Review Renal Changes in pregnancy

Physiological And Physical Changes In Pregnancy > Maternal & Newborn

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Renal Changes in pregnancy

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Total Questions : 4

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Question 1:

A nurse is teaching a pregnant client about the renal changes that occur during pregnancy.

The nurse explains that the amount of urine produced per day increases by 25% to 50% during pregnancy due to:.

A. Increased renal blood flow and increased glomerular permeability. B. Increased glomerular filtration rate and decreased tubular reabsorption. C. Decreased renal vascular resistance and increased plasma volume. D. Decreased serum osmolality and increased renal clearance.

Answer and Explanation

Choice A:

increased renal blood flow and increased glomerular permeability are not the main causes of increased urine production during pregnancy. Increased glomerular permeability may occur in some pathological conditions, such as preeclampsia, but not in normal pregnancy.

Choice B:

Dncreased glomerular filtration rate and decreased tubular reabsorption are not the main causes of increased urine production during pregnancy. Increased glomerular filtration rate is a consequence of decreased renal vascular resistance and increased plasma volume, not a cause. Decreased tubular reabsorption may occur in some pathological conditions, such as gestational diabetes, but not in normal pregnancy.

Choice C:

This is because pregnancy leads to physiologic changes in renal and systemic hemodynamics that cause important alterations in acid-base, electrolyte, and kidney function. One of these changes is a decrease in renal vascular resistance due to hormonal and mechanical factors, which results in increased renal blood flow and glomerular filtration rate. Another change is an increase in plasma volume by 30% to 50% due to increased aldosterone and vasopressin secretion.

Choice D:

Decreased serum osmolality and increased renal clearance are not the main causes of increased urine production during pregnancy. Decreased serum osmolality is a consequence of increased plasma volume and decreased thirst threshold, not a cause.

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Question 2:

A nurse is reviewing the laboratory results of a client who is at 28 weeks of gestation and has mild preeclampsia (gestational hypertension with proteinuria).

Which of the following findings should the nurse report to the provider?

A. Serum creatinine 0.6 mg/dL. B. Urinary protein 500 mg/day. C. Serum uric acid 4 mg/dL. D. Urinary specific gravity 1.015.

Answer and Explanation

Choice A:

Creatinine 0.6 mg/dL is within the normal range of 0.5 to 1.1 mg/dL for women.

Choice B:

This is because preeclampsia is a condition that causes high blood pressure and proteinuria (protein in the urine) after 20 weeks of gestation. Proteinuria is a sign of kidney damage and can lead to complications for the mother and the baby. The normal range of urinary protein is less than 300 mg/day.

Choice C:

Serum uric acid 4 mg/dL is within the normal range of 2.4 to 6 mg/dL for women. Uric acid is another waste product that is filtered by the kidneys and excreted in the urine. A high level of uric acid can cause gout or kidney stones.

Choice D:

Urinary specific gravity 1.015 is within the normal range of 1.005 to 1.030. Specific gravity measures how concentrated the urine is. A high specific gravity indicates dehydration or kidney dysfunction.

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Question 3:

A nurse is teaching a prenatal class about physiological changes during pregnancy and their effects on maternal nutrition and fluid intake requirements.

Which statement by one of the class participants indicates understanding?

A. “I should drink more fluids because my blood volume increases during pregnancy.”. B. “I should eat more protein because my kidneys work harder during pregnancy.”. C. “I should limit my sodium intake because my blood pressure increases during pregnancy.”. D. “I should take iron supplements because my red blood cell count decreases during pregnancy.”.

Answer and Explanation

Choice A:

This statement indicates understanding of the physiological changes that occur during pregnancy and their effects on maternal nutrition and fluid intake requirements. Drinking more fluids helps to maintain adequate hydration and blood volume, which supports fetal growth and development.

Choice B:

Eating more protein does not directly relate to the increased workload of the kidneys during pregnancy. Protein intake should be adequate to meet the needs of the mother and the fetus, but not excessive.

Choice C:

Limiting sodium intake is not necessary for most pregnant women, unless they have hypertension or pre-eclampsia. Sodium is important for fluid balance and blood pressure regulation, and restricting it may impair placental perfusion.

Choice D:

Taking iron supplements does not compensate for the decreased red blood cell count during pregnancy.

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Question 4:

A nurse is collecting a urine sample from a pregnant client who is at 24 weeks of gestation.

The nurse performs a dipstick test and finds glucose in the urine.

The nurse knows that the normal range of urinary glucose in pregnancy is:.

A. Less than 100 mg/dL or negative on dipstick. B. Less than 200 mg/dL or trace on dipstick. C. Less than 300 mg/dL or 1+ on dipstick. D. Less than 400 mg/dL or 2+ on dipstick.

Answer and Explanation

Choice A:

The normal range of urinary glucose in pregnancy is less than 100 mg/dL or negative on dipstick. This means that there is no glucose or very little glucose in the urine of a healthy pregnant woman.

Choice B:

Less than 200 mg/dL or trace on dipstick indicates a mild glycosuria, which is when glucose is found in the urine. This can be normal during pregnancy as the kidneys allow more glucose to pass into urine during pregnancy, but it could also suggest the possibility of having undetected diabetes before this pregnancy.

Choice C:

Less than 300 mg/dL or 1+ on dipstick indicates a moderate glycosuria, which is more likely to be a sign of diabetes. A glucose tolerance test (GTT) is recommended to confirm or rule out diabetes.

Choice D:

Less than 400 mg/dL or 2+ on dipstick indicates a severe glycosuria, which is almost certainly a sign of diabetes. A GTT is also recommended to diagnose diabetes.

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Renal Changes in pregnancy

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