CHAPTER 24: KIDNEY ANATOMY AND PHYSIOLOGY {Urden: Critical Care Nursing, 9th Edition}

C HAPTER 24: K IDNEY A NATOMY AND
P HYSIOLOGY
Urden: Critical Care Nursing, 9th Edition



MULTIPLE CHOICE


1. Which condition would result in an increased release of renin?
a. Increased release of angiotensin I
b. Increased release of angiot ensin II
c. Increased amount of sodium in the distal convoluted tubule
d. Reduced pressure in the glomerulus



ANS: D



Renin is released in response to reduced pressure in the glomerulus,
s ympathetic stimulation of the kidneys, and a decrease in the amount of
sodium in the distal convoluted tubule. Renin is converted to
angiotensin I, which is converted to the powerful vasoconstrictor
angiotensin II. Angiotensin II stimulates the adrenal glands to secrete
aldosterone, which acts on the distal tubules to resorb sodiu m from the
tubular lumen into the circulation. When sodium is retained, so is
water. Angiotensin II also constricts the renal vasculature, reducing
kidney blood flow and available glomerular filtrate, sending a signal to
the posterior pituitary to release antidiuretic hormone. The two systems
intertwine to maintain fluid and electrol yte balance.

, PTS: 1 DIF: Cognitive Level: Understanding REF: p.
612 | p. 613 | Figure 24 -4 OBJ: Nursing Process Step:
N/A TOP: Renal MSC: NC LEX: Physiologic Integrit y



2. The mobilization of calcium from bone stores is accomplished through the
influence of which hormone?
a. Antidiuretic hormone (ADH)
b. Parathyroid hormone (PTH)
c. Thyroid-stimulating hormone (TSH)
d. Erythropoietin



ANS: B



The mobilization of calcium from bone stores is accom plished through
the influence of parathyroid hormone. The kidneys secrete
erythropoietin, the hormone that controls erythrocyte (red blood cell)
production in the bone marrow.



PTS: 1 DIF: Cognitive Level: Remembering REF: p. 617
OBJ: Nursing Process Step: Assessment TOP: Renal
MSC: NC LEX: Physiologic Integrit y



3. Which t ype of intravenous fluid will not create a shift of fluids within the
vascular space?
a. Hypertonic
b. Hypotonic
c. Isotonic
d. Osmotic pressure



ANS: C

, An isotonic solution has roughl y the same concentr ation of particles as
the blood plasma; cells within an isotonic solution maintain
consistency and do not lose or gain fluid to their surroundings. A
hypertonic solution contains a greater concentration of particles than
that inside the cell and causes flu id to be drawn out of the cells. Used
inappropriatel y, too much fluid may be withdrawn, causing a withering
of the cell (crenation). A hypotonic solution contains a lesser
concentration of particles than that inside the cell and causes fluid to
be drawn into the cells. If used incorrectly, a hypotonic solution can
cause too much fluid to enter the cell, causing the cells to swell and
burst (hemol ysis). Osmotic pressure is created by solutes and other
substances (e.g., albumin, globulin, fibrinogen) suspende d in fluid.



PTS: 1 DIF: Cognitive Level: Understanding REF: p.
614 | p. 615 | Figure 24 -6 OBJ: Nursing Process Step:
N/A TOP: Renal MSC: NC LEX: Physiologic Integrit y



4. What substance is the most responsible for maintaining the colloid
osmotic pressure?
a. Intravascular plasma proteins
b. Intracellular potassium
c. Extracellular sodium
d. Interstitial potassium



ANS: A



Osmotic pressure is created by solutes and other substances (e.g.,
albumin, globulin, fibrinogen) suspended in fluid. Colloid osmotic
pressure is created primaril y by the presence of plasma proteins in the