Nephritis Summer Test 5

b,c,d,e (Characteristics of chronic glomerulonephritis​ include: a​ slow, progressive destruction of the​ glomeruli, a gradual decline in renal​ function, a symmetrical decrease in the size of the​ kidneys, and an eventual loss of the entire nephron. The surfaces of the kidneys become granular or​ roughened, not soft and boggy)

What are the characteristics of chronic​ glomerulonephritis? ​(Select all that​ apply.) a Surfaces of the kidneys become soft and boggy ​b Slow, progressive destruction of the glomeruli c Symmetrical decrease in the size of the kidneys d Gradual decline in renal function e Entire nephrons are eventually lost

a,b,c,e (

What findings during the nursing assessment may alert the nurse to a possible client diagnosis of​ nephritis? ​(Select all that​ apply.) a History of diabetes b Presence of infection c Complaint of cough d Complaint of weight loss e Presence of facial edema

1 (The underlying pathophysiology of nephrotic syndrome involves increased glomerular permeability, which allows larger molecules to pass through the membrane into the urine and be removed from the blood. This process causes massive loss of protein, edema formation, and decreased serum albumin levels. Key features include hypertension and renal insufficiency (decreased urine output) related to concurrent renal vein thrombosis, which may be a cause or an effect of nephrotic syndrome. Flank pain is seen in patients with acute pyelonephritis. Focus: Prioritization)

You are the admitting nurse for a patient with nephrotic syndrome. Which assessment finding supports this diagnosis? 1. Edema formation 2. Hypotension 3. Increased urine output 4. Flank pain

a (Rationale To control inflammation caused by acute postinfection​ glomerulonephritis, the nurse will administer an​ immunosuppressant, Cyclophosphamide​ (Cytoxan). Prednisone, a​ glucocorticoid, also decreases inflammation.​ However, this medication is contraindicated in acute postinfection glomerulonephritis.​ Lisinopril, an ACE​ inhibitor, is used in the management of this​ condition; however, it is used to reduce proteinuria and slow the progression of renal failure.​ Hydralazine, an​ antihypertensive, is also used in the management of this​ condition; however, it is used to treat hypertension.)

A client is admitted to a medical floor with acute postinfection glomerulonephritis. Which medication will the nurse administer in an effort to reduce the inflammation caused by this​ condition? a Cytoxan b Hydralazine c Prednisone d Lisinopril

4

A client is diagnosed with pyelonephritis. Which nursing action is priority for care now? 1. monitor hemoglobin levels 2. insert a urinary cath 3. stress importance of use of long term antibiotics 4. ensure sufficient hydration

d (Rationale Lisinopril​ (Zestril), an ACE​ inhibitor, is used to reduce proteinuria and slow the progression of renal failure in acute postinfection glomerulonephritis. To control inflammation caused by acute postinfection​ glomerulonephritis, the nurse will administer an​ immunosuppressant, Cyclophosphamide​ (Cytoxan). Prednisone​ (Deltasone), a​ glucocorticoid, also decreases inflammation.​ However, this medication is contraindicated in acute postinfection glomerulonephritis. Hydralazine​ (Apresoline), an​ antihypertensive, is also used in the management of this​ condition; however, it is used to treat hypertension.)

A client is newly diagnosed with acute postinfection glomerulonephritis. Which medication will the nurse administer to manage the protein loss associated with nephrotic​ syndrome? a Cyclophosphamide​ (Cytoxan) b Prednisone​ (Deltasone) c Hydralazine​ (Apresoline) d Lisinopril​ (Zestril)

c,e (Rationale: Glucocorticoids such as prednisone are used to induce remission in nephrotic syndrome. ACE inhibitors are used to reduce protein loss in the urine. Digoxin is not a drug used to treat nephrotic syndrome. Plasmapheresis, a procedure to remove damaging antibodies from plasma, is used to treat Goodpasture syndrome. Dialysis is used for renal failure and end-stage-renal disease.)

A client with acute nephrotic syndrome asks the nurse how the disease will be treated. The nurse tells the client that treatment will likely include the following: (Select all that apply.) a Plasmapheresis b Digoxin for renal failure c Glucocorticoids d Dialysis e ACE inhibitors

a,b,c (Rationale The clients who would best benefit from this teaching are those at greatest risk for developing nephritis. Those at greatest risk include clients with​ diabetes, sickle cell​ disease, and congestive heart failure​ (CHF). Pregnancy and prostate cancer do not increase the risk for developing nephritis.)

A community health nurse is planning to teach a group of clients about the​ etiology, risk​ factors, and prevention of nephritis. Which group of clients would best benefit from this​ education? ​(Select all that​ apply.) a Clients with diabetes b Clients with congestive heart failure c Parents of children with sickle cell disease d Pregnant female clients e Male clients with prostate cancer

c (A client with a history of a nonhealing skin infection may have a history of an infection of​ streptococcus, the infectious agent that can cause nephritis. The client with nephritis would have a history of weight​ gain, not​ loss, due to the retention of sodium and water. The client suspected of having nephritis would not have muscle wasting or flaccidity and would complain of abdominal or flank​ pain, not upper back or shoulder pain.)

A nurse is caring for Maria​ Lopez, a​ 68-year-old female who presents to the hospital in a hypertensive crisis. Ms.​ Lopez's healthcare provider has ruled out a neurological cause for her symptoms and now suspects that Ms. Lopez may be suffering from nephritis. Ms.​ Lopez's nurse is performing a focused exam and is now performing Ms.​ Lopez's health history intake. Which factor would the nurse suspect as being related to the possible diagnosis of​ nephritis? a Weight loss of 10 pounds over last 2 months b Muscle wasting or flaccidity c History of a nonhealing skin infection d Upper back or shoulder pain

b (Plasmapheresis is a therapy that is used to remove damaging antibodies from the​ client's blood. This procedure is also called plasma exchange therapy. With this​ therapy, plasma and​ glomerular-damaging antibodies are removed and the RBCs are then returned to the client along with albumin or human plasma to replace the plasma removed.)

A nurse is caring for Samuel​ McMurray, a​ 68-year-old man with rapidly progressive glomerulonephritis​ (RPGN). Mr.​ McMurray's past medical history includes diabetes mellitus and hypertension. His current blood pressure is​ 142/92 and his nurse notes​ 3+ pedal edema to both of Mr.​ McMurray's legs. Mr.​ McMurray's healthcare provider has ordered antihypertensive and immunosuppressive​ medications, as well as plasmapheresis. Mr. McMurray asks his​ nurse, "What is​ plasmapheresis?" Which response by the nurse is the most​ appropriate? ​a "This therapy is also called plasma infusion​ therapy." b ​"This therapy removes damaging antibodies from your​ blood." c ​"This therapy removes the plasma from your​ blood, washes​ it, and tests​ it." d "It is a therapy that is done only once to rid your body of harmful​ toxins."

d (A clinical manifestation of acute postinfection glomerulonephritis includes hematuria​ (blood in the​ urine). Taraj will not have glucosuria​ (glucose in the​ urine), muscle​ spasms, or ECG​ abnormalities, as these are not associated with acute postinfection glomerulonephritis.)

A nurse is caring for Taraj​ Singh, a​ 5-year-old child who was recently diagnosed with strep throat and treated.​ However, a week after​ Taraj's strep throat​ diagnosis, Taraj began complaining of a severe headache and​ Taraj's mother noticed Taraj had a swollen face.​ Taraj's healthcare provider has diagnosed Taraj with acute postinfection glomerulonephritis. Which additional manifestation will​ Taraj's nurse expect to find upon physical​ assessment? a ECG abnormalities b Muscle spasms c Glucosuria d Hematuria

d (Rationale This client is likely experiencing an alteration of​ coagulation, as petechiae and bruising are manifestations of altered coagulation. Petechiae and bruising are not manifestations of alterations of skin​ integrity, immunity, and fluid volume.)

A nurse is caring for a client with Goodpasture syndrome who recently had plasmapheresis for treatment of this condition. The nurse notes petechiae and bruising to the client​'s abdomen and face. Which potential complication of plasmapheresis does the nurse​ suspect? a Alteration of immunity b Alteration of fluid volume c Alteration of skin integrity d Alteration of coagulation

a,c,d,e (Rationale The nurse would pay particular attention to the lab values that are altered in nephritis. Increased serum creatinine levels occur with renal​ impairment, such as in glomerulonephritis. Glomerular diseases interfere with filtration and elimination of urea​ nitrogen, causing blood levels of BUN to rise. Urine creatinine is decreased when renal function is impaired because creatinine is not effectively eliminated from the body. Antistreptolysin O​ (ASO) titer detects streptococcal exoenzymes and is positive in acute postinfection glomerulonephritis. The erythrocyte sedimentation rate​ (ESR) is a general indicator of inflammatory response and is increased in glomerulonephritis.)

A nurse is caring for a client with a possible diagnosis of glomerulonephritis. Which laboratory values would the nurse pay particular attention to when monitoring for manifestations of this​ condition? ​(Select all that​ apply.) a Increased BUN b Decreased ESR c Positive ASO titer d Decreased urine creatinine e Increased serum creatinine

a,b,c,d (Rationale Interventions for a client with acute glomerulonephritis primarily focus on preventing​ infection, maintaining skin​ integrity, promoting nutritional​ balance, and maintaining fluid balance. Promoting an adequate sleep pattern may be an appropriate​ intervention; however, this is not a primary focus for this client.)

A nurse is caring for a client with acute glomerulonephritis. When planning care for this​ client, which interventions take primary​ focus? ​(Select all that​ apply.) a Maintain fluid balance b Maintain skin integrity c Promote nutritional balance d Prevent infection e Promote adequate sleep pattern

c,d,e (Rationale To promote adequate nutritional​ balance, the nurse should provide a diet with no added salt and low protein. To increase the client​'s ​appetite, the nurse should allow opportunity for family to bring food from home. Diets with a large amount of dairy and meat have too much​ protein, which is contraindicated in nephritis.​ Also, the nurse should serve age appropriate quantities to children.)

A nurse is caring for a client with nephritis and wishes to assist the client in maintaining nutritional balance. Which interventions best support the client​'s nutritional​ balance? ​(Select all that​ apply.) a Provide large portions of food across the life span b Provide a diet with large portions of meat and dairy c Provide opportunity for family to bring food from home d Provide a diet low in protein e Provide a diet with no added salt

a (Rationale While all choices are aimed at monitoring the client​'s fluid​ balance, measuring the client​'s abdominal girth is the only intervention which specifically addresses changes in ascites.)

A nurse is caring for a client with nephritis who also has ascites due to excess fluid volume. Which action by the nurse is the best way to monitor the client​'s degree of​ ascites? a Measure abdominal girth b Monitor intake and output c Monitor blood pressure d Measure CVP

a (Rationale: Soy and animal proteins are complete proteins that are necessary for growth and tissue healing. Complete proteins are preferred to incomplete proteins (like breads, cereals, and grains), and this client's protein intake will likely be restricted given his compromised renal function and vascular permeability which allows excessive protein excretion into the urine. Bed rest is necessary during the acute phase of the disease only. Even if the client is prescribed a diuretic, sodium may be restricted if the client is edematous. Fluid intake is based on the client's fluid volume status assessed by his urinary output, weight, blood pressure, and serum electrolytes; thus, there is not enough information to know about fluid intake or restrictions. )

The nurse evaluates teaching of a client with glomerulonephritis as effective when the client: a chooses soy or animal proteins for allowed grams of protein in the diet. b states the need to remain on complete bed rest even after discharge. c states he won't have to monitor his salt intake because he'll be on a diuretic. d limits fluid intake to 1500 mL per day.

a (Rationale: The child with nephrotic syndrome experiences edema, and is at risk for impaired skin integrity. Although the child may not tolerate activity, may not be coping well, and may be lonely, the physiological need is the priority of care)

The nurse is caring for a child diagnosed with nephrotic syndrome. Which is the most appropriate nursing diagnosis for the child? a Risk for impaired skin integrity b Activity intolerance c Risk for loneliness d Ineffective coping

b,d,e (Rationale Manifestations of acute glomerulonephritis​ include: crackles in the​ lungs, tea-colored urine and microscopic​ hematuria, high blood​ pressure, and weight gain.)

The nurse is caring for a client with suspected acute glomerulonephritis. Which clinical manifestations support this​ suspicion? ​(Select all that​ apply.) a Low blood pressure ​b Tea-colored urine c Weight loss d Microscopic hematuria e Crackles auscultated in lungs

c

The nurse is caring for a recently diagnosed adolescent with acute glomerulonephritis. What nursing diagnosis would receive priority for nursing intervention? a Imbalanced Nutrition: Less Than Body Requirements b Anxiety c Excess Fluid Volume d Ineffective Role Performance

a (Rationale: Systemic lupus erythematosis (SLE) is an inflammatory autoimmune disease where the body develops an autoimmune response to kidney tissue. A majority of people with SLE develop lupus nephritis which manifests in varying degrees of severity, with some of these individuals ultimately developing end stage renal disease. Azotemia is a symptom, not a cause, of glomerular disorders. Acute postinfectious glomerulonephritis occurs as a complication of the body's reaction to an earlier acute infection rather than a chronic condition. Goodpasture syndrome is a primary disease process rather than a secondary effect of a chronic condition. )

The nurse is caring for an ill adult client diagnosed with a glomerular disorder caused by a chronic inflammatory process. What is the most likely related condition? a Systemic lupus erythematosus (SLE) b Azotemia c Goodpasture syndrome d Acute postinfectious glomerulonephritis

a (Rationale A client with nephritis who has a​ pre-existing condition such as​ CHF, may present with infiltrates on a chest​ x-ray. This finding indicates pulmonary edema and excess fluid volume. Midabdominal pain and flank pain may also be​ present; however, these are classic symptoms of nephritis and are not unique to a client with a​ pre-existing condition. Purulent sputum is pus in the​ sputum, which indicates an infection in the​ lungs, not​ CHF, and is not typically present.)

The nurse is caring for an older adult client diagnosed with nephritis and congestive heart failure​ (CHF). Which clinical finding may be present in this​ client, which is not a typical finding in the client with​ nephritis? a Infiltrates on chest​ x-ray b Purulent sputum c Midabdominal pain d Flank pain

d (Rationale While all choices are​ problems, which should be addressed in planning care for the client with​ nephritis, impaired fluid balance is priority as this problem may be​ life-threatening if not addressed.)

The nurse is planning care for a client with acute glomerulonephritis. Which problem is priority for the nurse to address when caring for this​ client? a Impaired nutrition b Fatigue c Impaired skin integrity d Impaired fluid balance

d (Rationale: Acute postinfectious glomerulonephritis develops most commonly as a response to a recent group A beta-hemolytic streptococcal infection of the skin or pharynx. (It can also occur as a result of Staphylococcus, pneumococcus, and the Coxsackie virus.). Nausea and vomiting, likely viral in origin, and a moderate hypersensitivity reaction are not causes of glomerulonephritis. Nephritis can occur following trauma, but insufficient information is given to know whether the nephritis is due to this injury. More likely, this is postinfectious nephritis following a pharyngeal streptococcal infection 2 weeks ago. )

The nurse is preparing to care for a child with suspected glomerulonephritis. Which historical data collected on admission most strongly supports a diagnosis of acute postinfectious glomerulonephritis (APIGN)? a The child fell from a bike 3 days ago, landing on her left side. b The child and her siblings have had nausea and vomiting from a stomach virus this past week. c The child experienced a moderate hypersensitivity reaction yesterday. d The child had a positive throat culture for streptococcus 2 weeks ago.

c (Rationale: Bed rest is required during the acute phase of glomerulonephritis, so the parents are taught to keep the child quiet and to limit the child's activities to avoid fatigue and so that body resources can be directed at healing. . Exercise and visitation by friends are limited for this reason, and to avoid exposing the child to infections others might have. Fluids are usually restricted because of the compromised functioning of the kidneys until the disease begins to abate. )

The nursing is planning care for the child with glomerulonephritis and teaches the family which intervention for care to prevent further complications or compromise to kidney health? a Encourage visitation with friends. b Promote exercise and physical activity. c Provide the child with ample rest and quiet activities. d Force intake of oral fluids.

a,b (Rationale: The severely ill client with nephritis faces a healing process that may last years and will not be cured by the time of discharge. Following fluid restrictions in the hospital as ordered is important for preventing complications from bodily fluid overload. Adhering with treatment regimens and learning to self-manage the condition at home, including adhering to sodium and protein restrictions, will be an important aspect of current and long-term care. Although some clients may never recover and will face activity restrictions, Activity limitations will be based on individual tolerance and are not universally required. )

When providing care for a hospitalized and severely ill client with nephritis, what teaching should the nurse provide? (Select all that apply.) a "Maintaining fluid restrictions as ordered in the hospital is critical to avoid complications from excess fluid." b "Healing of the kidneys takes a long time; learning self-management of your condition will be important." c "You will face significant activity restrictions for the rest of your life." d "Your condition will probably be cured by the time you leave the hospital." e "It's highly unlikely that you'll have long-term dietary sodium and protein restrictions."

d (The erythrocyte sedimentation rate​ (ESR) is a general indicator of inflammatory response and may be elevated in acute postinfection glomerulonephritis and in lupus nephritis. BUN measures urea​ nitrogen, the end product of protein​ metabolism, created by the breakdown and metabolism of dietary and body proteins. Creatinine clearance is a specific indicator of renal function used to evaluate the glomerular filtration rate​ (GFR). Antistreptolysin O​ (ASO) titer detects streptococcal exoenzymes. ESR:The normal range is 0-22 mm/hr for men and 0-29 mm/hr for women. )

Which diagnostic test is a general indicator of inflammation and may be elevated in acute postinfection glomerulonephritis and in lupus​ nephritis? a BUN b Antistreptolysin O​ (ASO) titer c Creatinine clearance d Erythrocyte sedimentation rate​ (ESR)

d (The kidney scan uses nuclear medicine to visualize the kidney after intravenous administration of a radioisotope. The KUB​ (kidney, ureter,​ bladder) is an abdominal​ x-ray which evaluates kidney size and may rule out other causes. The renal ultrasound does not use nuclear medicine. The renal biopsy is a microscopic examination of kidney tissue and does not use nuclear medicine.)

Which diagnostic test used in the collaborative care of nephritis uses nuclear medicine to visualize the​ kidney? a KUB b Renal biopsy c Renal ultrasound d Kidney scan

4

Which factor would put the client at increased risk for pyelonephritis? 1. history of hypertension 2. intake of large quantities of cranberry juice 3. fluid intake of 2000 mL/day 4. history of diabetes mellitus

4 (chronic pyelonephritis is a long term condition, often requiring antibiotic treatment for several weeks or months and close monitoring to prevent perm. kidney damage. Bed rest and analgesics may be prescribed during the acute stage, but they are usually not required long term. A urine culture is typically ordered 2 weeks after stopping antibiotics to ensure the infection has been eradicated)

Which nursing action is most applicable to a client who is newly diagnosed with chronic pyelonephritis? 1. remain on bed rest up to 2 weeks 2. expect to take an analgesic on a regular basis for the next 6 months 3. expect to provide a urine specimen for culturing every 2 weeks for up to 6 months 4. expect to be on an antibiotic for several weeks or even months

a,b,e (The client with nephritis can have excess fluid​ volume, not deficient. ​ Also, the client with nephritis may be underweight rather than overweight due to dietary restrictions necessary to treat the disease. All other diagnoses are appropriate.)

Which nursing diagnoses are most appropriate for a client with​ nephritis? ​(Select all that​ apply.) a Fatigue b Risk for infection c Risk for deficient fluid volume d Imbalanced​ nutrition: more than body requirements e Risk for impaired skin integrity

b (Rationale Clients with diabetes are at greater risk for developing nephritis because diabetes can damage the vessels of the​ nephron, leading to nephritis. Urinary incontinence and foods high in sugar are not associated with nephritis. A history of high blood​ pressure, not​ low, would place the client at greater risk for developing nephritis because hypertension can damage the vessels of the​ nephron, leading to nephritis.)

Which question would be most appropriate for the nurse to ask when assessing the client for risk factors associated with​ nephritis? ​a "Do you eat foods high in​ sugar?" ​b "Do you have​ diabetes?" ​c "Do you have urinary​ incontinence?" ​d "Do you have a history of low blood pressure or​ fainting?"

d (Goodpasture syndrome is a rare autoimmune disorder of unknown etiology that may cause pulmonary symptoms such as hemoptysis due to​ antibodies, which may bind to alveolar basement​ membranes, damaging alveoli and causing pulmonary hemorrhage. Lupus nephritis is a result of systemic lupus erythematosus​ (SLE). Acute postinfectious glomerulonephritis​ (APIGN) results from infection. Goodpasture syndrome causes proteinuria and hematuria but not glucosuria.)

Which statement is true regarding Goodpasture​ syndrome? a It may cause glucosuria​ (glucose in the​ urine). b It is a result of systemic lupus erythematosus​ (SLE). c It is caused by an infection. d It may cause hemoptysis​ (bloody sputum).