PrepU CH. 24
When administering a thiazide diuretic the nurse recognizes these medications exert their effects in which of these areas of the kidney?
Distal and collecting tubules
When explaining to a class of nursing students enrolled in pathophysiology, the instructor states, "the majority of energy used by the kidney is for:
Active sodium transport mechanisms."
An adult has a serum sample taken to evaluate the BUN-creatinine ratio. Select the result that indicates a normal test.
BUN 10 mg/dL to creatinine 1 mg/dL
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
When caring for the client with kidney failure, the nurse anticipates that which of these laboratory test abnormalities will be present? Select all that apply.
Elevated potassium Decreased calcium Increased creatinine
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 Addison's disease. For which of these complications does the nurse monitor?
Elevations in potassium levels
A nurse is teaching a client about the functions of the kidney. Which would be the most appropriate information for the nurse to provide? Select all that apply.
Eliminates metabolic wastes Regulates calcium and phosphorus conservation and elimination Regulates blood pressure through the renin-aldosterone mechanism Regulates pH of body fluids through reabsorption and conservation
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.
Elimination of water Removal of waste products Removal of excess electrolytes
Which of the following statements most accurately captures the function of the ascending loop of Henle?
Impermeability to water and absorption of solutes yields highly dilute filtrate.
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 gout.
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
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.
The nurse is instructing a client on the procedure for obtaining a voided urine specimen to bring the laboratory for analysis. Which is the most important information for the nurse to tell the client?
Obtain the first-voided morning specimen.
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
A client in 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 two days prior. How could the nurse best respond?
"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 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?
"Often why 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."
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?
"This test provides a gauge of renal function."
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
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:
1000-1300 mL/minute.
A client suffering from a previous myocardial infarction (MI) has symptomology indicating ineffective renal blood vessel dilation, resulting in increased sodium retention. Which hormone level may have been affected by the MI?
ANP
Select the percentage of cardiac output that perfuses the kidneys.
20% to 25%
A nurse is monitoring a patient with renal failure. What glomerular filtration rate (GFR) would the nurse estimate if the creatinine clearance test result is 60 mL/min?
60 mL/min
A client is experiencing an increase in urinary output. The nurse determines this is a result of:
A decrease in antidiuretic hormone
Which client on a geriatric medical unit is most likely to require slow-release potassium supplements on a regular basis?
An 81-year-old man who takes a thiazide diuretic to control his hypertension.
When caring for the client in a shock state, the nurse recognizes that which of these compensatory substances may produce vasoconstriction of renal vessels? Select all that apply.
Angiotensin II Antidiuretic hormone Endothelins
Following an automobile accident where the patient had a traumatic amputation of their 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.
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
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)
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?
Between the 12th thoracic and 3rd lumbar vertebrae
The physician has prescribed a thiazide diuretic for a client. The nurse anticipates that the medication will:
Block the tubular reabsorption of sodium
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
At which of the following locations in the nephron would a health care professional first expect blood to be largely free of plasma proteins?
Bowman's space
The nurse is analyzing the results of a client's urinalysis. Which of these requires the nurse to follow up as they represent abnormal results? Select all that apply.
Casts present Bilirubin positive
Select the action of renin in the renin-angiotensin-aldosterone mechanism.
Converts angiotensin to angiotensin I
A nurse is evaluating a patient's morning laboratory values. Which of the following results requires that the nurse notify the health care provider?
Creatinine: 10.6 mg/dL
Which of the following occurrences is most likely to cause increased urination?
Decrease in anti-diuretic hormone
The nurse is caring for a client who has sustained a cervical spinal cord injury with resulting muscle wasting due to immobility. Which of these alterations in the laboratory tests does the nurse recognize is consistent with decreased muscle mass?
Decreased creatinine levels
The nurse is assessing 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
A nurse is caring for a patient with end-stage renal failure who has symptoms of anemia. The nurse anticipates administering which of the following interventions to increase red blood cell production?
Epoetin alfa
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?
Excessive urine output
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
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
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
A patient is hospitalized and being treated for an acute kidney injury. Which information is most useful to the nurse while evaluating for improvement in kidney function?
Glomerular filtration rate (GFR)
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?
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 level will drop, but her calcium level may rise.
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?
I8t removes water from the filtrate and returns it to the vascular compartment.
The nurse is admitting to the hospital a 45-year-old woman with a presumptive diagnosis of diabetes mellitus. While taking her history, she mentions that she has been eating a lot of sweets lately. How would the nurse expect this diet to impact her renal system?
Increase renal blood flow
The nurse is reviewing the laboratory work of several medical clients. Which laboratory result is most suggestive of abnormalities in kidney function?
Increased creatinine and blood urea nitrogen (BUN) levels
Which of the following lab results would be associated with abnormalities in kidney function? Select all that apply:
Increased creatinine levels Detectable levels of glucose in a urine sample Elevated cystatin-C level.
The nurse is caring for a client who prefers to consume a large amount of protein in the diet. Which of these does the nurse recognize may occur as a result of a high protein diet?
Increased glomerular filtration rate
The filtration of blood undergoes several steps between the entry of blood into the kidney and the accumulation of urine. Which location involved in the filtration of blood and the flow of filtrate is the first?
Interlobular artery
Which type of nephron is primarily responsible for concentrating urine?
Juxtamedullary nephrons
The health care 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 recognizes that ADH, antidiuretic hormone, exerts its effects in which of these locations?
Loop of Henle
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?
Macula densa
The nurse is administering a potent loop diuretic which blocks reabsorption of certain electrolytes. The nurse applies principles of pathophysiology when monitoring the client for deficiency of which of these substances in the blood?
Magnesium
The nurse in the cardiac clinic is teaching a client about his antihypertensive medications when he mentions he has strained his back and is taking over the counter ibuprofen for relief. Which information does the nurse need to relate to this client?
Non steroidal anti-inflammatory drugs cause fluid retention and should be avoided in those with hypertension.
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?
Pituitary gland
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
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
Many substances are both filtered out of the blood and reabsorbed into the blood in the kidneys. What is the plasma level at which a specific substance can be found in the urine?
Renal threshold
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
A client has experienced an increase in aldosterone secretion as a result of stimulation of the adrenal glands. The nurse anticipates which of the following responses?
Reduction in urinary sodium levels
The nurse is caring for a client with Addison's disease who has an absence of aldosterone. When reviewing the client's diagnostic test results, which of these consequences of low aldosterone levels does the nurse anticipate?
Serum potassium of 7.3 mEq/L
The renal clearance of any given substance (glucose, urea, creatinine, etc.) that is present in the filtrate is measured independently. What are the factors that determine renal clearance of a substance? (Select all that apply.)
The ability of the substance to be filtered in the glomeruli The capacity of the renal tubules to reabsorb or secrete the substance
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 client has reduced glomerular filtration reflecting damage to the kidney.
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.
The nurse is teaching an anatomy and physiology class to a group of nursing students. When discussing the juxtamedullary nephrons it is correct to relate which of these functions to the students?
The juxtamedullary nephrons function is to concentrate 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 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 patients sympathetic nervous system has been stimulated which has resulted in vasoconstriction of the afferent arteriole which causes a decrease in renal blood flow.
In the presence of aldosterone in the distal tube, what action would occur?
The urine would be nearly sodium free.
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.
Which diuretic acts by preventing sodium chloride reabsorption in the distal convoluted tubule?
Thiazide diuretics
Which diuretic acts by preventing the reabsorption of sodium chloride in the distal convoluted tubule?
Thiazide diuretics
A client is admitted to the hospital with a diagnosis of gout in the right foot and a kidney stone in the left ureter. The nurse recognizes that these conditions may have resulted from accumulation of:
Uric acid
Gout and the development of kidney stones are often attributed to high levels of what compound?
Uric acid
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?
Uric acid levels
Which of the following substances is most likely to be reabsorbed in the tubular segments of the nephron using passive transport mechanisms?
Water
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.
The client with chronic kidney disease asks the nurse why he must take active vitamin 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.
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:
an increase in glomerular filtration rate [GFR].
A client has been prescribed a drug that is not removed quickly by renal filtration. The drug likely has this quality because it is:
bound to plasma proteins.
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.
When explaining the function of the cells of the proximal tubule, the pathophysiology instructor will emphasize their role in: Select all that apply.
increasing the surface area for reabsorption. supporting active transport processes.
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 dialysis technician is providing care for a client with chronic renal failure. The technician would recognize which of the following characteristics of healthy kidneys? Select all that apply:
• Blood vessels, nerves and ureters all connect with the kidney at the hilus. • Each kidney consists of lobes, with each lobe comprised of nephrons
Which of the following statements about mesangial cells within the glomerulus is accurate? Mesangial cells: Select all that apply.
• Have phagocytic properties that remove macromolecular materials. • Enlarge (hyperplasia) in response to glomerular diseases.
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.
