Patho - Quiz 7

An elderly female patient has been hospitalized for the treatment of acute pyelonephritis. Which of the following characteristics of the patient is most likely implicated in the etiology of her current health problem? a) The patient recently had a urinary tract infection. b) The patient has peripheral vascular disease. c) The patient takes a diuretic and an ACE inhibitor each day for the treatment of hypertension. d) The patient was diagnosed with type 2 diabetes several years earlier.

a) The patient recently had a urinary tract infection.

The most recent assessment of a patient with a diagnosis of type 1 diabetes indicates a heightened risk of diabetic nephropathy. Which of the following assessment findings is most suggestive of this increased risk? a) Microalbuminuria b) Diabetic retinopathy c) Hematuria d) Orthostatic hypotension

a) Microalbuminuria

A 24-year-old college student has presented to the campus medical clinic with complaints of frequent, burning urination and has, subsequent to urinalysis, been diagnosed with an acute lower urinary tract infection (UTI) caused by E. coli. What teaching will the clinician most likely provide to the student? a) "Many of these bacteria are now resistant to some antibiotics, but I will take that into account when I choose which antibiotic to prescribe." b) "This likely shows that you have some sort of obstruction in your urinary system, so when that is treated your UTI will likely resolve as well." c) "This should likely resolve itself if you drink a lot of water and especially cranberry or blueberry juice." d) "Unfortunately, the bacteria causing your infection is no longer responsive to antibiotics, but there are alternative treatments that we can use."

a) "Many of these bacteria are now resistant to some antibiotics, but I will take that into account when I choose which antibiotic to prescribe."

A nurse educator is performing client education with a 51-year-old man who has been recently diagnosed with chronic kidney disease. Which of the following statements by the client would the nurse most likely want to correct or clarify? a) "My kidney problems increase my chance of developing high blood pressure or diabetes." b) "I'll have a risk of either bleeding too easily or possibly clotting too quickly, though dialysis can help minimize these effects." c) "My heart rate might go up because of my kidney disease, and my blood might be a lot thinner than it should be." d) "I'll be prone to anemia, since I'm not producing as much of the hormone that causes my bones to produce red blood cells."

a) "My kidney problems increase my chance of developing high blood pressure or diabetes."

Which of the following medications would the nurse anticipate being prescribed for the renal failure patient who has hyperphosphatemia? a) Calcium carbonate b) Levothyroxine (Synthroid) c) Sensipar (Cinacalcet) d) Vitamin D (calcitriol)

a) Calcium carbonate

Which of the following patient complaints most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma? a) Hematuria b) Cloudy urine c) Oliguria d) Urinary urgency

a) Hematuria

The nurse is providing care for a patient who has a diagnosis of kidney failure. Which of the following laboratory findings is consistent with this patient's diagnosis? a) Hypocalcemia b) Hypokalemia c) Hypophosphatemia d) Metabolic alkalosis

a) Hypocalcemia

A patient has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal calculi. Which of the following measures should the patient integrate into his lifestyle to reduce the risk of recurrence? a) Increased fluid intake and dietary changes b) Increased physical activity and use of over-the-counter diuretics c) Weight loss and blood pressure control d) Regular random blood glucose testing

a) Increased fluid intake and dietary changes

Which of the following descriptions is true of peritoneal dialysis? a) Treatment involves the introduction of a sterile dialyzing solution, which is drained after a specified time. b) Vascular access is achieved through an internal arteriovenous fistula or an external arteriovenous shunt. c) The dialyzer is usually a hollow cylinder composed of bundles of capillary tubes. d) Treatments typically occur three times each week for three to four hours.

a) Treatment involves the introduction of a sterile dialyzing solution, which is drained after a specified time.

The most common indicator of acute renal failure is: a) azotemia. b) uremia. c) anemia. d) edema.

a) azotemia.

Regardless of the cause, chronic kidney disease results in progressive permanent loss of nephrons, glomerular filtration and renal: a) endocrine functions. b) vascular pressure. c) hypophosphatemia. d) tubule dysplasia.

a) endocrine functions.

The kidney assists in blood pressure regulation by releasing_______ from the juxtaglomerular cells in response to decreased renal blood flow, resulting in efferent arteriole vasoconstriction. a) renin b) aldosterone c) angiotensin I d) angiotensin II

a) renin

The most damaging effects of urinary obstruction are the result of _____ and unrelieved obstruction of urine outflow. a) kidney hyperplasia b) urinary stasis c) concentrated urine d) renal hypertension

b) urinary stasis

An adult patient has been diagnosed with polycystic kidney disease. Which of the patient's following statements demonstrates an accurate understanding of this diagnosis? a) "I had a feeling that I was taking too many medications, and now I know the damage they can do." b) "I suppose I should be tested to see if my children might inherit this." c) "I've always been prone to getting UTIs, and now I know why." d) "I suppose I really should have paid more attention to my blood pressure."

b) "I suppose I should be tested to see if my children might inherit this."

A patient with a recent diagnosis of renal failure that will require hemodialysis is being educated in the dietary management of the disease. Which of the patient's following statements shows an accurate understanding of this component of treatment? a) "I'm making a point of trying to eat lots of bananas and other food rich in potassium." b) "I've made a list of high-phosphate foods so that I can try to avoid them." c) "I don't think I've been drinking enough, so I want to include 8 to 10 glasses of water each day." d) "I'm going to try a high-protein, low-carbohydrate diet

b) "I've made a list of high-phosphate foods so that I can try to avoid them."

Which of the following individuals likely faces the greatest risk for the development of chronic kidney disease? a) A patient who experienced a hemorrhagic stroke and now has sensory and motor deficits b) A patient with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet c) A first-time mother who recently lost 1.5 L of blood during a postpartum hemorrhage d) A patient whose diagnosis of thyroid cancer necessitated a thyroidectomy

b) A patient with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet

Which of the following data would a clinician consider as most indicative of acute renal failure? a) Decreased serum creatinine and blood urea nitrogen (BUN); decreased potassium and calcium levels b) Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR) c) Decreased urine output; hematuria; increased GFR d) Alterations in blood pH; peripheral edema

b) Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR)

Which of the following physiologic processes is performed by the kidneys and contributes to increased blood pressure? a) Secretion of aldosterone b) Production and release of renin c) Catalysis of the conversion of angiotensin I to angiotensin II d) Conversion of aldosterone to angiotensin

b) Production and release of renin

An athlete has become dehydrated during a long race in hot weather. Which of the following physiologic processes will occur in an attempt to protect the athlete's extracellular fluid volume? a) Dilation of the afferent and efferent arterioles b) Release of ADH from the posterior pituitary c) Increased water reabsorption in the distal convoluted tubule d) Increased water reabsorption in the ascending limb of the loop of Henle

b) Release of ADH from the posterior pituitary

In addition to regulating body fluids and electrolytes, the kidneys function in maintaining bone calcium levels by: a) synthesizing erythropoietin. b) activating vitamin D. c) stimulating bone marrow. d) excreting bicarbonate.

b) activating vitamin D.

Glomerulonephritis is usually caused by: a) glomerular membrane viruses. b) antigen-antibody complexes. c) catheter-induced infection. d) vesicoureteral reflux.

b) antigen-antibody complexes.

A patient had excessive blood loss and prolonged hypotension during surgery. His postoperative urine output is sharply decreased and his blood urea nitrogen (BUN) is elevated. The most likely cause for the change is acute: a) intrarenal nephrotoxicity. b) ischemic tubular necrosis. c) prerenal inflammation. d) bladder outlet obstruction.

b) ischemic tubular necrosis.

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

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

A 42-year-old male has been diagnosed with renal failure secondary to diabetes mellitus and is scheduled to begin dialysis soon. Which of the following statements by the client reflects an accurate understanding of the process of hemodialysis? a) "It's stressful knowing that committing to dialysis means I can't qualify for a kidney transplant." b) "Changing my schedule to accommodate 3 or 4 hours of hemodialysis each day will be difficult." c) "I won't be able to go about my normal routine during treatment." d) "I know I'll have to go to a hospital or dialysis center for treatment."

c) "I won't be able to go about my normal routine during treatment."

The clinical nurse educator on a nephrology unit of a large, urban hospital is orientating recent nursing graduates to the unit. Which of the following teaching points about acute tubular necrosis (ATN) should the educator include in the orientation session? a) "The cardinal signs of ATN are oliguria and retention of potassium, creatinine, and sulfates." b) "Ureteral and bladder outlet obstructions are often contributors to ATN." c) "Trauma, burns, and major surgery are common precursors to ATN." d) "Tubular epithelial cells are sensitive to ischemia and toxins, and damage is irreversible."

c) "Trauma, burns, and major surgery are common precursors to ATN."

Which of the following clinical findings among older adults is most unlikely to warrant further investigation and possible treatment? a) An 81-year-old male's serum creatinine level has increased sharply since his last blood work. b) A 90-year-old female's blood urea nitrogen (BUN) is rising. c) A 78-year-old female's GFR has been steadily declining over several years. d) An 80-year-old male whose urine dipstick reveals protein is present.

c) A 78-year-old female's GFR has been steadily declining over several years.

A patient has a diagnosis of chronic renal failure secondary to diabetic nephropathy. Which of the following hematologic changes may result from this patient's kidney disorder? a) Leukopenia b) Leukocytosis c) Anemia d) Thrombocytopenia

c) Anemia

Which of the following integumentary problems most often accompanies chronic kidney disease? a) Alopecia b) Petechiae and purpura c) Dry skin and pruritus d) Hirsutism and psoriasis

c) Dry skin and pruritus

A patient is beginning to recover from acute tubular necrosis. The recovery phase of ATN is characterized by: a) proteinuria. b) hypokalemia. c) diuresis. d) edema.

c) diuresis.

Only the kidneys can eliminate ____ from the body as a means of regulating body acid-base balance, when urine buffers are present. a) potassium (K+) b) ammonia (NH3) c) hydrogen (H+) d) phosphate (HPO4)

c) hydrogen (H+)

The edema that develops in persons with glomerulonephritis and nephrotic syndrome reflects: a) obstruction and reflux. b) inability to concentrate urine. c) salt and water retention. d) decreased glomerular permeability.

c) salt and water retention.

When the glomerular transport maximum for a substance such as blood glucose is exceeded and its renal threshold has been reached, the substance will: a) reabsorb quickly. b) counter-transport sodium. c) spill into the urine. d) attach to protein carriers.

c) spill into the urine.

A patient with a diagnosis of chronic kidney disease (CKD) may require the administration of which of the following drugs to treat the consequences of CKD?a) Antiarrhythmic medications b) Nonsteroidal anti-inflammatory drugs (NSAIDs) c) Opioid analgesics d) Antihypertensive medications

d) Antihypertensive medications

A patient's most recent blood work reveals a blood urea nitrogen (BUN) level of 36 mg/dL (normal range 8 to 25 mg/dL). Which of the following factors may have contributed to this finding? a) Parasympathetic nervous stimulation b) Action of ADH c) Increased salt intake d) Dehydration

d) Dehydration

Which of the following assessment findings is most suggestive of nephrotic syndrome? a) Renal colic and increased serum sodium b) Increased creatinine with normal blood urea nitrogen c) Hematuria and anemia d) Proteinuria and generalized edema

d) Proteinuria and generalized edema

Which one of the following blood tests reflects the glomerular filtration rate (GFR) and is used to estimate renal function? a) Blood urea nitrogen b) Blood protein c) Serum ammonia d) Serum creatinine

d) Serum creatinine

To maintain hematocrit levels in people with kidney failure, the nurse should be prepared to a) arrange for frequent blood transfusions in an outpatient clinic. b) administer prenatal vitamins twice a day. c) administer iron dextran intravenously. d) administer a subcutaneous injection of recombinant human erythropoietin (rhEPO).

d) administer a subcutaneous injection of recombinant human erythropoietin (rhEPO).

High-risk factors for development of adult renal cell cancer include: a) adrenal medulla tumors. b) inherited renal disease. c) anorexia/bulimia disorder. d) heavy smoking.

d) heavy smoking.

A characteristic manifestation of polycystic kidney disease is: a) massive proteinuria. b) renal colic. c) alkaline urine. d) hypertension.

d) hypertension

The functional unit of the kidney is known as the: a) cecum b) bladder c) trigone d) nephron

d) nephron

The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to: a) antibody complexes. b) inflammatory cells. c) red blood cells. d) plasma proteins.

d) plasma proteins.