*PATHO Exam III - PrepU Dive

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: p. 968

1000-1300 mL/minute or 20-25% of the cardiac output.

The nurse is educating a client about renal disease. A primary function of the kidneys is to filter blood to selectively reabsorb molecules needed for regular bodily function and excreted needed substances through urine. What percentage of cardiac output perfuses the kidneys? p.960

22% to 25%

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

22% to 25%

A client's urine results reveal proteinuria and microalbuminuria. The health care provider is likely to prescribed an examination that will assist in quantifying the amount of protein loss by the kidney. For which examination should the nurse prepare to educate the client?

24-hour urine test

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

A nurse is reviewing a client's laboratory results and notices the blood urea nitrogen (BUN):creatinine ratio is 16:1. This ratio most likely correlates to which factor in the client's medical history? A. Recent weight loss by following a low-protein diet B. 10-year history of heart failure treated medically C. Too much toasted bread p. 978

B. 10-year history of heart failure treated medically

A nurse educator is explaining the importance of maintaining GFR for the maintenance of homeostasis. Which of these plays an essential role in maintaining a constant GFR? pp. 971-972

Macula densa

The nurse recognizes that antidiuretic hormone (ADH) exerts its effects in which location?

Loop of Henle

A nurse is reviewing the mechanisms of action of diuretics. Which diuretic is the most effective? p. 975

Loop diuretics

A client in the hospital is frustrated at the inconvenience of having to collect his urine for an entire day and night as part of an ordered 24-hour urine-collection test. The client asks the nurse why the test is necessary since the client provided a single urine sample 2 days prior. How could the nurse best respond? p.977

"Often when an abnormal substance shows up in a urine test, a 24-hour urine collection is needed to determine exactly how much is present in your urine."

A 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? p.979

"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? p.978

"This test provides a gauge of renal function."

Constriction of efferent arteriole increases resistance to outflow from the glomeruli.. What does this cause in regards to glomerular pressure and GFR.

+ glomerular pressure + GFR

The kidneys normally produce 1.5L of urine each day. Urine is an amber, light-yellow fluid that is 5% dissolved solids. What percent of it is water? p.976

95%

The nurse is preparing the client with suspected bladder cancer for a biopsy via cystoscopy. What does the nurse teach the client about cystoscopy? p.979

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

A client asks the nurse what may have caused elevation in urinary protein levels (proteinuria) on a urine test. The bestresponse by the nurse would be:

Abnormal glomerular filtration

Which substance released by atrial muscle cells will inhibit sodium and water reabsoption?

Atrial natriuretic peptide (ANP)

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

What is BUN?

Blood urea nitrogen Measures the amount of urea nitrogen in the blood; urea is formed in the liver as the end product of protein metabolism.

How is the movement of fluid through the glomerular capillaries determined? p.965

By the same factors that facilitate fluid transfer in all capillary beds. -capillary hydrostatic pressure (filtration pressure) -capillary colloidal osmotic pressure (reabsorptive pressure) -capillary permeability

The nurse is caring for a client with an elevated blood urea nitrogen (BUN) level. Which factor is least likely to alter the blood urea nitrogen value? A. Broken toaster B. Protein intake C. Thyroid Disease

C. Thyroid disease

A nurse is evaluating a client's urinalysis. Which result requires that the nurse notify the health care provider? A. White blood cell count (WBC): 5,000-10,000 B. Platelet count: 150,000-400,000 C. White blood cell count (WBC): 20-26

C. White blood cell count (WBC): 20-26

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

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

Which occurrence is most likely to cause increased urination? p.969

Decrease in antidiuretic hormone

The nurse is teaching a group of nursing students about the major functions of the kidney. What should the nurse include in the discussion?

Elimination of water Removal of waste products Removal of excess electrolytes

What identifies the function of the kidneys in maintaining normal composition of internal body fluids? p. 973

Filtration and reabsorption of physiologically essential substances

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? p.964

Glomerulus

What is erythropoietin (EPO)?

Glycoprotein that *stimulates bone marrow* to make RBCs (which increases amount of Hgb available to carry oxygen)

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? p.974-975

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

When teaching the client with gout about the cause of the disease, which cause should the nurse relate? p.974

Increased levels of uric acid in the blood cause gout.

The nurse is caring for a client with profound dehydration. The nurse recognizes the body should release antidiuretic hormone (ADH) in this situation based on which type of feedback from the body?

Increased serum osmolarity

A nurse is reviewing the mechanisms of action of diuretics. Which diuretic is the most effective?

Loop diuretics

Mannitol has been ordered for a client with increased intracranial pressure. The nurse plans to administer this drug using which method? p.976

Intravenously

What does mannitol do?

It is a diuretic; used when we need a lot of water removed.

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 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

Normal BUN-creatine ratio is normally 10:1, What do ratios greater the 15:1 indicate?

Pre-renal conditions such as: congestive heart failure GI tract bleeding

The nurse is teaching a group of nursing students about the physiologic consequences of hypotension and reduced perfusion to the kidney. Which compensatory mechanism occurs immediately after renin release from the kidney?

Production of angiotensin I

The nurse is teaching a group of students about the physiologic consequences of hypotension and reduced perfusion to the kidney. Which compensatory mechanism occurs immediately after renin release from the kidney?

Production of angiotensin I

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?

Proximal convoluted tubule Loop of Henle Distal convoluted tubule Collecting tubule

A client arrives for "testing to see if my kidney arteries are open and working OK." The nurse interprets this statement and plans to educate the client about which radiologic study?

Renal angiography where dye is injected directly into the renal artery looking for vascular damage in the renal arteries.

The nurse is caring for a client with Addison disease who has an absence of aldosterone. When reviewing the client's diagnostic test results, which consequence of low aldosterone levels does the nurse anticipate? p.973

Serum potassium of 7.3 mEq/L (7.3 mmol/L) Note* 70 mEq/L is used each day however anything not filtered by the glomerulus should be secreted. In Addisons disease aldosterone is absent and K+ reabsorption exceeds secretion.

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: p. 970

Significant decrease in urine output due to decrease in renal blood flow.

What is CKD?

State in which kidneys have trouble regulating: 1. The body's fluid state 2. Electrolyte levels 3. Acid-base status ALSO erythropoiesis and Vitamin D metabolism are compromised

Diuretics can either block the reabsorption of components of the urine, or they can block the reabsorption of water back into the body. What does the increase in urine flow from the body depend on with a client taking diuretics?

The amount of sodium and chloride reabsorption that is blocked

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.

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? p.965

The client has reduced glomerular filtration, reflecting damage to the kidney.

Why would a nurse would be most concerned when the glomerular filtrate contains Protein? p.965

The glomerular filtrate has a chemical composition similar to plasma, but it contains no proteins because large molecules do not readily cross the glomerular wall.

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 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.

Clients with Chronic Kidney Disease (CKD) are at risk for demineralization of their bones since they are no longer able to: pp.974-975

Transform vitamin D to its active form.

True or False: An adult has a serum sample taken to evaluate the BUN-creatinine ratio. His results; BUN 10 mg/dL (3.57 mmol/L) to creatinine 1 mg/dL (88.40 µmol/L) were normal.

True

True or False: An adult has a serum sample taken to evaluate the BUN-creatinine ratio. The results; BUN 25 mg/dL (8.92 mmol/L) to creatinine 1 mg/dL (88.40 µmol/L) are normal.

True

Where does urine formation begin? p.965

With the filtration of essentially protein-free plasma through the glomerular capillaries into the Bowman space.

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 afferent and efferent arterioles are innervated by the sympathetic nervous system and are sensitive to vasoactive hormones such as ________?

angiotensin II.

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: p. 979

concentrate urine

What are the loop diuretics?

furosemide, bumetanide, torsemide, ethacrynic acid

What does Angiotensin II do to blood pressure?

increases blood pressure by stimulating kidneys to reabsorb more water and by releasing aldosterone

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.

What does the macula densa do?

is a chemoreceptor and osmoreceptors & respond to chemical changes related to solute concentrate

Normal BUN-creatine ratio is normally 10:1, What does ratios less than 10:1 indicate?

liver disease low-protein diet chronic dialysis

Approximately 125 mL of filtrate is formed each minute. This is called the glomerular filtration rate (GFR). What is the average GFR for an adult per minute, and per day? p.965

per minute 125 mL per day 180 L

Constriction of afferent arteriole causes ___________ in Renal Blood Flow (RBF), glomerular pressure, and GFR

reduction

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:

the SNS has caused afferent arteries to constrict to decrease blood flow.

The glomerulus is located between two arterioles. This allows for maintenance of a high-pressure filtration system. The capillary filtration pressure is approximately 60mm Hg and two to three times higher than that of other capillary beds. What is the filtration pressure and the GFR regulated by? p.965

the constriction and relaxation of the afferent and efferent arterioles.

A client with end-stage kidney disease has developed anemia. The nurse teach this client that the reason anemia has developed is: p.974

the damaged kidney is unable to produce erythropoietin. Note* Persons with end-stage kidney disease are often anemic because of the inability to produce erythropoietin.