patho ch 45 Disorders of Kidney and Urinary Tract Structure and Function

A patient diagnosed with renal calculi is trying to pass the stone. Which intervention should the nurse expect to first initiate for this patient? ANSWER I DON'T KNOW YET Unselected Request the healthcare provider initiate antibiotic therapy. Unselected Prepare the patient for surgery. Unselected Prepare the patient for ultrasound. Correct THE CORRECT ANSWER Hydrate the patient.

Hydrate the patient. Acute management of a renal calculi starts with pain control and hydration to help flush the stone out if it is small enough. Surgery is not always required. Ultrasound to break up the stone is not always needed. Stones are not caused by infections.

Which substance should the nurse identify as being responsible for the formation of the majority of renal calculi? ANSWER I DON'T KNOW YET Unselected Struvite Unselected Uric acid Unselected Cysteine Correct THE CORRECT ANSWER Calcium

Struvite The majority of renal calculi are calcium-based. Uric acid, struvite, and cysteine stones can also form, but are seen much less frequently.

A patient presents with acute flank pain and is diagnosed with renal calculi. The nurse should understand that which condition led to the development of stones? ANSWER I DON'T KNOW YET Unselected Aggregation of crystals Unselected Nuclei formation Unselected Rapid urine flow Correct THE CORRECT ANSWER Supersaturation

Supersaturation Stone formation usually involves damage to the lining of the urinary tract, decreased amounts of substances that allow crystals to aggregate, and slow urine flow that allows urine to crystallize. Stone formation begins with the inability of crystals to dissolve because of their high concentration, also called supersaturation. The excretion of large amounts of calcium by the kidney, urinary pH, and a lack of inhibitors all promote stone formation. The supersaturation results in the aggregation of crystals, leading to nuclei formation and eventual stone development.

A client who just had a cystoscopy reports voiding a large amount of​ blood-tinged urine. Which action should the nurse​ perform? A. Give reassurance that​ blood-tinged urine is common after a cystoscopy. B. Fill out an incident report. C. Contact the urologist to report a complication. D. Take the​ client's vital signs.

​A. Give reassurance that​ blood-tinged urine is common after a cystoscopy. Rationale: Some​ blood-tinged urine is not uncommon after a​ cystoscopy; it is not a complication or a reportable event. The client needs​ reassurance; the client might misunderstand the​ nurse's immediate taking of vital signs without reducing natural anxiety first.

The nurse wants to assess a​ client's risk for the development of bladder cancer. Which question should the nurse​ ask? A. ​"Do you​ smoke?" B. ​"Do you use opioids for pain​ control?" C. ​"Are you​ diabetic?" D. ​"Do you have high blood​ pressure?"

​A. ​"Do you​ smoke?" Rationale: Smoking is a risk factor for bladder cancer. Opioid use does not contribute to bladder cancer risk. Diabetes and high blood pressure both contribute to renal​ neuropathy, not cancer.

A patient has just been diagnosed with stage I nonmetastasized renal cell carcinoma and asks the nurse about the expected treatment. Which response should the nurse give? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER "Surgery is usually the best option for treatment." Unselected "Chemotherapy will be used to treat the cancer." Unselected "Molecularly targeted therapy will be the best option for treatment." Unselected "Immunotherapy will be the best option for treatment."

"Surgery is usually the best option for treatment." Surgery is indicated for the treatment of renal cell carcinoma (RCC) and is considered curative if the disease has not metastasized. Stage I is an early stage where the tumor is less than 7 cm and there is no metastasis. Chemotherapy, immunotherapy, and molecularly targeted therapy are used in advanced cases of RCC.

A patient asks the nurse what albuminuria means. Which response should the nurse give? ANSWER I DON'T KNOW YET Unselected "Decreased oxidative stress to the glomeruli allows protein to leak out into the urine." Unselected "High blood sugar increases selective permeability and protein leaks out into the urine." Correct THE CORRECT ANSWER "The glomeruli lost selective permeability allowing protein to leak out into the urine." Unselected "The ureter is damaged allowing protein to leak out into the urine."

"The glomeruli lost selective permeability allowing protein to leak out into the urine." Hyperglycemia, or high blood sugar, is considered the driving force behind the development of nephropathy. Left untreated, hyperglycemia results in the glycosylation of amino acids, microvascular complications, and increased oxidative stress. This, along with comorbid hypoxia, cause the glomeruli to lose their selective permeability, resulting in proteinuria. The ureter is after the kidney and not involved in filtration of the blood. The permeability of the capillaries involves gas, nutrient, and waste exchange, and is not increased with diabetic neuropathy.

A client diagnosed with bladder cancer is being evaluated for metastasis. Which noninvasive diagnostic lab test should the nurse anticipate being​ ordered? A. Computerized tomography​ (CT) scans B. Bladder ultrasound C. Urine cytology D. Urinalysis

​A. Computerized tomography​ (CT) scans Rationale: A CT scan is a noninvasive diagnostic lab test used to evaluate metastasis of tumor invasion of nearby organs.​ Urinalysis, bladder​ ultrasound, and urine cytology are not used for the evaluation of bladder cancer tumor metastasis.

The nurse asks the client with urinary calculi to describe the pain. Which description should the nurse​ expect? A. Pain across both flanks B. Burning with urination C. Dull aching D. ​Intense, acute pain

​D. ​Intense, acute pain Rationale: Urinary calculi can cause an​ intense, acute onset of pain. Dull aching accompanies cystitis. Burning with urination occurs with a urinary tract infection. Pain would impact one​ flank, not both.

The nurse is planning a screening for those at risk of bladder cancer. Which group should the nurse​ target? A. Men B. Nonsmokers C. Women D. Infants and children

A. Men ​Rationale: Men are three times as likely as women to develop bladder cancer. As with renal cell​ carcinoma, smoking has been identified as the most important risk factor. This cancer primarily affects​ adults, with few cases occurring in infants and children.

The nurse is assessing a patient who has a smoking history, hematuria, urgency, and dysuria. Which diagnosis should the nurse suspect? ANSWER I DON'T KNOW YET Unselected Urinary tract infection Unselected Renal cell carcinoma Correct THE CORRECT ANSWER Bladder cancer Unselected Urinary output obstruction

Bladder cancer Clinical manifestations of bladder cancer include hematuria, inflammation related to signs of urinary tract infection, and urinary output obstruction. Smoking is a major risk factor for bladder cancer. Together, these factors are not related to renal cell cancer, urinary tract infection, or urinary obstruction.

The nurse is reviewing the health history of a patient. The patient has a longtime history of smoking. The nurse recognizes that the patient is at risk for which disorder? ANSWER I DON'T KNOW YET Unselected Hypertensive nephropathy Unselected Cystitis Correct THE CORRECT ANSWER Bladder cancer Unselected Nephrolithiasis

Bladder cancer Smoking has been identified as the most important risk factor for the development of bladder cancer. Smoking has not been identified as a risk factor for cystitis, hypertensive neuropathy, or nephrolithiasis.

The nurse is assessing a patient with nephritic syndrome. Which clinical manifestation should the nurse expect? Unselected Hypotension Correct THE CORRECT ANSWER Hematuria Unselected Increased renal function Unselected Pain with urination

Hematuria Nephritic syndrome is a manifestation of glomerulonephritis. The clinical presentation of nephritic syndrome includes hematuria, mild proteinuria, hypertension, and decreased renal function. Pain with urination is associated with infection and nephrolithiasis.

The nurse is assessing a patient who has diabetic nephropathy. Which clinical manifestation should the nurse expect? ANSWER I DON'T KNOW YET Unselected Hypofiltration Unselected Increased renal function Unselected Increased glomerular filtration rate Correct THE CORRECT ANSWER Hypertension

Hypertension Manifestations of diabetic nephropathy are albuminuria and hyperfiltration, as well as hypertension. Renal function and glomerular filtration are decreased.

After completing a health history, the nurse suspects that a patient is at risk for developing hypertensive nephropathy. Which disorder did the nurse find in the patient's history? ANSWER CORRECT Unselected Abdominal aortic stenosis Correct YOU WERE UNSURE AND CORRECT Kidney stones with chronic glomerulonephritis Unselected Epstein-Barr virus Unselected Hypothyroidism

Kidney stones with chronic glomerulonephritis A history of other renal disorders, such as glomerulonephritis, can increase the risk factors for developing hypertensive nephropathy. Hyperthyroidism, Epstein-Barr virus, and abdominal aortic stenosis are not conditions that can increase the risk of developing hypertensive nephropathy.

A patient asks the nurse what complications occur when hypertension is untreated. Which complication should the nurse include in the response? ANSWER I DON'T KNOW YET Unselected Vasodilation decreasing blood flow to the kidney Unselected Decreased sympathetic nervous system response Unselected Decreased renin production Correct THE CORRECT ANSWER Nephropathy

Nephropathy Hypertension (HTN) may lead to the progression of kidney damage and hypertensive nephropathy. The sympathetic nervous system response is increased due to HTN and causes vasoconstriction, decreasing blood flow to the kidney. Renin production is increased with HTN.

The nurse is teaching a class about factors that increase the risk of diabetic nephropathy. Which factor should the nurse include? ANSWER I DON'T KNOW YET Unselected Controlled blood sugars Correct THE CORRECT ANSWER Obesity Unselected Diabetic diet Unselected Caucasian American

Obesity Risk factors for developing diabetic nephropathy are poor glycemic control, uncontrolled hypertension, obesity, smoking, race, and genetic factors. African American, Hispanic, American Indian, and Asian American individuals are more likely to develop diabetic nephropathy compared to other ethnic and racial groups. A diabetic diet and control of blood sugar decrease the risk of nephropathy.

The nurse is caring for a patient being evaluated for bladder cancer. Which laboratory result is inconsistent with bladder cancer? ANSWER I DON'T KNOW YET Unselected Hematuria Unselected Urinary tract infection Unselected Urinary output obstruction Correct THE CORRECT ANSWER Proteinuria

Proteinuria Clinical manifestations of bladder cancer include hematuria, inflammation related to signs of urinary tract infection, and urinary output obstruction. Proteinuria is not a clinical manifestation of bladder cancer.

A patient has pain, fever, and costovertebral angle tenderness. Which diagnosis should the nurse expect based on these symptoms? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Pyelonephritis Unselected Urethritis Unselected Cystitis Unselected Prostatitis

Pyelonephritis Patients with acute pyelonephritis usually complain of costovertebral angle pain, chills, and fever and may also have lower UTI symptoms. The costovertebral angle pain points to pyelonephritis, not urethritis, cystitis, and prostatitis.

A patient has bladder cancer that has invaded the muscle. Which treatment should the nurse expect for the patient? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Radical cystectomy with urinary diversion or partial cystectomy Unselected Only chemotherapy needed to shrink the tumor Unselected Transurethral resection of bladder tumor Unselected Cystoscopy with urine cytology

Radical cystectomy with urinary diversion or partial cystectomy Radical cystectomy with urinary diversion or partial cystectomy is indicated for bladder cancer that has invaded the muscle. Cystoscopy is just a scope to view the bladder and evaluate the symptoms. A transurethral resection of the bladder tumor is used when the muscle is not involved. Chemotherapy and radiation are options for the treatment of bladder cancer that has invaded the muscle, as are the more invasive transurethral resection of the tumor and radical cystectomy.

A patient has dull and achy flank pain, bright red blood in the urine, a palpable abdominal mass, and weight loss. Which disorder should the nurse associate with these clinical manifestations? ANSWER I DON'T KNOW YET Unselected Benign prostatic hypertrophy Correct THE CORRECT ANSWER Renal cell cancer Unselected Prostate cancer Unselected Chronic renal failure

Renal cell cancer Symptoms of renal cell cancer may include hematuria, abdominal mass, weight loss, and dull, aching pain. The mass in the abdomen is not a manifestation of prostate cancer, chronic renal failure, or benign prostatic hypertrophy.

Which finding in the patient's history should the nurse know is a risk factor for bladder cancer? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Smoking Unselected Cervical cancer Unselected Kidney stone Unselected Prostate cancer

Smoking Smoking has been identified as the most important risk factor for the development of bladder cancer. The etiology for the development of bladder cancer does not include kidney stones, prostate cancer, or cervical cancer.

A patient has urine leakage while coughing. Which term should the nurse use to document this type of incontinence? ANSWER I DON'T KNOW YET Unselected Urgency Unselected Postural Correct THE CORRECT ANSWER Stress Unselected Continuous

Stress Stress urinary incontinence is the most common form of urinary incontinence. Patients usually complain of urine leaking with coughing or sneezing. Urgency incontinence is the loss of urine with feeling of urgency. Postural incontinence is the involuntary loss of urine with position change. Continuous incontinence is the complaint of continuous leaking of urine.

A patient tells the nurse, "I just started having pain with urination, urgency, and frequency." Which test should the nurse request be ordered by the healthcare provider? ANSWER CORRECT Correct YOU WERE UNSURE AND CORRECT Urinalysis Unselected Kidney biopsy Unselected Blood sugar level Unselected Urine culture

Urinalysis A diagnosis of uncomplicated cystitis is usually made on the basis of clinical symptoms. The patient may be treated empirically without a urine culture, but urinalysis may rule out bacteriuria. A urine culture with sensitivities should be obtained for recurring infections, treatment failure, or pyelonephritis, and in complicated cases of cystitis. A kidney biopsy is not needed with cystitis, because the problem is in the bladder. A blood sugar level will only be needed in recurrent bladder infections to rule out diabetes.

Which condition is the most common cause of chronic pyelonephritis in children? ANSWER I DON'T KNOW YET Unselected Diabetes mellitus coupled with infected urine Correct THE CORRECT ANSWER Vesicoureteral reflux (VUR) coupled with infected urine Unselected Neurogenic bladder coupled with infected urine Unselected Immuocompromised status coupled with infected urine

Vesicoureteral reflux (VUR) coupled with infected urine VUR, coupled with infected urine, is the most common cause of chronic pyelonephritis in children. An immunocompromised status, neurogenic bladder, and diabetes are also causes of pyelonephritis.

The nurse is caring for a client diagnosed with urethritis. Which health information in the​ client's chart likely contributed to the development of this​ condition? A. Agonococcal infection B. Asian American C. Cigarette smoking D. ​6-year-old

​A. Agonococcal infection Rationale: Urethritis is infection and inflammation of the urethra and is usually associated with sexually transmitted disease in men. Urinary calculi typically have higher incidence in clients who are Asian American. Vesicoureteral reflux typically has a higher incidence in infants and young children. Cancer of the ureter and renal pelvis typically has a higher incidence in cigarette smokers.

The nurse is caring for a client with invasive​ T3-4M1 stage bladder cancer. Which organ is the most likely site for​ metastasis? (Select all that​ apply.) A. Liver B. Kidneys C. Bones D. Lungs E. Pancreas

​A. Liver C. Bones D. Lungs Rationale: The most common sites of metastasis in clients with invasive bladder cancer are pelvic lymph​ nodes, liver,​ lungs, and bones. The kidneys and pancreas are not the most common sites of metastasis with invasive bladder cancer.

A client has a history of repeated urinary tract infections​ (UTIs). Which clinical situation should the nurse know may contribute to the cause of these​ infections? (Select all that​ apply.) A. Trauma to the urinary tract B. Decreased urinary motility C. Overhydration D. Urinary stasis E. Blockage in the urinary

​A. Trauma to the urinary tract B. Decreased urinary motility D. Urinary stasis E. Blockage in the urinary Rationale: Decreased urinary​ motility, urinary​ stasis, trauma to the urinary​ tract, and a blockage in the urinary tract can cause a UTI.​ Dehydration, not​ overhydration, can contribute to the development of UTI.

The nurse is caring for a client with impaired kidney function. Which laboratory test should the nurse​ monitor? A. Cardiac enzymes B. Blood urea nitrogen and creatinine C. Blood cultures D. White blood cell counts

​B. Blood urea nitrogen and creatinine Rationale: The primary labs the nurse will monitor for a client with renal alterations are blood urea nitrogen and creatinine. These two labs monitor only the kidney function. Blood cultures are ordered when a client has a possible bacterial infection. White blood cell counts are ordered when monitoring the​ client's immune system. Cardiac enzymes are generally ordered for a client who has a suspected myocardial infarction.

The nurse is assessing a client who is being evaluated for bladder cancer. Which assessment finding supports the​ diagnosis? (Select all that​ apply.) A. Incontinence B. Dysuria C. Urgency D. Nocturia E. Grossly obvious hematuria

​B. Dysuria C. Urgency E. Grossly obvious hematuria Rationale: Urination with bladder cancer is​ intermittent, accompanied by​ dysuria, urgency, and hematuria​ (blood in the​ urine). Hematuria can be grossly obvious or​ microscopic, and found only when a diagnostic urinalysis is performed. Nocturia and incontinence are not associated with the signs and symptoms of hematuria experienced by clients with bladder cancer.

The nurse is caring for a client who smokes two packs of cigarettes daily. Which action should the nurse perform to help prevent urinary​ disease? A. Encourage the client to increase intake of vegetables. B. Explore the​ client's desire to quit smoking cigarettes. C. Teach the client to increase fluid intake to 2​ L/day. D. Tell the client to have yearly examinations.

​B. Explore the​ client's desire to quit smoking cigarettes. Rationale: The greatest modifiable risk factor associated with bladder cancer is smoking​ cigarettes; therefore, the​ nurse's action is to explore the​ client's desire to quit smoking and for referral to smoking cessation programs. Encouraging the client to increase the intake of vegetables and daily amount of fluids will not decrease the risk for bladder cancer from smoking cigarettes.​ Similarly, exploring the​ client's ability to have regular examinations will not decrease the risk for bladder cancer from smoking cigarettes.

The nurse is assessing a client diagnosed with urethritis. Which clinical manifestation should the nurse expect to​ find? A. Intense flank pain B. Urinary incontinence C. Blood in the urine D. Fever and chills

​C. Blood in the urine Rationale: Blood in the urine or semen is a clinical manifestation of urethritis. Fever and chills are more likely to be found with pyelonephritis. Intense flank pain is a clinical manifestation of urinary calculi. Urinary incontinence is a clinical manifestation of urethral stricture.

The nurse is planning care for a client with hypertensive nephropathy. Which goal should the nurse​ include? A. Blood pressure of​ 155/90 mmHg B. Sodium intake of 3 grams per day C. Cessation of smoking D. Body mass index of 30

​C. Cessation of smoking Rationale: Cessation of smoking is a goal for the client with hypertensive nephropathy. A body mass index of 25 or less would be a goal. Blood pressure should be below​ 140/90 mmHg. Sodium should be 2.4 grams or less.

The nurse is caring for a client being evaluated for bladder cancer. Which diagnostic test is the healthcare provider most likely to prescribe to directly visualize a suspected tumor in the​ bladder? A. Intravenous pyelography B. Cystogram C. Cystoscopy D. ​Kidney, ureters, and bladder​ (KUB) study

​C. Cystoscopy Rationale: Cystoscopy is a diagnostic procedure that allows for direct visualization and biopsy of tumors in the​ urethra, bladder, or ureters. A cystogram is an​ x-ray of the bladder and lower urinary tract with contrast media to evaluate bladder filling and emptying. An intravenous pyelography is a procedure used to evaluate bladder​ function, known or suspected​ obstructions, and lesions or congenital​ anomalies, primarily to look for the cause of hematuria. A KUB study is an​ x-ray procedure used for evaluation of renal​ calculi, kidney​ size, and masses in the kidney.

The nurse is caring for a client with diabetes and hypertension. The client is prescribed an​ angiotensin-converting enzyme​ (ACE) inhibitor. Which blood level should be monitored in this​ client? A. Chloride B. Glucose C. Potassium D. Sodium

​C. Potassium Rationale: Clients who are started on​ angiotensin-converting enzyme​ (ACE) inhibitors or an angiotensin II receptor blocker​ (ARB) should have their potassium and creatinine levels assessed after initiation of treatment and during​ treatment, because either hyperkalemia or a decrease in renal function can occur after starting therapy.

he nurse is caring for a client diagnosed with vesicoureteral reflux​ (VUR). Which risk factor is the nurse most likely to find in the​ client's history? A. History of using analgesics B. Exposure to textile dyes C. Sibling with VUR D. Urinary tract infection

​C. Sibling with VUR Rationale: Having a sibling with vesicoureteral reflux​ (VUR) is a risk factor for the​ disease, because there is a genetic component to the disease. Urinary tract infection is a risk factor for developing urinary calculi. Use of certain analgesics and exposure to certain dyes are risk factors for developing cancer of the ureter or renal pelvis.

he nurse is reviewing the health history of a client diagnosed with bladder cancer. Which risk factor is the nurse most likely to find in the​ client's history? A. ​High-cholesterol diet B. Vegetarian diet C. Tobacco use D. Alcohol use

​C. Tobacco use Rationale: The nurse would expect to find tobacco use or cigarette smoking in the history of a client diagnosed with bladder cancer. Smokers are three times as likely to develop bladder cancer as compared to nonsmokers. A​ high-cholesterol diet, vegetarian​ diet, and alcohol use are not risk factors for bladder cancer.

The pregnant woman asks the nurse why a urine sample is needed to test for a urinary tract infection​ (UTI) if she has no burning with urination. How should the nurse​ respond? A. ​"If there is no​ burning, we can skip the​ test." B. ​"Your urgency to urinate is likely from the growing baby and not a​ UTI." C. ​"All pregnant women develop​ UTIs." D. ​"You may have an infection without any​ symptoms."

​D. ​"You may have an infection without any​ symptoms." Rationale: Pregnant women can develop asymptomatic​ cystitis, placing the unborn baby at risk. Screening should be done to detect asymptomatic infection. Not all women develop a UTI with​ pregnancy, and the growing baby contributes to​ urgency, but screening is done to detect asymptomatic infection.

A patient diagnosed with a renal calculi asks the nurse, "Why am I getting fluids and medications instead of having the stones surgically removed?" Which response by the nurse is accurate? ANSWER I DON'T KNOW YET Unselected "Ultrasound must be used to break up the stone and will cause more pain." Unselected "Antibiotics will be needed due to stones being caused by an infection in the kidney." Correct THE CORRECT ANSWER "If the stone is small enough, it is better to pass the stone spontaneously." Unselected "Surgery is always required, but pain needs to be addressed first."

"If the stone is small enough, it is better to pass the stone spontaneously." Acute management of a renal calculi starts with pain control and hydration to help decrease the pain and allow the stone to pass if it is small enough. Surgery is not always required. Ultrasound to break up the stone is not always needed. Stones are not caused by infections.

The nurse is teaching a colleague about how hypertension causes kidney damage. Which statement by the colleague indicates successful teaching? ANSWER I DON'T KNOW YET Unselected "Decreased renin production activates the renin angiotensin-aldosterone system." Unselected "The SNS stimulates the blood vessels to dilate decreasing blood flow to the kidney." Unselected "Decreased action of the sympathetic nervous system (SNS) causes kidney hypertrophy." Correct THE CORRECT ANSWER "Renin-angiotensin-aldosterone system (RAAS) activation leads to decreased blood flow to the kidney."

"Renin-angiotensin-aldosterone system (RAAS) activation leads to decreased blood flow to the kidney." Activation of the RAAS is a main cause of primary hypertension (HTN) that may lead to the progression of kidney damage and chronic kidney disease. The activation of the RAAS system further increases the BP and decreases blood flow to the kidney. The sympathetic nervous system response is increased due to HTN and causes vasoconstriction, decreasing blood flow to the kidney. Renin production is increased with HTN.

A patient is diagnosed with renal cell cancer. Which clinical manifestation is consistent with this disorder? ANSWER CORRECT Unselected Weight gain Unselected Proteinuria Unselected Fever Correct YOU WERE UNSURE AND CORRECT Abdominal mass

Abdominal mass Symptoms of renal cell cancer (RCC) may include hematuria, abdominal mass, weight loss, and dull, aching pain. Fever and proteinuria are not related to RCC.

The nurse is discussing symptoms not typically associated with diabetic nephropathy that indicate the need for a kidney biopsy. Which symptom should the nurse include? ANSWER I DON'T KNOW YET Unselected An increase in glomerular filtration rate after starting medications Correct THE CORRECT ANSWER An increase in hypertension after initiation of blood pressure medications Unselected Determination if renal cancer has developed due to the medication treatment Unselected Increased urine ouptut due to diuretic use

An increase in hypertension after initiation of blood pressure medications A biopsy is not usually indicated unless the patient exhibits additional symptoms that are not typically associated with diabetic nephropathy. Presentation of urinary RBC casts may indicate another glomerular disorder; a rapid decline in kidney function; increase in hypertension after initiation of angiotensin-converting enzyme (ACE) inhibitors; or angiotensin receptor blocker (ARB) may be a sign of renal artery stenosis. An increase in glomeular filtration rate and increased urine output are not associated with worsening nephropathy. Renal cancer is not associated with hypertension medications used in nephropathy.

The nurse is caring for a patient diagnosed with membranous glomerulonephritis. Which treatment should the nurse expect for this patient? ANSWER I DON'T KNOW YET Unselected Antibiotic therapy Unselected Radiation Correct THE CORRECT ANSWER Antihypertensive therapy Unselected Surgery

Antihypertensive therapy Membranous glomerulonephritis usually presents as a primary glomerular disorder and is one of the leading causes of nephritic syndrome. Management of membranous glomerulonephritis consists of controlling blood pressure with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB). Antibiotics are not necessary because this is not an infective process. Surgery and radiation may be used for the patient with cancer, not membranous glomerulonephritis.

A urinalysis has been ordered for a patient who reports urinary frequency and burning upon urination. Which disorder should the nurse expect the test to reveal? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Bacteriuria Unselected Cancer Unselected Pyelonephritis Unselected Diabetes

Bacteriuria A urinalysis may rule out bacteriuria. A urine culture with sensitivities should be obtained for recurring infections, treatment failure, or pyelonephritis, and in complicated cases of cystitis. A kidney biopsy is done for cancer. A blood sugar level will be needed in recurrent bladder infections to rule out diabetes.

Which substance should the nurse identify as being responsible for the formation of the majority of renal calculi? ANSWER Unselected Struvite Unselected Uric acid Unselected Cysteine Unselected Calcium

Calcium Age-related barriers to voiding, such as decreased sensory capacity, contribute to incontinence in older patients. Increased urgency may contribute to incontinence, but is not the most likely cause. Constipation and increased urine output are not considered causes of incontinence.

An older patient reports loss of appetite, confusion, lethargy, and painful urination. Which disorder should the nurse suspect in this patient? ANSWER I DON'T KNOW YET Unselected Pyelonephritis Correct THE CORRECT ANSWER Cystitis Unselected Prostatitis Unselected Urethrit

Cystitis The combination of anorexia, confusion (in the older patients), lethargy, and dysuria are symptoms of cystitis. Symptoms are not related to urethritis, pyelonephritis, or prostatitis.

A client has benign prostatic​ hypertrophy, drinks a lot of​ milk, eats a lot of salty​ food, and takes calcium supplements. Which risk factor should the nurse monitor to prevent a urinary tract infection​ (UTI)? A. Drinking a lot of milk B. Taking calcium supplements C. Eating a lot of salty food D. Benign prostatic hypertrophy

D. Benign prostatic hypertrophy ​Rationale: Benign prostatic hypertrophy can cause urinary obstruction and impede​ flow, which are risk factors for developing a UTI. Drinking a lot of​ milk, eating a lot of salty​ food, and taking calcium supplements are risk factors for renal​ calculi, not risk factors for developing a UTI.

An older adult patient reports urine incontinence. Which age-related change is most likely the cause of it? ANSWER INCORRECT Unselected Increased urinary output Correct THE CORRECT ANSWER Decreased sensation Incorrect YOU WERE UNSURE AND INCORRECT Increased urgency Unselected Constipation

Decreased sensation Age-related barriers to voiding, such as decreased sensory capacity, contribute to incontinence in older patients. Increased urgency may contribute to incontinence, but is not the most likely cause. Constipation and increased urine output are not considered causes of incontinence.

Which risk factor should the nurse know is related to the development of pyelonephritis? ANSWER INCORRECT Correct THE CORRECT ANSWER Diabetes mellitus Unselected Obesity Incorrect YOU WERE UNSURE AND INCORRECT Urinary incontinence Unselected Hypertension

Diabetes mellitus Risk factors for pyelonephritis include the following: female gender, including whether the woman is sexually active, the type of contraception used (diaphragm and/or spermicide), and whether she is pregnant; abnormal genitourinary tract as a result of cystic disease, obstruction, neurogenic bladder, or the presence of catheters or stents; immunocompromised host, such as the recipient of a kidney transplant; and diabetes mellitus. Hypertension, incontinence, and obesity are not risk factors.

Which should the nurse identify as the basis of classification of renal cell carcinoma (RCC)? ANSWER I DON'T KNOW YET Unselected Benign or malignant Unselected Signs and symptoms noted in the patient Correct THE CORRECT ANSWER Pathology Unselected Treatment needed

Pathology RCCs are classified on the basis of pathology; the most common is clear cell RCC. RCC is a malignant cancer, so it is not classified as malignant or benign. Treatment is based on the pathology and stage of cancer. Signs and symptoms do not classify the cancer.

A 7-year-old girl has a urinary tract infection (UTI). Which fact should the nurse know about this situation? Unselected Males cannot develop urinary tract infections. Correct THE CORRECT ANSWER UTIs in children are more common in females. Unselected Urinary tract infections take longer to treat in children. Unselected It is unusual for a 7-year-old child to have a UTI.

UTIs in children are more common in females. UTIs in children are more common in females. The majority of infections are caused by Escherichia coli (E. coli), a fecal pathogen. Females are more at risk for UTIs due to having a short urethra. Males can develop urinary tract infections, but the incidence is greater in females. Urinary tract infections respond to treatment equally in children as in adults.

Which patient is most at risk for pyelonephritis? ANSWER CORRECT Unselected Man with kidney transplant Unselected Man with renal stent placed in ureter Unselected Sexually active woman Correct YOU WERE UNSURE AND CORRECT Woman with neurogenic bladder and diabetes

Woman with neurogenic bladder and diabetes Risk factors for pyelonephritis include female gender, including whether the woman is sexually active, the type of contraception used (diaphragm and/or spermicide), and whether she is pregnant; abnormal genitourinary tract as a result of cystic disease, obstruction, neurogenic bladder, or the presence of catheters or stents; immunocompromised host, such as the recipient of a kidney transplant; and diabetes mellitus. The female with neurogenic bladder and diabetes has more risk factors for the development of pyelonephritis than the other patients.

A client newly diagnosed with primary bladder cancer asks the nurse how the disease developed. How should the nurse​ respond? A. ​"Cancer has traveled from another area of the body to the​ bladder." B. ​"Carcinogenic particles irritated and broke down the urothelial tissue layer of the​ bladder." C. ​"The bladder cancer tumors that develop are benign in​ nature." D. ​"Bladder cancer resulted from repeated​ infections."

​ B. ​"Carcinogenic particles irritated and broke down the urothelial tissue layer of the​ bladder." Rationale: Carcinogenic particles and cells that remain in the bladder irritate the urothelium layer. This irritation causes a breakdown in the urothelium​ tissues, allowing the carcinogenic particles to invade. Primary cancer is not metastasis from another site. The diagnosis of cancer is done through the presence of​ malignant, not​ benign, cells. Bladder cancer is linked to cigarette​ smoking, not infections.