine. When ADH is present, the water that moved from the blood into the urine filtrate in the glomeruli is returned to the circulatory system, and when ADH is absent, the water is excreted in the urine. Pathologically, deficiency of ADH leads to polyuria and dehydration.

Which option identifies the function of the kidneys in maintaining normal composition of internal body fluids? A. Conversion of vitamin D to active form B. Excretion of the renin-angiotensin mechanism C. Filtration and reabsorption of physiologically essential substances D. Production of erythropoietin for red blood cell production

Filtration and reabsorption of physiologically essential substances

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? The bones no longer respond to vitamin D and demineralize. Vitamin D can no longer be released from the exocrine glands. The skin is no longer able to activate vitamin D for use. In renal disease, vitamin D is unable to be transformed to its active form.

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

he nurse is reviewing the laboratory work of several medical clients. Which laboratory result is most suggestive of abnormalities in kidney function? An absolute absence of protein in a urine sample Increased creatinine and blood urea nitrogen (BUN) levels Urine gravity of 1.030 and normal serum creatinine levels Normal creatinine levels and elevated blood urea nitrogen (BUN)

Increased creatinine and blood urea nitrogen (BUN) levels Increased creatinine and BUN is associated with abnormalities in renal function, as is the presence of glucose in a urine sample. Urine samples normally lack protein and have a specific gravity of 1.030 to 1.040. An elevated BUN coupled with normal creatinine is likely not attributable to impaired kidney function.

The nurse is caring for a client with heart failure and left atrial enlargement. Which physiologic consequence does the nurse anticipate when atrial natriuretic peptide (ANP) is released due to atrial stretch? Deamination of ammonia Retention of hydrogen ions Excretion of hydrogen ions Inhibition of aldosterone

Inhibition of aldosterone ANP is a hormone believed to have an important role in salt and water excretion by the kidney. It is synthesized in muscle cells of the atria of the heart and released when the atria are stretched, which results in an increase in renal blood flow and GFR. ANP inhibits aldosterone secretion by the adrenal gland and sodium reabsorption from the collecting tubules through its action on aldosterone and through direct action on the tubular cells.

Which type of nephron is primarily responsible for concentrating urine? Cortical nephrons Juxtamedullary nephrons Glomerulus network Peritubular network

Juxtamedullary nephrons The juxtamedullary nephrons are largely concerned with urine concentration. Cortical nephrons have short, thick loops of Henle that penetrate only a short distance into the medulla. Each nephron consists of a glomerulus, where blood is filtered, and a system of tubular structures where water, electrolytes, and other substances needed to maintain the constancy of the internal environment are reabsorbed into the bloodstream while other unneeded materials are secreted into the tubular filtrate for elimination.

The nurse recognizes that antidiuretic hormone (ADH) exerts its effects in which location? Loop of Henle Renal calyces Glomerular basement membrane Peritubular capillaries

Loop of Henle The loop of Henle controls the concentration of the urine by establishing a high concentration of osmotically active particles in the interstitium surrounding the medullary collecting tubules, where the antidiuretic hormone (ADH) exerts its effects.

The nurse is teaching a group of nursing students about the formation of urine in the nephron. Which component does the nurse teach is a component of the nephron? Select all that apply. Loop of Henle Distal convoluted tubule Collecting tubule Proximal convoluted tubule Renal pelvis

Loop of Henle Distal convoluted tubule Collecting tubule Proximal convoluted tubule

A client in shock is experiencing a decrease in the glomerular filtration rate (GFR). What is the physiologic reason for the kidney to decrease GFR at this time? Maintain adequate output Maintain acidic pH of the blood Maintain urine-concentrating ability of the kidneys Normalize glucose level in the blood

Maintain urine-concentrating ability of the kidneys When the kidneys have poor perfusion or increased sympathetic nervous system stimulation, blood flow diverts from going mainly to the cortex to decrease the filtration rate (and energy needs) while maintaining the concentration ability of urine—causing output to decrease. Pressure is unchanged by the blood flow diversion. Urine pH is normally alkaline with adequate amounts of buffer retained. It is abnormal for urine to contain any glucose.

A nurse is administering furosemide to a client with heart failure. Which electrolytes should the nurse monitor when giving this medication? Select all that apply. Potassium Magnesium Sodium Calcium Phosphorus

Potassium Magnesium Sodium Calcium By inhibiting this transport system, loop diuretics reduce the reabsorption of sodium chloride, decrease potassium reabsorption, and increase calcium and magnesium elimination. Prolonged use can cause significant loss of magnesium in some people. Because calcium is actively reabsorbed in the distal convoluted tubule, loop diuretics usually do not cause hypocalcemia. The loop diuretics may also increase uric acid retention and impair glucose tolerance.

An older adult client with high blood pressure is prescribed a thiazide diuretic. What should the nurse expect to happen to this client's potassium and calcium levels? Potassium and calcium levels will not change. Potassium level will drop, but calcium level may rise. Potassium level will rise, but calcium level may drop. Potassium and calcium levels will both go down.

Potassium level will drop, but calcium level may rise. Thiazide diuretics increase the loss of potassium in urine. Because calcium is actively reabsorbed in the distal convoluted tubule, it likely that the client's calcium level will go up, especially if the client takes the drug for a long time.

The nurse would be most concerned when the glomerular filtrate contains: Potassium Water Protein Sodium

Protein The glomerular filtrate has a chemical composition similar to plasma, but it contains almost no proteins because large molecules do not readily cross the glomerular wall. Potassium, sodium, and water would be filtered.

The nurse recognizes the kidney can be considered an endocrine organ as it may exert which action? Synthesis of renin-angiotensin-aldosterone Regulation of red blood cells through manufacture of erythropoietin Activation of vitamin D Synthesis of potassium Protein and albumin synthesis

Regulation of red blood cells through manufacture of erythropoietin The kidneys function as an endocrine organ in that they produce chemical mediators that travel through the blood to distant sites where they exert their actions. The kidneys participate in control of blood pressure in the following ways: via the renin-angiotensin-aldosterone mechanism; via regulation of red blood cell production through the synthesis of erythropoietin; via calcium metabolism by activating vitamin D.

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? BUN level 24-hour urine test Urine test, first void in morning Serum creatinine

Serum creatinine Creatinine is freely filtered in the glomeruli, is not reabsorbed from the tubules into the blood, and is only minimally secreted into the tubules from the blood; therefore, its blood values depend closely on the GFR. A normal serum creatinine level usually indicates normal renal function. If the value doubles, the GFR—and renal function—probably has fallen to half of its normal state. A rise in the serum creatinine level to three times its normal value suggests that there is a 75% loss of renal function. A BUN, 24-hour urine test, and urine test of first void in the morning do not tell the nurse about serum creatinine levels.

The nurse is analyzing the results of a client's urinalysis. Which finding requires the need for follow-up by the nurse because it is an abnormal result? Urine color amber Specific gravity 1.034 Bilirubin negative Occasional hyaline casts Negative nitrate bacteria

Specific gravity 1.034 Normal findings are: Color: yellow amber; appearance: clear to slightly hazy; specific gravity: 1.005-1.025 pH: 4.5-8.0 - (ave. 5to 6) volume: 600-2500 mL/24 hour (average 1200 mL/24 hr) : negative: glucose, ketones; blood, protein, bilirubin: urobilinogen: 0.5-4.0 mg/day; nitrate for bacteria: negative leukocyte esterase: negative; casts negative: occasional hyaline casts; red blood cells: negative or rare; crystals: negative (none); white blood cells: negative or rare; epithelial cells: few; hyaline casts 0-1/lpf (low-power field).

When the glomerular transport maximum for blood glucose is exceeded and its renal threshold has been reached, what happens to the excess glucose? Spills into the urine Attaches to protein carriers Reabsorbs quickly sodium countertransport

Spills into the urine When the substance (such as blood glucose) exceeds the number of carrier proteins available for transport, the transport maximum has been exceeded, the renal threshold is reached, and the substance will spill (not reabsorb) into the urine. Sodium cotransport helps to move the substance back into the tubule.

Which factor is likely to result in decreased renal blood flow? Release of nitric oxide Action of dopamine Action of prostaglandins Stimulation of the sympathetic nervous system

Stimulation of the sympathetic nervous system SNS stimulation results in decreased renal blood flow by vasoconstriction. Dopamine, nitric oxide, and prostaglandins are all vasodilators.

Which medication may be responsible for a client developing increased uric acid levels by decreasing ECF volume? Vitamin C Thiazide diuretics Penicillin antibiotics Antacids

Thiazide diuretics Because of its effect on uric acid secretion, aspirin is not recommended for treatment of gouty arthritis. Thiazide and loop diuretics also can cause hyperuricemia and gouty arthritis, presumably through a decrease in ECF volume and enhanced uric acid reabsorption.

Which diuretic acts by preventing the reabsorption of sodium chloride in the distal convoluted tubule? Thiazide diuretics Loop diuretics Potassium-sparing diuretics Osmotic diuretics

Thiazide diuretics Thiazide diuretics act by preventing the reabsorption of sodium chloride in distal convoluted tubule. K+-sparing diuretics reduce sodium reabsorption and decrease K+ secretion in the late distal tubule. Loop diuretics act on the ascending loop of Henle. Osmotic diuretics cause water to be retained in the proximal tube.

In contrast to the descending limb, the ascending limb of the loop of Henle is impermeable to which substance that results in dilute tubular filtrate? Chloride Calcium Potassium Water

Water The ascending limb (thin and thick) of the loop of Henle is impermeable to water, and the filtrate becomes more dilute and hypo-osmolar as a result. Sodium, potassium, and chloride have a cotransport system in the thick ascending segment and are reabsorbed there.

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? a) "This test provides a gauge of renal function." b) "This test measures circulating antidiuretic hormone levels." c) "This test measures urine-specific gravity." d) "This test measures the volume of urine output."

a) "This test provides a gauge of renal function." The GFR is the amount of filtrate that is formed each minute as blood moves through the glomeruli. The clearance rate for creatinine is the amount that is completely cleared by the kidneys in 1 minute.

In addition to regulating body fluids and electrolytes, the kidneys function in maintaining bone calcium levels by doing which of the following? a) Activating vitamin D b) Excreting bicarbonate c) Synthesizing erythropoietin d) Stimulating bone marrow

a) Activating vitamin D The kidneys aid in calcium metabolism by activating vitamin D after it is chemically converted by the liver. Bicarbonate buffering is unrelated to activation of vitamin D. Bone marrow is stimulated by the synthesis of erythropoietin to form red blood cells, which is unrelated to calcium levels.

Which of the following can be eliminated from the body by the kidneys as a means of regulating body acid-base balance when urine buffers are present? a) Hydrogen (H+) b) Potassium (K+) c) Phosphate (HPO4) d) Ammonia (NH3)

a) Hydrogen (H+)

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? a) Macula densa b) Renin c) Nitric oxide d) Prostaglandin

a) Macula densa The macula densa monitors filtrate flow in the distal tubule and communicates with juxtaglomerular cells of the afferent arteriole. Together they form the juxtaglomerular apparatus and regulate GFR. Prostaglandins, nitric oxide, and renin do not directly influence GFR.

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? a) Pituitary gland b) Adrenal gland c) Renal cortex d) Osmoreceptors

a) Pituitary gland ADH assists in maintenance of the extracellular fluid volume by controlling the permeability of the medullary collecting tubules. Osmoreceptors in the hypothalamus sense an increase in osmolality of extracellular fluids and stimulate the release of ADH from the posterior pituitary gland. In exerting its effect, ADH, also known as vasopressin, binds to receptors on the basolateral side of the tubular cells.

A client has been prescribed a drug that is not removed quickly by renal filtration. The drug likely has this quality because it is: a) bound to plasma proteins. b) a hydrophilic weak base. c) a hydrophilic weak acid. d) water soluble.

a) bound to plasma proteins. If the drug is bound to plasma proteins, it will not enter the filtrate. Hydrophilic acids and bases are easily eliminated by renal filtration. A water soluble drug is not immune to renal filtration.

Select the percentage of cardiac output that perfuses the kidneys. a) 15% to 20% b) 20% to 25% c) 10% to 15% 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;

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) Abnormal glomeruli filtration c) Urinary tract infection d) Poor fluid intake

b) Abnormal glomeruli filtration Urine tests for proteinuria are used to detect abnormal filtering of albumin by the glomeruli or defects in its reabsorption in the renal tubules.

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? a) Prevent reabsorption of sodium in the distal tubules b) Prevent conversion of angiotensin I to II c) Promote osmotic diuresis d) Block aldosterone

b) Prevent conversion of angiotensin I to II The juxtaglomerular cells of the kidney contain granules of inactive renin, an enzyme that functions in the conversion of angiotensinogen to angiotensin. Angiotensin I is converted to angiotensin II in the presence of converting enzyme. By blocking converting enzyme, angiotensin II, a potent vasoconstrictor, is not produced, lowering blood pressure.

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: a) high filtration rates in the glomerulus. b) innervation of the sympathetic nervous system causing constriction of the afferent arteriole. c) obstruction in the glomerular capillaries due to overabundance of large molecules being released. d) parasympathetic stimulation causing the renal arteries to constrict in response to pain.

b) innervation of the sympathetic nervous system causing constriction of the afferent arteriole. 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 zero. The location of the glomerulus between two arterioles allows for maintenance of a high-pressure filtration system. The glomerular filtrate has a chemical composition similar to plasma, but contains almost no proteins because large molecules do not readily pass through the openings in the glomerular capillary wall.)

The physician has prescribed a thiazide diuretic for a client. The nurse anticipates that the medication will: release antidiuretic hormone (ADH). activate the renin-angiotensin-aldosterone system. decrease the glomerular filtration rate (GFR). block the tubular reabsorption of sodium.

block the tubular reabsorption of sodium The thiazide diuretics, which are widely used to treat disorders such as hypertension, block sodium reabsorption in renal tubules and enhance the active reabsorption of calcium into the blood via the calcium-sodium exchange transport mechanism. If a client experienced a decrease in circulatory volume, this would activate the renin-angiotensin system, decrease the GFR, or release ADH.

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: a) 1700-2000 mL/minute. b) 100-300 mL/minute. c) 1000-1300 mL/minute. d) 500-800 mL/minute.

c) 1000-1300 mL/minute. In the adult, the kidneys are perfused with 1000 to 1300 mL of blood per minute, or 20% to 25% of the cardiac output.)

Although an average of ____ glomerular filtrate is formed each minute, only _____ is excreted as urine and the rest is reabsorbed in the tubules. a) 250 mL; 15 mL b) 175 mL; 10 mL c) 125 mL; 1 mL d) 200 mL; 5 mL

c) 125 mL; 1 mL Although an average of 125 mL of filtrate is formed each minute, only 1 mL is excreted in urine and the other 124 mL is reabsorbed across the tubular membrane.

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)? a) Angiotensin I b) Aldosterone c) Atrial natriuretic peptide (ANP) d) Antidiuretic hormone (ADH)

c) Atrial natriuretic peptide (ANP) Atrial natriuretic peptide is a hormone that is synthesized in the muscle cells of the atria of the heart and released when the atria are stretched. The actions of ANP include vasodilation of the afferent and efferent arterioles, which results in an increase in renal blood flow and glomerular filtration rate. Angiotensin I, which has few vasoconstrictor properties, leaves the kidneys and enters the circulation. ADH and aldosterone would decrease blood flow and GFR.

Select the option that identifies the function of the kidneys in maintaining normal composition of internal body fluids. a) Production of erythropoietin for red blood cell production b) Conversion of vitamin D to active form c) Filtration and reabsorption of physiologically essential substances d) Excretion of the renin-angiotensin mechanism

c) Filtration and reabsorption of physiologically essential substances The kidneys filter physiologically essential substances, such as sodium and potassium, from the blood, and selectively reabsorb those substances that are needed to maintain the normal composition of internal body fluids. Substances that are not needed or are in excess of those needed pass into the urine. In addition to regulating the volume and composition of body fluids, the kidneys also perform endocrine functions. They release renin, an enzymatic hormone that participates in the regulation of blood pressure and maintenance of the circulating blood volume; they produce erythropoietin, a hormone that stimulates red blood cell production; and they convert vitamin D to its active form.

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? a) After a nap b) Last void at night c) First void in morning d) At noon

c) First void in morning With diminished renal function, there is a loss of renal concentrating ability, and the urine specific gravity may fall to levels of 1.006 to 1.010 (usual range is 1.010 to 1.025 with normal fluid intake). These low levels are particularly significant if they occur during periods that follow a decrease in water intake.

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) An increase in GFR due to relaxation of the afferent arterioles c) Significant decrease in urine output due to decrease in renal blood flow d) Excess output of blood-tinged urine

c) 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.

The nurse is caring for a client with an elevated blood urea nitrogen (BUN) level. Which of these factors is least likely to alter the blood urea nitrogen value? a) Protein intake b) Dehydration c) Thyroid disease d) Gastrointestinal bleeding

c) Thyroid disease Urea is formed in the liver as a by-product of protein metabolism and is eliminated entirely by the kidneys. BUN is related to the GFR but, unlike creatinine, also is influenced by protein intake, gastrointestinal bleeding, and hydration status..

Clients with Chronic Kidney Disease (CKD) are at risk for demineralization of their bones since they are no longer able to: a) Excrete bicarbonate effectively b) Stimulate bone osteoclastic production c) Transform vitamin D to its active form d) Synthesize erythropoietin

c) Transform vitamin D to its active form The kidneys aid in calcium metabolism by activating vitamin D, after it is chemically converted by the liver. Bicarbonate buffering is unrelated to activation of vitamin D. Bone marrow is stimulated by the synthesis of erythropoietin to form red blood cells, which is unrelated to calcium levels.

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? a) Bicarbonate levels b) Potassium levels c) Uric acid levels d) Urea nitrogen levels

c) Uric acid levels Uric acid is a product of purine metabolism. Excessively high blood levels (i.e., hyperuricemia) can cause gout, and excessive urine levels can cause kidney stones.

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? a) Acetaminophen b) Advil c) Ibuprofen d) Aspirin

d) Aspirin Small doses of aspirin compete with uric acid for secretion into the tubular fluid and reduce uric acid secretion, and large doses compete with uric acid for reabsorption and increase uric acid excretion in the urine.

A nurse is evaluating a patient's morning laboratory values. Which of the following results requires that the nurse notify the health care provider? a) Sodium: 148 mEq/L b) Blood urea nitrogen: 20.0 mg/dL c) Potassium: 3.4 mEq/L d) Creatinine: 10.6 mg/dL

d) Creatinine: 10.6 mg/dL A rise in the serum creatinine level to three times its normal value suggests that there is a 75% loss of renal function, and with creatinine values of 10 mg/dL or more, it can be assumed that approximately 90% of renal function has been lost.

The nurse should anticipate that a client who collapsed while running his or her first marathon and has a urine specific gravity of 1.035 is experiencing: a) Frostbite b) Sun stroke c) Exhaustion d) Dehydration

d) Dehydration The usual range of specific gravity is 1.010 to 1.025 with normal fluid intake. Healthy kidneys can produce concentrated urine with specific gravity of 1.030 to 1.040 during periods of dehydration and dilute urine with a specific gravity that approaches 1.000 during periods of too much fluid intake.

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? a) Calyx b) Collecting tubule c) Renal pelvis d) Glomerulus

d) Glomerulus Alterations in the structure and function of the glomerular basement membrane are responsible for the leakage of proteins and blood cells into the filtrate that occurs in many forms of glomerular disease.

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? a) It causes tubular cells to lose their water permeability. b) It leads to the production of dilute urine. c) It lessens the amount of fluid entering the glomerulus. d) It removes water from the filtrate and returns it to the vascular compartment.

d) It removes water from the filtrate and returns it to the vascular compartment. ADH maintains extracellular volume by returning water to the vascular compartment. This leads to the production of concentrated urine by removing water from the tubular filtrate. In exerting its effect, ADH produces a marked increase in water permeability in tubular cells.

The nurse teaches the client with end-stage kidney disease who has developed anemia that the reason anemia has developed is which of these? a) Activation of vitamin D cannot occur when kidneys are damaged. b) Medications taken for kidney disease destroy the red blood cells. c) Clients with kidney disease must avoid consuming iron. d) The damaged kidney is unable to produce erythropoietin.

d) The damaged kidney is unable to produce erythropoietin. Persons with end-stage kidney disease often are anemic because of an inability of the kidneys to produce erythropoietin, the hormone that regulates the differentiation of red blood cells in the bone marrow..

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) This represents normal urinary output for 24 hours. b) The kidneys should produce a minimum of 10 ml/hour over one day. c) The normal kidney produces an average 3000 ml of urine daily. d) The kidneys should produce about 1.5 liters of urine each day.

d) The kidneys should produce about 1.5 liters of urine each day. The kidneys normally produce approximately 1.5 L or 1500 ml of urine each day.

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: a) excrete excess hydrogen ions. b) excrete potassium. c) concentrate protein. d) concentrate urine.

d) concentrate urine. Urine specific gravity is used to assess the kidneys' ability to concentrate urine and provides a valuable index of the hydration status and functional ability of the kidneys. Specific gravity does not evaluate electrolyte or acid--base functions of the kidneys. It is not affected by protein levels.

Clients with CKD are at risk for demineralization of their bones since they are no longer able to: stimulate bone osteoclastic production. synthesize erythropoietin. transform vitamin D to its active form. excrete bicarbonate effectively.

transform vitamin D to its active form. The kidneys aid in calcium metabolism by activating vitamin D after it is chemically converted by the liver. Bicarbonate buffering is unrelated to activation of vitamin D. Bone marrow is stimulated by the synthesis of erythropoietin to form red blood cells, which is unrelated to calcium levels.