Chapter 33: Renal System disorders

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

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.

A nurse is caring for a client with systemic lupus erythematosus (SLE). The client asks why a urinalysis is necessary. The best answer is that a urinalysis would determine whether which factor was present in the urine?

Blood or protein Explanation: Because of the high risk of kidney disease, all people with SLE should undergo routine urinalysis to monitor for the presence of hematuria or proteinuria.

A client has recently undergone diagnostic testing for possible BERGER DISEASE, IMMUNOGLOBULIN A NEPHROPATHY . The nurse caring for this client would anticipate the primary clinical manifestations to include which findings?

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

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

4-day-old infant with autosomal recessive polycystic kidney disease (ARPKD). Which physical assessment findings would the nurse associate with this disease process?

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

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 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 is the most likely diagnosis?

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.

The nurse suspects that a newborn infant who presents with bilateral flank masses, impaired lung development, and oliguria may be suffering from which disorder?

Autosomal recessive polycystic kidney disease (ARPKD) Explanation: The typical infant with ARPKD 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 procedure is a nonsurgical method of treatment for renal calculi (kidney stones)?

Extracorporeal shock wave lithotripsy (ESWL) Explanation: ESWL is a nonsurgical treatment that uses sound waves, laser, or dry shock wave energy to break apart the stones. All of the other procedures are surgical in nature

Which client would the nurse consider having the highest risk for developing a urinary tract infection?

Factors that contribute to the development of ascending infections of the urinary tract are outflow obstruction, catheterization and urinary instrumentation, vesicoureteral reflux, sexually active women, postmenopausal women, and neurogenic bladder.

The nurse is planning care for a client with a urinary tract obstruction. The nurse includes assessment for which possible complication?

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 client diagnosed with Goodpasture syndrome would require which therapy to remove proteins and autoantibodies from the system?

Plasmapheresis Explanation: Plasmapheresis is used to filter the blood for removal of proteins and the circulating anti-GBM antibodies. Renal transplantation would return the kidneys to normal function, but this is the extreme of treatment.

Congenital bilateral renal dysplasia can cause which problems during pregnancy and following delivery? Select all that apply.

Potter facies Oligohydramnios Pulmonary hypoplasia Renal failure

An older adult client has been hospitalized for the treatment of acute pyelonephritis. Which characteristic of the client is most likely implicated in the etiology of this current health problem?

Recently had a urinary tract infection Explanation: There are two routes by which bacteria can gain access to the kidney: ascending infection from the lower urinary tract and through the bloodstream. Ascending infection from the lower urinary tract is the most important and common route by which bacteria reach the kidney, resulting in acute pyelonephritis

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 Explanation: The tolerance to drugs varies with age and depends on renal function, state of hydration, blood pressure, and the pH of the urine.

One of the most damaging effects of urinary obstruction on kidney structures is which effect?

Urinary stasis Explanation: The most damaging effects of urinary obstruction are stasis of urine, which predisposes to infection and stone formation, and progressive dilation of the renal collecting ducts and renal tubular structures.

A nurse is caring for a client with diabetic glomerulosclerosis. The presence of which substance in the urine would be used in diagnosing this condition?

albumin Explanation: Microalbuminuria is an important predictor of future diabetic nephropathies and is evidence of glomerular damage. Normally, albumin as a large protein molecule, should not be passed through the glomerular filtration process. Microalbuminuria is defined as urinary albumin excretion of 30 to 300 mg in 24 hours