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A patient with chronic renal failure asks the nurse why he is anemic. the nurse explains that anemia accompanies chronic renal failure secondary to: A. blood loss via the urine B. renal insensitivity to vit a C. inadequate production of erythropoietin D. inadequate retention of serum iron ANSWERV ¥ C. inadequate production of erythropoietin the kidney is sensitive to oxygen saturations and secretes erythropoietin as needed to signal the bone marrow to m ake more RBC’s. when the kidney fails, erthropoietin stops being produced and the patient becomes anemic. Functions of kidney include: A. formation of urine B. regulation of body water and electrolytes C. acid-base balance D. all of the above ANS WERV ¥ D. all of the above the kidney regulates many hormonal and electrolyte functions. the major functions are: formation of urine, regulation of body water and electrolytes, acid-base balabce, production of erythropoietin, and production of renin Renal regulation of homeostasis includes: A. excretion of metabolic waste B. promotion of perfusion C. secretion of anti-diuretic hormone D. absorption of vancomycin ANSWERV Vv A. excretion of metabolic waste one of the major functions of the kidney is to remove waste products, perfusion is supported by cardiac function and volume status, secretion of ADH is from the pituitary, and absorption of vancomycin occurs at the tissue level- vancomycin is cleared via the kidney. The three processes of urine formation include: A. glomerular filtration, tubular filtration, and tubular secretion B. glomerular filteration, tubular reabsorption, and tubular sceretion. C. glomerular filtration, water reabsorption, excretion of sodium D. glomerular filtration, water secretion,and sodium secretion. ANSWERV V The formation of the urine begins with glomerular filtration-then the tubules reabsorb or secrete electrolytes and particles. those are the major processes. the tubules do not filtrate; sodium is regulated by multiple processes and is not a major process of the kidney funtion. water reabsorption is a function of tubular reabsorption or secretion. The glomerular filtration rate (GFR): A. equals about 180 liter/day B. equals about 125 liter/ minute C. Is often calculated by pharmacy and intensivists for drug administration D. All of the above ANSWERV ¥ D. All of the above GFR, a good indication of renal function, equals about 180 liters/day or about 125 ml/min, and is a calculated number by many critical care team members to dose drugs. GFR is excellant measure of current renal function Renal assessment includes: A. Glomerular filtration rate (GFR) B. Creatinine Strategies to prevent acute kidney injury include: A. limiting dehydration B. limiting and correct hypotension C. limiting exposure to nephrotoxins D. All of the above ANSWERV ¥ D. All of the above Excellant strategies for protecting renal function include: limiting intravascular dehydration, limiting and correcting hypotension, and most commonly limiting exposure to nephrotoxins- pharmokinetic therapy for pt on nephrotoxic drugs, renal protection for those recieving dye would also be included in this function Preventative measures for the onset of acute kidney injury include: A. LV isotonic hydration before nephrotoxins are administered B. Maintenance of adequate MAP C. Use of N-acetylcysteine for renal protection D. All of the above ANSWERV¥ D. All of the above Renal protection includes: IV hydration before administering nephrotoxins, such as intravenous contrast dye. Maintenance of an adequate MAP to profuse the kidney, use of drugs to further protect the kidney- the use of N-acetylcysteine before IV contrast dye (this is an oxygen radical scavenger that protects teh nephrons from injury that occurs with IV contrast dye) Prerenal failure is caused by: A. Poor cardiac output B. Poor volume status C. Renal artery stenosis D. All of the above ANSWERV ¥ D. All of the above The three main causes of prerenal failure are: poor cardiac function, poor volume status, and renal artery stenosis. All three prevent blood from reaching the kidney In the oliguric phase of acute renal failure the urine output: A. Is less than 400 ml/24 hours B. Is greater than 500 ml/24 hours C. Totally ceases D. Is not measure ANSWERYV V A. Is less than 400 ml/24 hours This is the marker of oliguria to the nephrologist. If the urine output is less than 400 ml/24 hours, the patient is said to be oliguric. In the diuretic phase of renal failure: A. Urine output does not change B. Oxygenation becomes worse C. Urine output slowly increases D. Electrolytes improve ANS WERY ¥ C. Urine output slowly increases In this phase of acute renal failure, urine output begins to improve with the mortality of the patient also improves. The electrolytes are still abnormal and the patient remains with a metabolic acidosis. The oxygentation of the patient should improve since the patient is eliminationg extra fluid. In the recovery phase of acute renal failure, the: A, pt is completely well B. Urine output is normal C. pt still has a mortality of ove 50% D. BUN: creatinine ratio is completely normal ANSWERV ¥ B. Urine output is normal A. sodium bicarbonate B. calcium chloride C. glucose and insulin infusion D. kayexalate and sorbitol ANSWERV V D. kayexalate and sorbitol These drugs actually remove potassium from the body by causing diarrhea. Potassium is then evacuated from the body. sodium bicarbonate, glucose and insulin actually shift the potassium from the intravasular compartment back into the cell and do not remove the potasium from the body. The electrolyte abnormality that produces a U wave on the ECG, a depressed ST-segment, and ventriculare irrtability is: A. hypernatremia B. hyperkalemia C. hypokalemia C. hypocalcemia ANSWERV V C. hypokalemia low potassium causes a ventricular irritability (VT and VF) and causes prominent U wave formation as well as ST-segment depression Which ECG finding would NOT be observed in the presence of hyperkalemia? A. prolonged PR interval B. absence of P waves C. ventricular irritability D. widened QRS complexes ANS WERV V C. ventriculare irritability hyperkalemia is a ventricular depressant causing bradycardias, widened QRS, absence of P waves, and heart blocks. ventricular irritability is from hypokalemia Which of the following elements is not filtered during glomerular filtration? A. sodium B. potassium C. proteins D. creatinine ANSWERY V C. proteins everything in the blood is filtered, except large molecules. large molecules, like protein, should not be filtered nor seen in the urine Which of the following lab values most closely approxiates normal serum osmolality? A. 50 to 100 mOsm B. 100 to 200 mOsm C. 250 to 300 mOsm D. 350 to 450 mOsm ANSWERV ¥ ©. 250 t0 300 mOsm The normal scrum osmolality is 275 to 295 mOsm Normal urine osmolality is: A. 100 to 200 mOsm B. 250-300 mOsm C. 350-400 mOsm D. 500-800 mOsm ANSWERV ¥ D. 500-800 mOsm The normal urine osmolality is 500-800 mOsm Which of the following corresponds most closely to the range of normal phosphate levels? A. 3-4.5 mg/dL B. 4.5-6.5 mg/dL C. 6-8 mg/dL B. 4/5-6.5 mg/dL C. 6-8 mg/dL D. 8.5-10.5 mg/dL ANSWERV V D. 8.5-10.5 mg/dL Which of the following would stimulae the release of antidiuretic hormone (ADH)? A. Decreased serum omosolality B. Increased serum osmolality C. Increased serum creatinine D. Decreased urine sodium ANSWERV ¥ B. Increased serum osmolality Increased serum omsolality would stimulate ADH to be released since ADH will hold on to water and sodium. The patient with increased serum osmolality would have an intravascular volume deficit- added water would improve the patient's osmolality The counter current mechanism in the nephron is designed to accomplish which purpose? A. Retain creatinine B. eliminate hydrogen ions C. concentrate urine D. increase water loss ANSWERV ¥ C. concentrate urine the counter current mechanism is how the nephron pulls more water back into the nephron. and can then be reabsorbed into the vasculature. This saves the patients intravasular volume Most reaborption occurs in which part of the nephron? A. proximal tubules B. loop of henle C. distal tubules D. collecting ducts ANSWERV ¥ B. Loop of Henle Water is brought back into the nephron via the counter current mechanism in the loop of henle. water is not reabsorbed from the proximal tubules, distal tubules and nothing is reabsorbed in the collecting ducts Which of the following corresponds most closely to the range of normal scrum ereatincine values? A. 0.8-1.8 mg/dL B. 2-2.9 mg/dL C. 3.2-4 mg/dL D. 4.5-5 mg/dL ANSWERV ¥ A. 0.8-1.8 mg/dL Although some labs may state a creatinine of 1.8 mg/dL is high normal mg/dL The primary etiology of hyperphosphatemia is: A. over-replacement B. hypercalcemia C. renal failure D. hypoalbuminemia ANSWERV ¥ C. renal failure "primary" means the first and most common cause of hyperphosphatemia. the correct answer is renal failure. over-replacement-in normal people- will not cause a change in phosphorus levels Bradycardia, tremors and twitching muscles are associated with which electrolyte disoder? A. hypokalemia B. hyperkalemia C. hypophosphatemia C. hyperphophatemia ANSWERV V B. hyperkalemia one reason for hyponatremia is fluid overload. the patient should be on a free water restriction and diuretic therapy to reduce intravascular volume The concentration of what electrolyte is inversely related to that of calcium? A. sodium B. potassium C. phosphate D. magnesium ANSWERV ¥ C. Phosphate Phosphorus and calcium are inversly related Trousseau's sign is a test for which electrolyte deficiency? A. Ilypophosphatemia B. hypercalcemia C. hypocalcemia D. hypokalemia ANS WERY V C. Hypocaleemia Trousseau's sign is significant for low calcium and causing tetany and hyper-reflexia Which organ or organ system is involved in the regulation of phosphate elimination? A. liver B. Respiratory system C. renal D. spleen ANSWERV V C. Renal system the kidney regulates phosphate levels Which of the following is a primary treatment to reduce magnesium levels? A. normal saline fluid B. dialysis C. mechanical ventilation D. calcium carbonate administration ANSWERV ¥ B. diaylsis dialysis is the only way to reduce high serum magnesium levels What is NOT a common sign of hypernatremia? A. tachycardia B. dry mucuos membranes C. poor skin turgor D. distended neck veins ANSWERY ¥ D. distended neck veins when hypernatremis is present the patient is intravascularly dry- dehydrated. signs of this would include: tachycardia, dry mucous membranes, and poor skin turgor. Distended neck veins will be present with a patient who is volume overload or has acute right ventricular failure. A patient has sustained blunt trauma to the left kidney following a blow to the kidney. which of the following manifestations indicate renal trauma? A. severe flank pain and diaphoresis B. hematuria and flank tenderness C. urethal bleeding D. severe flank pain and hemoptysis ANSWER¥ ¥ B. hematuria and flank tenderness many people with blunt trauma may present with severe pain and diaphoresis, however, with renal trauma the answer is hematuria and flank tenderness. looking for blood in the urine is the key sign of renal damage during trauma Cortical renal failure is most commonly caused by: A. infection 
