Chapter 33: Disorders of Renal Function

A nurse is explaining the clinical manifestations of diabetic nephropathy (diabetic glomerulosclerosis) to a client. Which statement would be the most important information for the nurse to provide?

Microalbuminuria is a predictor of future nephropathies.

Which assessment finding would lead the nurse to suspect the client has developed nephrotic syndrome?

Proteinuria and generalized edema

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

A nurse is caring for a client who has been diagnosed with kidney colic but has yet passed the stone. Which interventions would the nurse emphasize when planning the care for this client?

Strain the urine.

A nurse is caring for a client with systemic lupus erythematosis (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

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

Immunologic Nonimmunologic Heredity Diabetes

The nurse is assessing a client who has a unilateral obstruction of the urinary tract. Which clinical finding by the nurse correlates to this diagnosis?

Increase in blood pressure

The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to which substance?

Plasma proteins

Several clients in clinic today are reporting urinary signs/symptoms. Which reported manifestation(s) leads the health care provider to suspect acute pyelonephritis? Select all that apply.

Flank pain in the back Abrupt onset of fever and chills Urinary urgency and frequency

The nurse is caring for a client with cystitis. Which sign/symptom is most characteristic of the urine associated with cystitis?

Foul smell

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

Increased blood pressure

Unilateral obstruction of the urinary tract may result in renin secretion, thereby leading to which manifestation?

Increased blood pressure

What is the usual cause of acute pyelonephritis?

Infection

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 10 to 14 days even if symptoms of infection disappear.

Select the manifestations of renal cell carcinoma. Select all that apply.

Often silent in the early stages Hematuria Palpable flank mass

Which client is likely at the greatest risk of developing a urinary tract infection?

A 79-year-old client with an indwelling catheter

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

A client who has had an intestinal bypass has developed a kidney stone. Which type of kidney stone does the nurse recognize that this client will most likely be treated for?

Calcium

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

Catheter-associated bacteriuria

The family asks the nurse what the usual treatment of focal segmental glomerulosclerosis entails. What is the nurse's best response?

Corticosteroids

Most common uncomplicated urinary tract infections are caused by ____ that enter through the urethra.

Escherichia coli

A female teenager has experienced three uncomplicated urinary tract infections in the past 3 months. Which action should the nurse include in education for this teenager?

Taking antimicrobials to treat Escherichia coli while forcing fluids

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

Pseudomonas species

What are appropriate interventions in the care of a client 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 has been given the diagnosis of diffuse glomerulonephritis. The client asks the nurse what diffuse means. The nurse responds:

"All glomeruli and all parts of the glomeruli are involved."

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.

Which substance would not be found in glomerular filtrate?

Protein

Acute pyelonephritis is a result of:

Bacterial infection

A nurse's neighbor is experiencing some odd symptoms, and asks the nurse about them. The neighbor states having blood in the urine intermittently and thinks there is a lump in the back (where kidney is located). What advice is most appropriate for the nurse to relay to this neighbor?

"Make an appointment with your health care provider immediately."

The nurse on a geriatric unit is assessing four clients. Which client is most likely to exhibit bacteriuria?

A client who has a urinary catheter in place due to confusion

A child is recovering from a bout with group A beta-hemolytic Streptococcus infection. The child returns to the clinic a week later complaining of decrease in urine output with puffiness and edema noted in the face and hands. The health care provider suspects the child has developed:

Acute postinfectious glomerulonephritis

A nurse is caring for a client with diabetic glomerulosclerosis. The analysis is reviewed for the presence of which manifestation?

Albumin

The form of polycystic kidney disease (PKD) that first manifests in the early infant period is most commonly characterized as:

Autosomal recessive

Urinary tract infections (UTIs) in children do not generally present as they do in adults. What are the signs and symptoms of a UTI in a toddler? Select all that apply.

Diarrhea Abdominal pain Poor growth

The nurse is caring for a client with recurring urinary tract infections (UTIs). The client asks, "Other than taking antibiotics, what else can I do?" Which response by the nurse is most accurate?

Drink lots of fluids to help relieve the signs/symptoms of UTIs.

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

While taking a history from an adult client newly diagnosed with renal cell cancer, the nurse can associate which high-risk factor with the development of this cancer?

Heavy smoking

Which client clinical manifestation most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma?

Hematuria

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)

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

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

If a client is in the early phases of nephrotic syndrome, which area of the body will likely have the initial presence of edema?

Lower extremities

Which condition/disorder would the nurse see as being likely to cause the most serious long-term problems?

Polycystic kidney disease

The nurse reviews the lab results for a client who has advanced autosomal dominant polycystic kidney disease (ADPKD). The client 's hemoglobin is 8.8 g/dL (88 g/L). The nurse suspects this lab value is related to which cause?

Reduced production of erythropoietin

What is the most common cancer of the kidney?

Renal cell carcinoma

The nurse is performing a history and physical on a client with diabetic nephropathy. Findings include BP 124/80; smokes two packs of cigarettes/day; diet high in saturated fats and sodium. Which intervention can help prevent the progression of the diabetic nephropathy?

Smoking cessation program

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.

An obese client with a history of gout and a sedentary lifestyle has been advised by the primary health 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 type of kidney stones?

Uric acid stones

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

Urinary stasis

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 tumor

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

a streptococcal infection 7 to 12 days prior to onset.

A 25-year-old man of Asian ancestry arrives in the emergency room in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. He is eventually told that his kidney disease has no known treatment and results in protein deposits accumulating in the glomerulus. The client has likely been diagnosed with:

immunoglobulin A nephropathy.

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:

will not undergo an acute kidney injury by decreasing renal blood flow.

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