Patho Final, Chapter 26- Acute Kidney Injury and Chronic Kidney Disease, NUR565 Exam 4, patho chapter 26, Chapter 25 (30-40): Disorders of Renal Function, Chapter 27, 28, 29, Elsevier Acute Kidney and Chronic Kidney Disease: Chapter 47, Patho Test 1...

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The nurse is providing care for a patient who has a diagnosis of kidney failure. Which of the following laboratory findings is consistent with this patients diagnosis?

Hypocalcemia

The dialysis nurse is administering hemodialysis to a patient with chronic kidney failure. For what common complication should the nurse carefully monitor in this patient? 1 Hernias 2 Pneumonia 3 Hypotension 4 Lower back pain

Hypotension

A patient diagnosed with congestive heart failure has an arterial blood oxygen level (PaO2) of 89%. Which of the following terms should the nurse use to document a reduced oxygenation of arterial blood?

Hypoxemia

The nurse is caring for a client diagnosed with pneumonia. The client's arterial blood gas results identify decreased level oxygen in the arterial blood and a decreased in the partial pressure of oxygen. The nurse would interpret this as:

Hypoxemia

Antibody testing has confirmed that a man is positive for hepatitis A virus (HAV). Which of the patients statements suggests that he understands his new diagnosis?

I dont know why I didnt bother to get vaccinated against this.

A 66-year-old woman has been diagnosed with diverticular disease based on her recent complaints and the results of a computed tomography (CT) scan. Which of the patients following statements demonstrates an accurate understanding of this diagnosis?

I suppose I should try to eat more fiber and become a bit more active.

A client is suspected to have renal disease. The nurse would suggest which diagnostic determinations to confirm this diagnosis? Select all that apply.

Imaging studies; Ultrasonography; Measurement of cystatin C; Urinary sediment of red and white cells

A client diagnosed with CKD has begun to experience periods of epistaxis and has developed bruising of the skin and subcutaneous tissues. The nurse recognizes these manifestations as:

Impaired platelet function

For a client with which of the following is the use of oxygen at a rate above 2 L/minute inappropriate?

Chronic obstructive pulmonary disease (COPD), sitting in bed with cyanosis and pulse oximeter reading 57%

Which area of the body should a nurse focus on when palpating the thoracic cage of a client when assessing for any pulmonary disease? Select all that apply

Clavicles, and ribs.

Impaired skin integrity and skin manifestations are common in persons with chronic kidney disease. Pale skin and subcutaneous bruising are often present as a result of:

Impaired platelet function

Following the diagnosis of acute renal failure, the nurse knows that one of the earliest manifestations of tubular damage is which laboratory/diagnostic result?

Inability to concentrate urine

The nurse is assessing a client who has a unilateral obstruction of the urinary tract. Which clinical finding by the nurse correlates to this diagnosis?

Increase in blood pressure

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

Which alteration in acid-base balance could be expected as a compensatory response for a client with severe chronic respiratory impairment?

Increased arterial blood bicarbonate

The nurse is planning care for a client with a urinary tract obstruction. The nurse includes assessment for which possible complication?

Increased blood pressure

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

Increased blood pressure

When evaluating the pulmonary function test results for a COPD client, which one correlates to the mismatch of ventilation and perfusion associated with this diagnosis?

forced expiratory volume is decreased.

Factors that contribute to the formation of gallstones, or acute cholelithiasis, include:

gallbladder inflammation

Crohns type of inflammatory bowel disease is characterized by:

granulomatous lesions.

Which conditions have the potential to cause chronic kidney disease? Select all that apply. -Hypertension -Cardiomyopathy -Diabetes -Glomerulonephritis

-Hypertension -Diabetes -Glomerulonephritis

A child has received a kidney transplant at the age of 3. Knowing he will be on immunosuppressive agents like corticosteroids, the nurse should educate the parents about which long-term side effects? Select all that apply. -Excess weight loss -Hypertension -Frequent hematuria -Growth retardation -Development of cataracts

-Hypertension -Growth retardation -Development of cataracts

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

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

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. -Impaired phosphate excretion -Excess calcium deposits in bone -Decreased blood levels of calcium -Decreased release of parathyroid hormone (PTH) -Decreased blood levels of phosphate

-Impaired phosphate excretion -Decreased blood levels of calcium

Albuminuria is an important indicator of nephron damage. The nurse recognizes that which statements regarding albuminuria are correct? Select all that apply. -Increased excretion of low-molecular-weight globulins indicates chronic kidney disease (CKD). -Increased excretion of albumin indicates CKD. -Urine dipstick can detect albuminuria. -Albumin-to-creatinine ratio can confirm albuminuria. -Urine normally contains no protein.

-Increased excretion of albumin indicates CKD. -Urine dipstick can detect albuminuria. -Albumin-to-creatinine ratio can confirm albuminuria.

Acute respiratory failure is commonly signaled by varying degrees of hypoxemia and hypercapnia. Which physiologic findings are considered a direct result of respiratory acidosis that develops as a result of hypercapnia?

Increased cerebral blood flow

A client has a diagnosis of chronic renal failure secondary to diabetic nephropathy. Which of the following hematologic changes may result from this client's kidney disorder?

Anemia

Chronic kidney disease impacts many systems in the body. What is the most common hematologic disorder caused by CKD?

Anemia

The nurse recognizes that which medication is appropriate to give to patients with kidney failure? 1 Magnesium antacids 2 Aluminum preparations 3 Angiotensin receptor blockers 4 Nonsteroidal antiinflammatory agents

Angiotensin receptor blockers - Hypertension is a common finding in a patient with kidney failure due to retention of sodium and water. This is treated with angiotensin receptor blockers.

14. A client is admitted with worsening heart failure. The client is complaining about having to urinate frequently. The nurse knows that the physiology behind the body's response to decrease vascular volume by increasing urine output is due to: A) Release of atrial natriuretic peptide (ANP) from overstretched atria B) Renin secretion, resulting in angiotensin II formation C) Reabsorption of potassium from the proximal tubule D) Aldosterone secretion by the adrenal gland, which inhibits sodium absorption

Ans: A Feedback: ANP is believed to play an important role in salt and water excretion by the kidney. It is synthesized by muscle cells in the atria of the heart and released when the atria are stretched. Increased levels of this peptide directly inhibit the reabsorption of sodium and water in the renal tubules. ANP also inhibits renin secretion and therefore angiotensin II formation, which in turn reduces reabsorption of sodium. The decrease in sodium reabsorption increases urine output and helps return blood volume to normal. ANP levels, which become elevated when the atria are stretched in HF, help to decrease vascular volume by increasing urine output. Potassium reabsorption is not responsible for water excretion. Aldosterone secretion by the adrenal gland functions in the regulation of sodium and potassium elimination by the principal cells in the distal and collecting tubules.

8. A client who has been diagnosed with Addison disease will likely experience which of the following lab results related to the absence of aldosterone? A) Serum potassium levels elevated B) Increased serum sodium levels C) Elevated creatinine levels D) Decreased serum chloride levels

Ans: A Feedback: Aldosterone exerts a strong influence on potassium secretion in the distal and collecting tubules. In the absence of aldosterone, as occurs in Addison disease, potassium secretion is markedly decreased, causing blood levels to increase. In the presence of aldosterone, almost all the sodium in the distal tubular fluid is reabsorbed, and the urine essentially becomes sodium free. In the absence of aldosterone, virtually no sodium is reabsorbed from the distal tubule, and excessive amounts of sodium are lost in the urine.

15. A client who has developed stage 3 renal failure has been diagnosed with high phosphate levels. To avoid the development of osteodystrophy, the physician may prescribe a phosphate-binding agent that does not contain: A) Aluminum B) Calcium carbonate C) Calcium acetate D) Sevelamer hydrochloride

Ans: A Feedback: Aluminum-containing antacids can contribute to the development of osteodystrophy, whereas calcium-containing phosphate binders can lead to hypercalcemia, thus worsening soft tissue calcification, especially in persons receiving vitamin D therapy. Sevelamer hydrochloride is a newer phosphate-binding agent that does not contain calcium or aluminum.

2. 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 of the following early signs of prerenal injury? A) Sharp decrease in urine output B) Excessive voiding of clear urine C) Acute hypertensive crisis D) Intermittent periods of confusion

Ans: A Feedback: 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. Postrenal failure is obstructive in etiology, and intrinsic (or intrarenal) renal failure is reflective of deficits in the function of the kidneys themselves.

22. A client has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal calculi. Which of the following measures should the client integrate into his lifestyle to reduce the risk of recurrence? A) Increased fluid intake and dietary changes B) Weight loss and blood pressure control C) Regular random blood glucose testing D) Increased physical activity and use of over-the-counter diuretics

Ans: A Feedback: Depending on the type of stone that was present, many clients benefit from increased fluid intake and changes in diet. Weight loss, blood sugar and pressure control, and exercise are not central preventative measures. It would likely be inappropriate to recommend the use of over-the-counter diuretics as a preventative measure.

A client has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal calculi. Which measures should the client integrate into his or her lifestyle to reduce the risk of recurrence?

Increased fluid intake and dietary changes

The primary care provider for a newly admitted hospital patient has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The patients GFR will be extrapolated from serum levels of:

creatinine.

Which of the following manifestations are more commonly found in chronic bronchitis than in emphysema?

cyanosis

common cause of bacterial pneumonia in both community and hospital setting is: a) E. coli b) S. aureus c) enterobacter d) S. pneumoniae

d) S. pneumoniae

The pathogenic capacity of the tubercle bacillus is related to: a) formation of ghon focus lesion b) its inherent destructive capabilities c) rapid viral replication in host cells d) initiation of a cell-mediated immune response

d) initiation of cell-mediated immune response

which of the following individuals is most clearly in need of diagnostic testing for lung cancer? a) client who has required hospitalization with a fever and production of copious lung secretions b) client with history of secondary TB who failed to complete his prescribed course of antibiotics c) woman who complains of recurrent LRTI and who has sought care for increasing SOB d) man who demonstrates wasting of pelvic and shoulder muscles combined with signs of hypercalcemia

d) man who demonstrates wasting of pelvic and shoulder muscles combined with signs of hypercalcemia

a client has presented to an ambulatory clinic complaining of a persistent headache. what assessments should the clinician conduct to differentiate between rhino sinusitis and alternative health problems? a) take sputum sample for culture and sensitivity b) compare client's oral, tympanic, and axillary temp and order a WBC count c) palpate client's lymph nodes and inspect ears with otoscope d) perform transillumination and ask the client if bending forward exacerbates the headache

d) perform transillumination and ask if bending forward exacerbates headache

A distinguishing feature of viral influenza is: Select one: a. Profuse watery nasal discharge b. Direct contact transmission c. Constant pounding headache d. Abrupt-onset, profound malaise

d. Abrupt-onset, profound malaise --One distinguishing feature of influenza is the rapid onset, sometimes within minutes, of profound malaise. As with many viral respiratory tract infections, transmission is by aerosol or direct contact. In the early stages, the symptoms of influenza often are indistinguishable from other viral infections—fever, chills, malaise, muscle aching, headache, profuse watery nasal discharge, nonproductive cough, and sore throat. Persons with chronic rhinosinusitis complain of a constant pounding headache.

COPD clients live with persistently elevated PCO2 levels. Therefore, which assessment finding would likely initiate a stimulus for ventilation in this client population? Select one: a. Arterial blood gas pH of 7.35 b. PCO2 level of 65 mm Hg c. Pulse oximeter reading of 96% saturation d. PO2 level of 50 mm Hg

d. PO2 level of 50 mm Hg --The central chemoreceptors are extremely sensitive to short-term changes in blood PCO2 levels. An increase in the PCO2 of the blood produces an increase in ventilation that reaches its peak within a minute or so and then declines if the PCO2 level remains elevated. Thus, persons with chronically elevated blood PCO2 levels no longer respond to this stimulus for increased ventilation but rely on the stimulus provided by a decrease in arterial PO2 levels that is sensed by the peripheral chemoreceptors.

Which of the following is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma? Select one: a. Respiratory tract infections b. Cold weather c. Stress d. Pet dander

d. Pet dander --Extrinsic or atopic asthma is typically initiated by a type I hypersensitivity reaction induced by exposure to an extrinsic antigen or allergen such as pet dander. Intrinsic or nonatopic asthma triggers include respiratory tract infections, exercise, hyperventilation, cold air, drugs and chemicals, hormonal changes and emotional upsets, airborne pollutants, and gastroesophageal reflux.

With acute respiratory distress syndrome (ARDS), a client progressively increases his work of breathing. The physiological principle behind this respiratory distress is related to: Select one: a. Increases in left atrial pressure causing thickening of the lining of the pulmonary arteries b. The elevation of pulmonary venous pressure c. Structural abnormalities of pulmonary vessels with proliferation of the vessel intima d. The stiffening of the lung, making it more difficult to inflate

d. The stiffening of the lung, making it more difficult to inflate --As the disease (ARDS) progresses, the work of breathing becomes greatly increased as the lung stiffens and becomes more difficult to inflate. There is increased intrapulmonary shunting of blood, impaired gas exchange, and hypoxemia despite high supplemental oxygen therapy. With pulmonary hypertension, there are continued increases in left atrial pressure, which can lead to medial hypertrophy and intimal thickening of the small pulmonary arteries, causing sustained hypertension. Pulmonary hypertension also causes an elevation of pulmonary venous pressure.

A respiratory therapist has asked a client to breathe in as deeply as possible during a pulmonary function test. Inspiration is normally the result of which of the following phenomena?

decreased intrathorasic pressure

Thyroid hormone deficit ___________, which alters the function of all major organs in the body.

decreases metabolism

Client and family education regarding peritoneal dialysis should include assessing the client for:

dehydration that may appear as dry mucous membranes or poor skin turgor.

Manifestations of childhood renal disease are varied and may differ from adult onset renal failure. Features of childhood chronic kidney disease include:

developmental delays

Manifestations of childhood renal disease are varied and may differ from adult onset renal failure. Features of childhood chronic kidney disease include:

developmental delays.

A patient is beginning to recover from acute tubular necrosis. The recovery phase of ATN is characterized by:

diuresis.

Your patient describes a sensation of shortness of breath and the inability to get enough air. This is documented as:

dyspnea

Lower urinary tract symptoms

dysuria, frequency, and urgency, also are common. Nausea and vomiting may occur along with abdominal pain

Which of the following is defined as an irreversible enlargement of the air spaces beyond the terminal bronchioles, most notably in the alveoli, resulting in destruction of the alveolar walls and obstruction of airflow?

emphysema

The nurse is providing care for a client who has a diagnosis of kidney failure. Which of the following laboratory findings is consistent with this client's diagnosis?

Hypocalcemia

Regardless of the cause, chronic kidney disease results in progressive permanent loss of nephrons, glomerular filtration and renal:

endocrine functions.

a peptic ulcer affects a single layer of the stomach or duodenum

false

the digestive tract is a single layered tube

false

the storage and emptying of urine involves voluntary control only

false

A child with asthma is walking outside and develops a bronchospasm. The school nurse knows this bronchospasm has what effects on bronchioles with airflow? Select all that apply.

narrowing bronchioles, and impairs airflow.

Increased upper airway resistance and decreased airflow into the lungs in neonates (0 to 4 weeks of age) can result from:

nasal congestion

Alcoholic liver disease manifests in three stages. The intermediate stage, alcoholic hepatitis, is characterized by liver cell:

necrosis.

The nurse recognizes which laboratory data as the most significant indicator that a patient is responding positively to peritoneal dialysis? 1 Creatinine of 7 mg/dL 2 Potassium of 4.1 mEq/L 3 A below-normal calcium level 4 Increased level of blood urea nitrogen

Potassium of 4.1 mEq/L

A 43-year-old female has recently been diagnosed with systemic lupus erythematosus (SLE) glomerulonephritis. She has presented to the out-client department to have a renal biopsy. Knowing the usual treatment options, the nurse should anticipate educating the client (who has a positive biopsy result) on which of the following medications being prescribed? Select all that apply.

Prednisone, a corticosteroid; Captopril, an ACE inhibitor

A patients longstanding diagnosis of congenital hemolytic anemia often manifests itself with jaundice. What type of jaundice does this patient most likely experience?

Prehepatic

A newly admitted critical head injury client presents to the neuro-ICU. The client is unresponsive to painful stimuli but able to breathe on his own. As the shift progresses, the nurses note a decrease in the client's respiratory effort. The client cannot maintain his O2 saturation above 70%. The nurses should anticipate assisting in beginning what type of pulmonary support?

Prepare for mechanical ventilation.

An 86-year-old client is being treated for dehydration and hyponatremia after curtailing fluid intake to prevent urinary incontinence. Given these findings, the nurse recognizes that this client is likely in what phase of acute kidney injury?

Prerenal

An 86-year-old female patient has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to prevent urinary incontinence. The patients most recent laboratory results are suggestive of acute renal failure. How would this patients renal failure be categorized?

Prerenal

A client in renal failure has marked decrease in renal blood flow caused by hypovolemia, the result of gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which form of acute renal injury does this client have?

Prerenal failure

Nitric oxide, a vasodilator produced by the vascular endothelium, is important in renal control by: Select all that apply.

Preventing excessive vasoconstriction | allowing normal excretion of sodium & water

A client recently had surgery for a hip fracture. Which nursing intervention would be most effective for preventing pulmonary emboli in this client?

Prevention of the development of a deep vein thrombosis

A patient recently had surgery for a hip fracture. Which of the following nursing interventions would be most effective for preventing pulmonary emboli in this patient?

Prevention of the development of a deep vein thrombosis

Which of the following physiologic processes is performed by the kidneys and contributes to increased blood pressure?

Production and release of renin

Which of the following physiologic processes is a direct effect of the release of growth hormone by the anterior pituitary?

Production of insulin-like growth factors (IGFs) by the liver

An infant has been diagnosed with autosomal recessive polycystic kidney disease (ARPKD). Which of the following treatment goals would be considered the priority in the care of this child?

Respiratory support

The patient has right upper quadrant pain caused by acute choledocholithiasis. If the common bile duct becomes obstructed, manifestations will also include:

bilirubinuria.

a college student is lamenting the fact that she has developed a cold on the weekend prior to exam week. which of the following statements shows that the student has an accurate understanding of her URTI? a) "i'm just going to try and rest as much as i can until these bacteria clear up" b) "i think i'll go to campus clinic and see if i can get a prescription for antibiotics" c) "i suppose i should have been washing my hands more in the past few days" d) if i can just start some antihistamines asap i bet ill get over this faster"

c) "i should've been washing my hands more in the past few days"

which of the following types of lung cancer is associated with the best prognosis in the majority of patients? a) SCLC b) adenocarcinoma c) squamous cell carcinoma d) large cell carcinoma

c) squamous cell carcinoma

When evaluating the pulmonary function test results for a COPD client, which one correlates to the mismatch of ventilation and perfusion associated with this diagnosis? Select one: a. Total lung capacity (TLC) is decreased. b. Forced vital capacity (FVC) is elevated. c. Forced expiratory volume (FEV) is decreased. d. Marked decrease in residual volume (RV).

c. Forced expiratory volume (FEV) is decreased. --In clients with chronic lung disease, the FVC is decreased, the FEV1.0 is decreased, and the ratio of FEV1.0 to FVC is decreased. Lung volume measurements reveal a marked increase in RV, an increase in TLC, and elevation of the RV-to-TLC ratio.

Increased upper airway resistance and decreased airflow into the lungs in neonates (0 to 4 weeks of age) can result from: Select one: a. Productive coughing b. Sleeping supine c. Nasal congestion d. Frequent crying

c. Nasal congestion --The neonate (0 to 4 weeks of age) breathes predominantly through the nose and does not adapt well to mouth breathing. Any obstruction of the nose or nasopharynx may increase upper airway resistance and increase the work of breathing. While sleeping, the neonate's face should remain away from any surface or cloth in order to maintain an open nasal airway.

A client with an 80-pack-year history of tobacco smoking has presented to the clinic complaining of "bronchitis" cough for the past 5 months, weight loss, and shortness of breath. Today, this client "got scared" when he coughed up blood in his sputum. The health care provider is concerned this client may have which of the following possible diagnoses? Select one: a. Pulmonary embolism due to blood in sputum b. Tuberculosis due to long period of coughing c. Small cell lung cancer due to smoking history d. Pneumothorax related to chronic lung infection weakening the alveoli

c. Small cell lung cancer due to smoking history ---Small cell lung cancer has the strongest association with cigarette smoking and is rarely observed in someone who has not smoked; brain metastasis is common. The earliest symptoms (of lung cancer) usually are chronic cough, shortness of breath, and wheezing because of airway irritation and obstruction. Hemoptysis (i.e., blood in the sputum) occurs when the lesion erodes into blood vessels. There is no indication the client has risk factors for TB. Pulmonary emboli result from blood clots traveling to the lungs. Pneumothorax would cause different symptoms and be an acute, abrupt onset.

The pathogenic capacity of the tubercle bacillus is related to: Select one: a. Formation of a Ghon focus lesion b. Rapid viral replication in host cells c. The initiation of a cell-mediated immune response d. Its inherent destructive capabilities

c. The initiation of a cell-mediated immune response --The pathogenesis of tuberculosis, in previously unexposed immunocompetent people, is a cell-mediated immune response that confers resistance to the organism and development of hypersensitivity to the tubercular antigens. Pathologic manifestations of tuberculosis, such as caseating granuloma and cavitation, are the result of the hypersensitivity reaction rather than its inherent destructive capabilities. In persons with intact cell-mediated immunity, the cell-mediated immune response results in the development of a granulomatous lesion, called a Ghon focus, that contains the tubercle bacilli, modified macrophages, and other immune cells.

capsaicin, a specific C-fiber afferent neurotoxin

An elderly client has been brought to primary care provider. His gait is wide based and unsteady and lacking in fluidity, muscle tone appears normal. He needs to be assessed for what?

cerebellar disorder

You notice that your patient has a barrel chest. This is most likely a result of:

chronic alveolar distention

Which of the following diagnostic findings is related to the accumulation of the products of inflammation during typical pneumonia?

consolidation

Above the glottis that opens and closes for speech, the epiglottis performs which physiologic functions during swallowing?

cover the larynx

Reduced glomerular filtration rate (GFR), with a serum creatinine level that remains in the normal range, is associated with aging because _______ is reduced in elderly persons.

muscle mass

Which is an example of where a person could have hypoxia without hypoxemia?

myocardial infarction

What intervention is appropriate for a client with sarcoidosis?

Corticosteroids

The nurse recognizes that acute renal injury is characterized by which of the following?

Rapid decline in renal function

Which conditions have the potential to cause chronic kidney disease? Select all that apply.

- Hypertension - Diabetes - Glomerulonephritis

The most common indicator of acute renal failure is:

Azotemia

Subcutaneous bruising is often present as a result of which imbalance in the client with chronic kidney disease?

Impaired platelet function

Which substance would not be found in glomerular filtrate?

Protein

As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to which complication?

Pulmonary hypertension

Inflammatory bowel diseases are accompanied by systemic manifestations that include:

autoimmune anemia.

The major adrenal cortical hormones are steroids and are synthesized from acetate and:

cholesterol.

The mechanisms of liver damage in viral hepatitis include:

direct cellular injury.

1. The "cold viruses" are rapidly spread from person to person. The greatest source of spread is: A) Fingers B) Sneezing C) Plastic toys D) Eye mucosa

A) Fingers

The Helicobacter pylori protobacteria cause peptic ulceration by producing

toxins

A frantic parent reports a large mass in the child's abdomen; after diagnostic testing, the health care provider diagnoses a Wilms tumor, stage IV. After the provider leaves the room, the parents ask the nurse, "What does this mean?" Which response by the nurse is most accurate?

"A cancer of the kidney has most likely spread to the lungs."

A 35-year-old client is diagnosed with acute kidney injury (AKI) and is started on hemodialysis. The client is concerned with the diagnosis and wants to know what to expect in the progression of this disorder. Which statement best addresses the client's concern?

"Acute kidney injury is abrupt in onset and often reversible if recognized early and treated appropriately."

A client has been given the diagnosis of diffuse glomerulonephritis. The client asks the nurse what diffuse means. The nurse responds:

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

The nursing instructor is teaching a student nurse about continuous renal replacement therapy (CRRT). Which statement by the student nurse indicates effective learning? 1 "CRRT is provided over approximately 24 hours." 2 "CRRT does not require the addition of an anticoagulant." 3 "CRRT cannot be used in conjunction with hemodialysis." 4 "CRRT has a faster blood flow rate than hemodialysis."

"CRRT is provided over approximately 24 hours." - Continuous renal replacement therapy (CRRT) is a physiologic therapy that simulates kidney function day and night. CRRT is done either by cannulating an artery and a vein or by cannulating two veins. CRRT is provided continuously for approximately 24 hours. CRRT involves the flow of blood from the body through a filter and carries an increased risk of clotting; thus an anticoagulant must be added. CRRT can be performed along with hemodialysis. CRRT has a slower blood flow rate than intermittent hemodialysis.

An adult client with a history of worsening respiratory symptoms has presented for care. Which assessment question will best allow the clinician to address the possibility of chronic bronchitis?

"Do you tend to have a cough even when you don't feel sick?"

The nurse provides information to a nursing student about the administration of erythropoietin (EPO) therapy to a patient with chronic kidney disease (CKD). Which statement made by the nursing student indicates effective learning? 1 "EPO benefits a patient with plasma ferritin concentrations less than 100 mg/mL." 2 "EPO should be administered in higher doses to a patient with low hemoglobin levels." 3 "EPO, iron, sucrose, and folic acid of 1 mg/day should be administered to patients undergoing hemodialysis." 4 "EPO can be safely given to a patient that takes an antihypertensive and maintains a blood pressure of 150/90 mm Hg."

"EPO, iron, sucrose, and folic acid of 1 mg/day should be administered to patients undergoing hemodialysis."

The patient with end stage renal disease (ESRD) has decided to terminate dialysis treatments. Which is the best response by the nurse? 1 "I respect your decision. Would you like me to ask the health care provider for a palliative care consult?" 2 "I respect your decision, but believe you need to discuss options with your health care provider. Would you like me to page the health care provider to come speak with you?" 3 "You cannot stop now; you have so much to live for." 4 "Are you sure this is the right decision? How about if I ask a psychiatrist to come speak with you?"

"I respect your decision, but believe you need to discuss options with your health care provider. Would you like me to page the health care provider to come speak with you?"

The registered nurse is teaching a student nurse about the preoperative care to be provided to a patient before kidney transplantation. Which statement made by the student nurse indicates effective learning? 1 "I should label the access site as 'Dialysis access, no procedures.'" 2 "I should not explain the need of immunosuppressant drugs before surgery." 3 "I should inform the patient that dialysis is not required after transplantation." 4 "I should not empty the peritoneal cavity of patients undergoing peritoneal dialysis."

"I should label the access site as 'Dialysis access, no procedures.'"

An adult client has been diagnosed with polycystic kidney disease. Which of the client's following statements demonstrates an accurate understanding of this diagnosis?

"I suppose I should be tested to see if my children might inherit this."

An adult client has been diagnosed with polycystic kidney disease. Which statement by the client demonstrates an accurate understanding of this diagnosis?

"I suppose I should be tested to see if my children might inherit this."

"I suppose I should have been washing my hands more in the past few days."

An adult diagnosed with renal failure secondary to diabetes mellitus is scheduled to begin dialysis soon. Which statement by the client reflects an accurate understanding of the process of hemodialysis?

"I will not be able to go about my normal routine during treatment."

A client with a diagnosis of end-stage renal disease received a kidney transplant 2 years ago that was deemed a success. During the most recent follow-up appointment, the nurse should prioritize the client for referral based on which statement?

"I'm feeling a bit under the weather these days and I'm a bit feverish."

"I've made a list of high-phosphate foods, so that I can try to avoid them."

A 51-year-old man has been diagnosed with chronic bronchitis after a long history of recurrent coughing. Which of the man's following statements demonstrates a sound understanding of his new diagnosis?

"If I had quit smoking earlier than I did, I think I could have avoided getting bronchitis."

A nurse is performing client education with an adult recently diagnosed with chronic kidney disease. Which statement by the client would the nurse most likely want to correct or clarify?

"My kidney problems increase my chance of developing high blood pressure or diabetes."

An elderly patient who was recently diagnosed with emphysema asks the nurse what caused the disease. Which of the following statements is the best response?

"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?"

An older adult client who was recently diagnosed with emphysema asks the nurse what caused the disease. Which statement is the best response?

"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?"

A client with pulmonary arterial hypertension asks the health care provider, "Why are you giving me sildenafil? It is my lungs that are my problem, not erectile dysfunction." Which statement by the health care provider is the most appropriate response?

"Sildenafil causes vasodilation, which will help treat the high pressure in your lung vessels."

The nursing instructor is teaching a student nurse about the therapies for hyperkalemia associated with acute kidney injury. Which statement by the student nurse indicates effective learning? 1 "Insulin infusion is a permanent therapy." 2 "Sodium bicarbonate is a permanent therapy." 3 "Calcium gluconate infusion is a permanent therapy." 4 "Sodium polystyrene sulfonate is a permanent therapy."

"Sodium polystyrene sulfonate is a permanent therapy." - a cation-exchange resin that completely removes extra potassium; it is considered a permanent therapy.

In anatomy class, the instructor asks, "Explain how urine is expelled from the bladder during voiding." The student with the most accurate response would be:

"The detrusor muscle contract down on the urine and the ureteral orifices are forced shut. The external sphincter relaxes as urine moves out of the bladder."

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 kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney."

The nursing instructor asks the student nurse about fluid and electrolyte changes that occur in a patient with an acute kidney injury. Which statement by the student nurse indicates effective learning? 1 "The patient will have hypokalemia." 2 "The patient will have hypernatremia." 3 "The patient will have increased serum creatinine levels." 4 "The patient will have decreased levels of blood urea nitrogen."

"The patient will have increased serum creatinine levels." - Creatinine is a waste product of muscle catabolism. Patients with acute kidney injury cannot remove body waste and it accumulates in the blood, which raises the serum creatinine level. Acute kidney injury is associated with an increased level of potassium, a decreased level of sodium, and a decreased level of blood urea nitrogen.

"The right side of his heart (cor pulmonale) is not pumping effectively. Blood is backlogging in his body, which is why he is so swollen."

Which teaching points about acute tubular necrosis (ATN) should the renal nurse educator include in the orientation session of new nurses?

"Trauma, burns, and major surgery are common precursors to ATN."

A nurse is collecting a urine specimen prior to measuring the albumin level in a client's urine. A colleague states, "I thought albumin was related to liver function, not the kidney." How can the nurse best respond to this statement?

"Urine albumin levels are useful for diagnosing diabetic kidney disease."

A client has undergone a kidney transplant and voices concerns about organ rejection to the nurse. The most appropriate response by the nurse would be:

"You will be given medication to decrease the likelihood of your immune system attacking your new kidney."

A health care provider for an obese male who has a history of diabetes and hypertension reports that the client's glomerular filtration rate (GFR) is 51 mL/min with elevated serum creatinine levels. Which statement by the health care provider will likely answer the client's question about the result?

"Your chronic kidney disease has likely been caused by your diabetes and high blood pressure."

A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that which statements regarding CKD are correct? Select all that apply.

- Nephron destruction takes place over many months. - Signs and symptoms develop gradually. - Functioning nephrons compensate for those that are damaged. - There is a reduction in glomerular filtration rate (GFR) as nephrons are destroyed

A client is suspected to have renal disease. The nurse would suggest which diagnostic determinations to confirm this diagnosis? Select all that apply.

- Urinary sediment of red and white cells - Ultrasonography - Measurement of cystatin C - Imaging studies

A client is to begin peritoneal dialysis. The nurse knows that peritoneal dialysis may result in which complications? Select all that apply. -Catheter-related infection -Hyperglycemia -Dehydration -Pain -Edema

-Catheter-related infection -Hyperglycemia -Dehydration

A client with a recent diagnosis of renal failure requiring hemodialysis is being educated in the dietary management of the disease. Which statement by the client shows an accurate understanding of this component of treatment? Select all that apply. -"I'll increase the carbohydrates in my diet to provide sufficient energy." -"I've made a list of high-phosphate foods so that I can try to avoid them." -"I'm making a point of trying to eat lots of bananas and other food rich in potassium." -"I don't think I've been drinking enough, so I want to include 8 to 10 glasses of water each day." -"I'm going to try a high-protein, low-carbohydrate diet."

-"I'll increase the carbohydrates in my diet to provide sufficient energy." -"I've made a list of high-phosphate foods so that I can try to avoid them."

The nurse recognizes that which individuals have the greatest risk for the development of chronic kidney disease (CKD)? Select all that apply. -A client with a recent diagnosis of type 2 diabetes who does not monitor blood sugar -A client whose diagnosis of thyroid cancer necessitated a thyroidectomy -A 42-year-old client with uncontrolled hypertension averaging 170/94 mm Hg -A client who experienced a hemorrhagic stroke and now has sensory and motor deficits -A first-time mother who recently lost 1.5 L of blood during a postpartum hemorrhage

-A client with a recent diagnosis of type 2 diabetes who does not monitor blood sugar -A 42-year-old client with uncontrolled hypertension averaging 170/94 mm Hg

A diabetic client with a history of hypertension may receive a prescription for which medication to provide a renal protective effect by reducing intraglomerular pressure? Select all that apply. -Loop diuretics -ACE inhibitors -Angiotensin receptor blockers -Calcium channel blockers -A digitalis preparation

-ACE inhibitors -Angiotensin receptor blockers

The nurse caring for clients with chronic kidney disease (CKD) assesses for signs of renal osteodystrophy (skeletal damage). Which manifestations are characteristic of both high-bone-turnover and low-bone-turnover osteodystrophy? Select all that apply. -Abnormal bone resorption -Defective bone remodeling -Bone marrow fibrosis -Normal osteoblast and osteoclast numbers -Decreased osteoblast and elevated osteoclast proliferation

-Abnormal bone resorption -Defective bone remodeling

Sexual dysfunction in people with CKD is thought to be multifactorial. What are thought to be possible causes of sexual dysfunction in people with CKD? Select all that apply. -Antihypertensive drugs -Psychological factors -Uremic toxins -Inability to vasodilate veins -Sexually transmitted infections

-Antihypertensive drugs -Psychological factors -Uremic toxins

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

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

A client has developed chronic kidney disease (CKD). The nurse will advise the client to be alert for the development of which hematologic signs and symptoms associated with this disorder? Select all that apply. -Bruising -Gastrointestinal bleeding -Fatigue -Intravascular clotting -Bradycardia

-Bruising -Gastrointestinal bleeding -Fatigue

Select the body systems most commonly affected by chronic kidney disease in older adults. Select all that apply. -Cardiovascular system -Cerebrovascular system -Skeletal system -Gastrointestinal system -Immune system

-Cardiovascular system -Cerebrovascular system -Skeletal system

A client is diagnosed with decreased glomerular filtration rate but has no renal damage. The nurse recognizes this can occur with which disease process? Select all that apply. -Carbohydrate diet -Cirrhosis -Heart failure -Removal of one kidney -Dehydration

-Cirrhosis -Heart failure -Removal of one kidney -Dehydration

Which client does the nurse need to monitor for the development of intense intrarenal vasoconstriction that may induce prerenal failure? Select all that apply. -Client undergoing cardiac catheterization -Client taking acetaminophen for fever -Client taking cyclosporine to prevent rejection for a liver transplant -Client who is HIV positive -Client with an elevated blood urea nitrogen who is taking ibuprofen every 6 hours for back pain

-Client undergoing cardiac catheterization -Client taking cyclosporine to prevent rejection for a liver transplant -Client with an elevated blood urea nitrogen who is taking ibuprofen every 6 hours for back pain

Which clients would have a significant risk of developing the prerenal form of acute kidney injury (AKI)? Select all that apply. -Client who has lost large amounts of blood following a workplace injury -Adult who is admitted for intravenous antibiotic treatment of pyelonephritis -Older adult client with diagnoses of poorly controlled diabetes mellitus and heart failure -Adolescent who is admitted for treatment of an overdose of a nephrotoxic drug -Middle-aged client with a diagnosis of benign prostatic hyperplasia (BPH) -Older adult client who has been admitted for the treatment of dehydration and malnutrition

-Client who has lost large amounts of blood following a workplace injury -Older adult client with diagnoses of poorly controlled diabetes mellitus and heart failure -Older adult client who has been admitted for the treatment of dehydration and malnutrition

A client with chronic kidney disease (CKD) asks the nurse, "Why do I itch all the time?" The nurse bases there response on which integumentary physiologic factors that causes pruritis? Select all that apply. -Too harsh of soap while bathing -Decrease in perspiration -Limited sodium intake -Enlarged size of sweat glands -Elevated serum phosphate levels

-Decrease in perspiration -Elevated serum phosphate levels

If a client with CKD is developing uremic encephalopathy, the nurse will recognize which manifestations as one of the earliest? Select all that apply. -Decreased alertness -Delirium and hallucinations -New-onset seizures -Diminished awareness

-Decreased alertness -Diminished awareness

Anemia frequently occurs in clients with chronic kidney disease (CKD). The nurse will monitor these clients for which contributors to anemia? Select all that apply. -Decreased erythropoietin production -Iron overload -Anorexia -Bone marrow suppression -Chronic blood loss

-Decreased erythropoietin production -Anorexia -Bone marrow suppression -Chronic blood loss

A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that this client will experience which manifestations? Select all that apply. -Decreased renal endocrine function -Decreased tubular reabsorption -Proliferation of nephrons -Hypophospatemia -Decreased glomerular filtration

-Decreased renal endocrine function -Decreased tubular reabsorption -Decreased glomerular filtration

The nurse is preparing to assess a client who has just been admitted to the hospital with a diagnosis of prerenal failure. Which would the nurse expect the client to manifest? Select all that apply. -Decreased urinary output -Increased BUN -BUN-to-serum creatinine ratio of greater than 20:1 -Increased urinary output -Decreased BUN -BUN to serum creatinine ratio of 10:1

-Decreased urinary output -Increased BUN -BUN-to-serum creatinine ratio of greater than 20:1

The parents of a child who has been diagnosed with chronic kidney disease (CKD) ask the nurse about manifestations of the disease. Which information is the most appropriate information to provide these parents? Select all that apply. -Developmental delay -Delayed cognitive development -Secondary hyperparathyroidism -Growth impairment -Accelerated sexual maturation -Early-onset puberty

-Developmental delay -Delayed cognitive development -Secondary hyperparathyroidism -Growth impairment

A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor this client for which gastrointestinal signs and symptoms? Select all that apply. -Early morning nausea -Gastrointestinal ulceration -Decreased gastric secretion -Metallic taste -Anorexia

-Early morning nausea -Gastrointestinal ulceration -Metallic taste -Anorexia

A child is diagnosed with chronic kidney disease (CKD). The nurse knows that which statements regarding supportive renal therapy in children are true? Select all that apply. -Early transplantation is the preferred treatment when considering long-term effects. -Children older than 12 years will benefit from hemodialysis. -Less immune system suppression is needed in children than in adults. -Corticosteroid therapy reduces the risk of growth retardation in children. -Peritoneal dialysis is generally most appropriate for children younger than 6.

-Early transplantation is the preferred treatment when considering long-term effects. -Children older than 12 years will benefit from hemodialysis. -Peritoneal dialysis is generally most appropriate for children younger than 6.

In a client in the uremic state of chronic kidney failure (CKD), the nurse will monitor for which signs and symptoms correlated with uremia? Select all that apply. -Encephalopathy -Nausea -Increased vitamin D synthesis -Anemia -Apathy

-Encephalopathy -Nausea -Anemia -Apathy

The nurse caring for a client with chronic kidney disease (CKD) would monitor for which early manifestations of uremia? Select all that apply. -Elevated blood glucose -Fatigue -Nausea -Apathy -Weakness

-Fatigue -Nausea -Apathy -Weakness

Glomerular filtration rate (GFR) is the best indicator of renal function. The nurse knows that GFR can vary with which factors? Select all that apply. -Gender -Age -Body size -Diet -Ethnicity

-Gender -Age -Body size -Ethnicity

Older adults often have other chronic diseases that influence the early symptoms and signs of renal dysfunction. The nurse knows that which finding can be the dominant clinical events in older adults with early kidney disease? Select all that apply. -Heart failure -Hypertension -Oliguria -Discolored urine -Pruritus

-Heart failure -Hypertension

The nurse will monitor the client with chronic kidney disease (CKD) for which possible cardiovascular changes? Select all that apply. -Heart failure -Hypertension -Hypophospatemia -Impaired platelet function -Pericarditis

-Heart failure -Hypertension -Pericarditis

A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor for which manifestations of this disorder? Select all that apply. -Increased nitrogenous waste in blood -Anemia -Right ventricular dysfunction -Osteodystrophy -Hypercalcemia

-Increased nitrogenous waste in blood -Anemia -Osteodystrophy

A client is diagnosed with acute renal injury. The nurse will evaluate the client for which possible causes of this disorder? Select all that apply. -Ischemic injury -Nonischemic reduced renal blood flow -Obstruction of urinary outflow -Hormonal imbalance -Nephrotoxic substances

-Ischemic injury -Nonischemic reduced renal blood flow -Obstruction of urinary outflow -Nephrotoxic substances

The diagnosis is chronic kidney disease (CKD). While caring for a client with CKD, the nurse will monitor for which neurologic signs and symptoms? Select all that apply. -Loss of recent memory -Peripheral neuropathy -Restless legs syndrome -Burning sensation in feet -Increased alertness

-Loss of recent memory -Peripheral neuropathy -Restless legs syndrome -Burning sensation in feet

A client is diagnosed with renal failure. The nurse must monitor for failure of which functions? Select all that apply. -Maintenance of body water -Electrolyte balance -Adrenal secretion -Acid-base balance -Removal of metabolic waste from blood

-Maintenance of body water -Electrolyte balance -Acid-base balance -Removal of metabolic waste from blood

A nurse caring for a client with acute tubular necrosis (ATN) caused by myoglobinuria knows this may be caused by which finding in the client's medical history? Select all that apply. -Muscle damage -Hyperthermia -Hyperkalemia -Alcohol abuse -Prolonged seizures

-Muscle damage -Hyperthermia -Alcohol abuse -Prolonged seizures

A client with chronic kidney disease who has renal osteodystrophy should be assessed for which complications? Select all that apply. -Muscle weakness -Kidney stones -Bone pain -Stress fractures -Urosepsis

-Muscle weakness -Bone pain -Stress fractures

As nitrogenous wastes increase in the blood, the client with CKD may exhibit which clinical manifestations? Select all that apply. -Numbness in lower extremities -Photophobia -Extremely low platelet counts -Restless legs syndrome -Pruritis

-Numbness in lower extremities -Restless legs syndrome -Pruritis

Select the manifestations of renal cell carcinoma. Select all that apply. -Often silent in the early stages -Hematuria -Palpable flank mass -Does not metastasize

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

The nurse knows that a client with chronic kidney disease (CKD) may experience which changes in skin integrity? Select all that apply. -Pale skin -Brittle fingernails -Moist skin and mucous membranes -Increased oil gland secretion -Decreased perspiration

-Pale skin -Brittle fingernails -Decreased perspiration

A client with CKD is being treated for hyperphosphatemia and hypocalcemia. Select the most appropriate interventions. Select all that apply. -Phosphate-binding antacids -Activated vitamin D -Restriction of foods high in phosphate -Increased daily consumption of milk -Oral phosphate supplements

-Phosphate-binding antacids -Activated vitamin D -Restriction of foods high in phosphate

A client diagnosed with chronic kidney disease (CKD) with GFR < 5 mL/min/1.73 m2 should be monitored for which fluid and electrolye imbalance? Select all that apply. -Polyuria -Hyperkalemia -Metabolic alkalosis -Hypocalcemia -Hyponatremia

-Polyuria -Hyperkalemia -Hypocalcemia -Hyponatremia

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

-Prognosis is good with treatment. -The tumor is limited to the kidney and can be excised with the capsular surface intact.

When acute tubular necrosis (ATN) is suspected, the nurse will likely see which laboratory findings on the urinalysis report? Select all that apply. -Protein -Glucose -Red blood cells -Sodium excess -Cast cells

-Protein -Red blood cells -Cast cells

A client is diagnosed with chronic kidney disease (CKD). The nurse knows that which statements regarding CKD are correct? Select all that apply -Onset is abrupt. -Symptoms appear with 50% of nephrons lost. -Renal damage is irreversible. -Less than 1% of population is affected. -Hypertension is a major cause.

-Renal damage is irreversible. -Hypertension is a major cause.

Many drugs and other nephrotoxic agents can induce nephrotic acute tubular necrosis (ATN). The nurse knows that these agents cause tubular injury by which mechanisms? Select all that apply. -Renal vasoconstriction -Hyponatremia -Intratubular obstruction -Renal vasodilation -Direct tubular damage

-Renal vasoconstriction -Intratubular obstruction -Direct tubular damage

Hypertension frequently accompanies chronic kidney disease (CKD). The nurse knows that which mechanisms can contribute to this hypertension? Select all that apply. -Renin-angiotensin-aldosterone (RAAS) activation -Increased vasodilator prostaglandins -Sodium retention -Increased vasoconstriction -Increased blood volume

-Renin-angiotensin-aldosterone (RAAS) activation -Sodium retention -Increased vasoconstriction -Increased blood volume

A nurse is assessing a client diagnosed with CKD for neuromuscular manifestation. Select the manifestations the nurse may expect to find. Select all that apply. -Restless leg syndrome -Loss of recent memory -Peripheral neuropathy -Perceptual errors -Increased muscle strength -Increased alertness

-Restless leg syndrome -Loss of recent memory -Peripheral neuropathy -Perceptual errors

The nurse knows that a child with chronic kidney disease (CKD) may experience which manifestations? Select all that apply. -Bladder incontinence -Early sexual maturity -Intellectual disability -Severe growth deficit -High bone turnover

-Severe growth deficit -High bone turnover

Acute tubular necrosis (ATN) is the most common cause of intrinsic renal failure. What are the most common causes of ischemic ATN? Select all that apply. -Severe hypovolemia -Severe hypertension -Burns -Overwhelming sepsis -Severe hypervolemia

-Severe hypovolemia -Burns -Overwhelming sepsis

A client is diagnosed with early chronic kidney disease (CKD). The nurse will recommend which actions to slow progression of renal damage? Select all that apply. -Smoking cessation -Blood pressure control -High-protein diet -Angiotensin converting enzyme (ACE) inhibitor administration -Blood glucose control

-Smoking cessation -Blood pressure control -Angiotensin converting enzyme (ACE) inhibitor administration -Blood glucose control

What are appropriate interventions in the care of a client diagnosed with renal calculi? Select all that apply. -Straining the client's urine -Addressing the client's pain -Restricting the client's oral fluid intake -Keeping track of intake and output -Inserting a Foley catheter

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

The nurse recognizes that renal failure may result from which underlying causes? Select all that apply -Malnutrition -Systemic disease -Hepatic disease -Renal disease -Nonrenal urological abnormalities

-Systemic disease -Renal disease -Nonrenal urological abnormalities

Which diagnostic bloodwork is most suggestive of chronic kidney disease (CKD)?

A client with low vitamin D levels, low calcitrol levels, and elevated parathyroid hormone (PTH) levels

The nurse will monitor which clients at risk for the development of chronic kidney disease (CKD)? Select all that apply. -Systemic lupus erythematosus -Polycycstic kidney disease -Glomerulonephritis -Hyperlipidemia -Diabetes

-Systemic lupus erythematosus -Polycycstic kidney disease -Glomerulonephritis -Diabetes

A client with chronic kidney disease (CKD) is anemic. The nurse will attempt to alleviate the anemia in order to prevent which of the following? Select all that apply. -Tachycardia -Fatigue -Increased blood viscosity -Hypersomnia -Decreased myocardial oxygen

-Tachycardia -Fatigue -Decreased myocardial oxygen

Which clinical manifestations would lead the nurse to suspect that a client with renal failure is developing uremia? Select all that apply. -Weakness and fatigue. -Lethargy and confusion. -Extreme itching. -Blood in urine. -Urine smell in the stool.

-Weakness and fatigue. -Lethargy and confusion. -Extreme itching.

Which clients scheduled for an interventional radiology procedure requiring administration of radiocontrast dye would be considered high risk for nephrotoxicity? Select all that apply. -Adolescent with severe abdominal pain -Young adult with a history of glomerular nephritis who is reporting severe flank pain -Middle-aged adult with diabetes undergoing diagnostic testing for new-onset proteinuria -Adult with elevated liver enzymes possibly due to fatty liver cirrhosis -Middle-aged adult undergoing biopsy for a suspicious "spot" on a chest x-ray

-Young adult with a history of glomerular nephritis who is reporting severe flank pain -Middle-aged adult with diabetes undergoing diagnostic testing for new-onset proteinuria

Oxygen has been prescribed for a client with chronic obstructive pulmonary disease (COPD). Select the most appropriate treatment for the client.

1 to 2 L/min via nasal cannula

The health care provider is comparing results of a client's recent GFR measurement. Which result would be interpreted as normal?

120 to 130 mL/minute

Accumulation of nitrogenous wastes such as urea in the circulatory system is an early sigh of chronic kidney disease (CKD). The nurse knows that normal levels of urea in blood are approximately:

20 mg/dL (7.14 mmol/L)

The epiphyseal plate is the anatomical site in the bone which 1. enable the bone to provide sensory input to the brain 2. enable the bone to develop a lattice framework 3. enable bone to increase in length when growth hormone is released 4. enable bone to increase in calcium resorption and mineralization

The nurse is caring for a client with chronic kidney disease (CKD). The nurse determines the client may consume how much fluid intake per day?

500 to 800 mL/day

A client is suspected to have chronic kidney disease (CKD). The nurse will use which glomerular filtration rate (GFR) to aid in this diagnosis?

60 mL/min/1.73 m2 or less for 3 months

The nurse knows that a client with which glomerular filtration rate (GFR) would be classified as "decreased GFR"?

70 mL/min

Which clinical finding among older adults is most likely to be viewed as a normal part of age-related changes?

78-year-old client whose glomerular filtration rate (GFR) has been steadily declining over several years

During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description? A. The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction B. Atherosclerotic destruction of circulation to the brain resulting in lactic acid buildup that affects nerve transmission C. Muscle necrosis with resultant increase in fat/connective tissue replacing the muscle fibers D. Autoimmune disease where antibody loss of acetylcholine receptors at the neuromuscular junction causes decrease motor response

A Multiple sclerosis (MS) is an immune-mediated disorder that occurs in genetically susceptible individuals. The pathophysiology of MS involves demyelination and subsequent degeneration of nerve fibers in the central nervous system (CNS), marked by prominent lymphocytic invasion in the lesion. The infiltrate in nerve fiber (rather than vascular) sclerotic plaques contains CD8+ and CD4+ T cells as well as macrophages, which are thought to induce oligodendrocyte injury. With muscular dystrophy, the muscle undergoes necrosis, and fat and connective tissue replace the muscle fibers, which increases muscle size and results in muscle weakness. Now recognized as an autoimmune disease, myasthenia gravis is caused by an antibody-mediated loss of acetylcholine receptors in the neuromuscular junction.

Which individual is experiencing an immunologic lung disorder affecting ventilation that has caused the formation of a granuloma on chest x-ray?

A 30-year-old male who has been diagnosed with sarcoidosis

Which individual is at the highest risk of developing a urinary tract infection (UTI)?

A 30-year-old woman with poorly controlled diabetes mellitus

The "cold viruses" are rapidly spread from person to person. The greatest source of spread is: A) Fingers B) Sneezing C) Plastic toys D) Eye mucosa

A) Fingers

Which patient is most likely to develop chronic kidney disease (CKD) and should be taught preventive measures by the nurse? 1 A 50-year-old white female with hypertension 2 A 61-year-old Native American male with diabetes 3 A 40-year-old Hispanic female with cardiovascular disease 4 A 28-year-old African American female with a urinary tract infection

A 61-year-old Native American male with diabetes

The nurse is caring for four clients. Select the client at risk for the development of a pulmonary embolism.

A 62-year-old male postop repair of a fractured femur

A geriatric nurse is caring for several clients. Which alterations in health should the nurse attribute to age-related physiologic changes?

A 78-year-old woman's GFR has been steadily declining over several years.

Which of the following clients is likely at the greatest risk of developing a urinary tract infection?

A 79-year-old client with an indwelling catheter for urinary incontinence

Which of the following individuals most likely faces the greatest risk of developing Clostridium difficile colitis?

A 79-year-old hospital patient who is being treated with broad-spectrum antibiotics

A patient arrives to the emergency room via ambulance. The paramedic reports to you that the patient had, "a vagal attack." As the nurse you know this means: check all that apply a. parasympathetic nerve stimualtion b. slowing of heart rate c. vagus nerve stimulation d. release of acetycholine e. vasoconstriction

A B C D

A client has prerenal failure. The nurse knows that this type of failure is characterized by which relationship of blood urea nitrogen (BUN) to serum creatinine levels?

A BUN to creatinine level ratio of 20:1

A client has arrived in the emergency department in cardiogenic shock. Which of the following assessment findings confirm this diagnosis? Select all that apply. A. Difficult to arouse with changes in level of consciousness B. Bright red color noted in the nail beds and lips C. Less than 5 mL dark, concentrated urine in the past hour D. Diminished breath sounds in the bases, bilaterally E. BP reading of 80/65

A C E The signs and symptoms of cardiogenic shock are consistent with those of end-stage heart failure. The lips, nail beds, and skin may become cyanotic because of stagnation of blood flow. Mean arterial and systolic blood pressures decrease due to poor stroke volume, and there is a narrow pulse pressure because of arterial vasoconstriction. Urine output decreases because of lower renal perfusion pressures and the increased release of aldosterone. Neurologic changes, such as alterations in cognition or consciousness, may occur because of low cardiac output and poor cerebral perfusion.

A basketball player fell awkwardly when attempting to claim a rebound, a mishap that resulted in a tear to the anterior cruciate ligament (ACL) of his left knee. The school nurses will anticipate the player to exhibit which of the following clinical manifestations? Select all that apply. A. Edema (swelling) of the knee B.Immoveable (locked) knee joint C. Large hematoma on the anterior knee surface D. Intense pain E. Abscess formation

A D Ligaments are pliable enough to permit movement at the joints, but they tear rather than stretch when exposed to excess stress. Torn ligaments are extremely painful and accompanied by local swelling. Torn ligaments do not form abscesses or large hematomas.

Which client most likely faces the highest risk of developing secondary pulmonary hypertension?

A client with COPD and a 35 pack-year smoking history.

Which individual likely faces the greatest risk for the development of chronic kidney disease?

A client with a recent diagnosis of type 2 diabetes who does not monitor blood sugars or control diet

Which of the following individuals likely faces the greatest risk for the development of chronic kidney disease?

A client with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet

Which of the following clients is benefiting from the renin-angiotensin-aldosterone mechanism?

A college student admitted to the neurotrauma unit following traumatic brain injury requiring surgery to evacuate a large hematoma

The nurse is educating a client with chronic kidney disease (CKD). What is the recommended daily fluid intake for this client?

A daily fluid intake of 500 to 800 mL/day to maintain hydration

A client tells the nurse that he is concerned he may be developing chronic bronchitis and asks how the diagnosis is made. The most appropriate information for the nurse to provide would be:

A diagnosis of chronic bronchitis requires a history of a chronic productive cough that has persisted for at least 3 consecutive months in at least 2 consecutive years.

When explaining urinalysis results that show the presence of cast cells, the nurse informs the client that casts cells develop when the client has: Select all that apply.

A high protein concentration of the urine ;High urine osmolality

A loss of over half the client's normal kidney function

Which of the following clients is at risk for developing acute respiratory failure?

A middle-aged male diagnosed with amyotrophic lateral sclerosis (ALS) who has pneumonia with low O2 saturation

Which of the following individuals is experiencing the effects of a primary endocrine disorder?

A patient who has low calcium levels because of the loss of his parathyroid gland

Which of the following patients should the nurse observe most closely for the signs and symptoms of paralytic ileus?

A patient who is postoperative day 1 following gall bladder surgery

Which of the following individuals likely faces the greatest risk for the development of chronic kidney disease?

A patient with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet

Which of the following clients is at risk for developing a preventable disorder related to prolonged immobility?

A postsurgical client who is refusing to get out of bed and walk and will not wear those "uncomfortable elastic stocking"

An elderly female client has been hospitalized for the treatment of acute pyelonephritis. Which of the following characteristics of the client is most likely implicated in the etiology of her current health problem? The client:

A recent UTI

Which of the following individuals most likely faces the highest risk of developing chronic pancreatitis?

A woman who has six to eight drinks each evening

Which of the following clients would be considered at high risk for developing pneumonia (both community and hospital setting)? Select all that apply.

A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation, A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food, A school-aged child with severe asthma controlled by steroids admitted for an exacerbation

A nurse runs into an old high school friend after 20 years. She notes her friend continues to smoke after all these years. The friend asks, "Do you think I sound hoarse?" Upon further assessment, the nurse/friend notes her friend has several warning signs of cancer. Which manifestations would lead to this conclusion? Select all that apply. A) "I seem to have some difficulty swallowing food... this is new for me." B) "I seem to have more trouble holding my urine than I use to." C) "Can you feel how large my lymph nodes are on my neck and armpits (axillae)?" D) Pericardial friction rub heard on auscultation. E) Feels subcutaneous emphysema in upper chest area.

A) "I seem to have some difficulty swallowing food... this is new for me." C) "Can you feel how large my lymph nodes are on my neck and armpits (axillae)?"

20. A client with a recent diagnosis of renal failure who will require hemodialysis is being educated in the dietary management of the disease. Which of the client's following statements shows an accurate understanding of this component of treatment? A) "I've made a list of high-phosphate foods, so that I can try to avoid them." B) "I'm making a point of trying to eat lots of bananas and other food rich in potassium." C) "I'm going to try to maintain a high-fiber, low-carbohydrate diet." D) "I don't think I've been drinking enough, so I want to include 8 to 10 glasses of water each day."

A) "I've made a list of high-phosphate foods, so that I can try to avoid them."

If a CKD client is developing uremic encephalopathy, the earliest manifestations may include: Select all that apply. A) Decreased alertness B) Delirium and hallucinations C) New-onset seizures D) Diminished awareness

A) Decreased alertness D) Diminished awareness

A client with a recent diagnosis of renal failure who will require hemodialysis is being educated in the dietary management of the disease. Which of the client's following statements shows an accurate understanding of this component of treatment? A) "I've made a list of high-phosphate foods, so that I can try to avoid them." B) "I'm making a point of trying to eat lots of bananas and other food rich in potassium." C) "I'm going to try to maintain a high-fiber, low-carbohydrate diet." D) "I don't think I've been drinking enough, so I want to include 8 to 10 glasses of water each day."

A) "I've made a list of high-phosphate foods, so that I can try to avoid them."

A bladder cancer client asks the nurse, "What did the doctor mean by intravesicular chemotherapy? Am I going to lose all my hair and have to do for treatments over months and months?" The best response would be: A) "This is when they put the chemotherapy directly into the bladder to kill any cancer cells." B) "They will take you to radiology and inject some chemotherapy through your abdomen into your bladder." C) "The doctor will place a scope up your urethra, into the bladder, and burn the lining of the bladder with a laser and then inject some tuberculosis bacillus into the lining." D) "This is when they use a CyberKnife to cut off any lesions and then inject chemotherapy into the remaining portion of the bladder."

A) "This is when they put the chemotherapy directly into the bladder to kill any cancer cells."

A) Aluminum

A client who has developed stage 3 renal failure has been diagnosed with high phosphate levels. To avoid the development of osteodystrophy, the physician may prescribe a phosphate-binding agent that does not contain: A) Aluminum B) Calcium carbonate C) Calcium acetate D) Sevelamer hydrochloride

A) Aluminum

5. Which of the following individuals should be prioritized for receiving a seasonal influenza vaccination? A) An 81-year-old resident of a long-term care facility B) A 19-year-old man who was admitted to a hospital for an appendectomy C) A neonate who was born in a busy, inner-city hospital in late October D) An 86-year-old client whose flu symptoms have required hospitalization

A) An 81-year-old resident of a long-term care facility

Which of the following individuals should be prioritized for receiving a seasonal influenza vaccination? A) An 81-year-old resident of a long-term care facility B) A 19-year-old man who was admitted to a hospital for an appendectomy C) A neonate who was born in a busy, inner-city hospital in late October D) An 86-year-old client whose flu symptoms have required hospitalization

A) An 81-year-old resident of a long-term care facility

12. A client with a diagnosis of chronic kidney disease (CKD) may require the administration of which of the following drugs to treat coexisting conditions that carry a high mortality? A) Antihypertensive medications B) Antiarrhythmic medications C) Opioid analgesics D) Nonsteroidal anti-inflammatory drugs (NSAIDs)

A) Antihypertensive medications

A client with a diagnosis of chronic kidney disease (CKD) may require the administration of which of the following drugs to treat coexisting conditions that carry a high mortality? A) Antihypertensive medications B) Antiarrhythmic medications C) Opioid analgesics D) Nonsteroidal anti-inflammatory drugs (NSAIDs)

A) Antihypertensive medications

A client fell off a ladder and sustained a spinal cord injury that has resulted in bladder dysfunction. During the period immediately after the spinal injury, spinal shock develops and the bladder displays what type of function? A) Atonic B) Spasmodic C) Uninhibited D) Hyperactive

A) Atonic

Although urinary obstruction and urinary incontinence have almost opposite effects on urination, they can both result from: A) Bladder structure changes B) Bladder wall atrophy C) Micturition reflex spasms D) Bladder distensibility loss

A) Bladder structure changes

21. A 6-hour-old newborn develops a critical respiratory problem and is rushed to the ICU. The ICU nurses suspect the infant has respiratory distress syndrome (RDS) based on which findings? Select all that apply. A) Bluish discoloration of the skin and mucous membranes (central cyanosis) B) Substernal retractions with each breathe C) Periorbital edema D) Clubbed fingers E) Expiratory grunting

A) Bluish discoloration of the skin and mucous membranes (central cyanosis) B) Substernal retractions with each breathe E) Expiratory grunting

A 6-hour-old newborn develops a critical respiratory problem and is rushed to the ICU. The ICU nurses suspect the infant has respiratory distress syndrome (RDS) based on which findings? Select all that apply. A) Bluish discoloration of the skin and mucous membranes (central cyanosis) B) Substernal retractions with each breathe C) Periorbital edema D) Clubbed fingers E) Expiratory grunting

A) Bluish discoloration of the skin and mucous membranes (central cyanosis) B) Substernal retractions with each breathe E) Expiratory grunting

A client is experiencing bladder hyperactivity. The nurse should be prepared to educate the client about which of the following medications that may be injected to help decrease the bladder hyperactivity? A) Capsaicin, a specific C-fiber afferent neurotoxin B) Botulinum toxin type A C) Oxybutynin, an antimuscarinic agent D) Urecholine, a cholinergic agonist

A) Capsaicin, a specific C-fiber afferent neurotoxin

10. As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by: A) Decrease in GFR of 60 to 89 mL/minute/1.73 m2 B) Decrease in GFR to 30 to 59 mL/minute/1.73 m2 C) GFR decrease to 15 to 29 mL/minute/1.73 m2 D) Diminished GFR to less than 15 mL/minute/1.73 m2

A) Decrease in GFR of 60 to 89 mL/minute/1.73 m2

As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by: A) Decrease in GFR of 60 to 89 mL/minute/1.73 m2 B) Decrease in GFR to 30 to 59 mL/minute/1.73 m2 C) GFR decrease to 15 to 29 mL/minute/1.73 m2 D) Diminished GFR to less than 15 mL/minute/1.73 m2

A) Decrease in GFR of 60 to 89 mL/minute/1.73 m2

18. If a CKD client is developing uremic encephalopathy, the earliest manifestations may include: Select all that apply. A) Decreased alertness B) Delirium and hallucinations C) New-onset seizures D) Diminished awareness

A) Decreased alertness D) Diminished awareness

Following a dust storm in Arizona, several clients have presented to the clinic complaining of productive cough, fever, and night sweats. The health care provider suspects a fungal infection related to breathing dust. One particular client is critical. They suspect the infection has progressed outside the lung when they observe the client has: Select all that apply. A) Generalized lymph node enlargement B) Urine output decreased to 40 mL/hour C) Requires guaifenesin to cough up sputum D) An enlarged liver via palpation E) Copious bleeding at the site where the lab technician drew some blood

A) Generalized lymph node enlargement D) An enlarged liver via palpation E) Copious bleeding at the site where the lab technician drew some blood

25. A 2-year-old child is admitted to pediatric unit with bronchiolitis. The nurse calls the physician fearing the child is going into respiratory failure based on which of the following assessment findings? Select all that apply. A) Increased respiratory rate to 44 breaths/minute B) Substernal retractions becoming more pronounced C) New-onset expiratory grunting D) Productive cough with white secretions E) Faint wheezes noted in the posterior lung base

A) Increased respiratory rate to 44 breaths/minute B) Substernal retractions becoming more pronounced C) New-onset expiratory grunting

A 2-year-old child is admitted to pediatric unit with bronchiolitis. The nurse calls the physician fearing the child is going into respiratory failure based on which of the following assessment findings? Select all that apply. A) Increased respiratory rate to 44 breaths/minute B) Substernal retractions becoming more pronounced C) New-onset expiratory grunting D) Productive cough with white secretions E) Faint wheezes noted in the posterior lung base

A) Increased respiratory rate to 44 breaths/minute B) Substernal retractions becoming more pronounced C) New-onset expiratory grunting

The client has had prolonged urethral outlet obstruction. The nurse knows that physiologically, the client may likely develop small pockets of mucosal tissue, called cellulae, which can ultimately cause: Select all that apply. A) Infections due to stasis B) Backpressure on the ureters C) Development of hydroureters D) Sphincter dystonia

A) Infections due to stasis B) Backpressure on the ureters C) Development of hydroureters

20. Most respiratory disorders in infants produce a decrease in: A) Lung compliance B) Airway resistance C) Oxygen demand D) Respiratory rate

A) Lung compliance

Most respiratory disorders in infants produce a decrease in: A) Lung compliance B) Airway resistance C) Oxygen demand D) Respiratory rate

A) Lung compliance

14. A chronic kidney disease client who has renal osteodystrophy should be assessed for which of the following complications? Select all that apply. A) Muscle weakness B) Kidney stones C) Bone pain D) Stress fractures E) Urosepsis

A) Muscle weakness C) Bone pain D) Stress fractures

A chronic kidney disease client who has renal osteodystrophy should be assessed for which of the following complications? Select all that apply. A) Muscle weakness B) Kidney stones C) Bone pain D) Stress fractures E) Urosepsis

A) Muscle weakness C) Bone pain D) Stress fractures

11. As nitrogenous wastes increase in the blood, the CKD client may exhibit which of the following clinical manifestations? Select all that apply. A) Numbness in lower extremities B) Photophobia C) Extremely low platelet counts D) Restless leg syndrome E) Pruritis

A) Numbness in lower extremities D) Restless leg syndrome E) Pruritis

As nitrogenous wastes increase in the blood, the CKD client may exhibit which of the following clinical manifestations? Select all that apply. A) Numbness in lower extremities B) Photophobia C) Extremely low platelet counts D) Restless leg syndrome E) Pruritis

A) Numbness in lower extremities D) Restless leg syndrome E) Pruritis

5. A drug abuser was found unconscious after shooting up heroin 2 days prior. Because of the pressure placed on the hip and arm, the client has developed rhabdomyolysis. The nurse knows this can: A) Obstruct the renal tubules with myoglobin and damage tubular cells B) Be cured by administering an anticoagulant immediately C) Cause the kidney to develop renal stones due to stasis D) Cause compartment syndrome in the lower extremities

A) Obstruct the renal tubules with myoglobin and damage tubular cells

A drug abuser was found unconscious after shooting up heroin 2 days prior. Because of the pressure placed on the hip and arm, the client has developed rhabdomyolysis. The nurse knows this can: A) Obstruct the renal tubules with myoglobin and damage tubular cells B) Be cured by administering an anticoagulant immediately C) Cause the kidney to develop renal stones due to stasis D) Cause compartment syndrome in the lower extremities

A) Obstruct the renal tubules with myoglobin and damage tubular cells

A newly diagnosed paraplegic client who suffered an automobile accident appears to have control of bladder emptying. The health care provider explains this process to the client/family stating, "This function is allowing the motor component of the neural reflex to assist with bladder emptying and is primarily controlled by the: A) Parasympathetic division of the ANS." B) Sympathetic division of the ANS." C) Somatic nervous system." D) Hypogastric nervous system."

A) Parasympathetic division of the ANS."

22. While assessing a peritoneal dialysis client in his or her 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: A) Peritonitis B) Bowel perforation C) Too much sugar in the dialysis solution D) Bladder erosion

A) Peritonitis

While assessing a peritoneal dialysis client in his or her 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: A) Peritonitis B) Bowel perforation C) Too much sugar in the dialysis solution D) Bladder erosion

A) Peritonitis

7. When acute tubular necrosis (ATN) is suspected, the nurse will likely see which of the following laboratory findings on the urinalysis report? Select all that apply. A) Protein B) Glucose C) Red blood cells D) Sodium excess E) Cast cells

A) Protein C) Red blood cells E) Cast cells

When acute tubular necrosis (ATN) is suspected, the nurse will likely see which of the following laboratory findings on the urinalysis report? Select all that apply. A) Protein B) Glucose C) Red blood cells D) Sodium excess E) Cast cells

A) Protein C) Red blood cells E) Cast cells

A woman has sought care because of recurrent urinary tract infections, which have been increasing in both frequency and severity. The health care worker should explain which of the following physiological factors to the client that is likely contributing to recurrent UTIs? A) Reflux flow of urine that can occur from coughing or sneezing B) Fluctuations in urine pH related to beverage consumption C) Urethral trauma that occurs during sexual intercourse D) Inadequate intake of water

A) Reflux flow of urine that can occur from coughing or sneezing

A) Sharp decrease in urine output

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 of the following early signs of prerenal injury? A) Sharp decrease in urine output B) Excessive voiding of clear urine C) Acute hypertensive crisis D) Intermittent periods of confusion

A) Sharp decrease in urine output

15. A client with an 80-pack-year history of tobacco smoking has presented to the clinic complaining of "bronchitis" cough for the past 5 months, weight loss, and shortness of breath. Today, this client "got scared" when he coughed up blood in his sputum. The health care provider is concerned this client may have which of the following possible diagnoses? A) Small cell lung cancer due to smoking history B) Tuberculosis due to long period of coughing C) Pulmonary embolism due to blood in sputum D) Pneumothorax related to chronic lung infection weakening the alveoli

A) Small cell lung cancer due to smoking history

A client with an 80-pack-year history of tobacco smoking has presented to the clinic complaining of "bronchitis" cough for the past 5 months, weight loss, and shortness of breath. Today, this client "got scared" when he coughed up blood in his sputum. The health care provider is concerned this client may have which of the following possible diagnoses? A) Small cell lung cancer due to smoking history B) Tuberculosis due to long period of coughing C) Pulmonary embolism due to blood in sputum D) Pneumothorax related to chronic lung infection weakening the alveoli

A) Small cell lung cancer due to smoking history

24. A 6-month-old infant has been hospitalized with acute bronchiolitis. Which of the following treatments should be prioritized in the infant's care? A) Supplementary oxygen therapy B) Intravenous antibiotics C) Transfusion of fresh frozen plasma D) Tracheotomy

A) Supplementary oxygen therapy

A 6-month-old infant has been hospitalized with acute bronchiolitis. Which of the following treatments should be prioritized in the infant's care? A) Supplementary oxygen therapy B) Intravenous antibiotics C) Transfusion of fresh frozen plasma D) Tracheotomy

A) Supplementary oxygen therapy

A client with newly diagnosed squamous cell carcinoma of the lung asks, "So how do we treat this cancer?" Which response from the health care provider is most accurate? Select all that apply. A) Surgery to remove tumor B) Radiation therapy C) Chemotherapy D) Stem cell transplant E) Monoclonal antibody

A) Surgery to remove tumor B) Radiation therapy C) Chemotherapy

A client is admitted to hospital to rule out Legionnaire disease following a canoe trip where he was sprayed in the face with a lot of "creek" water. Which of the following manifestations are characteristic of Legionnaire pneumonia? Select all that apply. A) Temperature of 103.5°, pulse 80 B) "Talking but not making a lot of sense" (confusion) C) Decreased abdominal bowel sounds D) Productive cough with thick, yellow secretions E) Chest x-ray that reveals areas of consolidation suggestive of pneumonia

A) Temperature of 103.5°, pulse 80 B) "Talking but not making a lot of sense" (confusion) E) Chest x-ray that reveals areas of consolidation suggestive of pneumonia

A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis and has subsequently developed latent tuberculosis infection. Which of the following is true of this nurse? A) The nurse is likely asymptomatic. B) The nurse is now immune to more severe tuberculosis infection. C) The nurse can spread tuberculosis to others. D) The nurse has active tuberculosis infection.

A) The nurse is likely asymptomatic.

Which of the following signs and symptoms in a 2-year-old child should prompt assessment for a urinary tract infection? A) Unexplained fever and anorexia B) Decreased urine output and irritability C) Production of concentrated urine and recurrent nausea D) Frank hematuria

A) Unexplained fever and anorexia

Which of the following clients at the clinic should be encouraged to receive the pneumococcal polysaccharide vaccine (PPSV23)? A client: Select all that apply. A) Who is 65 years old with chronic asthma B) With a smoking history C) Who is a young adult with HIV-positive results D) Who is school-aged and has received a liver transplant E) Who is a teenager with history of kidney disease

A) Who is 65 years old with chronic asthma B) With a smoking history

A) Antihypertensive medications

A) Decrease in GFR of 60 to 89 mL/minute/1.73 m2

A) Numbness in lower extremities D) Restless leg syndrome E) Pruritis

A) Obstruct the renal tubules with myoglobin and damage tubular cells

A) Protein C) Red blood cells E) Cast cells

A) Sharp decrease in urine output

Disorders of the pyramidal tracts, such as a stroke, are characterized by: A. paralysis. B. hypotonia. C. involuntary movements. D. muscle rigidity.

A******* Disorders of the pyramidal tracts (e.g., stroke) are characterized by spasticity and paralysis; whereas those affecting the extrapyramidal tracts (e.g., Parkinson disease) by involuntary movements, muscle rigidity, and immobility without paralysis. Hypotonia is a condition of less-than-normal muscle tone, hypertonia or spasticity is a condition of excessive tone, and paralysis refers to a loss of muscle movement. Upper motor neuron (UMN) lesions produce spastic paralysis and lower motor neuron (LMN) lesions flaccid paralysis.

11. A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis and has subsequently developed latent tuberculosis infection. Which of the following is true of this nurse? A) The nurse is likely asymptomatic. B) The nurse is now immune to more severe tuberculosis infection. C) The nurse can spread tuberculosis to others. D) The nurse has active tuberculosis infection.

A. The nurse is likely asymptomatic.

Which of the following statements about the use of angiotensin-converting enzyme inhibitor medications and autosomal recessive polycystic kidney disease (ARPKD) is accurate?

ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction.

Which is the most common cause of acute kidney injury? 1 Bladder cancer 2 Prostate cancer 3 Acute tubular necrosis 4 Malignant hypertension

Acute tubular necrosis

Which statement about the use of angiotensin-converting enzyme (ACE) inhibitors and autosomal recessive polycystic kidney disease (ARPKD) is accurate?

ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction.

A diabetic client with a history of HTN may receive a prescription for which medication to provide renal protective effect by reducing intraglomerular pressure? SATA

ACE inhibitors; angiotension receptor blockers

One of the earliest signs of Cushing syndrome is the loss of variable diurnal secretion of cortisol-releasing hormone (CRH) and:

ACTH.

The nurse is caring for a patient undergoing peritoneal dialysis. What finding should the nurse report to the primary health care provider that would indicate peritonitis? 1 Oliguria 2 Hyperkalemia 3 Hyponatremia 4 Abdominal pain

Abdominal pain - Peritonitis is caused by either a Staphylococcus aureus or a Staphylococcus epidermidis infection. It is manifested by abdominal pain, cloudy peritoneal effluent, and increased white blood cell count.

Which of the following factors is most strongly associated with the pathogenesis of gallstones?

Abnormalities or stasis of bile

Which client is displaying manifestations of having a kidney stone?

Acute onset of colicky flank pain radiating to lower abdomen

A child is recovering from a bout with group A -hemolytic Streptococcus infection. They return to the clinic a week later complaining of decrease in urine output with puffiness and edema noted in the face and hands. The health care provider suspects the child has developed:

Acute postinfectious glomerulonephritis

A child is recovering from a bout with group A beta-hemolytic Streptococcus infection. The child returns to the clinic a week later complaining of decrease in urine output with puffiness and edema noted in the face and hands. The health care provider suspects the child has developed:

Acute postinfectious glomerulonephritis

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?

Acute pyelonephritis

A client had excessive blood loss and prolonged hypotension during an extensive surgery. The client's postoperative urine output is sharply decreased and the blood urea nitrogen (BUN) is elevated. Which cause is most likely responsible for these abnormal findings?

Acute tubular necrosis

The patient admitted with sepsis is at risk of developing what renal pathology? 1 Nephritis 2 Glomerular nephritis 3 Acute tubular necrosis 4 Chronic kidney disease

Acute tubular necrosis - Acute tubular necrosis is a result of an acute shock on the renal system and is recoverable, but the patient is likely to develop acute kidney impairment (AKI).

If a client with a kidney stone has the "classic" ureteral colic, the client will describe his pain as: Select all that apply.

Acute, intermittent; Excruciating; In the flank and upper outer quadrant of the abd.

The signs and symptoms of abrupt cessation of pharmacologic glucocorticoids closely resemble those of:

Addison disease.

The nurse just received an urgent laboratory value on a patient in renal failure. The potassium level is 6.3. The telemetry monitor is showing peaked T waves. Which prescription from the primary health care provider should be implemented first? 1 Administer regular insulin intravenously (IV) 2 Restrict dietary potassium intake to 40 meq daily 3 Administer kayexalate enema 4 Educate the patient on dietary restriction of potassium

Administer regular insulin intravenously (IV) - This patient is showing signs of hyperkalemia, which could be fatal and lead to myocardial damage. Regular insulin IV is needed to quickly force potassium into the cells.

The nurse is planning an education program on chronic kidney disease. Which ethnic group would the nurse target for promoting this event? 1 African Americans 2 Asian descent 3 Caucasian males 4 Hispanics

African Americans

While studying for renal test in pathophysiology class, a student helps a peer by reviewing facts about the cells of the proximal tubule. Which of the following functions should they include in this discussion? Select all that apply

Aids in reabsorption | Rich in mitochondria | Supports active transport processes

A client sustained a puncture injury to the chest resulting in development of a tension pneumothorax. What is the pathogenesis behind a tension pneumothorax?

Air is permitted to enter but not leave the pleural space, causing lung collapse.

Respiratory movement of air that does not participate in alveolar gas exchange is known as alveolar dead space. Dead space increases when alveolar/alveoli:

Air supply exceeds blood flow.

Acute-onset bronchial asthma causes wheezing and breathlessness as a result of which of the following?

Airway inflammation

A decrease in the serum level of which of the following substances is suggestive of liver injury?

Albumin

The physician suspects that a client with kidney stones has developed magnesium ammonium phosphate (struvite) stones based on which of the following urinalysis results? Select all that apply.

Alkaline urine PH |High urine phosphate level | High bacterial count

A client has been given the diagnosis of diffuse glomerulonephritis. They ask the nurse what diffuse means. The nurse responds:

All glomeruli and all parts of the glomeruli are involved.

A client has been given the diagnosis of diffuse glomerulonephritis. They ask the nurse what diffuse means. The nurse responds:

All glomeruli and all parts of the glomeruli are involved. Glomerular changes can be diffuse, involving all glomeruli and all parts of the glomeruli; focal, meaning only some of the glomeruli are affected; segmental, involving only a certain segment of each glomerulus; and mesangial, affecting only mesangial cells.

Aluminum

A client who has developed stage 3 renal failure has been diagnosed with high phosphate levels. To avoid the development of osteodystrophy, the physician may prescribe a phosphate-binding agent that does not contain: a) Aluminum b) Sevelamer hydrochloride c) Calcium acetate d) Calcium carbonate

Aluminum Aluminum-containing antacids can contribute to the development of osteodystrophy, whereas calcium-containing phosphate binders can lead to hypercalcemia, thus worsening soft tissue calcification, especially in persons receiving vitamin D therapy. Sevelamer hydrochloride is a newer phosphate-binding agent that does not contain calcium or aluminum.

A client has developed renal failure with associated high serum phosphate levels. To avoid the development of osteodystrophy, the health care provider will try to avoid phosphate-binding agents that contain which compound?

Aluminum salts

Which of the following residents of a long-term facility is exhibiting signs and symptoms that are indicative of hypothyroidism?

An 80-year-old woman who has uncharacteristically lost her appetite of late and often complains of feeling cold

Which of the following individuals displays the precursors to acromegaly?

An adult with an excess of growth hormone due to an adenoma

Ans: A Feedback: Diminished renal reserve is characteristic of renal insufficiency, when labs remain normal but there is renal insufficiency. Only the second stage, formerly known as renal insufficiency, is characterized by a decrease in GFR of 60 to 89 mL/minute/1.73 m2. The other choices represent stage 3, 4, and 5, respectfully.

24. While taking a history from an adult client newly diagnosed with renal cell cancer, the nurse can associate which of the following high-risk factors with the development of this cancer? A) Heavy smoking B) Inherited renal disease C) Adrenal medulla tumors D) Anorexia/bulimia disorder

Ans: A Feedback: Epidemiologic evidence suggests a correlation between heavy smoking and kidney cancer. Obesity also is a risk factor; particularly in women. The risk of renal cell carcinoma also is increased in persons with acquired cystic kidney disease associated with chronic renal insufficiency. Although the adrenal gland is adjacent to the kidney, primary adrenal tumors are unrelated to renal cell disease.

20. A client has a diagnosis of chronic renal failure secondary to diabetic nephropathy. Which of the following hematologic changes may result from this client's kidney disorder? A) Anemia B) Leukocytosis C) Thrombocytopenia D) Leukopenia

Ans: A Feedback: Erythropoietin is a polypeptide hormone that regulates the differentiation of RBCs in the bone marrow. Between 89% and 95% of erythropoietin is formed in the kidneys. The synthesis of erythropoietin is stimulated by tissue hypoxia, which may be brought about by anemia, residence at high altitudes, or impaired oxygenation of tissues due to cardiac or pulmonary disease. Persons with chronic kidney disease often are anemic because of an inability of the kidneys to produce erythropoietin. Changes in platelet or white blood cell levels are not likely to result directly from renal failure.

Ans: A Feedback: 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.

Ans: A Feedback: Myoglobin normally is not found in the serum or urine. It has a low molecular weight; if it escapes into the circulation, it is rapidly filtered in the glomerulus. A life-threatening condition known as rhabdomyolysis occurs when increasing myoglobinuria levels cause myoglobin to precipitate in the renal tubules, leading to obstruction and damage to surrounding tubular cells. Myoglobinuria most commonly results from muscle trauma but may result from exertion, hyperthermia, sepsis, prolonged seizures, and alcoholism or drug abuse. Rhabdomyolysis is not cured with anticoagulation administration nor does it cause kidney stones. Compartment syndrome occurs when there is insufficient blood supply to muscles and nerves due to increased pressure within one of the body's compartments.

15. When explaining the body's compensatory mechanisms to maintain a normal pH, the health care provider knows that the renal system: A) Works slower than the respiratory system, going into action 1 to 2 days after H+ remain elevated B) Will absorb more bile acids to try to normalize elevated H+ levels C) Will absorb more Na+ and water to dilute the elevated H+ in an effort to normalize pH D) Waits until the lungs have increased the respiratory rate to try to blow off excess CO2

Ans: A Feedback: Only the kidney can eliminate hydrogen from the body. Virtually all the excess H+ excreted in the urine are secreted into the tubular fluid by means of tubular secretory mechanisms. The ability of the kidneys to excrete large amounts of H+ in the urine is accomplished by combining the excess ions with buffers in the urine. The three major urine buffers are HCO3-, phosphate (HPO42-), and ammonia (NH3). An important aspect of this buffer system is that the deamination process increases whenever the body's hydrogen ion concentration remains elevated for 1 to 2 days.

Ans: A Feedback: Persons with chronic kidney disease (CKD) are usually encouraged to limit their dietary phosphorus as a means of preventing secondary hyperparathyroidism, renal osteodystrophy, and metastatic calcification. Excessive potassium and fluids are likely contraindicated in kidney disease individuals require hemodialysis. The amount of dietary fiber intake is not a priority when looking at primary needs of a CKD patient's food intake.

Ans: A Feedback: 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.

13. The most recent assessment of a client with a diagnosis of type 1 diabetes indicates a heightened risk of diabetic nephropathy. Which of the following assessment findings is most suggestive of this increased risk? A) Microalbuminuria B) Hematuria C) Orthostatic hypotension D) Diabetic retinopathy

Ans: A Feedback: The increased glomerular filtration rate (GFR) that occurs in persons with early alterations in renal function is associated with microalbuminuria, which is an important predictor of future diabetic nephropathies. Hematuria is not directly suggestive of diabetic nephropathy, although it is a highly significant assessment finding. Orthostatic hypotension and diabetic retinopathy are not direct indicators of diabetic nephropathy.

21. Clients with CKD are at risk for demineralization of their bones since they are no longer able to: A) Transform vitamin D to its active form B) Excrete bicarbonate effectively C) Stimulate bone osteoclastic production D) Synthesize erythropoietin

Ans: A Feedback: The kidneys aid in calcium metabolism by activating vitamin D, after it is chemically converted by the liver. Bicarbonate buffering is unrelated to activation of vitamin D. Bone marrow is stimulated by the synthesis of erythropoietin to form red blood cells, which is unrelated to calcium levels.

18. The most damaging effects of urinary obstruction are the result unrelieved obstruction of urine outflow and: A) Urinary stasis B) Concentrated urine C) Kidney hyperplasia D) Renal hypertension

Ans: A Feedback: The most damaging effects of urinary obstruction are stasis of urine, which predisposes to infection and stone formation, and unrelieved obstruction of urine outflow. Most commonly, the person has pain, signs, and symptoms of urinary tract infection (UTI) and manifestations of renal dysfunction, such as an impaired ability to concentrate urine. Progressive atrophy of the kidney is caused by obstruction of the outflow of urine. Hypertension is an occasional complication of urinary tract obstruction, since urine flow is obstructed rather than renal blood flow.

8. Following an episode of strep throat, the school nurse notices the fourth grade child has not recovered from this illness a week later. Upon further investigation, the nurse notices that the child has developed water retention. Which of the following assessments support this conclusion? Select all that apply. A) Periorbital edema B) BP 100/70 C) Swelling of the hands and fingers D) Vomiting after intake of any solid food E) Dizziness and right ear pain

Ans: A, B Feedback: Generalized edema, a hallmark of nephrosis, results from salt and water retention and a decrease in plasma colloid osmotic pressure due to loss of albumin in the urine. Glomerulonephritis is characterized by sodium and water retention that causes edema, particularly of the face and hands. Fluid retention usually results in an elevated BP, not a normal one. Vomiting and dizziness are not associated with this diagnosis.

14. Which of the following diagnostic and assessment results support the diagnosis of chronic pyelonephritis? Select all that apply. A) Polyuria (excess urine output) B) Nocturia (voiding at night) C) Bilateral flank pain D) Blood pressure 140/92 E) Severe pain in upper outer quadrant of the abdomen

Ans: A, B Feedback: The symptoms of chronic pyelonephritis often include a history of recurrent episodes of UTI or acute pyelonephritis. Loss of tubular function and the ability to concentrate urine give rise to polyuria and nocturia, and mild proteinuria is common. Severe hypertension often is a contributing factor in the progress of the disease. A BP of 140/92 is not considered "severe" hypertension. Flank and upper outer quadrant pain is usually associated with kidney stones.

11. A client has been recently undergone diagnostic testing for possible Berger disease. The nurse caring for this client would anticipate the primary clinical manifestations include which of the following? Select all that apply. A) Gross hematuria B) Recent upper respiratory infection C) Elevated ketone levels in the urine D) Fever, chills, and general body aches

Ans: A, B, D Feedback: Early in the disease, many people with the disorder have no obvious symptoms, and the disorder is discovered during screening or examination for another condition. In others, the disorder presents with gross hematuria that is preceded by upper respiratory tract infection, GI tract symptoms, or flulike illness. The hematuria lasts 2 to 6 days. Elevated ketones are usually associated with acidosis, fasting, high-protein diet, or diabetes to name a few.

10. 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: Select all that apply. A) Moist crackles in both lung fields B) Areas of diminished breath sounds due to pleural effusions C) Liver enlargement D) Kidneys palpable to deep palpation E) Increased circumference in the abdomen related to fluid excess

Ans: A, B, E Feedback: Generalized edema, which is a hallmark of the nephrotic syndrome, results from a decrease in the plasma colloidal osmotic pressure due to the hypoalbuminemia that develops as albumin is lost from the vascular compartment. Initially, the edema presents in dependent parts of the body such as the lower extremities, but becomes more generalized as the disease progresses. Dyspnea due to pulmonary edema, pleural effusions, and diaphragmatic compromise due to ascites (increase fluid in the abdominal cavity) can develop in persons with nephrotic syndrome. Live enlargement is not associated with nephrotic syndrome, but increased synthesis of lipoproteins in the liver secondary to a compensatory increase in albumin production may occur. Palpable kidney mass is associated with cancer.

24. When explaining urinalysis results that show the presence of cast cells, the nurse informs the client that casts cells develop when the client has: Select all that apply. A) A high protein concentration of the urine B) An elevated urine pH C) High urine osmolality D) More than one bacteria present in the urine

Ans: A, C Feedback: Casts are molds of the distal nephrons' lumen. A gel-like substance (Tamm-Horsfall mucoprotein) is formed in the tubular epithelium and is the major protein constituent of urinary casts. Casts composed of this gel but devoid of cells are called hyaline casts. These casts develop when the protein concentration of the urine is high, urine osmolality is high, and urine pH is low.

25. Reduced glomerular filtration rate (GFR), with a serum creatinine level that remains in the normal range, is associated with aging because elderly persons tend to have reduced: A) Calcium intake B) Muscle mass C) Drug tolerance D) Renal perfusion

Ans: B Feedback: Serum creatinine level is directly related to muscle metabolism. Because muscle mass is reduced in elderly persons, the creatinine level does not increase as readily with a lower GFR. Drug tolerance and renal perfusion can affect the GFR, but the age-related normal creatinine level can also be present. Calcium intake is unrelated to creatinine levels or GFR.

9. A client has been prescribed hydrochlorothiazide, a thiazide diuretic, to control high blood pressure. While educating the client about the actions of the medication, the nurse will mention which of the following actions? Select all that apply. A) Blocks Na+ reabsorption in distal tubules B) Establishes a high concentration of osmotically active particles C) Increases active reabsorption of Ca++ into the blood D) Juxtamedullary vasoconstriction, which controls water movement E) Establishes a high concentration of K+ within the cell

Ans: A, C Feedback: The thiazide diuretics, which are widely used to treat disorders such as hypertension, exert their action by blocking sodium reabsorption in this segment of the renal tubules, while enhancing the active reabsorption of calcium into the blood via the calcium-sodium exchange transport mechanism. For this reason, thiazide diuretics have proved useful in reducing the incidence of calcium kidney stones in persons with hypercalciuria. ATPase pump maintains a low sodium concentration inside the cell by moving sodium down its concentration into the cell through special sodium channels. The pump also establishes a high concentration of potassium within the cell, causing it to diffuse down its concentration gradient across the luminal membrane into the tubular fluid.

Ans: A, C, D Feedback: Both types of renal osteodystrophy are manifested by abnormal absorption and defective bone remodeling. Renal osteodystrophy is typically accompanied by reductions in bone mass, alterations in bone microstructure, bone pain, and skeletal fracture. There are changes in bone turnover, mineralization, and bone volume, accompanied by bone pain and muscle weakness, risk of fractures, and other skeletal complications. Kidney stones and urosepsis are not associated with renal osteodystrophy.

21. If a client with a kidney stone has the "classic" ureteral colic, the client will describe his pain as: Select all that apply. A) Acute, intermittent B) Diffuse over the entire lower back and legs C) Excruciating D) In the flank and upper outer quadrant of the abdomen

Ans: A, C, D Feedback: The symptoms of renal colic are caused by stones 1 to 5 mm in diameter that can move into the ureter and obstruct flow. Classic ureteral colic is manifested by acute, intermittent, and excruciating pain in the flank and upper outer quadrant of the abdomen on the affected side. The pain may radiate to the lower abdominal quadrant, bladder area, perineum, or scrotum in the man. The pain is usually not described as diffuse and over the entire low back and legs.

Ans: A, C, E Feedback: Nephron damage allows the larger protein cells to pass through the membrane and into the urine (normally, urine has very few proteins present). Further diagnostic information that can be obtained from the urinalysis includes hemoglobinuria (blood in the urine) and casts or crystals in the urine. Glucosuria in the urine is an indirect indication of extreme hyperglycemia, often unrelated to renal disease. Urine sodium concentration is maintained with prerenal azotemia; urine sodium decreases with renal tubule damage. Urine calcium is not diagnostic for ATN.

2. While studying for renal test in pathophysiology class, a student helps a peer by reviewing facts about the cells of the proximal tubule. Which of the following functions should they include in this discussion? Select all that apply. A) Aids in reabsorption B) Location for high-pressure capillary filtration C) Rich in mitochondria D) Plays a role in the medullary collecting tubule E) Supports active transport processes

Ans: A, C, E Feedback: The cells of the proximal tubule have a fine, villous structure that increases the surface area for reabsorption; they also are rich in mitochondria, which support active transport processes. The epithelial layer thins in segments of the loop of Henle and has few mitochondria, indicating minimal metabolic activity and reabsorptive function.

12. Nitric oxide, a vasodilator produced by the vascular endothelium, is important in renal control by: Select all that apply. A) Preventing excessive vasoconstriction B) Regulating renal blood flow C) Inhibiting prostaglandin synthesis D) Allowing normal excretion of sodium and water

Ans: A, D Feedback: Nitric oxide, a vasodilator produced by the vascular endothelium, appears to be important in preventing excessive vasoconstriction of renal blood vessels and allowing normal excretion of sodium and water. Prostaglandins do not appear to play a major role in regulating renal blood flow. Some medications like aspirin and NSAIDs inhibit prostaglandin synthesis.

Ans: A, D Feedback: Reductions in alertness and awareness are the earliest and most significant indications of uremic encephalopathy. Late in the disease process, the client may develop delirium, coma, and seizures.

Ans: A, D, E Feedback: The uremic state is characterized by signs and symptoms of altered neuromuscular function (e.g., fatigue, peripheral neuropathy, restless leg syndrome, sleep disturbances, uremic encephalopathy); gastrointestinal disturbances such as anorexia and nausea; white blood cell and immune dysfunction, and dermatologic manifestations such as pruritus. Photophobia and thrombocytopenia are usually not associated with CKD.

22. Which one of the following blood tests reflects the glomerular filtration rate (GFR) and is used to estimate renal function? A) Blood protein B) Serum creatinine C) Serum ammonia D) Blood urea nitrogen

Ans: B Feedback: Serum creatinine level is used to estimate functional capacity of the kidneys. Increased creatinine level indicates decreased GFR and renal function. Blood urea nitrogen (BUN) levels are influenced by hydration status, protein intake, and bleeding, in addition to renal function. Serum ammonia is a metabolic by-product of urea and can be influenced by multiple factors unrelated to kidney function.

10. An athlete has become dehydrated during a long race in hot weather. Which of the following physiologic processes will occur in an attempt to protect the athlete's extracellular fluid volume? A) Dilation of the afferent and efferent arterioles B) Release of ADH from the posterior pituitary C) Increased water reabsorption in the ascending limb of the loop of Henle D) Increased water reabsorption in the distal convoluted tubule

Ans: B Feedback: ADH assists in the maintenance of the extracellular fluid volume by controlling the permeability of the medullary collecting tubules. Osmoreceptors in the hypothalamus sense an increase in osmolality of extracellular fluids and stimulate the release of ADH from the posterior pituitary gland. In exerting its effect, ADH, also known as vasopressin, binds to receptors on the basolateral side of the tubular cells. Binding of ADH to the vasopressin receptors causes water channels, known as aquaporin-2 channels, to move into the luminal side of the tubular cell membrane, producing a marked increase in water permeability. The ascending limb of the loop of Henle and the distal convoluted tubule are largely impermeable to water, and arteriole dilation does not directly increase the amount of water reabsorbed from glomerular filtrate.

16. Which of the following medications may be responsible for a client developing increased uric acid levels by decreasing ECF volume? A) Vitamin C B) Thiazide diuretics C) Penicillin antibiotics D) Maalox products

Ans: B Feedback: Because of its effect on uric acid secretion, aspirin is not recommended for treatment of gouty arthritis. Thiazide and loop diuretics also can cause hyperuricemia and gouty arthritis, presumably through a decrease in ECF volume and enhanced uric acid reabsorption.

24. Manifestations of childhood renal disease are varied and may differ from adult-onset renal failure. A school-aged child with chronic kidney disease may exhibit: A) Low IQ level with borderline retardation B) Developmental delays such as uncoordinated gait and minimal fine motor skills C) Inability to control bladder, resulting in incontinence D) Frequent, uncontrolled rolling of the tongue and opening mouth extremely wide

Ans: B Feedback: Childhood chronic kidney disease is manifested by growth and developmental delays and late onset sexual maturity as a result of the uremic effects on endocrine function, bone abnormalities, and development of psychosocial problems. Renal failure is unrelated to the ability of children to have control of urine or bowel elimination. Intelligence is not affected by renal failure, although renal encephalopathy may affect behavior.

16. A client with a history of chronic pyelonephritis has been admitted several times with recurrent bacterial infection of the urinary tract. The nurse should anticipate educating this client with regard to which common treatment regimen? A) Increase intake of cranberry juice to 2 L/day. B) Continue taking antibiotics for full 10 to 14 days even if symptoms of infection disappear. C) Force micturition every 2 hours while awake. D) Take prescribed diuretics early in the day to avoid having to get up during the night.

Ans: B Feedback: Chronic pyelonephritis involves a recurrent or persistent bacterial infection superimposed on urinary tract obstruction, urine reflux, or both. Chronic obstructive pyelonephritis can be bilateral, caused by conditions that obstruct bladder outflow; or unilateral, such as occurs with ureteral obstruction. Cranberry juice, forced micturition, and diuretics are not standard treatments for chronic pyelonephritis.

3. Which of the following statements about the use of angiotensin-converting enzyme inhibitor medications and autosomal recessive polycystic kidney disease (ARPKD) is accurate? A) The use of ACE inhibitors will increase the vasopressin levels. B) ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction. C) The ACE inhibitors have been shown to shrink the size of the cysts inside the kidneys. D) ACE inhibitors should be used strictly in those clients who also have an underlying cardiac history.

Ans: B Feedback: In addition to increasing water intake to decrease vasopressin levels, the angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) may be used to interrupt the renin-angiotensin-aldosterone system as a means of reducing intraglomerular pressure and renal vasoconstriction. Although not approved by the Food and Drug Administration (FDA), there has been recent interest in the use of vasopressin receptor antagonists (vaptans) to decrease cyst development.

4. A client with significant burns on his lower body has developed sepsis on the 3rd day following his accident. Which of the following manifestations would the nurse anticipate for an ischemic acute tubular necrosis rather than prerenal failure? The client: A) Exhibits pulmonary and peripheral edema B) GFR does not increase after restoration of renal blood flow C) Undergoes emergent hemodialysis that does not result in decreased BUN and creatinine D) Exhibits oliguria and frank hematuria

Ans: B Feedback: In contrast to prerenal failure, the glomerular filtration rate (GFR) does not improve with the restoration of renal blood flow in acute renal failure caused by ischemic acute tubular necrosis. Edema, oliguria, and hematuria are not diagnostic of acute tubular necrosis (ATN), and hemodialysis does not normally fail to achieve a reduction in blood urea nitrogen (BUN) and creatinine.

23. A client has provided a routine urine sample during a scheduled visit to his primary care provider. Which of the following results is an expected finding in a healthy individual? A) Low to moderate amount of glucose in the urine B) Urine specific gravity of 1.020 C) Presence of moderate amounts of albumin with absence of other proteins D) Presence of urinary casts

Ans: B Feedback: Normal urine specific gravity ranges from 1.010 to 1.025. Glucose and casts are normally absent, and albumin is normally present in only scant amounts.

25. Which of the following client clinical manifestations most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma? A) Urinary urgency B) Hematuria C) Oliguria D) Cloudy urine

Ans: B Feedback: 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.

18. Which of the following physiologic processes is performed by the kidneys and contributes to increased blood pressure? A) Catalysis of the conversion of angiotensin I to angiotensin II B) Production and release of renin C) Secretion of aldosterone D) Conversion of aldosterone to angiotensin

Ans: B Feedback: Renin, an enzyme that is synthesized and stored in the juxtaglomerular cells of the kidney, enzymatically converts angiotensinogen to angiotensin I. Angiotensin I is converted to angiotensin II, a potent vasoconstrictor, in the lungs. Aldosterone is secreted by the adrenal glands and does not convert to angiotensin.

17. Prior to undergoing diagnostic testing with contrast, it is recommended that older adult clients have their creatinine level checked. The rationale for this is to ensure the client: A) Is not allergic to shell fish or iodine B) Will not undergo an acute kidney injury by decreasing renal blood flow C) Does not have a kidney stone obstructing the urethra D) Is in good enough health to withstand a walking on a treadmill

Ans: B Feedback: Some drugs, such as diuretics, high molecular weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus, and the nonsteroidal anti-inflammatory drugs (NSAIDs), can cause acute kidney injury by decreasing renal blood flow. Checking creatinine levels do not predict the client's allergies, a kidney stone, or tolerance for stress testing.

9. Which of the following assessment findings would lead the nurse to suspect the client has nephrotic syndrome? A) Hematuria and anemia B) Proteinuria and generalized edema C) Renal colic and increased serum sodium D) Increased creatinine with normal blood urea nitrogen

Ans: B Feedback: The nephrotic syndrome is characterized by massive proteinuria and lipiduria, along with an associated hypoalbuminemia, generalized edema, and hyperlipidemia.

6. A client is beginning to recover from acute tubular necrosis. The nurse would likely be assessing which of the following manifestations of the recovery phase of ATN? A) Edema B) Diuresis C) Proteinuria D) Hypokalemia

Ans: B Feedback: The recovery phase is first noticed as increased/excessive output (diuresis) of dilute urine and a fall in serum creatinine, indicating that the nephrons have recovered to the point at which urine excretion is possible. Potassium will remain elevated or continue to rise, since the diuresis occurs before renal function fully returns to normal. Edema/fluid retention is characteristic of the maintenance phase. Proteinuria is characteristic of glomerular disease and/or chronic kidney disease.

7. When the glomerular transport maximum for a substance such as blood glucose is exceeded and its renal threshold has been reached, the substance will: A) Reabsorb quickly B) Spill into the urine C) Countertransport sodium D) Attach to protein carriers

Ans: B Feedback: 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.

1. A diabetic client with a history of hypertension may receive a prescription for which medication to provide a renal protective effect by reducing intraglomerular pressure? Select all that apply. A) Loop diuretics B) ACE inhibitors C) Angiotensin receptor blockers D) Calcium channel blockers E) A digitalis preparation

Ans: B, C Feedback: The ACE inhibitors and ARBs reduce the effects of angiotensin II on renal blood flow. They also reduce intraglomerular pressure and may have a renal protective effect in persons with hypertension or type 2 diabetes. However, when combined with diuretics, they may cause prerenal injury in persons with decreased blood flow due to large-vessel or small-vessel kidney disease. Calcium channel blockers are vasodilators.

12. A 43-year-old female has recently been diagnosed with systemic lupus erythematosus (SLE) glomerulonephritis. She has presented to the out-client department to have a renal biopsy. Knowing the usual treatment options, the nurse should anticipate educating the client (who has a positive biopsy result) on which of the following medications being prescribed? Select all that apply. A) Lasix, a diuretic B) Prednisone, a corticosteroid C) Captopril, an ACE inhibitor D) Ampicillin, an antibiotic

Ans: B, C Feedback: Treatment depends on the extent of glomerular involvement. Oral corticosteroids and angiotensin-converting enzyme (ACE) inhibitors are the mainstays of treatment. Diuretics and antibiotics are not part of the treatment protocol.

19. The physician suspects that a client with kidney stones has developed magnesium ammonium phosphate (struvite) stones based on which of the following urinalysis results? Select all that apply. A) Elevated uric acid levels B) Alkaline urine pH C) High urine phosphate level D) High bacterial count E) Presence of cystine particles

Ans: B, C, D Feedback: Magnesium ammonium phosphate stones, also called struvite stones, form only in alkaline urine and in the presence of bacteria that possess an enzyme called urease, which splits the urea in the urine into ammonia and carbon dioxide. The ammonia that is formed takes up a hydrogen ion to become an ammonium ion, increasing the pH of the urine so that it becomes more alkaline. Because phosphate levels are increased in alkaline urine and because magnesium always is present in the urine, struvite stones form. Uric acid stones develop in conditions of gout and high concentrations of uric acid in the urine. Cystine stones account for less than 1% of kidney stones overall but represent a significant proportion of childhood calculi. They are seen in cystinuria, which results from a genetic defect in renal transport of cystine.

2. While taking a client history, which of the following assessments lead the nurse to suspect the client may have polycystic kidney disease? Select all that apply. A) Massive proteinuria on dipstick urine specimen B) Renal colic with flank pain C) Bright red blood in urine sample D) Elevated blood pressure of 180/94 E) Shortness of breath (SOB) with loud rhonchi and wheezes heard on auscultation

Ans: B, C, D Feedback: The manifestations of ADPKD include pain from the enlarging cysts that may reach debilitating levels, episodes of gross hematuria from bleeding into a cyst, infected cysts from ascending UTIs, and hypertension resulting from compression of intrarenal blood vessels with activation of the renin-angiotensin mechanism. Renal colic caused by nephrolithiasis, or kidney stones, occurs in about 20% of persons with ADPKD. One type of pain associated with kidney stones is renal colic, described as colicky pain that accompanies stretching of the collecting system or ureter. Nephrotic syndrome is characterized by massive proteinuria. SOB with abnormal respiratory sounds is not usually associated with ADPKD.

19. A chronic kidney disease (CKD) client asks the nurse, "Why do I itch all the time?" The nurse bases her response on which of the following integumentary physiologic factors that causes pruritis? Select all that apply. A) Too harsh of soap while bathing B) Decrease in perspiration C) Limited sodium intake D) Enlarged size of sweat glands E) Elevated serum phosphate levels

Ans: B, E Feedback: Dry, itchy skin is a common consequence of CKD. Pruritus is common; it results from the high serum phosphate levels and the development of phosphate crystals that occur with hyperparathyroidism. Harsh soap (may dry the skin), limited Na+ intake, and enlarged sweat glands are not noted to accompany or result in pruritus.

The emergency room provider diagnoses a client with a hemothorax. Which could be possible causes of this condition?

Fractured ribs following car accident

1. An adult client has been diagnosed with polycystic kidney disease. Which of the client's following statements demonstrates an accurate understanding of this diagnosis? A) "I suppose I really should have paid more attention to my blood pressure." B) "I've always been prone to getting UTIs, and now I know why." C) "I suppose I should be tested to see if my children might inherit this." D) "I had a feeling that I was taking too many medications, and now I know the damage they can do."

Ans: C Feedback: Autosomal dominant polycystic kidney disease is the most common of all inherited kidney diseases. The disorder is characterized by multiple expanding cysts of both kidneys that ultimately destroy the surrounding kidney structures and cause renal failure. The etiology of polycystic kidney disease (PKD) is not infective, and it is not caused by nephrotoxic drugs or uncontrolled hypertension.

23. Regardless of the cause, chronic kidney disease results in progressive permanent loss of nephrons and glomerular filtration, and renal: A) Tubule dysplasia B) Vascular pressure C) Endocrine functions D) Hypophosphatemia

Ans: C Feedback: Chronic kidney disease results in loss of nephrons, tubule, and endocrine functions such as erythropoietin production. Systemic and renal hypertension is commonly an early manifestation of chronic kidney disease, caused by resistance to blood flow through the constricted renal vessels. Tubule hypertrophy is a compensatory response for those destroyed—when the few remaining nephrons are destroyed, renal failure is apparent. Phosphate accumulates in the blood; since it is inversely related to calcium, the levels of which remain chronically low.

13. The nurse is providing care for a client who has a diagnosis of kidney failure. Which of the following laboratory findings is consistent with this client's diagnosis? A) Elevation in vitamin D levels B) Hypophosphatemia C) Hypocalcemia D) Hypokalemia

Ans: C Feedback: Diagnostic findings that are congruent with a diagnosis of kidney failure include hyperphosphatemia, hypocalcemia, a decrease in active vitamin D levels, and secondary hyperparathyroidism.

17. A client's most recent blood work reveals a blood urea nitrogen (BUN) level of 36 mg/dL (normal range 8 to 25 mg/dL). Which of the following factors may have contributed to this finding? A) Increased salt intake B) Action of ADH C) Dehydration D) Parasympathetic nervous system stimulation

Ans: C Feedback: During periods of dehydration, the blood volume and glomerular filtration rate (GFR) drop, and BUN levels increase. Increased salt intake, parasympathetic stimulation, and the action of ADH do not normally result in an increase in BUN.

3. In the intensive care unit (ICU), the nurse is caring for a trauma client who has abdominal injuries is beginning to have a decrease in BP and increased pulse rate and is pale with diaphoretic skin. The nurse is assessing the client for hemorrhagic shock. If the client is in shock, the nurse would expect to find: A) Excess output of blood-tinged urine B) Complaints of flank pain rotating around the abdominal muscles C) Significant decrease in urine output due to decrease in renal blood flow D) An increase in GFR due to relaxation of the afferent arterioles

Ans: C Feedback: During periods of strong sympathetic stimulation, such as shock, constriction of the afferent arteriole causes a marked decrease in renal blood flow and thus glomerular filtration pressure. Consequently, urine output can fall almost to 0. Unless the injury is specific to the kidney, the client will not have blood in urine and urine production will not be excessive. Flank pain is associated with obstruction due to stone formation. The GFR will decrease rather than increase.

9. 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) A need to increase water intake B) The kidneys are functioning normally C) A loss of over half the client's normal kidney function D) Concentrated urine

Ans: C Feedback: In clinical practice, GFR is usually estimated using the serum creatinine concentration. A GFR below 60 mL/minute/1.73 m2 represents a loss of one half or more of the level of normal adult kidney function. The GFR is not diagnostic for concentrated urine or the need to drink more water.

3. A client had excessive blood loss and prolonged hypotension during surgery. His postoperative urine output is sharply decreased, and his blood urea nitrogen (BUN) is elevated. The most likely cause for the change is acute: A) Prerenal inflammation B) Bladder outlet obstruction C) Tubular necrosis D) Intrarenal nephrotoxicity

Ans: C Feedback: Ischemic acute tubular necrosis (ATN) occurs most frequently in persons who have major surgery with prolonged renal hypoperfusion—this directly damages the tubular epithelial cells with acute suppression of renal function. Nephrotoxic ATN is caused by toxic agents or drugs. Prerenal vasoconstriction is associated with acute-onset loss of renal output. Bladder (postrenal) obstruction would not affect the BUN, since it rarely causes renal failure.

21. Client and family education regarding peritoneal dialysis should include assessing the client for: A) Bleeding around the arteriovenous fistula or an external arteriovenous shunt B) Signs and symptoms of hypoglycemia such as weakness, irritability, and shakiness C) Dehydration that may appear as dry mucous membranes or poor skin turgor D) Muscle cramps associated with hypoparathyroidism

Ans: C Feedback: Potential problems with peritoneal dialysis include infection, catheter malfunction, dehydration caused by excessive fluid removal, hyperglycemia, and hernia. The most serious complication is infection, which can occur at the catheter exit site, in the subcutaneous tunnel, or in the peritoneal cavity. In peritoneal dialysis, a sterile dialyzing solution is instilled through a catheter over a period of approximately 10 minutes. Then the solution is allowed to remain in the peritoneal cavity for a prescribed amount of time. Shunts, fistulas, and artificial dialyzers are associated with hemodialysis, which is usually performed three times weekly.

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

Ans: D Feedback: 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 with a diagnosis of chronic kidney disease (CKD) may require the administration of which of the following drugs to treat coexisting conditions that carry a high mortality?

Antihypertensive medications

5. An automobile accident client is brought to the emergency department in hypovolemic shock from internal bleeding. Nurses are closely monitoring urine output since a significant decrease signifies that: A) The kidneys are probably injured. B) Renal arteries are clogged with blood. C) The SNS has caused afferent arteries to constrict to decrease blood flow. D) Vagus nerve has caused bradycardia, which decreases amount of blood reaching kidneys.

Ans: C Feedback: The afferent and the efferent arterioles are innervated by the sympathetic nervous system and are sensitive to vasoactive hormones, such as angiotensin II. During periods of strong sympathetic stimulation, such as shock, constriction of the afferent arteriole causes a marked decrease in renal blood flow and thus glomerular filtration pressure. Consequently, urine output can fall almost to 0. There is no enough information to conclude the kidneys are injured, the renal arteries are clotted, or the vagus nerve has been innervated.

7. A child is recovering from a bout with group A -hemolytic Streptococcus infection. They return to the clinic a week later complaining of decrease in urine output with puffiness and edema noted in the face and hands. The health care provider suspects the child has developed: A) Autosomal recessive polycystic kidney disease B) Adult-onset medullary cystic disease C) Acute postinfectious glomerulonephritis D) Acute nephritic syndrome

Ans: C Feedback: The classic case of poststreptococcal glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days—the time needed for the development of antibodies. Oliguria, which develops as the GFR decreases, is one of the first symptoms. Proteinuria and hematuria follow because of increased glomerular capillary wall permeability. Sodium and water retention gives rise to edema (particularly of the face and hands) and hypertension. Adults with medullary cystic kidney disease present first with polyuria, polydipsia, and enuresis (bed-wetting), which reflect impaired ability of the kidneys to concentrate urine. The typical infant with ARPKD presents with bilateral flank masses, accompanied by severe renal failure, signs of impaired lung development, and variable degrees of liver fibrosis and portal hypertension. Acute nephritic syndrome is characterized by sudden onset of hematuria, variable degrees of proteinuria, diminished glomerular filtration rate (GFR), oliguria, and signs of impaired renal function.

19. Which of the following clients is benefiting from the renin-angiotensin-aldosterone mechanism? A) A teenager who received an injury to the flank area during football practice B) A toddler who was recently diagnosed with cystic fibrosis C) A college student admitted to the neurotrauma unit following traumatic brain injury requiring surgery to evacuate a large hematoma D) A middle-aged adult with osteoarthritis requiring arthroscopic knee surgery to repair a torn meniscus

Ans: C Feedback: The kidney releases renin, which enters the blood stream to convert angiotensinogen to angiotensin I. The angiotensin I travels to the lungs, where it is converted to angiotensin II. Angiotensin II acts directly on the kidneys. Renin functions by means of angiotensin II to produce intrarenal vasoconstriction. This helps to regulate blood pressure, which could be a problem for the client having bleeding (hematoma) inside the brain.

4. When explaining to a CKD client how urea is absorbed, which of the following transport mechanisms will be mentioned? A) Primary active transport B) Secondary active transport C) Passive transport D) Active sodium transport

Ans: C Feedback: The mechanisms of transport across the tubular cell membrane are similar to those of other cell membranes in the body and include active and passive transport mechanisms. Water and urea (a by-product of protein metabolism) are passively absorbed along concentration gradients. Sodium (Na+), other electrolytes, as well as urate, glucose, and amino acids, are reabsorbed using primary or secondary active transport mechanisms to move across the tubular membrane. The bulk of energy used by the kidney is for active sodium transport mechanisms that facilitate sodium reabsorption and cotransport of other electrolytes and substances such as glucose and amino acids.

25. The nurse should anticipate that a client who collapsed while running his or her first marathon and has a urine specific gravity of 1.035 is experiencing: A) Frostbite B) Sun stroke C) Dehydration D) Exhaustion

Ans: C Feedback: The usual range of specific gravity is 1.010 to 1.025 with normal fluid intake. Healthy kidneys can produce concentrated urine with specific gravity of 1.030 to 1.040 during periods of dehydration and dilute urine with a specific gravity that approaches 1.000 during periods of too much fluid intake. Frostbite, sunstroke, and exhaustion do not change urine specific gravity if fluid volume is normal.

15. An elderly female client has been hospitalized for the treatment of acute pyelonephritis. Which of the following characteristics of the client is most likely implicated in the etiology of her current health problem? The client: A) Has been diagnosed with type 2 diabetes several years earlier B) Takes a diuretic and an ACE inhibitor each day for the treatment of hypertension C) Recently had a urinary tract infection D) Has peripheral vascular disease

Ans: C Feedback: There are two routes by which bacteria can gain access to the kidney: ascending infection from the lower urinary tract and through the bloodstream. Ascending infection from the lower urinary tract is the most important and common route by which bacteria reach the kidney, resulting in acute pyelonephritis. Diabetes, hypertension controlled by a diuretic and an ACE inhibitor, and peripheral vascular disease are not associated with acute pyelonephritis.

5. Glomerulonephritis is usually caused by: A) Vesicoureteral reflux B) Catheter-induced infection C) Antigen-antibody complexes D) Glomerular membrane viruses

Ans: C Feedback: 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.

20. An obese, male client with a history of gout and a sedentary lifestyle has been advised by his primary care provider to avoid organ meats, certain fish, and other foods that are high in purines. The care provider is demonstrating an awareness of the client's susceptibility to which of the following types of kidney stones? A) Calcium stones B) Magnesium ammonium phosphate stones C) Uric acid stones D) Cystine stones

Ans: C Feedback: Uric acid stones develop in conditions of gout and when high concentrations of uric acid in the urine. Unlike radiopaque calcium stones, uric acid stones are not visible on x-ray films. According to Table 25-2, these stones develop in clients who eat a high-purine diet like Atkins.

16. A client with a long-standing diagnosis of chronic kidney disease has been experiencing increasing fatigue, lethargy, and activity intolerance in recent weeks. His care team has established that his GFR remains at a low, but stable, level. Which of the following assessments is most likely to inform a differential diagnosis? A) Blood work for white cells and differential B) Cystoscopy and ureteroscopy C) Assessment of pancreatic exocrine and endocrine function D) Blood work for hemoglobin, red blood cells, and hematocrit

Ans: D Feedback: Anemia is a frequent, and debilitating, consequence of CKD. The anemia may be due to chronic blood loss, hemolysis, bone marrow suppression due to retained uremic factors, and decrease in red cell production due to impaired production of erythropoietin and iron deficiency. Pancreatic function is not typically affected by CKD, and endoscopic examination is less likely to reveal a cause of fatigue. An infectious etiology is possible and would be informed by white cell assessment, but this is less likely than anemia given the client's complaints.

6. While explaining the tubular role in reabsorption, the nurse will stress that a diet high in sodium intake will result in sodium reabsorption in which of the following renal locations? A) Descending limb of the loop of Henle B) Ascending limb of the loop of Henle C) Bowman capsule D) Proximal convoluted tubule

Ans: D Feedback: Approximately 65% of all reabsorptive and secretory processes that occur in the tubular system take place in the proximal tubule. Electrolytes, such as Na+, K+, Cl-, and bicarbonate (HCO3-), are 65% to 80% reabsorbed in this location.

17. Impaired skin integrity and skin manifestations are common in persons with chronic kidney disease. Pale skin and subcutaneous bruising are often present as a result of: A) Thrombocytopenia B) Anticoagulant therapy C) Decreased vascular volume D) Impaired platelet function

Ans: D Feedback: Bruising and pale skin are present with chronic kidney disease because platelet function is impaired. Adequate platelets are available, but the function is abnormal. Renal clients do not routinely receive anticoagulant therapy, since they already have bleeding tendencies. Increased vascular volume is associated with renal disease.

8. Which of the following individuals likely faces the greatest risk for the development of chronic kidney disease? A) A first-time mother who recently lost 1.5 L of blood during a postpartum hemorrhage B) A client whose diagnosis of thyroid cancer necessitated a thyroidectomy C) A client who experienced a hemorrhagic stroke and now has sensory and motor deficits D) A client with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet

Ans: D Feedback: Chronic kidney disease (CKD) is a pathophysiologic process that results in the loss of nephrons and a decline in renal function that has persisted for more than 3 months. CKD can result from diabetes, hypertension, glomerulonephritis, lupus (SLE), and polycystic kidney disease. The prevalence and incidence of CKD continue to grow, reflecting the growing elderly population and the increasing number of people with diabetes and hypertension. Hemorrhage may result in acute renal failure, but it is not associated with chronic kidney disease. Stroke and loss of the thyroid gland are not noted to underlie cases of chronic kidney disease.

6. A client has been given the diagnosis of diffuse glomerulonephritis. They ask the nurse what diffuse means. The nurse responds: A) Only some of the glomeruli are affected. B) Only one segment of each glomerulus is involved. C) That the mesangial cells are being affected. D) All glomeruli and all parts of the glomeruli are involved.

Ans: D Feedback: Glomerular changes can be diffuse, involving all glomeruli and all parts of the glomeruli; focal, meaning only some of the glomeruli are affected; segmental, involving only a certain segment of each glomerulus; and mesangial, affecting only mesangial cells.

11. Which of the following factors is likely to result in decreased renal blood flow? A) Action of dopamine B) Release of nitric oxide C) Action of prostaglandins D) Sympathetic nervous system stimulation

Ans: D Feedback: Sympathetic nervous system (SNS) stimulation results in decreased renal blood flow by vasoconstriction. Dopamine, nitric oxide, and prostaglandins are all vasodilators.

1. Protein and blood cell leakage into the filtrate that occurs in many forms of glomerular disease is a result of changes in the structure and function of the glomerular: A) Renal corpuscle B) Bowman capsule C) Peritubular network D) Basement membrane

Ans: D Feedback: The basement membrane is a meshwork of collagen fibers, with slit pores between the fibers creating size-dependent permeability that (normally) does not allow large molecules, such as protein and blood cells through. The renal corpuscle contains the Bowman capsule and capillaries surrounding it. Peritubular capillary network is a low-pressure reabsorptive system that permits rapid fluid/solute transfer to/from the tubules.

13. Which of the following aspects of kidney function is performed by the juxtaglomerular apparatus? A) Regulating urine concentration B) Facilitating active transport to reabsorb electrolytes C) Regulating sodium and potassium elimination D) Matching changes in GFR with renal blood flow

Ans: D Feedback: The juxtaglomerular apparatus is thought to represent a feedback control system that links changes in the glomerular filtration rate (GFR) with renal blood flow.

23. A young child has been diagnosed with Wilms tumor after his mother discovered an unusual mass, prompting a diagnostic workup. Which of the following characteristics is typical of Wilms tumor? The tumor is usually: A) Asymptomatic B) Self-limiting C) A secondary neoplasm D) Encapsulated

Ans: D Feedback: Wilms tumor usually is a solitary mass that occurs in any part of the kidney. It usually is sharply demarcated and variably encapsulated. It is not a self-limiting health problem, and chemotherapy, radiotherapy, and/or surgery may be utilized. Symptoms include hypertension, abdominal pain, and vomiting.

Glomerulonephritis is usually caused by:

Antigen-antibody complexes

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?

Antihypertensive medications

A patient with a diagnosis of chronic kidney disease (CKD) may require the administration of which of the following drugs to treat the consequences of CKD?

Antihypertensive medications

A patient has Stage 3 chronic kidney disease (CKD) and is being taught about a low potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat? 1 Apple, green beans, and a roast beef sandwich 2 Granola made with dried fruits, nuts, and seeds 3 Watermelon and ice cream with chocolate sauce 4 Bran cereal with a half of a banana, milk, and orange juice

Apple, green beans, and a roast beef sandwich

A car accident client is admitted with a chest tube following pneumothorax. He also has an elevated blood alcohol level. When the nurse enters his room, she notes the client is dyspneic, short of breath, and holding his chest tube in his hand. When the nurse pulls the linens back, she finds a "sucking" chest wound. After calling a "code blue," the next priority intervention would be to:

Apply a Vaseline gauze (airtight) dressing over the insertion site

The nurse who is providing care for a patient with pancreatic cancer should prioritize which of the following assessments?

Assessment for deep vein thrombosis

A 33-year-old patient has been admitted to the hospital for the treatment of Graves disease. Which of the following assessments should the patients care team prioritize?

Assessment of the patients vision and oculomotor function

Prolonged immobility is implicated in the development of which disorder?

Atelectasis and pulmonary embolism

open and allow blood to flow from the atria into the ventricles period of time when the heart relaxes after contraction Volume of blood flowing through either systemic or pulmonary circulation per minute volume of blood ejected per beat reduced oxygenation of arterial blood reduced oxygenation of cells in tissues

Atrioventricular valves diastole cardiac output stroke volume hypoexemia hypoxia

A toddler seems to have a little "cold" and runny nose. During the night, the parents awaken hearing a "tight" coughing sound. On arrival to the emergency department, the nurses suspect bronchial asthma based on which assessment data? Select all that apply.

Audible wheezing Respiratory rate—44 with prolonged exhalation Sitting upright, leaning forward, and using accessory muscles to breathe

The form of polycystic kidney disease (PKD) that first manifests in the early infant period is most commonly characterized as:

Autosomal recessive

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

Autosomal recessive polycystic kidney disease (ARPD)

Atelectasis is the term used to designate an incomplete expansion of a portion of the lung. Depending on the size of the collapsed area and the type of atelectasis occurring, the nurse may see a shift of the mediastinum and trachea. Which way does the mediastinum and trachea shift in compression atelectasis?

Away from the affected lung

Which clinical manifestation is the most common indicator of acute kidney injury?

Azotemia

Acute renal failure occurs at a high rate in seriously ill people who are in intensive care units. What is the most common indicator of acute renal failure?

Azotemia and a decrease in the GFR

In a normal electrocardiogram, the P-R interval represents: A. atrial depolarization B. onset of atrial activation to onset of ventricular activity C. "electrical systole" of the ventricles D. ventricular depolarization

You understand that the purpose of reduction is to: a. expose the fracture site in order to repair b. hold the bone fragments in place c. realign the bone fragments d. apply firm, steady pull to the fragments

A client has fractured his sternum when his chest hit the steering wheel during an accident. Which of the following statements most accurately describes the physiologic function of bone marrow? : A. By adulthood, all red bone marrow has been replaced by yellow bone marrow. B. Hematopoiesis takes place in red bone marrow. C. Yellow bone marrow is hematopoietically active in infants, but not in adults. D. Yellow bone marrow predominates in infants.

B Blood cell production takes place exclusively in red bone marrow, which predominates in infants and decreases (but not disappears) with age. Yellow bone marrow is composed primarily of adipose tissue and is not hematopoietically active. As the need for RBC production decreases during postnatal life, red marrow is gradually replaced with yellow bone marrow in most of the bones. In adults, red marrow persists in the vertebrae, ribs, sternum, and ilea.

A chronic kidney disease (CKD) client asks the nurse, "Why do I itch all the time?" The nurse bases her response on which of the following integumentary physiologic factors that causes pruritis? Select all that apply. A) Too harsh of soap while bathing B) Decrease in perspiration C) Limited sodium intake D) Enlarged size of sweat glands E) Elevated serum phosphate levels

B) Decrease in perspiration E) Elevated serum phosphate levels

A 77-year-old woman has been admitted to the geriatric medical unit of the hospital for the treatment of pneumonia. The nurse providing care for the client notes the presence of nasal calcitonin, vitamin D, and calcium chloride on the client's medication administration record. The nurse should conclude that this client likely has a history of: A. Osteoarthritis B. Osteoporosis C. Scleroderma D. Rheumatoid arthritis

B Common pharmacologic treatments for osteoporosis include nasal calcitonin, vitamin D supplements, and calcium supplements. This combination of drugs does not address the etiology or manifestations of scleroderma, osteoarthritis, or rheumatoid arthritis.

College students were given various amounts of alcohol within a specified timeframe and then asked to drive an obstacle course. The rationale for poor performance in driving as the amount of alcohol intake increased includes, "The blood-brain barrier: A. Interacts negatively with the potassium-sodium pump, allowing alcohol to freely flow into the capillaries of the brain." B. Allows alcohol, a very lipid-soluble molecule to rapidly enter the brain." C. Excludes water-based compounds from crossing the brain with the exception of alcohol." D. Allows more bilirubin to cross the barrier producing brain damage."

B The blood-brain barrier prevents many drugs from entering the brain. Most highly water-soluble compounds are excluded from the brain, especially molecules with high ionic charge, such as many of the catecholamines. In contrast, many lipid-soluble molecules cross the lipid layers of the blood-brain barrier with ease. Alcohol, nicotine, and heroin are very lipid soluble and rapidly enter the brain.

A newly diagnosed paraplegic client who suffered an automobile accident appears to have control of bladder emptying. The health care provider explains this process to the client/family stating, "This function is allowing the motor component of the neural reflex to assist with bladder emptying and is primarily controlled by the: A. Sympathetic division of the ANS." B. Parasympathetic division of the ANS." C. Hypogastric nervous system." D. Somatic nervous system."

B The motor component of the neural reflex to assist with bladder emptying is primarily controlled by the parasympathetic division of the ANS, and the relaxation and storage functions of the bladder are controlled by the sympathetic division. The somatic nervous system innervates the skeletal muscles of the external sphincter and the pelvic floor muscles that together control the outflow of urine. The afferent input from the bladder and urethra is carried to the CNS by fibers that travel with PS, somatic, and sympathetic (hypogastric) nerves.

A client presents to the orthopedic clinic for evaluation since the primary care provider thinks the client may have rheumatoid arthritis (RA). Which statement by the client correlates with the diagnosis of RA? Select all that apply. A. "Just look at my face. It looks like I have varicose veins on my cheeks." B. "Look, I didn't button all my shirt buttons...it just hurts too much and look at the swelling in my hands." C. "Every time I get something out of the freezer, my hands turn reddish purple in color." D. "I'm having a hard time opening doors since it hurts so bad." E. "Look how my hand is deformed. My doctor calls it 'hyperextension.'"

B D E Rheumatoid arthritis (RA) joint involvement usually is symmetric and polyarticular. Pain with turning door knobs, opening jars, and buttoning shirts is commonly reported due to swelling of the wrists and small joints of the hand. Hyperextension of the PIP joint and partial flexion of the distal interphalangeal (DIP) joint is called a swan neck deformity. As the RA inflammatory process progresses, synovial cells and subsynovial tissues undergo reactive hyperplasia. With osteoarthritis (OA), joint changes result from the inflammation caused when the cartilage attempts to repair itself, creating osteophytes or spurs. Raynaud phenomenon (a vascular disorder characterized by reversible vasospasm of the arteries supplying the fingers) and telangiectasia (dilated skin capillaries) are characteristic of scleroderma.

The nurse is scheduled to teach a client experiencing urinary incontinence about Kegel exercises. Which of the following descriptors should the nurse include in this education? A) "Drink at least two glasses of water and then try to hold it for at least 3 hours before going to the bathroom." B) "Contract and relax the pelvic floor muscles at least 10 times every hour while awake." C) "After you have emptied your bladder, continue sitting on the commode and try to forcefully expel more urine." D) "Try to start and stop urination while sitting in a bathtub full of warm soapy water."

B) "Contract and relax the pelvic floor muscles at least 10 times every hour while awake."

A public health nurse is conducting a health promotion class for a group of older adults. Which of the participants' following statements demonstrates an accurate understanding of the risk factors for bladder cancer? A) "I suppose I should listen to my doctor and drink more cranberry juice." B) "More than ever, I guess it would worthwhile for me to quit smoking." C) "I can see that preventing bladder cancer is one more benefit of a healthy diet." D) "I think I should be okay because there's no history of bladder cancer in my family that I'm aware of."

B) "More than ever, I guess it would worthwhile for me to quit smoking."

12. While administering a tuberculin (TB) skin test, a client who is HIV positive asks, "I heard from my friends, this test may not work on me since I have HIV." The health care provider's best response would be: A) "This test is 99.9% specific, so it will give us an accurate result." B) "Sometimes immunocompromised clients will have negative results if you are unable to mount a normal immune reaction." C) "Most of the time, with HIVpositive clients, we see more false-positive results since you may have a similar infection in your body." D) "If your test comes back positive, we will send a blood test off to a special lab to confirm you really have TB before we start treatment."

B) "Sometimes immunocompromised clients will have negative results if you are unable to mount a normal immune reaction."

While administering a tuberculin (TB) skin test, a client who is HIV positive asks, "I heard from my friends, this test may not work on me since I have HIV." The health care provider's best response would be: A) "This test is 99.9% specific, so it will give us an accurate result." B) "Sometimes immunocompromised clients will have negative results if you are unable to mount a normal immune reaction." C) "Most of the time, with HIVpositive clients, we see more false-positive results since you may have a similar infection in your body." D) "If your test comes back positive, we will send a blood test off to a special lab to confirm you really have TB before we start treatment."

B) "Sometimes immunocompromised clients will have negative results if you are unable to mount a normal immune reaction."

6. Which of the following clients would be considered at high risk for developing pneumonia (both community and hospital setting)? Select all that apply. A) A teenager who spends a lot of time at local coffee shops using Wi-Fi to chat with friends B) A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation C) A college female who is pregnant (unplanned) who has been consuming alcohol prior to positive pregnancy test D) A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food E) A school-aged child with severe asthma controlled by steroids admitted for an exacerbation

B) A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation D) A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food E) A school-aged child with severe asthma controlled by steroids admitted for an exacerbation

Which of the following clients would be considered at high risk for developing pneumonia (both community and hospital setting)? Select all that apply. A) A teenager who spends a lot of time at local coffee shops using Wi-Fi to chat with friends B) A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation C) A college female who is pregnant (unplanned) who has been consuming alcohol prior to positive pregnancy test D) A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food E) A school-aged child with severe asthma controlled by steroids admitted for an exacerbation

B) ACE inhibitors C) Angiotensin receptor blockers

A diabetic client with a history of hypertension may receive a prescription for which medication to provide a renal protective effect by reducing intraglomerular pressure? Select all that apply. A) Loop diuretics B) ACE inhibitors C) Angiotensin receptor blockers D) Calcium channel blockers E) A digitalis preparation

B) ACE inhibitors C) Angiotensin receptor blockers

4. A distinguishing feature of viral influenza is: A) Direct contact transmission B) Abrupt-onset, profound malaise C) Constant pounding headache D) Profuse watery nasal discharge

B) Abrupt-onset, profound malaise

A distinguishing feature of viral influenza is: A) Direct contact transmission B) Abrupt-onset, profound malaise C) Constant pounding headache D) Profuse watery nasal discharge

B) Abrupt-onset, profound malaise

In men experiencing nonrelaxing external sphincter with associated urine retention, the health care worker should assess for which of the following possible causes? A) Increased intra-abdominal pressure B) Chronic prostatitis C) Chronic stress response D) Pelvic inflammatory disease

B) Chronic prostatitis

B) Decrease in perspiration E) Elevated serum phosphate levels

As left heart failure progresses: A. pulmonary vascular resistance decreases B. left end-diastolic volume decreases C. left ventricular preload increases D. systemic vascular resistance decreases

B) Developmental delays such as uncoordinated gait and minimal fine motor skills

Manifestations of childhood renal disease are varied and may differ from adult-onset renal failure. A school-aged child with chronic kidney disease may exhibit: A) Low IQ level with borderline retardation B) Developmental delays such as uncoordinated gait and minimal fine motor skills C) Inability to control bladder, resulting in incontinence D) Frequent, uncontrolled rolling of the tongue and opening mouth extremely wide

B) Developmental delays such as uncoordinated gait and minimal fine motor skills

B) Diuresis

A client is beginning to recover from acute tubular necrosis. The nurse would likely be assessing which of the following manifestations of the recovery phase of ATN? A) Edema B) Diuresis C) Proteinuria D) Hypokalemia

B) Diuresis

B) GFR does not increase after restoration of renal blood flow

A client with significant burns on his lower body has developed sepsis on the 3rd day following his accident. Which of the following manifestations would the nurse anticipate for an ischemic acute tubular necrosis rather than prerenal failure? The client: A) Exhibits pulmonary and peripheral edema B) GFR does not increase after restoration of renal blood flow C) Undergoes emergent hemodialysis that does not result in decreased BUN and creatinine D) Exhibits oliguria and frank hematuria

B) GFR does not increase after restoration of renal blood flow

7. A family brings their elderly father to emergency department. He has been exposed to pneumococcal pneumonia at his retirement home. Today, they noted a change in his mental status. They thought he might need some oxygen. Which of the other assessment findings would correlate with this diagnosis? Select all that apply. A) Expiratory wheezes throughout all lung fields B) Increase in chest pain with deep inspiration C) Absent breathe sounds on the entire right side of the lung D) Loss of appetite for past few days E) Purulent sputum with bloody patches

B) Increase in chest pain with deep inspiration D) Loss of appetite for past few days E) Purulent sputum with bloody patches

A family brings their elderly father to emergency department. He has been exposed to pneumococcal pneumonia at his retirement home. Today, they noted a change in his mental status. They thought he might need some oxygen. Which of the other assessment findings would correlate with this diagnosis? Select all that apply. A) Expiratory wheezes throughout all lung fields B) Increase in chest pain with deep inspiration C) Absent breathe sounds on the entire right side of the lung D) Loss of appetite for past few days E) Purulent sputum with bloody patches

B) Increase in chest pain with deep inspiration D) Loss of appetite for past few days E) Purulent sputum with bloody patches

B) Muscle mass

Reduced glomerular filtration rate (GFR), with a serum creatinine level that remains in the normal range, is associated with aging because elderly persons tend to have reduced: A) Calcium intake B) Muscle mass C) Drug tolerance D) Renal perfusion

B) Muscle mass

An elderly client who experiences chronic pain takes opioid analgesics on a regular basis, a practice that has resulted in frequent constipation and occasional bowel obstructions. Which of the following problems may directly result from these gastrointestinal disorders? A) Urinary tract infections B) Overflow urinary incontinence C) Bladder cancer D) Neurogenic bladder

B) Overflow urinary incontinence

19. Which of the following characteristics of the lungs of infants and small children creates an increased risk of respiratory disorders? A) Type II alveoli in children may overproduce surfactant. B) Smaller airways create a susceptibility to changes in airway resistance and airflow. C) The pneumotaxic center in the pons is underdeveloped until 8 years of age. D) There are fewer chemoreceptors in the young medulla.

B) Smaller airways create a susceptibility to changes in airway resistance and airflow.

Which of the following characteristics of the lungs of infants and small children creates an increased risk of respiratory disorders? A) Type II alveoli in children may overproduce surfactant. B) Smaller airways create a susceptibility to changes in airway resistance and airflow. C) The pneumotaxic center in the pons is underdeveloped until 8 years of age. D) There are fewer chemoreceptors in the young medulla.

B) Smaller airways create a susceptibility to changes in airway resistance and airflow.

Which of the following events would suggest that an individual's physiologic response to an obstruction has progressed beyond the compensatory stage and is now in the decompensatory stage? A) The bladder muscle hypertrophies. B) The detrusor loses its power of contraction. C) The ability to suppress urination is diminished. D) The individual experiences urgency.

B) The detrusor loses its power of contraction.

The body compensates for obstructed urine outflow up to a certain point. Which of the following signs/symptoms lead the nurse to suspect decompensatory changes are occurring? Select all that apply. A) Reports of renal colic B) Urinary frequency noted C) High residual volume up to 1000 mL D) Postvoid residual volume less than 50 mL E) Must strain to initiate the stream of urine

B) Urinary frequency noted C) High residual volume up to 1000 mL E) Must strain to initiate the stream of urine

A female teenager has experienced three uncomplicated urinary tract infections in the last 3 months. Knowing the anatomical location of the urethra, the nurse should educate this teenager about: A) Proper handwashing to decrease amount of Pseudomonas growing on the hands B) Wiping from front to back to prevent Escherichia coli contamination of the urethra C) Wearing gloves when wiping perineum after defecation to prevent Staphylococcus aureus infection D) Washing hands prior to inserting a tampon to minimize the risk of group B Streptococcus

B) Wiping from front to back to prevent Escherichia coli contamination of the urethra

A diabetic client with a history of hypertension may receive a prescription for which medication to provide a renal protective effect by reducing intraglomerular pressure? Select all that apply. A) Loop diuretics B) ACE inhibitors C) Angiotensin receptor blockers D) Calcium channel blockers E) A digitalis preparation

B) ACE inhibitors C) Angiotensin receptor blockers

B) Diuresis

B) GFR does not increase after restoration of renal blood flow

Soon after delivery, the mother grabs the nurse's arm and states, "Something's wrong...I can't get my breath." Which assessments lead the nurse to suspect the client has had an amniotic emboli travel to the lungs? Select all that apply.

BP 90/65; pulse 130, irregular; respiratory rate 35, shallow. Productive cough with blood-streaked sputum

Acute pyelonephritis is a result of:

Bacterial infection

A patient with a 25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which of the following terms should the nurse use to document this finding?

Barrel chest

The nurse is caring for a client who has had acute blood loss from ruptured esophageal varices. What does the nurse recognize is an early sign of prerenal failure?

Baseline urine output of 50 mL/hr that is now 10 mL/hr

Protein and blood cell leakage into the filtrate that occurs in many forms of erular disease is a result of changes in the structure and function of the glomerular:

Basement membrane

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 client has been prescribed hydrochlorothiazide, a thiazide diuretic, to control high blood pressure. While educating the client about the actions of the medication, the nurse will mention which of the following actions? Select all that apply.

Blocks Na+ reabsorption in distal tubules | Increases active reabsorption of Ca++ into the blood

A moderate hemothorax diagnosis would be confirmed by the presence of which of the following?

Blood filling approximately one-third of the pleural space

A client with a history of chronic kidney disease (CKD) is experiencing increasing fatigue, lethargy, and activity intolerance. The care team has established that the client's glomerular filtration rate (GFR) remains at a low, but stable, level. Which laboratory assessments will most likely be prescirbed to help determine the cause of these new symptoms?

Blood work for hemoglobin, red blood cells, and hematocrit

A client with a history of chronic kidney disease (CKD) is experiencing increasing fatigue, lethargy, and activity intolerance. The care team has established that the client's glomerular filtration rate (GFR) remains at a low, but stable, level. Which laboratory assessments will most likely be prescribed to help determine the cause of these new symptoms?

Blood work for hemoglobin, red blood cells, and hematocrit

A patient with a longstanding diagnosis of chronic kidney disease has been experiencing increasing fatigue, lethargy, and activity intolerance in recent weeks. His care team has established that his GFR remains at a low, but stable, level. Which of the following assessments is most likely to inform a differential diagnosis?

Blood work for hemoglobin, red blood cells, and hematocrit

Blood work for hemoglobin, red blood cells, and hematocrit Anemia is a frequent, and debilitating, consequence of CKD. The anemia may be due to chronic blood loss, hemolysis, bone marrow suppression due to retained uremic factors, and decrease in red cell production due to impaired production of erythropoietin and iron deficiency. Pancreatic function is not typically affected by CKD, and endoscopic examination is less likely to reveal a cause of fatigue. An infectious etiology is possible and would be informed by white cell assessment, but this is less likely than anemia given the client's complaints

Individuals with liver disease often experience the effects of excess serum ammonia as a result of impairment of the livers ability to process ammonia. How does the liver process ammonia in healthy individuals?

By processing it into urea and releasing it into the circulation

A 55-year-old male client has reported joint pain in his feet. Which of the following blood work results should prompt further testing to rule out primary gout? A. Increased C-reactive protein (CRP) B. Increased polymorphonuclear leukocytes C. Increased serum uric acid D. Increased serum cortisol

C Although hyperuricemia is not diagnostic of gout, it is suggestive and should prompt further assessment. Increases in CRP, polymorphonuclear leukocytes, and cortisol levels are not as closely associated with the body's response to gout.

A college student is lamenting the fact that she has developed a cold on the weekend prior to exam week. Which of the following statements shows that the student has an accurate understanding of her upper respiratory infection? A) "I'm just going to try to rest as much as I can until these bacteria clear up." B) "I think I'll go to the campus clinic and see if I can get a prescription for antibiotics." C) "I suppose I should have been washing my hands more in the past few days." D) "If I can just start some antihistamines as soon as possible I bet I'll get over this faster."

C) "I suppose I should have been washing my hands more in the past few days."

A client who has had recurrent UTIs asks the nurse about the old wise tale of drinking cranberry juice daily. The nurse can respond: A) "There is no research on this topic, so I don't think it will help you." B) "Studies on this are based on a person drinking at least 1 gallon of juice/day." C) "Research suggests cranberry juice will reduce bacterial adherence to the lining of the urinary tract." D) "Beer is probably more effective at killing bacteria than cranberry juice."

C) "Research suggests cranberry juice will reduce bacterial adherence to the lining of the urinary tract."

In anatomy class, the instructor asks, "Explain how urine is expelled from the bladder during voiding." The student with the most accurate response would be: A) "The urothelium acts as a barrier to prevent urine from seeping into capillaries." B) "The beginning of micturition occurs when neurons send messages down to the pudendal nerve." C) "The detrusor muscle contract down on the urine and the ureteral orifices are forced shut. The external sphincter relaxes as urine moves out of the bladder." D) "It's really the external sphincter muscle that controls urination. The somatic nervous system innervates the muscles of the external sphincter and the pelvic floor muscles that together control the outflow of urine."

C) "The detrusor muscle contract down on the urine and the ureteral orifices are forced shut. The external sphincter relaxes as urine moves out of the bladder."

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

C) A 79-year-old client with an indwelling catheter for urinary incontinence

C) A loss of over half the client's normal kidney function

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) A need to increase water intake B) The kidneys are functioning normally C) A loss of over half the client's normal kidney function D) Concentrated urine

C) A loss of over half the client's normal kidney function

C) Dehydration that may appear as dry mucous membranes or poor skin turgor

Client and family education regarding peritoneal dialysis should include assessing the client for: A) Bleeding around the arteriovenous fistula or an external arteriovenous shunt B) Signs and symptoms of hypoglycemia such as weakness, irritability, and shakiness C) Dehydration that may appear as dry mucous membranes or poor skin turgor D) Muscle cramps associated with hypoparathyroidism

C) Dehydration that may appear as dry mucous membranes or poor skin turgor

A pregnant woman who is beginning her third trimester has been diagnosed with a urinary tract infection (UTI). Which of the following factors most likely predisposed this client to the development of a UTI? A) Increased urine alkalinity during pregnancy B) Hypertrophy of the bladder wall C) Dilation of the upper urinary structures D) Spastic peristalsis of the ureters

C) Dilation of the upper urinary structures

C) Endocrine functions

Regardless of the cause, chronic kidney disease results in progressive permanent loss of nephrons and glomerular filtration, and renal: A) Tubule dysplasia B) Vascular pressure C) Endocrine functions D) Hypophosphatemia

C) Endocrine functions

22. A mother rushes her toddler into the emergency department stating, "My baby can't breathe." Initial assessment reveals the child is struggling to breathe in an upright position. He has both inspiratory and expiratory stridor and is using his chest muscles to breath. The nurse suspects the child has which of the following acute respiratory infections? A) Croup B) Asthma C) Epiglottitis D) Bronchiolitis

C) Epiglottitis

A mother rushes her toddler into the emergency department stating, "My baby can't breathe." Initial assessment reveals the child is struggling to breathe in an upright position. He has both inspiratory and expiratory stridor and is using his chest muscles to breath. The nurse suspects the child has which of the following acute respiratory infections? A) Croup B) Asthma C) Epiglottitis D) Bronchiolitis

C) Epiglottitis

C) Hypocalcemia

The nurse is providing care for a client who has a diagnosis of kidney failure. Which of the following laboratory findings is consistent with this client's diagnosis? A) Elevation in vitamin D levels B) Hypophosphatemia C) Hypocalcemia D) Hypokalemia

C) Hypocalcemia

18. Increased upper airway resistance and decreased airflow into the lungs in neonates (0 to 4 weeks of age) can result from: A) Frequent crying B) Sleeping supine C) Nasal congestion D) Productive coughing

C) Nasal congestion

Increased upper airway resistance and decreased airflow into the lungs in neonates (0 to 4 weeks of age) can result from: A) Frequent crying B) Sleeping supine C) Nasal congestion D) Productive coughing

C) Nasal congestion

23. A child is brought to the emergency department with a respiratory infection. The child is struggling to breath and is very anxious. The health care providers suspect epiglottitis. Which of the following interventions would be a priority? A) Have parents help hold the child down so blood work can be drawn and sent to lab so WBC count can be reviewed. B) Try to get the child to open his mouth so you can put a tongue blade in the back of the throat to look for swelling or pustules. C) Place the child upright in bed and begin preparing for a tracheostomy placement. D) Administer the first dose of an antibiotic vial liquid suspension as soon as possible to begin fighting the infection.

C) Place the child upright in bed and begin preparing for a tracheostomy placement.

A child is brought to the emergency department with a respiratory infection. The child is struggling to breath and is very anxious. The health care providers suspect epiglottitis. Which of the following interventions would be a priority? A) Have parents help hold the child down so blood work can be drawn and sent to lab so WBC count can be reviewed. B) Try to get the child to open his mouth so you can put a tongue blade in the back of the throat to look for swelling or pustules. C) Place the child upright in bed and begin preparing for a tracheostomy placement. D) Administer the first dose of an antibiotic vial liquid suspension as soon as possible to begin fighting the infection.

C) Place the child upright in bed and begin preparing for a tracheostomy placement.

C) Tubular necrosis

Which condition places the client at risk for hypercapnia if given high-flow oxygen as treatment for a ventilation perfusion mismatch?

Chronic bronchitis from smoking

A client had excessive blood loss and prolonged hypotension during surgery. His postoperative urine output is sharply decreased, and his blood urea nitrogen (BUN) is elevated. The most likely cause for the change is acute: A) Prerenal inflammation B) Bladder outlet obstruction C) Tubular necrosis D) Intrarenal nephrotoxicity

C) Tubular necrosis

A 40-year-old female with the diagnosis of multiple sclerosis has been experiencing severe bladder spasms along with less bladder volume. This is likely due to: Select all that apply. A) Bladder atonia B) Autonomic hyperreflexia C) Uninhibited bladder D) Neurogenic detrusor overactivity

C) Uninhibited bladder D) Neurogenic detrusor overactivity

A female client asks, "Why do I leak urine every time I cough or sneeze?" The health care worker's response is based on which physiologic principle? A) Involuntary bladder continence during filling B) A pressure difference between the urethra and bladder C) When intravesical pressure exceeds maximal urethral closure pressure D) A decrease in bladder distensibility

C) When intravesical pressure exceeds maximal urethral closure pressure

C) A loss of over half the client's normal kidney function

C) Tubular necrosis

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

Calcium

The nurse is caring for a client with chronic renal failure who is on hemodialysis three times a week. In order to treat hyperphosphatemia and hypocalcemia, which medication will the nurse administer to decrease absorption of phosphate from the gastrointestinal tract?

Calcium carbonate

Which medication would the nurse anticipate being prescribed for the client with renal failure who has hyperphosphatemia?

Calcium carbonate

Chronic obstructive pulmonary disease (COPD) is a combination of disease processes. What disease processes have been identified as being part of COPD?

Chronic obstructive bronchitis and emphysema

The patient has had type 1 diabetes mellitus for 25 years and now is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse finds that the patient has newly developed hypertension and difficulty with blood glucose control. The nurse should know that which diagnostic study will be most indicative of chronic kidney disease (CKD) in this patient? 1 Serum creatinine 2 Serum potassium 3 Microalbuminuria 4 Calculated glomerular filtration rate (GFR)

Calculated glomerular filtration rate (GFR) - The best study to determine kidney function or CKD that would be expected in the patient with diabetes is the calculated GFR that is obtained from the patient's age, gender, race, and serum creatinine. It would need to be abnormal for three months to establish a diagnosis of CKD.

volume of blood flowing through systemic or pulmonary c amount of blood ejected from the ventricle heart sound that correlates with closure of AV valves heart sound that correlates with closure of semilunar valves . the volume of blood ejected per beat during systole

Cardiac Output ejection fraction S1 S2 stroke volume

The nurse performs an admission assessment of a patient with acute renal failure. For which common complication does the nurse assess the patient? 1 Polyphagia 2 Hypernatremia 3 Hypotensive shock 4 Cardiac dysrhythmias

Cardiac dysrhythmias - Because the kidneys are not effectively removing waste products, including electrolytes, an increased potassium level (hyperkalemia) of more than 5.0 mEq/L is common in acute renal failure and places the patient at risk for cardiac arrhythmias.

A patient has a glomerular filtration rate (GFR) of 50 mL/minute and a serum potassium level of 8 mEq/L? The nurse should monitor the patient for what complication? 1 Hypotension 2 Respiratory failure 3 Metabolic acidosis 4 Cardiac dysrhythmias

Cardiac dysrhythmias - The patient's glomerular filtration rate (GFR) of 50 mL/min is indicative of stage 3 chronic kidney disease and the patient's serum potassium level of 8 mEq/L indicates hyperkalemia, which may lead to cardiac dysrhythmias.

When acute tubular necrosis (ATN) is suspected, the nurse will likely see which laboratory findings on the urinalysis report? Select all that apply.

Cast cells; Red blood cells; Protein

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

Catheter-associated bacteriuria

A patient with chronic kidney disease has an arteriovenous (AV) graft in the right forearm. What is the nurse's priority in determining the patency of the graft? 1 Determine the range of motion of the right arm and shoulder 2 Observe for clubbing of the fingers on the right hand of the AV graft site 3 Compare radial pulses by checking the right and left pulses simultaneously 4 Check for a bruit by listening over the right arm AV graft site with a stethoscope

Check for a bruit by listening over the right arm AV graft site with a stethoscope - The arteriovenous (AV) graft is an artificial connection between an artery and vein to provide access for hemodialysis. Thrombosis may occur; therefore the need to determine patency is an essential assessment. Palpation of the site should indicate a thrill, which also indicates that the graft is patent. Listening over the AV graft should reveal a bruit sound, indicating patency. A bruit sounds similar to the impulse beat heard when measuring blood pressure.

The nurse determines that the client has clubbing of the fingertips. Which is the best intervention?

Check the patient's O2 saturation level.

A client is diagnosed with pulmonary embolism. Which symptom would most likely be present?

Chest pain and dyspnea

A patient is diagnosed with pulmonary embolism. Which of the following symptoms would most likely be present?

Chest pain and dyspnea

Bronchiectasis is considered a secondary COPD, and with the advent of antibiotics, it is not a common disease entity. In the past, bronchiectasis often followed specific diseases. Which disease did it not follow?

Chickenpox

Bronchiectasis is considered a secondary COPD, and, with the advent of antibiotics, it is not a common disease entity. In the past, bronchiectasis often followed specific diseases. Which disease did it not follow?

Chickenpox

Anemia frequently occurs in clients with chronic kidney disease (CKD). The nurse will monitor these clients for which contributors to anemia? Select all that apply.

Chronic blood loss; Anorexia; Decreased erythropoietin production; Bone marrow suppression

The family asks the nurse what the usual treatment of focal segmental glomerulosclerosis entails. What is the nurse's best response?

Corticosteroids

The nurse caring for four male clients recognizes which client is at highest risk for developing post-renal kidney failure?

Client with prostatic hyperplasia

The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney failure?

Client with prostatic hyperplasia

A hospital client with a diagnosis of chronic renal failure has a prescription for measurement of serum electrolyte levels three times per week. Which statement best captures the relationship between renal failure and sodium regulation?

Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption.

Which medical term describes a manifestation of bleeding disorders in clients with chronic kidney disease (CKD)?

Coagulopathies

When assessing the mental status of a patient in acute renal failure, the nurse recognizes that abnormal findings are most likely caused by: 1 Anger related to denial of chronic illness 2 Delirium-related to hypoxia of brain cells 3 Confusion related to an increased urea level 4 Aggression related to possible underlying comorbidities

Confusion related to an increased urea level - In renal disease, urea is not filtered out of the blood by the kidneys and therefore accumulates in the blood. This results in toxicity to brain tissue, causing confusion.

Which additional physical finding would you anticipate seeing in a child suspected of having a Wilms tumor?

Congenital anomalies, usually of the genitourinary system

A client has developed chronic hypoxia and has developed pulmonary hypertension (HTN). The nurse recognizes that the most likely cause of pulmonary hypertension would be:

Constriction of the pulmonary vessels in response to hypoxemia

The nurse is teaching a patient with acute kidney injury about lifestyle modifications. Which actions by the patient indicate effective teaching? 1 Consuming less salt 2 Eating foods rich in protein 3 Increase intake of fluids 4 Consuming potassium-rich foods

Consuming less salt - Sodium causes fluid and water retention and thereby increases blood volume; thus, the patient should consume less salt. Patients with renal impairment should decrease protein intake because proteins break down into urea, which is dangerous if it accumulates in the brain. Increasing the intake of fluid will increase the volume of fluid in the body. Because the kidney function is impaired, excess fluid cannot be eliminated and it accumulates in the body leading to edema and congestive cardiac failure.

A client with a history of chronic pyelonephritis has been admitted several times with recurrent bacterial infection of the urinary tract. The nurse should anticipate educating this client with regard to which common treatment regimen?

Continue taking antibiotics for full 10 to 14 days even if symptoms of infection disappear.

An 80-year-old client with diabetes has a GFR of 41 mL/min/1.73 m2. His physical and workup show uremia, azotemia, and elevated BUN. Which action should be done first to slow the decline of his kidney function?

Control blood glucose and blood pressure

A client with primary lung disease has developed right heart failure. The health care provider would document this as:

Cor pulmonale

A client asks, "Why did my provider order a glomerular filtration rate (GFR) to my usual blood work?" The nurse's best response is based on the fact that GFR can estimate serum levels of which substance?

Creatinine

The nurse reviews lab tests that have been prescribed for a patient in acute renal failure. Which is the best indicator of renal function? 1 Potassium 2 Creatinine 3 BUN (blood urea nitrogen) 4 ALT (alanine aminotransferase)

Creatinine - Creatinine is the best indicator of renal function. Creatinine is a waste product of the skeletal muscles and is excreted through the kidneys. In renal failure, the kidneys are unable to excrete creatinine, leading to a serum level greater than the normal range of 0.2 to 1.0 mL/dL. Potassium excretion and regulation are impaired in acute renal failure, and potassium may therefore be increased. However, potassium may be increased for reasons other than renal disease, whereas increased creatinine is specific to renal disease. Blood urea nitrogen (BUN) is also used to measure kidney function, but other disorders such as dehydration may cause an increase in BUN. Alanine aminotransferase (ALT) is related to liver dysfunction, not renal dysfunction.

Correct D. a chronic autoimmune disease mediated by antiacetylcholine receptor antibodies that act at the neuromuscular junction. Correct B. primary demyelinating disorder leading to widespread neurologic dysfunction, and forms yellowish plaques of scar tissue Correct A. causes progress muscle atrophy (wasting), and is rapidly fatal from respiratory failure. Correct C. acquired inflammatory disease that results in demyelination of the peripheral nerves, often preceeded by a campylobactor jejuni infection.

D Myesthenia Gravis B Multiple Sclerosis A ALS C Gullian- Barre Disease

A neighbor is complaining to a friend (who happens to be a nurse) about several changes in their body. Which of the following complaints raises a "red flag" because it could be a sign of epithelial cell bladder cancer? A) "Seems like I'm holding onto more water these days." B) "Every now and then, I have urine leak when I cough." C) "Sometimes I get a sharp pain in my side while exercising." D) "I noticed my urine is pinkish red, but I'm not having any pain when I pee."

D) "I noticed my urine is pinkish red, but I'm not having any pain when I pee."

D) A client with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet

Which of the following individuals likely faces the greatest risk for the development of chronic kidney disease? A) A first-time mother who recently lost 1.5 L of blood during a postpartum hemorrhage B) A client whose diagnosis of thyroid cancer necessitated a thyroidectomy C) A client who experienced a hemorrhagic stroke and now has sensory and motor deficits D) A client with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet

D) A client with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet

17. Which of the following individuals is most clearly in need of diagnostic testing for lung cancer? A) A client who has required hospitalization with a fever and the production of copious lung secretions B) A client with a history of secondary tuberculosis who failed to complete his prescribed course of antibiotics C) A woman who complains of recurrent lower respiratory infections and who has sought care for increasing shortness of breath D) A man who demonstrates wasting of the pelvic and shoulder muscles combined with signs of hypercalcemia

D) A man who demonstrates wasting of the pelvic and shoulder muscles combined with signs of hypercalcemia

Which of the following individuals is most clearly in need of diagnostic testing for lung cancer? A) A client who has required hospitalization with a fever and the production of copious lung secretions B) A client with a history of secondary tuberculosis who failed to complete his prescribed course of antibiotics C) A woman who complains of recurrent lower respiratory infections and who has sought care for increasing shortness of breath D) A man who demonstrates wasting of the pelvic and shoulder muscles combined with signs of hypercalcemia

D) A man who demonstrates wasting of the pelvic and shoulder muscles combined with signs of hypercalcemia

D) Blood work for hemoglobin, red blood cells, and hematocrit

A client with a long-standing diagnosis of chronic kidney disease has been experiencing increasing fatigue, lethargy, and activity intolerance in recent weeks. His care team has established that his GFR remains at a low, but stable, level. Which of the following assessments is most likely to inform a differential diagnosis? A) Blood work for white cells and differential B) Cystoscopy and ureteroscopy C) Assessment of pancreatic exocrine and endocrine function D) Blood work for hemoglobin, red blood cells, and hematocrit

D) Blood work for hemoglobin, red blood cells, and hematocrit

D) Impaired platelet function

Impaired skin integrity and skin manifestations are common in persons with chronic kidney disease. Pale skin and subcutaneous bruising are often present as a result of: A) Thrombocytopenia B) Anticoagulant therapy C) Decreased vascular volume D) Impaired platelet function

D) Impaired platelet function

After reviewing the 24-hour intake and output of a hospital client, the nurse suspects that the client may be experiencing flaccid bladder dysfunction. Which of the following diagnostic methods is most likely to confirm or rule out whether the client is retaining urine? A) Blood test for creatinine, blood urea nitrogen, and glomerular filtration rate B) Urine test for culture and sensitivity C) Routine urinalysis D) Measurement of postvoid residual (PVR) by ultrasound

D) Measurement of postvoid residual (PVR) by ultrasound

A client has presented to an ambulatory clinic complaining of a persistent headache. What assessments should the clinician conduct to differentiate between rhinosinusitis and alternative health problems? A) Take a sputum sample for culture and sensitivity. B) Compare the client's oral, tympanic, and axillary temperatures and order a white blood cell count. C) Palpate the client's lymph nodes and inspect the ears with an otoscope. D) Perform transillumination and ask the client if bending forward exacerbates the headache.

D) Perform transillumination and ask the client if bending forward exacerbates the headache.

The pathogenic capacity of the tubercle bacillus is related to: A) Formation of a Ghon focus lesion B) Its inherent destructive capabilities C) Rapid viral replication in host cells D) The initiation of a cell-mediated immune response

D) The initiation of a cell-mediated immune response

Many factors contribute to the incontinence that is common among the elderly. A major factor is increased: A) Detrusor muscle function B) Intake of liquids and water C) Urethral closing pressure D) Use of multiple medications

D) Use of multiple medications

Although the distal portion of the urethra often contains pathogens, the urine formed in the kidney and found in the bladder is sterile because of the: A) Alkaline urine B) Glomerular filtering C) Warm temperature D) Washout phenomenon

D) Washout phenomenon

D) A client with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet

3. Which of the following individuals likely faces the greatest risk for the development of chronic kidney disease? A. A first-time mother who recently lost 1.5L of blood during a postpartum hemorrhage B. A patient whose diagnosis of thyroid cancer necessitated a thyroidectomy C. A patient who experienced a hemorrhagic stroke and now has sensory and motor deficits D. A patient with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet

D) A patient with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet

A client arrives in the emergency department suffering a traumatic brain injury as a result of a car accident. While assessing this client, the nurse notices the client has an irregular breathing pattern consisting of prolonged inspiratory gasps interrupted by expiratory efforts. The underlying physiological principle for these signs would include:

Damage has occurred at the connection between the pneumotaxic and apneustic centers.

As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by:

Decrease in GFR of 60 to 89 mL/minute/1.73 m2

As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by: a) Decrease in GFR to 30 to 59 mL/minute/1.73 m2 b) Diminished GFR to less than 15 mL/minute/1.73 m2 c) Decrease in GFR of 60 to 89 mL/minute/1.73 m2 d) GFR decrease to 15 to 29 mL/minute/1.73 m2

Decrease in GFR of 60 to 89 mL/minute/1.73 m2 Diminished renal reserve is characteristic of renal insufficiency, when labs remain normal but there is renal insufficiency. Only the second stage, formerly known as renal insufficiency, is characterized by a decrease in GFR of 60 to 89 mL/minute/1.73 m2. The other choices represent stage 3, 4, and 5, respectfully.

Decrease in perspiration; Elevated serum phosphate levels

During hemodialysis, the patient develops light-headedness and nausea. What is the priority action by the nurse? 1 Administer hypertonic saline 2 Administer a blood transfusion 3 Decrease the rate of fluid removal 4 Administer antiemetic medications

Decrease the rate of fluid removal

If a CKD client is developing uremic encephalopathy, the earliest manifestations may include: Select all that apply.

Decreased alertness; Diminished awareness

A respiratory therapist has asked a client to breathe in as deeply as possible during a pulmonary function test. Inspiration is normally the result of which of the following phenomena?

Decreased intrathoracic pressure

There can be many reasons for a client to present with hypoxemia. For a client's PO2 to fall, a respiratory disease is usually involved. Often, clients have involvement from more than one mechanism. Which factors will result in hypoxemia? Select all that apply.

Decreased oxygen in air Disease in respiratory system Dysfunction of neurologic system

A patient with a glomerular filtration rate (GFR) of 30 mL/min has a hemoglobin of 5 g/dL. The peripheral smear tests show that the red blood cells are normocytic and normochromic. The nurse suspects that which physiologic change led to this condition? 1 Reduced excretion of potassium 2 Increased extracellular fluid volume 3 Defective reabsorption of bicarbonate 4 Decreased production of erythropoietin

Decreased production of erythropoietin

A client has just been admitted to the postsurgical unit following a below-the-knee amputation. Which of the following measures should her care team prioritize to prevent atelectasis during the client's immediate recovery?

Deep-breathing exercises and early mobilization

A client's most recent blood work reveals a blood urea nitrogen (BUN) level of 36 mg/dL (normal range 8 to 25 mg/dL). Which of the following factors may have contributed to this finding?

Dehydration

A 1-year-old baby boy with renal dysplasia risks end-stage renal disease unless intervention occurs. Which treatment option is his care team most likely to reject?

Dietary restriction plus erythropoietin

The nurse should anticipate that a client who collapsed while running his or her first marathon and has a urine specific gravity of 1.035 is experiencing:

Dehydration

Client and family education regarding peritoneal dialysis should include assessing the client for:

Dehydration that may appear as dry mucous membranes or poor skin turgor

Manifestations of childhood renal disease are varied and may differ from adult-onset renal failure. A school-aged child with chronic kidney disease may exhibit which manifestation?

Developmental delays such as uncoordinated gait and minimal fine motor skills

A diagnosis of tension pneumothorax would be suspected in which physical assessment finding?

Deviated trachea

A new client presents with elevated BUN, systemic edema, a BP of 145/93 mm Hg, recurrent infections, and a GFR of 51 mL/min/1.73 m2. Which treatment should the nurse anticipate?

Dialysis

A client with chronic kidney disease (CKD) is starting hemodialysis. Which diet will the dialysis nurse likely recommend?

Diet low in proteins but including eggs and lean meat

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?

Dietary protein

A pregnant woman in the third trimester reports burning and pain on urination. Which physiologic changes during pregnancy increase the risk for urinary tract infection (UTI)? Select all that apply.

Dilation of the renal calyces, pelvis, and ureters Muscle-relaxing effects of progesterone-like hormones Mechanical obstruction from the enlarged uterus

A client is beginning to recover from acute tubular necrosis. The nurse would likely be assessing which of the following manifestations of the recovery phase of ATN?

Diuresis

A client is beginning to recover from acute tubular necrosis. During which phase of acute kidney injury will the nurse assess an increase in urine output?

Diuretic phase

Several urine tests can be useful in establishing a diagnosis of acute renal failure (ARF). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which type of drug?

Diuretics

A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is:

Dorsiflexion of hands and feet

Which dermatologic problem most often accompanies chronic kidney disease (CKD)?

Dry skin and pruritus

Which of the following integumentary problems most often accompanies chronic kidney disease?

Dry skin and pruritus

A client reports chest pain to the nurse. Which characteristics of the pain indicate bronchial irritation?

Dull pain in mid-chest that is worse when coughing

Which of the following signs and symptoms most clearly suggests the need for endoscopy to rule out esophageal cancer?

Dysphagia in an individual with no history of neurologic disease

A client is being treated for chronic kidney disease (CKD). One of the nurse's responsibilities is to explain to the client the need to keep her blood pressure under control. Why is blood pressure control so important in CKD clients?

Elevated blood pressure will exacerbate nephron loss and accelerate renal failure.

The nurse caring for a patient with heart failure notes the patient has decreased urine output of 200 mL/day. Which laboratory finding aids in the diagnosis of prerenal azotemia in this patient? 1 Elevated blood urea nitrogen (BUN) 2 Normal creatinine level 3 Decreased sodium level 4 Decreased potassium level

Elevated blood urea nitrogen (BUN)

A young child has been diagnosed with Wilms tumor after his mother discovered an unusual mass, prompting a diagnostic workup. Which of the following characteristics is typical of Wilms tumor? The tumor is usually:

Encapsulated

When evaluating the pulmonary function test results for a COPD client, which one correlates to the mismatch of ventilation and perfusion associated with this diagnosis?

Forced expiratory volume (FEV) is decreased.

The health care provider suspects a newly admitted client may have a hemothorax. The client most likely experienced:

Fractured or dislocated ribs

A patient donated a kidney via a laparoscopic donor nephrectomy to a nonrelated recipient. The patient is experiencing a lot of pain and refuses to get up to walk. How should the nurse handle this situation? 1 Have the transplant psychologist convince the patient to walk. 2 Encourage even a short walk to avoid complications of surgery. 3 Tell the patient that no other patients have ever refused to walk. 4 Tell the patient that he or she is lucky it was not necessary to have an open nephrectomy.

Encourage even a short walk to avoid complications of surgery. - Because ambulating will improve bowel, lung, and kidney function with improved circulation, even a short walk with assistance should be encouraged after pain medication.

Regardless of the cause, chronic kidney disease results in progressive permanent loss of nephrons and glomerular filtration, and renal:

Endocrine functions

A man with chronic alcoholism is diagnosed with acute respiratory distress syndrome (ARDS) due to alcohol abuse. Assessment findings include diffuse bilateral infiltrates of the lung tissue and marked hypoxemia. What is the primary physiologic change that results in ARDS?

Epithelial injury with increased permeability of the alveolar-capillary membrane

What is the most common cause of a lower urinary tract infection?

Escherichia coli

Which clinical action plan is most appropriate for a patient in stage 3 of chronic kidney disease? 1 Diagnosis and treatment 2 Estimation of progression 3 Renal replacement therapy 4 Evaluation and treatment of complications

Evaluation and treatment of complications - A patient in stage 3 of chronic kidney disease has a moderate decrease in the glomerular filtration rate (GFR). The most appropriate clinical action plan for this patient is evaluation and treatment of complications.

Which of the following pathophysiologic phenomena may result in a diagnosis of Cushing disease?

Excess ACTH production by a pituitary tumor

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

Extracorporeal shock wave lithotripsy (ESWL)

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

Extracorporeal shock wave lithotripsy (ESWL) ESWL is a nonsurgical treatment that uses sound waves, laser, or dry shock wave energy to break apart the stones. All of the other procedures are surgical in nature.

The nurse is caring for a patient with severe burns in the emergency department. His laboratory values reveal serum creatinine level of 5 mg/dL, and the glomerular filtration rate (GFR) has decreased by 75%. What stage of acute kidney failure is this patient exhibiting? 1 Risk 2 Injury 3 Failure 4 Loss

Failure - As per the RIFLE (Risk, Injury, Failure, Loss, and End-stage) classification for staging acute kidney injury, this patient is at the Failure stage. When the GFR has decreased by 25%, the patient is at the Risk stage. The patient with a GFR that has decreased by 50% is at the Injury stage. The patient with persistent acute kidney failure experiences a complete loss of kidney function and is at the Loss stage.

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?

Failure to mount a fever with infection

Hypercapnia refers to an abnormal increase in oxygen levels.

False

Primary tuberculosis represents either reinfection from inhaled droplet nuclei or reactivation of a previously healed primary lesion.

False

The nurse is planning an educational course on risk factors for chronic kidney disease. Which factors should the nurse identify as nonmodifiable risk factors? Select all that apply. 1 Hypertension 2 Type II diabetes 3 Family history of chronic kidney disease (CKD) 4 Age greater than 60 5 Exposure to nephrotoxic drugs

Family history of chronic kidney disease (CKD) Age greater than 60

A middle-aged woman is admitted with acute pyelonephritis. Which assessment finding correlates with this diagnosis?

Flank pain, dysuria, and nausea/vomiting

The student nurse is preparing a dietary chart for a patient with acute kidney injury. Which foods included by the nurse in the diet chart need correction? 1 Foods rich in fiber 2 Foods rich in potassium 3 Foods rich in fatty acids 4 Foods rich in carbohydrates

Foods rich in potassium

GFR does not increase after restoration of renal blood flow

The health care provider is reviewing laboratory results of a client. Select the diagnostic test that is considered the best measurement of overall kidney function.

Glomerular filtration rate (GFR)

Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of:

Graves disease.

A client has been recently undergone diagnostic testing for possible Berger disease. The nurse caring for this client would anticipate the primary clinical manifestations include which of the following? Select all that apply.

Gross hematuria; Recent upper respiratory infections; Fever, chills, and general body aches

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 Β-hemolytic streptococci

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

While taking a history from an adult client newly diagnosed with renal cell cancer, the nurse can associate which of the following high-risk factors with the development of this cancer?

Heavy smoking

Which client clinical manifestation most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma?

Hematuria

Which of the following client clinical manifestations most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma?

Hematuria

What is an intrarenal cause of acute kidney injury? 1 Renal artery thrombosis 2 Neuromuscular disorders 3 Benign prostatic hyperplasia 4 Hemolytic blood transfusion reaction

Hemolytic blood transfusion reaction

Which factor contributes to the development of polycystic kidney disease?

Hereditary mutations in polycystin I and II

Common results of respiratory failure are hypoxemia and which of the following?

Hypercapnia

Common results of respiratory failure are hypoxemia and:

Hypercapnia

Which clinical manifestation of acute kidney injury may cause changes in an electrocardiogram? 1 Hyperkalemia 2 Fluid overload 3 Hyponatremia 4 Metabolic acidosis

Hyperkalemia

While caring for a patient with an acute kidney injury, the patient complains of severe weakness and palpitations. The electrocardiogram reveals widening of the QRS complex and an elevated T wave. What complication does the nurse suspect in this patient? 1 Hyperkalemia 2 Hypercalcemia 3 Hypernatremia 4 Hyperchloremia

Hyperkalemia

A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?

Hypertension

Which conditions have the potential to cause chronic kidney disease? Select all that apply.

Hypertension; Glomerulonephritis; Diabetes

A client with asthma comes to the emergency department very anxious due to increasing shortness of breath. Physical assessment reveals tachypnea, and an arterial blood gas shows decreased carbon dioxide levels and hypoxemia. What is the most likely cause?

Hyperventilation

An asthmatic patient comes to the emergency department very anxious due to increasing shortness of breath. Physical assessment reveals tachypnea, and an arterial blood gas shows decreased carbon dioxide levels and hypoxemia. Which of the following is the most likely cause?

Hyperventilation

A client has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal calculi. Which of the following measures should the client integrate into his lifestyle to reduce the risk of recurrence?

Increased fluid intake and dietary changes

A client with a history of emphysema is experiencing hypoxemia after a taxing physical therapy appointment. Which of the following physiologic phenomena will occur as a consequence of hypoxemia?

Increased heart rate

A client with a history of emphysema is experiencing hypoxemia after a taxing physical therapy appointment. Which physiologic phenomenon will occur as a consequence of hypoxemia?

Increased heart rate

Which assessment findings would the health care provider consider as most indicative of acute renal failure?

Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR)

A patient has renal failure. The nurse, reviewing the lab results, recognizes which finding as indicative of the diminished renal function associated with the diagnosis? 1 Hypokalemia 2 Increased serum urea and serum creatinine 3 Anemia and decreased blood urea nitrogen 4 Increased serum albumin and hyperkalemia

Increased serum urea and serum creatinine

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

Increasing the normal saline intravenous infusion rate prior to the exam

What is the usual cause of acute pyelonephritis?

Infection

Which of the following characteristics differentiates inflammatory diarrhea from the noninflammatory type?

Infection of intestinal cells

A 60-year-old male patient has presented to his primary care provider to follow up with his ongoing treatment for peptic ulcer disease. What is the most likely goal of this patients pharmacologic treatment?

Inhibiting gastric acid production

The sensation of chest tightness due to an impending asthmatic attack appears to be related to which of the following physiological causes?

Input from lung receptors that monitor bronchial constriction.

A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be:

Insertion of a large-bore needle or chest tube

In hemodialysis, access to the vascular system is most commonly through:

Internal arteriovenous fistula

A client sustained acute tubular injury approximately 2 hours ago. Which cause of acute kidney injury (AKI) would the nurse suspect the client is experiencing?

Intrarenal

A client has acute pyelonephritis. The nurse will monitor the client for development of:

Intrarenal failure

A patient with chronic kidney failure (CKD) has a paralytic ileus and laboratory findings of a serum potassium level of 7 mEq/L and a phosphate level of 3.5 mg/dL. The nurse anticipates that what medication will be prescribed? 1 Calcium carbonate 2 Lanthanum carbonate 3 Sodium polystyrene sulfonate 4 Intravenous 10% calcium gluconate

Intravenous 10% calcium gluconate

The nurse should monitor for which adverse effect of erythropoietin in patients with kidney failure? 1 Paralytic ileus 2 Iron deficiency 3 Hyperparathyroidism 4 Systemic lupus erythematosus

Iron deficiency - Erythropoietin (EPO) helps replenish EPO stores in the body and promotes erythropoiesis in a patient with kidney failure. A side effect of EPO is iron deficiency anemia from increased demand for iron to support erythropoiesis.

A patient with a recent diagnosis of renal failure that will require hemodialysis is being educated in the dietary management of the disease. Which of the patients following statements shows an accurate understanding of this component of treatment?

Ive made a list of high-phosphate foods so that I can try to avoid them.

According to the Kidney Disease Outcome Quality Initiative (KDOQI) guidelines, in the first stage of kidney disease, the nurse will assess which finding?

Kidney damage with normal glomerular filtration rate (GFR)

Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct?

Kidneys convert inactive vitamin D to its active form, calcitriol.

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 providing dietary instruction for a client with chronic kidney disease (CKD) who is on hemodialysis. Which food would the nurse encourage the client to restrict?

Lean meats

Adverse effects of emboli on pulmonary circulation and airways include:

Local vasoconstriction

The client with emphysema should be educated about changes in lung tissue that may include which of the following changes? Select all that apply.

Loss of elastic recoil, Difficulty exhaling due to inability to recoil, Increased lung compliance

In addition to progressive permanent loss of nephrons, chronic kidney disease can result in which other consequence?

Loss of endocrine functions

The nurse assesses a client with renal failure for encephalopathy caused by uremia. Which clinical manifestation will the nurse likely find?

Loss of recent memory and inattention.

The nurse is caring for a patient with chronic kidney disease who is undergoing hemodialysis. What is an appropriate diet for this patient? 1 High-protein and low-calcium 2 Low-protein and low-potassium 3 High-protein and high-potassium 4 Low-protein and high-phosphorus

Low-protein and low-potassium

If a client is in the early phases of nephrotic syndrome, which area of the body will likely have the initial presence of edema?

Lower extremities

The nurse provides discharge instructions to a patient with chronic kidney disease (CKD). Which action by the patient indicates effective learning? 1 Maintains a pillbox organizer at home 2 Takes over-the-counter medications for pain 3 Takes aluminum-based laxatives for constipation 4 Includes sweet potatoes and chocolates in the diet

Maintains a pillbox organizer at home - A patient with chronic kidney disease has to take many medications, and maintaining a pillbox organizer at home helps the patient in medication compliance. The nurse should instruct the patient to avoid over-the-counter drugs, because most of these drugs are nephrotoxic, which leads to further deterioration of kidney function. The patient must avoid aluminum-based laxatives, because aluminum is accumulated in the body, leading to bone disease such as osteomalacia. Sweet potatoes and chocolates are rich in potassium and, therefore, they must be avoided to prevent hyperkalemia and fatal dysrhythmias.

A client has a marked decrease in the glomerular filtration rate (GFR); lab values with high blood urea nitrogen (BUN), potassium, and creatinine levels; urine output less than 10 mL/hr; 3+ pitting edema in the lower extremities; and BP 170/95. Which phase of acute tubular necrosis (ATN) does the nurse identify the client is in based on assessment data?

Maintenance phase

Assessment findings of a patient with chronic kidney failure include a glomerular filtration rate (GFR) of 10 mL/min, numbness and burning sensation in the legs, and a blood urea nitrogen level (BUN) of 26 mg/dL. The nurse anticipates that which intervention will be included on the patient's plan of care? 1 Make a referral for dialysis. 2 Administer sodium polystyrene sulfonate. 3 Restrict sodium bicarbonate. 4 Provide a magnesium-containing antacid.

Make a referral for dialysis. - Numbness and burning sensation in the legs are manifestations of peripheral neuropathy caused by nitrogenous waste accumulation in the brain. A patient with a chronic kidney disease (CKD), increased blood urea nitrogen (BUN) levels, and a very low glomerular filtration rate of 10 mL/min should undergo dialysis to remove nitrogenous wastes and prevent fluid accumulation due to impaired excretion.

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.

Massive proteinuria (>3.5 g/day) Lipiduria Generalized edema Hyperlipidemia

Which of the following aspects of kidney function is performed by the juxtaglomerular apparatus?

Matching changes in GFR with renal blood flow

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

Microalbuminemia is a predictor of future nephropathies.

The most recent assessment of a client with a diagnosis of type 1 diabetes indicates a heightened risk of diabetic nephropathy. Which of the following assessment findings is most suggestive of this increased risk?

Microalbuminuria

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: Select all that apply.

Moist crackles in both lung fields; Areas of diminished breath sounds due to pleural effusions; Increased circumference in the abdomen related to fluid excess

A farmer is admitted with hypersensitivity pneumonitis. Which factor could have caused his condition?

Moldy grain dust

Which intervention should the nurse perform for a patient with acute kidney injury who is on hemodialysis? 1 Monitor bilirubin levels 2 Monitor the color of feces 3 Monitor blood glucose levels 4 Monitor for discharge at access site

Monitor for discharge at access site

The patient has a form of glomerular inflammation that is progressing rapidly. The patient is gaining weight and the urine output is declining steadily. What is the priority nursing intervention? 1 Monitor the patient's cardiac status 2 Teach the patient about hand washing 3 Obtain a serum specimen for electrolytes 4 Increase direct observation of the patient

Monitor the patient's cardiac status

Which of the following statements is true of colorectal cancer?

Most cases are quite advanced before symptoms become apparent.

Reduced glomerular filtration rate (GFR), with a serum creatinine level that remains in the normal range, is associated with which factor of normal age-related change?

Muscle mass

A chronic kidney disease client who has renal osteodystrophy should be assessed for which of the following complications? Select all that apply.

Muscle weakness; Bone pain; Stress fractures

A 35-year-old female ultramarathon runner is admitted to hospital following a day-long, 80-km race because her urinary volume is drastically decreased and her urine is dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis. Why is her urine red?

Myoglobinuria

An ultramarathon runner is admitted following a day-long, 50-mile (80-kilometer) race because urinary volume is drastically decreased and the urine is dark red. What is the likely cause of the red urine?

Myoglobinuria

Both type 1 and type 2 diabetes mellitus can cause damage to the glomeruli of the kidneys. Which renal disease is diabetic nephropathy associated with?

Nephrotic syndrome

The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for:

Nephrotoxic acute tubular necrosis

The nurse is caring for a patient who had a surgery for an arteriovenous fistula (AVF) in preparation for hemodialysis. What precautionary step should the nurse follow when caring for this patient? 1 Perform venipuncture in the extremity only after three months. 2 Allow insertion of IV lines in the extremity only after six months. 3 Never take blood pressure measurements in the extremity. 4 Initiate hemodialysis after four weeks.

Never take blood pressure measurements in the extremity.

A 45-year-old client with chronic kidney disease (CKD) voices concern about her dialysis treatment. The client would like to work and spend time with her family. Which type of dialysis will best fit this client's lifestyle?

Nocturnal intermittent peritoneal dialysis (NIPD)

As nitrogenous wastes increase in the blood, the CKD client may exhibit which of the following clinical manifestations? Select all that apply.

Numbness in the lower extremities; Restless leg syndrome; Pruritis

A drug abuser was found unconscious after shooting up heroin 2 days prior. Because of the pressure placed on the hip and arm, the client has developed rhabdomyolysis. The nurse knows this can:

Obstruct the renal tubules with myoglobin and damage tubular cells

Perform transillumination and ask the client if bending forward exacerbates the headache.

A client with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which condition does the nurse suspect is common with this stage of kidney disease?

Pericarditis

A drug abuser was found unconscious after shooting up heroin 2 days prior. Because of the pressure placed on the hip and arm, the client has developed rhabdomyolysis. The nurse knows this can: a) Be cured by administering an anticoagulant immediately b) Cause the kidney to develop renal stones due to stasis c) Cause compartment syndrome in the lower extremities d) Obstruct the renal tubules with myoglobin and damage tubular cells

Obstruct the renal tubules with myoglobin and damage tubular cells Myoglobin normally is not found in the serum or urine. It has a low molecular weight; if it escapes into the circulation, it is rapidly filtered in the glomerulus. A life-threatening condition known as rhabdomyolysis occurs when increasing myoglobinuria levels cause myoglobin to precipitate in the renal tubules, leading to obstruction and damage to surrounding tubular cells. Myoglobinuria most commonly results from muscle trauma but may result from exertion, hyperthermia, sepsis, prolonged seizures, and alcoholism or drug abuse. -Rhabdomyolysis is not cured with anticoagulation administration nor does it cause kidney stones. -Compartment syndrome occurs when there is insufficient blood supply to muscles and nerves due to increased pressure within one of the body's compartments.

An ultrasound has confirmed appendicitis as the cause of a 20-year-old mans sudden abdominal pain. Which of the following etiologic processes is implicated in the development of appendicitis?

Obstruction of the intestinal lumen

The client with substance use disorder was found unconscious after overdosing on heroin 2 days prior. Because of prolonged pressure on the muscles the client has developed myoglobinuria, causing which complication?

Obstruction of the renal tubules with myoglobin and damaged tubular cells

Which of the following clients is at greatest risk for developing a urinary tract infection (UTI)?

Older adult female client admitted with an indwelling Foley catheter that has been in place for 1 month

Which is a clinical manifestation of acute kidney injury? 1 Oliguria 2 Uremia 3 Anemia 4 Pruritus

Oliguria - Oliguria is a sign of acute kidney injury. Uremia, anemia, and pruritus are signs of chronic kidney injury.

A client with postrenal acute kidney injury (AKI) exhibits oliguria and edema with laboratory results revealing increased levels of urea, potassium, and creatinine. Based on these data, which phase of AKI is this client most likely experiencing?

Oliguric phase

The nurse is educating a donor who is willing to donate a kidney to a family member. The nurse explains the positioning during the procedure and describes that the flank will be exposed. For what surgical procedure will the nurse prepare the donor? 1 Cholecystectomy 2 Open nephrectomy 3 Ureteroneocystostomy 4 Laparoscopic nephrectomy

Open nephrectomy

Which skeletal complication can occur as a result of high-turnover renal osteodystrophy?

Osteitis fibrosa

COPD clients live with persistently elevated PCO2 levels. Therefore, which assessment finding would likely initiate a stimulus for ventilation in this client population?

PO2 level of 50 mm Hg

COPD clients live with persistently elevated PCO2 levels. Therefore, which assessment finding would likely initiate a stimulus for ventilation in this client population?

PO2 levels of 50 mmHg

Parasympathetic nervous system stimulation resulting in airway constriction

When explaining to a CKD client how urea is absorbed, which of the following transport mechanisms will be mentioned?

Passive transport

A client is diagnosed with a tumor in the urinary bladder. The nurse will monitor the client for:

Postrenal failure

Following an episode of strep throat, the school nurse notices the fourth grade child has not recovered from this illness a week later. Upon further investigation, the nurse notices that the child has developed water retention. Which of the following assessments support this conclusion? Select all that apply.

Periorbital edema; BP 100/70

A patient who has been on peritoneal dialysis for two years reports nausea, vomiting, diarrhea, and fluid discharge from the catheter exit to the nurse. The laboratory reports reveal an increased white blood cell count (WBC). Which condition does the nurse suspect in the patient? 1 Hernia 2 Peritonitis 3 Intraperitoneal bleeding 4 Displacement of diaphragm

Peritonitis

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:

Peritonitis

Which factor is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma?

Pet dander

Which of the following is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma?

Pet dander

The nurse preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD) should know that this medication should have a beneficial effect on which laboratory value? 1 Sodium 2 Potassium 3 Magnesium 4 Phosphorus

Phosphorus - Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore, administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with CKD.

The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to which substance?

Plasma proteins

A client diagnosed with Goodpasture syndrome would require which therapy to remove proteins and autoantibodies from the system?

Plasmapheresis

Unilateral chest pain associated with respiratory movements is usually described as which of the following?

Pleuritic

A pulmonary embolism occurs when there is an obstruction in the pulmonary artery blood flow. Classic signs and symptoms of a pulmonary embolism include dyspnea, chest pain, and increased respiratory rate. What is a classic sign of pulmonary infarction?

Pleuritic pain

Pain is an expected assessment finding in clients who have which lung disease?

Pleuritis

Pain is an expected assessment finding in patients who have which of the following lung diseases?

Pleuritis

A short, nonsmoking middle-aged man presents to the emergency room with left-sided chest pain and a cough. He says that the pain started abruptly, just after lunch, and that breathing and coughing make it worse. He denies recent injury. He is breathing shallowly and rapidly and expresses fear that he may be having a "heart attack." Breath sounds are normal, and he is not cyanotic. Which condition is most likely causing his symptoms?

Pleuritis related to infection

The nurse knows that which sign is one of the earliest manifestations of acute renal failure (ARF)?

Polyuria

Which of the following diagnostic and assessment results support the diagnosis of chronic pyelonephritis? Select all that apply.

Polyuria; Nocturia

A client has an obstructive urine outflow related to benign prostatic hyperplasia. Due to the inability to excrete adequate amounts of urine, which type of renal failure should the nurse closely monitor for?

Postrenal failure

A client with a history of emphysema from long-term cigarette smoking has loss of many alveoli. When comparing the type I alveolar cell physiologic function with the primary role of type II alveoli, the nurse would be aware that the type II alveoli are responsible for:

Production of surfactant

Which of the following substances would not be found in glomerular filtrate? a) Protein b) Sodium c) Potassium d) Water

Protein

When acute tubular necrosis (ATN) is suspected, the nurse will likely see which of the following laboratory findings on the urinalysis report? Select all that apply.

Protein; RBC's; Cast cells

Which assessment finding would lead the nurse to suspect the client has developed nephrotic syndrome?

Proteinuria and generalized edema

Which of the following assessment findings would lead the nurse to suspect the client has nephrotic syndrome?

Proteinuria and generalized edema

Which of the following assessment findings would lead the nurse to suspect the client has nephrotic syndrome?

Proteinuria and generalized edema The nephrotic syndrome is characterized by massive proteinuria and lipiduria, along with an associated hypoalbuminemia, generalized edema, and hyperlipidemia.

Which nursing interventions in a patient with kidney injury would be beneficial in providing safe and effective care? 1 Provide spicy food 2 Provide mouth care 3 Provide plenty of fluids 4 Provide ibuprofen if the patient experiences pain

Provide mouth care - Patients with acute kidney injury experience mucous membrane irritation because of the production of ammonia in the saliva. Therefore, the nurse should provide oral care to prevent stomatitis.

While explaining the tubular role in reabsorption, the nurse will stress that a diet high in sodium intake will result in sodium reabsorption in which of the following renal locations?

Proximal convoluted tubule

Phosphate excretion is impaired in chronic kidney disease (CKD), resulting in high serum phosphate levels and the development of phosphate crystals. Which manifestation of hyperphosphatemia should the nurse assess for?

Pruritus

Which symptom occurs in a client with chronic kidney disease (CKD) as a result of elevated serum phosphate levels and the development of phosphate crystals that occur with hyperparathyroidism?

Pruritus

A patient has a glomerular filtration rate (GFR) of 40 mL/minute and a blood pressure of 140/90 mm Hg. The nurse suspects that which medication will increase the patient's blood pressure? 1 Gemfibrozil 2 Darbepoetin alfa 3 Pseudoephedrine 4 Aluminum antacids

Pseudoephedrine

Cystic fibrosis (CF) is an autosomal recessive disorder involving the secretion of fluids in specific exocrine glands. The genetic defect in CF inclines a person to chronic respiratory infections from a small group of organisms. Which organisms create chronic infection in a child with cystic fibrosis?

Pseudomonas aeruginosa and Staphylococcus aureus

Acute pyelonephritis is an infection of the renal parenchyma and renal pelvis. What is a common cause of acute pyelonephritis?

Pseudomonas species The most common causative agents of acute pyelonephritis are gram-negative bacteria, including E. coli and Proteus, Klebsiella, Enterobacter, and Pseudomonas. The other answers are not considered a common causative agent of acute pyelonephritis. (less)

Three days following surgical repair of a hip fracture a client becomes anxious and complains of sudden shortness of breath. What disorder is the client most likely experiencing?

Pulmonary embolism

Pulmonary hypertension is usually caused by long-term exposure to hypoxemia. When pulmonary vessels are exposed to hypoxemia, what is their response?

Pulmonary vessels constrict

The nurse needs to assess the oxygen status of a client who is suddenly experiencing shortness of breath. The most appropriate noninvasive measurement technique would be:

Pulse oximetry

The nurse needs to assess the oxygen status of a client who is suddenly experiencing shortness of breath. The most appropriate noninvasive measurement techniques would be:

Pulse oximetry

Recently had a urinary tract infection

An older adult client has been hospitalized for the treatment of acute pyelonephritis. Which characteristic of the client is most likely implicated in the etiology of this current health problem?

Recently had a urinary tract infection

While caring for a patient with kidney failure, the patient has three episodes of vomiting and diarrhea. Which action should the nurse perform as a priority? 1 Administer antiemetic. 2 Record the blood pressure. 3 Record the volume of fluid lost. 4 Administer water with a high salt content.

Record the volume of fluid lost.

The nurse reviews the lab results for a client who has advanced autosomal dominant polycystic kidney disease (ADPKD). The client 's hemoglobin is 8.8 g/dL (88 g/L). The nurse suspects this lab value is related to which cause?

Reduced production of erythropoietin

What causes prerenal acute kidney injury? 1 Release of nephrotoxins 2 Reduced renal blood flow 3 Urine reflux into renal pelvis 4 Presence of extrarenal tumors

Reduced renal blood flow

A 72-year-old client is scheduled for a kidney transplant. The nurse knows that which aspect of advanced age has a positive effect on the success of kidney transplant survival?

Reduction in T-lymphocyte function

Which phenomenon contributes to the difficulties with absorption, distribution, and elimination of drugs that are associated with kidney disease?

Reductions in plasma proteins increase the amount of free drug and decrease the amount of protein-bound drug.

Which client should the nurse see first?

Refractory asthma, PEF 210 mL out of best PEF 450 mL, diminished wheezing.

An athlete has become dehydrated during a long race in hot weather. Which of the following physiologic processes will occur in an attempt to protect the athlete's extracellular fluid volume?

Release of ADH from the posterior pituitary

A client is admitted with worsening heart failure. The client is complaining about having to urinate frequently. The nurse knows that the physiology behind the body's response to decrease vascular volume by increasing urine output is due to:

Release of atrial natriuretic peptide (ANP) from overstretched atria

What is the most common cancer of the kidney?

Renal cell carcinoma

While taking a client history, which of the following assessments lead the nurse to suspect the client may have polycystic kidney disease? Select all that apply.

Renal colic with flank pain; Bright red blood in urine sample; Elevated BP of 180/94

A patient is being administered 15 g sodium polystyrene sulfonate (Kayexalate) orally for hyperkalemia. Which intervention should the nurse perform? 1 Observe the patient for iron overload. 2 Inform the patient that constipation is an expected side effect. 3 Provide magnesium-containing antacids. 4 Report peaked T waves in electrocardiogram (ECG).

Report peaked T waves in electrocardiogram (ECG).

A client arrives in the ED after an automobile accident. Which clinical manifestations lead the nurse to suspect a pneumothorax? Select all that apply.

Respiratory rate 34. Asymmetrical chest movements, especially on inspiration Diminished breath sounds over painful chest area

A client with a history of heart failure and COPD (caused by 60 pack/year smoking) presents to the clinic reporting difficulty breathing. Auscultation of breath sounds reveal absent/diminished breath sounds in the right lower lobe. Which other manifestations lead the health care provider to suspect the client may have developed atelectasis? Select all that apply.

Respiratory rate—32; pulse rate—122 beats/min. "Having a hard time catching my breath." Using accessory muscles to help him breathe.

Neuromuscular disorders can be triggered by CKD. For those clients on dialysis, approximately two-thirds suffer from what peripheral neuropathy?

Restless legs syndrome

When caring for a patient during the oliguric phase of acute kidney injury (AKI), what is an appropriate nursing intervention? 1 Weigh patient three times weekly 2 Increase dietary sodium and potassium 3 Provide a low-protein, high-carbohydrate diet 4 Restrict fluids according to previous daily loss

Restrict fluids according to previous daily loss

A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which intervention would be most appropriate for the nurse to provide?

Restrict intake of dietary protein

A patient has a glomerular filtration rate (GFR) of 70 mL/minute, a blood pressure of 140/100 mm Hg, and fluid accumulation in the legs. To help prevent heart failure, the nurse should provide the patient with which instruction? 1 Limit protein intake. 2 Restrict sodium to 2 g/day. 3 Take vitamin D supplements. 4 Avoid magnesium-containing laxatives.

Restrict sodium to 2 g/day. -A patient with a glomerular filtration rate of 70 mL/min has stage 2 chronic kidney disease. A blood pressure of 140/100 mm Hg along with fluid accumulation in the legs indicates that the patient has hypertension and edema. Patients with increased blood urea nitrogen levels should limit protein intake to prevent neurologic complications. High sodium retention may lead to heart failure, so the patient should restrict sodium intake to 2 grams per day.

Which diagnosis puts a client at risk for developing an immunologic form of interstitial lung disease?

Rheumatoid arthritis

The edema that develops in persons with glomerulonephritis and nephrotic syndrome reflects which physiologic principle?

Salt and water tubular reabsorption

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?

Serum creatinine

Which one of the following blood tests reflects the glomerular filtration rate (GFR) and is used to estimate renal function?

Serum creatinine

A client who has been diagnosed with Addison disease will likely experience which of the following lab results related to the absence of aldosterone?

Serum potassium levels elevated

A child is brought to the emergency department struggling to breathe with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which of the following is the most likely diagnosis?

Severe asthma attack

A child struggling to breathe is brought to the emergency department with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. What is the most likely diagnosis?

Severe asthma attack

Sharp decrease in urine output

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 of the following early signs of prerenal injury? a) Intermittent periods of confusion b) Excessive voiding of clear urine c) Acute hypertensive crisis d) Sharp decrease in urine output

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 child is brought to the emergency department with an asthma attack. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which drug will the nurse anticipate administering first?

Short-acting beta 2-adrenergic agonists such as albuterol (SABA)

A child is brought to the emergency department with an asthma attack. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which of the following drugs will the nurse anticipate administering first?

Short-acting beta 2-adrenergic agonists such as albuterol (SABA)

In the intensive care unit (ICU), the nurse is caring for a trauma client who has abdominal injuries is beginning to have a decrease in BP and increased pulse rate and is pale with diaphoretic skin. The nurse is assessing the client for hemorrhagic shock. If the client is in shock, the nurse would expect to find:

Significant decrease in urine output due to decrease in renal blood flow

A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that which statements regarding CKD are correct? Select all that apply.

Signs and symptoms develop gradually; Functioning nephrons compensate for those that are damaged; Nephron destruction takes place over many months; There is a reduction in glomerular filtration rate (GFR) as nephrons are destroyed.

Small cell lung cancer due to smoking history

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

Sodium

Which of the following meals is most likely to exacerbate an individuals celiac disease?

Spaghetti with meatballs and garlic bread

When the glomerular transport maximum for a substance such as blood glucose is exceeded and its renal threshold has been reached, the substance will:

Spill into the urine

While caring for a patient who is undergoing peritoneal dialysis on a regular basis, the nurse finds that the patient has redness and drainage at the exit site of the peritoneal catheter. What does the nurse anticipate the culture results will reveal? 1 Candida infection 2 Aspergillus infection 3 Cryptococcal infection 4 Staphylococcus aureus infection

Staphylococcus aureus infection

Drug-related nephropathies involve functional and/or structural changes to the kidney after exposure to a drug. What does the tolerance to drugs depend on?

State of hydration

A patient had the surgical creation of an arteriovenous graft for the administration of hemodialysis. For what complication should the dialysis nurse monitor during hemodialysis? 1 Hernia 2 Bronchitis 3 Pneumonia 4 Steal syndrome

Steal syndrome

A patient who has been taking 80 mg of prednisone, a glucocorticoid, each day has been warned by his primary care provider to carefully follow a plan for the gradual reduction of the dose rather than stopping the drug suddenly. What is the rationale for this directive?

Stopping the drug suddenly may cause adrenal insufficiency.

A nurse is caring for a client who has been diagnosed with kidney colic but has yet passed the stone. Which interventions would the nurse emphasize when planning the care for this client?

Strain the urine.

A nurse is caring for a patient who has been diagnosed with kidney colic and has not yet passed the stone. Which of the following interventions should the nurse be sure to include when planning the care for this patient?

Strain the urine. All urine should be strained during an attack in the hope of retrieving the stone for chemical analysis and determination of type. This information, along with a careful history and laboratory tests, provides the basis for long-term preventative measures. The patient will require an increase in fluid intake. The patient will also require an opioid analgesic to control the pain.

The nurse develops a plan to prevent atelectasis in a postsurgical client. Which intervention will be effective?

Supervision of hourly deep-breathing exercises

Which of the following factors accounts for the poor prognosis that typically accompanies a diagnosis of primary hepatocellular cancer?

Surgical options do not exist because removal of all or part of the liver is a threat to health.

Which of the following factors is likely to result in decreased renal blood flow?

Sympathetic nervous system stimulation

A patient has developed the facial appearance that is characteristic of myxedema, along with an enlarged tongue, bradycardia, and voice changes. Which of the following treatment modalities is most likely to benefit this patient?

Synthetic preparations of T3 or T4

A patient with end-stage chronic kidney disease is scheduled for hemodialysis. What recommendation should the nurse give to the patient? 1 Drink more fluids 2 Eat protein-rich foods 3 Take folic acid supplementation 4 Take phosphate supplementation

Take folic acid supplementation

The nurse recognizes that which recommendation is appropriate for a patient with chronic kidney disease (CKD)? 1 Eat prunes and raisins. 2 Take phosphate binders with meals. 3 Drink plenty of water. 4 Take calcium and iron supplements on an empty stomach.

Take phosphate binders with meals.

A client has experienced severe hemorrhage and is in prerenal failure. The nurse anticipates the client's blood urea nitrogen (BUN) and serum creatinine laboratory results will be in which range?

The BUN-to-creatinine ratio is 20:1.

An automobile accident client is brought to the emergency department in hypovolemic shock from internal bleeding. Nurses are closely monitoring urine output since a significant decrease signifies that

The SNS has caused afferent arteries to constrict to decrease blood flow

When thinking in terms of airway radius with regard to resistance, the lung structure responsible for the most airway resistance to airflow would be:

The bronchioles near the trachea

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?

Wilms tumor

A young adult with a history of intermittent flank pain, repeated urinary tract infections (UTIs), and hematuria is diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which pathophysiologic abnormality most likely has contributed to the development of ADPKD?

The client has inherited a tendency for epithelial cells in the tubules to proliferate inappropriately.

The nurse is caring for the following clients. Select the client at highest risk for the development of atelectasis.

The client who is postop total knee replacement and receiving client-controlled analgesia

The nurse is caring for the following clients. Select the client at highest risk for the development of atelectasis.

The client who is postoperative after a total knee replacement and receiving patient-controlled analgesia

A client with significant burns on his lower body has developed sepsis on the third day following his accident. Which manifestation would the nurse anticipate for an ischemic acute tubular necrosis rather than prerenal failure?

The client's GFR does not increase after restoration of renal blood flow

A nurse observes that a client's urine is cola colored and considers which factor as a possible reason?

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

A nursing student asks if a client diagnosed with chronic obstructive pulmonary disease (COPD) is at risk if he receives oxygen at a level that increases the PO2 above 60 mm Hg. The best response would be:

The client's ventilation will be severely depressed.

A 56-year-old woman has been diagnosed with CKD. She first went to the doctor due to complications of hypertension. How are hypertension and CKD related?

The mechanisms that produce hypertension in CKD include an increased vascular volume and increased activity of the renin-angiotensin-aldosterone system.

A patient with significant burns on his lower body has developed sepsis on the third day following his accident. Which of the following developments is most clearly suggestive of ischemic acute tubular necrosis rather than prerenal failure?

The patients GFR does not increase after restoration of renal blood flow

The patients GFR does not increase after restoration of renal blood flow.

With acute respiratory distress syndrome (ARDS), a client progressively increases his work of breathing. The physiological principle behind this respiratory distress is related to:

The stiffening of the lung, making it more difficult to inflate

The parents of a child with cystic fibrosis ask the nurse to explain the sweat test performed on their newborn. How should the nurse respond?

The sweat test measures the concentration of salt in the infant's sweat.

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 medications may be responsible for a client developing increased uric acid levels by decreasing ECF volume?

Thiazide diuretics

A college student is training for a marathon in the mountains. One day, she experiences a sharp pain and suddenly becomes short of breath. At the emergency room, chest x-ray reveals a spontaneous pneumothorax. The client asks the nurse to explain why this happened. The nurse states, "For unknown reasons, you lose intrapleural negative pressure.

This means your lungs collapsed and expelled its air when you lose negative pressure."

Thoracentesis

An older adult client who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which treatment modality is most likely to resolve the client's most recent health problem?

Thoracentesis

While providing postoperative care for a live kidney donor, the nurse monitors the hematocrit levels. What rationale does the nurse provide to the patient for this action? 1 To assess for bleeding 2 To assess for impairment 3 To assess for hypokalemia 4 To assess for hyponatremia

To assess for bleeding

Clients with CKD are at risk for demineralization of their bones since they are no longer able to:

Transform vitamin D to its active form

A man sustained a puncture injury to his chest that caused a tension pneumothorax to form. This is a life-threatening condition because:

Trapped, inspired air collapses the lung.

Clients with chronic obstructive lung disease (COPD) may experience airway closure at the end of normal instead of low lung volumes, which result in:

Trapping of large amounts of air that cannot participate in gas exchange

A client with chronic kidney disease (CKD) will be managed with peritoneal dialysis. Which description of this type of dialysis is most accurate?

Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time.

Which of the following descriptions is true of peritoneal dialysis?

Treatment involves the introduction of a sterile dialyzing solution, which is drained after a specified time

Which of the following descriptions is true of peritoneal dialysis?

Treatment involves the introduction of a sterile dialyzing solution, which is drained after a specified time.

Acute bronchiolitis is a viral infection that has a peak incidence between 3 to 6 months of age and is most commonly caused by respiratory syncytial virus (RSV).

True

Extrinsic or atopic asthma is typically initiated by a type I hypersensitivity reaction induced by exposure to an antigen or allergen.

True

Lung compliance refers to the ease with which the lungs can be inflated.

True

The peripheral chemoreceptors monitor arterial oxygen levels and will stimulate respirations when the PO2 has dropped below 60 mm Hg.

True

Tubular necrosis

Which of the following signs and symptoms is most suggestive of acute cholecystitis?

Upper right quadrant or epigastric pain

Wilms tumor

Which condition should the nurse suspect in a patient with chronic kidney disease (CKD) who develops osteomalacia? 1 Asterixis 2 Uremic frost 3 Gastroparesis 4 Uremic red eye

Uremic red eye - Chronic kidney disease mineral and bone disorder (CKD-MBD) is a common complication of CKD and results in both skeletal and extraskeletal complications. Osteomalacia is a skeletal complication. Calcium deposition in the eye may create irritation leading to uremic red eye, an extraskeletal complication.

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?

Uric acid

An obese, male client with a history of gout and a sedentary lifestyle has been advised by his primary care provider to avoid organ meats, certain fish, and other foods that are high in purines. The care provider is demonstrating an awareness of the client's susceptibility to which of the following types of kidney stones?

Uric acid stones

Which finding indicates oliguria? 1 Urinary output of 350 mL/day 2 Urinary output of 450 mL/day 3 Urinary output of 550 mL/day 4 Urinary output of 650 mL/day

Urinary output of 350 mL/day - A urinary output rate of less than 400 mL/day indicates oliguria; thus a urinary output of 350 mL/day suggests oliguria. Urine outputs of 450, 550, or 650 mL/day are considered normal.

One of the most damaging effects of urinary obstruction on kidney structures is which effect?

Urinary stasis

The most damaging effects of urinary obstruction are the result unrelieved obstruction of urine outflow and:

Urinary stasis

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?

Urine cloudy with strong odor

The patient is in the diuretic phase of acute kidney injury. What education should the nurse provide to the patient regarding this phase? Select all that apply. 1 Urine output is increased. 2 The kidney has become fully functional. 3 The electrolyte imbalance will be normalized. 4 This phase will last no more than three weeks 5 There is a possibility that the fluid volume will be reduced in the body.

Urine output is increased. This phase will last no more than three weeks There is a possibility that the fluid volume will be reduced in the body.

A client has provided a routine urine sample during a scheduled visit to his primary care provider. Which of the following results is an expected finding in a healthy individual?

Urine specific gravity of 1.020

Which diagnoses should be considered in children who present with urinary symptoms without bacteriuria?

Vaginitis, sexual molestation, or pinworms Urinary symptoms in the absence of bacteriuria suggest vaginitis, urethritis, and use of irritating bubble baths, sexual molestation, pinworms, or viral cystitis. In adolescent girls dysuria and vaginal discharge suggest vaginitis or vulvitis.

A female client asks, "Why do I leak urine every time I cough or sneeze?" The health care worker's response is based on which physiologic principle?

When intravesical pressure exceeds maximal urethral closure pressure

Prior to undergoing diagnostic testing with contrast, it is recommended that older adult clients have their creatinine level checked. The rationale for this is to ensure the client:

Will not undergo an acute kidney injury by decreasing renal blood flow

Prior to undergoing diagnostic testing with contrast, it is recommended that older adult clients have their creatinine level checked. The rationale for this is to ensure the client:

Will not undergo an acute kidney injury by decreasing renal blood flow Some drugs, such as diuretics, high molecular weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus, and the nonsteroidal anti-inflammatory drugs (NSAIDs), can cause acute kidney injury by decreasing renal blood flow. Checking creatinine levels do not predict the client's allergies, a kidney stone, or tolerance for stress testing. (less)

A patient is admitted with pneumoconiosis. His history most likely reveals which of the following?

Work in a coal mine for 20 years

A client is diagnosed with pneumoconiosis. Which aspect of the client's history is most likely the cause of this diagnosis?

Worked in a coal mine for 20 years

When explaining the body's compensatory mechanisms to maintain a normal pH, the health care provider knows that the renal system:

Works slower than the respiratory system, going into action 1 to 2 days after H+ remain elevated

The nurse instructs a patient with hyperphosphatemia to avoid what food item? 1 Yogurt 2 Soy sauce 3 Canned soup 4 Salad dressing

Yogurt - Yogurt is rich is phosphate and should be avoided by patients with hyperphosphatemia.

The parents of a child diagnosed with cystic fibrosis (CF) ask about the risk of any future children having the condition. How should the nurse respond?

You have a 25% chance that your next child will have CF.

a loss of over half the client's normal kidney function.

The nurse recognizes the most common cause of acute postinfectious glomerulonephritis as:

a streptococcal infection 7 to 12 days prior to onset.

which of the following clients at the clinic should be encouraged to receive the pneumococcal polysaccharide vaccine (PPSV23)? a client: (select all that apply) a) who is 65 years old with chronic asthma b) with a smoking history c) young adult with HIV positive results d) who is school aged and has received a liver transplant e) who is a teen with history of kidney disease

a) 65 y/o with chronic asthma b) smoking history

which of the following individuals should be prioritized for receiving a seasonal influenza vaccination? a) 81 year old resident of LTC facility b) 19 year old man who was admitted to a hospital for an appendectomy c) neonate who was born in a busy, inner-city hospital in late october d) 86 year old whose flu symptoms have required hospitalization

a) 81 year old living in LTC

client with an 80-pack-year history of tobacco smoking has presented to clinic complaining of "bronchitis" cough for past 5 months, weight loss, and SOB. today, this client "got scared" when he coughed up blood in his sputum. the provider is concerned this client may have which of the following possible diagnoses? a) SCLC due to smoking history b) TB due to long period of coughing c) pulmonary embolism due to blood in sputum d) pneumothorax related to chronic lung infection weakening alveoli

a) SLCL

A nurse runs into an old high school friend after 20 years. She notes her friend continues to smoke after all these years. The friend asks, "Do you think I sound hoarse?" Upon further assessment, the nurse/friend notes her friend has several warning signs of cancer. Which manifestations would lead to this conclusion? Select all that apply: a) "i seem to have some difficulty swallowing food. this is new for me" b) "i seem to have more trouble holding my urine than i used to" c) "can you feel how large my lymph nodes are on my neck and armpits?" d) pericardial friction rub heard on auscultation e) feels subQ emphysema in upper chest area

a) difficulty swallowing food c) large lymph nodes on neck and armpits

the "cold viruses" are rapidly spread from person to person. the greatest source of spread is a) fingers b) sneezing c) plastic toys d) eye mucosa

a) fingers

Following a dust storm in Arizona, several clients have presented to the clinic complaining of productive cough, fever, and night sweats. The health care provider suspects a fungal infection related to breathing dust. One particular client is critical. They suspect the infection has progressed outside the lung when they observe the client has (select all that apply): a) generalized lymph node enlargement b) urine output decreased to 40 mL/hr c) requires guaifenesin to cough up sputum d) enlarged liver via palpation e) copious bleeding at the site where the lab tech drew blood

a) generalized lymph node enlargement d) enlarged liver e) copious bleeding at blood draw site

people infected with HIV and TB lack a hypersensitivity response to the tuberculin test as a result of: a) inherent anergy b) host cell depletion c) poor lung perfusion d) boosting phenomenon

a) inherent anergy

a nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis and has subsequently developed latent TB infection. which of the following is true of this nurse? a) nurse is likely asymptomatic b) nurse if now immune to more severe TB infection c) nurse can spread TB to others d) nurse has active TB infection

a) nurse is likely asymptomatic

which of the 4 categories of bronchogenic carcinoma has the greatest association with tobacco smoking and tends to metastasize to the brain? a) small cell b) large cell c) squamous cell d) adenocarcinoma

a) small cell

a client with newly diagnosed squamous cell carcinoma of the lungs asks, "so how do we treat this cancer?" which response from provider is most accurate? select all that apply: a) surgery to remove tumor b) radiation therapy c) chemo d) stem cell transplant e) monoclonal antibody

a) surgery b) radiation c) chemo

client is admitted to hospital to rule out Legionnaire disease following a canoe trip where he was sprayed in the face with a lot of "creek" water. which of the following manifestations are characteristic of Legionnaire pneumonia? select all that apply a) temp of 103.5, pulse 80 b) talking but not making a lot of sense (confusion) c) decreased abdominal bowel sounds d) productive cough with thick, yellow secretions e) chest X-ray that reveals areas of consolidation suggestive of pneumonia

a) temp of 103.5, pulse 80 b) confusion e) chest xray revealing ares of consolidation suggestive of pneumonia

Legionnaire disease is a form of bronchopneumonia caused by an organism frequently found in: a) warm, standing water b) public restrooms c) fermenting yogurt d) potted plant dirt

a) warm, standing water

A young, male child is born with severe respiratory failure. Over the course of months, the parents note his body looks swollen. They ask, "Is our baby's kidneys not working right? Why is he so swollen?" The nurse bases his or her reply on which of the following physiological principles? Select one: a. "The right side of his heart (cor pulmonale) is not pumping effectively. Blood is backlogging in his body, which is why he is so swollen." c. "This happens when he has so many secretions in his lungs. Maybe we should try some expectorant to thin his secretions so he can cough them out." d. "We just need to call the physician and ask him to give you a prescription for more water pills."

a. "The right side of his heart (cor pulmonale) is not pumping effectively. Blood is backlogging in his body, which is why he is so swollen." ---The term cor pulmonalerefers to right heart failure resulting from primary lung disease or pulmonary hypertension. The increased pressures and work result in hypertrophy and eventual failure of the right ventricle. The manifestations of cor pulmonale include signs of right-sided heart failure, which include venous congestion, peripheral edema, shortness of breath, and a productive cough, which becomes worse during periods of heart failure. None of the other statements are applicable to these parents' questions.

Above the glottis that opens and closes for speech, the epiglottis performs which physiologic functions during swallowing? Select one: a. Cover the larynx b. Open the epiglottis c. Constrict the airways d. Collapse the vocal cords

a. Cover the larynx --During swallowing, the free edges of the epiglottis move downward to cover the larynx, thereby preventing liquids and foods from entering. When substances other than air manage to enter the airway, the vocal folds serve as a sphincter, causing the larynx muscles to constrict and close and/or collapse the airway as a protective measure.

A respiratory therapist has asked a client to breathe in as deeply as possible during a pulmonary function test. Inspiration is normally the result of which of the following phenomena? Select one: a. Decreased intrathoracic pressure b. Increased intrapleural pressure c. Increased airway pressure d. Decreased intrapulmonary pressure

a. Decreased intrathoracic pressure ---During inspiration, contraction of the diaphragm and expansion of the chest cavity produce a decrease in intrathoracic pressure, causing air to move into the lungs.

When a client with a history of asthma takes a walk outside on a windy day with high pollen counts, she may experience an asthma attack, resulting in an increase in respiration rate and wheezing. The body's response is likely related to which pathophysiological principle? Select one: a. Parasympathetic nervous system stimulation resulting in airway constriction b. Inhibition of glandular secretions, which causes build up of mucus in the lungs c. Influx of macrophages to wall of the pollen, thereby stopping the attack d. Release of catecholamines causing blood vessel constriction

a. Parasympathetic nervous system stimulation resulting in airway constriction --The parasympathetic (PS) fibers are excitatory neurons that respond to acetylcholine. Stimulation of the PSN is responsible for airway constriction, blood vessel dilation, and increased glandular secretion. The sympathetic nervous system (SNS), which responds to the catecholamines norepinephrine and epinephrine, produces airway dilation, blood vessel constriction, and inhibition of glandular secretions.

An elderly client who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which of the following treatment modalities is most likely to resolve the client's most recent health problem? Select one: a. Thoracentesis b. Supplementary oxygen therapy c. Administration of bronchodilators d. Administration of corticosteroids

a. Thoracentesis --With large effusions, thoracentesis may be used to remove fluid from the intrapleural space and allow for reexpansion of the lung.

A distinguishing feature of viral influenza is:

abrupt onset around malaise

Both high-turnover and low-turnover renal osteodystrophy, the skeletal complications of chronic kidney disease, are manifested by abnormal _________ and defective bone __________.

absorption; remodeling

The pathogenic capacity of the tubercle bacillus is related to:

the initiation of a cell-mediated immune response

A 16-year-old girl has been admitted to the emergency department after ingesting 20 g of acetaminophen (Tylenol) in a suicide attempt. The care team would recognize that this patient faces a severe risk of:

acute fulminant hepatitis.

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.

Upon auscultation of your patient's lung sounds, you notice a high-pitched wheezing sound. This is due to:

airway constriction

Acute gastritis refers to a transient inflammation of the gastric mucosa that is most commonly associated with:

alcohol intake.

A client with a diagnosis of chronic kidney disease (CKD) may require the administration of which of the following drugs to treat coexisting conditions that carry a high mortality?

antihypertensive medications

A client involved in a car accident is admitted with a chest tube following pneumothorax. He also has an elevated blood alcohol level. When the nurse enters his room, she notes the client is dyspneic, short of breath, and holding his chest tube in his hand. When the nurse pulls the linens back, she finds a "sucking" chest wound. After calling a "code blue," the next priority intervention would be to:

apply a Vaseline gauze (airtight) dressing over the insertion site.

Your 4-month old cousin is diagnosed with gastroesophageal reflux. She spits up frequently after feedings and is irritable for about 1 hour after eating. At her last health check up, the practitioner mentioned that she is at risk for pneumonia. What would be the most likely cause for this

aspiration

Acute pancreatitis involves activated pancreatic enzymes that escape into surrounding tissues to cause _______.

autodigestion

The most common cause of hypothyroidism is:

autoimmune thyroiditis.

The most common indicator of acute renal failure is:

azotemia.

while administering a TB skin test, a client who is HIV positive asks, "i heard from my friends, this test may not work on me since i have HIV." the HC provider's best response would be: a) "this test is 99.9% specific, so it will give us an accurate result" b) "sometimes immunocompromised clients will have negative results if you are unable to mount a normal immune reaction" c) "most of the time, with HIV positive clients, we see more false-positives since you may have a similar infection in your body" d) if your test comes back positive, we will send a blood test off to a special lab to confirm you really have TB before we start treatment

b) "sometimes immunocompromised clients have negative results if you are unable to mount a normal immune reaction"

a distinguishing feature of viral influenza is: a) direct contact transmission b) abrupt onset, profound malaise c) constant pounding headache d) profuse watery nasal discharge

b) abrupt onset, profound malaise

family brings their elderly father to ED. he has been exposed to pneumococcal pneumonia at his retirement home. today they noted a change in his mental status. they thought he might need some oxygen. which of the other assessment findings would correlate with this diagnosis? select all that apply: a) expiratory wheezes throughout all lung fields b) increase in chest pain with deep inspiration c) absent breath sounds on entire right side of lung d) loss of appetite for past few days e) purulent sputum with bloody patches

b) increase in chest pain with deep inspiration d) loss of appetite for past few days e) purulent sputum with bloody patches

a patient has been admitted to a medical unit of a hospital for the treatment of pneumonia attributed to S. pneumonia. which of the following considerations is the priority in this patient's treatment? a) maintaining patient's ADLs b) maintaining patient's airway c) monitoring/treating patient's pain d) preventing and treating patient's fever

b) maintaining airway

which of the following clients would be considered at high risk for developing pneumonia (both CAP and HAP) select all that apply: a) teen who spends a lot of time at local coffee shops using wifi to chat with friends b) you adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation c) college female who is pregnant (unplanned) who has been consuming alcohol prior to positive pregnancy test d) HIV-positive client with WBC count of 2000 who has been camping near a commercial farm raising chickens for food e) school aged child with severe asthma controlled by steroids admitted for an exacerbation

b) motorcycle accident with head injury requiring tracheostomy and mechanical ventilation d) HIV positive client with WBC count 2000 camping near chicken farm e) school aged child with severe asthma controlled by steroids admitted for exacerbation

The "cold viruses" are rapidly spread from person to person. The greatest source of spread is: Select one: a. Sneezing b. Fingers c. Plastic toys d. Eye mucosa

b. Fingers --Cold viruses have been found to survive for more than 5 hours on the skin and hard surfaces, such as plastic countertops. Aerosol spread of colds through coughing and sneezing is much less important than the spread by fingers picking up the virus from contaminated surfaces and carrying it to the nasal membranes and eyes. The fingers are the greatest source of spread, and the nasal mucosa and conjunctival surface of the eyes are the most common portals of entry of the virus.

Generalized acute hypoxia in lung tissue, when alveolar oxygen levels drop below 60 mm Hg, causes pulmonary: Select one: a. Hypertension b. Vasoconstriction c. Vasospasms d. Embolus formation

b. Vasoconstriction --Vasoconstriction of pulmonary vessels is a compensatory response to generalized lung tissue hypoxia. Embolus formation causes a localized hypoxic response. Vasospasms are not involved with the hypoxia response by lung tissue. Pulmonary hypertension is the result of chronic lung tissue hypoxia.

A child is experiencing an acute exacerbation of asthma. Which quick-acting treatment is most appropriate for this client?

beta-adrenergic agonists

in the stomach, chyme is churned by peristalsis into the antrum, which contracts, reverses the flow, and allows more churning. Because the pylorus is contracted during antral contraction, gastric content empties into the duodenum:

between contractions

The "cold viruses" are rapidly spread from person to person. The greatest source of spread is:

fingers

A client with chronic kidney disease has been admitted with increased shortness of breath and abnormal breath sounds (rales heard to scapular region of posterior back). The admission hemoglobin level is 7.8 g/dL. Vital signs are as follows: respiratory rate 30; BP 180/98; pulse 110. +3 pitting edema in lower extremities bilaterally. Knowing the correlation of hypertension and associated anemia, the nurse suspects this client has developed:

heart failure.

Which of the following is not a change in the bronchi and bronchioles related to chronic bronchitis?

hypertrophy of bronchial mucous glands

Primary adrenal insufficiency is manifested by:

hyponatremia and hypoglycemia.

A clinician is assessing the muscle tone of a client who has been diagnosed with a lower motor neuron lesion. which finding is congruent with the cliemt's diagnosis.

hypotonia

Which of the following refers to cellular deprivation of oxygen

hypoxia

A client with CKD has a GFR of 28 mL/min/1.73 m2. When teaching the client about dietary modifications, the nurse should recommend:

identifying and limiting phosphorus intake.

A client has been diagnosed with cholecystitis (gallbladder inflammation) that has impaired the normal release of bile. Which of the following gastrointestinal consequences is this client likely to experience?

impaired digestion of fats

Impaired skin integrity and skin manifestations are common in persons with chronic kidney disease. Pale skin and subcutaneous bruising are often present as a result of:

impaired platelet function.

family brings their elderly father to emergency department. He has been exposed to pneumococcal pneumonia at his retirement home. Today, they noted a change in his mental status. They thought he might need some oxygen. Which of the other assessment findings would correlate with this diagnosis? Select all that apply.

increase in chest pain with deep inspiration, Loss of appetite for past few days, Purulent sputum with bloody patches

A predominant effect of a prolonged excessive growth hormone level is:

increased blood glucose levels.

A 60-year-old male client has presented to his primary care provider to follow up with his ongoing treatment for peptic ulcer disease. What is the most likely goal of this client's pharmacologic treatment?

inhibiting gastric acid production

The immune suppressive and anti-inflammatory effects of cortisol cause:

inhibition of prostaglandin synthesis.

A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be:

insertion of a large-bore needle or chest tube.

Which of the following increases the affinity of oxygen to hemoglobin?

iron

ischemic tubular necrosis.

As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by:

isotonic polyuria

As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by:

isotonic polyuria.

Abnormally high accumulation of bilirubin in the blood causes:

jaundice

Pleuritic chest pain associated with respiratory movements is usually described as

localized

The iatrogenic form of Cushing syndrome is caused by:

long-term cortisone therapy.

The nurse caring for a client with diverticulitis should assess for which of the following clinical manifestations?

lower left quadrant pain

Diverticulitis, a complication of diverticulosis, is manifested by acute:

lower left quadrant pain.

How would you know if you had hypoxemia or hypercapnia?

measure arterial blood gases

measurement of postvoid residual (PVR) by ultrasound

A 45-year-old female is being treated for ovarian cancer. Her treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of:

nephrotoxic acute tubular necrosis (ATN).

A major factor in the development of hepatic encephalopathy is:

neurotoxin accumulation.

The most common cause of thyrotoxicosis is Graves disease, which has the distinguishing characteristic of _____ in addition to a diffuse goiter.

ophthalmopathy

overflow urinary incontinence

The major manifestations of Cushing syndrome include:

overt diabetes mellitus.

parasympathetic nervous system stimulation resulting in a airway constriction.

Which of the following is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma?

pet dander

Kupffer cells function as ______ to remove harmful substances or cells from the portal blood as it moves through the venous sinusoids.

phagocytes

A client with chronic kidney disease has developed cardiac calcification. On admission the priority assessment would be for the nurse to:

place on a heart monitor to watch for arrhythmias.

The late manifestations of cirrhosis are related to liver failure and:

portal hypertension.

Major causes of mechanical bowel obstruction include:

postoperative adhesions.

When acute tubular necrosis (ATN) has occurred instead of prerenal azotemia, laboratory test findings will show the presence of excessive urine:

protein

When acute tubular necrosis (ATN) has occurred instead of prerenal azotemia, laboratory test findings will show the presence of excessive urine:

protein.

Unlike the Crohn type of inflammatory bowel disease, the ulcerative colitis type is characterized by:

pseudopolyps.

A hallmark of irritable bowel syndrome is abdominal pain:

relieved by defecation.

as a protective measure to keep abdominal inflammation and infection localized the peritoneum:

secretes fibrous exudate

As a protective measure to keep abdominal inflammation and infection localized, the peritoneum:

secretes fibrous exudate.

small cell lung cancer due to smoking history

which of the following meals is most likely to exacerbate an individuals's celiac disease?

spaghetti with meatballs and garlic bread

A major complication of persistent gastroesophageal reflux is:

strictures

Motility along the length of the GI tract, controlling the function of each segment of the GI tract and integrating signals for absorption of nutrients primarily, is innervated by which portion of the enteric nervous system?

submucosal plexus

Following the analysis of a recent barium enema and colonoscopy with biopsy, a patient has been diagnosed with colorectal cancer. Which of the following treatment modalities will be the mainstay of this patients treatment?

surgery

the right side of this heart (for pulmonale) is not pumping effectively. blood is backlogging into his body which is why he is swollen.

With acute respiratory distress syndrome (ARDS), a client progressively increases his work of breathing. The physiological principle behind this respiratory distress is related to:

the stiffening of the lung, making it more difficult to inflate

A client has been diagnosed with an incompetent pyloric sphincter. This client is experiencing a lot of abdominal pain and nausea. When this client vomits, the nurse should expect what type of secretions will be in the basin?

thick, brownish, foul-smelling emesis

thoracentiesis

Two of the major causes of gastric irritation and ulcer formation are aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and infection with Helicobacter pylori.

true

each day approx. 7000ml of fluid is secreted into the GI tract

true

flaccid bladder dysfunction is a neurogenic disorder of the bladder in which the bladder emptying is impaired

true

most uncomplicated UTs are caused by e. coli

true

non inflammatory diarrhea is associated with large volume watery and non bloody stools

true

A patient had excessive blood loss and prolonged hypotension during surgery. His postoperative urine output is sharply decreased and his blood urea nitrogen (BUN) is elevated. The most likely cause for the change is acute: A. bladder outlet obstruction. B. ischemic tubular necrosis. C. prerenal inflammation. D. intrarenal nephrotoxicity.

tubular necrosis

Generalized acute hypoxia in lung tissue, when alveolar oxygen levels drop below 60 mm Hg, causes pulmonary:

vasoconstriction

In addition to mucus, the intestinal mucosa produces two other types of secretions. Copious amounts of the serous-type fluid are secreted to act as a:

vehicle for absorption

Both prehepatic and posthepatic causes of portal hypertension include the formation of:

venous thrombosis.

Prior to undergoing diagnostic testing with contrast, it is recommended that older adult clients have their creatinine level checked. The rationale for this is to ensure the client:

will not undergo an acute kidney injury by decreasing renal blood flow.

A 10-year-old male is experiencing an acute exacerbation of his asthma. The most appropriate treatment for this client would be:

β-adrenergic agonist

The physician suspects that a client with kidney stones has developed magnesium ammonium phosphate (struvite) stones based on which of the following urinalysis results? Select all that apply.

• Alkaline urine pH • High urine phosphate level • High bacterial count Magnesium ammonium phosphate stones, also called struvite stones, form only in alkaline urine and in the presence of bacteria that possess an enzyme called urease, which splits the urea in the urine into ammonia and carbon dioxide. The ammonia that is formed takes up a hydrogen ion to become an ammonium ion, increasing the pH of the urine so that it becomes more alkaline. Because phosphate levels are increased in alkaline urine and because magnesium always is present in the urine, struvite stones form. Uric acid stones develop in conditions of gout and high concentrations of uric acid in the urine. Cystine stones account for less than 1% of kidney stones overall but represent a significant proportion of childhood calculi. They are seen in cystinuria, which results from a genetic defect in renal transport of cystine

A toddler seems to have a little "cold" and runny nose. At bedtime, he appears to be OK. A few hours later, parents awaken hearing a "tight" coughing sound. They recognize the child is not breathing well, so they rush to the emergency department. On arrival, the nurses suspect bronchial asthma based on which of the following assessment data? Select all that apply.

• Audible wheezing • Respiratory rate—44 with prolonged exhalation • Sitting upright, leaning forward, and using accessory muscles to breathe

Soon after delivery, the mother grabs the nurses arm and states, "Something's wrong...I can't get my breath." Which of the following assessments lead the nurse to suspect the client has had an amniotic emboli travel to the lungs? Select all that apply.

• BP 90/65; pulse 130, irregular; respiratory rate 35, shallow. • Productive cough with blood-streaked sputum.

If a CKD client is developing uremic encephalopathy, the earliest manifestations may include: Select all that apply. a) Delirium and hallucinations b) New-onset seizures c) Diminished awareness d) Decreased alertness

• Decreased alertness • Diminished awareness Reductions in alertness and awareness are the earliest and most significant indications of uremic encephalopathy. - Late in the disease process, the client may develop delirium, coma, and seizures.

There can be many reasons for a client to present with hypoxemia. For a client's PO2 to fall, a respiratory disease is usually involved. Often, clients have involvement from more than one mechanism. Which of the following will result in hypoxemia? (Select all that apply.)

• Decreased oxygen in air • Disease in respiratory system • Dysfunction of neurologic system

Which are the earliest manifestations that a client is developing hypoxemia? Select all that apply.

• Diaphoresis • Tachycardia

Urinary tract infections (UTIs) in children do not generally present as they do in adults. What are the signs and symptoms of a UTI in a toddler? (Select all that apply.)

• Diarrhea • Abdominal pain • Poor growth Toddlers often present with abdominal pain, vomiting, diarrhea, abnormal voiding patterns, foul-smelling urine, fever, and poor growth. Toddlers do not typically have frequency in voiding, nor do they complain of burning when they urinate

What manifestations would the nurse expect to find when assessing a client with a right pleural effusion? Select all that apply.

• Dyspnea on exertion • Diminished right breath sounds • Hypoxemia

When assessing a patient with acute pylenephritis, the nurse would expect the patient to exhibit which of the following symptoms?

• High fever • Flank tenderness • Nausea and vomiting • Chills

Which factors increase the risk that a client will develop chronic obstructive pulmonary disease (COPD)? Select all that apply.

• History of tobacco use • History of asthma

A chronic kidney disease client who has renal osteodystrophy should be assessed for which of the following complications? Select all that apply. a) Stress fractures b) Bone pain c) Muscle weakness d) Urosepsis e) Kidney stones

• Muscle weakness • Bone pain • Stress fractures Both types of renal osteodystrophy are manifested by abnormal absorption and defective bone remodeling. Renal osteodystrophy is typically accompanied by reductions in bone mass, alterations in bone microstructure, bone pain, and skeletal fracture. There are changes in bone turnover, mineralization, and bone volume, accompanied by bone pain and muscle weakness, risk of fractures, and other skeletal complications. -Kidney stones and urosepsis are not associated with renal osteodystrophy.

Which manifestations are most common in clients with COPD that is predominantly chronic bronchitis? Select all that apply.

• Peripheral edema • Cyanosis • Increased mucus secretion

Which manifestations are most common in clients with COPD that is predominantly emphysema? Select all that apply.

Patho Final, Chapter 26- Acute Kidney Injury and Chronic Kidney Disease, NUR565 Exam 4, patho chapter 26, Chapter 25 (30-40): Disorders of Renal Function, Chapter 27, 28, 29, Elsevier Acute Kidney and Chronic Kidney Disease: Chapter 47, Patho Test 1...

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