Deck 40: Mechanisms of Endocrine Control

Question 1

Which of the following data would a clinician consider as most indicative of acute renal failure?

A) Alterations in blood pH; peripheral edema
B) Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR)
C) Decreased serum creatinine and blood urea nitrogen (BUN); decreased potassium and calcium levels
D) Decreased urine output; hematuria; increased GFR

Answer 1

Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR)

Question 2

Which of the following clients would be considered to have a significant risk of developing the prerenal form of acute renal failure? Select all that apply.

A) A 22-year-old male who has lost large amounts of blood following a workplace injury
B) A 41-year-old female who is admitted for intravenous antibiotic treatment of pyelonephritis
C) A 79-year-old male with diagnoses of poorly controlled diabetes mellitus and heart failure
D) A 20-year-old male who is admitted for treatment of an overdose of a nephrotoxic drug
E) A 68-year-old male with a diagnosis of benign prostatic hyperplasia (BPH)
F) An 80-year-old female who has been admitted for the treatment of dehydration and malnutrition

Answer 2

A 22-year-old male who has lost large amounts of blood following a workplace injury
A 79-year-old male with diagnoses of poorly controlled diabetes mellitus and heart failure
An 80-year-old female who has been admitted for the treatment of dehydration and malnutrition

Question 3

The clinical nurse educator on a nephrology unit of a large, urban hospital is orientating recent nursing graduates to the unit. Which of the following teaching points about acute tubular necrosis (ATN) should the educator include in the orientation session?

A) "The cardinal signs of ATN are oliguria and retention of potassium, creatinine, and sulfates."
B) "Ureteral and bladder outlet obstructions are often contributors to ATN."
C) "Trauma, burns, and major surgery are common precursors to ATN."
D) "Tubular epithelial cells are sensitive to ischemia and toxins, and damage is irreversible."

Answer 3

"Trauma, burns, and major surgery are common precursors to ATN."

Question 4

Which of the following patients scheduled for an interventional radiology procedure requiring administration of radiocontrast dye would be considered at high risk for nephrotoxicity? Select all that apply.

A) A 14-year-old with severe abdominal pain
B) A 25-year-old with a history of glomerular nephritis who is complaining of severe flank pain
C) A 67-year-old diabetic undergoing diagnostic testing for new-onset proteinuria
D) A 45-year-old with elevated liver enzymes possibly due to fatty liver cirrhosis
E) A 53-year-old male undergoing biopsy for a suspicious "spot" on his chest x-ray

Question 5

A 35-year-old female ultramarathon runner is admitted to the hospital following a day-long, 50-mile race because her urinary volume is drastically decreased and her urine is dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis.
Why is her urine red?

A) Hematuria
B) Hemoglobinuria
C) Myoglobinuria
D) Kidney bleeding

Question 6

Following the diagnosis of acute renal failure, the nurse knows that one of the earliest manifestations of residual tubular damage is which of the following lab/diagnostic results?

A) Elevated blood urea nitrogen (BUN)
B) Serum creatinine elevation
C) Inability to concentrate urine
D) Reduced glomerular filtration rate

Question 7

A family physician is providing care for a 61-year-old obese male who has a history of diabetes and hypertension. Blood work has indicated that the man has a GFR of 51 mL/minute with elevated serum creatinine levels. Which of the following statements will the physician most likely provide the client in light of these results?

A) "We will regularly monitor your kidney function, but most likely your kidneys will be able to compensate on their own and intervention is not required."
B) "You likely have chronic kidney disease, and there may be urine in your blood until it is controlled."
C) "Your chronic kidney disease has likely been caused by your diabetes and high blood pressure."
D) "You're in kidney failure, and I'll be starting dialysis treatment immediately."

Question 8

A nurse is collecting a urine specimen prior to measuring the albumin level in a client's urine. A colleague questions the rationale for the test, stating, "I thought albumin was related to liver function, not kidney function." How can the nurse best respond to this statement?

A) "Urine should normally be free of any proteins, and albumin is one of the more common proteins to be excreted in chronic renal failure."
B) "Urine albumin levels are useful for diagnosing diabetic kidney disease."
C) "A urine dipstick test will tell us exactly how much albumin is being spilled by the client's kidneys."
D) "A urine test for albumin allows us to estimate the client's GFR quite accurately."

Question 9

Which of the following clinical manifestations would lead the nurse to suspect the renal failure patient is developing uremia? Select all that apply.

A) Weakness and fatigue
B) Lethargy and confusion
C) Extreme itching
D) Blood in urine
E) Urine smell in the stool

Question 10

A hospital client with a diagnosis of chronic renal failure has orders for measurement of her serum electrolyte levels three times per week. Which of the following statements best captures the relationship between renal failure and sodium regulation?

A) Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption.
B) Renal clients often require a sodium-restricted diet to minimize the excretion load on remaining nephrons.
C) Clients with renal failure often maintain high sodium levels because of decreased excretion.
D) Restricting sodium intake helps to preserve nephron function and has the additional benefit of lowering blood pressure.

Question 11

Which of the following clients' diagnostic blood work is most suggestive of chronic kidney disease (CKD)?

A) A client with high pH; low levels of calcium; and low levels of phosphate
B) A client with low vitamin D levels; low calcitriol levels; and elevated parathyroid hormone (PTH) levels
C) A client with low bone density; low levels of calcium; and low levels of phosphate
D) A client with low potassium levels; low calcitriol levels; and increased PTH levels

Question 12

Which of the following medications would the nurse anticipate being prescribed for the renal failure patient who has hyperphosphatemia?

A) Vitamin D (calcitriol)
B) Calcium carbonate
C) Levothyroxine (Synthroid)
D) Sensipar (Cinacalcet)

Question 13

To maintain hematocrit levels in people with kidney failure, the nurse should be prepared to

A) arrange for frequent blood transfusions in an outpatient clinic.
B) administer iron dextran intravenously.
C) administer a subcutaneous injection of recombinant human erythropoietin (rhEPO).
D) administer prenatal vitamins twice a day.

Question 14

A nurse educator is performing client education with a 51-year-old man who has been recently diagnosed with chronic kidney disease. Which of the following statements by the client would the nurse most likely want to correct or clarify?

A) "I'll be prone to anemia, since I'm not producing as much of the hormone that causes my bones to produce red blood cells."
B) "My heart rate might go up because of my kidney disease, and my blood might be a lot thinner than it should be."
C) "My kidney problems increase my chance of developing high blood pressure or diabetes."
D) "I'll have a risk of either bleeding too easily or possibly clotting too quickly, though dialysis can help minimize these effects."

Question 15

The nurse assessing a renal failure patient for encephalopathy caused by high uremic levels may observe which of the following clinical manifestations?

A) Severe chest pain with pericardial friction rub on auscultation
B) Stiff immobile joints and contractures
C) Loss of recent memory and inattention
D) Pruritus with yellow hue to skin tone

Question 16

Which of the following phenomena contributes to the difficulties with absorption, distribution, and elimination of drugs that are associated with kidney disease?

A) Reductions in plasma proteins increase the amount of free drug and decrease the amount of protein-bound drug.
B) Acute tubular necrosis is associated with impaired drug reabsorption through the tubular epithelium.
C) Decreased retention by the kidneys often renders normal drug dosages ineffective.
D) Dialysis removes active metabolites from circulation minimizing therapeutic effect.

Question 17

A 42-year-old male has been diagnosed with renal failure secondary to diabetes mellitus and is scheduled to begin dialysis soon. Which of the following statements by the client reflects an accurate understanding of the process of hemodialysis?

A) "It's stressful knowing that committing to dialysis means I can't qualify for a kidney transplant."
B) "I know I'll have to go to a hospital or dialysis center for treatment."
C) "Changing my schedule to accommodate 3 or 4 hours of hemodialysis each day will be difficult."
D) "I won't be able to go about my normal routine during treatment."

Question 18

Following kidney transplantation, the patient is prescribed maintenance immunosuppressive therapy consisting of prednisone, azathioprine, and cyclosporine. Educating the patient about long-term maintenance on immunosuppressive therapy should include discussion of side effects that may include: (Select all that apply).

A) cardiovascular complications.
B) increased risk of developing cancer.
C) nephrotoxicity of a newly transplanted kidney.
D) development of moon face and buffalo hump.
E) ringing or buzzing of the ears.

Question 19

A 1-year-old baby boy with renal dysplasia risks end-stage renal disease unless intervention occurs. Which of the following treatment options is his care team most likely to reject?

A) Dietary restriction plus erythropoietin
B) Continuous cyclic peritoneal dialysis
C) Renal transplantation
D) Continuous ambulatory peritoneal dialysis

Question 20

Which of the following clinical findings among older adults is most unlikely to warrant further investigation and possible treatment?

A) An 81-year-old male's serum creatinine level has increased sharply since his last blood work.
B) A 78-year-old female's GFR has been steadily declining over several years.
C) A 90-year-old female's blood urea nitrogen (BUN) is rising.
D) An 80-year-old male whose urine dipstick reveals protein is present.