The Renal System

Question 1

Nephron

Answer 1

functional unit of the kidney

Question 2

glomerulus

Answer 2

bundle of capillaries where filtration occurs in the nephron

Question 3

functions of the renal system

Answer 3

controls acid-base balance
produces bicarbonate
maintains electrolytes
removes urea
removes nitrogen
removes creatinine
produces erythropoietin
activates vitamin D
regulates H20 Balance and blood pressure control with RAAS

Question 4

RAAS

Answer 4

activated when BP drops too low
- SNS stimulates juxtaglomerular cells to release renin
- Renin activates angiotensinogen in the liver
- Angiotensinogen converted to angiotensin I
- ACE converts AI to AII in the lungs
- AII causes vasoconstriction and causes adrenal release of aldosterone
- Aldosterone stimulates retaininment of sodium and water, increasing blood volume and blood pressure.

Question 5

Loop Diuretics

Answer 5

work on the Loop of Henle
- Bumetanide
- Furosemide
- Torsemide

Question 6

Potassium Sparing Diuretics

Answer 6

inhibits sodium and potassium exchange via sodium channels in distal nephron; spares excretion of potassium.
- Eplerenone
- Spironalactone

Question 7

Thiazide Diuretics

Answer 7

Acts on distal convoluted tubule to inhibit sodium chloride co-transporter; increases resorption of sodium and water and increased urine output.
- Chlorothiazide
- hydrochlorothiazide

Question 8

Furosemide

Answer 8

Pharm. Class: Loop diuretic
Action: acts on the loop of Henle to increase urine output by affecting the sodium resorption of nephrons; inhibits potassium chloride transporter, causing sodium to be exerted in the urine, causing diuresis.
Considerations: monitor potassium levels; most effective ; may cause hypokalemia

Question 9

Spironolactone

Answer 9

Pharm. Class: K+ sparing Diuretics
Action: inhibits sodium and potassium exchange via sodium channels in distal nephron; spares potassium.
Indications: hypertension, edema, swelling, hypokalemia.
Considerations: Montior potassium levels; may be combined with thiazide diuretics for efficacy.

Question 10

Hydrochlorothiazide

Answer 10

Stronger than K+ Sparing diuretics
Action: acts on the distal convoluted tubule to inhibit sodium chloride co-transporter; increases resorption of sodium and water and increases urinary output.
Considerations: monitor electrolytes; monitor blood pressure.

Question 11

Catheter Considerations

Answer 11

there should never be dependent loops
sterile technique for insertion
if you ever break the sterile field, you always get a new kit
CAUTIS are caused by catheterization and to prevent, remove the catheter as soon as possible and provide daily peri care.

Question 12

Pyelonephritis

Answer 12

infection of the kidneys

Question 13

Cystitis

Answer 13

Infection of the bladder

Question 14

What is the intervention for emptying over 800mL from the bladder via catheter?

Answer 14

stop draining the bladder because the bladder is at risk for spasms.
This patient is at risk of developing bladder spasms if the bladder is completely drained. Anything over 800 mL that is drained out at one time puts the patient at risk for developing bladder spasms since there is not enough time to adjust from being abundant to shrinking. The bladder can be fully drained after 30 min to an hour.

Question 15

Most effective teaching for a client with a flaccid bladder

Answer 15

Since bladder muscles will not contract to increase intrabladder pressure and promote urination, the process is initiated manually. Overflow incontinence is continuous involuntary leakage or dribbling of urine that occurs with incomplete bladder emptying. It can be seen in men with an enlarged prostate and clients with a neurologic disorder (e.g. Parkinson’s disease, spinal cord injury). An impaired neurologic function can interfere with the standard mechanisms of urine elimination, resulting in a neurogenic bladder. The client with a neurogenic bladder does not perceive bladder fullness and is unable to control the urinary sphincters. The bladder may become flaccid and distended or spastic, with frequent involuntary urination.

Question 16

Phenazopyridine

Answer 16

Phenazopyridine relieves urinary tract pain, burning, irritation, and discomfort, as well as urgent and frequent urination caused by urinary tract infections, surgery, injury, or examination procedures. However, phenazopyridine is not an antibiotic; it does not cure infections.

Question 17

Phenazopyridine side effects

Answer 17

headache
dizziness
upset stomach
yellowing of the skin or eyes
fever
confusion
skin discoloration (blue to bluish-purple)
shortness of breath
skin rash
sudden decrease in the amount of urine
swelling of the face, fingers, feet, or legs

Question 18

Phenazopyridine education

Answer 18

Phenazopyridine can interfere with laboratory tests, including urine tests for glucose (sugar) and ketones. If you have diabetes, you should use Clinitest rather than Tes-Tape or Clinistix to test your urine for sugar. Urine tests for ketones (Acetest and Ketostix) may give false results. Before you have any tests, tell the laboratory personnel and doctor that you take this medication.

Phenazopyridine stains clothing and contact lenses. Avoid wearing contact lenses while taking this medicine.

Do not let anyone else take your medication. Your prescription is probably not refillable.

If you still have symptoms after you finish the phenazopyridine, call your doctor.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Question 19

Allopurinol

Answer 19

Allopurinol is prescribed to patients with gout or kidney stones and works by reducing the amount of uric acid produced by the body. Patients taking this medication should be encouraged to drink plenty of water, at least 3,000 mL per day.
This medication does not work immediately and may take a few months to reach full effectiveness.

Question 20

Phenazopyridine

Answer 20

he use of phenazopyridine produces a harmless orange (to red) color in the client’s urine.
✓ Phenazopyridine is prescribed for the symptomatic relief of dysuria, urinary urgency, irritation, and other discomforts of the lower urinary tract caused by infection, trauma, surgery, endoscopic procedures, or the passage of sounds or catheters.

✓ Phenazopyridine only provides symptomatic relief for the dysuria.

✓ Phenazopyridine should be discontinued when symptoms are controlled.

✓ A common harmless effect of this medication is urine discoloration, which will appear red or orange.

Question 21

Mannitol

Answer 21

Mannitol is an osmotic diuretic indicated for cerebral edema. Mannitol may crystallize when exposed to low temperatures. Because of this, mannitol is always administered intravenously through intravenous tubing with a filter.
✓ Mannitol is used in treating patients in the early oliguric phase of acute renal failure.

✓ For it to be effective in this setting, however, enough renal blood flow and glomerular filtration must remain to enable the drug to reach the renal tubules.

✓ Mannitol can also promote the excretion of toxic substances, reduce intracranial pressure, and treat cerebral edema.

✓ The normal intracranial pressure is 10-15 mm Hg.

Question 22

Pre-Renal Causes of AKI

Answer 22

Hypovolemia is a common prerenal cause of acute kidney injury (AKI). Prerenal reasons are those factors that are external to the kidney. Hypovolemia causes a decrease in blood flow to the organs. Hypovolemia can lead to intrarenal kidney disease.

Question 23

Diabetes Insipidus

Answer 23

Diabetes insipidus (DI) is a condition that affects the balance of fluids in the body. It occurs when the body does not produce enough of a hormone called antidiuretic hormone (ADH), also known as vasopressin, or when the kidneys do not respond properly to ADH.

✓There are two types of diabetes insipidus: central DI and nephrogenic DI.

Central DI occurs when there is a problem with the production or release of ADH from the hypothalamus or pituitary gland in the brain. This can be caused by a number of factors, such as a brain injury, infection, tumor, or genetic conditions.
Nephrogenic DI occurs when the kidneys are unable to respond to ADH properly, even though ADH is being produced and released normally by the body. This can be caused by certain medications, such as lithium, or by genetic conditions.

Question 24

Management of a client with urinary catheter

Answer 24

When managing a client with an indwelling urinary catheter, the nurse should –

Evaluate the reasoning for the indwelling catheter. The insertion of an indwelling catheter is invasive, so other measures such as external devices should be considered.
Minimize the amount of time that a client has the device. Urinary catheters are directly implicated in catheter-associated urinary tract infections (CAUTIs).
Perform meticulous hand hygiene before the insertion of the device. Aseptic technique during the insertion of the device is imperative.
Ensure system patency by decreasing kinks and loops in the tubing. The catheter should always be below the bladder and catheters with anti-reflux valves are highly preferred.

Question 25

Causes of increased BUN and creatinine related to drugs and pathology

Answer 25

✓ Elevations of the creatinine (normal: 0.6-1.2 mg/dL for males, 0.5-1.1 mg/dL for females) usually are caused by nephrotoxic medications or toxins such as an NSAID (ketorolac), antibiotic (vancomycin), or sulfa-based drugs. Other causes include decreased renal blood flow from renal artery stenosis or an insult to the kidneys from trauma.
✓ BUN (normal 10-20 mg/dL) elevations may be caused by dehydration, infection, a high protein diet, and liver disease.

Question 26

Polycystic Kidney disease Education

Answer 26

A client with polycystic kidney disease, the client should be educated on the following points -
* Measure and record your blood pressure daily.
* Take your temperature if you suspect you have a fever. If a fever is present, notify your provider.
* Weigh yourself every day at the same time of day and with the same amount of clothing; notify your primary health care provider if you have a sudden weight gain.
* Limit your salt intake to help control your blood pressure once hyperfiltration is no longer a symptom of your disease (once chronic kidney disease [CKD] is present).
* Notify your provider if your urine smells foul or has a new occurrence of blood in it.
* Notify your provider if you have a headache that does not go away or if you have visual disturbances because these are symptoms of a stroke or bleeding in the brain.
* Monitor bowel movements to prevent constipation.

Question 27

While auscultating a client’s bowel sounds, the nurse notes a swooshing sound to the left of the umbilical area. What would be the nurse’s priority action?

Answer 27

Upon auscultation, the nurse should suspect this client is presenting with an abdominal aortic aneurysm (AAA) due to the bruit or swooshing sound. The nurse should immediately notify the patient’s healthcare provider of this urgent situation. An AAA Rupture can occur spontaneously or with trauma. If the aneurysm bursts, it may cause life-threatening bleeding. The aneurysm should be assessed immediately to determine the need for surgical intervention

Question 28

Nephrotic Syndrome

Answer 28

Nephrotic syndrome is a kidney disorder. There is renal glomerular damage, which leads to massive proteinuria. Proteinuria is the increased amount of protein in the urine due to protein loss from the bloodstream. Because protein from the bloodstream is being lost in the urine, there is decreased protein in the bloodstream. This is can be referred to as hypoproteinemia, or hypoalbuminemia, as albumin is the type of protein lost in the bloodstream. This hypoalbuminemia causes decreased oncotic pressure in the vasculature, causing profound edema. Proteinuria is the first classic manifestation of nephrotic syndrome . Hypoalbuminemia is the second classic manifestation of nephrotic syndrome`. Edema is the third classic manifestation of nephrotic syndrome

Question 29

The nurse is caring for a patient who has just returned from an intravenous urography procedure. Which of the following nursing interventions is most important at this time?
A. Assess the venipuncture site for redness
B. Monitor urinary output
C. Instruct the client to remain motionless
D. Encourage the patient to drink at least 1 L of fluid

Answer 29

Choice D is correct. The dye used during intravenous urography is sometimes nephrotoxic. Thus patients should be encouraged to increase fluids unless contraindicated.

Choice A is incorrect. While the venipuncture site should always be monitored, some redness is expected and not alarming. Therefore, this is not a necessary action.

Choice B is incorrect. Monitoring urinary output is a critical nursing intervention because it may be the first sign of nephrotoxicity. However, increasing fluids is more urgent.

Choice C is incorrect. This client does not need to remain motionless following an intravenous urography procedure.

Question 30

Which of the following labs for a client with acute renal failure should be reported immediately?

A. Blood urea nitrogen 50 mg/dL
B. Serum potassium 6mEq/L
C. Venous blood pH 7.30
D. Hemoglobin of 10.3 mg/dL

Answer 30

Although all of these findings are abnormal, elevated potassium is a life-threatening finding and must be reported immediately. Acute renal failure can cause a significant imbalance in lab values. Although all of the lab results listed are abnormal, the elevated potassium level is a life-threatening finding.

Question 31

When epinephrine is administered to a client, the nurse should expect this agent to rapidly affect:

Answer 31

Epinephrine rapidly affects both alpha and beta-adrenergic receptors, eliciting a sympathetic response. Epinephrine is a hormone secreted by the medulla of the adrenal glands. Strong emotions such as fear or anger cause epinephrine to be released into the bloodstream, which causes an increase in heart rate, muscle strength, blood pressure, and sugar metabolism.

Question 32

Percutaneous Kidney Biopsy

Answer 32

A percutaneous kidney biopsy will be required to lay supine immediately following the procedure to achieve and maintain hemostasis. A back roll may be used to provide additional support.
A percutaneous kidney biopsy is indicated for several reasons, including the diagnosis of idiopathic nephrotic syndrome.

✓ The client will be positioned prone for the procedure, and immediately following the procedure, the client should be supine for four to six hours to ensure hemostasis.

✓ Urine output will be monitored closely post-procedure.

✓ The nurse should immediately report any bruising to the area and hematuria.

Question 33

24 hour urine collection

Answer 33

When instructing a client on the proper way to perform a 24-hour urinalysis collection, the client should be taught that the specimen collection begins at 0800. At that time, the client should urinate into the toilet. That initial void – officially marking the commencement of the test – is not saved and should be flushed. Following the discarding of this initial first sample, all urine voided by the client during the following 24-hour period must be collected and stored in the designated collection bottles provided by the laboratory (of note, the entire specimen must be refrigerated or kept on ice during the collection period). At 0800 the next morning, the client voids and adds that final specimen to the specimen container, thus marking the end of the 24-hour urinalysis collection.
A 24-hour urinalysis is a timed urine collection used to assess kidney function.
More specifically, the test is often to perform a metabolic evaluation of urinary stone disease, proteinuria evaluation, estimating renal function via creatinine clearance, and/or to assess residual renal function in end-stage renal disease clients via urea and creatinine clearance.
Although this testing is primarily performed on an outpatient basis, it can also be performed on inpatient clients if needed.
For this test, clients are provided one to two 24-hour urinalysis collection bottles to store the collected urine specimen throughout the testing period.
The collected specimen will need to be refrigerated or kept on ice for the 24-hour testing period.
No urine should be discarded during the collection period.

Question 34

Dialysis Disequilibrium Syndrome

Answer 34

Headache and nausea may be a manifestation associated with dialysis disequilibrium syndrome (DDS). This is a complication experienced by clients undergoing their first dialysis and may range from mild to severe.
DDS is usually self-limiting and is common during the first treatment. This is caused by removing urea, which causes a fluid shift that may lead to cerebral edema. The nurse should remain with the client and institute fall precautions. Notifying the primary healthcare provider (PHCP) should be done despite most DDS being self-limiting. Other complications of hemodialysis include hypotension, bleeding, angina, and cramps.