Chapter 33: Disorders of Renal Function

A cytotechnologist is performing genetic testing on a series of tissues. One tissue comes back with the WT1 mutation, and it's mapped to chromosome 11. What disease will the client most likely develop? A. Wilms tumor B. Renal cell carcinoma C. Pyelonephritis D. Alport syndrome

A. Wilms tumor Wilms tumor occurs in childhood Renal cell carcinoma occurs in adulthood

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. A. flank pain in the back B. abrupt onset of fever and chills C. heart palpitations D. shortness of breath E. urinary urgency and frequency

A. flank pain in the back B. abrupt onset of fever and chills E. urinary urgency and frequency

A client has been given the diagnosis of diffuse glomerulonephritis. The client asks the nurse what diffuse means. The nurse responds: A. "All glomeruli and all parts of the glomeruli are involved." "The mesangial cells are being affected." "Only one segment of each glomerulus is involved." "Only some of the glomeruli are affected."

A. "All glomeruli and all parts of the glomeruli are involved."

Acute pyelonephritis is a result of: A. Bacterial infection B. Renal failure C. Viral infection D. Chronic reflux

A. Bacterial infection

A nurse is assessing a client's risk for developing a hospital-acquired urinary tract infection (UTI) and determines that which of the following places the client at greatest risk? A. Impaired bladder emptying B. Increased sexual activity C. Prostate enlargement D. Indwelling urinary catheter

D. Indwelling urinary catheter Instrumentation and urinary catheterization are the most common predisposing factors for hospital-acquired (nosocomial) urinary tract infections. The other items increase risk factors but are not necessarily related to hospitalization.

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? A. increased nitrites B. positive glucose C. specific gravity of 1.025 D. solid formations

A. increased nitrites

A major complication of prolonged bed rest is an increased risk of kidney stones. The nurse knows that this is most likely related to: A. saturation of urine with calcium salts. B. a limited access to fluids while hospitalized. C. increased urine levels of citrate. D. frequency of urination.

A. saturation of urine with calcium salts. Prolonged immobility leads to bone resorption and an elevation in serum calcium which can cause the development of calcium-containing kidney stones -Elevated urine levels of citrate are a prominent inhibitor of calcium stone formation.

Which client is likely at the greatest risk of developing a urinary tract infection? A. A pregnant woman who has been experiencing urinary frequency B. A 79-year-old client with an indwelling catheter C. A confused, 81-year-old client who is incontinent of urine D. A client with a diagnosis of chronic kidney disease who requires regular hemodialysis

B. A 79-year-old client with an indwelling catheter

The nurse is caring for a 9-year-old child who has been diagnosed with urinary tract infection (UTI). Which is a commonly associated manifestation of this disorder? A. Encopresis B. Enuresis C. Endoscopic D. Anuria

B. Enuresis enuresis = involuntary urination

If a client is in the early phases of nephrotic syndrome, which area of the body will likely have the initial presence of edema? A. Abdomen B. Lower extremities C. Hands D. Eyelids

B. Lower extremities Initially, the edema caused by nephritic syndrome presents in the dependent parts of the body, such as the lower extremities

A nurse is caring for a client who has a recent history of passing calcium urinary stones. Which of the following is a priority nursing consideration for this client? A. Bowel elimination B. Hydration C. Skin care D. Bed rest

Hydration A major goal of treatment in people who have passed kidney stones or have had them removed is to prevent their recurrence. Adequate fluid intake reduces the concentration of stone-forming crystals in the urine and needs to be encouraged.

A client diagnosed with Goodpasture syndrome would require which therapy to remove proteins and autoantibodies from the system? A. Kidney removal B. Plasmapheresis C. Intravenous calcium D. Renal transplant

B. Plasmapheresis Plasmapheresis is used to filter the blood for removal of proteins and the circulating anti-GBM antibodies

A young woman presents with signs and symptoms of urinary tract infection (UTI). The nurse notes that this is the fifth UTI in as many months. What would this information lead the nurse to believe? A. There is possible obstruction in the urinary tract. B. The woman has multiple sexual partners. C. The woman takes too many bubble baths. D. The woman does not clean herself properly.

A. There is possible obstruction in the urinary tract.

Which client is displaying manifestations of having a kidney stone? A. Acute onset of colicky flank pain radiating to lower abdomen B. Elevation in systemic blood pressure and frequent urination C. A visible abdominal mass and abdominal pain in bilateral lower quadrants D. Increased thirst and urinary output with warm, dry skin

A. Acute onset of colicky flank pain radiating to lower abdomen

Which clinical manifestations would you expect to see in an infant diagnosed with autosomal recessive polycystic kidney disease (ARPKD)? A. Bilateral flank masses and impaired lung development B. Ascending urinary tract infection and vomiting C. Elevated systemic blood pressure and severe pain D. Gross hematuria and massive generalized edema

A. Bilateral flank masses and impaired lung development

Hospitalized neonates are at greatest risk of developing septicemia related to which procedure? A. Catheter-associated bacteriuria B. Collection of urine for analysis C. Arterial blood gas measurement D. Suctioning of tracheostomy

A. Catheter-associated bacteriuria

A nurse is caring for a client diagnosed with nephrotic syndrome. The nurse is aware that the client may manifest which of the following? Select all that apply. A. Lipiduria B. Generalized edema C. Hyperlipidemia D. Hyperalbuminemia E. Massive proteinuria (>3.5 g/day)

A. Lipiduria B. Generalized edema C. Hyperlipidemia E. Massive proteinuria (>3.5 g/day) Nephrotic syndrome is characterized by massive proteinuria (≥3.5 g/day in adults) and lipiduria (e.g., free fat, oval bodies, fatty casts), along with an associated hypoalbuminemia (<3 g/dL [30 g/L]), generalized edema, and hyperlipidemia. -The nephrotic syndrome is not a specific glomerular disease but a constellation of clinical findings that result from an increase in glomerular permeability and loss of plasma proteins in the urine.

A nurse is caring for a child with Wilms tumor, stage I. Which statements are true regarding this diagnosis? Select all that apply. A. Prognosis is good with treatment. B. The tumor has undergone hematogenous metastasis, most commonly involving the lung. C. Prognosis is poor even with treatment. D. The tumor is limited to the kidney and can be excised with the capsular surface intact.

A. Prognosis is good with treatment. D. The tumor is limited to the kidney and can be excised with the capsular surface intact. Long-term survival rates have increased to 90% for Wilms tumor stages I through III.

The nurse is performing a history and physical on a client with diabetic nephropathy. Findings include BP 124/80; smokes two packs of cigarettes/day; diet high in saturated fats and sodium. Which intervention can help prevent the progression of the diabetic nephropathy? A. Smoking cessation program B. Walking program C. Increase dietary sodium intake D. DASH diet with limited caloric intake

A. Smoking cessation program

A client diagnosed with Goodpasture syndrome would require which therapy to remove proteins and autoantibodies from the system? A. Intravenous calcium B. Plasmapheresis C. Renal transplant D. Kidney removal

B. Plasmapheresis Plasmapheresis is used to filter the blood for removal of proteins and the circulating anti-GBM antibodies.

Which factor contributes to the development of polycystic kidney disease? A. Enlargement in the basement membrane of the kidney B. A reduction in prerenal blood flow to the kidneys C. Hereditary mutations in polycystin I and II D. Multiple recurrent urinary tract infections

C. Hereditary mutations in polycystin I and II Polycystic kidney disease is typically related to dominant or recessive hereditary mutations in polycystin. The other options are related to urinary tract infections.

What is the usual cause of acute pyelonephritis? A. Obstruction B. Reflux C. Infection D. Autoimmunity

C. Infection

One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which electrolyte? A. Glucose B. Potassium C. Hydrogen D. Sodium

D. Sodium

The nurse caring for an older adult notes a marked decrease in mental acuity over a 24-hour period. What assessment indicates the most likely cause of this change? A. Hearing aid batteries are run down B. No bowel movement in 48 hours C. Exacerbation of osteoarthritis D. Urine cloudy with strong odor

D. Urine cloudy with strong

A 34-year-old woman presents with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in her lower back. She is also experiencing dysuria, urinary frequency, and a feeling of urgency. Her partner states that she has been very tired the last few days and that she looked like she may have the flu. What is the most likely diagnosis? A. Acute renal failure B. Acute pyelonephritis C. Renal calculi D. Renal cell carcinoma

B. Acute pyelonephritis Acute pyelonephritis tends to present with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in the loin area of the back that is unilateral or bilateral. Lower urinary tract symptoms, including dysuria, frequency, and urgency also are common.

A client admitted with acute pyelonephritis has shaking chills and acute pain. What other clinical manifestations will the nurse likely assess for this diagnosis? Select all that apply. A. Change in level of consciousness and hallucinations B. Shallow breathing and expiratory wheezes C. Moderate to high fever D. Pale skin and dry mucous membranes E. Frequency, urgency, and dysuria

C. Moderate to high fever E. Frequency, urgency, and dysuria A client diagnosed with Goodpasture syndrome would require which therapy to remove proteins and autoantibodies from the system? Intravenous calcium Plasmapheresis Renal transplant Kidney removal

An infant has been diagnosed with autosomal recessive polycystic kidney disease (ARPKD). Which treatment goal would be considered the priority in the care of this child? A. Prophylactic antibiotics B. Rehydration therapy C. Respiratory support D. Total parenteral nutrition

C. Respiratory support Aggressive ventilatory support is often necessary for neonates with ARPKD due to the presence of pulmonary hypoplasia and hypoventilation. Hydration, nutrition, and infection prevention are relevant aspects of care, but respiratory interventions are the priority.

A client is being treated with colchicine for pain in the big right toe. The client begins to complain of severe right flank pain and is diagnosed with kidney stones. Which type of kidney stone does the nurse recognize this client is most likely affected by? A. Magnesium ammonium phosphate B. Cystine C. Uric acid D. Calcium

C. Uric acid Uric acid stones develop in conditions of gout and high concentrations of uric acid in the urine; it accounts for about 7% of all stones.

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: A. nephrotic syndrome. B. kidney stones. C. acute postinfectious glomerulonephritis. D. acute renal failure.

C. acute postinfectious glomerulonephritis. The classic case of poststreptococcal glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days: