Chapter 25: Disorders of Renal Function- Prep-U

**The nurse should assess which of the following when assessing for the initial presence of edema in a patient with nephrotic syndrome? a. Eyelids b. Hands c. Entire abdomen d. Lower extremities

d. Initially the edema caused by nephritic syndrome presents in the dependent parts of the body, such as the lower extremities, but becomes more generalized as the disease progresses.

The nurse reviews the lab results for a patient who has advanced autosomal dominant polycystic kidney disease (ADPKD). The patient 's hemoglobin is 8.8 g/dL. The nurse suspects this lab value is related to which of the following causes? a) Poor dietary intake of iron b) Low calcium levels c) Reduced production of erythropoietin d) Hemorrhage

Reduced production of erythropoietin As ADPKD progresses, the nephrons reduce the production of erythropoietin (EPO). EPO is necessary for red blood cell production by bone marrow, so EPO deficiency causes anemia.

***Hospitalized patients are at the greatest risk of developing septicemia related to which procedure? a. Catheter-associated bacteriuria b. Acute viral cystitis c. Asymptomatic bacteriuria d. Obstructive pyelonephritis

a. Catheter-associated bacteriuria remains the most frequent cause of gram-negative septicemia in hospitalized patients.

***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) frequency, urgency, and dysuria. b) change in level of consciousness and hallucinations. c) shallow breathing and expiratory wheezes. d) moderate to high fever. e) pale skin and dry mucous membranes.

• moderate to high fever. • frequency, urgency, and dysuria. 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. (less)

***Which one of the following would the nurse see as being liable to cause the most serious long-term problems? a) Unilateral renal agenesis b) Polycystic kidney disease c) Simple renal cyst d) Horseshoe kidney

Polycystic kidney disease 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 horeshoe-shaped structure. The condition usually does not cause problems. Polycystic kidneys may be associated with aneurysm, and subarachnoid hemorrhage is a frequent cause of death.

Acute postinfectious glomerulonephritis, as its name implies, follows an acute infection somewhere else in the body. What is the most common cause of acute postinfectious glomerulonephritis? a) E. coli b) S. aureus c) Group A Β-hemolytic streptococci d) P. aeruginosa

Group A Β-hemolytic streptococci Group A Β-hemolytic streptococci have the ability to seed from one area of the body to another. One area it seeds to is the kidney, where it causes acute postinfectious glomerulonephritis. Other organisms can cause acute postinfectious glomerulonephritis, but they are not the most common cause of the disease.

***The nurse is assessing a patient with diabetic nephropathy whose blood pressure is 124/80. The patient smokes two packs of cigarettes a day and consumes a diet high in saturated fats and sodium. The nurse's plan of care should focus on which of the following to decrease the patient's risk for progression of the diabetic nephropathy?

Smoking cessation program Hypertension and cigarette smoking have been implicated in the progression of diabetic nephropathy. The control of blood pressure (to levels of 130/80 mm Hg or less) and smoking cessation are recommended as primary and secondary prevention strategies in persons with diabetes.

Drug-related nephropathies occur all too often. They involve functional and/or structural changes to the kidney after exposure to a drug. What does the tolerance to drugs depend on? a) Glomerular filtration rate b) State of hydration c) Proteinuria d) Vesicoureteral reflux

State of hydration The tolerance to drugs varies with age and depends on renal function, state of hydration, blood pressure, and the pH of the urine. None of the other answers are correct.

***An newborn has been diagnosed with renal agenesis. Which characteristics should the nurse mention to the parents as it correlates to this diagnosis? Select all that apply. a. Low-set ears b. Epicanthic folds (skin of the upper eyelid) are present c. Receding chin d. Eyes are situated very close together e. Long, narrow nose

a. b. & c. Newborns with renal agenesis often have characteristic facial features, called Potter syndrome, that are caused by fetal compression due to a marked reduction in amniotic fluid levels. The eyes are widely separated and have epicanthic folds, the ears are set low, the nose is broad and flat, and the chin is receding and limb defects often are present.

***Acute pyelonephritis is a result of which of the following? a. Renal failure b. Chronic reflux c. Bacterial infection d. Viral infection

c. 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.

A nurse is caring for a child with Wilms tumor, stage I. Which of the following can be said regarding this diagnosis? Select all that apply. a) The tumor is limited to the kidney and can be excised with the capsular surface intact. b) The tumor has undergone hematogenous metastasis, most commonly involving the lung. c) Prognosis is good with treatment. d) Prognosis is poor even with treatment.

• Prognosis is good with treatment. • The tumor is limited to the kidney and can be excised with the capsular surface intact. Long-term survival rates have increased to 90% for Wilms tumor stages I through III. The tumors usually are staged using the National Wilms' Tumor Study Group classification: stage I tumors are limited to the kidney and can be excised with the capsular surface intact.

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) Skin care c) Bed rest d) Hydration

Hydration 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.

Which of the following statements about the use of angiotensin-converting enzyme inhibitor medications 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) The use of ACE inhibitors will increase the vasopressin levels. c) The ACE inhibitors have been shown to shrink the size of the cysts inside the kidneys. d) ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction.

ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction. 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.

A client has been given the diagnosis of diffuse glomerulonephritis. They ask the nurse what diffuse means. The nurse responds: a) All glomeruli and all parts of the glomeruli are involved. b) Only some of the glomeruli are affected. c) That the mesangial cells are being affected. d) Only one segment of each glomerulus is involved.

All glomeruli and all parts of the glomeruli are involved. Glomerular changes can be diffuse, involving all glomeruli and all parts of the glomeruli; focal, meaning only some of the glomeruli are affected; segmental, involving only a certain segment of each glomerulus; and mesangial, affecting only mesangial cells.

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) Sugar b) Blood or protein c) Cancer cells d) Potassium

Blood or protein Because of the high risk of kidney disease, all people with SLE should undergo routine urinalysis to monitor for the presence of hematuria or proteinuria.

Which of the following best describes nephronophthisis-medullary cystic kidney disease? a) Small elongated cysts form in the collecting ducts and maintain contact with the nephron of origin. b) Cysts are restricted to the corticomedullary border. c) Cysts develop in the kidney as a consequence of aging, dialysis, or other conditions that affect tubular function. d) The tubule wall, which is lined by a single layer of tubular cells, expands and then rapidly closes the cyst off from the tubule of origin.

Cysts are restricted to the corticomedullary border. Nephronophthisis and adult-onset medullary cystic kidney disease both produce progressive medullary tubulointerstitial cystic disease. The other conditions described are elsewhere in the renal space.

***The nurse is assessing a patient who has a unilateral obstruction of the urinary tract. The nurse anticipates the patient may develop: a) Excretion of dilute urine b) Increase in blood pressure c) Inability to control urination d) Increased urine output

Increase in blood pressure 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

Staghorn kidney stones, or struvite stones, are usually located in the renal pelvis. These stones are made from what? a) Uric acid b) Calcium oxalate c) Magnesium ammonium phosphate d) Cystine

Magnesium ammonium phosphate Phosphate levels are increased in alkaline urine and magnesium, always present in the urine, and combine to form struvite stones. These stones can increase in size until they fill an entire renal pelvis. Because of their shape, they often are called staghorn stones. The other minerals can form stones, but not staghorn stones.

****A nurse observes that a patient's urine is cola colored and considers which of the following as a possible reason? a) The patient has ingested a dark-colored drink. b) The patient's urine contains material from the degradation of red blood cells. c) The patient has an elevation of urine potassium. d) The patient's urine has a decrease in the specific gravity.

The patient's urine contains material from the degradation of red blood cells. When red blood cells degrade in the urine, urine may appear cola colored.

***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 had any type of infection within the last 2 weeks?" b) "Do you have a history of heart failure?" c) "Have you ever been diagnosed with diabetes?" d) "Have you recently had kidney stones?"

"Have you had any type of infection within the last 2 weeks?" 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 client has a tubulointerstitial disorder and is no able to concentrate urine. The nurse will likely assess which manifestations associated with this disorder? Select all that apply. a) Acidic urine b) Nocturia c) Hematuria d) Polyuria

• Polyuria • Nocturia The tubulointerstitial disorders are distinguished clinically from glomerular diseases by the absence, in the early stages, of such hallmarks of nephritis and nephrosis as hematuria and proteinuria, and by the presence of disorders in tubular function. These disorders, which are often subtle, include the inability to concentrate urine, as evidenced by polyuria and nocturia; interference with acidification of urine, resulting in metabolic acidosis; and diminished tubular reabsorption of sodium and other substances.

Congenital disorders of the kidneys are fairly common, occurring in approximately 1:1000 live births. What is the result to the newborn when bilateral renal dysplasia occurs? (Select all that apply.) a) Oligohydramnios b) Potter facies c) Pulmonary hypoplasia d) Multicystic kidneys e) Renal failure

• Potter facies • Oligohydramnios • Pulmonary hypoplasia • Renal failure Bilateral renal dysplasia causes oligohydramnios and the resultant Potter facies, pulmonary hypoplasia, and renal failure. Multicystic kidneys are a disorder, not the result of a congenital problem.

***A 34 year-old man has been taking up to 2400 mg of ibuprofen per day following a motor vehicle several months ago and consequent chronic pain. He has recently been diagnosed with chronic analgesic nephritis as a result of his high analgesic intake. The man is surprised at the diagnosis, stating, "I thought that taking too many drugs hurt your liver if anything, not your kidneys." What is the most appropriate response to the man's statement? a) "Your liver does perform most of the detoxifying in your body, but your kidneys can perform this role if the liver is unable to." b) "Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs." c) "High drug intake can cause your kidneys to be very vulnerable to infections, which is likely what happened in your case." d) "It is very rare for someone as young as yourself to have kidney damage like this; usually only older people are vulnerable to kidney damage from drugs."

"Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs." High flow and pressure combined with the metabolic transformative of drugs makes the kidneys vulnerable to drug toxicity. They do not play a backup role to the liver in the metabolism of drugs, and while structural and functional damage may occur with drug overuse, infection is a less likely consequence. The elderly are particularly vulnerable to drug-related nephritis and nephropathies, but it would be incorrect to conclude that younger people are thus immune.

***A nurse is caring for a patient with diabetic glomerulosclerosis. The analysis is reviewed for the presence of which of the following manifestations? a) Albumin b) Red blood cells c) Sodium d) Potassium

Albumin The clinical manifestations of diabetic glomerulosclerosis are closely linked to those of diabetes. The increased glomerular filtration rate that occurs in people with early alterations in renal function is associated with microalbuminuria, which is defined as urinary albumin excretion of 30 to 300 mg in 24 hours.

Which additional physical finding would you anticipate seeing in a child suspected of having a Wilms tumor? a) A visible fine red rash on the body b) Presence of a palpable flank mass c) Anomalies of the genitourinary system d) Massive generalized edema

Anomalies of the genitourinary system An important feature of Wilms tumor is its association with other congenital anomalies, aniridia (absence of the iris), hemihypertrophy (enlargement of one side of the face or body), and other congenital anomalies, usually of the genitourinary system. Wilms tumor usually is a solitary mass that occurs in any part of the kidney. The common presenting signs are a large asymptomatic abdominal mass and hypertension.

***The nurse suspects that a newborn infant who presents with bilateral flank masses, impaired lung development, and oliguria may be suffering from which of the following disorders? a) Autosomal recessive polycystic kidney disease (ARPD) b) Simple renal cysts c) Horseshoe kidney abnormality d) Autosomal dominant polycystic kidney disease

Autosomal recessive polycystic kidney disease (ARPD) The typical infant with ARPD presents with bilateral flank masses, accompanied by severe renal failure, signs of impaired lung development, and variable degrees of liver fibrosis and portal hypertension.

Which clinical manifestations would you expect to see in an infant diagnosed with autosomal recessive polycystic kidney disease (ARPKD)? a) Gross hematuria and massive generalized edema b) Elevated systemic blood pressure and severe pain c) Bilateral flank masses and impaired lung development d) Ascending urinary tract infection and vomiting

Bilateral flank masses and impaired lung development Clinical manifestations of the typical infant with ARPKD include bilateral flank masses, accompanied by severe renal failure, signs of impaired lung development, and variable degrees of liver fibrosis and portal hypertension. Potter facies and other defects associated with oligohydramnios may be present. Hypertension is usually noted within the first few weeks of life and is often severe.

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) Cystine b) Uric acid c) Calcium d) Magnesium ammonium

Calcium 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.

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

Continue taking antibiotics for full 10 to 14 days even if symptoms of infection disappear. 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.

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

Elevated urine protein and hypoalbuminemia 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.

***The nurse is evaluating her patient's risk for an urinary tract infection. Which of the following patients has the highest risk?

Patient with obstructed urinary outflow from the kidney 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.

A patient has passed a kidney stone composed of uric acid (urate). Which of the following pathological conditions is a contributing factor for the development of this type of kidney stone? a) Arteriosclerosis b) Atherosclerosis c) Gout d) Sickle-cell disease

Gout Uric acid stones develop in conditions of gout and high concentrations of uric acid in the urine.

***A patient is to receive a radiocontrast media as part of a diagnostic scan. Which of the following is intended to reduce the nephrotoxic effects of the radiocontrast media? a) Administering ibuprophen 600 mg prior to the procedure b) Administering one unit of packed red blood cells c) Having the patient take nothing by mouth d) Increasing the normal saline intravenous infusion rate to 125 mL/hour

Increasing the normal saline intravenous infusion rate to 125 mL/hour Some drugs, such as high-molecular-weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus and nonsteroidal anti-inflammatory drugs can cause acute prerenal failure by decreasing renal blood flow. Administering intravenous saline can improve hydration and renal perfusion to decrease the toxic effects of the radiocontrast media.

Which one of the following is the usual cause of acute pyelonephritis? a) Autoimmunity b) Obstruction c) Infection d) Reflux

Infection Gram-negative bacteria, including Escherichia coli and Proteus, Klebsiella, Enterobacter, and Pseudomonas species, are the most common causative agents for acute pyelonephritis.

A nurse is caring for a patient who is diagnosed with acute poststreptococcal glomerulonephritis. Which of the following is the most common clinical presentation of this condition? a) Occult hematuria b) Nephrotic syndrome c) Nephritic syndrome d) Renal colic

Nephritic syndrome The acute nephritic syndrome is the clinical correlate of acute glomerular inflammation. The nephritic syndromes produce a proliferative inflammatory response, whereas the nephrotic syndrome produces increased permeability of the glomerulus. The acute nephritic syndrome may occur in such a systemic disease as systemic lupus erythematosus. Typically, however, it is associated with acute proliferative glomerulonephritis such as postinfectious glomerulonephritis. Acute postinfectious glomerulonephritis usually occurs after infection with certain strains of A beta-hemolytic streptococci and is caused by deposition of immune complexes of antibody and bacterial antigens

Surgical stone removal is indicated for which of the following instances? a) Stone too small to pass b) Mild, intermittent pain for one day c) Obstruction of urine flow d) Small stone without evidence of size increase

Obstruction of urine flow Open stone surgery may be required to remove large calculi or those that are resistant to other forms of removal. Kidney stones are a major cause of upper urinary tract obstruction.

A patient diagnosed with Goodpasture's syndrome would require which of the therapies to remove proteins and autoantibodies from the system? a) Intervenous calcium b) Renal transplant c) Kidney removal d) Plasmapheresis

Plasmapheresis Plasmapheresis is used to filter the blood for removal of proteins and the circulating anti-GBM (glioblastoma multiforme) antibodies. Renal transplantation would return the kidneys to normal function, but are the extreme of treatment. The other options would not produce the necessary treatment outcomes

**Which of the following substances would not be found in glomerular filtrate? a) Water b) Protein c) Potassium d) Sodium

Protein The glomerular filtrate has a chemical composition similar to plasma which contains sodium, potassium and water, but it contains no proteins because large molecules do not readily cross the glomerular wall.

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

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

***Which of the following is the most common cancer of the kidney? a) Lymphoma b) Renal cell carcinoma c) Wilms tumor d) Transitional cell carcinoma

Renal cell carcinoma Renal cell carcinoma accounts for 80% to 90% of all kidney tumors.

A 22 year-old female with a history of intermittent flank pain, repeated UTIs and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of this diagnosis? a) She has inherited undersized kidneys that are prone to calculi formation. b) UTIs coupled with an impaired immune response have caused her ADPKD. c) She has inherited a tendency for epithelial cell in her tubules to proliferate inappropriately. d) Severe hypertension and portal hypertension are likely precursors.

She has inherited a tendency for epithelial cell in her tubules to proliferate inappropriately. ADPKD is an inherited condition, and the etiology is thought to involve cysts arising in segments of the renal tubules from a few epithelial cells that proliferate abnormally. UTIs are consequent, not causative, of the condition. Severe hypertension and portal hypertension are more commonly associated with ARPKD (autosomal recessive polycystic kidney disease) than ADPKD. Kidneys are typically oversized in ADPKD and renal calculi are not noted sequelae

A nurse is caring for a patient who has been diagnosed with kidney colic and has not yet passed the stone. Which of the following interventions should the nurse be sure to include when planning the care for this patient? a) Have the client take cool baths. b) Administer acetominophen (Tylenol) every 4 hours for pain. c) Restrict fluid intake. d) Strain the urine.

Strain the urine. All urine should be strained during an attack in the hope of retrieving the stone for chemical analysis and determination of type. This information, along with a careful history and laboratory tests, provides the basis for long-term preventative measures. The patient will require an increase in fluid intake. The patient will also require an opioid analgesic to control the pain

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) There is possible obstruction in the urinary tract. d) The woman does not clean herself properly.

There is possible obstruction in the urinary tract. 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.

Prior to undergoing diagnostic testing with contrast, it is recommended that older adult clients have their creatinine level checked. The rationale for this is to ensure the client: a) Is not allergic to shell fish or iodine b) Does not have a kidney stone obstructing the urethra c) Is in good enough health to withstand a walking on a treadmill d) Will not undergo an acute kidney injury by decreasing renal blood flow

Will not undergo an acute kidney injury by decreasing renal blood flow Some drugs, such as diuretics, high molecular weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus, and the nonsteroidal anti-inflammatory drugs (NSAIDs), can cause acute kidney injury by decreasing renal blood flow. Checking creatinine levels do not predict the client's allergies, a kidney stone, or tolerance for stress testing.

***A 25-year-old Asian American man arrives in the emergency room in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What disease has likely caused of his hematuria and how should it be treated? a. Immunoglobulin A nephropathy and may be advised to use omega-3 fatty acids to delay progression of disease. b. Goodpasture syndrome and will be treated with plasmapheresis and immunosuppressive therapy. c. Kimmelstiel-Wilson syndrome and should be treated with medication to control of high blood pressure. d. Membranous glomerulonephritis and it should be treated with corticosteroids.

a. Immunoglobulin A (IgA) nephropathy (Beurger disease), is a primary glomerulonephritis characterized by the presence of glomerular IgA immune complex deposits. It can occur at any age, but most commonly occurs with clinical onset in the second and third decades of life. It is more common in males than females and is the most common cause of glomerular nephritis in Asians. There is no satisfactory treatment for IgA nephropathy. Goodpasture syndrome is a form of glomerulonephritis; treatment includes plasmapheresis to remove circulating anti-GBM antibodies and immunosuppressive therapy to inhibit antibody production. Membranous glomerulonephritis is the most common cause of primary nephrosis in adults, most commonly those in their sixth or seventh decade. It is treated with corticosteroids. In nodular glomerulosclerosis, also known as Kimmelstiel-Wilson syndrome, there is nodular deposition of hyaline in the mesangial portion of the glomerulus. As the sclerotic process progresses in the diffuse and nodular forms of glomerulosclerosis in many cases, early changes in glomerular function can be reversed by careful control of blood glucose levels. Control of high blood pressure and smoking cessation are recommended as primary and secondary prevention strategies in persons with diabetes.

***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 diagnosis is the most likely? a. Acute pyelonephritis b. Renal calculi c. Acute renal failure d. Renal cell carcinoma

a. 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.

***A cytotechnologist is performing genetic testing on a series of tissues. One tissue comes back with the WT1 mutation, and it's mapped to chromosome 11. What disease will the client most likely develop? a. Wilms tumour b. Renal cell carcinoma c. Alport syndrome d. Pyelonephritis

a. Wilms tumour gene, WT1, which is located on chromosome 11, encodes a transcription factor that is critical for normal kidney development. Roughly 20% of all Wilms tumours carry WT1 mutations. Renal cell carcinoma is a different mutation, as is Alport syndrome. Pyelonephritis is an infection.

***Which of the following is a nonsurgical method of treatment for renal calculi (kidney stones)? a. Extracorporeal shock wave lithotripsy (ESWL) b. Percutaneous nephrolithotomy c. Percutaneous ureterolithotomy d. Retrograde ureteroscopy

a. Extracorporeal shock wave lithotripsy (ESWL) ESWL is a nonsurgical treatment that uses sound waves, laser, or dry shock wave energy to break apart the stones. All of the other procedures are surgical in nature.

***Which of the following are appropriate interventions in the care of a patient diagnosed with renal calculi? Select all that apply. a. Keeping track of intake and output b. Addressing the client's pain c. Restricting the client's oral fluid intake d. Straining the client's urine e. Inserting a Foley catheter

a. b. d. One of the major manifestations of kidney stones is pain. Treatment includes relief of pain. All urine should be strained during an attack in the hope of retrieving the stone for chemical analysis and determination of type. Adequate fluid intake reduces the concentration of stone-forming crystals in the urine and needs to be encouraged. Keeping track of intake and output will help to identify poor output possibly due to obstruction by a calculi. A Foley catheter is not indicated when the patient is able to urinate.

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) acute renal failure. b) acute postinfectious glomerulonephritis. c) nephrotic syndrome. d) kidney stones.

acute postinfectious glomerulonephritis. 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 (Glomerular filtration rate ) decreases, is one of the first symptoms.

***The nurse on a geriatric unit is assessing four clients. Which client is most likely to exhibit pyuria and high counts of urine colony-forming units? a. A client whose father is known to have died of bladder cancer b. A client who has urinary catheter in place due to confusion c. A client who will soon undergo a hysterectomy d. A male client who has had a penile implant for several years

b. Catheters are among the greatest risks for UTI's, which are associated with high CFU counts and pyuria. None of the other listed factors is closely associated with the development of UTI's.

***A nurse is giving discharge instructions for a patient who was diagnosed with acute pyelonephritis 3 days previously. Which of the following is important for the nurse to discuss when instructing the patient? a. The patient will require bed rest at home for 7 days. b. It is important that the patient take the prescribed antibiotic for the duration of the prescription. c. Because the patient received antibiotics in the hospital, there are no further medications required. d. Restrict fluid intake to 1 L/day.

b. Acute pyelonephritis is treated with appropriate antimicrobial drugs and may also require intravenous hydration. Unless obstruction or other complications in the patient occur, the symptoms usually disappear within several days. Treatment with an appropriate antimicrobial agent usually is continued for 10-14 days.

**A nurse on an acute medical unit of a hospital has admitted a 62 year-old female from the emergency department who has been diagnosed with acute pyelonephritis. Which of the following statements most accurately conveys an aspect of the knowledge base that the nurse needs to perform adequate care and teaching? a. Imaging tests are likely to reveal scarring and deformation of the renal calices and pelvis. b. Flank pain, dysuria and nausea and vomiting are likely assessment findings. c. The infection in the kidney is most likely a manifestation of a systemic infection. d. Most cases of acute pyelonephritis are attributable to poorly controlled hypertension.

b. Manifestations of acute pyelonephritis include pain, frequency, urgency, dysuria, nausea and vomiting. Chronic rather than acute pyelonephrities 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.

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

b. Acute onset of colicky or dull and achy intermittent flank pain 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.

***Unilateral obstruction of the urinary tract may result in renin secretion, thereby leading to which of the following? a. Increased urinary output b. Decreased sodium retention c. Increased blood pressure d. Decreased heart rate

c. In cases of unilateral obstruction of the kidney, renin secretion is enhanced, probably secondary to impaired renal blood flow. This would result in increased sodium retention, and increased blood pressure. Urine output would be decreased, and heart rate would not necessarily be affected.

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

c. 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.

***A nurse is administering medications to a patient with a kidney stone. Which medication does the nurse administer that will lower urinary calcium by increasing tubular reabsorption to decrease the amount of calcium in the urine? a. Bumetanide (Bumex) b. Spironolactone (Aldactone) c. Furosemide(Lasix) d. Hydrochlorothiazide (HCTZ)

d. Thiazide diuretics lower urinary calcium by increasing tubular reabsorption so that less remains in the urine. Drugs that bind calcium in the gut may be used to inhibit calcium absorption and urinary excretion.

***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 β-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.

***A patient is being treated with colchicine (Colcrys) for pain in the big right toe. The patient begins to complain of severe right flank pain and is diagnosed with kidney stones. Which of the following types of kidney stones does the nurse recognize this patient is most likely affected by? a. Magnesium ammonium phosphate b. Cystine c. Calcium 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.

***The nurse is planning care for a patient with a urinary tract obstruction. The nurse includes assessment for which of the following possible complications? a. Decreased blood pressure b. Polyuria c. Diluted urine 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.

If a client with a kidney stone has the "classic" ureteral colic, the client will describe his pain as: Select all that apply. a) Excruciating b) In the flank and upper outer quadrant of the abdomen c) Diffuse over the entire lower back and legs d) Acute, intermittent

• Acute, intermittent • Excruciating • In the flank and upper outer quadrant of the abdomen The symptoms of renal colic are caused by stones 1 to 5 mm in diameter that can move into the ureter and obstruct flow. 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. The pain is usually not described as diffuse and over the entire low back and legs.

***Which client would be considered at a higher risk for developing Goodpasture Syndrome, an aggressive form of glomerulonephritis? Select all that apply. a) Elderly person with a recent influenza infection b) Painter working with a busy construction crew who finishes all the house painting indoor and out c) Electrician who wires homes and businesses for high-definition Internet d) Hair style expert who specializes in coloring [dyes] hair e) Middle-aged over-the-road truck driver

• Elderly person with a recent influenza infection • Painter working with a busy construction crew who finishes all the house painting indoor and out • Hair style expert who specializes in coloring [dyes] hair The cause of the disorder [Goodpasture Syndrome] is unknown, although influenza infection and exposure to hydrocarbon solvent (found in paints and dyes) have been implicated in some persons, as have various drugs and cancers. There is not a greater risk associated with truck drivers or electricians.

The nurse is caring for a patient who has not received prenatal care during her pregnancy. The patient delivers a newborn who dies an hour after birth because of total agenesis of both kidneys. Which of the following physical features does the newborn exhibit that correlates with this diagnosis? Select all that apply. a) Imperforate anus b) Broad and flat nose c) Low-set ears d) Cleft lip e) Eyes widely separated with epicanthic folds

• Eyes widely separated with epicanthic folds • Low-set ears • Broad and flat nose Total agenesis of both kidneys is incompatible with extrauterine life. Infants are stillborn or die shortly after birth of pulmonary hypoplasia. Newborns with renal agenesis often have characteristic facial features, sometimes called Potter syndrome, resulting from the effects of oligohydramnios. The eyes are widely separated and have epicanthic folds, the ears are low set, the nose is broad and flat, the chin is receding, and limb defects are often present.

A client has been recently undergone diagnostic testing for possible Berger disease. The nurse caring for this client would anticipate the primary clinical manifestations include which of the following? Select all that apply. a) Fever, chills, and general body aches b) Gross hematuria c) Recent upper respiratory infection d) Elevated ketone levels in the urine

• Gross hematuria • Recent upper respiratory infection • Fever, chills, and general body aches Early in the disease, many people with the disorder have no obvious symptoms, and the disorder is discovered during screening or examination for another condition. In others, the disorder presents with gross hematuria that is preceded by upper respiratory tract infection, GI tract symptoms, or flulike illness. The hematuria lasts 2 to 6 days. Elevated ketones are usually associated with acidosis, fasting, high-protein diet, or diabetes to name a few.