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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 During periods of dehydration, the blood volume and GFR drop, and BUN levels increase. The renal tubules are permeable to urea, which means that the longer the tubular fluid remains in the kidneys, the greater the reabsorption of urea into the blood.
A nurse is teaching a client scheduled for a cystoscopy about the procedure. Which statement made by the client verifies that the teaching has been successful?
"The doctor will insert a lighted tube through my urethra into my bladder in order to inspect the inside of the bladder." Cystoscopy provides a means for direct visualization of the urethra, bladder, and ureteral orifices. It relies on the use of a cystoscope, an instrument with a lighted lens. The cystoscope is inserted through the urethra into the bladder. Biopsy specimens, lesions, small stones, and foreign bodies can be removed from the bladder.
A client is scheduled for a creatinine clearance test to measure the glomerular filtration rate (GFR). The client asks the nurse what this test is used for. What is the nurse's best response?
"This test provides a gauge of renal function. The 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.
A new client on hemodialysis is watching his blood being filtered through a dialyzer. He asks the nurse how much blood typically passes through the kidney every minute? The nurse responds:
1000-1300 mL/minute. In the adult, the kidneys are perfused with 1000 to 1300 mL of blood per minute, or 20% to 25% of the cardiac output.
The nurse is educating a client about renal disease. Which percentage of cardiac output perfuses the kidneys?
22% to 25% In the adult, the kidneys are perfused with 1000 to 1300 mL of blood per minute, or 22% to 25% of the cardiac output; 10% to 15% and 15% to 20% represent a decreased percentage; 27% to 30% is an increased percentage.
The nurse is preparing the client with suspected bladder cancer for a biopsy via cystoscopy. What does the nurse teach the client about cystoscopy?
A flexible, lighted tube will be inserted into the bladder and a tissue sample will be taken. Cystoscopy allows direct visualization of the urethra, bladder, and ureteral orifices. A cystoscope, an instrument with a lighted lens, is inserted through the urethra into the bladder. Biopsy specimens, lesions, small stones, and foreign bodies can be removed from the bladder.
Which statement about the use of angiotensin-converting enzyme (ACE) inhibitors and autosomal recessive polycystic kidney disease (ARPKD) is accurate?
ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction.
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 Urine tests for proteinuria are used to detect abnormal filtering of albumin by the glomeruli or defects in its reabsorption in the renal tubules. A decrease in antidiuretic hormone would result in increased output; poor fluid intake would produce concentrated urine; a urinary tract infection would cause white blood cells to be in the urine.
In addition to regulating body fluids and electrolytes, the kidneys' endocrine function in maintaining bone calcium levels consists of what process?
Activating vitamin D The kidneys aid in calcium metabolism by activating vitamin D after it is chemically converted by the liver. Bicarbonate buffering is unrelated to activation of vitamin D. Bone marrow is stimulated by the synthesis of erythropoietin to form red blood cells, which is unrelated to calcium levels.
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? Select all that apply.
As stated above, the nephron tubule is divided into four segments: a highly coiled segment called the proximal convoluted tubule, which drains Bowman capsule; a thin, looped structure called the loop of Henle; a distal coiled portion called the distal convoluted tubule; and a collecting tubule, which joins with several tubules to collect the filtrate.
When the urologist wants to directly visualize the bladder, urethra, and ureteral orifices, what diagnostic test would he use?
Cystoscopy Cystoscopy provides a means for direct visualization of the urethra, bladder, and ureteral orifices. It relies on the use of a cystoscope, an instrument with a lighted lens. None of the other tests provide direct visualization of the bladder, urethra, and ureteral orifices.
A client has just been admitted to the emergency department after sustaining severe injuries and massive blood loss following a motor vehicle accident. The nurse predicts that the client's glomerular filtration rate will:
Decrease
Urine specific gravity is normally 1.010 to 1.025 with adequate hydration. When there is loss of renal concentrating ability due to impaired renal function, low concentration levels are exhibited. When would the nurse consider the low levels of concentration to be significant?
First void in morning With diminished renal function, there is a loss of renal concentrating ability, and the urine specific gravity may fall to levels of 1.006 to 1.010 (usual range is 1.010 to 1.025 with normal fluid intake). These low levels are particularly significant if they occur during periods that follow a decrease in water intake (e.g., during the first urine specimen on arising in the morning).
The nurse is assessing a client who has a unilateral obstruction of the urinary tract. Which clinical finding by the nurse correlates to this diagnosis?
Increase in blood pressure Hypertension is an occasional complication of urinary tract obstruction. It is more common in cases of unilateral obstruction in which renin secretion is enhanced, probably secondary to impaired renal blood flow. In these circumstances, removal of the obstruction often leads to a reduction in blood pressure. The urine output would be decreased and not diluted.
While taking her history on woman with a tentative diagnosis of diabetes mellitus, the client mentions she has been eating a lot of sweets lately. How would the nurse expect this diet to impact the client's renal system?
Increase renal blood flow Large increases in renal blood flow and GFR occur with high blood glucose levels in persons with uncontrolled diabetes mellitus, but the exact mechanism of this increase is unknown.
When teaching the client with gout about the cause of the disease, which cause should the nurse relate
Increased levels of uric acid in the blood cause gout. Uric acid is a product of purine metabolism. High blood levels of uric acid (hyperuricemia) can cause gout, and excessive urine levels can cause kidney stones.
When teaching the client with gout about the cause of the disease, which cause should the nurse relate?
Increased levels of uric acid in the blood cause gout. Uric acid is a product of purine metabolism. High blood levels of uric acid (hyperuricemia) can cause gout, and excessive urine levels can cause kidney stones.
If a client is in the early phases of nephrotic syndrome, which area of the body will likely have the initial presence of edema?
Initially, the edema caused by nephritic syndrome presents in the dependent parts of the body, such as the lower extremities, but becomes more generalized as the disease progresses.
The kidneys aid in calcium metabolism by activating vitamin D after it is chemically converted by the liver. Bicarbonate buffering is unrelated to activation of vitamin D. Bone marrow is stimulated by the synthesis of erythropoietin to form red blood cells, which is unrelated to calcium levels.
Late distal and cortical collecting tubule The late distal-convoluting and the cortical collecting tubules are the sites of aldosterone action on sodium and potassium reabsorption. The thin ascending and thick ascending loops of Henle use the cotransport of sodium, potassium, and chloride. The proximal tubule reabsorbs sodium and water in equal proportions, in contrast to the thin descending loop (main site of water loss from filtrate). The elbow segment of the loop of Henle has the highest filtrate osmolality.
The nurse has delegated obtaining a urine specimen for testing to the nursing assistant. What does the nurse emphasize the assistant should do to ensure accuracy of testing?
Obtain a freshly voided specimen. A freshly voided specimen is most reliable when obtaining urine for testing.
The nurse caring for an older adult notes a marked decrease in mental acuity over a 24-hour period. What assessment indicates the most likely cause of this change?
Older adults are prone to infections without obvious symptoms of fever and purulent drainage. Approximately 50% of all older adults with infections will develop vague symptoms such as anorexia, fatigue, weakness, or change in mental status. Constipation is not noted for stimulating mental status changes. Loss of hearing from malfunctioning hearing aids is most likely to cause difficulties of communication. Urine cloudy with strong odor
The anemia that occurs with end-stage kidney disease is often caused by the kidneys themselves. What loss of function in the kidney results in anemia of end-stage kidney disease?
Produce erythropoietin Persons with end-stage kidney disease often are anemic because of an inability of the kidneys to produce erythropoietin. This anemia usually is managed by the administration of a recombinant erythropoietin (epoetin alfa), produced through DNA technology, to stimulate erythropoiesis.
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 Ultrasonographic studies use the reflection of ultrasonic waves to visualize deep structures of the body. Ultrasonography is used to visualize the structures of the kidneys and is used to diagnose many urinary tract disorders, including congenital anomalies, renal abscesses, hydronephrosis, and kidney stones. Ultrasonography also enables accurate placement of needles for renal biopsy and catheters for percutaneous nephrostomy tubes.
The nurse is reviewing the results of a renal client's laboratory results. This client's urine specific gravity allows the nurse to assess the kidneys' ability to:
concentrate urine Urine specific gravity is used to assess the kidneys' ability to concentrate urine and provides a valuable index of the hydration status and functional ability of the kidneys. Specific gravity does not evaluate electrolyte or acid-base functions of the kidneys. It is not affected by protein levels.
A nursing student studying pharmacology is learning how angiotensin converting enzyme inhibitors (ACE) work. The student is correct when stating that the mechanism of action of ACE inhibitors is to:
prevent conversion of angiotensin I to II. The juxtaglomerular cells of the kidney contain granules of inactive renin, an enzyme that functions in the conversion of angiotensinogen to angiotensin. Angiotensin I is converted to angiotensin II in the presence of converting enzyme. By blocking converting enzyme, angiotensin II, a potent vasoconstrictor, is not produced, thus lowering blood pressure.
A major complication of prolonged bed rest is an increased risk of kidney stones. The nurse knows that this is most likely related to:
saturation of urine with calcium salts. Prolonged immobility leads to bone resorption and an elevation in serum calcium which can cause the development of calcium-containing kidney stones. Elevated urine levels of citrate are a prominent inhibitor of calcium stone formation. Fluid intake is not likely to be limited but regardless, it would not contribute to kidney stone formation. Urinary frequency is not a factor in kidney stone formation.
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. Bicarbonate buffering is unrelated to activation of vitamin D. Bone marrow is stimulated by the synthesis of erythropoietin to form red blood cells, which is unrelated to calcium levels.
