PATHO CH25

The nurse recognizes the most common cause of acute postinfectious glomerulonephritis as:

A streptococcal infection 7 to 12 days prior to onset

Most primary glomerular disease is caused by which of the following?

Autoimmunity

The form of polycystic kidney disease (PKD) that first manifests in the early infant period is most commonly characterized as which of the following?

Autosomal recessive

A patient has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause?

"Have you had any type of infection within the last 2 weeks?"

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?

"What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved."

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?

"Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs."

Which of the following individuals is at the highest risk of developing a urinary tract infection (UTI)?

A 30 year-old woman with poorly controlled diabetes mellitus.

Which of the following statements about the use of angiotensin-converting enzyme inhibitor medications and autosomal recessive polycystic kidney disease (ARPKD) is accurate?

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

A patient is being evaluated for kidney stones. The nurse anticipates the patient will manifest:

Acute onset of colicky or dull and achy intermittent flank pain

A child is recovering from a bout with group A β-hemolytic Streptococcus infection. They return to the clinic a week later complaining of decrease in urine output with puffiness and edema noted in the face and hands. The health care provider suspects the child has developed:

Acute postinfectious glomerulonephritis

A nurse is caring for a patient with diabetic glomerulosclerosis. The analysis is reviewed for the presence of which of the following manifestations?

Albumin

A client has been given the diagnosis of diffuse glomerulonephritis. They ask the nurse what diffuse means. The nurse responds:

All glomeruli and all parts of the glomeruli are involved.

A four year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the emergency department by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the healthcare team's initial differential diagnosis most likely be?

Alport syndrome

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?

Autosomal recessive polycystic kidney disease (ARPD)

Acute pyelonephritis is a result of which of the following?

Bacterial infection

Which clinical manifestations would you expect to see in an infant diagnosed with autosomal recessive polycystic kidney disease (ARPKD)?

Bilateral flank masses and impaired lung development

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?

Blood or protein

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?

Increasing the normal saline intravenous infusion rate to 125 mL/hour

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?

Calcium

Hospitalized patients are at the greatest risk of developing septicemia related to which procedure?

Catheter-associated bacteriuria

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?

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

Which one of the following is the usual cause of acute pyelonephritis?

Infection

Which laboratory findings should you expect to see in a patient diagnosed with nephritic syndrome?

Elevated urine protein and hypoalbuminemia

Which of the following pain descriptions would lead the nurse to suspect the client is experiencing ureteral colic?

Excruciating pain in the flank and upper outer quadrant of abdomen that radiates to bladder area.

Which of the following is a nonsurgical method of treatment for renal calculi (kidney stones)?

Extracorporeal shock wave lithotripsy (ESWL)

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?

Flank pain, dysuria and nausea and vomiting are likely assessment findings.

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?

Gout

Which factor contributes to the development of polycystic kidney disease?

Hereditary mutations in polycystin I and II

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?

Hydration

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?

Hydrochlorothiazide (HCTZ)

A client has a dilated renal pelvis due to obstruction of urine outflow from the kidney. The pressure of filtrate formation is damaging the renal structures. Which condition is most likely?

Hydronephrosis

A 73 year-old man presents to his family physician with complaints of recent urinary hesitation, and is eventually diagnosed with benign prostatic hyperplasia (BPH). Which of the following clinical consequences would his care provider expect prior to the resolution of his health problem?

Hydroureter and pain

Signs of nephrotic syndrome include proteinuria, edema, hyperlipidemia, and which of the following?

Hypoalbuminemia

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?

Immunoglobulin A nephropathy and may be advised to use omega-3 fatty acids to delay progression of disease.

The nurse is assessing a patient who has a unilateral obstruction of the urinary tract. The nurse anticipates the patient may develop:

Increase in blood pressure

Manifestations of polycystic kidney disease include which of the following?

Increase in kidney size bilaterally

The nurse is planning care for a patient with a urinary tract obstruction. The nurse includes assessment for which of the following possible complications?

Increased blood pressure

Unilateral obstruction of the urinary tract may result in renin secretion, thereby leading to which of the following?

Increased blood pressure

The nurse should assess which of the following when assessing for the initial presence of edema in a patient with nephrotic syndrome?

Lower extremities

A nurse is explaining the clinical manifestations of diabetic nephropathy (diabetic glomerulosclerosis) to a patient. Which would be the most important information for the nurse to provide?

Microalbuminemia is a predictor of future nephropathies.

Both type 1 and type 2 diabetes mellitus can cause damage to the glomeruli of the kidneys. What renal disease is diabetic nephropathy associated with?

Nephrotic syndrome

The nurse is presenting an educational program about renal carcinoma. The nurse determines that the participants understand early signs of the disease when they identify which of the following as an early sign or symptom?

None of the above

Surgical stone removal is indicated for which of the following instances?

Obstruction of urine flow

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

A patient diagnosed with Goodpasture's syndrome would require which of the therapies to remove proteins and autoantibodies from the system?

Plasmapheresis

Which one of the following would the nurse see as being liable to cause the most serious long-term problems?

Polycystic kidney disease

Which of the following substances would not be found in glomerular filtrate?

Protein

The nurse is reviewing the lab results of a patient with suspected nephrotic syndrome. The nurse anticipates that the results to include:

Protein in the urine

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?

Reduced production of erythropoietin

Which of the following is the most common cancer of the kidney?

Renal cell carcinoma

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?

She has inherited a tendency for epithelial cell in her tubules to proliferate inappropriately.

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

One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which of the following electrolytes?

Sodium

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?

State of hydration

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?

Strain the urine.

A nurse is caring for a patient with renal cell cancer. Which of the following is the treatment of choice for this condition?

Surgical resection

A nurse observes that a patient's urine is cola colored and considers which of the following as a possible reason?

The patient's urine contains material from the degradation of red blood cells.

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?

There is possible obstruction in the urinary tract.

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?

Uric acid

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:

Will not undergo an acute kidney injury by decreasing renal blood flow

A nurse is caring for a patient with hematuria. The nurse understands this may be a clinical manifestation of which of the following conditions? Select all that apply.

• Acquired renal cyst • Renal cell carcinoma • Renal calculi

If a client with a kidney stone has the "classic" ureteral colic, the client will describe his pain as: Select all that apply.

• Acute, intermittent • Excruciating • In the flank and upper outer quadrant of the abdomen

A patient who developed acute pyelonephritis asks the nurse what caused the infection. Which should be included in the nurse's response? Select all that apply.

• Acute pyelonephritis is caused by bacterial infection. • Escherichia coli is the causative agent in about 80% of cases. • Outflow obstruction, catheterization, and urinary instrumentation.

A school nurse is teaching a group of fourth-grade girls about personal hygiene. Important teaching points aimed at reducing the incidence of urinary tract infection (UTI) include which of the following? Select all that apply.

• Avoiding bubble baths • Wiping from front to back after a bowel movement • Careful hand washing

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.

• Eyes widely separated with epicanthic folds • Low-set ears • Broad and flat nose

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.

• Gross hematuria • Recent upper respiratory infection • Fever, chills, and general body aches

When assessing a patient with acute pylenephritis, the nurse would expect the patient to exhibit which of the following symptoms?

• High fever • Flank tenderness • Nausea and vomiting • Chills

A nine year-old boy has been diagnosed with the nephritic syndrome. Place the following stages in the development of his health problem in ascending order. Use all the options.

• Hypoalbuminemia • Proteins escape from plasma to glomerular filtrate. • Increased glomerular membrane permeability. • Accumulation of fluid in interstitial tissue (edema). • Decreased colloidal osmotic pressure

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.

• Massive proteinuria (>3.5 g/day) • Lipiduria • Generalized edema • Hyperlipidemia

Which are contributing factors of acute postinfectious glomerulonephritis? Select all that apply.

• Occurs after infection of group A ?-hemolytic streptococci. • May result from impetigo. • Primarily infects the pharynx.

Select the manifestations of renal cell carcinoma. Select all that apply.

• Often silent in the early stages • Hematuria • Palpable flank mass

A pediatric unit will be receiving an eight day-old infant with a suspected congenital renal disorder. Which of the following renal abnormalities could be the possible cause? Select all that apply.

• One of the infant's kidneys may have failed to develop normally. • The kidneys may be misshapen and have cysts present. • The upper or lower poles of the two kidneys may be fused.

Which of the following are appropriate interventions in the care of a patient diagnosed with renal calculi? Select all that apply.

• Straining the client's urine • Addressing the client's pain • Keeping track of intake and output