NUR334 PrepU: Chapter 25 - Disorders of Renal Function

A patient has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause?

"Have you had any type of infection within the last 2 weeks?"

The nurse should assess which of the following when assessing for the initial presence of edema in a patient with nephrotic syndrome?

Lower extremities.

A nurse is explaining the clinical manifestations of diabetic nephropathy (diabetic glomerulosclerosis) to a client. Which would be the most important information for the nurse to provide?

Microalbuminemia is a predictor of future nephropathies.

The nurse is reviewing the lab results of a patient with suspected nephrotic syndrome. The nurse anticipates that the results to include:

Protein in the urine.

Which of the following substances would not be found in glomerular filtrate?

Protein.

One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which of the following electrolytes?

Sodium.

A 34 year-old man has been taking up to 2400 mg of ibuprofen per day following a motor vehicle several months ago and consequent chronic pain. He has recently been diagnosed with chronic analgesic nephritis as a result of his high analgesic intake. The man is surprised at the diagnosis, stating, "I thought that taking too many drugs hurt your liver if anything, not your kidneys." What is the most appropriate response to the man's statement?

"Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs."

A school nurse is teaching a group of fourth-grade girls about personal hygiene. Important teaching points aimed at reducing the incidence of urinary tract infection (UTI) include which of the following? Select all that apply.

-Wiping from front to back after a bowel movement. -Avoiding bubble baths. -Careful hand washing.

Acute postinfectious glomerulonephritis, as its name implies, follows an acute infection somewhere else in the body. What is the most common cause of acute postinfectious glomerulonephritis?

Group A B-hemolytic streptococci.

A nine year-old boy has been diagnosed with the nephritic syndrome. Place the following stages in the development of his health problem in ascending order. Use all the options.

-Hypoalbuminemia. -Decreased colloidal osmotic pressure. -Proteins escape from plasma to glomerular filtrate. -Increased glomerular membrane permeability. -Accumulation of fluid in interstitial tissue (edema).

An newborn has been diagnosed with renal agenesis. Which characteristics should the nurse mention to the parents as it correlates to this diagnosis? Select all that apply.

-Low-set ears. -Epicanthic folds (skin of the upper eyelid) are present. -Receding chin.

Select the manifestations of renal cell carcinoma. Select all that apply.

-Palpable flank mass. -Often silent in the early stages. -Hematuria.

Which one of the following would the nurse see as being liable to cause the most serious long-term problems?

Polycystic kidney disease.

The nurse on a geriatric unit is assessing four clients. Which client is most likely to exhibit pyuria and high counts of urine colony-forming units?

A client who has urinary catheter in place due to confusion.

A patient is being evaluated for kidney stones. The nurse anticipates the patient will manifest:

Acute onset of colicky or dull and achy intermittent flank pain.

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:

Acute postinfectious glomerulonephritis.

A four year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the emergency department by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the healthcare team's initial differential diagnosis most likely be?

Alport syndrome.

The nurse suspects that a newborn infant who presents with bilateral flank masses, impaired lung development, and oliguria may be suffering from which of the following disorders?

Autosomal recessive polycystic kidney disease (ARPD).

Acute pyelonephritis is a result of which of the following?

Bacterial infection.

Which clinical manifestations would you expect to see in an infant diagnosed with autosomal recessive polycystic kidney disease (ARPKD)?

Bilateral flank masses and impaired lung development.

A patient who has had an intestinal bypass has developed a kidney stone. Which of the following types of kidney stone does the nurse recognize that this patient will most likely be treated for?

Calcium.

Hospitalized patients are at the greatest risk of developing septicemia related to which procedure?

Catheter-associated bacteriuria.

The family asks the nurse what the usual treatment of focal segmental glomerulosclerosis entails. The nurse responds:

Corticosteroids.

Which of the following pain descriptions would lead the nurse to suspect the client is experiencing ureteral colic?

Excruciating pain in the flank and upper outer quadrant of abdomen that radiates to bladder area.

Which of the following is a nonsurgical method of treatment for renal calculi (kidney stones)?

Extracorporeal shock wave lithotripsy (ESWL).

A nurse on an acute medical unit of a hospital has admitted a 62 year-old female from the emergency department who has been diagnosed with acute pyelonephritis. Which of the following statements most accurately conveys an aspect of the knowledge base that the nurse needs to perform adequate care and teaching?

Flank pain, dysuria, and nausea and vomiting are likely assessment findings.

Which factor contributes to the development of polycystic kidney disease?

Hereditary mutations in polycystin I and II.

A client has a dilated renal pelvis due to obstruction of urine outflow from the kidney. The pressure of filtrate formation is damaging the renal structures. Which condition is most likely?

Hydronephrosis.

A 25-year-old Asian American man arrives in the emergency room in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What disease has likely caused of his hematuria and how should it be treated?

Immunoglobulin A nephropathy and may be advised to use omega-3 fatty acids to delay progression of disease.

The nurse is assessing a patient who has a unilateral obstruction of the urinary tract. The nurse anticipates the patient may develop:

Increase in blood pressure.

A patient is to receive a radiocontrast media as part of a diagnostic scan. Which of the following is intended to reduce the nephrotoxic effects of the radiocontrast media?

Increasing the normal saline intravenous infusion rate to 125 mL/hour.

Which one of the following is the usual cause of acute pyelonephritis?

Infection.

Wilms tumor is a tumor of childhood. It is usually an encapsulated mass occurring in any part of the kidney. What are the common presenting signs of a Wilms tumor?

Large asymptomatic abdominal mass and hypertension.

The nurse is evaluating her patient's risk for an urinary tract infection. Which of the following patients has the highest risk?

Patient with obstructed urinary outflow from the kidney.

A patient diagnosed with Goodpasture's syndrome would require which of the therapies to remove proteins and autoantibodies from the system?

Plasmapheresis.

The nurse reviews the lab results for a patient who has advanced autosomal dominant polycystic kidney disease (ADPKD). The patient 's hemoglobin is 8.8 g/dL. The nurse suspects this lab value is related to which of the following causes?

Reduced production of erythropoietin.

The nurse is assessing a patient with diabetic nephropathy whose blood pressure is 124/80. The patient smokes two packs of cigarettes a day and consumes a diet high in saturated fats and sodium. The nurse's plan of care should focus on which of the following to decrease the patient's risk for progression of the diabetic nephropathy?

Smoking cessation program.

A nurse observes that a patient's urine is cola colored and considers which of the following as a possible reason?

The patient's urine contains material from the degradation of red blood cells.

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?

There is possible obstruction in the urinary tract.

Which of the following are appropriate interventions in the care of a patient diagnosed with renal calculi? Select all that apply.

-Keeping track of intake and output. -Addressing the client's pain. -Straining the client's urine.

Manifestations of polycystic kidney disease include which of the following?

Increase in kidney size bilaterally.

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.

The nurse is planning care for a patient with a urinary tract obstruction. The nurse includes assessment for which of the following possible complications?

Increased blood pressure.

Unilateral obstruction of the urinary tract may result in renin secretion, thereby leading to which of the following?

Increased blood pressure.

A client presents with sudden onset of hematuria, variable proteinuria, decreased GFR, oliguria, and signs of impaired renal function. Upon taking a history the nurse learns that the client had strep throat 3 weeks ago. Upon renal biopsy the diagnosis of acute glomerulonephritis is confirmed. What mechanism of damage is the most plausible?

Injury resulting from circulating antigen--antibody complexes that become trapped in the glomerular membrane.