NR 545 FINAL EXAM 2023-2024 ACTUAL EXAM STUDY GUIDE
WITH QUESTIONS AND DETAILED ANSWERS||ALREADY
GRADED A+
Week 7 : renal and urological disorders
- Questions can include pathophysiology, health assessment (normal and abnormal), and pharmacologic treatment
- Review required readings, course lectures, case study and learning activity.
Fluid and electrolyte balance- processes in the kidney - Hormones controlsreabsorption of fluid and electrolytes
o Antidiuretic hormone
▪ From posterior pituitary; controls reabsorption of water by altering permeability of distal convoluted tubule and collecting duct
o Aldosterone
▪ Secreted by adrenal cortex; controlssodium reabsorption and water by exchanging Na ions for K or hydrogen ions in distal convoluted
tubule
o Atrial natriuretic hormone
▪ From heart; 3
rd hormone controlling fluid balance by reducing Na and fluid reabsorption in kidneys
Renal circulation process
Laboratory testing- purpose and interpretation ; Age related urinary changes ; Conditions/diagnoses associated with urine color changes
Diagnostic test - Urinalysis
o Constituents and characteristics of urine may vary w/ dietary intake, drugs, and care w/ which specimen is handled
o Urine is normally: clear, straw colored and has mild color
o Urine pH is 4.5-8.0
o Appearance
▪ Cloudy indicate presence of large amounts of protein, blood cells or bacteria and pus
▪ Dark color indicate hematuria (blood), excessive bilirubin content or highly concentrated urine
▪ Unpleasant or unusual odor indicate infection or result from certain dietary components or medications
o Abnormal constituents(present in significant quantities)
▪ Blood (hematuria) - small (microscopic) amounts of blood indicates infection, inflammation, or tumors in urinary tract
- large numbers of RBC (gross hematuria) indicates increased glomerular permeability or hemorrhage in tract
▪ protein (proteinuria, albuminuria) - indicatesleakage of albumin or mixed plasma proteinsinto filtrate d/t inflammation and increased glomerular
permeability
▪ bacteria (bacteriuria) and pus (pyuria) - indicatesinfection in urinary tract
▪ urinary casts (microscopic sized molds of tubules, consisting of one or more cells (bacteria, protein, and so on)) - indicatesinflammation of kidney tubules
▪ specific gravity - indicates ability of tubulesto concentrate the urine
- very low specific gravity= dilute urine; related to renal failure
▪ glucose and ketones(ketoacids) - found when DM is not well controlled
- blood test
o elevated serum urea (BUN and Cr)
▪ indicate failure to excrete nitrogen wastes d/t decreased GFR
▪ resultsfrom protein metabolism
o metabolic acidosis (decreased pH and Bicarb)
▪ indicate decreased GFR and failure of tubulesto control acid-base balance
o anemia (low hgb)
▪ indicated decreased erythropoietin secretion and/or bone marrow depression d/t accumulated wastes
o electrolytes
▪ depend on related fluid balance
▪ retention of fluid= GFR is decreased and may result in dilution effect
o antibody level antistreptolysin O (ASO) or antistreptokinase (ASK)
▪ used for dx of post-streptococcal glomerulonephritis
o renin
▪ indicate cause of HTN - other test
o culture and sensitivity on urine specimens
▪ used to identify the causative organism in urinary infection and select drug tx
o clearance testsuch as Cr or insulin clearance or radioisotopestudy
▪ used to assess GFR
o radiologic testsuch asradionuclide imagining, angiography, US, CT, MRI and IV pyelography(IVP)
▪ used to visualize structures and abnormalities in urinary system
o cystoscopy
▪ visualizes lower urinary tract and may be used in performing a biopsy or removing kidney stones