Renal Quizzing Questions Chapters 29-30

17. A nurse is administering furosemide (Lasix) to a client. Which responses indicate therapeutic effects

Select all that apply. • Furosemide is a diuretic (any agent that enhances the flow of urine). Diuretics are commonly used to treat hypertension and edema caused by heart failure, cirrhosis, and nephrotic syndrome. Diuretics do not increase edema, decrease urine output, or increase blood pressure.

22. A nurse is assessing the effects of a client's renin-angiotensin-aldosterone system. Which piece of equipment should the nurse obtain

• A blood pressure cuff is needed to determine the increase in blood pressure. The renin-angiotensin-aldosterone system causes sodium and water reabsorption in the renal tubules through the effects of aldosterone, antidiuretic hormone, and angiotensin II, causing vasoconstriction and increased blood pressure. An otoscope is for ears and will not be effective. A thermometer is for temperature, not for blood pressure. A cystoscope is a type of endoscope inserted through the urethra and is used to visualize the inside of a bladder; this process (cystoscopy) does not measure blood pressure.

2. A nurse is caring for a client with postrenal acute kidney injury. The nurse is caring for which client

• A client with an obstruction

24. How is a decreased calcium level restored in clients with normal renal function

• A decreased plasma calcium level stimulates the secretion of parathyroid hormone, causing renal calcium reabsorption. Parathyroid hormone then stimulates a sequence of events that helps restore plasma calcium toward normal levels. The pituitary gland does not release calcium. Calcium is absorbed in the intestines, not the stomach. Increased intake of milk products will not increase calcium absorption.

19. A nurse is asked which hormone inhibits the reabsorption of sodium and water at the distal convoluted tubule. How should the nurse respond

• ANP is secreted from cells in the right atrium of the heart. When right atrial pressure rises, ANP inhibits secretion of renin, inhibits angiotensin-induced secretion of aldosterone, relaxes vascular smooth muscle, and inhibits sodium and water absorption by kidney tubules. Angiotensin is a component of the renin-angiotensin system. Angiotensin II causes blood vessels to constrict, drives blood pressure up, and releases aldosterone. Aldosterone stimulates tubule cells to reabsorb sodium.

26. Which substance controls a client's final urine concentration

• Antidiuretic hormone controls the final concentration of urine. It is secreted from the posterior pituitary and increases water permeability in the last segment of the distal tubule and the entire collecting ducts. Urea, an end product of protein metabolism, is excreted by the kidneys. Renin stimulates the renin-angiotensin-aldosterone system, which can increase systemic arterial pressure and change renal blood flow. Renin forms angiotensin I that is converted to angiotensin II, which stimulates the secretion of aldosterone and causes vasoconstriction.

5. A male client is having difficulty voiding and complains of "dribbling" after voiding which is from an enlarged prostate. Which area (see diagram) should the nurse choose to illustrate where urinary flow is affected

• Area 3

12. A client has a tumor that is producing excess antidiuretic hormone. The blood volume and blood pressure increase. What other hormone will the nurse expect to increase

• Atrial natriuretic peptide is released in response to elevated blood volume and pressure and acts to increase water and sodium excretion to decrease blood volume and blood pressure. Aldosterone and angiotensin I and II would decrease in response to elevated blood volume and pressure.

23. A client has mildly impaired renal function. Which laboratory result should the nurse monitor for an estimation of this client's glomerular filtration rate (GFR)

• Cystatin C, a stable protein in serum, is also a marker for estimating GFR, particularly for mildly to moderately impaired renal function. Aldosterone, vitamin D, and antidiuretic hormone measurements do not indicate the glomerular filtration rate.

16. A nurse is describing kidney function. Which term should the nurse use to describe the elimination of a substance in the final urine

• Excretion is the elimination of a substance in the final urine. Tubular secretion is the transfer of substances from the plasma of the peritubular capillary to the tubular lumen. Glomerular filtration is the movement of fluid and solutes across the glomerular capillary membrane and into the Bowman space. Tubular reabsorption is the movement of fluids and solutes from the tubular lumen to the peritubular capillary plasma.

3. A client has lipiduria. Which clinical manifestation will the nurse observe upon assessment

• Fat droplets floating in urine

25. A diuretic is prescribed for a client. What is the difference in spironolactone (Aldactone) and furosemide (Lasix)

• Furosemide inhibits active transport of potassium and spironolactone inhibits aldosterone, resulting in potassium retention (potassium sparing drug). An osmotic diuretic is mannitol, glycerol, or urea. A carbonic anhydrase inhibitor is acetazolamide. Spironolactone does not attract water nor does it diminish the reabsorption of sodium; the drug blocks sodium reabsorption and retains potassium. The blocking of hydrogen ion secretions is performed by carbonic anhydrase inhibitors. Furosemide inhibits active transport of chloride, sodium, and potassium.

1. Which information from the client indicates teaching by the nurse about the primary effect of antidiuretic hormone (ADH) in the kidneys was successful

• It stimulates water reabsorption

31. Which information from a client indicates teaching by the nurse was successful about the kidneys

• Kidneys are responsible for homeostasis of electrolytes. The nephron is the functional unit of the kidney, not the glomerulus. The kidneys are involved in the activation of vitamin D and contain more than 1 million nephrons.

20. A client is having difficulty voiding. The healthcare provider suspects an enlarged prostate. What bladder function test will best determine prostatic obstruction

• Pressure flow studies measure the pressure required to empty the bladder and identify bladder outlet obstruction such as with prostate enlargement. Ureteroscopy is a diagnostic procedure in which an ureteroscope is inserted through the urethra and bladder and directly into the ureter and upper urinary tract to visualize the upper urinary tract. An electromyography is the measurement of nerve impulses and muscle activity in the urethral sphincter by placing sensors on skin near the urethra and rectum or by placing sensors on a catheter placed in the urethra or rectum. Video urodynamics are the imaging of x-rays or ultrasound waves during fluid filling of the bladder and shows size and shape of the urinary tract.

27. Which intrinsic mechanism allows a client's renal blood flow and glomerular filtration rate to stay relatively constant

• Renal blood flow and glomerular filtration rate (GFR) are relatively constant, a relationship maintained by an intrinsic autoregulatory mechanism. The purpose of autoregulation of blood flow is to prevent large changes in GFR when there are increases or decreases in systemic blood pressure. The detrusor is the smooth muscle coat of the bladder. Contraction of the bladder during micturition (urination) compresses the distal end of the ureter, preventing reflux. The ratio of glomerular filtrate to renal plasma flow per minute (125/600 = 0.20) is called the filtration fraction.

7. A nurse is teaching the staff about the pathophysiology of the renin-angiotensin-aldosterone system in response to hypotension. Which information should the nurse include

• Renin is formed and stored in the arteriole cells of the juxtaglomerular apparatus, which releases renin if hypotension occurs. Renin binds with a precursor to angiotensin from the liver to form angiotensin I. Low blood flow stimulates the juxtaglomerular apparatus to release the renin, but renin is not from the glomerulus. Aldosterone stimulates the collecting tubules to reabsorb more water by increasing the permeability.

4. A nurse is teaching an adult class about the major risk factor for developing bladder cancer. Which information should the nurse include

• Smoking

10. A nursing assistance personnel asks a nurse why the safe dosages of medications for infants are so much less than adults. How should the nurse respond

• The decreased ability to efficiently remove solutes in the infant results in increased toxicity risks. Infants have shorter, not longer, loops of Henle and a decreased ability to concentrate urine, which results in increased volumes of urine as well as an increased frequency. There is an increased, not decreased, risk for metabolic acidosis but the blood pH does not affect all medications. Newborns have a decreased, not increased, ability to efficiently remove excess water and solutes.

8. A nurse is teaching about the renal corpuscle. Which structures should the nurse include in the teaching session that compose the renal corpuscle

• The glomerulus and Bowman capsule are called the renal corpuscle. Podocytes and filtration slits are located in the glomerular epithelium and assist with preventing proteinuria unless they become damaged. Cortical and midcortical nephrons are types of nephrons with a varying loop of Henle lengths. Mesangial cells (shaped like smooth muscle cells) and the mesangial matrix support the capillaries.

18. What term should the nurse use to describe the part of the client's kidney that is the entry and exit for renal blood vessels, nerves, lymphatic vessels, and ureter

• The hilum is a medial indentation that serves as the entry and exit for the renal blood vessels, nerves, lymphatic vessels, and ureter. The cortex is the outer layer of the kidney; the medulla forms the inner part of the kidney; and the calyces are chambers that receive urine from the collecting ducts.

21. Which information from a client indicates teaching by the nurse was successful regarding the anatomic location of the kidneys

• The kidneys are protected by strong back muscles and fat. They are located on either side of the vertebral column between the twelfth thoracic vertebra and the third lumbar vertebra. The right kidney is lower than the left kidney.

29. A nurse is teaching about the components of a nephron to a client. Which information will the nurse include

• The loop of Henle, collecting duct, and proximal convoluted tubules are all parts of a nephron. The ureter is part of the urinary tract, not part of the nephron. The trigone is part of the bladder, not part of the nephron.

14. A nurse is teaching the staff about blood vessels of the kidney. Which term should the nurse use to describe the capillaries that surround the proximal and distal convoluted tubules and the loop of Henle

• The peritubular capillaries surround the proximal and distal convoluted tubules and the loop of Henle in the renal cortex. The renal papillae are the projections of the renal pyramids into the minor calyces. The arcuate arteries in the kidneys are not capillaries. The glomerular capillaries are four to eight vessels arranged in a fistlike structure; they arise from the afferent arteriole and empty into the efferent arteriole, which carries blood to the peritubular capillaries.

33. If a client's posterior pituitary is damaged, which hormone is affected

• The posterior pituitary secretes antidiuretic hormone. The kidneys secrete renin. The adrenal cortex secretes aldosterone. The juxtamedullary cortex in the kidneys secretes erythropoietin.

32. A nurse is describing a structure of the client's kidney that contains collecting ducts. Which term is best for the nurse to use

• The pyramids contain the collecting ducts and long loops of Henle. Lymphatic vessels, blood vessels, and nerves enter and exit the kidney through the hilum. The calyces (both minor and major) are collection areas for urine as it drains from the collecting ducts. The medulla forms the inner part of the kidney and consists of regions called pyramids.

11. Which information from a client indicates teaching by the nurse was successful about the renal structure that drains urine directly into the ureter

• The renal pelvis drains urine into the ureter. The bladder drains urine into the urethra. The proximal tubule drains into the loop of Henle. The collecting duct drains urine into the minor calyx.

15. A client is having pain in the ureters. Where should the nurse assess for this type of pain

• The upper part of the ureter is innervated by the tenth thoracic nerve roots, with referred pain to the umbilicus. The innervation of lower segments of the ureter arises from the sacral nerves, with referred pain to the vulva or penis. Ureter pain is not felt in the back, lower chest, or buttocks.

6. The nurse is caring for a client experiencing acute kidney injury (AKI). The chart notes that the client's urine output is increasing significantly and that the serum creatinine level has decreased and normalized. The client is in which phase of AKI

• Turbidity should be clear; purulent matter will make the turbidity cloudy. A normal pH is 4.6 to 8.0 so pH is normal (7.0). Glucose should normally be negative. Specific gravity is normally 1.010 to 1.025 (1.015).

13. Which hormone is synthesized by the distal tubule and collecting ducts and could be affected when a client has kidney problems

• Urodilatin is produced by the distal tubule and collecting ducts. Aldosterone is synthesized by the adrenal cortex under the regulation of the renin-angiotensin-aldosterone system. Uromodulin produced in the loop of Henle is a protein that binds to uropathogens to protect the kidneys. Antidiuretic hormone is secreted from the posterior pituitary and increases water permeability and reabsorption.

30. A nurse is teaching aging adults about possible changes in renal function with age. Which information should the nurse include

• Various changes happen to the renal system during aging, including a decreased number of nephrons, impairment of renal blood flow, and altered sodium and water balance. Glucose absorption is slower, not faster, and there is an increased number of sclerotic glomeruli. Obesity does not accelerate a decline in glomerular filtration rate.

9. A nurse is teaching the staff about the network of capillaries that is the only source of blood to supply the medulla. Which information should the nurse include in the teaching session

• Vasa recta is a network of capillaries that is the only source of blood supply to the medulla. The renal artery supplies blood to the lower, middle, and upper thirds of the kidney. Interlobar arteries travel down the renal columns and between pyramids, forming the afferent glomerular arteries. Peritubular capillaries surround convoluted portions of the proximal and distal tubules and the loop of Henle and are adapted for cortical and juxtamedullary nephrons.

28. A client admitted with chronic renal failure and pneumonia has a very low dose of antibiotic prescribed. A coworker asks why the dosage is below recommended levels. How should the nurse respond

• When renal tubules are damaged because of chronic kidney failure, secretory transport mechanisms may not eliminate some drugs effectively, causing toxic levels. Countercurrent exchange systems causing fluid exchanges via parallel tubes is a normal action in the loop of Henle and is related to concentration of urine and is not related to the excretion of medications. The conjugation of the drug with sulfate and glucuronic acid is performed in the liver, not the kidney.