Chapter 32: Structure and Function of the Kidney

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

Decrease

The nurse 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 area?

Pituitary Gland

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 mechanism of action of common diuretics. What best reflects the mechanism of these drugs?

They block the reabsorption of sodium and chloride in the nephron.

Which medication may be responsible for a client developing increased uric acid levels by decreasing ECF volume?

Thiazide diuretics

When explaining the body's compensatory mechanisms to maintain a normal pH, the health care provider knows that the renal system:

works slower than the respiratory system, going into action 1 to 2 days after H+ remain elevated.

Which factor is likely to result in decreased renal blood flow?

Stimulation of the sympathetic nervous system

Which type of nephron is primarily responsible for concentrating urine?

Juxtamedullary nephrons

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."

The pathophysiology instructor will emphasize that the cells of the proximal tubule have a fine, villous structure that increases surface area, allowing for which physiologic function to occur with fluids? Select all that apply.

- Supports active transport processes - Increase in reabsorption

The nurse is educating a client about renal disease. Which percentage of cardiac output perfuses the kidneys?

22% to 25%

A nurse is monitoring a client with renal failure. What glomerular filtration rate (GFR) would the nurse estimate if the creatinine clearance test result is 60 mL/min (1 mL/s/m2)?

60 mL/min

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

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

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

A nurse is evaluating a client's morning laboratory values. Which result requires that the nurse notify the health care provider?

Creatinine: 10.6 mg/dL (937.04 µmol/L)

Which diagnostic study would be effective in determining direct visualization of the bladder and ureters?

Cystoscope

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

A nurse is administering spironolactone to a client. Which electrolyte imbalance should the nurse monitor for?

Hyperkalemia

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 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

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

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.

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 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 has increased aldosterone levels. Which effect does the nurse expect as the result of increased aldosterone levels?

decreased urine sodium levels

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 nursing student studying pharmacology is learning how angiotensin converting enzyme inhibitors (ACE) work. The student is correct when stating that the mechanism of action of ACE inhibitors is to:

prevent conversion of angiotensin I to II.

A client with end-stage kidney disease has developed anemia. The nurse teach this client that the reason anemia has developed is:

the damaged kidney is unable to produce erythropoietin.