Unit 7 Kidneys Prep U

A 29 year old female presents with cloudy urine, flank pain, hematuria, and fever. which of the following does the nurse suspect the patient is most likely experiencing? a. acute cystitis b. renal calculi c. chronic renal failure d. postrenal renal failure

A

A nurse is caring for a patient with systemic lupus erythematosis (SLE). The patient asks why a urinalysis is necessary. The best answer is that a urinalysis would determine whether which of the following factors was present in the urine? a) Blood or protein b) Sugar c) Cancer cells d) Potassium

A

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR? a) Serum creatinine b) BUN c) Serum protein d) Albumin level

A

A patient in renal failure has marked decrease in renal blood flow caused by hypovolemia, caused by gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which of the following forms of acute renal injury does this patient have? a) Prerenal failure b) Intrarenal failure c) Postrenal failure d) Chronic renal failure

A Prerenal failure, the most common form of acute renal failure, is characterized by a marked decrease in renal blood flow. It is reversible if the cause of the decreased renal blood flow can be identified and corrected before kidney damage occurs.

A 60 year-old man has been diagnosed with renal calculi after repeated episodes of excruciating flank pain in recent weeks. The man states that, "I don't know how this could happen to me, since I'm so careful about eating a healthy diet." What is the most appropriate response to the man's statement? a) "What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved." b) "Your diet may have played a part in this, but in fact genetics are likely primarily to blame." c) "You likely don't need to change your diet, but now that you have stones in one kidney, you're at very high risk of growing them in the other kidney." d) "Your diet might be normally healthy, but high intake of normally beneficial minerals like calcium and magnesium can lead to stones."

A Renal calculi have a complex etiology that includes diet, but also many other metabolic and endocrine factors, among others. Genetics are not identified as a contributor and mineral intake is not likely to be the sole factor. Stone formation is normally unilateral.

Which laboratory findings should you expect to see in a patient diagnosed with nephritic syndrome? a) Elevated urine protein and hypoalbuminemia b) Low triglycerides and elevated sodium levels c) Abnormal blood clotting and elevated blood pressure d) Decreased high-density lipoproteins and increased iron levels

A The nephritic syndrome is due to glomerular disease that is usually of acute onset and is accompanied by grossly visible hematuria, mild to moderate proteinuria, and hypertension. The nephrotic syndrome, also due to glomerular disease, is characterized by heavy proteinuria, hypoalbuminemia, and severe edema

Which laboratory findings should you expect to see in a patient diagnosed with nephritic syndrome? a) Elevated urine protein and hypoalbuminemia b) Abnormal blood clotting and elevated blood pressure c) Low triglycerides and elevated sodium levels d) Decreased high-density lipoproteins and increased iron levels

A The nephritic syndrome is due to glomerular disease that is usually of acute onset and is accompanied by grossly visible hematuria, mild to moderate proteinuria, and hypertension. The nephrotic syndrome, also due to glomerular disease, is characterized by heavy proteinuria, hypoalbuminemia, and severe edema.

Choice Multiple question - Select all answer choices that apply. A client is admitted with acute pyelonephritis. As the nurse enters the room, the client has shaking chills and reports acute pain. Other clinical manifestations the nurse will assess includes: Select all that apply. a) moderate to high fever. b) shallow breathing and expiratory wheezes. c) change in level of consciousness and hallucinations. d) frequency, urgency, and dysuria. e) pale skin and dry mucous membranes.

A, D The onset of acute pyelonephritis is usually abrupt, with 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. It is not associated with expiratory wheezes, hallucinations, or dry mucous membranes.

The nurse is instructing a patient with advanced kidney disease (AKD) about a dietary regimen. Which of the following restrictions should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD? a) Fats b) Dietary protein c) Foods high in calcium d) Carbohydrates

B Restriction of dietary proteins may decrease the progress of renal impairment in people with advanced renal disease. Proteins are broken down to form nitrogenous wastes, and reducing the amount of protein in the diet lowers the blood urea nitrogen and reduces symptoms.

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) Acute hypertensive crisis b) Sharp decrease in urine output c) Intermittent periods of confusion d) Excessive voiding of clear urine

B 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 patient is being evaluated for kidney stones. The nurse anticipates the patient will manifest: a) A visible abdominal mass and abdominal pain b) Acute onset of colicky or dull and achy intermittent flank pain c) Elevation in systemic blood pressure and frequent urination d) Increased thirst and increased urinary output

B One of the major manifestations of kidney stones is pain. Depending on the location, there are two types of pain associated with kidney stones—colicky or non colicky. 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

Choice Multiple question - Select all answer choices that apply. Select the manifestations of renal cell carcinoma. Select all that apply. a) Does not metastasize b) Palpable flank mass c) Hematuria d) Often silent in the early stages

B, C, D Kidney cancer is largely a silent disorder during its early stages, and symptoms usually denote advanced disease. Presenting features 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. It is, however, intermittent and may be microscopic; as a result, the tumor may reach considerable size before it is detected. One of the features of renal cell carcinoma is its ability to metastasize.

Choice Multiple question - Select all answer choices that apply. A nurse is caring for a patient diagnosed with nephrotic syndrome. The nurse is aware that the patient may manifest which of the following? Select all that apply. a) Hyperalbuminemia b) Hyperlipidemia c) Massive proteinuria (>3.5 g/day) d) Generalized edema e) Lipiduria

B, C, D, E Nephrotic syndrome is characterized by massive proteinuria (≥3.5 g/day in adults) and lipiduria (e.g., free fat, oval bodies, fatty casts), along with an associated hypoalbuminemia (<3 g/dL), generalized edema, and hyperlipidemia. The nephrotic syndrome is not a specific glomerular disease but a constellation of clinical findings that result from an increase in glomerular permeability and loss of plasma proteins in the urine.

A 30 year old male is demonstrating hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin being the major protein. The most probable diagnosis the nurse will see documented on the chart is a. cystitis b. chronic pyelonephritis c. acute glomerulonephritis d. renal calculi

C

A 42 year old male is involved in a motor vehicle accident during which he loses a lot of blood. the nurse realizes he is in acute renal failure caused by a. kidney stones b. immune complex deposition in the glomerulus c. inadequate renal blood flow d. obstruction of the proximal tubule

C

While planning care for a patient who has acute pyelonephritis, a nurse recalls the most common condition associated with the development of acute pyelonephritis is a. cystitis b. renal cancer c. urinary tract obstruction d. nephrotic syndrome

C

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? a) "You will need to have a renal transplant to live a productive, healthy life." b) "The occurrence of acute kidney injury will always eventually result in chronic renal failure." c) "Acute kidney injury is abrupt in onset and often reversible if recognized early and treated appropriately." d) "Once your condition improves you can be placed on peritoneal dialysis for the rest of your life."

C AKI is the result of a rapid decline in kidney function that increases blood levels of nitrogenous wastes. Once the underlying cause is treated, AKI is potentially reversible if the precipitating factors can be corrected or removed before permanent damage occurs.

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) Take prescribed diuretics early in the day to avoid having to get up during the night. b) Force micturition every 2 hours while awake. c) Continue taking antibiotics for full 10 to 14 days even if symptoms of infection disappear. d) Increase intake of cranberry juice to 2 L/day.

C 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.

The nurse is evaluating her patient's risk for an urinary tract infection. Which of the following patients has the highest risk? a) Patient with high levels of glucose in the urine b) Patient with infective endocarditis c) Patient with obstructed urinary outflow from the kidney d) Patient with septicemia

C Factors that contribute to the development of ascending infections of the urinary tract are outflow obstruction, catheterization and urinary instrumentation, vesicoureteral reflux, pregnancy, and neurogenic bladder.

The nurse is reviewing the lab results of a patient with suspected nephrotic syndrome. The nurse anticipates that the results to include: a) Decreased tryglycerides b) Abnormal blood clotting factors c) Protein in the urine d) Serum hyperalbuminemia e) Decreased low-density lipoproteins

C in a person with nephrotic syndrome there is massive proteinuria (protein in the urine), serum hypoalbuminemia, generalized edema and hyperlipidemia.

Choice Multiple question - Select all answer choices that apply. A client who is suspected of having acute renal failure would first be assessed by which of the following blood tests? Select all that apply. a) CBC b) Phosphorus c) Creatinine d) Blood urea nitrogen

C, D Blood tests such as blood urea nitrogen and creatinine provide information about renal function. A complete blood count and phosphorus level would identify other problems.

The nurse is reviewing the diagnosis of four male clients. Select the diagnosis that places the clients at risk for developing postrenal kidney failure. a) Intratubular obstruction b) Acute pyelonephritis c) Severe hypovolemia d) Prostatic hyperplasia

D The most common cause of postrenal kidney failure is prostatic hyperplasia. Postrenal failure results from conditions that obstruct urine outflow. The obstruction can occur in the ureter, bladder, or urethra. Intratubular obstruction and acute pyelonephritis are intrarenal causes of kidney failure, and severe hypovolemia is a prerenal cause.

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? a) The woman takes too many bubble baths. b) The woman has multiple sexual partners. c) The woman does not clean herself properly. d) There is possible obstruction in the urinary tract.

D 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.

A nurse is caring for a patient who has a recent history of passing calcium urinary stones. Which of the following is a priority nursing consideration for this patient? a) Bowel elimination b) Bed rest c) Skin care d) Hydration

D A major goal of treatment in people who have passed kidney stones or have had them removed is to prevent their recurrence. Adequate fluid intake reduces the concentration of stone-forming crystals in the urine and needs to be encouraged.

A patient has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause? a) "Have you ever been diagnosed with diabetes?" b) "Have you recently had kidney stones?" c) "Do you have a history of heart failure?" d) "Have you had any type of infection within the last 2 weeks?"

D Acute post-infectious Glomerulonephritis usually occurs after infection with certain strains of group A β-hemolytic streptococci and is caused by deposition of immune complexes of antibody and bacterial antigens. Other organism can also cause this infection.

A patient who has had an intestinal bypass has developed a kidney stone. Which of the following types of kidney stone does the nurse recognize that this patient will most likely be treated for? a) Uric acid b) Cystine c) Magnesium ammonium d) Calcium

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