Patho II PrepU Chp. 33

A client has been diagnosed with systemic lupus erythematosus. The client now presents with sudden hematuria, variable proteinuria, and a decreased glomerular filtration rate. What is a probable diagnosis? a. Acute nephritic syndrome b. Goodpasture syndrome c. Acute nephrotic syndrome d. Chronic glomerulonephritis

a Acute nephritic syndrome may occur as a secondary complicating disorder in systemic diseases, such as SLE. In its most dramatic form, 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.

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? a. Magnesium ammonium b. Calcium c. Cystine d. Uric acid

b Most kidney stones are calcium stones—calcium oxalate, calcium phosphate, or a combination of the two materials. Clients who have had intestinal bypass surgery are at a higher risk for developing calcium kidney stones.

The nurse is evaluating the urinalysis results of a client presenting with polyuria and lower abdominal pain due to a suspected urinary tract infection. Which finding should the nurse expect? a. specific gravity of 1.025 b. increased nitrites c. positive glucose d. solid formations

b The nurse would expect the urinalysis of a client with a urinary tract infection to have increased nitrites, because bacteria reduce nitrates in the urine to nitrites. Glucose and protein are not normal findings and would require follow-up. Specific gravity of 1.025 is within normal limits; solid formations in the urine suggest calculi.

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? a. Decrease acidity of urine b. Increase immune availability c. Thin mucus to prevent bacterial adherence d. Increase washout of urine

d The normal flow of urine functions to wash bacteria from the urinary tract. If a client is not drinking enough, urine can become stagnant and promote infection. Increased consumption of water will increase the washout. Water has no effect on acidity, consistency of mucus, or immune function.

The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to which substance? a. Plasma proteins b. Inflammatory cells c. Red blood cells d. Antibody complexes

a The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to plasma proteins. Some of nephrotic glomerular injury results from circulating antigen-antibody complexes that become trapped in the glomerular membrane. The nephritic syndromes are characterized by hematuria with red cell casts.

Most common uncomplicated urinary tract infections are caused by ____ that enter through the urethra. a. Escherichia coli b. Pseudomonas c. Group B Streptococcus d. Staphylococcus aureus

a Most commonly, urinary tract infections (UTIs) are caused by Escherichia coli bacteria that enter through the urethra. Other uropathic pathogens include Staphylococcus saprophyticus in uncomplicated UTIs, and both non-E. coli Gram-negative rods (Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas) and Gram-positive cocci (Staphylococcus aureus, Group B Streptococcus) in complicated UTIs.

Which client clinical manifestation most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma? a. Hematuria b. Urinary urgency c. Cloudy urine d. Oliguria

a 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.

The family asks the nurse what the usual treatment of focal segmental glomerulosclerosis entails. What is the nurse's best response? a. Antibiotics b. Corticosteroids c. Antiviral medications d. Pain medications

b The disorder usually is treated with corticosteroids. Although kidney transplantation is the preferred treatment for end-stage kidney disease, focal segmental glomerulonephritis occurs in half of these people. Pain medications may help relieve symptoms but will not treat the disease. Antivirals and antibiotics are not effective in FSGS.

The nurse is planning care for a client with a urinary tract obstruction. The nurse includes assessment for which possible complication? a. Diluted urine b. Decreased blood pressure c. Polyuria d. Increased blood pressure

d Urinary tract obstruction can lead to hypertension related to increased renin secretion. The urine output would be decreased and not diluted.

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

a Prolonged immobility leads to bone resorption and an elevation in serum calcium which can cause the development of calcium-containing kidney stones. Elevated urine levels of citrate are a prominent inhibitor of calcium stone formation. Fluid intake is not likely to be limited but regardless, it would not contribute to kidney stone formation. Urinary frequency is not a factor in kidney stone formation.

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

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

A child has been brought to an urgent care clinic. The parents state that the child is "not making water." When taking a history, the nurse learns the child had a sore throat about 1 week ago but seems to have gotten over it. "We [parents] only had to give antibiotics for 3 days for the throat to be better." The nurse should suspect the child has developed: a. kidney stones. b. nephrotic syndrome. c. acute renal failure. d. acute postinfectious glomerulonephritis.

d The classic case of poststreptococcal glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days: the time needed for the development of antibodies. The primary infection usually involves the pharynx (pharyngitis), but can also result from a skin infection (impetigo). Oliguria, which develops as the GFR decreases, is one of the first symptoms.

The formation of magnesium ammonium phosphate (struvite) kidney stones is directly associated with which cause? a. High urine calcium b. Hydronephrosis c. Hyperuricemia d. Urinary tract infections

d There are four types of kidney stones: calcium (i.e., oxalate and phosphate) stones, which are associated with increased serum calcium levels; magnesium ammonium phosphate (i.e., struvite) stones, which are associated with urinary tract infections (UTIs); uric acid stones, which are related to elevated uric acid levels; and cystine stones, which are seen in cystinuria. Urinary obstructive disorders increase the risk of infection and calculi formation, renal hypertension, and hydronephrosis.

Acute pyelonephritis is a result of: a. Bacterial infection b. Renal failure c. Viral infection d. Chronic reflux

a Acute pyelonephritis represents a bacterial infection of the upper urinary tract, specifically the kidney parenchyma and renal pelvis. Gram-negative bacteria, including Escherichia coli and Proteus, Klebsiella, Enterobacter, and Pseudomonas species, are the common causative agents. Staphylococcus species and Streptococcus faecalis may also cause pyelonephritis, but they are uncommon.

The nurse is caring for a client with recurring urinary tract infections (UTIs). The client asks, "Other than taking antibiotics, what else can I do?" Which response by the nurse is most accurate? a. Include lots of calcium in your diet to promote urinary health. b. Drink lots of fluids to help relieve the signs/symptoms of UTIs. c. Monitor and limit your intake of fats, especially triglycerides in your diet. d. Eat plenty of yogurt that contains protein to prevent future infection.

b Forcing fluids may relieve signs and symptoms, and this approach is used as an adjunct to antimicrobial treatment. The only cure for recurrent lower UTIs is by removing the infectious source like urinary catheter or infected bladder stones.

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

b 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.

Which condition/disorder would the nurse see as being likely to cause the most serious long-term problems? a. Simple renal cyst b. Polycystic kidney disease c. Unilateral renal agenesis d. Horseshoe kidney

b Polycystic kidneys may be associated with aneurysm, and subarachnoid hemorrhage is a frequent cause of death. Agenesis refers to failure of an organ to develop at all. The other kidney usually undergoes compensatory hypertrophy and performs the function of the missing kidney. Most simple cysts do not produce signs or symptoms or compromise renal function. A horseshoe kidney occurs when the upper and lower poles of the two kidneys are fused, producing a horseshoe-shaped structure. The condition usually does not cause problems.

An obese client with a history of gout and a sedentary lifestyle has been advised by the primary health care provider to avoid organ meats, certain fish, and other foods that are high in purines. This treatment would be advised for which type of kidney stones? a. Magnesium ammonium phosphate stones b. Uric acid stones c. Cystine stones d. Calcium stones

b Uric acid stones develop in conditions of gout and when high concentrations of uric acid develop in the urine. Unlike radiopaque calcium stones, uric acid stones are not visible on x-ray films. These stones develop in clients who eat a high-purine diet like Atkins.

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

c Acute pyelonephritis tends to present with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in the loin area of the back that is unilateral or bilateral. Lower urinary tract symptoms, including dysuria, frequency, and urgency also are common. There may be significant malaise, and the person usually looks and feels ill. Nausea and vomiting may occur along with abdominal pain. Cancer, kidney stones, and acute renal failure have different presentations.

The nurse recognizes the most common cause of acute postinfectious glomerulonephritis as: a. prolonged blockage of the ureter with a stone. b. uncontrolled diabetes with increased proteinuria. c. drug-induced damage to the renal glomeruli. d. a streptococcal infection 7 to 12 days prior to onset.

d Acute postinfectious glomerulonephritis usually occurs after infection with certain strains of group A beta-hemolytic streptococci and is caused by deposition of immune complexes. It also may occur after infections by other organisms, including staphylococci and a number of viral agents, such as those responsible for mumps, measles, and chickenpox.

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

d One of the major manifestations of kidney stones is pain. Depending on the location, there are two types of pain associated with kidney stones-colic or noncolic. The pain may radiate to the lower abdominal quadrant, bladder area, perineum, or scrotum in men. Stones are not externally visible or palpable. Obstruction by a stone may result in urinary retention and increased fluid volume.