Final Renal- Prep U
A client presents at the testing center for an intravenous pyelogram. What question should the nurse ask to ensure the safety of the client? "Do you have any allergies?" "Who has come with you today?" "Have you any artificial joints?" "Do you have a pacemaker?"
"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.
Question 2 The nurse is admitting a client who is to undergo an open renal biopsy. About which of the following comments by the client should the nurse be most concerned? "I took my usual dose of Coumadin last night." "I have not eaten since 8 pm last night." "I brought a copy of my living will with me." "I signed the consent form in the physician's office."
"I took my usual dose of Coumadin last night." Explanation: A renal biopsy is an invasive procedure, whereby a small incision is made. Coumadin (warfarin) is an anticoagulant, and taking it places the client at increased risk for bleeding complications.
The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? "I will feel a warm sensation as the dye is injected." "I should remove all jewelry before the test." "I should let the staff know if I feel claustrophobic." "I will need to drink all of the dye as quickly as possible."
"I will feel a warm sensation as the dye is injected." Explanation: A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected.
A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address? "I've had diabetes for 4 years." "I'm allergic to shellfish." "I haven't eaten since midnight." "My physician diagnosed me with hypertension 3 months ago."
"I'm allergic to shellfish." Explanation: An allergy to iodine, shellfish, or other seafood should immediately be investigated because the contrast agent used in the procedure may contain iodine, which can cause a severe allergic reaction. Although contrast agents should be used cautiously in clients with diabetes mellitus, investigating this isn't the nurse's priority if the client also has a shellfish allergy. It's appropriate for the client to not eat after midnight before the procedure. The client's hypertension isn't a priority because this condition is the likely reason the renal angiography was ordered.
A client comes to the clinic reporting urinary symptoms. Which statement would most likely alert the nurse to suspect benign prostatic hyperplasia (BPH)? A. "I've had a fever and noticed I've been running to the bathroom more often." B. "I'm waking up at night to urinate and I've noticed some burning, too." C. "I've had trouble getting started when I urinate, often straining to do so." D. "I've had some pain in my lower abdomen lately and felt a bit sick to my stomach."
"I've had trouble getting started when I urinate, often straining to do so." Explanation: Symptoms that might alert the nurse to BPH include difficulty initiating urination and abdominal straining with urination. Although fever, urinary frequency, nocturia, pelvic pain, nausea, vomiting, and fatigue may be noted, they also may suggest other conditions such as urinary tract infection. Fever, nausea, vomiting, and fatigue are general symptoms that can accompany many conditions.
A nursing student asks the nurse why older adults are at risk for renal disease. The best response by the nurse is: "The glomerular filtration rate decreases as we age." "Contractility of the bladder wall increases with age." "Urethral hypertrophy occurs following menopause." "Hypoplasia of the prostate occurs in older men."
"The glomerular filtration rate decreases as we age." Explanation: The GFR decreases 1 ml/min per year beginning between the ages of 35 and 40 years. Contractility of the bladder wall decreases with age. Women experience urethral atrophy after menopause, while men experience hyperplasia of the prostate with aging.
A client is scheduled for a transurethral resection of the prostate (TURP). Which statement demonstrates that the expected outcome of "client demonstrates understanding of the surgical procedure and aftercare" has been met? "I'll have to stay in the hospital for about 3 to 4 days after the surgery." "I'll have a small incision on my lower abdomen after the procedure." "The surgeon is going to remove the entire prostate gland." "The surgeon is going to insert a scope through my urethra to remove a portion of the gland."
"The surgeon is going to insert a scope through my urethra to remove a portion of the gland." Explanation: TURP involves the surgical removal of the inner portion of the gland through an endoscope inserted through the urethra. There is no external skin incision. Typically, the procedure is performed in an outpatient setting but may require an overnight hospital stay.
CASE STUDY 1.B Medical History Nonsmoker Bilateral hip osteoarthritis, hip pain treated with ibuprofen 400 mg orally three times per day Has increased ibuprofen dose over last week to 800 mg three times per day due to increased hip pain
1000 (WBC) count 8 × 103 cells/mm3 (8 × 109/l) Hemoglobin 14 g/dl (140 g/l) 14 to 17.4 g/dl (140 to 174 g/l) Hematocrit 42% (0.42) Platelet count 140,000 mcl (140 × 109/l) Blood urea nitrogen (BUN) 38 mg/dl (13.57 mmol/l) Serum creatinine 1.9 mg/dl (167.96 mcmol/l) Serum sodium 147 mEq/l (147 mmol/l) Serum potassium 5.9 mEq/l (5.7 mmol/l) Urine sediment is normal with a few hyaline casts Urine specific gravity 1.04 Renal ultrasound within normal limits
The nurse coming on shift on the medical unit is taking a report on four clients. What client does the nurse know is at the greatest risk of developing ESKD? a. A client with a history of polycystic kidney disease b A client with diabetes mellitus and poorly controlled hypertension c A client who is morbidly obese with a history of vascular disorders d. A client with severe chronic obstructive pulmonary disease
A client with diabetes mellitus and poorly controlled hypertension Explanation: Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may cause ESKD. A client with more than one of these risk factors is at the greatest risk for developing ESKD. Therefore, the client with diabetes and hypertension is likely at highest risk for ESKD.
A client with acute kidney injury has decreased erythropoietin production. Upon analysis of the client's complete blood count, the nurse will expect which of the following results? An increased hemoglobin and decreased hematocrit A decreased hemoglobin and hematocrit A decreased mean corpuscular volume (MCV) and red cell distribution width (RDW) An increased mean corpuscular volume (MCV) and red cell distribution width (RDW)
A decreased hemoglobin and hematocrit Explanation: The decreased production of erythropoietin will result in a decreased hemoglobin and hematocrit. The client will have normal MCV and RDW because the erythrocytes are normal in appearance.
After undergoing renal arteriogram, in which the left groin was accessed, a client complains of left calf pain. Which intervention should the nurse perform first? Assess peripheral pulses in the left leg. Place cool compresses on the calf. Exercise the leg and foot. Assess for anaphylaxis.
Assess peripheral pulses in the left leg. Explanation: The nurse should begin by assessing peripheral pulses in the left leg to determine if blood flow was interrupted by the procedure. The client may also have thrombophlebitis. Cool compresses aren't used to relieve pain and inflammation in thrombophlebitis. The leg should remain straight after the procedure. Calf pain isn't a symptom of anaphylaxis.
The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform the health care provider that the client may be exhibiting signs of acute kidney injury (AKI)? a.The client is unable to initiate voiding for 2 days. b.The urine is cloudy and has visible sediment with a foul odor. c.Average urine output has been 10 mL/hr for several hours. d.The client reports left-sided flank pain.
Average urine output has been 10 mL/hr for several hours. Explanation: Oliguria (<400 mL/day of urine or 0.5 mL/kg an hour over 6 hours) is the most common clinical situation seen in AKI. The client's inability to void and/or urine hesitancy is typically seen with kidney stones, prostate problems, and/or a urinary tract infection (UTI). Urine that has visible sediment and is cloudy and foul smelling is more suggestive of a UTI. Acute flank pain is sometimes seen in AKI. Generally, flank pain has some connection to a variety of kidney diseases like acute glomerular inflammation and polycystic kidney disease.
A creatinine clearance test has been ordered. The nurse prepares to: Collect the client's urine for 24 hours. Obtain a clean catch urine. Obtain a blood specimen. Insert a straight catheter for a specimen
Collect the client's urine for 24 hours. Explanation: A creatinine clearance test is a 24-hour urine test and is useful in evaluating renal disease.
An appropriate nursing intervention for the client following a nuclear scan of the kidney is to: Encourage high fluid intake. Strain all urine for 48 hours. Apply moist heat to the flank area. Monitor for hematuria.
Encourage high fluid intake. Explanation: A nuclear scan of the kidney involves the IV administration of a radioisotope. Fluid intake is encouraged to flush the urinary tract to promote excretion of the isotope. Monitoring for hematuria, applying heat, and straining urine do not address the potential renal complications associated with the radioisotope.
The nurse is instructing a 3-year-old's parent regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as a normal finding for this age group? Dysuria Enuresis Hematuria Anuria
Enuresis Explanation: The nurse would be most correct to document that enuresis, the involuntary voiding during sleep or commonly called "wetting the bed," is a normal finding in a pediatric client younger than 5 years old. Dysuria (pain on urination), hematuria (red blood cells in urine), and anuria (urine output less than 50 mL/day) are all abnormal findings needing further investigation.
A client is being treated for acute kidney injury (AKI) and daily weights have been ordered. The nurse notes a weight gain of 3 pounds over the past 48 hours. What is suggested by this assessment finding? Excessive nutritional intake Excess fluid volume Sedentary lifestyle Adult failure to thrive
Excess fluid volume Explanation: If the client with AKI gains or does not lose weight, fluid retention should be suspected. Short-term weight gain is not associated with excessive caloric intake or a sedentary lifestyle. Failure to thrive is not associated with weight gain.
Which of the following is the priority issue for the client in the oliguric phase of acute renal failure? Fluid volume excess Urinary retention Activity intolerance Disturbed body image
Fluid volume excess Explanation: The oliguric phase is characterized by fluid retention.
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? Glomerulonephritis Hypovolemia Ureteral calculus Dysrhythmia
Glomerulonephritis Explanation: Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
The nurse is caring for a client suspected of having renal dysfunction. When reviewing laboratory results for this client, the nurse interprets the presence of which substances in the urine as most suggestive of pathology? Potassium and sodium Bicarbonate and urea Glucose and protein Creatinine and chloride
Glucose and protein Explanation: The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that they are not excreted in the urine.
A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? Elevated serum creatinine Hyperkalemia Hyperphosphatemia Elevated urea and nitrogen
Hyperphosphatemia Explanation: Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.
The nurse is obtaining a health history from a 58-year-old client stating that he is having difficulty obtaining an erection during sexual activity. The client asks how an "erectile medication" works and if there are any side effects to the medication. The nurse explains the action of the medication and directions for use and warns of which side effect related to the client's history? A Asthma with beta-adrenergic inhaler use B Hypotension with nitrate use C Chronic pain with narcotic use D Arthritis with corticosteroid use
Hypotension with nitrate use Explanation: Due to the action of the medication on the smooth muscles and blood vessels, clients are advised not to take medications to treat erectile dysfunction when also prescribed a nitrate drug for chest pain or heart problems. Combining medication could result in a serious drop in blood pressure. Although all disease processes and medication therapy should be screened for interactions, hypotension with nitrate use the most serious side effects.
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? Increase fat intake and limit carbohydrates. Eliminate fat intake and increase protein intake. Increase carbohydrates and limit protein intake. Increase protein, carbohydrates, and fat intake.
Increase carbohydrates and limit protein intake. Explanation: Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.
A client is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag? Red wine colored Tea colored Amber Light pink
Light pink Explanation: The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light-pink color 24 hours after surgery.
The nurse is providing care to a client who has had a transurethral resection of the prostate. The client has a three-way catheter drainage system in place for continuous bladder irrigation. The nurse anticipates that the catheter may be removed when the urine appears as which of the following? Reddish-pink with numerous clots Dark amber with copious mucous Light yellow and clear Light pink with few red streaks
Light yellow and clear Explanation: Typically a three-way catheter drainage system is removed when the urine appears clear and amber (light yellow). Reddish-pink urine with clots usually occurs in the immediate postoperative period. Eventually the urine becomes light pink within 24 hours after surgery. Dark amber urine suggests concentrated urine commonly associated with dehydration.
The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated? Obtaining blood samples from the left arm Palpating the fistula for a "thrill" Obtaining a blood pressure reading from the right arm Placing the client's watch on the left wrist
Obtaining a blood pressure reading from the right arm Explanation: The nurse assesses the vascular access for patency. The bruit, or "thrill," over the venous access site must be evaluated at least every shift. The nurse takes precautions to ensure that the extremity with the vascular access is not used for measuring blood pressure or for obtaining blood specimens; tight dressings, restraints, or jewelry over the vascular access must be avoided as well.
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? Diuresis Oliguria Acute tubular necrosis Restored glomerular function
Oliguria Explanation: During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.
Explanation: This client is showing manifestations of acute kidney injury, most likely due to increased intake of nonsteroidal anti-inflammatory drugs (NSAIDs). High doses of NSAIDs, especially in the older adult, can lead to acute kidney injury. The client's signs and symptoms are consistent with fluid volume overload as urinary output decreases. Hyperkalemia is a life-threatening condition that can occur with acute kidney injury. Sodium polystyrene sulfonate can be given orally or by retention enema to reduce hyperkalemia by exchanging sodium ions for potassium ions in the intestine. Because the onset of action is more than 6 hours, it is indicated for clients who do not have electrocardiogram (ECG) changes caused by hyperkalemia, as in this client. Because the client has crackles on auscultation of the lungs and is lethargic and sleeping, the nurse needs to encourage the client to cough and take deep breaths to r
Polycystic kidney disease is a genetic disorder characterized by fluid-filled cysts and a grossly enlarged kidney. This disease is slowly progressive and does not appear suddenly, as in acute kidney injury. This client's renal scan did not reveal fluid-filled cysts. Glomerulonephritis is an inflammation of the glomerular capillary membrane that typically follows a bacterial or viral infection. This client has a normal white blood cell (WBC) count and is afebrile, suggesting that an infection is not present. Renal artery stenosis, a narrowing of the renal artery most often by the atherosclerotic process, triggers the renin-angiotensin system and sympathetic nervous system, resulting in hypertension. The kidneys may be reduced in size and atrophied. This client does not have hypertension and the renal ultrasound shows no abnormal anatomical kidney changes. Dietary protein should be restricted in the client with acute kidney injury to limit the buildup of nitrogenous waste products. Because hyperkalemia is a life-threatening condition that may occur in clients with acute kidney injury, potassium supplements should not be administered to the client. The client with acute kidney injury should not have angiography with contrast media because contrast media is a risk factor for acute kidney injury and can worsen renal function in this client. Urine ketones may be present with very high blood glucose levels in clients with diabetes. Urobilirubin is monitored to detect liver damage, not kidney function. While renin is secreted by the kidneys, it is not used to monitor kidney function in acute kidney injury.
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? Previous episode of acute pyelonephritis History of hyperparathyroidism Recent history of streptococcal infection History of osteoporosis
Recent history 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.
The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client? Urine output of 35 to 40 mL/hour Pain of 3 out of 10, 1 hour after analgesic administration SpO2 at 90% with fine crackles in the lung bases Blood tinged drainage in Jackson-Pratt drainage tube
SpO2 at 90% with fine crackles in the lung bases Explanation: Altered Breathing Pattern and Ineffective Airway Clearance Risk are often challenges in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output is monitored to maintain a urine output of greater than 30 mL/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.
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? Encourage oral fluids. Administer furosemide (Lasix) 20 mg IV Start hemodialysis after a temporary access is obtained. Start IV fluids with a normal saline solution bolus followed by a maintenance dose
Start IV fluids with a 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.
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. Tall, peaked T waves Shortened QRS complex Multiple spiked P waves Prolonged ST segment
Tall, peaked T waves Explanation: Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.
A client's most recent laboratory findings indicate a glomerular filtration rate (GFR) of 58 mL/min. The nurse should recognize what implication of this diagnostic finding? The client is likely to have a decreased level of blood urea nitrogen (BUN). The client is at risk for hypokalemia. The client is likely to have irregular voiding patterns. The client is likely to have increased serum creatinine levels.
The client is likely to have increased serum creatinine levels. Explanation: The adult GFR can vary from a normal of approximately 125 mL/min (1.67 to 2.0 mL/sec) to a high of 200 mL/min. A low GFR is associated with increased levels of BUN, creatinine, and potassium.
Which clinical finding should a nurse look for in a client with chronic renal failure? Hypotension Uremia Metabolic alkalosis Polycythemia
Uremia Explanation: Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.
A client admitted with impaired renal function is reporting severe, stabbing pain in the flank and lower abdomen is being assessed for renal calculi. The nurse recognizes that the stone is most likely in what anatomic location? Meatus Bladder Ureter Urethra
Ureter Explanation: Ureteral pain is characterized as a dull continuous pain that may be intense with voiding felt in the flank or lower abdominal area. The pain may be described as sharp or stabbing if the bladder is full. This type of pain is inconsistent with a stone being present in the bladder. Stones are not normally situated in the urethra or meatus.
The nurse is caring for a client who describes changes in voiding patterns. The client states, "I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesn't seem to be much urine flow." What would the nurse expect this client's physical assessment to reveal? Hematuria Urine retention Dehydration Kidney injury
Urine retention Explanation: Increased urinary urgency and frequency coupled with decreasing urine volume strongly suggest urine retention. Hematuria may be an accompanying symptom, but is likely related to a urinary tract infection secondary to the retention of urine. Dehydration and kidney injury both result in a decrease in urine output, but the client with these conditions does not have normal urine production and decreased or minimal flow of urine to the bladder. The symptoms of urgency and frequency do not accompany kidney injury and dehydration due to decreased urine production.
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? Blood glucose level of 200 mg/dl White blood cell (WBC) count of 20,000/mm3 Potassium level of 3.5 mEq/L Hematocrit (HCT) of 35%
White blood cell (WBC) count of 20,000/mm3 Explanation: An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.
A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include: continuous inflow and outflow of irrigation solution. intermittent inflow and continuous outflow of irrigation solution. continuous inflow and intermittent outflow of irrigation solution. intermittent flow of irrigation solution and prevention of hemorrhage
continuous inflow and outflow of irrigation solution. Explanation: When preparing for continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.
The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? pH 7.20, PaCO2 36, HCO3 14- pH 7.31, PaCO2 48, HCO3 24- pH 7.47, PaCO2 45, HCO3 33- pH 7.50, PaCO2 29, HCO3 22-
pH 7.20, PaCO2 36, HCO3 14- Explanation: Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.
