Ch 32, 33, 34, 35 PrepU (renal)
Unilateral obstruction of the urinary tract may result in renin secretion, thereby leading to which manifestation? Increased urinary output Decreased sodium retention Increased blood pressure Decreased heart rate
Increased blood pressure
The nursing instructor who is teaching about disorders of the lower urinary tract realizes a need for further instruction when one of the students makes which statement? "Alterations in bladder function can include urinary incontinence with involuntary loss of urine." "Alterations in bladder function occurs frequently in the elderly." "Alterations in bladder function can only occur when there is incontinence." "Alterations in bladder function can include urinary obstruction with retention or stasis of urine."
"Alterations in bladder function can only occur when there is incontinence."
The nursing instructor who is teaching about incontinence in older adults recognizes a need for further instruction when a student makes which statement? "Frequency is not a major problem for the elderly." "A number of factors that contribute to incontinence can be altered." "Many factors can contribute to incontinence." "Incontinence can increase social isolation in the elderly."
"Frequency is not a major problem for the elderly."
Following a health promotion class, which statement by a participant demonstrates an accurate understanding of the risk factors for bladder cancer? "More than ever, I guess it would be worthwhile for me to quit smoking." "I can see that preventing bladder cancer is one more benefit of a healthy diet." "I think I should be okay because there's no history of bladder cancer in my family that I'm aware of." "I suppose I should listen to my health care provider and drink more cranberry juice."
"More than ever, I guess it would be worthwhile for me to quit smoking."
A new client on hemodialysis is watching his blood being filtered through a dialyzer. He asks the nurse how much blood typically passes through the kidney every minute? The nurse responds: 500-800 mL/minute. 1700-2000 mL/minute. 100-300 mL/minute. 1000-1300 mL/minute.
1000-1300 mL/minute.
The nurse is evaluating client risk for the development of overactive bladder/urge incontinence and determines that which client is at highest risk for this condition? A client with diabetes mellitus A client embarrassed to use a bedpan A client whose arthritis makes walking difficult A client who gave birth to two large-for-gestational age infants
A client with diabetes mellitus Overactive bladder/urge incontinence can be caused by disorders of the detrusor muscle structure, which can occur as the result of the aging process or disease conditions such as diabetes mellitus. A stroke client develops this condition as a result of neurogenic causes rather than having a disorder of detrusor muscle problem.
The nurse is evaluating client risk for the development of overactive bladder/urge incontinence and determines that which client is at highest risk for this condition? A client with diabetes mellitus A client whose arthritis makes walking difficult A client who gave birth to two large-for-gestational age infants A client embarrassed to use a bedpan
A client with diabetes mellitus Overactive bladder/urge incontinence can be caused by disorders of the detrusor muscle structure, which can occur as the result of the aging process or disease conditions such as diabetes mellitus. A stroke client develops this condition as a result of neurogenic causes rather than having a disorder of detrusor muscle problem.
Which client is displaying manifestations of having a kidney stone? Increased thirst and urinary output with warm, dry skin Elevation in systemic blood pressure and frequent urination A visible abdominal mass and abdominal pain in bilateral lower quadrants Acute onset of colicky flank pain radiating to lower abdomen
Acute onset of colicky flank pain radiating to lower abdomen One of the major manifestations of kidney stones is pain. Depending on the location, there are two types of pain associated with kidney stones-colic or noncolic. The pain may radiate to the lower abdominal quadrant, bladder area, perineum, or scrotum in men. Stones are not externally visible or palpable. Obstruction by a stone may result in urinary retention and increased fluid volume.
A warehouse worker is experiencing trouble with incontinence, especially when lifting heavy objects. What intervention is most appropriate for this client's needs? Administration of alpha-adrenergic agonist drugs as ordered Intermittent catheterization Bladder ultrasonography two to three times daily Administration of diuretics as ordered to promote frequent bladder emptying
Administration of alpha-adrenergic agonist drugs as ordered
The nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is: Testicular Kidney Bladder Uterine
Bladder
What contributes to impairment in renal function in aging? Increase in renal mass Enhancement of the proximal tubule function Decrease in functioning nephrons Increase in glomerular filtration rate
Decrease in functioning nephrons Overall, there is a decreased kidney mass with aging, predominately in the renal cortex. There is a generalized decrease in functioning nephrons. In fact, adults tend to lose approximately 10% of their nephrons for each decade beginning at 40 years of age. Proximal tubule function does not increase and neither does the glomerular filtration rate.
A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that this client will experience which manifestations? Select all that apply. Proliferation of nephrons Decreased renal endocrine function Decreased tubular reabsorption Hypophosphatemia Decreased glomerular filtration
Decreased renal endocrine function Decreased tubular reabsorption Decreased glomerular filtration
The nurse is instructing a client with advanced kidney disease (AKD) about a dietary regimen. Which restriction should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD? Carbohydrates Dietary protein Fats Foods high in calcium
Dietary protein Restriction of dietary proteins may decrease the progress of renal impairment in people with advanced renal disease. Proteins are broken down to form nitrogenous wastes, and reducing the amount of protein in the diet lowers the blood urea nitrogen and reduces symptoms.
Which dermatologic problem most often accompanies chronic kidney disease (CKD)? Hirsutism and psoriasis Alopecia and fungal rashes Petechiae and purpura Dry skin and pruritus
Dry skin and pruritus
People with chronic kidney disease (CKD) have impaired immune responses due to high levels of urea and metabolic wastes in the blood. What is one thing missing in the immune response when a person with CKD is exposed to sick people? Decrease in granulocyte count Failure to mount a fever with infection Failure of a phagocytic response with infection Impaired humoral immunity response with infection
Failure to mount a fever with infection Many persons with CKD fail to mount a fever with infection, making diagnosis more difficult. All of the other answers occur.
While taking a history from an adult client newly diagnosed with renal cell cancer, the nurse can associate which high-risk factor with the development of this cancer? Heavy smoking Inherited renal disease Adrenal medulla tumors Gastroesophageal reflux disease (GERD)
Heavy smoking
Which client clinical manifestation most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma? Hematuria Urinary urgency Oliguria Cloudy urine
Hematuria Presenting features of renal cancer include hematuria, flank pain, and presence of a palpable flank mass. Gross or microscopic hematuria, which occurs in more than 50% of cases, is an important clinical clue. Urgency, oliguria, and cloudy urine are not as closely associated with renal carcinoma.
Chronic kidney disease (CKD) can cause derangement of calcium and phosphate metabolism. The nurse will monitor a client with CKD for which lab abnormality? Select all that apply. Decreased release of parathyroid hormone (PTH) Decreased blood levels of calcium Excess calcium deposits in bone Decreased blood levels of phosphate Impaired phosphate excretion
Impaired phosphate excretion Decreased blood levels of calcium In CKD, renal ability to excrete phosphate declines. As blood levels of phosphate increase, levels of calcium inversely related to phosphate fall. This provokes an increase in PTH, which stimulates mobilization of calcium from bone.
The client with chronic kidney disease asks the nurse why he must take active vitamin D (calcitriol) as a medication. What is the most appropriate response by the nurse? In renal disease, vitamin D is unable to be transformed to its active form. The skin is no longer able to activate vitamin D for use. The bones no longer respond to vitamin D and demineralize. Vitamin D can no longer be released from the exocrine glands.
In renal disease, vitamin D is unable to be transformed to its active form. Cholecalciferol and ergocalciferol must undergo chemical transformation to become active: first to 25-hydroxycholecalciferol in the liver and then to 1,25-dihydroxycholecalciferol in the kidneys. Individuals with end-stage renal disease are unable to transform vitamin D to its active form and may require pharmacologic preparations of the active vitamin (calcitriol) for maintaining mineralization of their bones.
A nurse advises a client with recurring UTIs to drink large amounts of water. What normal protective action is the nurse telling the client to utilize? Increase washout of urine Increase immune availability Decrease acidity of urine Thin mucus to prevent bacterial adherence
Increase washout of urine The normal flow of urine functions to wash bacteria from the urinary tract. If a client is not drinking enough, urine can become stagnant and promote infection. Increased consumption of water will increase the washout. Water has no effect on acidity, consistency of mucus, or immune function.
The nurse is reviewing the laboratory work of several medical clients. Which laboratory result is most suggestive of abnormalities in kidney function? Urine gravity of 1.030 and normal serum creatinine levels Increased creatinine and blood urea nitrogen (BUN) levels Normal creatinine levels and elevated blood urea nitrogen (BUN) An absolute absence of protein in a urine sample
Increased creatinine and blood urea nitrogen (BUN) levels
What is the usual cause of acute pyelonephritis? Infection Autoimmunity Reflux Obstruction
Infection Gram-negative bacteria, including Escherichia coli and Proteus, Klebsiella, Enterobacter, and Pseudomonas species, are the most common causative agents for acute pyelonephritis.
An older adult presents to the primary health care provider's office with a report of bladder leakage. Which assessment correlates with a diagnosis of stress incontinence? Large amount of urine leakage during a hyperglycemic episode Urinary retention followed by overflow and incomplete emptying Loss of small amounts of urine when laughing or sneezing Complete bladder emptying when the first sensation of fullness is felt
Loss of small amounts of urine when laughing or sneezing
Following the diagnosis of nephrotic syndrome, the nurse knows the clinical manifestations occur as a result of a decreased plasma colloidal osmotic pressure. Therefore, the nurse should assess the client for which signs? Select all that apply. Areas of diminished breath sounds due to pleural effusions Liver enlargement Kidneys palpable to deep palpation Moist crackles in both lung fields Increased circumference in the abdomen related to fluid excess
Moist crackles in both lung fields Areas of diminished breath sounds due to pleural effusions Increased circumference in the abdomen related to fluid excess
The nurse has delegated obtaining a urine specimen for testing to the nursing assistant. What does the nurse emphasize the assistant should do to ensure accuracy of testing? Record the volume of urine obtained in the medical record. Encourage the client to drink water prior to obtaining the specimen. Obtain a freshly voided specimen. Teach the client the purpose of the test.
Obtain a freshly voided specimen.
Select the manifestations of renal cell carcinoma. Select all that apply. Often silent in the early stages Hematuria Does not metastasize Palpable flank mass
Often silent in the early stages Hematuria Palpable flank mass
A client asks the nurse what the most common sign/symptom of bladder cancer is. Which is the best response by the nurse? Continual dysuria Intermittent urgency Painless hematuria Urinary frequency
Painless hematuria The most common sign of bladder cancer is painless hematuria. Gross hematuria is a presenting sign in 75% of persons with the disease, and microscopic hematuria is present in most others. Frequency, urgency, and dysuria occasionally accompany the hematuria.
The nurse would be most concerned when the glomerular filtrate contains: Protein Potassium Water Sodium
Protein The glomerular filtrate has a chemical composition similar to plasma, but it contains almost no proteins because large molecules do not readily cross the glomerular wall. Potassium, sodium, and water would be filtered.
The nurse recognizes that acute renal injury is characterized by which of the following? Decreased blood urea nitrogen (BUN) Rapid decline in renal function Irreversible damage to nephrons Low incidence of mortality
Rapid decline in renal function Acute renal injury is a rapid decline in kidney function. BUN rises as nitrogenous wastes are not removed from the circulation. If the cause can be ameliorated, the injury is usually reversible. Most at risk are seriously ill clients; the mortality rate is between 40% and 90% in these clients.
The GFR is considered to be the best measure of renal function. What is used to estimate the GFR? Serum creatinine BUN Serum protein Albumin level
Serum creatinine In clinical practice, GFR is usually estimated using the serum creatinine concentration. The other answers are not used to estimate the GFR.
An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which early sign of prerenal injury? Sharp decrease in urine output Intermittent periods of confusion Excessive voiding of clear urine Acute hypertensive crisis
Sharp decrease in urine output Dehydration and its consequent hypovolemia can result in acute renal failure that is prerenal in etiology. The kidney normally responds to a decrease in GFR with a decrease in urine output. Thus, an early sign of prerenal injury is a sharp decrease in urine output. Post-renal failure is obstructive in etiology, and intrinsic (or intrarenal) renal failure is reflective of deficits in the function of the kidneys themselves.
A medical client's routine urinalysis includes the following data: Casts: positive Red blood cells: negative Crystals: negative White blood cells: negative Epithelial cells: few Which interpretation of these findings is the most plausible? The client may have leukopenia. The client has no indication of renal pathology. Urine specific gravity is likely to be lower than normal. The client's urine contains excessive protein.
The client's urine contains excessive protein. The presence of casts is associated with proteinuria, such as that which accompanies nephrotic syndrome. An absence of white cells is expected, and does not denote leukopenia. There is no clear indication of the specific gravity from these findings.
A client with chronic kidney disease (CKD) will be managed with peritoneal dialysis. Which description of this type of dialysis is most accurate? The dialyzer is usually a hollow cylinder composed of bundles of capillary tubes. Vascular access is achieved through an internal arteriovenous fistula or an external arteriovenous shunt. Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time. Treatments typically occur three times each week for 3 to 4 hours.
Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time.
A client is diagnosed with gout in the right foot and a kidney stone in the left ureter. The nurse recognizes these conditions may have resulted from accumulation of which chemical in the body? Protein Uric acid Urea Albumin
Uric acid Uric acid is a product of purine metabolism. Excessively high blood levels (i.e., hyperuricemia) can cause gout, and excessive urine levels can cause kidney stones. Albumin, protein, and urea do not contribute to kidney stone or gout formation.
The nurse is caring for a client who is diagnosed with gout. Which laboratory study does the nurse monitor to monitor this condition? Urea nitrogen levels Potassium levels Uric acid levels Bicarbonate levels
Uric acid levels Uric acid is a product of purine metabolism. Excessively high blood levels (i.e., hyperuricemia) can cause gout, and excessive urine levels can cause kidney stones.
The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents: a need to increase water intake. that the kidneys are functioning normally. a loss of over half the client's normal kidney function. concentrated urine.
a loss of over half the client's normal kidney function.
The nurse recognizes the most common cause of acute postinfectious glomerulonephritis as: prolonged blockage of the ureter with a stone. a streptococcal infection 7 to 12 days prior to onset. drug-induced damage to the renal glomeruli. uncontrolled diabetes with increased proteinuria.
a streptococcal infection 7 to 12 days prior to onset.
The nurse is reviewing the results of a renal client's laboratory results. This client's urine specific gravity allows the nurse to assess the kidneys' ability to: concentrate urine. excrete excess hydrogen ions. concentrate protein. excrete potassium.
concentrate urine. Urine specific gravity is used to assess the kidneys' ability to concentrate urine and provides a valuable index of the hydration status and functional ability of the kidneys. Specific gravity does not evaluate electrolyte or acid-base functions of the kidneys. It is not affected by protein levels.
A 65-year-old female who smokes presents with increased urinary frequency, dysuria, and sporadic, painless hematuria. The client's follow-up will likely include: bladder retraining. long-term intermittent catheterization. cystoscopy. lithotripsy.
cystoscopy.
The nurse assesses a client in an ambulatory care facility. Which manifestation(s) leads the nurse to advocate for investigation of possible acute pyelonephritis? Select all that apply. shortness of breath heart palpitations abrupt onset of fever and chills urinary urgency and frequency flank pain in the back
flank pain in the back abrupt onset of fever and chills urinary urgency and frequency
A client has been diagnosed with an uncomplicated urinary tract infection (UTI) for the second time in a year. Which teaching will the nurse include to prevent the most common cause of recurrent uncomplicated UTIs? wearing gloves when wiping perineum after defecation to prevent Staphylococcus aureus infection washing hands prior to inserting a tampon to minimize the risk of group B Streptococcus proper handwashing to decrease amount of Pseudomonas growing on the hands hygiene practices to reduce exposing the urethral meatus to Escherichia coli
hygiene practices to reduce exposing the urethral meatus to Escherichia coli
The nurse is evaluating the urinalysis results of a client presenting with polyuria and lower abdominal pain due to a suspected urinary tract infection. Which finding should the nurse expect? increased nitrites solid formations specific gravity of 1.025 positive glucose
increased nitrites The nurse would expect the urinalysis of a client with a urinary tract infection to have increased nitrites, because bacteria reduce nitrates in the urine to nitrites. Glucose and protein are not normal findings and would require follow-up. Specific gravity of 1.025 is within normal limits; solid formations in the urine suggest calculi.
A client in the hospital is frustrated at the inconvenience of having to collect his urine for an entire day and night as part of an ordered 24-hour urine-collection test. The client asks the nurse why the test is necessary since the client provided a single urine sample 2 days prior. How could the nurse best respond? •"A single urine sample lets your care team determine if there are bacteria in your urine, but other tests of urine chemistry need a longer term view." •"Often when an abnormal substance shows up in a urine test, a 24-hour urine collection is needed to determine exactly how much is present in your urine." •"Only a longer-term test is able to show whether your kidneys are letting sugar spill out into your urine." •"Current lab tests aren't able to detect the small quantities of most substances contained in a single urine sample."
"Often when an abnormal substance shows up in a urine test, a 24-hour urine collection is needed to determine exactly how much is present in your urine."
With the increased risk of drug toxicity among chronically ill older adults, which statement by the nurse explains why the older adult's kidney is vulnerable to toxic injury? "The health care provider does not always monitor for toxicity at each follow-up appointment." "The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney." "Every drug dosage should be determined by client weight but most clients refuse to get on the scale." "Prescribed medications may not be monitored as closely as they should be since Medicare does not reimburse for routine laboratory testing."
"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney." Alterations in pharmacokinetics occur with advancing age and increase the likelihood of toxic reactions. The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney. The toxic effects, which cause some minor necrosis, are generally limited to the proximal tubule. In addition, the kidney is an important site for metabolic processes that transform relatively harmless agents into toxic metabolites. It would not necessarily be effective care to rely on medication therapy as only a last resort. Monitoring would not prevent toxicity but rather identify it earlier. Not all medications can be prescribed by a client's weight.
A client newly diagnosed with glomerulonephritis asks the nurse, "What caused me to get this disease?" Which response by the nurse is most accurate? Catheter-induced infection Glomerular membrane viruses Antigen-antibody complexes Vesicoureteral reflux
Antigen-antibody complexes Two types of immune mechanisms have been implicated in the development of glomerular disease: injury resulting from antibodies reacting with fixed glomerular antigens and injury resulting from circulating antigen-antibody complexes that become trapped in the glomerular membrane. Reflux, which is the most common cause of chronic pyelonephritis, results from superimposition of infection on congenital vesicoureteral reflux or intrarenal reflux. Urinary catheters provide a means for microorganisms to ascend into the urinary tract to cause bladder infections or pyelonephritis.
A client has been diagnosed with chronic kidney disease (CKD). Which drug category is usually administered to treat coexisting conditions that manifest early in CKD? Nonsteroidal anti-inflammatory drugs (NSAIDs) Antiarrhythmic medications Opioid analgesics Antihypertensive medications
Antihypertensive medications Hypertension is a common result of CKD, and the mechanisms that produce hypertension in CKD include increased vascular volume, elevation of peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins, and increased activity of the renin-angiotensin-aldosterone system. NSAIDs, opioids, and antiarrhythmics are not as frequently indicated for the treatment of CKD.
While assessing a peritoneal dialysis client in the home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as: Bladder erosion Peritonitis Too much sugar in the dialysis solution Bowel perforation
Peritonitis Potential problems with peritoneal dialysis include infection, catheter malfunction, dehydration, hyperglycemia, and hernia. Bowel perforation can occur, but the fluid would be stool colored. The client may develop hyperglycemia; however, this will not cause the fluid to be cloudy. If bladder erosion had occurred, the fluid would look like urine and not be cloudy and white.
Which physiologic process is performed by the kidneys and contributes to increased blood pressure? Conversion of aldosterone to angiotensin Production and release of renin Secretion of aldosterone Catalysis of the conversion of angiotensin I to angiotensin II
Production and release of renin
When the glomerular transport maximum for blood glucose is exceeded and its renal threshold has been reached, what happens to the excess glucose? Attaches to protein carriers sodium countertransport Reabsorbs quickly Spills into the urine
Spills into the urine
When the glomerular transport maximum for blood glucose is exceeded and its renal threshold has been reached, what happens to the excess glucose? Reabsorbs quickly Attaches to protein carriers Spills into the urine sodium countertransport
Spills into the urine
When the glomerular transport maximum for blood glucose is exceeded and its renal threshold has been reached, what happens to the excess glucose? Spills into the urine Reabsorbs quickly Attaches to protein carriers sodium countertransport
Spills into the urine When the substance (such as blood glucose) exceeds the number of carrier proteins available for transport, the transport maximum has been exceeded, the renal threshold is reached, and the substance will spill (not reabsorb) into the urine. Sodium cotransport helps to move the substance back into the tubule.
A client is admitted with lower urinary tract obstruction and stasis. Which action is the primary intervention? Urinary catheterization Laxative administration Administration of intravenous fluids Increased oral fluids
Urinary catheterization The relief of lower urinary tract obstruction is directed toward relief of bladder distension through urinary catheterization. This is the primary intervention. The other interventions are not the priority.
A child has been brought to an urgent care clinic. The parents state that the child is "not making water." When taking a history, the nurse learns the child had a sore throat about 1 week ago but seems to have gotten over it. "We [parents] only had to give antibiotics for 3 days for the throat to be better." The nurse should suspect the child has developed: kidney stones. nephrotic syndrome. acute renal failure. acute postinfectious glomerulonephritis.
acute postinfectious glomerulonephritis. The classic case of poststreptococcal glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days: the time needed for the development of antibodies. The primary infection usually involves the pharynx (pharyngitis), but can also result from a skin infection (impetigo). Oliguria, which develops as the GFR decreases, is one of the first symptoms.
A nursing student studying pharmacology is learning how angiotensin converting enzyme inhibitors (ACE) work. The student is correct when stating that the mechanism of action of ACE inhibitors is to: block aldosterone. promote osmotic diuresis. prevent reabsorption of sodium in the distal tubules. prevent conversion of angiotensin I to II.x
prevent conversion of angiotensin I to II. The juxtaglomerular cells of the kidney contain granules of inactive renin, an enzyme that functions in the conversion of angiotensinogen to angiotensin. Angiotensin I is converted to angiotensin II in the presence of converting enzyme. By blocking converting enzyme, angiotensin II, a potent vasoconstrictor, is not produced, thus lowering blood pressure.
A client with end-stage kidney disease has developed anemia. The nurse teach this client that the reason anemia has developed is: clients with kidney disease must avoid consuming iron. medications taken for kidney disease destroy the red blood cells. activation of vitamin D cannot occur when kidneys are damaged. the damaged kidney is unable to produce erythropoietin.
the damaged kidney is unable to produce erythropoietin.