PATHO [ M.7- ]

The nurse is providing care for a client who has a diagnosis of kidney failure. Which of the following laboratory findings is consistent with this client's diagnosis? Elevation in vitamin D levels Hypocalcemia Hypokalemia Hypophosphatemia

Hypocalcemia

Impaired skin integrity and skin manifestations are common in persons with chronic kidney disease. Pale skin and subcutaneous bruising are often present as a result of: Impaired platelet function Anticoagulant therapy Thrombocytopenia Decreased vascular volume

Impaired platelet function

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

Anemia

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

Production and release of renin

A public health nurse is conducting a health promotion class for a group of older adults. Which of the participants' following statements demonstrates an accurate understanding of the risk factors for bladder cancer? "I suppose I should listen to my doctor and drink more cranberry juice." "I can see that preventing bladder cancer is one more benefit of a healthy diet." "I think I should be okay because there's no history of bladder cancer in my family that I'm aware of." "More than ever, I guess it would worthwhile for me to quit smoking."

"More than ever, I guess it would worthwhile for me to quit smoking."

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

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

A bladder cancer client asks the nurse, "What did the doctor mean by intravesicular chemotherapy? Am I going to lose all my hair and have to do for treatments over months and months?" The best response would be: "This is when they use a CyberKnife to cut off any lesions and then inject chemotherapy into the remaining portion of the bladder." "They will take you to radiology and inject some chemotherapy through your abdomen into your bladder." "This is when they put the chemotherapy directly into the bladder to kill any cancer cells." "The doctor will place a scope up your urethra, into the bladder, and burn the lining of the bladder with a laser and then inject some tuberculosis bacillus into the lining."

"This is when they put the chemotherapy directly into the bladder to kill any cancer cells."

A client has been prescribed hydrochlorothiazide, a thiazide diuretic, to control high blood pressure. While educating the client about the actions of the medication, the nurse will mention which of the following actions? Select all that apply( 2 answers) .

- Increases active reabsorption of Ca++ into the blood - Blocks Na+ reabsorption in distal tubules

A 43-year-old female has recently been diagnosed with systemic lupus erythematosus (SLE) glomerulonephritis. She has presented to the out-client department to have a renal biopsy. Knowing the usual treatment options, the nurse should anticipate educating the client (who has a positive biopsy result) on which of the following medications being prescribed? Select all that apply ( 2 answers).

- Prednisone, a corticosteroid - Captopril, an ACE inhibitor

Nitric oxide, a vasodilator produced by the vascular endothelium, is important in renal control by: Select all that apply ( 2 answers).

- Preventing excessive vasoconstriction - Allowing normal excretion of sodium and water

If a CKD client is developing uremic encephalopathy, the earliest manifestations may include: Select all that apply ( 2 answers).

- decreased alertness - diminished awareness

The nurse should anticipate that a client who collapsed while running his or her first marathon and has a urine specific gravity of 1.035 is experiencing:

- dehydration The usual range of specific gravity is 1.010 to 1.025 with normal fluid intake. Healthy kidneys can produce concentrated urine with specific gravity of 1.030 to 1.040 during periods of dehydration and dilute urine with a specific gravity that approaches 1.000 during periods of too much fluid intake. Frostbite, sunstroke, and exhaustion do not change urine specific gravity if fluid volume is normal.

Following the diagnosis of nephrotic syndrome, the nurse knows the clinical manifestations occur as a result of a decreased plasma colloidal osmotic pressure. Therefore, the nurse should assess the client for: Select all that apply ( 3 answers).

- most crackles in both lung fields - increased circumference in the abdomen related to fluid excess - area of diminished breath sounds due to pleural effusions

A 40-year-old female with the diagnosis of multiple sclerosis has been experiencing severe bladder spasms along with less bladder volume. This is likely due to: Select all that apply ( 2 answers).

- uninhibited bladder - neurogenic detrusor overactivity

Which of the following clients is likely at the greatest risk of developing a urinary tract infection? A client with a diagnosis of chronic kidney disease who requires regular hemodialysis A confused, 81-year-old client who is incontinent of urine A pregnant woman who has been experiencing urinary frequency A 79-year-old client with an indwelling catheter for urinary incontinence

A 79-year-old client with an indwelling catheter for urinary incontinence

Which of the following clients is likely at the greatest risk of developing a urinary tract infection? A 79-year-old client with an indwelling catheter for urinary incontinence A confused, 81-year-old client who is incontinent of urine A pregnant woman who has been experiencing urinary frequency A client with a diagnosis of chronic kidney disease who requires regular hemodialysis

A 79-year-old client with an indwelling catheter for urinary incontinence

When explaining urinalysis results that show the presence of cast cells, the nurse informs the client that casts cells develop when the client has: Select all that apply ( 2 answers). An elevated urine pH More than one bacteria present in the urine A high protein concentration of the urine High urine osmolality

A high protein concentration of the urine High urine osmolality

The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents: A need to increase water intake Concentrated urine The kidneys are functioning normally A loss of over half the client's normal kidney function

A loss of over half the client's normal kidney 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 should be used strictly in those clients who also have an underlying cardiac history. ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction. The use of ACE inhibitors will increase the vasopressin levels. 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.

Which of the following statements about the use of angiotensin-converting enzyme inhibitor medications and autosomal recessive polycystic kidney disease (ARPKD) is accurate? The use of ACE inhibitors will increase the vasopressin levels. ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction. The ACE inhibitors have been shown to shrink the size of the cysts inside the kidneys. ACE inhibitors should be used strictly in those clients who also have an underlying cardiac history.

ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction.

A client has been given the diagnosis of diffuse glomerulonephritis. They ask the nurse what diffuse means. The nurse responds: All glomeruli and all parts of the glomeruli are involved. That the mesangial cells are being affected. Only some of the glomeruli are affected. Only one segment of each glomerulus is involved.

All glomeruli and all parts of the glomeruli are involved.

A client who has developed stage 3 renal failure has been diagnosed with high phosphate levels. To avoid the development of osteodystrophy, the physician may prescribe a phosphate-binding agent that does not contain: Aluminum Sevelamer hydrochloride Calcium acetate Calcium carbonate

Aluminum

Glomerulonephritis is usually caused by: Catheter-induced infection Glomerular membrane viruses Antigen-antibody complexes Vesicoureteral reflux

Antigen-antibody complexes

A client with a diagnosis of chronic kidney disease (CKD) may require the administration of which of the following drugs to treat coexisting conditions that carry a high mortality? Opioid analgesics Antiarrhythmic medications Nonsteroidal anti-inflammatory drugs (NSAIDs) Antihypertensive medications

Antihypertensive medications

A client fell off a ladder and sustained a spinal cord injury that has resulted in bladder dysfunction. During the period immediately after the spinal injury, spinal shock develops and the bladder displays what type of function? Uninhibited Hyperactive Spasmodic Atonic

Atonic

Following an episode of strep throat, the school nurse notices the fourth grade child has not recovered from this illness a week later. Upon further investigation, the nurse notices that the child has developed water retention. Which of the following assessments support this conclusion? Select all that apply ( 2 answers). Swelling of the hands and fingers Periorbital edema Vomiting after intake of any solid food BP 100/70 Dizziness and right ear pain

BP 100/70

Protein and blood cell leakage into the filtrate that occurs in many forms of glomerular disease is a result of changes in the structure and function of the glomerular: Basement membrane Peritubular network Bowman capsule Renal corpuscle

Basement membrane

Although urinary obstruction and urinary incontinence have almost opposite effects on urination, they can both result from: Bladder structure changes Bladder wall atrophy Micturition reflex spasms Bladder distensibility loss

Bladder structure changes

A client with a long-standing diagnosis of chronic kidney disease has been experiencing increasing fatigue, lethargy, and activity intolerance in recent weeks. His care team has established that his GFR remains at a low, but stable, level. Which of the following assessments is most likely to inform a differential diagnosis? Assessment of pancreatic exocrine and endocrine function Blood work for white cells and differential Cystoscopy and ureteroscopy Blood work for hemoglobin, red blood cells, and hematocrit

Blood work for hemoglobin, red blood cells, and hematocrit

A client is experiencing bladder hyperactivity. The nurse should be prepared to educate the client about which of the following medications that may be injected to help decrease the bladder hyperactivity? Oxybutynin, an antimuscarinic agent Urecholine, a cholinergic agonist Capsaicin, a specific C-fiber afferent neurotoxin Botulinum toxin type A

Capsaicin, a specific C-fiber afferent neurotoxin

A client with a history of chronic pyelonephritis has been admitted several times with recurrent bacterial infection of the urinary tract. The nurse should anticipate educating this client with regard to which common treatment regimen? Continue taking antibiotics for full 10 to 14 days even if symptoms of infection disappear. Take prescribed diuretics early in the day to avoid having to get up during the night. Force micturition every 2 hours while awake. Increase intake of cranberry juice to 2 L/day.

Continue taking antibiotics for full 10 to 14 days even if symptoms of infection disappear.

As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by: Decrease in GFR to 30 to 59 mL/minute/1.73 m2 Decrease in GFR of 60 to 89 mL/minute/1.73 m2 GFR decrease to 15 to 29 mL/minute/1.73 m2 Diminished GFR to less than 15 mL/minute/1.73 m2

Decrease in GFR of 60 to 89 mL/minute/1.73 m2

A client'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? Parasympathetic nervous system stimulation Action of ADH Increased salt intake Dehydration

Dehydration

Client and family education regarding peritoneal dialysis should include assessing the client for: Bleeding around the arteriovenous fistula or an external arteriovenous shunt Signs and symptoms of hypoglycemia such as weakness, irritability, and shakiness Muscle cramps associated with hypoparathyroidism Dehydration that may appear as dry mucous membranes or poor skin turgor

Dehydration that may appear as dry mucous membranes or poor skin turgor

A pregnant woman who is beginning her third trimester has been diagnosed with a urinary tract infection (UTI). Which of the following factors most likely predisposed this client to the development of a UTI? Hypertrophy of the bladder wall Spastic peristalsis of the ureters Dilation of the upper urinary structures Increased urine alkalinity during pregnancy

Dilation of the upper urinary structures

A young child has been diagnosed with Wilms tumor after his mother discovered an unusual mass, prompting a diagnostic workup. Which of the following characteristics is typical of Wilms tumor? The tumor is usually: A secondary neoplasm Self-limiting Encapsulated Asymptomatic

Encapsulated

A client with significant burns on his lower body has developed sepsis on the 3rd day following his accident. Which of the following manifestations would the nurse anticipate for an ischemic acute tubular necrosis rather than prerenal failure? The client: Exhibits oliguria and frank hematuria Exhibits pulmonary and peripheral edema Undergoes emergent hemodialysis that does not result in decreased BUN and creatinine GFR does not increase after restoration of renal blood flow

GFR does not increase after restoration of renal blood flow

Which of the following client clinical manifestations most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma? Oliguria Urinary urgency Hematuria Cloudy urine

Hematuria

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

Increased fluid intake and dietary changes

Which of the following aspects of kidney function is performed by the juxtaglomerular apparatus? Regulating sodium and potassium elimination Matching changes in GFR with renal blood flow Facilitating active transport to reabsorb electrolytes Regulating urine concentration

Matching changes in GFR with renal blood flow

The most recent assessment of a client 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? Hematuria Diabetic retinopathy Microalbuminuria Orthostatic hypotension

Microalbuminuria

The most recent assessment of a client 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? Orthostatic hypotension Hematuria Diabetic retinopathy Microalbuminuria

Microalbuminuria

As nitrogenous wastes increase in the blood, the CKD client may exhibit which of the following clinical manifestations? Select all that apply ( 3 answers). Numbness in lower extremities Photophobia Restless leg syndrome Pruritis Extremely low platelet counts

Numbness in lower extremities Restless leg syndrome Pruritis

An elderly client who experiences chronic pain takes opioid analgesics on a regular basis, a practice that has resulted in frequent constipation and occasional bowel obstructions. Which of the following problems may directly result from these gastrointestinal disorders? Overflow urinary incontinence Urinary tract infections Bladder cancer Neurogenic bladder

Overflow urinary incontinence

A newly diagnosed paraplegic client who suffered an automobile accident appears to have control of bladder emptying. The health care provider explains this process to the client/family stating, "This function is allowing the motor component of the neural reflex to assist with bladder emptying and is primarily controlled by the:

Parasympathetic division of the ANS

When explaining to a CKD client how urea is absorbed, which of the following transport mechanisms will be mentioned? Active sodium transport Passive transport Secondary active transport Primary active transport

Passive transport

While assessing a peritoneal dialysis client in his or her home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as:

Peritonitis

While explaining the tubular role in reabsorption, the nurse will stress that a diet high in sodium intake will result in sodium reabsorption in which of the following renal locations? Descending limb of the loop of Henle Proximal convoluted tubule Bowman capsule Ascending limb of the loop of Henle

Proximal convoluted tubule

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

Recently had a urinary tract infection

When acute tubular necrosis (ATN) is suspected, the nurse will likely see which of the following laboratory findings on the urinalysis report? Select all that apply ( 3 answers). Glucose Red blood cells Cast cells Protein Sodium excess

Red blood cells Cast cells Protein

A woman has sought care because of recurrent urinary tract infections, which have been increasing in both frequency and severity. The health care worker should explain which of the following physiological factors to the client that is likely contributing to recurrent UTIs? Reflux flow of urine that can occur from coughing or sneezing Fluctuations in urine pH related to beverage consumption Inadequate intake of water Urethral trauma that occurs during sexual intercourse

Reflux flow of urine that can occur from coughing or sneezing

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? Dilation of the afferent and efferent arterioles Release of ADH from the posterior pituitary Increased water reabsorption in the distal convoluted tubule Increased water reabsorption in the ascending limb of the loop of Henle

Release of ADH from the posterior pituitary

As nitrogenous wastes increase in the blood, the CKD client may exhibit which of the following clinical manifestations? Select all that apply ( 3 answers). Restless leg syndrome Numbness in lower extremities Pruritis Extremely low platelet counts Photophobia

Restless leg syndrome Numbness in lower extremities Pruritis

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

Serum creatinine

Which of the following medications may be responsible for a client developing increased uric acid levels by decreasing ECF volume? Maalox products Thiazide diuretics Vitamin C Penicillin antibiotics

Thiazide diuretics

In the intensive care unit (ICU), the nurse is caring for a trauma client who has abdominal injuries is beginning to have a decrease in BP and increased pulse rate and is pale with diaphoretic skin. The nurse is assessing the client for hemorrhagic shock. If the client is in shock, the nurse would expect to find: An increase in GFR due to relaxation of the afferent arterioles Excess output of blood-tinged urine Significant decrease in urine output due to decrease in renal blood flow Complaints of flank pain rotating around the abdominal muscles

Significant decrease in urine output due to decrease in renal blood flow

Which of the following factors is likely to result in decreased renal blood flow?

Sympathetic nervous system stimulation

An automobile accident client is brought to the emergency department in hypovolemic shock from internal bleeding. Nurses are closely monitoring urine output since a significant decrease signifies that: The kidneys are probably injured. Renal arteries are clogged with blood. The SNS has caused afferent arteries to constrict to decrease blood flow Vagus nerve has caused bradycardia, which decreases amount of blood reaching kidneys.

The SNS has caused afferent arteries to constrict to decrease blood flow

Which of the following events would suggest that an individual's physiologic response to an obstruction has progressed beyond the compensatory stage and is now in the decompensatory stage? The detrusor loses its power of contraction. The bladder muscle hypertrophies. The ability to suppress urination is diminished. The individual experiences urgency.

The detrusor loses its power of contraction.

Clients with CKD are at risk for demineralization of their bones since they are no longer able to: Transform vitamin D to its active form Excrete bicarbonate effectively Stimulate bone osteoclastic production Synthesize erythropoietin

Transform vitamin D to its active form

A client 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:

Tubular necrosis

Which of the following signs and symptoms in a 2-year-old child should prompt assessment for a urinary tract infection? Decreased urine output and irritability Frank hematuria Production of concentrated urine and recurrent nausea Unexplained fever and anorexia

Unexplained fever and anorexia

An obese, male client with a history of gout and a sedentary lifestyle has been advised by his primary care provider to avoid organ meats, certain fish, and other foods that are high in purines. The care provider is demonstrating an awareness of the client's susceptibility to which of the following types of kidney stones? Cystine stones Magnesium ammonium phosphate stones Calcium stones Uric acid stones

Uric acid stones

The most damaging effects of urinary obstruction are the result unrelieved obstruction of urine outflow and: Concentrated urine Renal hypertension Urinary stasis Kidney hyperplasia

Urinary stasis

Although the distal portion of the urethra often contains pathogens, the urine formed in the kidney and found in the bladder is sterile because of the:

Washout phenomenon

A female client asks, "Why do I leak urine every time I cough or sneeze?" The health care worker's response is based on which physiologic principle?

When intravesical pressure exceeds maximal urethral closure pressure

Prior to undergoing diagnostic testing with contrast, it is recommended that older adult clients have their creatinine level checked. The rationale for this is to ensure the client: Is in good enough health to withstand a walking on a treadmill Does not have a kidney stone obstructing the urethra Will not undergo an acute kidney injury by decreasing renal blood flow Is not allergic to shell fish or iodine

Will not undergo an acute kidney injury by decreasing renal blood flow

A female teenager has experienced three uncomplicated urinary tract infections in the last 3 months. Knowing the anatomical location of the urethra, the nurse should educate this teenager about:

Wiping from front to back to prevent Escherichia coli contamination of the urethra

When explaining the body's compensatory mechanisms to maintain a normal pH, the health care provider knows that the renal system: Waits until the lungs have increased the respiratory rate to try to blow off excess CO2 Works slower than the respiratory system, going into action 1 to 2 days after H+ remain elevated Will absorb more Na+ and water to dilute the elevated H+ in an effort to normalize pH Will absorb more bile acids to try to normalize elevated H+ levels

Works slower than the respiratory system, going into action 1 to 2 days after H+ remain elevated