PrepU Ch. 25: Disorders of Renal Function
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. The use of ACE inhibitors will increase the vasopressin levels. ACE inhibitors should be used strictly in those clients who also have an underlying cardiac history. The ACE inhibitors have been shown to shrink the size of the cysts inside the kidneys.
ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction. Explanation: 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 diagnosed with systemic lupus erythematosus. The client now presents with sudden hematuria, variable proteinuria, and a decreased glomerular filtration rate. Which of the following is a probable diagnosis? Goodpasture syndrome Acute nephritic syndrome Acute nephrotic syndrome Chronic glomerulonephritis
Acute nephritic syndrome Explanation: Acute nephritic syndrome may occur as a secondary complicating disorder in systemic diseases, such as SLE. In its most dramatic form, acute nephritic syndrome is characterized by sudden onset of hematuria, variable degrees of proteinuria, diminished glomerular filtration rate (GFR), oliguria, and signs of impaired renal function.
A patient is being evaluated for kidney stones. The nurse anticipates the patient will manifest: Elevation in systemic blood pressure and frequent urination A visible abdominal mass and abdominal pain Increased thirst and increased urinary output Acute onset of colicky or dull and achy intermittent flank pain
Acute onset of colicky or dull and achy intermittent flank pain Explanation: 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.
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? Renal cell carcinoma Acute renal failure Acute pyelonephritis Renal calculi
Acute pyelonephritis Explanation: 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 nurse is caring for a patient with diabetic glomerulosclerosis. The analysis is reviewed for the presence of which of the following manifestations? Sodium Red blood cells Potassium Albumin
Albumin Explanation: 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.
A client has been given the diagnosis of diffuse glomerulonephritis. They ask the nurse what diffuse means. The nurse responds: That the mesangial cells are being affected. Only some of the glomeruli are affected. All glomeruli and all parts of the glomeruli are involved. Only one segment of each glomerulus is involved.
All glomeruli and all parts of the glomeruli are involved. Explanation: 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.
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? Horseshoe kidney abnormality Simple renal cysts Autosomal dominant polycystic kidney disease Autosomal recessive polycystic kidney disease (ARPD)
Autosomal recessive polycystic kidney disease (ARPD) Explanation: 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 of the following patients is at greatest risk for developing a urinary tract infection (UTI)? Elderly female patient admitted with an indwelling Foley catheter that has been in place for 1 month Male patient two days postoperative hip fracture repair whose Foley catheter was removed on postoperative day 1 Middle-aged male patient admitted for dehydration due to strenuous exercise in hot weather Woman who has just given birth and had a straight urinary catheter inserted prior to delivery
Elderly female patient admitted with an indwelling Foley catheter that has been in place for 1 month Explanation: Urinary catheters are a source of urethral irritation and provide a means for entry of microorganisms into the urinary tract. Catheter-associated bacteriuria remains the most frequent cause of Gram-negative septicemia in hospitalized patients. A catheter in place for 1 month places the patient at greatest risk for a UTI.
A 10-year-old girl has developed a lower urinary tract infection (UTI). Which symptoms does the nurse correlate with this diagnosis in the older child? Select all that apply. Suprapubic discomfort Abdominal pain Dysuria Enuresis Vomiting
Enuresis Dysuria Suprapubic discomfort Explanation: In older children with lower UTIs, the classic features—enuresis, frequency, dysuria, and supraputbic discomfort—are more common. Abdominal pain is seen in toddlers. Vomiting is also seen in toddlers.
Most common uncomplicated urinary tract infections are caused by ____ that enter through the urethra. Pseudomonas Group B Streptococcus Escherichia coli Staphylococcus aureus
Escherichia coli Explanation: Most commonly urinary tract infections (UTIs) are caused by Escherichia coli bacteria that enter through the urethra. Other uropathic pathogens include Staphylococcus saprophyticus in uncomplicated UTIs, and both non-E. coli gram-negative rods (Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas) and gram-positive cocci (Staphylococcus aureus, Group B Streptococcus) in complicated UTIs.
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? Increase washout of urine Thin mucus to prevent bacterial adherence Increase immune availability Decrease acidity of urine
Increase washout of urine Explanation: 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.
The acute care unit has had an increase in Gram-negative septicemia over the last 6 months. Which of the following would the infection care nurse know might require clinical focus of the most common cause of these types of infections? Knowledge of starting IV fluids Knowledge of the administration of subcutaneous insulin Knowledge of performing activities of daily living Knowledge of aseptic technique when inserting urethral catheters
Knowledge of aseptic technique when inserting urethral catheters Explanation: Knowledge of aseptic techniques when inserting urethral catheters is essential when there are incidences of catheter-associated bacteriuria. Catheter-associated bacteriuria remains the most frequent cause of Gram-negative septicemia in hospitalized patients. Studies have shown that bacteria adhere to the surface of the catheter and initiate the growth of a biofilm that then covers the surface of the catheter.
The nurse should assess which of the following when assessing for the initial presence of edema in a patient with nephrotic syndrome? Hands Entire abdomen Eyelids Lower extremities
Lower extremities Explanation: 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.
Which one of the following would the nurse see as being liable to cause the most serious long-term problems? Horseshoe kidney Simple renal cyst Unilateral renal agenesis Polycystic kidney disease
Polycystic kidney disease Explanation: 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.
The nurse is reviewing the lab results of a patient with suspected nephrotic syndrome. The nurse anticipates that the results to include: Decreased low-density lipoproteins Serum hyperalbuminemia Protein in the urine Abnormal blood clotting factors Decreased tryglycerides
Protein in the urine Explanation: In a person with nephrotic syndrome there is massive proteinuria (protein in the urine), serum hypoalbuminemia, generalized edema and hyperlipidemia.
Which of the following assessment findings would lead the nurse to suspect the client has nephrotic syndrome? Proteinuria and generalized edema Increased creatinine with normal blood urea nitrogen Hematuria and anemia Renal colic and increased serum sodium
Proteinuria and generalized edema Explanation: The nephrotic syndrome is characterized by massive proteinuria and lipiduria, along with an associated hypoalbuminemia, generalized edema, and hyperlipidemia.
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? Low calcium levels Reduced production of erythropoietin Poor dietary intake of iron Hemorrhage
Reduced production of erythropoietin Explanation: 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.
While taking a client history, which assessment findings lead the nurse to suspect the client may have polycystic kidney disease? Select all that apply. Renal colic with flank pain Shortness of breath (SOB) with loud rhonchi and wheezes heard on auscultation Massive proteinuria on dipstick urine specimen Elevated blood pressure of 180/94 Bright red blood in urine sample
Renal colic with flank pain Bright red blood in urine sample Elevated blood pressure of 180/94 Explanation: The manifestations of ADPKD include pain from the enlarging cysts that may reach debilitating levels, episodes of gross hematuria from bleeding into a cyst, infected cysts from ascending UTIs, and hypertension resulting from compression of intrarenal blood vessels with activation of the renin-angiotensin mechanism. Renal colic caused by nephrolithiasis, or kidney stones, occurs in about 20% of persons with ADPKD. One type of pain associated with kidney stones is renal colic, described as colicky pain that accompanies stretching of the collecting system or ureter. Nephrotic syndrome is characterized by massive proteinuria. SOB with abnormal respiratory sounds is not usually associated with ADPKD.
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 Decrease dietary fats Walking program Increase dietary sodium intake
Smoking cessation program Explanation: 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.
Which of the following are appropriate interventions in the care of a patient diagnosed with renal calculi? Select all that apply. Keeping track of intake and output Inserting a Foley catheter Straining the client's urine Restricting the client's oral fluid intake Addressing the client's pain
Straining the client's urine Addressing the client's pain Keeping track of intake and output Explanation: 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 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? The woman has multiple sexual partners. The woman does not clean herself properly. The woman takes too many bubble baths. There is possible obstruction in the urinary tract.
There is possible obstruction in the urinary tract. Explanation: 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.
One of the complications of asymptomatic urinary tract infection (UTI) during pregnancy is the risk of preterm birth. True False
True Explanation: Complications of asymptomatic UTI during pregnancy include preterm delivery of low birth weight infants, acute and chronic pyelonephritis, and persistent bacteriuria.
A nurse is caring for a six-year-old girl who exhibits manifestations of a urinary tract infection but whose urine culture is negative for microorganisms. Which must be considered when urinary symptoms are present in the absence of bacteriuria? Select all that apply. Excessive cranberry juice intake Vaginitis Sexual molestation Pinworms Viral cystitis
Vaginitis Sexual molestation Viral cystitis Pinworms Explanation: Urinary symptoms in the absence of bacteriuria suggest vaginitis, urethritis, sexual molestation, use of irritating bubble baths, pinworms, or viral cystitis. Cranberry juice is not a causative agent.
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: acute postinfectious glomerulonephritis. kidney stones. acute renal failure. nephrotic syndrome.
acute postinfectious glomerulonephritis. Explanation: 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 decreases, is one of the first symptoms.
Glomerulonephritis is usually caused by: Glomerular membrane viruses Vesicoureteral reflux Catheter-induced infection Antigen-antibody complexes
Antigen-antibody complexes Explanation: Two types of immune mechanisms have been implicated in the development of glomerular disease: injury resulting from antibodies reacting with fixed glomerular antigens and injury resulting from circulating antigen-antibody complexes that become trapped in the glomerular membrane. Reflux, which is the most common cause of chronic pyelonephritis, results from superimposition of infection on congenital vesicoureteral reflux or intrarenal reflux. Urinary catheters provide a means for microorganisms to ascend into the urinary tract to cause bladder infections or pyelonephritis.
A patient informs the nurse that she is having problems with frequent urinary tract infections (UTIs). Which of the following suggestions can the nurse make that may prevent UTIs by reducing bacterial adherence to the epithelial lining of the urinary tract? Cranberry juice Dairy products such as milk and cheese Oranges Herbal teas
Cranberry juice Explanation: Cranberry juice has been suggested as a preventive measure for women with recurrent UTIs. Evidence suggests that cranberry juice reduces bacterial adherence to the epithelial lining of the urinary tract. Because of its mechanism of action, the juice is also being studied with periodontal disease and Helicobacter pylori-associated gastritis and has been documented as an antioxidant and possible cholesterol-lowering therapy.
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 Decreased blood pressure Polyuria Diluted urine
Increased blood pressure Explanation: Urinary tract obstruction can lead to hypertension related to increased renin secretion. The urine output would be decreased and not diluted.
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? Because the patient received antibiotics in the hospital, there are no further medications required. Restrict fluid intake to 1 L/day. The patient will require bed rest at home for 7 days. It is important that the patient take the prescribed antibiotic for the duration of the prescription.
It is important that the patient take the prescribed antibiotic for the duration of the prescription. Explanation: 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.
Drug-related nephropathies 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 Vesicoureteral reflux Medication class Proteinuria
State of hydration Explanation: 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.
The nurse is evaluating her patient's risk for an urinary tract infection. Which of the following patients has the highest risk? Patient with infective endocarditis Patient with septicemia Patient with high levels of glucose in the urine Patient with obstructed urinary outflow from the kidney
Patient with obstructed urinary outflow from the kidney Explanation: 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.
Which of the following is the most common cancer of the kidney? Wilms tumor Renal cell carcinoma Lymphoma Transitional cell carcinoma
Renal cell carcinoma Explanation: Renal cell carcinoma accounts for 80% to 90% of all kidney tumors.
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? Administering ibuprophen 600 mg prior to the procedure Having the patient take nothing by mouth Administering one unit of packed red blood cells Increasing the normal saline intravenous infusion rate to 125 mL/hour
Increasing the normal saline intravenous infusion rate to 125 mL/hour Explanation: 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.
