Renal Function & Disorders

To assess circulating oxygen levels, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommends the use of which of the following diagnostic tests? a) Hemoglobin b) Hematocrit c) Arterial blood gases d) Serum iron levels

A) Hemoglobin Explanation: Although hematocrit has always been the blood test of choice to assess for anemia, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines, recommend that anemia be quantified using hemoglobin rather than hematocrit measurements. Hemoglobin is recommended as it is more accurate in the assessment of circulating oxygen than hematocrit. Serum iron levels measure iron storage in the body. Arterial blood gases assess the adequacy of oxygenation, ventilation, and acid-base status.

Which of the following electrolytes is a major cation in body fluid? a) Potassium b) Bicarbonate c) Chloride d) Phosphate

A) Potassium Potassium is a major cation that affects cardiac muscle functioning. Chloride is an anion. Bicarbonate is an anion. Phosphate is an anion.

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? a) Dehydration b) Crackles c) Hypertension d) Hyperkalemia

A) Dehydration The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.

A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately? a) Potassium b) Sodium c) Chloride d) CO2

A) Potassium The nurse should identify potassium: 2.2 mEq/L as critical because a normal potassium level is 3.8 to 5.5 mEq/L. Severe hypokalemia can cause cardiac and respiratory arrest, possibly leading to death. Hypokalemia also depresses the release of insulin and results in glucose intolerance. The glucose level is above normal (normal is 75 to 110 mg/dl) and the chloride level is a bit low (normal is 100 to 110 mEq/L). Although these levels should be reported, neither is life-threatening. The BUN (normal is 8 to 26 mg/dl) and creatinine (normal is 0.8 to 1.4 mg/dl) are within normal range.

A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? a) Alkaline b) Acidic c) Basic d) Neutral

B) Acidic Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals acidic urine pH. A pH above 7.0 is considered an alkaline or basic solution. A pH of 7.0 is considered neutral.

Which of the following is a correct route of administration for potassium? a) IV (intravenous) push b) Oral c) Intramuscular d) Subcutaneous

B) Oral Potassium may be administered through the oral route. Potassium is never administered by IV push or intramuscularly to avoid replacing potassium too quickly. Potassium is not administered subcutaneously.

The calcium level of the blood is regulated by which mechanism? a) Androgens b) Adrenal gland c) Parathyroid hormone (PTH) d) Thyroid hormone (TH)

C) PTH The serum calcium level is controlled by PTH and calcitonin. The thyroid hormone, adrenal gland, or androgens do not regulate the calcium level in the blood.

A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing? a) Hyperglycemia b) Hypercalcemia c) Hyperkalemia d) Hypernatremia

C) Hyperkalemia Administering regular insulin I.V. concomitantly with 50 ml of dextrose 50% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia. This combination doesn't help reverse the effects of hypercalcemia, hypernatremia, or hyperglycemia.

An elderly client takes 40 mg of Lasix twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use? a) Hypophosphatemia b) Hypernatremia c) Hypokalemia d) Hyperkalemia

C) Hypokalemia Hypokalemia (potassium level below 3.5 mEq/L) usually indicates a defict in total potassium stores. Potassium-losing diuretics, such as loop diuretics, can induce hypokalemia.

A nurse should assess for hyperkalemia as indicated by: a) diaphoresis. b) tremors. c) muscle weakness. d) constipation.

C) Muscle weakness Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and results from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

Patients diagnosed with hypervolemia should avoid sweet or dry food because: a) It obstructs water elimination. b) It can cause dehydration. c) It can lead to weight gain. d) It increases the client's desire to consume fluid.

D) It increases the client's desire to consume fluid The management goal in hypervolemia is to reduce fluid volume. For this reason, fluid is rationed, and the client is advised to take limited amount of fluid when thirsty. Sweet or dry food can increase the client's desire to consume fluid. Sweet or dry food does not obstruct water elimination nor does it cause dehydration. Weight regulation is not part of hypervolemia management except to the extent that it is achieved on account of fluid reduction.

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? a) "The effluent should be allowed to drain by gravity." b) "It is important to use strict aseptic technique." c) "The infusion clamp should be open during infusion." d) "It is appropriate to warm the dialysate in a microwave."

D) It is appropriate to warm the dialysate in a microwave Explanation: The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.

True or False? The primary function of the kidney is to excrete nitogeneous waste products.

False Primary function of kidney is to regulate the volume and composition of extracellular fluids

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? a) Therapeutic index b) GI absorption rate c) Liver function studies d) Creatinine clearance

D) Creatinine clearance The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? a) Decreased blood urea nitrogen (BUN) b) Decreased potassium c) Increased serum albumin d) Increased serum creatinine

D) Increased serum creatinine In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.

Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? a) Increased red blood cell count b) Decreased serum potassium level c) Increased serum calcium level d) Increased serum creatinine level

D) Increased serum creatinine level Explanation: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.

True or False? GFR is primarily dependent on adequate blood flow and adequate hydrostatic pressure.

True

True or False? Increased permeability in the glomerulus causes loss of proteins into the urine.

True

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a) Weight loss b) Fever c) Absence of pain d) Diuresis

b) Fever Fever is an indicator of infection or transplant rejection.

A nursing instructor is reviewing with the class the steps in urine formation. Place in the correct order from first to last the sequence the instructor would present. -Filtrate enters Bowman's capsule -Plasma filtered through glomerulus -Formed urine drains from the collecting tubules, into the renal pelvis, and down each ureter to the bladder -Filtrate moves through tubular system of the nephron and is either reabsorped or excreted

-Plasma filtered through glomerulus -Filtrate enters Bowman's capsule -Filtrate moves through tubular system of the nephron and is either reabsorped or excreted -Formed urine drains from the collecting tubules, into the renal pelvis, and down each ureter to the bladder

When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? a) Check for thrill or bruit over the access site. b) Warm the solution to body temperature. c) Inspect the catheter insertion site for infection. d) Add the prescribed drug to the dialysate.

A) Check for thrill or bruit over the access site. When preparing a client for hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency. Inspecting the catheter insertion site for infection, adding the prescribed drug to the dialysate, and warming the solution to body temperature would be necessary when preparing a client for peritoneal dialysis.

A patient with an obstruction of the renal artery causing renal ischemia exhibits HTN. One factor that may contribute to HTN: a) increase renin release b) increased ADH secretion c) decreased aldosterone secretion d) increased synthesis and release of prostaglandins

A) Increase Renin Release Renin is released in resonse to decreased B/P, renal ischemia, eosinophil chemotactic factor (ECF) depletion, and other factors affecting blood suppy to the kidney. It is they catalyst of the renin-angiotensin-aldosterone system, which raises B/P when stimulated. ADH is secreted by the posterior pituitary in response to serum hyperosmolality and low blood volume. Aldosterone is secreted within the renin-angiotensin II, and kidney prostaglandins lower B/P by causing vasodilation.

A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact? a) The kidneys are situated just above the adrenal glands. b) The left kidney usually is slightly higher than the right one. c) The kidneys lie between the 10th and 12th thoracic vertebrae. d) The average kidney is approximately 5 cm (2?) long and 2 to 3 cm (¾? to 1??) wide.

B) The left kidney usually is slightly higher than the right one The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4??) long, 5 to 5.8 cm (2? to 2¼?) wide, and 2.5 cm (1?) thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae.

A 57-year-old homeless female with a history of alcohol abuse has been admitted to your hospital unit. She was admitted with signs and symptoms of hypovolemia - minus the weight loss. She exhibits a localized enlargement of her abdomen. What condition could she be presenting? a) Hypovolemia b) Pitting edema c) Third-spacing d) Anasarca

C) Third spacing Third-spacing describes the translocation of fluid from the intravascular or intercellular space to tissue compartments, where it becomes trapped and useless. The client manifests signs and symptoms of hypovolemia with the exception of weight loss. There may be signs of localized enlargement of organ cavities (such as the abdomen) if they fill with fluid, a condition referred to as ascites.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a) Serum sodium level of 135 mEq/L b) Serum potassium level of 4.9 mEq/L c) Temperature of 99.2° F (37.3° C) d) Urine output of 20 ml/hour

D) Urine output of 20 ml/hour Explanation: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? a) Perform deep-breathing exercises vigorously. b) Avoid carrying heavy items. c) Auscultate the lungs frequently. d) Wear a mask when performing exchanges.

D) Wear a mask when performing exchanges The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.

True or False? Prostaglandin synthesis by the kidneys causes vasodilation and increased renal blood flow.

True

True or False? Water is the primary substance reabsorbed in the collecting duct?

True

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? a) Acute glomerulonephritis b) Acute renal failure c) Nephrotic syndrome d) Chronic renal failure

A) Acute glomerulonephritis Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

A priority nursing intervention for a client with hypervolemia involves which of the following? a) Monitoring respiratory status for signs and symptoms of pulmonary complications. b) Establishing I.V. access with a large-bore catheter. c) Encouraging the client to consume sodium-free fluids. d) Drawing a blood sample for typing and crossmatching.

A) Monitoring respiratory status for signs ans symptoms of pulmonary complications Hypervolemia, or fluid volume excess (FVE), refers to an isotonic expansion of the extracellular fluid. Nursing interventions for FVE include measuring intake and output, monitoring weight, assessing breath sounds, monitoring edema, and promoting rest. The most important intervention in the list involves monitoring the respiratory status for any signs of pulmonary congestion. Breath sounds are assessed at regular intervals.

Retention of which electrolyte is the most life-threatening effect of renal failure? a) Potassium b) Calcium c) Phosphorous d) Sodium

A) Potassium Retention of potassium is the most life-threatening effect of renal failure.

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? a) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. b) Administer furosemide (Lasix) 20 mg I.V. c) Encourage oral fluids. d) Start hemodialysis after a temporary access is obtained.

A) Start IV fluids with normal saline solution bolus followed by a maintenance dose. Explanation: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.

A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess: a) Trousseau's sign. b) Hegar's sign. c) Homans' sign. d) Goodell's sign.

A) Trossaeu's sign This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a) Urine output of 250 ml/24 hours b) Temperature of 100.2° F (37.8° C) c) Serum creatinine level of 1.2 mg/dl d) Blood urea nitrogen (BUN) level of 22 mg/dl

A) Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply. a) Vitamin D synthesis b) Secretion of prostaglandins c) Vitamin B production d) Secretion of insulin e) Regulation of blood pressure

A) Vitamin D synthesis B) Secretion of prostaglandins E) Regulation of blood pressure Explanation: Functions of the kidney include secretion of prostaglandins, regulation of blood pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body does not produce Vitamin B.

A group of nursing students are studying for a test over acid-base imbalance. One student asks another what the major chemical regulator of plasma pH is. What should the second student respond? a) Renin-angiotensin-aldosterone system b) Bicarbonate-carbonic acid buffer system c) Sodium-potassium pump d) ADH-ANP buffer system

B) Bicarbonate-carbonic acid buffer system The major chemical regulator of plasma pH is the bicarbonate-carbonic acid buffer system. Therefore options A and C are incorrect. Option D does not exist, it is only a distractor for this question.

A nurse, when caring for a client, notes that the specific gravity of the client's urine is low. What could have lead to the low specific gravity of urine? a) Repeated diarrhea b) Excess fluid intake c) Frequent vomiting d) Urine retention

B) Excessive fluid intake Excess fluid intake results in low specific gravity of urine. Excessive fluid intake will result in formation of dilute urine. When the urine is diluted, it results in low specific gravity of urine. Frequent vomiting, repeated diarrhea, and urine retention will result in high specific gravity of urine.

Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate? a) Give medications that promote fluid retention. b) Limit sodium and water intake. c) Teach client behaviors that decrease urination. d) Assess for dehydration.

B) Limit sodium and water intake Implement prescribed interventions such as limiting sodium and water intake and administering ordered medications that promote fluid elimination. Assessing for dehydration and teaching to decrease urination would not be appropriate interventions.

Which is the correct term for the ability of the kidneys to clear solutes from the plasma? a) Glomerular filtration rate (GFR) b) Renal clearance c) Specific gravity d) Tubular secretion

B) Renal Clearance Explanation: Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. GFR is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.

A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in: a) 1 hour. b) 24 hours. c) 1 minute. d) 30 minutes.

C) 1 minute Explanation: The creatinine clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.

A client presents at the testing center for an intravenous pyelogram. What question should the nurse ask to ensure the safety of the client? a) "Have you any artificial joints?" b) "Do you have a pacemaker?" c) "Do you have any allergies?" d) "Who has come with you today?"

C) Do you have any allergies? Explanation: Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood.

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? a) History of hyperparathyroidism b) History of osteoporosis c) Recent history of streptococcal infection d) Previous episode of acute pyelonephritis

C) Recent hx of streptococcal infection Explanation: Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a) Impaired urinary elimination b) Toileting self-care deficit c) Risk for infection d) Activity intolerance

C) Risk for infection Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: a) a decreased serum phosphate level secondary to kidney failure. b) an increased serum calcium level secondary to kidney failure. c) water and sodium retention secondary to a severe decrease in the glomerular filtration rate. d) metabolic alkalosis secondary to retention of hydrogen ions.

C) water and sodium retention secondary to a severe decrease in the glomerular filtration rate. Explanation: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

Which of the following urine specific gravity values would indicate to the nurse that the patient is receiving excessive IV fluid therapy? a) 1.002 b) 1.010 c) 1.025 d) 1.030

a) 1.002 A urine specific gravity of 1.002 is low, indicating dluite urine and the excretion of excess fluid. Fluid overload, diuretics, or lack of ADH can cause dilute urine. Normal urine specific gravity indicates concentrated urine that would be seen in dehydration.