Kidneys and electrolytes chapters 10,24,26
When explaining to a class of nursing students enrolled in pathophysiology, the instructor states, "The majority of energy used by the kidney is for: -Filtration of drugs out of the body. -Secretion of erythropoietin for production of RBCs. - Active sodium transport mechanisms." -Removal of excess glucose from the blood."
- Active sodium transport mechanisms."
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? -"Current lab tests aren't able to detect the small quantities of most substances contained in a single urine sample. -"Only a longer term test is able to show whether your kidneys are letting sugar spill out into your urine." - "A single urine sample lets your care team determine if there are bacteria in your urine, but other tests of urine chemistry need a longer term view." -"Often when 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."
-"Often when 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."
The health care provider has ordered a urinalysis for a normally healthy client admitted to the hospital with dehydration. The client has been vomiting for the past 3 days and has had minimal oral intake. Upon analysis of the results, the urine specific gravity reflects: -1.040 -1.001 -1.010 -1.025
-1.040
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: -100-300 mL/minute. -500-800 mL/minute. -1000-1300 mL/minute. -1700-2000 mL/minute.
-1000-1300 mL/minute.
Select the percentage of cardiac output that perfuses the kidneys. -20% to 25% -15% to 20% -10% to 15% -25% to 30%
-20% to 25%
During a period of extreme excess fluid volume, a renal dialysis patient may be administered which type of IV solution to shrink the swollen cells by pulling water out of the cell? -0.9 % sodium chloride. -5% dextrose and water. -3% sodium chloride. -Lactated Ringer's solution.
-3% sodium chloride.
The nurse has just received the lab results of a client's calcium level. The nurse identifies a normal calcium level as: -9.0 to 10.5 mg/dL -12.0 to 15.0 mg/dL -13.5 to 14.5 mg/dL -3.5 to 5.3 mg/dL
-9.0 to 10.5 mg/dL
A geriatric nurse is caring for several clients. Which alterations in clients' health should the nurse attribute to age-related physiologic changes? -An 81-year-old man's serum creatinine level has increased sharply since his last blood work. -A 78-year-old woman's GFR has been steadily declining over several years. -A 90-year-old woman's blood urea nitrogen (BUN) is rising. -A dipstick of an 80-year-old man's urine reveals protein is present.
-A 78-year-old woman's GFR has been steadily declining over several years.
Which of the following clients' diagnostic bloodwork is most suggestive of chronic kidney disease (CKD)? -A client with high pH; low levels of calcium and low levels of phosphate -A client with low vitamin D levels; low calcitrol levels and elevated parathyroid hormone (PTH) levels -A client with low bone density; low levels of calcium and low levels of phosphate -A client with low potassium levels; low calcitrol levels and increased PTH levels
-A client with low vitamin D levels; low calcitrol levels and elevated parathyroid hormone (PTH) levels
The nurse is educating a patient with chronic kidney disease (CKD). What is the recommended daily fluid intake for this patient? -No oral intake of fluids -Intake equal to daily urine output to maintain hydration -A daily fluid intake of 500 to 800 mL/day to maintain hydration -A minimum of 2000 mL/day to flush out the kidneys
-A daily fluid intake of 500 to 800 mL/day to maintain hydration
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? -Advil -Acetaminophen -Ibuprofen -Aspirin
-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) -Antidiuretic hormone (ADH) -Aldosterone -Angiotensin I
-Atrial natriuretic peptide (ANP)
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? -Retention of sodium -Low blood pressure -Excessive urine output -Retention of chloride
-Excessive urine output
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? -Baseline blood pressure of 150/90 mm Hg that is now 130/80 mm Hg -Baseline heart rate of 100 bpm that has increased to 120 bpm -Baseline urine output of 50 mL/hr that is now 10 mL/hr -Foul smelling, cloudy urine
-Baseline urine output of 50 mL/hr that is now 10 mL/hr
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? -Upper abdomen, under the costal margins -Right costal margin, anterior abdomen -Lower abdomen in the suprapubic area -Between the 12th thoracic and 3rd lumbar vertebrae
-Between the 12th thoracic and 3rd lumbar vertebrae
Serum phosphorus level has a reciprocal relationship with which of the following serum electrolytes? -Potassium -Sodium -Calcium -Chloride
-Calcium
The nurse is caring for a patient with chronic renal failure who is on hemodialysis three times a week. In order to treat hyperphosphatemia and hypocalcemia, which of the following medications will the nurse administer to decrease absorption of phosphate from the gastrointestinal tract? -Epoetin alfa (Procrit) -Furosemide (Lasix) -Lactulose (Cephulac) -Calcium carbonate
-Calcium carbonate
Protein-dependent forces that promote fluid movement into the intravascular space are known as which of the following pressures? -Capillary filtration -Interstitial filtration -Capillary osmotic -Tissue filtration
-Capillary osmotic
When caring for a patient with hyperkalemia, the nurse prioritizes assessment of which of the following body systems? -Cardiovascular -Hepatic -Cerebrovascular -Pulmonary
-Cardiovascular
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? -Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption. -Renal clients often require a sodium-restricted diet to minimize the excretion load on remaining nephrons. -Clients with renal failure often maintain high sodium levels because of decreased excretion. -Restricting sodium intake helps to preserve nephron function and has the additional benefit of lowering blood pressure.
-Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption.
An 80-year-old client with diabetes has a GFR of 41 mL/min/1.73 m2. His physical and workup show uremia, azotemia, and elevated BUN. Which action should be done first to slow the decline of his kidney function? -Do a kidney transplant -Control blood glucose and blood pressure -Increase intravenous fluids - Restrict protein in the diet
-Control blood glucose and blood pressure
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 -Increase -Stop filtering -Remain unchanged
-Decrease
A nurse is caring for a patient with severe liver failure. Knowing that the patient's condition has resulted in impaired synthesis of albumin, the nurse understands that the patient's generalized edema is related to which of the following? -Increased hydrostatic pressure -Increased capillary permeability -Decreased colloidal osmotic pressure -Obstruction of lymphatic flow
-Decreased colloidal osmotic pressure
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. -Decreased renal endocrine function -Decreased tubular reabsorption -Proliferation of nephrons -Hypophospatemia -Decreased glomerular filtration
-Decreased renal endocrine function -Decreased tubular reabsorption -Decreased glomerular filtration
The nurse is caring for a client with diabetic ketoacidosis. Which assessment finding is characteristic of metabolic acidosis? -Deep and rapid respirations -Shallow but rapid respirations -Deep inspirations followed by shallow expirations. -Apnea followed by hyperpnea
-Deep and rapid respirations
A new client presents with elevated BUN, systemic edema, a BP of 145/93 mm Hg, recurrent infections, and a GFR of 51 mL/min/1.73 m2. What treatment should the nurse anticipate? -Intravenous antibiotics -Bone marrow transplant -Dialysis -Kidney transplant
-Dialysis
The nurse is caring for a patient who receives hemodialysis. The nurse knows that hemodialysis involves movement of charged or uncharged particles along a concentration gradient. Which of the following best describe this process? -Diffusion -Osmosis -Evaporation -Osmotic pressure
-Diffusion
A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is which of the following? -Unsteady gait -Burning sensation in feet -Dorsiflexion of hands and feet -Demyelination of nerve fibers
-Dorsiflexion of hands and feet
The nurse is teaching a group of nursing students about the major functions of the kidney. Which of these should the nurse include in the discussion? Select all that apply. -Removal of red blood cells -Elimination of water -Synthesis of insulin -Removal of waste products -Removal of excess electrolytes
-Elimination of water -Removal of waste products -Removal of excess electrolytes
In a client in the uremic state of chronic kidney failure (CKD), the nurse will monitor for which signs and symptoms correlated with uremia? Select all that apply. -Encephalopathy -Nausea -Increased vitamin D synthesis -Anemia -Apathy
-Encephalopathy -Nausea -Anemia -Apathy
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 -Production of erythropoietin for red blood cell production -Excretion of the renin-angiotensin mechanism -Conversion of vitamin D to active form
-Filtration and reabsorption of physiologically essential substances
The nurse volunteering in the medical tent for a road race on a hot, humid day is asked to see a runner who has collapsed on the road. The nurse notes he has sunken eyes, a temperature of 100 degrees Fahrenheit, and dizziness. These are signs of a fluid volume deficit. Recognizing fluid volume deficit, which of these interventions does the nurse carry out first? -Offer water by mouth. -Begin cooling of his body by ice packs. -Give him a transfusion of FFP. -Give him an electrolyte solution by mouth.
-Give him an electrolyte solution by mouth.
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? -Calyx -Glomerulus -Collecting tubule -Renal pelvis
-Glomerulus
A 62-year-old woman with high blood pressure is to begin long-term treatment with a thiazide diuretic that she thinks she'll need to take for some time. What should the nurse expect to happen to her potassium and calcium levels? -Her potassium and calcium levels will not change. -Her potassium and calcium levels will both go down. -Her potassium level will drop, but her calcium level may rise. -Her potassium level will rise, but her calcium level may drop.
-Her potassium level will drop, but her calcium level may rise.
A nurse observes peaked, narrow T waves on the electrocardiogram of a patient suffering from renal failure. The nurse suspects that the client is experiencing which of the following conditions? -Hypokalemia -Hyperkalemia -Hyponatremia -Hypernatremia
-Hyperkalemia
Which of the following have the potential to cause chronic kidney disease? (Select all that apply.) -Hypertension -Cardiomyopathy -Diabetes -Glomerulonephritis
-Hypertension -Diabetes -Glomerulonephritis
A nurse is caring for a patient with hypoparathyroidism. Which of the following is a major concern for the patient? -Hypocalcemia -Hypokalemia -Hyponatremia -Hypernatremia
-Hypocalcemia
A community health nurse who is attending a marathon recognizes which of the following types of hypotonic hyponatremia is likely when a patient reports muscle weakness, cramping, and general fatigue in spite of adequate water hydration during the run? -Hypovolemic -Hypervolemic -Euvolemic -Normovolemic
-Hypovolemic
Skeletal disorders frequently accompany chronic kidney disease (CKD). The nurse recognizes which statements regarding bone turnover in CKD are correct? Select all that apply. -In high-bone-turnover, there is both increased bone formation and increased resorption. -High-bone-turnover produces porous, coarse-fibered bone. -Metabolic acidosis of CKD can affect bone turnover. -Both high and low turnover present risk for fracture. -Low bone turnover is characterized by increased osteoblasts and osteoclasts.
-In high-bone-turnover, there is both increased bone formation and increased resorption. -High-bone-turnover produces porous, coarse-fibered bone. -Metabolic acidosis of CKD can affect bone turnover. -Both high and low turnover present risk for fracture.
The 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 -Normal creatinine levels and elevated BUN -Urine gravity of 1.030 and normal serum creatinine levels -Increased creatinine and blood urea nitrogen (BUN) levels
-Increased creatinine and blood urea nitrogen (BUN) levels
Which of the following data would a clinician consider as most indicative of acute renal failure? -Alterations in blood pH; peripheral edema -Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR). -Decreased serum creatinine and blood urea nitrogen (BUN); decreased potassium and calcium levels -Decreased urine output; hematuria; increased GFR
-Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR).
The nurse is caring for a client with profound dehydration. The nurse recognizes the body should release ADH in this situation based on which of these types of feedback from the body? -Increased serum osmolarity -Decreased serum potassium -Atrial natriuretic peptide -Loss of hydrogen ions in the urine
-Increased serum osmolarity
Lymph fluid arises directly from which one of the following spaces? -Intercellular -Plasma -Interstitial -Intravascular
-Interstitial
A client has acute pyelonephritis. The nurse will monitor the client for development of which of the following? -Prerenal failure -Intrarenal failure -Post renal failure -Chronic kidney disease
-Intrarenal failure
A client has an increase in her anion gap (AG). What does the nurse determine is the significance of this finding? -It indicates the client has metabolic alkalosis. -It indicates the client has respiratory alkalosis. -It indicates the client has metabolic acidosis. -It indicates the client has respiratory acidosis.
-It indicates the client has metabolic acidosis.
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. -It lessens the amount of fluid entering the glomerulus. -It leads to the production of dilute urine. -It causes tubular cells to lose their water permeability.
-It removes water from the filtrate and returns it to the vascular compartment.
Which type of nephron is primarily responsible for concentrating urine? -Cortical nephrons -Juxtamedullary nephrons -Glomerulus network -Peritubular network
-Juxtamedullary nephrons
Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which of the following statements regarding vitamin D is correct? -Kidneys convert inactive vitamin D to its active form, calcitriol. -Calcitriol stimulates release of parathyroid hormone (PTH). -Suppression of parathyroid hormone release is characteristic of CKD. -Calcitriol blocks gastrointestinal absorption of calcium.
-Kidneys convert inactive vitamin D to its active form, calcitriol.
The nurse assessing a renal failure patient for encephalopathy caused by uremia may observe which of the following clinical manifestations? -Severe chest pain with pericardial friction rub on auscultation. -Stiff immobile joints and contractures. -Loss of recent memory and inattention. -Pruritus with yellow hue to skin tone.
-Loss of recent memory and inattention.
The client has arterial blood gases (ABG) drawn. The results are a pH of 7.50, pCO2 30, and HCO3- 24. The nurse understands that which of the following could cause these ABG results? -Mechanical ventilation -Severe potassium deficit -Extreme obesity -Fasting
-Mechanical ventilation
The nurse is reviewing the following lab results of a client diagnosed with renal failure: pH: 7.24 PCO2: 38 mm Hg HCO3:18 mEq/L The nurse would interpret this as: -Metabolic acidosis -Respiratory acidosis -Metabolic alkalosis -Respiratory alkalosis
-Metabolic acidosis
The nurse is caring for a client with a longstanding diagnosis of hypocalcemia secondary to kidney disease. For which of the following clinical manifestations does the observe in this patient? -High fluid intake and copious amounts of dilute urine output. -Muscular spasms and complaints of tingling in hands/feet. -Lethargy and change in level of consciousness. -Loss of appetite and complaints of nausea.
-Muscular spasms and complaints of tingling in hands/feet.
A 35-year-old female ultramarathon runner is admitted to hospital following a day-long, 80-km race because her urinary volume is drastically decreased and her urine is dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis. Why is her urine red? -Glomerular rupture -HemoglobinuriaHemoglobinuria -Myoglobinuria -Renal corpuscle rupture
-Myoglobinuria
The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for: -Nephrotoxic acute tubular necrosis -Ischemic acute tubular necrosis -Chronic kidney disease -Postrenal failure
-Nephrotoxic acute tubular necrosis
The nurse has delegated obtaining a urine specimen for testing to the nursing assistant. Which of these does the nurse emphasize the assistant should do to ensure accuracy of testing? -Obtain a freshly voided specimen. -Encourage the client to drink water prior to obtaining the specimen. -Teach the client the purpose of the test. -Record the volume of urine obtained in the medical record.
-Obtain a freshly voided specimen.
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. -Pale skin -Brittle fingernails -Moist skin and mucous membranes -Increased oil gland secretion -Decreased perspiration
-Pale skin -Brittle fingernails -Decreased perspiration
When explaining the role of the proximal tubule in terms of medication administration, the nursing instructor will emphasize that which of the following medications are bound to plasma proteins and require the proximal tubule secretion of exogenous organic compounds to help with filtration? Select all that apply. -Penicillin. -Aspirin. -Morphine sulfate. -Potassium chloride. -Sodium chloride.
-Penicillin. -Aspirin. -Morphine sulfate.
The nurse knows that which sign is one of the earliest manifestations of acute renal failure (ARF)? -Elevated urinary glucose -Elevated plasma uric acid -Polyuria -Hypokalemia
-Polyuria
A client is diagnosed with a tumor in the urinary bladder. The nurse will monitor the client for which of the following? -Prerenal failure -Intrarenal failure -Postrenal failure -Chronic kidney disease
-Postrenal failure
The nurse is reviewing lab results of a client diagnosed with metabolic acidosis. The most important electrolyte for the nurse to assess would be: -Magnesium (Mg2+) -Sodium (Na+) -Potassium (K+) -Calcium (Ca2+)
-Potassium (K+)
The nurse suspects a client who had a colon resection 4 days ago, is unable to pass flatus, and has no audible bowel sounds has a paralytic ileus. The nurse recognizes which of these abnormal laboratory results is consistent with this problem? -Magnesium level of 1.9 mg/dL -Sodium level of 138 mEq/L -Calcium level of 8.6 mg/dL -Potassium level of 2.8 mEq/L
-Potassium level of 2.8 mEq/L
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 -Prevent reabsorption of sodium in the distal tubules -Block aldosterone -Promote osmotic diuresis
-Prevent conversion of angiotensin I to II
The nurse is reviewing the diagnosis of four male clients. Select the diagnosis that places the clients at risk for developing postrenal kidney failure. -Prostatic hyperplasia -Intratubular obstruction -Severe hypovolemia -Acute pyelonephritis
-Prostatic hyperplasia
The nurse would be most concerned when the glomerular filtrate contains: -Potassium -Water -Sodium -Protein
-Protein
Body weight consists of which of the following percentages of body water? 7% 40% 60% 90%
60%
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 -Afferent arteriole -Efferent arteriole -Bowman's capsule
-Proximal tubules
A patient with schizophrenia is admitted to the behavioral health department and is observed drinking copious amounts of water and voiding large amounts of dilute urine. The nurse recognizes this behavior is consistent with which of these problems? -Psychogenic polydipsia -Hypodipsia -False thirst -Kidney failure
-Psychogenic polydipsia
A patient is diagnosed with gouty arthritis. To prevent the buildup of uric acid and recurrence of gout attacks, the nurse teaches the patient to avoid eating foods containing which of the following compounds? -Purine -Potassium -Gluten -Tyrosine
-Purine
The renal control mechanism of restoring the acid-base balance is accomplished through which process? -Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms. -Regulation of the production of carbonic acid -Reabsorption of hydrogen and excretion of carbonic acid -Stimulation of the chemoreceptors in the brain stem
-Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms.
A 72-year-old patient is scheduled for a kidney transplant. The nurse knows that which aspect of advanced age has a positive effect on the success of kidney transplant survival? -Psychological maturity -Decreased muscle mass -Acceptance of immunosuppressive therapy -Reduction in T-lymphocyte function
-Reduction in T-lymphocyte function
A 72-year-old patient is scheduled for a kidney transplant. The nurse knows that which aspect of advanced age has a positive effect on the success of kidney transplant survival? -Reduction in T-lymphocyte function -Psychological maturity -Acceptance of immunosuppressive therapy -Decreased muscle mass
-Reduction in T-lymphocyte function
A client is diagnosed with chronic kidney disease (CKD). The nurse knows that which statements regarding CKD are correct? Select all that apply -Onset is abrupt. -Symptoms appear with 50% of nephrons lost. -Renal damage is irreversible. -Less than 1% of population is affected. -Hypertension is a major cause.
-Renal damage is irreversible. -Hypertension is a major cause.
A patient has been diagnosed with a brain tumor that cannot be removed surgically. During each office visit the nurse will be assessing the patient for syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following assessments would alert the clinic nurse that the patient may be developing this complication? -Report of decreased urine output, no edema noted in ankles, increasing headache. -Hyperglycemia, dry mucous membranes, projectile vomiting. -Fever, diarrhea, nausea. -Muscle cramps, tingling around the mouth/lips, unexplained bruising.
-Report of decreased urine output, no edema noted in ankles, increasing headache.
Neuromuscular disorders can be triggered by CKD. For those clients on dialysis, approximately two thirds suffer from what peripheral neuropathy? -Raynaud syndrome -Burning hands and feet -Tingling and loss of sensation in lower limbs -Restless legs syndrome
-Restless legs syndrome
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? -BUN level -24-hour urine test -Urine test, first void in morning -Serum creatinine
-Serum creatinine
The GFR is considered to be the best measure of renal function. What is used to estimate the GFR? -BUN -Serum creatinine -Albumin level -Serum protein
-Serum creatinine
A 77 year-old female hospital patient has contracted Clostridium difficile during her stay, and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces? -She is susceptible to isotonic fluid volume deficit. -She is prone to isotonic fluid volume excess. -She could develop third-spacing edema as a result of plasma protein losses. -She is at risk of compensatory fluid volume overload secondary to gastrointestinal water and electrolyte losses.
-She is susceptible to isotonic fluid volume deficit.
When caring for patients with disorders of sodium balance, the nurse asks the provider which of the following findings are consistent with hypernatremia? -Sodium 158 mEq/L and serum osmolality of 320 mOsm/kg -Sodium 135 mEq/L and serum osmolality of 275 mOsm/kg -Sodium 148 mEq/L and serum osmolality of 280 mOsm/kg -Sodium 145 mEq/L and serum osmolality of 295 mOsm/kg
-Sodium 158 mEq/L and serum osmolality of 320 mOsm/kg
The condition of a client with metabolic acidosis from an intestinal fistula is not improving. The pulse is 125 beats/min and the BP 84/56mm Hg. ABG values are: pH 7.1, HCO3- 18 mEq/L, PCO2 57mm Hg. What IV medication should the nurse expect to provide next? -Epinephrine -Antibiotics -Sodium bicarbonate -Potassium chloride
-Sodium bicarbonate
A nurse is caring for a patient with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is high, and serum osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which of the following problems could the patient be diagnosed with? -Syndrome of inappropriate antidiuretic hormone (ADH) -Diabetes insipidus -Liver disease with ascites -Hyperglycemia
-Syndrome of inappropriate antidiuretic hormone (ADH)
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 rate is normal. -The client has reduced glomerular filtration reflecting damage to the kidney. -The client has low blood pressure causing the reduced glomerular filtration rate. -The client has diabetes causing the reduced glomerular filtration rate.
-The client has reduced glomerular filtration reflecting damage to the kidney.
What is the nurse's expectation about a client's ability to compensate for a metabolic blood gas disorder? -The client will compensate with the respiratory system. -The client will not be able to compensate. -The client will compensate with the same system. -The client's breathing will slow down.
-The client will compensate with the respiratory system.
The nurse teaches the client with end-stage kidney disease who has developed anemia that the reason anemia has developed is which of these? -Medications taken for kidney disease destroy the red blood cells. -The damaged kidney is unable to produce erythropoietin. -Clients with kidney disease must avoid consuming iron. -Activation of vitamin D cannot occur when kidneys are damaged.
-The damaged kidney is unable to produce erythropoietin.
A physician who is providing care for a 71 year-old male client with a recent diagnosis of renal failure and an acid-base imbalance is explaining some of the underlying etiology of the man's diagnoses to him and his family. Which of the following phenomena would most accurately underlie the teaching that the physician provides? -The kidneys are integral to the reabsorption of hydrogen ions and maintenance of a low pH. -Blood buffer systems and respiratory control can compensate for inadequate renal control of pH. -The kidneys have the primary responsibility for eliminating excess hydrogen ions from the body. -pH is kept at an optimal level through the renal secretion of bicarbonate ions in blood filtrate.
-The kidneys have the primary responsibility for eliminating excess hydrogen ions from the body.
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. -The normal kidney produces an average 3000 ml of urine daily. - This represents normal urinary output for 24 hours. -The kidneys should produce a minimum of 10 ml/hour over one day.
-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 infection is deep inside the kidney and it will take a long time for the antibiotics to kill the bacteria. -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 glomeruli filtration system gets overwhelmed in times of stress (like infections) and can become clogged with waste material from the bacteria. -The ability to transport substances from the tubular fluid into the peritubular capillaries become impaired which results in fluid being forced out of capillaries into the glomerulus.
-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 uric acid and glucose in the renal tubules. -They enhance absorption of potassium in the loop of Henle. -They promote release of aldosterone from the adrenal glands. -They block the reabsorption of sodium and chloride in the nephron.
-They block the reabsorption of sodium and chloride in the nephron.
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: -a small decrease in serum blood urea nitrogen level. -a normal urine output with fruity odor present. -a small amount of blood-tinged urine. -an increase in glomerular filtration rate [GFR].
-an increase in glomerular filtration rate [GFR].
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: -an angiotensin II effect resulting in higher blood pressure readings. -excess blood and clots in the urine. -decrease renal blood flow resulting in decrease in urine output. -large amounts of undiluted urine.
-decrease renal blood flow resulting in decrease in urine output.
respiratory alkalosis is caused by what: -hypoventilation -hyperventilation -Cheyne stokes -Trusseaus
-hyperventilation
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: -parasympathetic stimulation causing the renal arteries to constrict in response to pain. -innervation of the sympathetic nervous system causing constriction of the afferent arteriole. -high filtration rates in the glomerulus. -obstruction in the glomerular capillaries due to overabundance of large molecules being released.
-innervation of the sympathetic nervous system causing constriction of the afferent arteriole.
A client with chronic kidney disease has developed cardiac calcification. On admission the priority assessment would be for the nurse to: -check the BP in both arms and compare. -place on a heart monitor to watch for arrhythmias. -assess for pulses in the feet bilaterally. -listen to the heart for extra clicking sounds.
-place on a heart monitor to watch for arrhythmias.
Potassium is the major cation in the body. It plays many important roles, including the excitability of nerves and muscles. Where is this action particularly important? -The heart -The brain -The lungs -The liver
The heart
Bruising of the skin is a manifestation of bleeding disorders in patients with CKD. True False
True
