PrepU CH.25

A frantic mother brings her young child into the emergency department. She states that during the evening bath, she noticed a large mass in her child's abdomen. After diagnostic testing, the pediatrician tells the parents that their child has Wilms tumor, Stage IV. After the doctor leaves the room, the parents ask the nurse, "What does this mean?" The nurse will respond, "Your child ('s):

"has cancer of the kidney that has spread most likely to their lungs."

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 client who has urinary catheter in place due to confusion

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 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?

Acute pyelonephritis

A patient who developed acute pyelonephritis asks the nurse what caused the infection. Which should be included in thenurse'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 nurse is caring for a patient with diabetic glomerulosclerosis. The analysis is reviewed for the presence of which of the following manifestations?

Albumin

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

Which additional physical finding would you anticipate seeing in a child suspected of having a Wilms tumor?

Anomalies of the genitourinary system

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 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 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

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.

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

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

Catheter-associated bacteriuria

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

Elevated urine protein and hypoalbuminemia

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.

Which factor contributes to the development of polycystic kidney disease?

Hereditary mutations in polycystin I and II

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 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)

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

Hypoalbuminemia

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

Which stresses can cause injury to the kidney glomerulus? Select all that apply.

Immunologic Nonimmunologic Heredity Diabetes

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

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

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

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

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

Infection

Which of the following can be said about acute drug-induced interstitial nephritis? Select all that apply.

It is an autoimmune disease. It may be related to a sensitivity to sulfonamide drugs. It manifests as a fever, hematuria, mild proteinuria, and possibly a rash. It may result in acute renal failure.

Which statements are true regarding a Wilms tumor? Select all that apply.

It is the most common childhood malignant tumor. It presents with an abdominal mass Treatment includes chemotherapy, radiation and surgery

Wilms tumor is a tumor of childhood. It is usually an encapsulated mass occurring in any part of the kidney. What are the common presenting signs of a Wilms tumor?

Large asymptomatic abdominal mass and hypertension

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 caring for a patient who is diagnosed with acute poststreptococcal glomerulonephritis. Which of the following is the most common clinical presentation of this condition?

Nephritic syndrome

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

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.)

Potter facies Oligohydramnios Pulmonary hypoplasia Renal failure

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

The nurse working in the nursery is caring for a 4-day-old infant with autosomal recessive polycystic kidney disease (ARPKD). Which physical assessment findings would the nurse associate with this disease process? Select all that apply.

Severe hypertension 120/90 • Hypoventilation due to impaired lung development • Palpable masses located in the flank area bilaterally

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

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.

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

A client suffering from chronic hypertension is beginning to show the symptoms of glomerular disease. This client's kidney damage is due to what phenomenon?

The higher pressures force protein and cells through the glomerular membrane, resulting in glomerular inflammation.

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.

The family members of a client who has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD) asks the nurse what they should do to find out if they have this disease. The nurse will respond that they should visit with their healthcare provider and ask about having which lab/diagnostic test to screen for the disease?

Ultrasound of the kidney

A teenager has been admitted with the diagnosis of Alport Syndrome. The client has been passing large amounts of blood in the urine. Knowing that this disorder is inherited and associated with other abnormalities, the nurse should focus assessment on which area?

Visual disturbances and hearing loss

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?

Wilms tumour

A child has been admitted to the pediatric unit with a tentative diagnosis of lipoid nephrosis. While taking the history, which items lead the nurse to suspect the diagnosis is accurate? The child has a history of: Select all that apply.

recent upper respiratory infection. recent routine vaccines.

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

Manifestations of polycystic kidney disease include which of the following?

Increase in kidney size bilaterally

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?

Acute nephritic syndrome

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

Autoimmunity

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

Protein

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

A streptococcal infection 7 to 12 days prior to onset

An newborn has been diagnosed with renal agenesis. The nurse caring for the mother mentions some of the classic signs/symptoms of this disease. Which characteristic should the nurse mention to the parents as it relates to this disease? Select all that apply.

Epicanthic folds (skin of the upper eyelid) are present Low-set ears Receding chin

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

Acute pyelonephritis is an infection of the renal parenchyma and renal pelvis. What is a common cause of acute pyelonephritis?

Pseudomonas species

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.

Because the associated nephropathy is an important cause of end-stage renal failure in children and adolescents, a toddler who has had an uncomplicated bout of urinary tract infection (UTI) should still be evaluated for:

Vesicoureteral reflux

Acute pyelonephritis is a result of which of the following?

Bacterial infection

A patient is concerned that medication may damage his kidneys. Which factor(s) place the patient at most risk for developing a drug-related nephropathy? Select all that apply.

Age/elderly Prescription methicillin and other synthetic antibiotics Diuretics Procedures involving radiocontrast media Nonsteroidal anti-inflammatory drugs (NSAIDs)

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)

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.

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?

It is important that the patient take the prescribed antibiotic for the duration of the prescription.

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.

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.

Polyuria Nocturia

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

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

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?

Group A Β-hemolytic streptococci

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

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

Extracorporeal shock wave lithotripsy (ESWL)

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 client has been diagnosed with having calcium oxalate kidney stones following intravenous pyelography. Which of the following teaching points about the treatment of the health problem are justifiable? Select all that apply:

"You may need to cut out cocoa, chocolate and some nuts from your diet." "Extracorporeal shock-wave lithotripsy treatment may be used to fragment larger stones."

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."

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 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

Magnesium renal stones are associated with which of the following conditions?

Infection

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.

The family asks the nurse what the usual treatment of focal segmental glomerulosclerosis entails. The nurse responds:

corticosteroids.

During a physical assessment of a newborn in the nursery, the nurse palpates a mass over the kidney area. Testing reveals the infant has multicystic dysplastic kidney disorder. While educating the family, the nurse will share that many times the cysts will regress without intervention. However, the parents need to know the child will need annual: Select all that apply.

ultrasound, assessing cysts for possible cancer formation. blood pressure measurement, assuring proper functioning of unaffected kidney

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.

• Prognosis is good with treatment. • The tumor is limited to the kidney and can be excised with the capsular surface intact.

A client has been admitted with suspected kidney cancer. The client has had blood in the urine and some flank pain, but associated these sympstoms with a kidney stone, because of a previous experience This episode didn't go away, so the client sought treatment. The client asks the nurse what testing procedures would be ordered to confirm the diagnosis? The nurse responds: Select all that apply.

• ultrasound of the kidney looking for masses. • computerized tomography (CT) scan looking for lesions and metastasis. • magnetic resonance imaging (MRI) to identify if the inferior vena cava is involved