Renal Disorders (davis quiz)

A nurse is evaluating a patient's risk for renal disorders. Which of the following increase the risk for renal dysfunction? Select all that apply. A patient with diabetes mellitus A patient with severe hypertension A patient with systemic lupus erythematosus A patient with cirrhosis A patient with peptic ulcer disease

A patient with diabetes mellitus A patient with severe hypertension A patient with systemic lupus erythematosus

Azotemia is

an increase in BUN levels

Kidney function can also be evaluated by ;

analized by blood levels of blood urea nitrogen(BUN) and creatinine(Cr). -Both are waste products that should be filtered and removed by the kidneys.

Chronic renal failure (CRF)_________.?? don't know the answer

appears with normal CBC and serum electrolyte levels. has a rapid and progressive onset. is always the result of prerenal kidney injury. follows five stages of progression with decreasing glomerular filtration rate.

A patient is suffering declining kidney function due to an autoimmune disease. The patient asks the nurse how much of his kidney must suffer damage to lead to end stage renal disease (ESRD). Which of the following is the appropriate response by the nurse? Usually ESRD develops when less than 10% of the nephrons are damaged. Usually ESRD develops when 10% to 20% of the nephrons are damaged. Usually ESRD develops when 65% to 75% of the nephrons are damaged. Usually ESRD develops when 90% to 95% of the nephrons are damaged.

Usually ESRD develops when 90% to 95% of the nephrons are damaged.

Which of the following substances may be needed as a supplement for a patient suffering renal osteodystrophy? Iron Vitamin D Glucosamine Vitamin E

Vitamin D

Chronic renal failure (CRF)_________. appears with normal CBC and serum electrolyte levels. has a rapid and progressive onset. is always the result of prerenal kidney injury. follows five stages of progression with decreasing glomerular filtration rate.

follows five stages of progression with decreasing glomerular filtration rate.

Choose the classification for each type of renal dysfunction. Nephrotoxic medications

intrarenal Nephrotoxic medications, as the name implies, damage the kidneys. Because the kidneys are directly damaged, this is a form of intrarenal dysfunction.

Stone formation within the kidneys in known as _____________________. pyelonephritis polycystic kidney disease nephrolithiasis nephrotic syndrome

nephrolithiasis

Increasing serum creatinine levels may indicate _________________. decreased blood urea nitrogen reduced glomerular filtration rate azotemia increasing glomerular filtration rate

reduced glomerular filtration rate

Increased SERUM creatinine may indicate

reduced glomerular filtration rate, abbreviated GFR.

For which of the following would antibiotics be appropriate as the primary treatment? Select all that apply. Group A beta-hemolytic streptococci (GABHS) glomerulonephritis Nephrotic syndrome Pyelonephritis Goodpasture's syndrome Polycystic kidney disease

(GABHS) glomerulonephritis Pyelonephritis

a classic sign of kidney dysfunction?

- Costovertebral angle (CVA) pain - hematuria : blood in the urine, - proteinuria : protein in the urine.

what is the kidney dysfunction ?

1) Decreased perfusion of the kidneys activates the renin-angiotensin-aldosterone system, abbreviated RAAS, increasing sodium and water retention and potentially leading to hypertension. 2) As the kidneys produce erythropoietin to increase red blood cells, failing kidneys cause lower than normal red blood cell levels. 3)synthesize vitamin D, which helps absorb calcium. -Hypocalcemia may develop in kidney failure.

a measurement of urine concentration = dehydration

1) Glucose in the urine most commonly results from hyperglycemia, and may indicate diabetes. 2) Diabetic ketoacidosis may cause ketones to appear in the urine. 3)Proteins in the urine can result from intense exercise, after which minimal levels may appear, and from glomerulonephritis, which may lead to more significant levels. 4)Blood in the urine may indicate damage to structures of the renal system. 5)The presence of bilirubin and urobilinogen may indicate liver damage, 6) the presence of nitrite and leukocyte esterase normally indicate infection of the renal system.

Kidney dysfunction may become so compromised that dialysis may be required. Two forms of dialysis may be used :

1) peritoneal dialysis : a patient's peritoneum is filled with fluid to be exchanged 2) hemodialysis : blood is drawn from the body, run through a dialyzer, and then returned to the body. -Both methods seek to carry out the kidney's function of filtering the blood.

Patients at risk for renal dysfunction include ;

1) taking nephrotoxic medications, 2)recent streptococcal infections, 3)patients suffering from diabetes mellitus and/or 4)hypertension, and patients with major surgery.

A patient's chart shows blood urea nitrogen (BUN) is 22 mg/dL and creatinine is 2.0 mg/dL. The nurse is asked to report the BUN-to-creatinine level. What is the correct response for the nurse to make, expressed as a ratio? Enter numeral online.

11

A nurse is assessing the laboratory results of a client who is suspected of having glomerular damage. Which value of serum albumin is most indicative of the condition in this client? 4.0 g/dL 5.0 g/dL 2.5 g/dL 5.5 g/dL

2.5 g/dLA low serum albumin level would be indicative of glomerular damage

What treatment option should be considered first for George's condition? Peritoneal dialysis Antibiotics Hemodialysis Adequate fluid maintenance

Adequate fluid maintenance In prerenal acute kidney injury, maintaining adequate perfusion to the kidney is key. Thus, in George's case, adequate fluid maintenance will be required to ensure the kidneys receive enough blood flow to maintain GFR and filter wastes.

Which of the following are true? Select all that apply. Renin levels increase with poor kidney perfusion. Heart failure results in postrenal failure. Nephrotoxic drugs are a cause of intrarenal failure. Staphylococcal infections are common causes of kidney failure. Spinal stenosis pain is common symptom of kidney dysfunction.

A. Renin levels increase with poor kidney perfusion D. Nephrotoxic drugs are a cause of infrarenal failure

A nurse is treating a patient with kidney dysfunction. She notices that serum albumin levels are 2.8 g/dl. Which of the following is the appropriate interpretation by the nurse? Albumin levels are normal. Albumin levels are increased. Glomerular filtration rate (GFR) must be reduced. Albumin levels are decreased, due to loss in urine. Albumin levels are unaffected by renal function; thus, this value is not helpful.

Albumin levels are decreased, due to loss in urine.

Choose the classification for each type of renal dysfunction. Postrenal failure NEPHROTOXIC DRUGS BENIGN PROSTATIC HYPERPLASIA DECREASED KIDNEY PERFUSION

BENIGN PROSTATIC HYPERPLASIA Prostatic hyperplasia may cause postrenal failure. As the prostate enlarges, it may compress the urethra, preventing normal movement of fluid from the kidneys.

What is the cause of polycystic kidney disease? Genetic disorder Autoantibody attack of the glomeruli Precipitation of crystals in filtrate Elevated blood sugar

Genetic disorder

Choose the classification for each type of renal dysfunction. Pain presentation with kidney pathologies SEVERE HEADACHE COSTOVERTEBRAL ANGLE PAIN RIGHT UPPER QUADRANT PAIN

COSTOVERTEBRAL ANGLE PAIN Costovertebral angle (CVA) pain is a hallmark of pathologic conditions of the kidney. Pain is present in the lower back between the location of the kidneys and lower ribs.

A patient passes a kidney stone. What is the most likely composition of the stone? Cystine Uric acid Calcium Magnesium

Calcium

Which statements are valid only for prerenal kidney injury when compared with both intrarenal and postrenal kidney injury? Select all that apply. Can be caused by prostatic hyperplasia Is associated with a significant increase in the glomerular filtration rate (GFR) Caused by any condition that decreases blood flow and renal perfusion Can be caused by radiopaque dye used in imaging studies Can be caused by hypovolemic shock

Caused by any condition that decreases blood flow and renal perfusion Can be caused by hypovolemic shock

A student nurse compares the symptoms of acute glomerulonephritis 사구체신염 (AGN) with nephrolithiasis신장결석. Which symptoms should the student nurse identify as likely to be observed in a patient with AGN rather than nephrolithiasis? Select all that apply. Patient writhing in pain Cola-colored urine Ureteral colic pain Costovertebral angle tenderness Sudden edema and hematuria

Cola-colored urine Costovertebral angle tenderness Sudden edema and hematuria

Which of the following are waste products that may elevate in the serum when the kidneys are failing? Select all that apply. Glomerular filtration rate Albumin Creatinine Leukocyte esterase Blood urea nitrogen

Creatinine Blood urea nitrogen

Kidney failure may cause reduced vitamin ___________ synthesis, resulting in reduced _____________absorption. D, calcium E, calcium A, calcium D, potassium

D, calcium

Choose the classification for each type of renal dysfunction. Erythropoietin levels in kidney failure INCREASED UNCHANGED DECREASED

DECREASED Kidneys produce erythropoietin. When kidney damage or failure occurs, synthesis of erythropoietin is compromised.

Why are BUN and Cr levels higher than normal in George? Disruption of the buffering system Muscle breakdown is increasing serum levels of these factors Decreased GFR Antibody attack of the glomeruli have increased secretion of these substances

Decreased GFR George's BUN and Cr are increasing because normally these substances are filtered by the kidney and partially removed from the blood. When GFR decreases, these factors increase in the blood.

Which of the following may explain George's anemia? Select all that apply. Decreased erythropoietin Not enough protein intake Anemia commonly accompanies heart failure Lack of intrinsic factor Glomerular damage

Decreased erythropoietin Glomerular damage The kidneys produce erythropoietin to maintain red blood cells levels. If the kidneys are damaged, erythropoietin levels may fall. Intrinsic factor is found in the stomach and is not altered by kidney failure. Finally, if the glomeruli are damaged, red blood cells may be filtered into the urine, leading to hematuria.

Which of the following is a cause of prerenal failure? Nephrotoxic medications Streptococcal infection Decreased perfusion Ureter obstruction

Decreased perfusion

In George's condition, why is GFR lower than normal? Decreased perfusion of the kidney Elevated pressure due to hydronephrosis Blockage of the glomerular membrane by antibodies Cyst formation within the kidneys

Decreased perfusion of the kidney George's heart failure likely makes maintaining adequate perfusion of body tissues difficult. As perfusion of the kidneys declines, so does the GFR.

Why is oliguria occurring in George? Nephron cell necrosis Decreased renal perfusion and GFR Increased BUN and Cr are blocking renal filtration Cyst formation due to genetic disease is blocking renal blood flow

Decreased renal perfusion and GFR George is experiencing oliguria for the same reason BUN and Cr levels are elevating: the kidneys are not adequately perfused. Urine is only formed when the blood is filtered. If insufficient blood is available for filtration, urine formation decreases.

A renal patient presents with edema. What may be the primary cause of this edema? Urinary stone causing backup Decreased serum albumin due to renal loss. Increased gluconeogenesis by the kidney Decreased erythropoietin synthesis

Decreased serum albumin due to renal loss.

A patient wants to know how he can prevent future kidney stones. Which of the following is an appropriate recommendation? Drink at least 3/L per day. Take calcium supplements. Maintain current dietary choices. Take a daily prophylactic antibiotic.

Drink at least 3/L per day.

Choose the classification for each type of renal dysfunction. Sign of urinary tract infection in urinalysis ELEVATED KETONES ELEVATED LEUKOCYTE ESTERASE ELEVATED CR

ELEVATED LEUKOCYTE ESTERASE The presence of leukocyte esterase in urinalysis can indicate urinary tract infection. Elevated ketones may indicate the presence of diabetic ketoacidosis. Cr stands for creatinine, a waste product that should be present in urine.

Why does George experience disorientation as a result of renal failure? Elevated toxin levels in the blood Anemia Hyperkalemia Elevated urine output by the kidney

Elevated toxin levels in the blood Encephalopathy may develop with acute or chronic renal failure when toxins buildup in the blood. These toxins begin to compromise brain function.

A patient with chronic renal failure reports that he is feeling like his skin is "itching." What is an appropriate response by the nurse? Suggest that the patient switch to a different cream or lotion. Suggest that the patient switch laundry detergents. Evaluate laboratory values to assess toxin levels in the blood. Suggest the patient may be developing a sensitivity to the bed linen.

Evaluate laboratory values to assess toxin levels in the blood.

A patient is diagnosed with nephrotic syndrome. Which of the following does the nurse expect to observe? Decreased serum blood urea nitrogen (BUN) Fatty casts in urine Absence of edema Patient in severe pain due to stone formation

Fatty casts in urine

A patient has polycystic kidney disease. The nurse correctly determines which of the following is the cause? Bacterial infection Autoimmune disorder Genetic disorder Too much calcium in the diet

Genetic disorder

Which of the following findings may encourage a clinician to begin considering discussing the possibility of a need for a kidney transplant? Damage to 50% of the nephrons Presence of periorbital edema Glomerular filtration rate (GFR) < 12 ml/min Protein in urine

Glomerular filtration rate (GFR) < 12 ml/min

Plasmapheresis would be a treatment option for a patient with which of the following conditions? Acute kidney injury End-stage renal disease Pyelonephritis Goodpasture's syndrome

Goodpasture's syndrome

Which of the following conditions result from autoantibodies attacking the glomeruli? Polycystic kidney disease Pyelonephritis Nephrolithiasis Goodpasture's syndrome

Goodpasture's syndrome

A patient is diagnosed with Goodpasture's syndrome. Which of the following statements are true about this condition? Select all that apply. Goodpasture's syndrome is an autoimmune disease. Goodpasture's syndrome is often asymptomatic. Goodpasture's syndrome is a form of PKD. Goodpasture's syndrome is an inherited disorder. Dialysis may be required to treat Goodpasture's syndrome.

Goodpasture's syndrome is an autoimmune disease. Dialysis may be required to treat Goodpasture's syndrome.

Choose the classification for each type of renal dysfunction. Type of dialysis in which blood drawn from body enters dialyzer HEMODIALYSIS PERITONEAL DIALYSIS PLEURAL DIALYSIS

HEMODIALYSIS In peritoneal dialysis, a patient's peritoneum is filled with fluid to be exchanged. Hemodialysis requires blood to be drawn from the body, run through a dialyzer, and then returned to the body.

A patient is to undergo renal ultrasound. Which of the following is the test most likely used to assess? Glomerular filtration rate (GFR) Hydronephrosis Casts Azotemia

Hydronephrosis

Chronic renal failure may be associated with which of the following conditions? Select all that apply. Hypertension Diabetes Osteoporosis Staphylococcal infections Influenza infection

Hypertension Diabetes Osteoporosis

Choose the classification for each type of renal dysfunction. Azotemia INCREASED SERUM BUN DECREASED SERUM BUN INCREASED GFR

INCREASED SERUM BUN Azotemia as defined as elevated blood urea nitrogen levels. This condition can be caused by decreased glomerular filtration.

Choose the classification for each type of renal dysfunction. RAAS activation with kidney damage INCREASES SODIUM AND WATER RETENTION SIGN THAT KIDNEY TRANSPLANT IS IMMINENT CAUSES HYPOTENSION

INCREASES SODIUM AND WATER RETENTION RAAS is the renin-angiotensin-aldosterone system. When this system is activated, sodium and water are retained by the kidneys to increase blood volume and blood pressure. This does indicate that kidney transplant is imminent.

Choose the classification for each type of renal dysfunction. Type of kidney injury resulting from glomerulonephritis PRERENAL INTRARENAL POSTRENAL

INTRARENAL Glomerulonephritis is an inflammatory condition of the glomeruli of the kidney. Because the kidneys are directly damaged, this is an example of an intrarenal condition. The most common organism that causes glomerulonephritis is Group A beta-hemolytic streptococcus.

Which of the following are true statements about acute glomerulonephritis? Select all that apply. (사구체신염) Nephrolithiasis is a primary cause of acute glomerulonephritis. Patients with acute glomerulonephrititis have no dietary restrictions. Glomerular permeability is lessened, preventing filtration of the blood. In acute glomerulonephritis, blood cells and protein may appear in the urine. Streptococcal infections can result in glomerulonephritis.

In acute glomerulonephritis, blood cells and protein may appear in the urine. Streptococcal infections can result in glomerulonephritis. -사구체 신염 (gloe-mer-u-low-nuh-FRY-tis)은 신장에있는 작은 필터 (사구체)의 염증입니다. Glomeruli는 혈류에서 과도한 체액, 전해질 및 노폐물을 제거하여 소변으로 보냅니다. 사구체 신염 은 갑자기 (급성) 또는 점진적으로 (만성) 나타날 수 있습니다

Damage to the glomeruli may result in which of the following? Select all that apply. Increased serum blood urea nitrogen Increased serum creatinine Proteinuria Hematuria Albuminuria

Increased serum blood urea nitrogen Increased serum creatinine Proteinuria Hematuria Albuminuria

A nurse is speaking to a patient with nephrotic syndrome. Which recommendations will be helpful for the patient? Ingest a high protein diet (3 to 4 g/kg/day) Ingest a low-sodium diet (< 1500 g/day) Encourage overhydration Ingest a low-calorie/restrictive diet

Ingest a low-sodium diet (< 1500 g/day)

A nursing student is studying the progression of acute kidney injury. What is the proper order for the progression of acute kidney injury? Kidney function decreases Oliguria develops Initial insult or injury to the kidney Diuresis with reduced concentrating ability by kidney Recovery with return to normal urine concentration

Initial insult or injury to the kidney Kidney function decreases Oliguria develops Diuresis with reduced concentrating ability by kidney Recovery with return to normal urine concentration

A patient is taking a nephrotoxic drug. Which type of renal dysfunction is the nurse most likely concerned about developing? Prerenal Intrarenal Postrenal Juxtarenal

Intrarenal

Prerenal dysfunction implies a problem "before" the kidneys.

It occurs when blood flow and perfusion to the kidneys is reduced. Heart failure, trauma, and shock may cause prerenal failure.

A nurse is reviewing urinalysis results. Which factors does she review to see whether the patient has a urinary tract infection? Select all that apply. Glucose Bilirubin Albumin Leukocyte esterase Nitrite

Leukocyte esterase Nitrite

Intrarenal dysfunction results from an injury to the kidney itself.

Nephrotoxic drugs, streptococcal infections, and systemic diseases may induce this type of damage.

Infection of the renal system may be evident by the presence of which of the following in a urine sample? Select all that apply. Nitrite Leukocyte esterase Calcium Glucose Albumin

Nitrite Leukocyte esterase Glucose

Choose the classification for each type of renal dysfunction. Shock PRERENAL INTRARENAL POSTRENAL

PRERENAL Shock can result from a number of causes. With this condition, inadequate perfusion of organs and tissues occurs, including the kidneys. As the problem involves delivery of blood to the kidneys, it is a prerenal condition.

What type of edema is George likely to experience with renal failure? Pulmonary edema Periorbital edema Dependent edema Localized edema in feet

Periorbital edema Edema manifests in a number of ways in the body, but a particular form of edema, periorbital edema, may signify renal failure. The swelling around the eyes often develops with increased fluid accumulation.

For a confirmative diagnosis of Goodpasture's disease, the nurse anticipates which of the following? Glomerular filtration rate (GFR) measurement decreases. Positive immunoglobulin results. Intravenous pyelogram (IVP) shows obstruction. Urinalysis shows the presence of casts.

Positive immunoglobulin results.

George, age 72, recently suffered a heart attack, damaging his left ventricle. He appears to be suffering from left-sided heart failure. Stroke volume, blood pressure, and cardiac output are all reduced. George's renal function may be impaired. Serum blood urea nitrogen (BUN) and creatinine (Cr) levels are increasing and glomerular filtration rate (GFR) is significantly reduced. Oliguria is present, as is edema of the face and extremities. George seems to be becoming more confused and disoriented. Further blood laboratory values reveal hypocalcemia, hyperkalemia, and anemia. Based on the information provided, which type of renal dysfunction is most likely in George's case: prerenal, intrarenal, or postrenal? Prerenal Intrarenal Postrenal None. Based on available data, George's renal function appears normal.

Prerenal The most likely renal failure type is prerenal. Prerenal failure occurs when the kidneys are not adequately perfused. In George's case, his heart failure is likely resulting in reduced blood flow to the kidneys. The increasing levels of BUN and Cr, along with decreasing GFR, shows George's kidneys are not functioning normally

A nursing student suspects that a patient has a lower urinary tract infection (UTI). The nursing educator, however, believes that the patient may have pyelonephritis. Which of the following signs or symptoms did the nursing educator notice that may indicate pyelonephritis? Presence of leukocyte esterase in the urinalysis results Level of pain the patient is self-reporting Presence of fever Patient's past medical history

Presence of fever

The urinalysis results of a patient in the end stage of chronic renal failure is likely to show which of the following? Presence of white blood cells (WBCs), red blood cells (RBCs), and protein Elevated leukocyte esterase Elevated ketones Elevated nitrite

Presence of white blood cells (WBCs), red blood cells (RBCs), and protein

Which of the following would alert the clinician that the patient may have acute glomerulonephritis? Select all that apply. Pain with urination Protein in urine Oliguria Blood in urine Fluid accumulation in renal pelvis

Protein in urine Blood in urine

Which of the following are common signs of kidney dysfunction? Select all that apply. Proteinuria Decreased serum creatinine Rash Hematuria Costovertebral angle pain

Proteinuria Hematuria Costovertebral angle pain

Glomerular filtration rate (GFR) is recorded as 12 ml/min. What is the correct interpretation by the nurse? Renal function has returned to normal. The patient is ready to be discharged. Renal function is not normal, as the patient is in stage 3 chronic renal failure (CRF). Renal function is above normal levels. Renal function indicates stage 5 CRF.

Renal function indicates stage 5 CRF.

A patient's glomerular filtration rate (GFR) is 110 ml/min. Which of the following interpretations is correct? Renal function is normal. The value is too high; the kidneys are not concentrating the urine. This value is too low; the patient is retaining fluids. The value is too low due to decreased renal perfusion.

Renal function is normal.

Choose the classification for each type of renal dysfunction. Damaging infection to kidney STAPHYLOCOCCAL CLOSTRIDIAL STREPTOCOCCAL

STREPTOCOCCAL Group A beta-hemolytic streptococcal infections may damage the glomeruli of the kidneys. Staphylococcal and clostridial infections do not target the kidney.

A patient arrives in the emergency department complaining of a kidney stone. Which of the following is the appropriate nursing intervention? Restrict all fluids. Withhold pain medications until the stone is passed. Strain urine. Offer sedative.

Strain urine.

Which of the following bacterial infections is most worrisome to the clinician in regards to glomerular damage? Staphylococcal Clostridial Neisseria Streptococcal

Streptococcal

Which type of infection most commonly causes damage to the kidneys? Neisserial Clostridial Streptococcal Staphylococcal

Streptococcal

What is the most common cause of acute glomerulonephritis? Streptococcal infection Epstein-Barr virus Staphylococcal infection Cytomegalovirus

Streptococcal infection

A patient's urinalysis reveals the presence of glucose. Which of the following should be considered first? The patient is eating too many carbohydrates. Decreased glomerular filtration rate (GFR) is concentrating the urine too much The patient may have diabetes mellitus. The patient has kidney failure.

The patient may have diabetes mellitus.

A critical care patient is to receive continual renal replacement therapy (CRRT). What is an appropriate description to share with family members of the patient? The patient's blood will be purified over 24 hours. CRRT is a form of hemodialysis and is done every three days. CRRT is a form of plasmapheresis and removes antibodies from the plasma. CRRT provides IV infusions due to fluid loss.

The patient's blood will be purified over 24 hours.

A patient has oliguria. Which of the following interpretations by the nurse is correct? The patient has increased urine output compared to normal. The patient has a urinary stone. The patient's urine output is less than 400 ml/day. The patient's glomerular filtration rate (GFR) must be elevated.

The patient's urine output is less than 400 ml/day.

Creatinine clearance is measured

to assess glomerular functioning.