10.D Nephritis

Which assessment finding should alert the nurse to a possible client diagnosis of​ nephritis? (Select all that​ apply.) A. Complaint of cough B. Complaint of weight loss C. Presence of infection D. Presence of facial edema E. History of diabetes

A, C, D, E Facial edema is a manifestation of nephritis due to the retention of sodium and water. A client complaint of cough may indicate Goodpasture​ syndrome, a rare genetic disorder that causes nephritis and may cause a cough due to antibody destruction of alveoli. Infection may cause nephritis. A client with diabetes is more prone to developing nephritis due to vascular damage to the glomerulus. Weight loss is not a manifestation of nephritis.

Does Goodpasture syndrome affect men or women more?

Men

Inflammation of the kidneys is called?

Nephritis

Which patient below is at MOST RISK for developing acute glomerulonephritis? A. A 3 year old male who has a positive ASO titer. B. A 5 year old male who is recovering from an appendectomy. C. An 18 year old male who is diagnosed with HIV. D. A 6 year old female newly diagnosed with measles.

The answer is A. An ASO (antistreptolysin) titer is a test used to diagnose strep infections. Remember strep infections increase, especially in the pediatric population, the risk of developing AGN. Patients in options B, C, and D are not at risk for this.

While providing care to a pediatric patient with acute glomerulonephritis, you note the urine output to be 10 mL/hr. The patient weighs 30 lbs. As the nurse, you will want to limit what type of foods from the patient's diet? A. Calcium-rich foods B. Potassium-rich foods C. Purine -rich foods D. None of the above because the patient's urinary output is normal based on the patient's weight.

The answer is B. This patient is experiencing OLIGURIA (low urinary output). The patient weighs 30 lbs. which is 13.6 kg (30/2.2= 13.6). Remember a normal urinary output for a pediatric patient should be 1 mL/kg/hr. Based on the patient's weight, their urinary output is 10 mL/hr...it should be 13.6 mL/hr. Therefore, the patient is at high risk for retaining POTASSIUM due to decreased renal function. The nurse should limit foods high in potassium.

A patient who is experiencing poststreptococcal glomerulonephritis has edema mainly in the face and around the eyes. As the nurse, you know to expect the edema to be most prominent during the? A. Evening B. Afternoon C. Morning D. Bedtime

The answer is C. Patients will experience the most prominent swelling in the face in the morning when they awake. This is a common finding with kidney disorders. The skin of the eyes is fragile, folded, and pocketed which makes it easier for fluid to collect around the eyes. In addition, this is where the swelling looks more noticeable.

Within the past month, the admission rate of patients with poststreptococcal glomerulonephritis has doubled on your unit. You are proving an in-service to your colleagues about this condition. Which statement is CORRECT about this condition? A. "This condition tends to present 6 months after a strep infection of the throat or skin." B. "It is important the patient consumes a diet rich in potassium based foods due to the risk of hypokalemia." C. "Patients are less likely to experience hematuria with this condition." D. "This condition is not caused by the streptococcal bacteria attacking the glomerulus, but by the immune system's response to the bacteria by creating an antigen-antibody complex which inflames the glomerulus."

The answer is D. This is the only correct statement. Option A is wrong because this condition tends to present 10-14 days (not 6 months) after a strep infection of the throat or skin. Option B is wrong because the patient is at risk for HYPERkalemia (not HYPOkalemia) especially if low urinary output is present. Option C if wrong because patients with this conditon will experience hematuria which is a hallmark of this condition.

TRUE or FALSE: Poststreptococcal glomerulonephritis is a type of NEPHROTIC SYNDROME, which means there is the leakage of BOTH red blood cells and protein from the inflamed glomerulus into the filtrate.

The answer is FALSE: Poststreptococcal glomerulonephritis is a type of NEPHRITIC (not nephrOtic) SYNDROME, which means there is the leakage of BOTH red blood cells and protein from the inflamed glomerulus into the filtrate. In Nephrotic Syndrome, there is only leakage of PROTEIN (not red blood cells) into the filtrate.

Which of the following are NOT a sign and symptom of acute glomerulonephritis (poststreptococcal)? SELECT-ALL-THAT-APPLY: A. Hypotension B. Increased Glomerular filtration rate C. Cola-colored urine D. Massive proteinuria E. Elevated BUN and creatinine F. Mild swelling in the face or eyes

The answers are A, B, D. The patient with AGN may experience HYPERtension (not hypotension), DECREASED glomerular filtration rate (NOT increased), MILD (not massive) proteinuria. Massive proteinuria is a classic sign and symptom in Nephrotic Syndrome which doesn't present with hematuria. Options C, E, and F can be present in AGN.

A 5 year old male is admitted with acute glomerulonephritis. On assessment, you note mild edema predominately in the face and tea-colored urine. The patient's blood pressure is 165/110, heart rate 95, oxygen saturation 98% on room air, and temperature 98.9 'F. In your nursing care plan, what nursing interventions will you include in this patient's plan of care? SELECT-ALL-THAT-APPLY: A. Initiate and maintain a high sodium diet daily. B. Monitor intake and output hourly. C. Encourage patient to ambulate every 2 hours while awake. D. Assess color of urine after every void. E. Weigh patient every daily on a standing scale. F. Encourage the patient to consume 4 L of fluid per day.

The answers are B, D, and E. Patients with acute glomerulonephritis experience proteinuria and hematuria. In addition, they may experience mild edema (mainly in the face/eyes), hypertension, and in severe cases renal failure/oliguria. Therefore, it is very important the nurse monitors intake and output every hour, assesses color of urine, and weighs the patient every day on a standing scale. Option A is wrong because the patient should be consuming a LOW (not high) sodium diet. Option C is wrong because the patient should maintain bed rest until recovered due to experiencing hypertension. Option F is wrong because the patient will be on a fluid restriction...4 L is a lot of fluid to consume. It is generally 2 L or less of fluids per day.

The nurse is caring for a client with suspected acute glomerulonephritis. Which clinical manifestation supports this​ suspicion? (Select all that​ apply.) ​a. Tea-colored urine b. Microscopic hematuria c. Weight loss d. Crackles auscultated in lungs e. Low blood pressure

a, b, d

The nurse is screening a client for the risk of nephritis. Which question should the nurse​ ask? (Select all that​ apply.) ​ a. "Do you have a history of​ diabetes?" ​b. "Does your family have a history of kidney​ disease?" ​c. "Do you have a history of low blood​ pressure?" ​d. "Do you have a history of bladder​ infections?" ​e. "Does your family have a history of gastric​ reflux?

a, b, d Diabetes and hypertension​ (not low blood​ pressure) can cause damage to the fragile vessels of the​ nephron, thereby putting the client at greater risk for nephritis. A family history of kidney disease also predisposes the client to developing nephritis. Infections can travel from the bladder to the​ kidney, thereby damaging the kidney. Gastric reflux is not related to nephritis.

The nurse planning care for a client diagnosed with nephritis assigns a goal of maintaining fluid volume balance. Which intervention should the nurse include in the​ client's plan of​ care? (Select all that​ apply.) a. Measuring abdominal girth b. Providing a​ low-sodium diet c. Encouraging fluid intake d. Offering ice chips frequently e. Keeping sheets tight and​ wrinkle-free

a, b, d The client diagnosed with nephritis will be on a fluid restriction diet. Fluids are​ restricted, not pushed. Measuring abdominal girth allows the nurse to monitor the degree of ascites. Offering frequent ice chips is a means to relieve thirst. Providing a​ low-sodium diet will decrease fluid retention by the kidneys. Keeping sheets tight and without wrinkles helps to promote skin integrity.

The community health nurse discusses the risk factors for nephritis with a group of community members. Which risk factor should the nurse include in the​ teaching? (Select all that​ apply) a. Diabetes b. Drug abuse c. Hypotension d. Hypothyroidism e. Overuse of​ over-the-counter painkillers

a, b, e Diabetes causes damage to the fragile vessels of the nephron that can result in nephritis. Drug abuse and the chronic overuse of​ over-the-counter painkillers increase the risk.​ Hypertension, not​ hypotension, damages the nephron to cause nephritis. Hypothyroidism is not a risk factor for nephritis.

The nurse instructs a pregnant client diagnosed with nephritis about the possible effects of nephritis on the pregnancy. Which should the nurse include in the​ teaching? (Select all that​ apply.) a. Preeclampsia b. Abruptio placenta c. Preterm delivery d. Fetal loss e. Infant with low birthweight

a, c, d

The nurse admits a client diagnosed with glomerulonephritis. The nurse should identify which characteristic that occurs with​ glomerulonephritis? (Select all that​ apply.) ​ a. Slow, progressive destruction of the glomeruli b. Surfaces of the kidneys becoming soft and boggy c. Symmetrical decrease in the size of the kidneys d. Entire nephrons eventually being lost e. Gradual decline in renal function

a, c, d, e Characteristics of chronic glomerulonephritis include a​ slow, progressive destruction of the​ glomeruli, a gradual decline in renal​ function, a symmetrical decrease in the size of the​ kidneys, and an eventual loss of the entire nephron. The surfaces of the kidneys become granular or​ roughened, not soft and boggy.

When planning care for a client with acute​ glomerulonephritis, the nurse should prioritize which​ intervention? (Select all that​ apply.) a. Maintaining fluid balance b. Promoting an adequate sleep pattern c. Using standard precautions d. Maintaining skin integrity e. Promoting nutritional balance

a, c, d, e Interventions for a client with acute glomerulonephritis primarily focus on preventing​ infection, maintaining skin​ integrity, promoting nutritional​ balance, and maintaining fluid balance. Promoting an adequate sleep pattern may be an appropriate​ intervention; however, this is not a primary focus for this client.

The nurse is caring for a client in the acute phase of postinfectious glomerulonephritis. Which intervention should the nurse​ implement? (Select all that​ apply.) a. Fluid restriction b. Parenteral nutrition c. Protein restriction d. Chest physiotherapy e. Bedrest

a, c, e A client in the acute phase of postinfectious glomerulonephritis is placed on​ bedrest, so the body can conserve energy. Only sensible fluid loss is replaced until the renal status is known. Because of the​ azotemia, protein consumption is limited. Chest physiotherapy is used to clear the lungs of secretions in pulmonary diseases. Parenteral nutrition is not necessary with​ glomerulonephritis, as the client will still be able to eat.

The nurse admits a hypertensive client diagnosed with glomerulonephritis. Which medication should the nurse expect to be ordered for the​ client? ​ a. Angiotensin-converting enzyme​ (ACE) inhibitor b. Antibiotic c. Glucocorticoid d. Beta blocker

a. Angiotensin-converting enzyme​ (ACE) inhibitor ACE inhibitors or angiotensin receptor blockers​ (ARBs) are the first choice for antihypertensive agents in glomerulonephritis. These medications slow the progression of renal failure. They also reduce protein loss associated with nephrotic syndrome. Beta blockers are not indicated in​ glomerulonephritis; they are used to reduce hypertension and cardiac workload. Antibiotics are used to treat infections and glucocorticoids reduce inflammation.

The nurse teaches a client diagnosed with nephritis about risk factors for the disease. Which disease should the nurse list as being likely to cause​ nephritis? a. Congestive heart failure b. Celiac disease c. Asthma d. Graves disease

a. Congestive heart failure Congestive heart failure can damage the kidneys due to hypoxia and​ hypoperfusion, thereby causing nephritis. None of the other diseases listed in this question causes nephritis.

Which problem is a priority for the nurse to address when caring for a client with acute​ glomerulonephritis? a. Impaired fluid balance b. Fatigue c. Impaired skin integrity d. Impaired nutrition

a. Impaired fluid balance While all choices are problems that should be addressed in planning care for the client diagnosed with​ nephritis, impaired fluid balance is a priority as this problem may be​ life-threatening if not addressed.

One of the most severe consequences of SLE, an inflammatory autoimmune disorder affecting the connective tissue of the body. Manifestations range from microscopic hematuria to massive proteinuria. Its progression may be slow and chronic or fulminant, with a sudden onset and the rapid development of renal failure. a. Lupus nephritis b. Goodpasture syndrome c. Acute postinfectious glomerulonephritis d. Plasmapheresis

a. Lupus nephritis

The nurse assesses a client suspected of having glomerulonephritis. Which assessment finding should indicate to the nurse that the suspected diagnosis is​ correct? a. Peripheral and central cyanosis b. Facial and peripheral edema c. Decreased bowel sounds d. Prolonged capillary refill

b. Facial and peripheral edema Because renal function is impaired in​ glomerulonephritis, the client will exhibit​ facial, periorbital, and peripheral edema. Peripheral cyanosis indicates hypoxia and is a respiratory problem. Prolonged capillary refill and decreased bowel sounds are not signs of glomerulonephritis.

Rare autoimmune disorder of unknown etiology. It is characterized by formation of antibodies to the glomerular basement membrane. These antibodies may also bind to alveolar basement membranes, damaging alveoli and causing pulmonary hemorrhage, damaging alveoli and causing pulmonary hemorrhage. Cough, shortness of breath, and hemoptysis (bloody sputum) are early respiratory manifestations. a. Lupus nephritis b. Goodpasture syndrome c. Acute postinfectious glomerulonephritis d. Plasmapheresis

b. Goodpasture syndrome

The nurse is discussing ways to prevent the development of nephritis with a client. Which strategy should the nurse​ include? a. Cutting down on smoking b. Maintaining blood pressure control c. Maintaining good dental hygiene d. Practicing​ stress-reduction techniques

b. Maintaining blood pressure control While the exact cause of nephritis is​ unknown, maintaining good blood pressure control​ (controlling hypertension) is one way to prevent damage to the kidneys and reduce the incidence of nephritis. Quitting​ smoking, not cutting​ down, is recommended. Good dental hygiene and reducing stress are not associated with the risk of developing nephritis.

The nurse is caring for a client diagnosed with nephritis. Which assessment finding on discharge leads the nurse to determine that treatment was​ successful? a. The​ client's temperature is 101.5°F. b. The client has regained urine output. c. The client has gained less than 5 pounds. d. The​ client's sodium level is 150​ mEq/L.

b. The client has regained urine output. Successful treatment of nephritis is evidenced by the client maintaining or regaining a normal urine output. The​ client's weight should return to the​ pre-admission weight as all retained fluid is excreted. An elevated temperature indicates that the client might be experiencing an infection. The​ client's sodium level should return to normal levels (135-145 mEq/L).

A client suspected of having nephritis is scheduled for a test at the nuclear medicine department. The client asks the​ nurse, "What test am I​ having?" Which test should the nurse​ identify? a. Renal ultrasound b. Renal biopsy c. Kidney scan ​d. Kidney, ureter, bladder​ (KUB)

c. Kidney scan The kidney scan uses nuclear medicine to visualize the kidney after intravenous administration of a radioisotope. The KUB​ (kidney, ureter,​ bladder) is an abdominal​ x-ray that evaluates kidney size and may rule out other causes. The renal ultrasound does not use nuclear medicine. The renal biopsy is a microscopic examination of kidney tissue and does not use nuclear medicine.

A patient who has had a recent streptococcal infection of the pharynx (strep throat) should be monitored for development of which condition? a. Osteomyelitis b. Chronic kidney disease c. Benign prostatic hyperplasia d. Acute postinfectious glomerulonephritis (APIGN)

d. Acute postinfectious glomerulonephritis (APIGN)

A client is suspected of having acute postinfectious glomerulonephritis. Which test​ result, if​ elevated, should lead the nurse to determine that the suspected diagnosis is​ correct? a. Creatinine clearance b. Antistreptolysin O​ (ASO) titer c. Blood urea nitrogen​ (BUN) d. Erythrocyte sedimentation rate​ (ESR)

d. Erythrocyte sedimentation rate​ (ESR) The ESR is a general indicator of inflammatory response and may be elevated in acute postinfectious glomerulonephritis and in lupus nephritis. BUN measures urea​ nitrogen, the end product of protein​ metabolism, created by the breakdown and metabolism of dietary and body proteins. Creatinine clearance is a specific indicator of renal function used to evaluate the glomerular filtration rate​ (GFR). The ASO titer detects streptococcal exoenzymes.

A client is admitted with acute postinfectious glomerulonephritis. Which medication should the nurse expect to be prescribed for the client to reduce​ inflammation? ​ a. Angiotensin-converting enzyme​ (ACE) Inhibitor b. Antihypertensive c. Glucocorticoid d. Immunosuppressant

d. Immunosuppressant To control inflammation caused by acute postinfectious​ glomerulonephritis, the nurse will administer an immunosuppressant. A glucocorticoid also decreases inflammation.​ However, this medication is contraindicated in acute postinfectious glomerulonephritis. An ACE inhibitor is used in the management of this​ condition; however, it is used to reduce proteinuria and slow the progression of renal failure. An antihypertensive is also used in the management of this​ condition; however, it is used to treat hypertension.

The client diagnosed with nephritis​ states, "No one in my family has ever had any kidney disease. Where do you think this nephritis came​ from?" Which response by the nurse is most​ accurate? ​ a. "I think your celiac disease must have damaged your​ kidneys." ​b. "The fact that you have thyroid disease probably caused damage to your​ kidneys." c. ​"It is possible that your history of arthritis caused the​ nephritis." d. ​"Your congestive heart failure might have damaged your​ kidneys."

d. ​"Your congestive heart failure might have damaged your​ kidneys." While the cause of nephritis is​ unknown, many diseases can damage the kidneys and cause nephritis. Congestive heart failure is one of them due to poor perfusion to the kidneys. Thyroid​ disease, celiac​ disease, and arthritis do not.

The community health nurse speaks with a group of older adult community members about reasons they are at a higher risk for nephritis. Which reason should the nurse​ include? a. Higher incidence of cardiac problems b. Lower risk of developing chronic kidney disease ​c. Long-term use of proton pump inhibitors​ (PPIs) ​d. Long-term use of antihypertensives

​c. Long-term use of proton pump inhibitors​ (PPIs) Medications such as PPIs and certain antibiotics​ (not antihypertensives) are associated with an increase in nephritis. Older adults have a higher risk of developing chronic kidney disease. Cardiac problems are not shown to increase the risk of nephritis.