quiz 10 patho - renal
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
Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct?
Kidneys convert inactive vitamin D to its active form, calcitriol.
The major sites where aldosterone exerts its action on sodium reabsorption and potassium regulation occur in which tubule location?
Late distal and cortical collecting tubule
The nurse recognizes that antidiuretic hormone (ADH) exerts its effects in which location?
Loop of Henle
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?
Myoglobinuria, -can cause acute tubular necrosis via intratubular obstruction, involves the leaching of myoglobin from skeletal muscle into the urine, bypassing the usual filtration by the glomerulus. Excess exercise and muscle trauma can contribute
A client has experienced severe hemorrhage and is in prerenal acute kidney injury. The nurse anticipates the client's blood urea nitrogen (BUN) and serum creatinine laboratory results will be in which range?
The BUN-to-creatinine ratio is 20:1.
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 why an abnormal substance shows up in urine test, a 24-hour urine collection is needed to determine exactly how much it is present in your urine."
A nurse is collecting a urine specimen prior to measuring the albumin level in a client's urine. A colleague questions the rationale for the test, stating, "I thought albumin was related to liver function, not kidney function." How can the nurse best respond to this statement?
"Urine albumin levels are useful for diagnosing diabetic kidney disease."
A 60-year-old man has been diagnosed with renal calculi after repeated episodes of excruciating flank pain in recent weeks. The man states that, "I don't know how this could happen to me, since I'm so careful about eating a healthy diet." What is the most appropriate response to the man's statement?
"What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved."
A pediatric unit will be receiving an 8-day-old infant with a suspected congenital renal disorder. Which of the following renal abnormalities could be the possible cause?
-One of the infant's kidneys may have failed to develop normally. -The kidneys may be misshapen and have cysts present. -The upper or lower poles of the two kidneys may be fused.
azotemia
(excessive) urea and nitrogenous substances in the blood
Which of the following lab results would be associated with abnormalities in kidney function?
-Increased creatinine levels -Detectable levels of glucose in a urine sample -Elevated cystatin-C level.
A client is diagnosed with early chronic kidney disease (CKD). The nurse will recommend which actions to slow progression of renal damage?
-Smoking cessation -Blood pressure control -Angiotensin converting enzyme (ACE) inhibitor administration -Blood glucose control
A female client with suspected glomerular disease has been referred to a nephrologist. The nurse knows that which of the following clinical manifestations may be present with the diagnosis of acute nephritic syndrome?
-Sudden onset of hematuria -Proteinuria -Edema
Normal urine specific gravity ranges
1.010 to 1.025
normal levels of urea in blood are approximately:
20 mg/dL
Which of the following individuals is at the highest risk of developing a urinary tract infection (UTI)?
A 30-year-old woman with poorly controlled diabetes mellitus
Which of the following clinical findings among older adults is most unlikely to warrant further investigation and possible treatment?
A 78-year-old female's GFR has been steadily declining over several years.
Which of the following clients' diagnostic blood work is most suggestive of chronic kidney disease (CKD)?
A client with low vitamin D levels; low calcitriol levels; and elevated parathyroid hormone (PTH) levels
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
One of the many tests done during urodynamic studies is the sphincter electromyelogram. What does this test study?
Activity of the voluntary muscles of the perineal area
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 (3.57 mmol/L) to creatinine 1 mg/dL (88.40 µmol/L) Explanation: The BUN-creatinine ratio is approximately 10:1.
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
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 space
Which of the following medications would the nurse anticipate being prescribed for the renal failure patient who has hyperphosphatemia?
Calcium carbonate
While educating the client about the immunosuppressive therapy, which side effects should the nurse include in the teaching plan?
Cardiovascular complications Increased risk of developing cancer Development of metabolic dysfunction
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
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?
Control blood glucose and blood pressure
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
A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that this client will experience which manifestations?
Decreased renal endocrine function Decreased tubular reabsorption Decreased glomerular filtration
DIAPPERs acronym r/t incontinence in older adults
Dementia Infection Atropic vaginitis Pharm agents Psychological causes Endocrine conditions Restricted mobility
A 1-year-old baby boy with renal dysplasia risks end-stage renal disease unless intervention occurs. Which of the following treatment options is his care team most likely to reject?
Dietary restriction plus erythropoietin
dermatologic problem most often accompanies chronic kidney disease (CKD)?
Dry skin and pruritus
A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor this client for which gastrointestinal signs and symptoms?
Early morning nausea Gastrointestinal ulceration Metallic taste Anorexia
Why is blood pressure control so important in CKD clients?
Elevated blood pressure will exacerbate nephron loss and accelerate renal failure.
major functions of the kidney
Elimination of water Removal of waste products Removal of excess electrolytes
Which of the following pain descriptions would lead the nurse to suspect the client is experiencing ureteral colic?
Excruciating pain in the flank and upper outer quadrant of the abdomen that radiates to the bladder area
Which option identifies the function of the kidneys in maintaining normal composition of internal body fluids
Filtration and reabsorption of physiologically essential substances
Which option identifies the function of the kidneys in maintaining normal composition of internal body fluids?
Filtration and reabsorption of physiologically essential substances
function of the kidneys in maintaining normal composition of internal body fluids:
Filtration and reabsorption of physiologically essential substances
A nurse in an acute medical unit of a hospital has admitted a 62-year-old female from the emergency department who has been diagnosed with acute pyelonephritis. Which of the following statements most accurately conveys an aspect of the knowledge base that the nurse needs to perform adequate care and teaching?
Flank pain, dysuria, and nausea vomiting are likely assessment findings.
The nurse is caring for a client with a disease causing excess antidiuretic hormone (ADH). When performing the assessment, the nurse should focus on which manifestation of excess ADH?
Fluid volume excess
A client has developed gout and is experiencing a "flare-up" with excruciating pain in the feet and toes. The client provides a list of recent new medications to treat worsening heart failure. The nurse's concern is that one may cause retention of uric acid. Which drug should the nurse ask the health care provider about?
Furosemide, a loop diuretic
A 62-year-old woman with high blood pressure is to begin long-term treatment with a thiazide diuretic that she thinks she will 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.
Disorders of phosphate and calcium metabolism frequently occur in clients with chronic kidney disease (CKD). The nurse recognizes which statement regarding phosphate and calcium imbalances is correct?
Hypercalcemia can lead to osteodystrophy of CKD, which predisposes clients to cardiovascular disorders.
Which 3 conditions have the potential to cause chronic kidney disease?
Hypertension Diabetes Glomerulonephritis
A 68-year-old woman with a new onset of vascular dementia has recently begun retaining urine. Which of the following physiological phenomena would her care providers most realistically expect to currently occur as a result of her urinary retention?
Hypertrophy of the bladder muscle and increased bladder wall thickness
The nurse is caring for a client with heart failure and left atrial enlargement. Which physiologic consequence does the nurse anticipate when atrial natriuretic peptide (ANP) is released due to atrial stretch?
Inhibition of aldosterone
To treat enuresis in a young girl, her pediatrician prescribes desmopressin, an antidiuretic hormone (ADH) nasal spray, before bedtime. What is the most likely rationale for this treatment?
It removes water from the filtrate and returns it to the vascular compartment.
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.
A client with postrenal acute kidney injury (AKI) exhibits oliguria and edema with laboratory results revealing increased levels of urea, potassium, and creatinine. Based on these data, which phase of AKI is this client most likely experiencing?
Oliguric phase
When explaining to a CKD client how urea is absorbed, which transport mechanism will be mentioned?
Passive transport
Which physiologic process is performed by the kidneys and contributes to increased blood pressure?
Production and release of renin
The nurse would be most concerned when the glomerular filtrate contains:
Protein Explanation: The glomerular filtrate has a chemical composition similar to plasma, but it contains almost no proteins because large molecules do not readily cross the glomerular wall. Potassium, sodium, and water would be filtered.
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
Damage to which of the following areas of a nephron would most likely result in impaired secretion and reabsorption?
Proximal tubule
When teaching a pharmacology class the nurse relates that 65% of all reabsorptive and secretory processes that occur in the tubular system take place in which area?
Proximal tubules
Which of the following phenomena contributes to the difficulties with absorption, distribution, and elimination of drugs that are associated with kidney disease?
Reductions in plasma proteins increase the amount of free drug and decrease the amount of protein-bound drug.
The nurse recognizes the kidney can be considered an endocrine organ as it may exert which action?
Regulation of red blood cells through manufacture of erythropoietin
An athlete has become dehydrated during a long race in hot weather. Which physiologic process will occur in an attempt to protect the athlete's extracellular fluid volume?
Release of antidiuretic hormone from the posterior pituitary
The nurse is instructing a client with neurogenic bladder to perform intermittent self-catheterization. What teaching points should the nurse include?
Scheduling catheterization for every 4 hours Signs and symptoms of autonomic dysreflexia
Which blood test reflects the glomerular filtration rate (GFR) and is used to estimate renal function?
Serum creatinine -used to estimate functional capacity of the kidneys. -Increased creatinine level indicates decreased GFR and renal function
A 22-year-old female with a history of intermittent flank pain, repeated UTIs, and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of this diagnosis?
She has inherited a tendency for epithelial cells in her tubules to proliferate inappropriately.
A 51-year-old woman diagnosed with a cerebrovascular accident (CVA) 5 months prior is distressed that she has had several recent episodes of urinary incontinence. She has asked her nurse practitioner why this is the case. Which of the following statements best captures the fact that would underlie the nurse's response to the client?
She may be unable to sense her bladder filling as a result of her MS.
Which factor is likely to result in decreased renal blood flow?
Stimulation of the sympathetic nervous system
A 61-year-old woman who has had an upper respiratory infection for several weeks has presented to her family physician with complaints of a recent onset of urinary retention. She reveals to her physician that she has been taking nonprescription cold medications over and above the suggested dose for the past 2 weeks. Which of the following phenomena will her physician most likely suspect is contributing to her urinary retention?
The anticholinergic effects of the medication are impairing normal bladder function.
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. Explanation: Approximately 125 mL of filtrate is formed each minute. This is called the glomerular filtration rate (GFR). This rate can vary from a few milliliters per minute to as high as 200 mL/minute.
During male ejaculation, which of the following statements addresses why sperm is not normally seen inside the bladder?
The musculature of the trigone area, bladder neck, and prostatic urethra contract at the same time.
Which medication may be responsible for a client developing increased uric acid levels by decreasing ECF volume?
Thiazide diuretics
The clinical nurse educator on a nephrology unit of a large, urban hospital is orientating recent nursing graduates to the unit. Which of the following teaching points about acute tubular necrosis (ATN) should the educator include in the orientation session?
Trauma, burns, and major surgery are common precursors to ATN."
When preparing a client with a suspected kidney tumor for a renal biopsy, the nurse teaches the client that which diagnostic method may be used to aid in accuracy of the procedure?
Ultrasound
The nurse administers the drug vasopressin to a client with a pituitary disorder. Based on knowledge of pathophysiology, the nurse anticipates the client will react in which way?
Water will be retained and decreased urine output will result.
Which of the following clinical manifestations would lead the nurse to suspect the renal failure patient is developing uremia?
Weakness and fatigue Lethargy and confusion Extreme itching
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."
What medication competes with uric acid for secretion into the tubular fluid, thereby reducing uric acid secretion?
aspirin
Kidneys convert inactive vitamin D to its active form:
calcitriol
Juxtamedullary nephron function
concentrate urine
This client's urine specific gravity allows the nurse to assess the kidneys' ability to:
concentrate urine.
A patient in the ICU has been diagnosed with hypovolemic shock. BP is 88/53, heart rate 122, and respiratory rate 26. Given these vital signs, the nurse should expect the urine output to be:
decreased below 30 mL/hour with decreased GFR.
A patient in the ICU has been diagnosed with hypovolemic shock. His BP is 88/53, heart rate 122, and respiratory rate 26. Given these vital signs, the nurse should expect the urine output to be
decreased below 30 mL/hour with decreased GFR.
When explaining about the passage of urine to a group of nursing students, the clinic nurse asks them which muscle is primarily responsible for micturition?
detrusor
An older adult with urge incontinence and overactive bladder begins medication treatment with oxybutynin. Which side effects would the nurse include in the education?
dry mouth and constipation
Most common uncomplicated urinary tract infections are caused by ____ that enter through the urethra.
e-coli
Following the diagnosis of acute renal failure, the nurse knows that one of the earliest manifestations of residual tubular damage is which of the following lab/diagnostic results?
elevated BUN
. A frantic mother brings her young child into the emergency department. She states that during the evening bath, she noticed a large mass in her child's abdomen. After diagnostic testing, the pediatrician tells the parents that their child has Wilms tumor, stage IV. After the doctor leaves the room, the parents ask the nurse, "What does this mean?" The nurse will respond, "Your child ('s)
has cancer in the kidney that has spread most likely to his lungs."
A 73-year-old man presents to his family physician with complaints of recent urinary hesitation and is eventually diagnosed with benign prostatic hyperplasia (BPH). Which of the following clinical consequences would his care provider expect prior to the resolution of his health problem?
hydroureter and pain
A client is to receive a radiocontrast media as part of a diagnostic scan. Which intervention is intended to reduce the nephrotoxic effects of the radiocontrast media?
increasing the normal saline intravenous infusion rate prior to the exam
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.
Which type of nephron is primarily responsible for concentrating urine?
juxtamedullary nephrons
The adult child of an older adult has noticed that the parent has become incontinent of urine for the first time. The client is diagnosed with transient urinary incontinence. To what is this condition most attributable in this population?
medications
intrarenal (intrinsic) failure
nephrons are destroyed
The health care provider has prescribed an aminoglycoside (gentamicin) for a client. Which complication is the client is at risk for?
nephrotoxic acute tubular necrosis
A 45-year-old client is being treated for ovarian cancer. The treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of which complication?
nephrotoxic acute tubular necrosis (ATN)
A client in acute kidney injury has marked decrease in renal blood flow caused by hypovolemia, the result of gastrointestinal bleeding. The nurse is aware that this form of acute kidney injujry can be reversed if the bleeding is under control. Which form of acute kidney injury does this client have?
prerenal kidney injury
Glomerular Filtration Rate (GFR)
provides a gauge of renal function . The GFR is the amount of filtrate that is formed each minute as blood moves through the glomeruli. The clearance rate for creatinine is the amount that is completely cleared by the kidneys in 1 minute.
The kidney has no ability to:
regenerate nephrons
The kidney releases ________, which enters the bloodstream to convert angiotensinogen to angiotensin I.
renin enzyme that is synthesized and stored in the juxtaglomerular cells of the kidney
postrenal failure
result of obstruction of urine outflow
A client with Addison disease has been admitted to regulate fluid and electrolyte imbalances. The nurse can anticipate that the client's blood work will show:
serum potassium levels have increased
If the client is in shock, the nurse would expect to find:
significant decrease in urine output due to decrease in renal blood flow.
oliguria
small amounts of urine
One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which electrolyte?
sodium
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 have the primary responsibility for eliminating excess hydrogen ions from the body.
A client tells the nurse that he is experiencing involuntary loss of urine associated with a strong desire to void (urgency). The nurse would recognize this as:
urge incontinence
While assessing a patient with urosepsis, the ICU nurse notes the patient's BP is 80/54; HR 132; RR 24; and pulse oximetry 89% on 6 lpm O2. Over the last hour, the patient's urine output is 15 mL. When explaining to a new graduate nurse, the nurse will emphasize that the patient's status may relate to that:
the patient's sympathetic nervous system has been stimulated that has resulted in vasoconstriction of the afferent arteriole, which causes a decrease in renal blood flow.
A patient asks the nurse what it means when the doctor said that he had adenocarcinoma of the bladder. Reviewing the pathophysiologic principles behind this type of cancer, the nurse knows:
this is a rare but highly metastatic tumor that has a very poor prognosis.
Clients with CKD are at risk for demineralization of their bones since they are no longer able to:
transform vitamin D to its active form. The kidneys aid in calcium metabolism by activating vitamin D after it is chemically converted by the liver.
Asterixis
tremor of the hand when the wrist is extended
The client has just been diagnosed with bladder cancer and asks the nurse what causes it. What would be the nurse's best response to the client?
unknown cause
One of the most reliable predictors for worsening autosomal dominant polycystic kidney disease is:
urine albumin excretion (UAE).
uremia
urine in the blood
Which of the following substances is most likely to be reabsorbed in the tubular segments of the nephron using passive transport mechanisms?
water
A nurse educator is orientating new nurses to a renal unit of the hospital. Which of the following teaching points should the nurse include as part of a review of normal glomerular function?
"Glomerular filtrate is very similar to blood plasma found elsewhere in circulation."
A patient has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause?
"Have you had any type of infection within the last 2 weeks?"
A diabetes education nurse is teaching a group of recently diagnosed diabetics about the potential genitourinary complications of diabetes and the consequent importance of vigilant blood glucose control. Which of the following teaching points best conveys an aspect of bladder dysfunction and diabetes mellitus?
"It's important for you to empty your bladder frequently because diabetes carries risks of kidney damage that can be exacerbated by incomplete bladder emptying."
A 63-year-old woman has visited a physician because she has been intermittently passing blood-tinged urine over the last several weeks, and cytology has confirmed a diagnosis of invasive bladder cancer. Which of the following statements by the physician is most accurate?
"It's likely that you'll need surgery, possibly a procedure called a cystectomy."
A 24-year-old college student has presented to the campus medical clinic with complaints of frequent, burning urination and has, subsequent to urinalysis, been diagnosed with an acute lower urinary tract infection (UTI) caused by E. coli. What teaching will the clinician most likely provide to the student?
"Many of these bacteria are now resistant to some antibiotics, but I will take that into account when I choose which antibiotic to prescribe
A nurse educator is performing client education with a 51-year-old man who has been recently diagnosed with chronic kidney disease. Which of the following statements by the client would the nurse most likely want to correct or clarify?
"My kidney problems increase my chance of developing high blood pressure or diabetes."
Which of the following data would a clinician consider as most indicative of acute renal failure?
-Increased nitrogenous waste levels; -decreased glomerular filtration rate (GFR)
A client has been diagnosed with having calcium oxalate kidney stones following intravenous pyelography. Which of the following teaching points about the treatment of the health problem are justifiable?
-"You may need to cut out cocoa, chocolate, and some nuts from your diet." -"Extracorporeal shock-wave lithotripsy treatment may be used to fragment larger stones."
Which of the following patients scheduled for an interventional radiology procedure requiring administration of radiocontrast dye would be considered at high risk for nephrotoxicity
-A 25-year-old with a history of glomerular nephritis who is complaining of severe flank pain -A 67-year-old diabetic undergoing diagnostic testing for new-onset proteinuria
A nurse has noted the high incidence of urinary tract obstructions of a variety of etiologies. Which of the following individuals are at risk of developing urinary obstructions?
-A 29-year-old female, pregnant for the first time -A 70-year-old male with benign prostatic hyperplasia (BPH) -A 58-year-old male with renal calculi -A 28-year-old male with a neurogenic bladder secondary to spinal cord injury
Which of the following individuals are likely to display identified risk factors for the development of lower urinary tract obstruction?
-A 68-year-old man who has been diagnosed with benign prostatic hyperplasia (BPH) -A 30-year-old woman who has been diagnosed with gonorrhea -A 74-year-old woman who has developed a lower bowel obstruction following several weeks of chronic constipation -A 20-year-old man who has spina bifida and consequent impaired mobility
Which of the following clients would be considered to have a significant risk of developing the prerenal form of acute renal failure?
-A 79-year-old male with diagnoses of poorly controlled diabetes mellitus and heart failure -An 80-year-old female who has been admitted for the treatment of dehydration and malnutrition
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?
-Blood vessels, nerves, and ureters all connect with the kidney at the hilus. -Each kidney consists of lobes, with each lobe comprised of nephrons.
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?
-Blood vessels, nerves, and ureters all connect with the kidney at the hilus. -Each kidney consists of lobes, with each lobe comprised of nephrons.
The nurse should anticipate that a patient diagnosed with spastic bladder dysfunction may be prescribed which of the following medications that will help decrease detrusor muscle tone and increase bladder capacity?
-Ditropan (Oxybutynin), an antimuscarinic drug -Detrol LA (tolterodine tartrate), an antimuscarinic drug
A nurse is teaching a client about the functions of the kidney. Which would be the most appropriate information for the nurse to provide?
-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
A 9-year-old boy has been diagnosed with the nephrotic syndrome. Place the following stages in the development of his health problem in ascending order.
-Hypoalbuminemia -Increased glomerular membrane permeability -Decreased colloidal osmotic pressure -Proteins escape from the plasma to the glomerular filtrate -Accumulation of fluid in the interstitial tissue (edema)
When educating the patient about possible treatments following surgery for bladder cancer, the nurse might include which of the following chemotherapy options?
-Intravesical chemotherapy with doxorubicin (Adriamycin) -Bacillus Calmette-Guérin (BCG) vaccine -Endocan, a tumor angiogenesis inhibitor
While living and hiking in the Rocky Mountains, a gentleman slipped and fell. He goes to an urgent care where an x-ray was done, and some blood was drawn for a CBC. The clinic informs him that he is anemic. What may contribute to this person's anemia?
-Living in a high altitude -Tissue hypoxia -Inability to manufacture erythropoietin
Following kidney transplantation, the patient is prescribed maintenance immunosuppressive therapy consisting of prednisone, azathioprine, and cyclosporine. Educating the patient about long-term maintenance on immunosuppressive therapy should include discussion of side effects that may include:
-cardiovascular complications. -increased risk of developing cancer.
Which of the following statements about mesangial cells within the glomerulus is accurate? They:
-have phagocytic properties that remove macromolecular materials. -enlarge (hyperplasia) in response to glomerular diseases.
Which client(s) is likely experiencing an increase in renal blood flow (RBF) and an increase in glomerular filtration rate (GFR) related to their current health status?
-keto diet -uncontrolled diabetes
Oliguric phase of AKI
-marked decrease in glomerular filtration rate (GFR), causing sudden retention of endogenous metabolites, such as urea, potassium, sulfate, and creatinine, that normally are cleared by the kidneys. -The urine output is usually lowest at this point. -Fluid retention gives rise to edema, water intoxication, and pulmonary congestion.
prerenal injury manifestations
-sharp decrease in urine output -disproportionate elevation of blood urea nitrogen (BUN) in relation to serum creatinine levels. -vascular volume and renal perfusion are decreased (dehydration)
The kidneys should produce about _____ L of urine each day.
1.5L
When teaching a client about kidney disease, the nurse will mention that the average amount of filtrate formed each minute in a healthy kidney is how many milliliters?
125ml
normal levels of urea in blood are approximately:
20mg/dL
Which percentage of cardiac output perfuses the kidneys?
22-25%
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
A warehouse worker is experiencing trouble with incontinence, especially when lifting heavy objects. What intervention is most appropriate for this client's needs?
Administration of alpha-adrenergic agonist drugs as ordered
Which of the following clients on a medical unit of a hospital is most likely to be experiencing health problems that may be attributable to kidney disease?
An 81-year-old female client with osteoporosis and anemia
Following an automobile accident where the patient had a traumatic amputation of his lower leg and lost greater than 40% of his blood volume, he is 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
A middle-aged man with diabetes reports that he must strain to urinate and that his urine stream is weak and dribbling. He also reports feeling that his bladder never really empties. The nurse knows that all of his complaints are likely caused by which of the following medical diagnoses?
Bladder atony with dysfunction
diagnostic test that is considered the best measurement of overall kidney function.
Glomerular filtration rate (GFR)
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
The nurse and nursing student are caring for a client with kidney dysfunction who requires a test to determine glomerular filtration rate. The nurse recognizes that the student understands the test when the student states:
I will need to start a 24-hour urine collection.
A 25-year-old Asian American man arrives in the emergency room in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What disease has likely caused of his hematuria and how should it be treated?
Immunoglobulin A nephropathy and may be advised to use omega-3 fatty acids to delay progression of disease
Which of the following statements most accurately captures the function of the ascending loop of Henle?
Impermeability to water and absorption of solutes yields a highly dilute filtrate.
A 55-year-old man has made an appointment to see his family physician because he has been awakening three to four times nightly to void and often has a sudden need to void with little warning during the day. What is the man's most likely diagnosis and possible underlying pathophysiological problem?
Overactive bladder that may result from both neurogenic and myogenic sources
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?
Penicillin Aspirin Morphine sulfate
A client with CKD is being treated for hyperphosphatemia and hypocalcemia. Select the most appropriate interventions
Phosphate-binding antacids Activated vitamin D Restriction of foods high in phosphate
treatment for hyperphosphatemia and hypocalcemia
Phosphate-binding antacids Activated vitamin D Restriction of foods high in phosphate
A client has an obstructive urine outflow related to benign prostatic hyperplasia. Due to the inability to excrete adequate amounts of urine, which type of renal failure should the nurse closely monitor for?
Postrenal failure
The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents:
a loss of over half the client's normal kidney function.
.A 4-year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the emergency department by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the health care team's initial differential diagnosis most likely be?
alport syndrome
A patient who has suffered a spinal cord injury at C4 is experiencing a sudden change in condition. His BP is 186/101; heart rate is 45; and he is profusely sweating and complaining of "not feeling right." The nurse should:
palpate his bladder for overdistention
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]. Explanation: The client's increase in blood glucose results in an increase in blood flow and GFR. These increases allow sodium excretion to be maintained at a near-normal level while increasing the excretion of the waste products of protein metabolism, such as urea. The same mechanism is thought to explain the large increases in renal blood flow and GFR that occur with high blood glucose levels in persons with uncontrolled diabetes mellitus.
AKI 4 phases
onset phase: tubular injury is induced oliguric phase: GFR falls, nitrogenous wastes accumulate, and urine output decreases diuretic phase: the kidneys try to heal and urine output increases recovery phase: tubular edema resolves and renal function improves. During recovery, there is normalization of fluid and electrolyte balance.
The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to which substance?
plasma proteins
An 86-year-old client is being treated for dehydration and hyponatremia after curtailing fluid intake to prevent urinary incontinence. Given these findings, the nurse recognizes that this client is likely in what phase of acute kidney injury?
prerenal
Which component of glomerular filtrate can passively cross the tubular epithelial cell membrane?
urea
