Pathophysiology Chapter 24

A new client on hemodialysis is watching his blood being filtreed through a dialyzer. He asks the nurse how much blood typically passes through the kidney every minute? The nurse responds:

1000-1300 mL/min

Select the percentage of cardiac output that perfuses the kindeys

20-25%

The nurse is reviewing the lab work of several medical clients. Which lab result is most suggestive of abnormalities in kidney function?

Increased creatinine and BUN levels

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

What is the average amount of urine (in liters) produced daily by a man of average height and weight and in good health

1.5

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 2 days ago. How could the nurse best respond to the patient's question?

"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 nurse is teaching a group of nursing students about the formation of urine in the nephron. Which of these components does the nurse teach are components of the nephron?

-loop of henle -distal convoluted tubule -proximal convoluted tubule -collecting tubule

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

95%

A client is experiencing an increase in urine output. THe nurse determines this is a result of:

A decrease in ADH

Following an automobile accident where the patient had a traumatic amputation of thier lower leg and lost >40% of their blood volume, they are currently not producing any urine output. The nurse bases this phenomena on which of the following humoral substances responsible for causing severe vasoconstriction of the renal vessels?

Angiotensin II and ADH

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?

Atrial Natriuretric Peptide (ANP)

The nurse is reviewing the most recent blood lab results of a client. The nurse would classify which lab results as abnormal?

BUN: 26 mg/dL Creatinine: 2.6 mg/dL pH: 7.23 Calcium: 4.1 mg/dL Potassium: 6.5 mEq/L

Which of the following occurences is most likely to cause increased urination?

Decrease in anti-diuretic hormone

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

Increased levels of uric acid in the blood cause of gout

The client with chronic kidney disease asks the nurse why he must take active vitamine D (calcitriol) as a medication. Which of these is the most appropriate response by the nurse?

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

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?

aspirin

When caring for a client with dehydration, the nurse anticipates the client will have an alteration in which of these substances in the blood?

blood urea nitrogen

A client has been prescribed a drug that is not removed quickly by renal filtration. This drug likely has this quality because it is:

bound to plasma proteins

The nurse is reviewing the results of a renal client's lab results. The client's urine specific gravity allows the nurse to assess the kidney's ability to:

concentrate urine

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

decrease

The nurse is caring for a client who has sustained a cervial spinal cord injury with resulting muscle wasting due to immobility. Which of these alteration in the lab tests does the nurse recognize is consistent with decreased muscle mass?

decreased creatinine levels

The nurse is assesing a client who has come to the family practice clinic for an annual checkup. The nurse performs a dip stick of the client's urine for screening, which reveals glucose in the urine. The nurse recognizes this may occur with which of the following medical problems?

diabetes

The nurse collects a urine sample but forgets the sample in the clients room for several hours. What is the nurse's best action?

discard the sample and recollect in the morning

The nurse is caring for a client with suspected dehydration. Which of these results does the nurse recognize will help confirm this diagnosis>

elevated urine specific gravity

The nurse is caring for a client with a condition of deficiency of ADH. When assessing the client, which of these findings does the nurse anticipate?

excessive urine output

Urine specific gracity 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 the morning

The nurse is caring for a client with a disease causing excess antidiuretic hormone. When performing the assessment, the nurse should focus on which of these consequences of excess ADH?

fluid volume excess

In the ED, a client arrives following a car accident. His P is 122, BP 88/60, RR 18bpm. Urine output is 4 mL over the first hour on arrival. When in shock, this lowered urine output is primarily due to:

innervation of the sympathetic nervous system causing constriction of the afferent arteriole

To treat enuresis in a young girl, her pediatrician prescribes desmopressin, an ADH nasal spray before bedtime. Which rationale for this treatment is the most likely?

it removes water from the filtrate and returns in to the vascular compartment

The healthcare provider has prescribed a diuretic to inhibit the Na+/K+/2Cl- cotransporters for a client. The nurse recognizes the medication as a:

loop diuretic

The nurse has delegated obtaining a urine specimen for testing to the nursing assistant. Which of these does the nurse emphasize the assitant should do to ensure accuracy of testing?

obtain a freshly voided substance

The nurse is explaining the role of endothelial cells in synthesizing vasoactive substances, one of which nitiric oxide. What affect does nitric oxide have on renal blood flow?

opens the renal vessels to increase blood flow

The nurse and nursing student are caring for a client with a condition causing a 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?

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 physiologic consequences of hypotension and reduced perfusion to the kidney. Which of these compensatory mechanisms occurs immediately after renin release from the kidney?

production of angiotensin I

The nurse would be most concerned when the glomerular filtrate contains:

protein

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?

serum creatinine

The nurse is analyzing the results of a client's urinalysis. Which of these findings does the nurse need to follow up because they are abnormal results?

specific gracity 1.034

The nurse teaches the client with end-stage kidney disease who has developed anemia that the reason anemia has developed is which of these?

the damaged kidney is unable to produce erythropoietin

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

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 patients sympathetic nervous system has beeen stimulate 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 the reabsorption of sodium and chloride in the nephron

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

to prevent conversion of angiotensin I to II

The nurse administers the drug vasopressin to a patient with a pituitary disorder. Based on knowledge of pathophysiology, the nurse anticipates the client will react in which of these ways?

water will be retained and decreased urine output will result