Patho quiz 6 Renal

The nursing instructor who is teaching about disorders of the lower urinary tract realizes a need for further instruction when one of the students makes which statement?

"Alterations in bladder function can only occur when there is incontinence." Explanation: Alterations in bladder function include urinary obstruction with retention or stasis of urine and urinary incontinence with involuntary loss of urine. Alterations in bladder function does occur more frequently with aging.

The nurse is scheduled to teach a client experiencing urinary incontinence about Kegel exercises. Which descriptor should the nurse include in this education?

"Contract and relax the pelvic floor muscles at least 10 times every hour while awake." Explanation: Exercises for the pelvic muscles (or Kegel exercises) involve repetitive contraction and relaxation of the pelvic floor muscles and are an essential component of client-dependent behavioral interventions. None of the other distractors are examples of Kegel exercises.

A client experienced asymptomatic UTIs while pregnant. The client asks the nurse if this places her at any risk for complications. Which would be the best response by the nurse?

"You are at risk for developing acute pyelonephritis." Explanation: The complications of asymptomatic UTIs during pregnancy include persistent bacteriuria, acute and chronic pyelonephritis, and preterm delivery of infants with low birth weight. The length of labor is not impacted by the UTI.

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 Explanation: The kidney normally responds to a decrease in the glomerular filtration rate with a decrease in urine output. Thus, an early sign of prerenal failure is a sharp decrease in urine output.

A client has just been diagnosed with urinary incontinence. The primary nurse knows that the treatment/management of incontinence can include which measures? Select all that apply.

Behavioral measures Surgical correction Pharmacologic measures Non-catheter devices to obstruct urine flow Indwelling catheter Explanation: Treatment or management of incontinence depends on the type of incontinence and other health problems as well as the client's age. It includes behavioral measures, pharmacologic measures, surgical correction, noncatheter devices to obstruct urine flow, and indwelling catheters. Removing a kidney is not a treatment.

A nurse is caring for a client who has experienced a cervical spinal injury related to swimming. On assessment, which finding(s) leads the nurse to suspect the client is experiencing autonomic hyperreflexia, requiring immediate intervention? Select all that apply.

Blood pressure is currently 180/92 mm Hg Heart rate is averaging 46 beats/min On palpation of skin, profuse sweating noted Explanation: A spinal cord injury at the cervical level is often accompanied by a condition known as autonomic hyperreflexia, because the injury interrupts central nervous system control of sympathetic reflexes in the spinal column. It is manifested as severe hypertension (BP 180/92 mm Hg), bradycardia (heart rate below 60 beats/min), and sweating. It can be triggered by overdistention of the bladder like a kinked urinary catheter. Redness on the back could mean beginning of a pressure injury. A cervical spine injury causes paraplegia or quadriplegia; therefore, there would not be numbness and tingling in the lower extremities.

A nurse is evaluating a client's morning laboratory values. Which result requires that the nurse notify the health care provider?

Creatinine: 10.6 mg/dL (937.04 µmol/L) Explanation: A rise in the serum creatinine level to three times its normal value suggests that there is a 75% loss of renal function, and with creatinine values of 10 mg/dL or more, it can be assumed that approximately 90% of renal function has been lost.

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 Explanation: Prerenal injury is manifested by a sharp decrease in urine output and a disproportionate elevation of blood urea nitrogen (BUN) in relation to serum creatinine levels. Consequently, there also is a disproportionate elevation in the ratio of BUN to serum creatinine, from a normal value of 10:1 to a ratio greater than 20:1.

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. Explanation: 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.

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 Explanation: The detrusor muscle is the muscle of micturition. When it contracts, urine is expelled from the bladder. External sphincter is a circular muscle that surrounds the urethra distal to the base of the bladder and can stop micturition when it is occurring. Trigone is a smooth triangular area that is bounded by ureters and the urethra. Urinary vesicle is another name for the bladder.

The nurse is caring for a client with a condition of deficiency of antidiuretic hormone (ADH). When assessing the client, which finding does the nurse anticipate?

Excessive urine output. Explanation: ADH regulates the ability of the kidneys to concentrate urine. When ADH is present, the water that moved from the blood into the urine filtrate in the glomeruli is returned to the circulatory system, and when ADH is absent, the water is excreted in the urine. Pathologically, deficiency of ADH leads to polyuria and dehydration.

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

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

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

Flank pain, dysuria, and nausea/vomiting Explanation: Manifestations of acute pyelonephritis include pain, frequency, urgency, dysuria, nausea, and vomiting. Chronic rather than acute pyelonephritis is often caused by hypertension, while most cases are caused by ascending bacteria, not systemic infections. Scarring is more commonly a result of chronic pyelonephritis.

When caring for the client with proteinuria, the nurse recognizes that dysfunction in which structure of the kidney allows protein to leak into the urine?

Glomerulus. Explanation: Alterations in the structure and function of the glomerular basement membrane are responsible for the leakage of proteins and blood cells into the filtrate that occurs in many forms of glomerular disease.

The nurse will monitor the client with chronic kidney disease (CKD) for which possible cardiovascular changes? Select all that apply.

Heart failure Hypertension Pericarditis Explanation: Hypertension often occurs early in CKD due to several factors, including increased blood volume. Congestive heart failure and pericarditis can occur with more advanced CKD. Hyperphosphatemia develops as kidneys lose ability to excrete phosphate.

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 Explanation: Hypertension is an occasional complication of urinary tract obstruction. It is more common in cases of unilateral obstruction in which renin secretion is enhanced, probably secondary to impaired renal blood flow. In these circumstances, removal of the obstruction often leads to a reduction in blood pressure. The urine output would be decreased and not diluted.

The pathophysiology instructor will emphasize that the cells of the proximal tubule have a fine, villous structure that increases surface area, allowing for which physiologic function to occur with fluids? Select all that apply.

Increase in reabsorption Supports active transport processes Explanation: The tubule is composed of a single layer of epithelial cells resting on a basement membrane. The structure of the epithelial cells varies with tubular function. 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 glomerulus is a high-pressure capillary filtration system; the nephrons are the functional units of the kidney, where soluble nutrients are reabsorbed into the blood; this allows waste products to be secreted from the blood into tubular fluid.

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. Explanation: Any increase in glomerular membrane permeability allows proteins to escape from the plasma into the glomerular filtrate. Massive proteinuria results, leading to hypoalbuminemia. Generalized edema, which is the hallmark of nephronic syndrome, results from the loss of colloidal osmotic pressure. Membranous glomerulonephritis begins with an insidious onset associated with hematuria and mild hypertension. With Immunoglobulin A nephropathy, the presence of glomerular immunoglobulin A immune complex deposits occur.

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

The nurse is instructing a client on the procedure for obtaining a voided urine specimen to bring the laboratory for analysis. What is the most important information for the nurse to tell the client?

Obtain the first morning specimen. Explanation: Urine tests can be performed on a single urine specimen or on a 24-hour urine specimen. First-voided morning specimens are useful for qualitative protein and specific gravity testing. A freshly voided specimen is most reliable. Urine specimens that have been left standing may contain lysed red blood cells, disintegrating casts, and rapidly multiplying bacteria.

A nurse is caring for a client in spinal shock. Which intervention is appropriate in relation to the client's urinary status?

Perform intermittent catheterization Explanation: After a spinal cord injury, the early effects on bladder function are quite different from those that follow recovery from the initial injury. During the period immediately after spinal cord injury, a state of spinal shock develops, during which all the reflexes, including the micturition reflex, are depressed. The bladder is atonic and cannot contract. Intermittent catheterization is necessary to prevent injury to urinary structures associated with overdistension of the bladder.

The nurse is conducting a community health education program on urinary retention and urinary incontinence. The nurse determines that the participants are understanding the education when they state that the most common cause of urinary retention is:

Prostate enlargement Explanation: In men, the enlarged prostate (due to hypertrophy or hyperplasia) frequently causes nonrelaxing external sphincter with urine retention. The stress response can cause retention of urine as part of the "fight-or-flight" response, unrelated to sphincter dysfunction. Developmental delays are associated with female or male children (not men). Psychosocial disorders sometimes have a transient effect on bladder function, and are rarely a cause of sphincter dysfunction in female or male clients.

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 early sign of prerenal injury?

Sharp decrease in urine output. Explanation: 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.

The nursing students have learned in class that causes of urinary obstruction and urinary incontinence include which of the following? Select all that apply.

Structural changes in the bladder Structural changes in the urethra Impairment of neurologic control of bladder function Explanation: Urinary obstruction and urinary incontinence can be caused by several factors, including structural changes in the bladder, structural changes in the urethra, and impairment of neurologic control of bladder function. Changes in the gallbladder or pancreas do not cause urinary obstruction or incontinence.

The nurse caring for clients who have bladder cancer identifies which treatments to be acceptable for this cancer? Select all that apply.

Surgical removal Radiation therapy Chemotherapy Explanation: The methods used in treatment depend upon the grade of the tumor and degree of invasiveness. They include surgical removal, radiation therpay, and chemotherapy. Hypnosis and herbal therapy are not recommended treatments for this disease.

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. Explanation: Urinary tract obstruction encourages the growth of microorganisms and should be suspected in persons with recurrent UTIs. The other answers can cause lower UTIs, but an obstruction would be considered because of the frequency of the infections.

Which of the following are risk factors for developing a UTI? (Select all that apply.)

Urinary obstruction Postmenopausal status Prostate disease Neurogenic bladder Explanation: There is an increased risk for UTIs in persons with urinary obstruction and reflux, in people with neurogenic disorders that impair bladder emptying, in women who are sexually active, in postmenopausal women, in men with diseases of the prostate, and in elderly persons.

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. Explanation: Prerenal AKI is manifested by a sharp decrease in urine output such as 300 mL/24 hours and a disproportionate elevation of BUN in relation to serum creatinine levels. A normal value is 10:1, but a value of 21:1 is a disporportionate elevation in the ratio. The hemoglobin level of 12.0 g/dL (120 g/L) is on the low end of normal for adults. For adults in their 50s, a GFR of 93 is normal. Serum creatinine levels are normal from 0.6 to 1.2 mg/dL (53 to 106 µmol/L).

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. Explanation: 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.

A client with end-stage kidney disease has developed anemia. The nurse teach this client that the reason anemia has developed is:

the damaged kidney is unable to produce erythropoietin. Explanation: Persons with end-stage kidney disease often are anemic because of an inability of the kidneys to produce erythropoietin, the hormone that regulates the differentiation of red blood cells in the bone marrow.