Patho Final Study Guide
A client's urine results reveal proteinuria and microalbuminuria. The health care provider is likely to prescribed an examination that will assist in quantifying the amount of protein loss by the kidney. For which examination should the nurse prepare to educate the client?
24-hour urine test
Which individual is at the highest risk of developing a urinary tract infection (UTI)?
A 30-year-old woman with poorly controlled diabetes mellitus
A client is admitted to the hospital with acute kidney injury (AKI). Which diagnostic test will the nurse assess to best determine the cause of the AKI?
BUN: creatinine or urea: creatinine ratio
A middle-aged man with diabetes reports that he must strain to urinate, that his urine stream is weak and dribbling, and that his bladder never really empties. The nurse knows that all of his symptoms are likely caused by which diagnosis?
Bladder atony with dysfunction
Which medication would the nurse anticipate being prescribed for the client with renal failure who has hyperphosphatemia?
Calcium carbonate
When teaching a community education class about the seven warning signs of cancer, the nurse will note which is the most common sign of bladder cancer?
Painless, bloody urine
Because they strengthen the pelvic floor muscles, Kegel exercises are most likely to help which urinary problem?
Stress incontinence
The nurse knows that which clinical manifestations may be present with the diagnosis of acute nephritic syndrome? Select all that apply.
Sudden onset of hematuria Proteinuria Edema
Which statements about mesangial cells within the glomerulus are accurate? Select all that apply.
They have phagocytic properties that remove macromolecular materials. They enlarge (hyperplasia) in response to glomerular diseases.
Which substance is most likely to be reabsorbed in the tubular segments of the nephron using passive transport mechanisms?
Water
Which clients scheduled for an interventional radiology procedure requiring administration of radiocontrast dye would be considered high risk for nephrotoxicity? Select all that apply.
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
A nurse educator is orientating new nurses to a renal unit of the hospital. Which teaching point should the nurse include as part of a review of normal glomerular function?
"Glomerular filtrate is very similar in composition to blood plasma found elsewhere in circulation."
A young adult client has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause?
"Have you had any type of infection within the past 2 weeks?"
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 diabetes education nurse is teaching a group about the potential genitourinary complications of diabetes. Which teaching point best conveys an aspect of bladder dysfunction and diabetes mellitus?
"It is important for you to empty your bladder frequently because diabetes carries risks of kidney damage that can be exacerbated by incomplete bladder emptying."
A client has visited the health care provider reporting intermittent passing of blood-tinged urine over the last several weeks. Cytology confirms a diagnosis of invasive bladder cancer. Which statement by the provider is mostaccurate about treatment options?
"It is likely that you will need surgery, possibly a procedure called a cystectomy."
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."
A client expresses frustration at the inconvenience of having to collect urine for an entire day and night as part of a prescribed 24-hour urine collection test. The client asks the nurse, "Why is this test necessary since I gave a single urine sample 2 days ago?" How could the nurse best respond to this question?
"Often when an abnormal substance shows up in urine test, a 24-hour urine collection is needed to determine exactly how much is present in your urine."
A client has recently been diagnosed with renal calculi and asks the nurse, "What should I be eating to prevent stone formation?" What is the most appropriate response to the client's statement?
"What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved."
A client is in cardiogenic shock following a massive myocardial infarction. The client's family asks the nurse, "Why are the health care providers recommending dialysis since its the heart that is sick?" Which response by the nurse is most appropriate at this time?
"When a person has a large heart attack and goes into shock due to heart failure, there is a decrease in renal perfusion which allows toxins to increase in the blood."
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 has been taking up to 2400 mg of ibuprofen per day for chronic pain following a motor vehicle accident. The client is diagnosed with chronic analgesic nephritis. The client states, "I thought that taking too many drugs hurt your liver if anything, not your kidneys." What is the most appropriate response to the client's statement?
"Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs."
Which individuals are displaying identified risk factors for the development of lower urinary tract obstruction? Select all that apply.
68-year-old man who has been diagnosed with benign prostatic hyperplasia (BPH) 30-year-old woman who has been diagnosed with gonorrhea 74-year-old woman who has developed a lower bowel obstruction following several weeks of chronic constipation 20-year-old man who has spina bifida and consequent impaired mobility
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
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
A client has suffered damage to the anterior pituitary gland, reducing the ability to respond to increases in plasma osmolality. The nurse should monitor for what expected assessment findings. Select all that apply.
A urine specific gravity of 1.000 Increased thirst and fluid consumption A urine to serum osmolality of 1.5:1
The nurse suspects the client may have developed partial bilateral ureter obstruction. What evidence assessment findings support this suspicion? Select all that apply.
A urine specific gravity of 1.001 An increase in urine output
When teaching a class of nursing students, the pathophysiology instructor asks, "What is the majority of energy used for by the kidney?" Which response is most accurate?
Active sodium transport mechanisms.
The nurse is creating a plan of care for a client with autosomal dominant polycystic kidney disease (ADPKD). What should the nurse include in the plan of care? Select all that apply.
Administration of antihypertensives Inspection of urine output low sodium diet
A young boy who is deaf and has bilateral cataracts is brought to the clinic. The parent found blood in the toilet after the boy voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the health care team's initial differential diagnosis most likely be?
Alport syndrome
A clinic nurse is reviewing laboratory results for several clients with appointments this day. The nurse notes that several of the clients have elevated creatinine levels. Which client(s) would the nurse be most concerned about and highlight the results for the health care provider to review? Select all that apply.
An older adult client whose creatinine level is 4.5 mg/dL (397.80 μmol/L) Client with a history of uncontrolled diabetes with creatinine level of 2.7 mg/dL (238.68 μmol/L)
A client with a traumatic amputation of the lower leg has lost >40% of blood volume and is currently not producing any urine output. The nurse bases this phenomena on which humoral substance that is responsible for causing severe vasoconstriction of the renal vessels?
Angiotensin II and antidiuretic hormone
A client with a traumatic amputation of the lower leg has lost >40% of blood volume and is currently not producing any urine output. The nurse bases this phenomenon on which humoral substance that is responsible for causing severe vasoconstriction of the renal vessels?
Angiotensin II and antidiuretic hormone
The nurse is planning care for a client with functional incontinence. What actions should the nurse include in the plan of care? Select all that apply.
Arrange for a commode at bedside. Ensure eyeglasses are within reach. Perform a medication review.
The nurse is planning the care for a client with acute kidney injury (AKI). What should the nurse prioritize in the client's plan of care? Select all that apply.
Assessing fluid balance Monitoring electrolyte levels Promoting infection control
A client has stopped taking the prescribed anticholinergic medication for overactive bladder, due to the associated side effects of dry mouth, constipation, and reflux. Which other medication, injected directly into the bladder, is an alternative treatment for this condition?
Botulinum toxin type A
A client in the intensive care unit is diagnosed with hypovolemic shock based on a blood pressure of 88/53 mm Hg, heart rate of 122 beats/min, respiratory rate of 26 breaths/min. Given these vital signs, what urine output should the nurse expect?
Decreased below 30 mL/hr with decrease glomerular filtration rate (GFR).
When explaining about the passage of urine to a group of nursing students, the clinic nurse asks them which muscle is primarily responsible for micturition. Which student response is correct?
Detrusor
A client is undergoing an endoscopic resection of the bladder for cancer and the provider has asked the nurse to prepare for intravesical chemotherapy. Which medication will the nurse prepare?
Doxorubicin
A nurse is teaching parents of a child who is being discharged after treatment for a streptococcal infection. For what symptoms should the nurse teach the parents to observe, because they are related to the risk for poststreptococcal glomerulonephritis? Select all that apply.
Edema Decreased urine output
The nurse is assessing a female neonate on the neonate's first clinic appointment after leaving the hospital. Which manifestations leads the nurse to suspect the neonate has developed a urinary tract infection? Select all that apply.
Fever higher than 101°F (38.3°C) Poor skin perfusion with ashen color Abdominal distention Irritability
A middle-aged woman is admitted with acute pyelonephritis. Which assessment finding correlates with this diagnosis?
Flank pain, dysuria, and nausea/vomiting
A 5-year-old child who had been receiving dialysis treatments has undergone renal transplant and will now be taking prednisone. The parents are hopeful the child's development and overall health will normalize. The nurse should inform the parents that taking prednisone can result in some similar adverse effects as living with chronic kidney disease (CKD). Which effects should the nurse include? Select all that apply.
Fluid retention Increased risk for infection Delayed growth Weakened bone structure
A client in the intensive care unit is receiving a blood transfusion. The client immediately developed a reddish-color urine flowing into the Foley bag. What is likely the cause of this red urine and what priority intervention should the nurse implement?
Hemoglobinuria indicating an acute hemolytic reaction; the transfusion must be stopped immediately.
When providing education to a client with diabetes mellitus who is diagnosed with bladder atony, which treatment measure(s) will the nurse include? Select all that apply.
How to use abdominal compression for complete bladder emptying Timing of voiding to occur at least every 3 to 4 hours while awake
An older adult client with a new onset of vascular dementia has recently begun retaining urine. Which physiologic phenomenon would the providers most realistically expect to be currently occurring as a result of the urinary retention?
Hypertrophy of the bladder muscle and increased bladder wall thickness
A client has been diagnosed with possible IgA nephropathy. The nurse will educate the client about which essential diagnostic test to confirm this diagnosis?
Immunofluorescence microscopy
Which statement most accurately captures the function of the ascending loop of Henle?
Impermeability to water and absorption of solutes yields highly dilute filtrate.
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
Which client's laboratory result would be associated with abnormalities in kidney function? Select all that apply.
Increased creatinine levels Detectable levels of glucose in a urine sample Elevated cystatin C level
A nurse is teaching a student about nephrotic syndrome. Which statement(s) about the pathogenesis of nephrotic syndrome is accurate and should be included in the education? Select all that apply.
Increased glomerular membrane permeability allow proteins to escape from the plasma into glomerular filtrate. Massive proteinuria is a result of the increased permeability. Loss of colloidal osmotic pressure causes generalized edema.
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)
The nurse is caring for a client with nephrosis and notes generalized edema. The nurse attributes this finding to which processes? Select all that apply.
Increased permeability of glomerular capillaries Decreased serum albumin Increased aldosterone levels
To treat enuresis in a young child, the health care provider prescribes desmopressin, an antidiuretic hormone (ADH) nasal spray, before bedtime. What is the most likely rationale for this treatment?
It removes water from the filtrate and returns it to the vascular compartment.
The nurse is caring for a client in emergent fluid overload requiring rapid diuresis. Which diuretic should the nurse be prepared to administer?
Loop
Which laboratory value result correlates to the development of diabetic glomerulosclerosis?
Microalbuminuria
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
A client with systemic lupus erythematosus (SLE) glomerulonephritis is experiencing a worsening of the disease and has progressed to the higher classes resulting in renal involvement. Which medication(s) will likely be prescribed by the health care provider to treat the deterioration of the renal function? Select all that apply.
Oral corticosteroid Lisinopril an angiotensin-converting enzyme (ACE) inhibitor
A male client reports awakening three to four times nightly to void, and often has a sudden need to void with little warning during the day. What is this client's most likely diagnosis and possible underlying pathophysiologic problem?
Overactive bladder that may result from both neurogenic and myogenic sources
The nurse should anticipate that a client diagnosed with spastic bladder dysfunction may be prescribed what medications that will help decrease detrusor muscle tone and increase bladder capacity? Select all that apply.
Oxybutynin, an antimuscarinic drug Tolterodine tartrate, an antimuscarinic drug
When explaining the role of the proximal tubule in terms of medication administration, the nursing instructor will emphasize that which medications are bound to plasma proteins and require the proximal tubule secretion of exogenous organic compounds to help with filtration? Select all that apply.
Penicillin Aspirin Morphine sulfate
A client has a ureteral calculi in the proximal region. The nurse is planning to educate the client about the treatment of choice for removal of the stone in this location. For which intervention will the nurse educate the client?
Percutaneous nephrolithotomy
An older adult resident of an assisted living facility has been inconsistently continent of urine until the last several weeks. Which intervention by the care providers at the facility is the most likely priority?
Performing a physical examination and history to determine the exact cause and character of the incontinence.
The nurse is caring for a client with type 2 diabetes mellitus who complains of waking up with damp sheets. The client is not "wetting the bed" but fears urine is leaking when sleeping. Which assessment is the nurse's priority?
Post-void residual urine assessment
Damage to which area of a nephron would most likely result in impaired secretion and reabsorption?
Proximal tubule
A client with hypertension, arthritis, and early chronic kidney disease (CKD) has developed viral gastroenteritis and is unable to consume adequate fluids. Which prescribed medications should the nurse caution the client about taking due to the increased risk for prerenal acute kidney injury? Select all that apply
Ramipril Ibuprofen Hydrochlorothiazide
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.
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 a group of four male clients with chronic kidney disease (CKD) and coronary artery disease. The nurse will prioritize which client as being at greatest risk for angina?
The client with a hemoglobin level of 8.0 g/dL (80 g/L)
While assessing a client with urosepsis, the nurse notes the client's blood pressure is 80/54 mm Hg; heart rate is 132 beats/min; respiratory rate is 24 breaths/min; pulse oximetry 89% on 6 lpm O2. Over the last hour, the clients' urine output is 15 mL. When explaining to a new graduate nurse, the nurse will explain which physiologic principle?
The client's sympathetic nervous system has been stimulated, which has resulted in vasoconstriction of the afferent arteriole that in turn causes a decrease in renal blood flow.
A health care provider is caring for an older adult client with a recent diagnosis of renal failure and an acid-base imbalance. The family asks, "What is the underlying cause of the renal failure?" Which phenomenon would most accurately answer the question?
The kidneys have the primary responsibility for eliminating excess hydrogen ions from the body.
During male ejaculation, which statement addresses why sperm is not normally seen inside the bladder?
The musculature of the trigone area, bladder neck, and prostatic urethra contract at the same time.
A client asks the nurse, "The doctor said I have adenocarcinoma of the bladder. What does this mean?" What information should the nurse provide to the client related to the pathophysiologic principles of this type of cancer?
This is a rare and highly metastatic form of bladder cancer.
An older adult resident of a long term care facility with a recent history of repeated urinary tract infections and restlessness is suspected of having urinary retention. Which intervention by the care team is most appropriate to confirm urine retention?
Ultrasound bladder scanning to determine the residual volume of urine after voiding.
A nurse is caring for a group of clients and reviewing the recent laboratory values and medical charts. What adult client(s) is exhibiting early manifestations of prerenal acute kidney injury (AKI), which should be reported to the health care provider? Select all that apply.
Urine output has dropped from 1200 mL/24 hours to current 300 mL/24 hours. Blood urea nitrogen (BUN) to creatinine ratio has gone from 10:1 to 21:1.
Because nephropathy is an important cause of end-stage renal failure in children, a toddler who has had an uncomplicated bout of urinary tract infection (UTI) should still be evaluated for the presence of which renal disorder?
Vesicoureteral reflux
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.
