Topic 7: Fluid, Electrolyte, and Acid-base homeostasis and Renal

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Which fluid will be most effective in restoring extracellular volume?

Normal saline (0.9%)

A patient with renal disease is at risk for development of uremia as his nephrons progressively deteriorate because

GFR declines

Osteodystrophy commonly occurs in patients with chronic renal failure because of

insufficient active vitamin D

A patient's arterial blood gases on room air are pH = 7.35, PaCO2 = 32 mm Hg, and HCO3- = 17 mEq/L. What is the correct interpretation?

Compensated metabolic acidosis

Hypermagnesemia and hypercalcemia both cause excessive neuromuscular excitability.

False

Two thirds of body fluids are within the intracellular fluid compartments.

True

An electrolyte disorder that frequently accompanies ketoacidosis is

hyperkalemia

Which of the following arterial blood gases indicates a compensated respiratory acidosis?

pH 7.36, PaCO2 55, HCO3- 30

Which of the following statements best describes the pathophysiologic process of hypernatremia?

Increased extracellular osmolality leads to cellular shriveling

After a patient has received fluid therapy for several hours, her supine and standing heart rate and blood pressure are recorded. Which of the following results indicate a need for further therapy?

Supine HR 88, BP 100/80; standing HR 110, BP 98/78

Signs and symptoms of chronic renal failure begin to appear when approximately 75% of nephrons have been lost.

True

Match the disease processes with their clinical manifestations (answers are used more than once).

Proteinuria - nephrotic syndrome; Azotemia - uremic syndrome; Oliguria - uremic syndrome; Hyperlipidemia - nephrotic syndrome

Classify the following arterial blood gas: pH = 7.52, PaCO2 = 30 mm Hg, HCO3- = 24 mEq/L.

Respiratory alkalosis

Prerenal oliguria is a reversible stage of acute renal failure.

True

Which of the following is not usually associated with nephrosis?

Hematuria

Administration of sodium bicarbonate to an individual with acidosis will

increase formation of carbon dioxide in the blood.

The pain that accompanies kidney disorders is called

nephralgia

Renal artery stenosis, hypertension, and nephrosclerosis may all contribute to renal failure by causing

renal ischemia.

A person who experiences a panic attack and develops hyperventilation symptoms may experience.

numbness and tingling in extremities.

A patient's serum level upon admission was 148 mEq/L, her heart rate was 110 lying supine, and her blood pressure was 88/60. What is the most appropriate fluid therapy

Give IV normal saline (0.9%).

Two important renal buffers are

NH3 and HPO42+

The most helpful laboratory value in monitoring the progression of renal failure is

serum creatinine.

The oliguric phase of acute tubular necrosis is characterized by

rapidly developing uremia.

The finding of ketones in the urine suggests that a patient may have which of the following acid-base disorders

Metabolic acidosis

Abnormalities in intracellular regulation of enzyme activity and cellular production of ATP are associated with

hypophosphatemia

A total of 70% to 80% of the water and electrolytes filtered by the kidney are reabsorbed by the

proximal tubule.

Vomiting of stomach contents or continuous nasogastric suctioning may predispose to development of

metabolic acid deficit.

Which of the following hormones is associated with an increase in hypotonic fluid reabsorption from the tubular fluid

Aldosterone

A person with acute pyelonephritis would most typically have

fever

A high urine sodium and a fractional sodium excretion greater than 1 is associated with:

acute tubular necrosis.

The primary function of the vasa recta is to:

reabsorb interstitial water.

The most likely cause of anemia in a patient with renal failure is

insufficient erythropoietin.

Decreased neuromuscular excitability can be seen in which two electrolyte disorders

Hypercalcemia and hypermagnesemia

The nerves that carry pain sensations from the kidney enter the cord at T10 to L1.

True

Because of continuing decreased urine output, the function of a patient's kidneys is evaluated with urine electrolytes. The urine Na+ is found to be quite low. This is most likely due to

aldosterone effect on kidney tubules.

C.G. is a 42-year-old with type 1 diabetes that is normally well controlled with insulin. Three days ago she developed a viral infection with high fever and has not been checking her blood glucose regularly. She is now in the emergency department complaining of abdominal pain and flu symptoms. C.G.'s urine is positive for glucose and ketones, and serum glucose and blood gases are obtained. What fluid balance problem is C.G. at risk for secondary to glycosuria?

Water deficit

Which of the following findings on urinalysis should prompt further evaluation?

Nitrites

The glucose transporter in the proximal tubule:

may be saturated at high filtered glucose loads.

Appropriate therapy for prerenal oliguria includes

fluid administration.

A patient with gouty arthritis develops renal calculi. The composition of these calculi is most likely to be

uric acid crystals.

Osmoreceptors located in the hypothalamus control the release of

vasopressin (antidiuretic hormone, ADH).

A 14-month-old girl is brought to urgent care by her parents for persistent fever, vomiting, and diarrhea. Upon questioning, the parents report that the child has had only one to two wet diapers per day for the last 2 days. The child's weight is noted to be 2 pounds less than her normal weight. This is equivalent to approximately how much fluid loss?

One liter

A patient who develops acute renal failure after receiving nephrotoxic antibiotics most likely has postrenal acute renal failure.

False

Polycystic kidney disease is

genetically transmitted.

The organism most commonly associated with acute pyelonephritis is

Escherichia coli.

A patient with chronic renal failure has chronically elevated blood pressure requiring pharmacologic therapy. Which of the following drugs may be inappropriate because it interferes with the mechanisms that maintain GFR

ACE inhibitors

Which of the following conditions would result in increased GFR?

Increased glomerular hydrostatic pressure

The body compensates for metabolic alkalosis by

hypoventilation

Appropriate management of progressive renal failure includes

erythropoietin administration.

Renal involvement after streptococcal infection is associated with

an immune complex reaction.

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