NURS 317 Unit 1 Chapter 32 Path Point Questions Flashcards
The nurse is caring for a client with a condition of deficiency of antidiuretic hormone (ADH). When assessing the client, which finding does the nurse anticipate?
A) Retention of chloride
B) Retention of sodium
C) Excessive urine output
D) Low blood pressure
C) Excessive urine output
Rationale:ADH regulates the ability of the kidneys to concentrate urine. When ADH is present, the water that moved from the blood into the urine filtrate in the glomeruli is returned to the circulatory system, and when ADH is absent, the water is excreted in the urine. Pathologically, deficiency of ADH leads to polyuria and dehydration.
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?
A) Lower abdomen in the suprapubic area
B) Right costal margin, anterior abdomen
C) Between the 12th thoracic and 3rd lumbar vertebrae
D) Upper abdomen, under the costal margins
C) Between the 12th thoracic and 3rd lumbar vertebrae
Rationale:The kidneys are paired, bean-shaped organs that lie outside the peritoneal cavity in the back of the upper abdomen, one on each side of the vertebral column at the level of the 12th thoracic to 3rd lumbar vertebrae.
The nurse is caring for a client who has produced an average of 20 mL/hour for the previous day. The nurse recognizes this compares in which way to the normal urine output?
A) This represents normal urinary output for 24 hours.
B) The kidneys should produce about 1.5 L of urine each day.
C) The normal kidney produces an average 3000 mL of urine daily.
D) The kidneys should produce a minimum of 10 mL/hr over one day.
B) The kidneys should produce about 1.5 L of urine each day.
Rationale:The kidneys normally produce approximately 1.5 L or 1500 ml of urine each day.
The nurse is analyzing the results of a client’s urinalysis. Which results require the nurse to follow up as they represent abnormal results? Select all that apply.
A) Casts present
B) Specific gravity 1.010
C) Leukocyte esterase negative
D) Amber-colored urine
E) Bilirubin positive
A) Casts present
E) Bilirubin positive
Rationale:The following results should appear in the normal urinalysis: Color: yellow amber; appearance: clear to slightly hazy, color yellow amber; specific gravity: 1.005–1.025; bilirubin: negative; casts: negative; leukocyte esterase: negative.
The nurse would be most concerned when the glomerular filtrate contains:
A) Water
B) Potassium
C) Protein
D) Sodium
C) Protein
Rationale: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
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?
A) Furosemide, a loop diuretic
B) Lisinopril, an ACE-inhibitor
C) Isosorbide mononitrate, a nitrate
D) Spironolactone, an aldosterone receptor antagonist
A) Furosemide, a loop diuretic
Rationale:Furosemide may increase uric acid retention and impair glucose tolerance. Spironolactone may reduce K+ excretion and cause severe hyperkalcemia. Aldosterone receptor antagonists may also cause metabolic acidosis. Lisinopril is used to treat hypertension and congestive heart failure, and to improve survival after a heart attack. The most common side effects of lisinipril is a persistent cough, low blood pressure and dizziness. Nitrates are often used together to treat heart failure. They dilate blood vessels so it ‘s easier for the heart to receive and pump blood. Their common side effects include dizziness, headache, and edema.
When caring for a client with dehydration, the nurse anticipates the client will have an alteration in which substance in the blood?
A) Bicarbonate
B) Erythropoietin
C) Iric acid
D) Blood urea nitrogen
D) Blood urea nitrogen
Rationale: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.
Which occurrence is most likely to cause increased urination?
A) Decrease in antidiuretic hormone
B) Increased secretion of aldosterone
C) Activation of angiotensin
D) Decrease in glomerular filtration rate
A) Decrease in antidiuretic hormone
Rationale:Increased urination or polyuria is caused by low levels of ADH, which stimulates the kidneys to absorb more water. The other options do not have this physiologic effect.
The nurse is assigned multiple clients with anemia. Which client may be experiencing a failure of the body to produce erythropoietin and thus may require supplemental injections of this hormone?
A) Client with impaired oxygenation related to chronic obstructive pulmonary disease (COPD)
B) Client with a recent wound that bled a large amount but is now healing well
C) Client with history of chronic kidney failure
D) Client who recently had surgery and is scheduled for a follow-up visit
E) Client living at a high altitude
C) Client with history of chronic kidney failure
Rationale:Erythropoietin is a glycoprotein hormone that is produced by fibroblasts in the kidney and regulates the production of red blood cells in the bone marrow. Persons with end-stage kidney disease often are anemic because the kidneys can no longer produce erythropoietin. Impaired oxygenation of tissues due to cardiac or pulmonary disease stimulates the kidney to produce erythropoietin. A client whose recent wound is healing is likely not experiencing anemia related to loss of erythropoietin production. Some clients experience blood loss after surgery, but this should stimulate the kidney to produce more erythropoietin.
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:
A) Urinary tract infection
B) Abnormal glomerular filtration
C) Poor fluid intake
D) Decrease in antidiuretic hormone
B) Abnormal glomerular filtration
Rationale: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.
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? Select all that apply.
A) Client on a low-calorie, low-fat diet
B) Client on a “keto” diet plan
C) Client with chronic obstructive pulmonary disease (COPD)
D) Client who exercises at least 1 hour/day
E) Client with uncontrolled diabetes mellitus
B) Client on a “keto” diet plan
E) Client with uncontrolled diabetes mellitus
Rationale:A high-fat, low-carbohydrate eating plan is designed to get the body to go into ketosis. Within 1 to 2 hours after ingestion of a high-protein meal, RBF increases by 20% to 30%. Also clients with uncontrolled diabetes mellitus experience increases in RBF and GFR that occur with high blood glucose levels. Clients with COPD may have impaired oxygenation to the kidney which would decrease, not increase RBF. Exercising correctly and ingesting fluids regularly should not cause an increase in RBF or GFR.
In the presence of aldosterone in the distal tube, what action would occur?
A) Sodium would be excreted in the urine.
B) Sodium would not be reabsorbed.
C) There would be no change in sodium.
D) The urine would be nearly sodium-free.
D) The urine would be nearly sodium-free.
Rationale:In the presence of aldosterone, almost all the sodium in the distal tubular fluid is reabsorbed, and the urine is sodium free. In the absence of aldosterone, virtually no sodium is reabsorbed from the distal tubule so it would not be excreted.
A nurse is teaching a client about the functions of the kidney. Which would be the most appropriate information for the nurse to provide? Select all that apply.
A) Regulates blood pressure through the renin–aldosterone mechanism
B) Regulates pH of body fluids through reabsorption and conservation
C) Regulates calcium and phosphorus conservation and elimination
D) Maintains homeostasis of red blood cells by production of estrogen
E) Eliminates metabolic wastes
F) Regulates osmolality of intracellular fluid through action of antidiuretic hormone (ADH)
A) Regulates blood pressure through the renin–aldosterone mechanism
B) Regulates pH of body fluids through reabsorption and conservation
C) Regulates calcium and phosphorus conservation and elimination
E) Eliminates metabolic wastes
Rationale:The functions of the kidney focus on elimination of water, excess electrolytes, metabolic acids, and waste products from the blood. Regulation of RBC is maintained by the secretion of erythropoietin. ADH regulates the osmolality of extracellular fluid.
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?
A) Deamination of ammonia
B) Excretion of hydrogen ions
C) Inhibition of aldosterone
D) Retention of hydrogen ions
C) Inhibition of aldosterone
Rationale:ANP is a hormone believed to have an important role in salt and water excretion by the kidney. It is synthesized in muscle cells of the atria of the heart and released when the atria are stretched, which results in an increase in renal blood flow and GFR. ANP inhibits aldosterone secretion by the adrenal gland and sodium reabsorption from the collecting tubules through its action on aldosterone and through direct action on the tubular cells.
An adult has a serum sample taken to evaluate the BUN–creatinine ratio. Select the result that indicates a normal test.
A) BUN 10 mg/dL (3.57 mmol/L) to creatinine 1 mg/dL (88.40 μmol/L)
B) BUN 40 mg/dL (14.28 mmol/L) to creatinine 2 mg/dL (176.80 μmol/L)
C) BUN 25 mg/dL (8.92 mmol/L) to creatinine 1 mg/dL (88.40 μmol/L)
D) BUN 30 mg/dL (10.71 mmol/L) to creatinine 2.5 mg/dL (221.0 μmol/L)
A) BUN 10 mg/dL (3.57 mmol/L) to creatinine 1 mg/dL (88.40 μmol/L)
Rationale:The BUN–creatinine ratio is approximately 10:1. The other results, ratios greater than 15:1, represent prerenal conditions, such as congestive heart failure and upper gastrointestinal bleeding, that produce an elevation in BUN not creatinine.
