2021 - NURS 272 - Kidney Quiz PDF

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Professor Balzaretti...

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1. What components of the nephron unit does FUROSEMIDE decrease fluid absorption? - Loop of Henle/ Distal tubules/ Proximal tubule - Explanation: - Loop diuretic → inhibits sodium & chloride reabsorption from the 3 locations 2. What is the action of the antidiuretic hormone? (ADH) - Decrease water loss in urine - Explanation: - ADH is released from the POSTERIOR PITUITARY GLAND & released mainly in response to decreasing in blood volume or increased concentration of sodium in plasma - Decrease production of urine → increase reabsorption of water by renal tubules 3. Which clinical finding indicates that an IV has been infiltrated, rather than causing inflammation? a. Coolness b. Explanation: i. The IV solution is 75 degrees → when infiltrated, the skin is cool to the touch w/ the liquid being in the tissue 4. What volume of solution for a cleansing enema is administered to an adolescent client? a. 500 - 750 mL b. Explanation: i. Infants = 150 -250 mL ii. Toddler = 250 -350 mL iii. School-age children = 300 - 500 mL iv. Adolescents = 500 - 750 mL 5. Which symptoms indicate that a client w/ inhalation anthrax is in the FULMINANT stage? a. Hematemesis b. Explanation: i. Prodromal stage → fever, dry cough, & mild chest pain ii. Fulminant stage → hematemesis 6. What percentage of total body water is found in a premature newborn? a. 85% b. Explanation: i. Full-term infant → 70 -80% ii. Ages 1 - 2 → 64% 7. Which hormone regulates blood levels of calcium?

a. Parathyroid hormone (PTH) b. Explanation: i. Luteinizing hormone (LH) → stimulates the production of sex hormones, promote the growth of reproductive organs, & stimulate reproductive processes ii.

Thyroid-stimulating hormone (TSH) → release of thyroid hormones & the growth and functioning of thyroid glands

iii.

Adrenocorticotropic hormone (ACTH) → promotes the growth of the

adrenal cortex & stimulate the release of corticosteroids 8. Which action is promoted by vasopressin? a. Reabsorption of water b. Explanation: i. Vasopressin is an ADH hormone that helps reabsorb water into the capillaries ii. Aldosterone promotes sodium reabsorption iii. Natriuretic hormones promote the tubular secretion of sodium iv. Erythropoietin stimulates the bone marrow to make RBC 9. Which hormonal deficiency causes diabetes insipidus in a client? a. ADH b. Explanation: i. Decreased prolactin → decreased amounts of milk secretion after birth ii. iii.

Decreased thyrotropin → hypothyroidism, weight gain, & lethargy Decreased luteinizing hormone (LH) → menstrual abnormalities,

decreased libido, & breast atrophy 10. Which clinical finding would nurses associate w/ hypokalemia? a. Muscle weakness b. Explanation: i. Diminishes the magnitude of the neuronal & muscle cell resting potentials 11. The nurse administers a parental preparation of potassium slowly to avoid which complication? a. Cardiac arrest b. Explanation: i. Too rapid administration → long refractory period in the cardiac cycle, resulting in cardiac dysrhythmias & arrest 12. What should be expected to decrease when pt is administered serum albumin IV to pt w/ ascites? a. Abdominal girth b. Explanation:

i.

Increase the osmotic effect & pull fluid back into the intravascular compartment → increase renal flow & urine output ⇒ resulting in

decreased abd girth 13. Which dietary restriction will the nurse expect to be included in the plan for a client w/ ventricular failure? a. Sodium b. Explanation: i. Restriction of sodium → reduce water retention & cardiac workload w/ the decreased fluid 14. To be a universal recipient, a person must have which blood type? a. AB b. Type AB → both A & B antigen on RBCs and no antibodies against either antigen 15. A client is admitted for dehydration & an IV infusion of normal saline is started at 125 mL/h. One hour later, the client begins screaming “I can’t breathe!” How would the nurse respond? a. Elevate the head of the client’s bed & obtain vital signs b. Elevating the head of the bed facilitates breathing by decreasing pressure against the diaphragm. Vital signs reflex the current status of the client i. Discontinuing the IV is unsafe b/c more iv meds may be needed (read this wrong for “stopping IV”) 16. Which degree of edema will result in a 6-mm deep indentation upon pressure application? a. 3+ b. Edema classifications: i. 4+ → 8 mm ii.

3+ → 6 mm

iii. 2+ → 4 mm iv. 1+ → 2 mm 17. Which gland is affected in aldosternoma? a. Adrenal cortex b. Aldosteronoma is an aldosterone-secreting adrenoma of the adrenal cortex 18. A 2-year-old child is admitted with gastroenteritis and dehydration. Intravenous fluids are prescribed. Which is the most appropriate site for the first intravenous insertion? a. Dorsal metacarpals of the hand b. 1st choice of insertion site → distal (low) on the periphery of an extremity & progress proximally (upward) toward the trunk i. Upper extremities are most appropriate sites for IV insertion of 1 years or

ii. iii. iv.

older Scalp veins are used for infants only if peripheral veins aren’t accessible Foot veins shouldn’t be used once walking Antecubital fossa should be avoided → arm will have to be immobilized

to stabilize the intravenous insertion site to prevent an infiltration 19. Which statement regarding calcitonin is correct? a. It’s actions are opposite to that of parathyroid hormone b. Calcitonin reduces serum calcium levels, whereas parathyroid hormone increases serum calcium levels i. Secreted by parafollicular cells of the thyroid gland ii. Decreases calcium & phosphorus levels by decreasing bone resorption iii. Works along w/ parathyroid hormone to maintain calcium levels in blood iv. Calcitonin = decrease/ Parathyroid = increase 20. One liter of 5% dextrose solution contains 50 grams of sugar. The nurse calculates that 3 L solution/day will supply approximately how many kilocalories? a. 600 kcal b. Carbs ⇒ 4 kcal/g i. 3 L x 50 g/L x 4 kcal/g ⇒ 600 kcal 21. Which goal would the nurse expect a client receiving treatment for bacterial cystitis to achieve before their discharge from the hospital? a. Achieve relief of clinical symptoms & maintain kidney function b. Relief of symptoms & continued urine output are measurable repsonse to therapy and are the desired outcomes 22. The nurse is caring for a client w/ severe burns & determines the client is at risk for hypovolemic shock. Which physiological finding supports the nurse’s conclusion? a. Plasma protein moving out of the intravascular compartment b. The shift of plasma proteins into the burned area increases the shift of fluid from the intravascular → interstitial compartment i. Results in decreased blood volume & hypovolemic shock 23. Which collecting structure is located at the end of the renal papilla? a. Calyx b. The calyx is a cup-like structure that collects urine and is located at the end of each papilla i. Capsule → outer surface of the kidney consisting of fibrous tissue ii. iii.

Renal cortex → outer tissue layer Rnal columns → cortical tissue that dip down into the interior of the

kidney & separate the pyramids 24. A pregnant client w/ severe preeclampsia is receiving intravenous magnesium sulfate. Which item would the nurse keep at the bedside in case of magnesium sulfate toxicity?

a. Calcium gluconate b. The antagonist of magnesium sulfate is calcium gluconate 25. The nurse is educating a client about managing hypoglycemia unawareness. Which information would the nurse provide? a. Refrain from alternative testing sites b. The same site should be used to obtain blood glucose levels → provide consistent readings b/c blood glucose levels are changing rapidly i. Should use glucose meter to monitor for consistency 26. The nurse assess bilateral +4 peripheral edema while assessing a client w/ heart failure & peripheral vascular disease. Which is the pathophysiological reason for excessive edema? a. Shift of fluid into the interstitial spaces b. Edema → accumulation of fluid in the interstitial spaces i.

When the heart is unable to maintain adequate blood flow throughout

the circulatory systems → excess fluid pressure w/in the blood vessels can cause shifts into the interstitial spaces 27. Which part of the kidney produces the hormone BRADYKININ? a. Juxtaglomerular cells of the arterioles b. The juxtaglomerular cells of the arterioles produce the hormone bradykinin → increases blood flow & vascular permeability i.

Kidney tissue → produce prostaglandins that regulate internal blood flow by vasodilation or vasoconstriction

ii.

Kidney parenchyma → produces erythropoietin that stimulates the bone marrow to make RBCs

iii.

Renin-producing granular cells → produce renin hormone that raises

blood pressure as a result of angiotensin & aldosterone secretion 28. Which component of the client’s nephron acts as a receptor site for the antidiuretic hormone to regulate water balance? a. Collecting ducts b. The collecting ducts regulate water balance & act as a receptor site for antidiuretic hormone i. Bowman capsule → collects glomerular filtrate & funnels it into the tubule ii.

Distal convoluted tubule → acts as a site for additional water & electrolyte reabsorption

iii.

Proximal convoluted tubule → site for reabsorption of sodium,

chloride, water, & urea 29. A client with chronic kidney disease selects treatment using continuous ambulatory

peritoneal dialysis (CAPD). Which statement indicates the client understands the purpose of this therapy? a. The treatment uses the peritoneum as a semipermeable membrane to clear toxins by osmosis & diffusion b. Diffusion moves particles from an area of greater concentration to an area of lesser concentration/osmosis moves fluid from an area of lesser concentration to an area of greater concentration of particles → removing waste products into the dialysate (which is then drained from the abdomen) 30. When ammonia is excreted by healthy kidneys, which mechanism usually is maintained? a. Acid-base balance of the body b. The excreted ammonia combines w/ H+ ions in glomerular filtrate to form ammonium ions, that are excreted from the body i. Helps rid the body of excess hydrogen → maintaining acid-base balance 31. Which assessment finding of a client w/ heart failure would prompt the nurse to contact the health care provider? SATA a. Fatigue, orthopnea, pitting edema, dry hacking cough, 4-pound weight gain b. Signs of worsening heart failure → fatigue, weakness, orthopnea, pitting edema, weight gain, & dry hacking cough 32. Which assessment finding in a client signifies a mild form of hypocalcemia? a. Numbness around the mouth b. A numbness or tingling sensation around the mouth or in the hands & feets indicates mild to moderate hypocalcemia i. Severe hypocalcemia → seizures, hand spasms, & severe muscle cramps 33. In which part of the kidney are glucose and amino acids reabsorbed? a. Proximal tubule b. Glucose, amino acids, electrolyte, & bicarbonate → proximal tubule 34. Which action would the nurse include in the plan of care for a client admitted w/ heart failure who has gained 20 pounds in 3 weeks. SATA a. Diuretics, low-salt diet, daily weight checks, fluid restriction, intake & output, oxygen administration b. Heart failure interventions should be focused on decreasing fluid restriction 35. Which nursing interventions is the priority for a client with stroke who is transitioned from the emergency department (ED) to other settings? a. Assessing the level of consciousness b. LOC is priority nursing action i. Monitoring the vital signs, reassuring the client, & monitoring specific client manifestations are ONGOING NURSING INTERVENTIONS 36. The nurse administers vasopressin to a client and recalls the medication is which type of

hormone? a. Antidiuretic hormone b. Vasopressin → ADH i. ii.

Somatotropin → growth hormone Gonadotropin → luteinizing hormone

iii. Thyrotropin → thyroid-stimulating hormone 37. The client’s IV site is tender with erythema, warmth, and mild edema. Which action will the nurse take? a. Change the IV site b. Presence of inflammation → IV catheter should be removed to prevent the development of thrombophlebitis i.

Irrigating the IV / slowing rate of infusion → don’t address underlying problem and may worsen irritation

ii. Analgesic → don’t resolve the problem; only temporary pain relief 38. Which clinical manifestations occurs in a client with vasopressin deficiency? a. Hypotension b. Vasopressin regulates fluid levels & blood pressure → deficiency would cause hypotension i. Impotence, amenorrhea, & decreased libido → caused by luteinizing & follicle-stimulating hormone deficiences 39. Which medication can cause diabetes insipidus? a. Demeclocycline b. Prolonged use of demeclocycline can cause diabetes insipidus → decreases the production of ADH by the kidneys i.

Cabergoline → inhibits the release of growth hormone

ii.

Prolactin → stimulates the dopamine receptors in the brain

iii. Metyrapone & aminoglutethimide → decreases cortisol production 40. The nurse is preparing to administer an intravenous piggyback antibiotic that has been newly prescribed. Shortly after initiation, the client becomes restless and flushed and begins to wheeze. After stopping the infusion, which priority action will the nurse take? a. Assess the client’s respiratory status b. Client is experiencing allergic rxn → severe allergic rxn commonly cause respiratory distress as a result of laryngeal edema or severe bronchospasm i. Assessing & maintaining client’s airway → PRIORITY ii. iii.

Nurse must determine client’s status before notifying PHP Vital signs (including BP & pulse oximetry) → obtained after airway

patency is ensured & maintained 41. Which cation regulates intracellular osmolarity? a. Potassium b. Decrease in serum K+ → decrease in cell wall pressure & results in water moving out of the cell i.

→ regulates metabolic activities, transmission & conduction of nerve

impulses, cardiac conduction, & smooth & skeletal muscle contraction 42. Which hormone aids in regulating intestinal calcium & phosphorus absorption? a. Glucocorticoids b. Adrenal glucocorticoids → aid in regulating intestinal calcium & phosphorus absorption by increasing or decreasing protein metabolism i.

Insulin → act together w/ growth hormone to build & maintain healthy bone tissue

ii.

Thyroxine → increases rate of protein synthesis in all types of tissues

iii.

Parathyroid hormone secretion → increases in response to decreased serum calcium concentration & stimulates the bones to promote

osteoclastic activity 43. Which components of the nephron unit does furosemide decrease fluid reabsorption? SATA a. Loop of henle, distal tubules, proximal tubule, b. Furosemide or “loop diuretics” → inhibits sodium & chloride from the ascending loop of henle, proximal tubules, & distal tubules i.

Glomerulus → site of glomerular filtration

ii.

Bowman capsule → site of collection of glomerular filtrate & contains the glomerulus

44. A client is admitted w/ metabolic acidosis. Which 2 body systems would the nurse assess for compensatory changes? a. Increased respirations blow off CO2 → decrease hydrogen ion concentration & pH increases (less acidity) b. Decreased respirations result in CO2 build-up → increase hydrogen ion concentration & pH falls (more acidity) c. Kidneys conserve or excrete bicarbonate & hydrogen ions → help adjust body’s pH 45. The nurse gave a client the prescribed sodium polystyrene sulfonate. Which assessment finding indicates that the medication has been effective? a. Decrease in serum potassium level

b. Sodium polystyrene sulfonate → given to treat hyperkalemia i.

Effectiveness of the medication → determined by decreasing serum

potassium level ii. Binds w/ potassium in the GI system & often causes diarrhea iii. Adverse effects → sodium retention & hypernatremia 1. Decreases serum calcium levels in small # of pts 2. Doesn’t increase calcium 46. Which action would the nurse implement first for a client whose serum potassium level has increased to 5.8 mEq/L? a. Take vital signs & notify the HCP b. Vital signs monitor cardiorespiratory status → hyperkalemia causes cardiac dysrhythmias i. HCP should be notified b/c medical intervention may be necessary c. Wrong answer choices: i. Repeat laboratory test → take time & probably reaffirm the original results ⇒ CLIENT NEEDS IMMEDIATE INTERVENTION ii.

Cardiac arrest team → always on alert & will respond when called for cardiac arrest

iii. Electrocardiogram & lidocaine → insufficient interventions 47. A client has been given a prescription for furosemide 40 mg every day in conjunction with digoxin. Which concern would prompt the nurse to ask the healthcare provider about potassium supplements? a. Digoxin toxicity occurs rapidly in the presence of hypokalemia b. Furosemide promotes potassium excretion & hypokalemia increases cardiac excitability → digoxin more likely to cause dysrhythmias when potassium is low 48. A client receiving a hemodialysis treatment ask the nurse which substances are being removed. Which substance can the nurse report is being removed during hemodialysis? a. Sodium b. Sodium is an electrolyte that passes through the semi permeable membrane during hemodialysis i. Rbc / Glucose / Bacteria→ don’t pass through semi-permneable membrane during hemodialysis 49. After a subtotal gastrectomy, the client begins eating a variety of food textures and form. After meals, the client reports cramping discomfort, rapid pulse, and waves of weakness, often followed by nausea and vomiting. Which physiological response does the nurse suspect occurs after the client eats? a. Quick passage of hyperosmolar food solution into the small intestine

b. Without an adequate stomach reservoir → hypertonic, concentrated food masses move into the small intestine ⇒ cause it to draw fluid from surrounding blood and tissue, causing hypovolemia & symptoms of shock (dumping syndrome) i. Food passes too quickly into the small intestine ii. Food mass more concentrated than surrounding fluid (hypertonic) 50. A client who has chronic kidney failure is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the client indicates understanding of the therapy? a. It uses the peritoneum as a semi-permeable membrane to clear toxins by osmosis & diffusion b. Removal of waste products into the dialysate, which is drained from the abdomen...