Module 13: Alterations of Renal and Urinary Tract Function
Hematuria after a GI viral infection Feedback: The disease manifests with gross or microscopic (30% to 40%) hematuria 24 to 48 hours after an upper respiratory tract or gastrointestinal mucosal viral infection.
A patient has IgA nephropathy (Berger disease). What classic finding will the nurse assess for in this patient?
Hydroureter
A patient has a dilated ureter from an obstructed upper urinary tract. Which term will the nurse use to describe this condition?
Stress
A patient has a loss of urine when laughing or sneezing. Which type of incontinence does the nurse suspect the patient is experiencing?
Urge
A patient has a sudden and strong desire to urinate that is associated with involuntary contractions of the detrusor. Which type of incontinence is this patient experiencing?
Urine culture Feedback: Infections are diagnosed by urine culture of specific microorganisms with counts of 10,000/ml or more from freshly voided urine.
A patient has a suspected urinary tract infection. Which laboratory test is it most important for the nurse to obtain?
Acute kidney injury Feedback: The term "acute kidney injury" is preferred to the term "acute renal failure" because it captures the spectrum of this syndrome, which ranges from minimal or subtle changes in renal function to complete renal failure requiring renal replacement therapy.
A patient has acute renal failure. What is another term the nurse can use to describe this condition?
Carefully monitor fluid and electrolyte balance
A patient has an acute kidney injury. Which intervention will the nurse incorporate into a plan of care for this patient?
Urinary catheterization kit Feedback: The post-void urine is measured by catheterization within 5 to 15 minutes of urination or through a bladder ultrasound machine that measures bladder height and width to provide an approximation of urine within the vesicle.
A patient has an obstruction of urine flow in the lower urinary tract. After the patient voids, what equipment should the nurse have ready?
Painless hematuria Feedback: Gross painless hematuria is the archetypal clinical manifestation of bladder cancer.
A patient has bladder cancer. Which assessment finding is most typical for this patient?
Kidney scarring Feedback: Chronic pyelonephritis is a persistent or recurrent infection of the kidney leading to scarring of one or both kidneys.
A patient has chronic pyelonephritis. What does the nurse suspect occurred in the patient's body?
Hyperlipidemia Feedback: Many clinical manifestations of nephrotic syndrome are related to loss of serum proteins and associated sodium retention, including edema, hyperlipidemia, lipiduria, vitamin D deficiency, and hypothyroidism.
A patient has nephrotic syndrome. Which laboratory result will the nurse monitor?
Hypovolemia Feedback: Hypovolemia, hemorrhage, and shock are examples of prerenal acute renal failure/acute kidney injury.
A patient has prerenal acute renal failure/acute kidney injury. What does the nurse suspect caused this condition?
Vesicoureteral reflux
A patient has pyelonephritis from chronic backup of urine into the ureters and kidneys. Which predisposing factor does this patient have for pyelonephritis?
I Feedback: If confined to the kidney capsule, it is stage I.
A patient has renal cell carcinoma that is confined to the kidney capsule. What stage is the patient's cancer?
Integumentary system Feedback: The effects of uremia on the integumentary system include abnormal pigmentation, pruritus, and uremic frost.
A patient has uremic frost. Which of the following is it most important for the nurse to assess?
Painful urination Feedback: Clinical manifestations of cystitis usually include frequency, urgency, dysuria (painful urination), and suprapubic and low back pain.
A patient with cystitis has dysuria. Which of the following assessment findings are consistent with dysuria?
Hematuria with red cell casts
A patient with glomerulonephritis has nephritic type sediment. What will the nurse observe in the urine?
loss of plasma proteins in the urine. Feedback: Glomerular membrane damage in nephrotic syndrome results in the loss of plasma proteins in the urine. Loss of albumin causes a decrease in plasma oncotic pressure that favors fluid movement from the capillaries into the tissues, resulting in edema.
A patient with nephrotic syndrome asks the nurse what causes the edema. How should the nurse respond? The edema results from:
Stage V Feedback: Stage V is called end-stage kidney/renal disease and the GFR is less than 15 ml/min.
A patient's glomerular filtration rate (GFR) is 13 ml/min. Which stage of chronic kidney disease is the patient experiencing?
painful urination. Feedback: Dysuria, painful urination, is present with both disorders.
A symptom that manifests with both urinary tract infection and pyelonephritis is:
Lithotripsy Feedback: Lithotripsy is a noninvasive way to treat kidney stones with ultrasound waves.
A urologist is describing a procedure that uses ultrasound waves to break large renal calculi into smaller stones that can be passed through the urinary tract. Which procedure is the urologist discussing?
Protein Feedback: By definition, nephrotic syndrome is the daily loss of more than 3.5 grams of protein in the urine.
Extreme loss of which substance alerts the nurse that the patient is most likely experiencing nephrotic syndrome?
Erythropoietin Feedback: Since the kidneys are the sites of production of erythropoietin, this hormone often needs to be replaced in individuals with chronic renal failure to prevent anemia.
For a patient with chronic renal failure, which of the following hormones often needs to be therapeutically replaced?
Obligatory and compensatory growth Feedback: The contralateral kidney must undergo obligatory and compensatory growth in order to compensate for the loss of function in the obstructed kidney.
If a patient's right kidney becomes blocked/obstructed, what should the nurse suspect will happen in the patient's left kidney?
prostate enlargement. Feedback: Prostate enlargement from benign prostatic hypertrophy or prostate cancer obstructs the male urethra as it passes through the gland.
Obstruction of the lower urinary tract in males is often caused by:
uric acid. Feedback: Renal calculi are formed from struvite, calcium oxalate, uric acid, and, rarely, cystine.
Renal calculi can be formed from:
renal colic. Feedback: Renal colic is the flank pain that occurs with obstruction of the proximal ureter or renal pelvis.
The main clinical manifestation of a kidney stone that obstructs the ureter is:
urinary reflux. Feedback: When a bacterial, fungal, or viral infection is present in the urinary tract, urinary retention and reflux increase the risk of the infection ascending the ureter to the kidneys, resulting in pyelonephritis.
Which patient is most prone to the development of pyelonephritis? A patient with:
hydronephrosis. Feedback: Dilation of the urinary tract occurs proximal to the obstruction. In this case the proximal renal pelvis and kidney would enlarge, causing a condition known as hydronephrosis.
A consequence of an upper urinary tract obstruction is:
dehydration. Feedback: A major modifiable risk factor for the development of renal calculi in the general population is dehydration, since most renal calculi form when salts in the urine become concentrated or "supersaturated."
A major modifiable risk factor for the development of renal calculi in the general population is:
of a vitamin D deficiency. Feedback: Vitamin D, required for calcium absorption in the digestive tract, is activated in the kidneys. With chronic renal failure, vitamin D is not activated.
A nurse assesses a patient with chronic renal failure for osteomalacia and spontaneous bone fractures because:
Loss of albumin stimulates lipoprotein synthesis by the liver and hyperlipidemia results.
A nurse is asked why hyperlipidemia occurs in nephrotic syndrome. What is the nurse's best response?
Nephrotic syndrome Feedback: The pathophysiology of nephrotic syndrome occurs at the glomerular membrane.
A nurse is describing a glomerular disorder. Which disease is the nurse discussing?
Neurogenic bladder
A nurse is describing the following conditions: detrusor hyperreflexia, vescicosphincter dyssynergia, and detrusor areflexia/acontractile. Which type of urinary disorder is the nurse discussing?
Angiotensin II Feedback: Angiotensin II promotes glomerular hypertension and hyperfiltration caused by efferent arteriolar vasoconstriction and also promotes systemic hypertension.
A nurse is describing the pathophysiology of chronic renal failure or chronic kidney disease. Which substance should the nurse discuss?
Renal insufficiency Feedback: Renal insufficiency generally refers to a decline in renal function to about 25% of normal or a GFR of 25 to 30 ml/min.
A nurse is reviewing laboratory results and notices that the patient's renal function is less than 25% of normal functioning. Which term will the nurse use to describe this condition?
10% Feedback: By definition, end-stage renal failure refers to a decline in renal function to 10% or less of normal.
A nurse is teaching about end-stage renal failure. Which information should the nurse include? End-stage renal failure refers to a decline in renal function to ____ or less of normal.
Postobstructive diuresis Feedback: Relief of bilateral, partial urinary tract obstruction or complete obstruction of one kidney is usually followed by a brief period of diuresis (commonly called postobstructive diuresis).
A patient had both kidneys obstructed but is now unobstructed and urinating large amounts of urine. What term should the nurse use to describe this process?
antigen-antibody complexes that deposit on the glomerular membrane. Feedback: The cause of glomerulonephritis is the formation of antigen-antibody complexes in which the antigen is a nonrenal streptococcal infection. The antigen-antibody complexes are deposited in the glomerular membrane, where an injurious inflammatory response ensues.
The nurse is describing the pathophysiology of post-streptococcal glomerulonephritis. Which information should the nurse include? The cause of this type of glomerulonephritis is:
Nocturia Feedback: Overactive bladder is defined by the International Continence Society as a symptom syndrome of urgency, with or without urge incontinence, and usually associated with frequency and nocturia.
The nurse is reading the patient's history. Which of the following will help confirm the diagnosis of overactive bladder?
Proteinuria Feedback: In glomerular disease, small plasma proteins such as albumin escape across the damaged glomerular membrane, resulting in protein in the urine that can be detected in urinalysis.
The nurse is reviewing laboratory results. Which finding would the urinalysis show in a patient who is developing glomerular disease?
Oliguria Feedback: Renal failure first presents with oliguria, or decreased urine output.
The patient is admitted to the hospital with acute renal failure or acute kidney injury. Which assessment finding will the nurse observe initially?
Salt restricted Feedback: Nephrotic syndrome is commonly treated by adhering to a normal-protein (i.e., 1 g/kg body weight/day, some may need supplements), low-fat, salt-restricted diet.
What type of diet will the nurse encourage for a patient with nephrotic syndrome?
Duration of the blockage Feedback: The severity of an obstructive uropathy is determined by (1) the location of the obstructive lesion, (2) the involvement of one or both upper urinary tracts, (3) the severity (completeness) of the blockage, (4) the duration of the blockage, and (5) the nature of the obstructive lesion.
Which information will help the nurse determine the severity of a patient's urinary tract obstruction?
Escherichia coli
Which microorganism will the nurse most likely observe on the report of a patient who has developed a urinary tract infection (UTI)?
Hyperkalemia Feedback: Hyperkalemia from decreased renal excretion of potassium can cause dysrhythmias and cardiac arrest and is the most pressing factor in the decision to dialyze.
Which of the following complications associated with renal failure should cause the nurse to notify the primary care provider of the need for immediate dialysis?
Glomerulosclerosis, tubulointerstitial inflammation, and proteinuria Feedback: Characteristic features of chronic renal disease pathophysiology include glomerular hypertension, glomerulosclerosis, proteinuria, tubulointerstitial inflammation, and fibrosis.
Which of the following concepts should the nurse include when describing the pathophysiology for chronic renal disease?
Protein Feedback: Protein restriction is necessary to avoid excessive uremia caused by metabolism of amino acids. Adequate caloric intake is necessary, and there is no reason to restrict carbohydrates or fats in the diet.
Which of the following dietary nutrients should be restricted when the patient has renal failure/ chronic kidney disease?
angiotensin converting enzyme inhibitors. Feedback: Angiotensin converting enzyme inhibitors are sometimes used as treatment for chronic renal failure.
Which of the following indicates that the nurse needs more instruction regarding chronic renal failure? The nurse states that a cause of chronic renal failure is:
An obese male patient Feedback: Renal cell carcinoma occurs two times more often in men than women. Tobacco use and obesity are also risk factors.
Which of the following patients is most at risk for the development of renal cell carcinoma?
Neurogenic bladder Feedback: A condition in which neurologic lesions cause bladder dysfunction is called neurogenic bladder.
Which of the following terms will the nurse use to describe bladder dysfunction caused by a neurological disorder?
smokes. Feedback: Smoking is a major risk factor for many cancers, including bladder cancer.
Which patient is most at risk for developing bladder cancer? A patient who:
Diabetic woman with an indwelling catheter Feedback: At risk are individuals with indwelling catheters and persons with diabetes mellitus, neurogenic bladder, or urinary tract obstruction. Cystitis is more common in women because of the shorter urethra and the closeness of the urethra to the anus (increasing the possibility of bacterial contamination).
Which patient is most prone to cystitis?